Bermuda Consolidated Legislation

 

BERMUDA STATUTORY INSTRUMENT

SR&O 10/1971

HOSPITAL INSURANCE (PORTABILITY) REGULATIONS 1971

[made under section 40 of the Hospital Insurance Act 1970
[title 18 item 9] and brought into operation on 1 April 1971]

ARRANGEMENT OF REGULATIONS

1 Interpretation

2 Claim for expenses

3 Limit

4 Submission of claim

5 Cessation of ordinary residence

Interpretation

1 In these Regulations —

"the Act" means the Hospital Insurance Act 1970;

"approved hospital" means a hospital outside Bermuda which —

(a) is licensed or approved as a hospital by the government hospital authority in whose jurisdiction the hospital is situated; and

(b) is approved by the Commission for the purposes of the Act.

Claim for expenses

2 A claim may be made in accordance with these Regulations by or on behalf of a person insured by the Commission under the health in surance plan who receives treatment in an approved hospital to recover from the Commission so much of the actual cost of such treatment as, subject to the qualification expressed in regulation 3, is covered by the health insurance plan.

Limit

3 The amount recoverable under regulation 2 —

(a) shall, in respect of in-patient treatment of a particular disability, be limited to expenses incurred over a period of not more than 45 days during a twelve month period;

(b) shall not include the cost of transportation to or from the approved hospital;

(c) shall not exceed the amount which would have been re coverable at the applicable public ward per diem rate if the treatment had been received in the general hospital;

(cc) shall not include the cost of any hospice care;

(d) shall not include the cost of any treatment for alco holism;

(e) shall not exceed the amount payable for a similar service provided by the medical staff of the general hospital.

[Regulation 3 amended by BR 18/1991 effective 1 April 1991]

Submission of claim

4 Claims under these Regulations shall be made to the Insurance Officer in such form as the Commission may determine and the claimant shall submit —

(a) a detailed receipt from the approved hospital showing the payment made to the hospital by or on behalf of the insured person or such other proof of the costs incurred as the Insurance Officer may in any particular case al low; and

 (aa) a detailed receipt from a registered medical practitioner showing the payment made to such practitioner by or on behalf of the insured person for services rendered which are covered by an order made under section 11 of the Act; and

(b) such information relating to the treatment received in the approved hospital as the Commission may require for the purpose of determining the claim.

Cessation of ordinary residence

5 (1) Where a person who is insured by the Commission under the health insurance plan ceases to be ordinarily resident in Bermuda these Regulations shall, subject to paragraph (2), continue to apply in respect of hospital treatment received by that person for the duration of the period for which he has paid premiums in advance.

(2) Notwithstanding the provisions of paragraph (1), these Reg ulations shall cease to apply in respect of hospital or medical treatment received by an insured person upon the expiration of a period of six months from the date on which he ceases to be ordinarily resident in Bermuda.

 

 

 

 

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