Government Employee Health Insurance (GEHI)
All government pensioners, employees, and their dependants are covered under the Government Employee Health Insurance (GEHI) plan.
GEHI provides you with premium health care at fair rates, and claims are processed in a timely manner.
Requirements for spouses and dependants
For spouses and dependants of government employees and pensioners, there are the following requirements to be aware of:
- If an employed spouse is insured by their employer for standard hospital benefits only, they may be insured with GEHI for fringe (non-hospital) benefits;
- Unemployed spouses must be enrolled;
- A newborn baby must be added within 1 month of its date of birth. After that time, there will be a six-month waiting period before the newborn can join GEHI;
- Children in full-time education can have GEHI coverage up to age 26. Minor child coverage is for those in a recognized educational facility or school locally from birth to age 21. Adult child coverage is for children overseas in school up to age 26 and in local school from age 21 to 26. At the age of 26, coverage ceases.
- Semi-private (S.I.S) coverage is not necessary for children. The Government of Bermuda provides youth subsidy, which covers the local cost of hospital care (at the public ward level) for children under the Bermuda school leaving age and up until age 21 if the child is enrolled in full-time school in Bermuda.
GEHI Dental Plan
There are two levels of dental plan coverage:
- Basic Dental Plan
This plan is designed to cover preventative services such as routine examinations, X-rays, fillings, root canals, cleaning and scaling, etc.
- Comprehensive Dental Plan
This plan includes the benefits under the basic plan as well as major restorative services such as Inlays, Crowns, Bridges and Dentures. The Orthodontic benefits are payable for services for dependent children only.
describing the benefits of the GEHI Dental Plan for more information.
The government provides all employees and pensioners with Basic Dental Plan coverage. Those would wish to have the Comprehensive Dental Plan must pay 100% of the premium for the additional coverage.
Spouses, unmarried children under 16 years of age, as well as students ages 16-21 are eligible to be enrolled in the GEHI Dental Plan if they are covered under the GEHI Health Plan.
To enroll, please complete the
. You will also need to fill in the
and list all dependants and the state of current dental health for each dependant.
Current Fee Schedule
| Type of Service | Fee |
| Basic Benefits | |
| Charges at King Edward Memorial Hospital | Per the established Fee Schedule |
| Per the established Fee Schedule | Per the established Fee Schedule |
| Hospice Care | Per the established Fee Schedule |
| Hospital Emergency and Outpatient Services | Unlimited |
| Artificial Limbs and Appliances/Orthopedic Braces | $15,000.00 (Lifetime maximum) |
| Doctor's Visits | |
| General Practitioner | $57.00 |
| Specialist (GP referral required) | $161.00 (initial) $66.00 (follow up) |
| Home Visit - GP | $128.00 (please submit medical report) |
| Home Visit - Specialist | By Report Only |
| Group Psychologist Therapy Sessions | $57.00 (24 visits per fiscal year) |
| Clinical Psychologist | $97.00 (12 visits per fiscal year) |
| Psychiatrist | $161.00 (initial) $100.00 (follow up) (25 visits per fiscal year) |
| Physiotherapy/Occupational Therapy | $43.00 (12 visits per fiscal year, physician referral required) |
| Speech Therapy | $53.00 per one hour visit (12 visits per fiscal year, physician referral required) |
| Chiropodist | $51.00 (6 visits per fiscal year) |
| Chiropractor | $61.00 (12 visits per fiscal year) |
| Preventative Health Care | |
| Diabetic/ Nutritional Counseling | $53.00 (initial) $33.00 (follow up – 6 visits per fiscal year, physician referral required) |
| Allergy Services | $500.00 (lifetime maximum) (includes testing and treatment) |
| Routine Lab/Diagnostic Testing | $100 % of the established Fee Schedule |
| Asthma & Allergy Education | $47.00 (Initial) $29.00 (Follow up) (6 visits per policy year) [Physician referral is mandatory] |
| Health and Wellness Benefits | |
| Annual Gynecological Examination | $161.00 (Specialist) $57.00 (General Practitioner) |
| Well Baby Care | $161.00 (initial) $66.00 (follow up) |
| Annual Physical Examination | $96.00 |
| Prescription Drugs (not including drugs for infertility or erectile dysfunction) | 80% of total cost of prescribed drugs This includes birth control (patches, injectable and oral medication), and drugs for smoking cessation and weight loss.*Please note that prescription drugs for weight loss and smoking cessation must be paid for by the insured and submitted to G.E.H.I. for the applicable reimbursement. (Maximum of $150.00 per month) |
| Vision Care (An eye exam is required for reimbursement and purchase of the eyewear must occur within the same calendar year) | $300.00 (annually/calendar year) $50.00 (for eye exam) $250.00 (for eyewear) |
| Elective Care | |
| Tubal Ligation and Vasectomy (Coverage does not include reversals) | AMA Current Procedural Terminology (CPT) Ingenix National Fee Analyzer (2009) |
| Lasik Surgery | Reimbursement of up to $3,000.00 toward the cost of the procedure and other associated costs, such as travel and overseas accommodation. (Maximum lifetime benefit) |
| Lap Band Procedure | Pre-approval is required by G.E.H.I. Must be referred by a local specialist, based on a strict set of guidelines, confirming medical necessity. (Fee will be paid at 100% of usual and customary charges) |
| Overseas Treatment | |
| Level I: Emergency overseas treatment | 100% of usual and customary, as approved by the G.E.H.I. Management Committee. |
| Level II: Medically necessary overseas treatment (Must be referred by a local specialist and pre-approved by G.E.H.I.) | 100% of usual and customary, as approved by the G.E.H.I. Management Committee. |
| Level III: Elective overseas treatment | Local rate plus 50% of the difference in charges for similar services in Bermuda or as approved by the G.E.H.I. Management Committee. |
| Level IV: Treatment available in Bermuda | Reimbursement for overseas charges (not considered by G.E.H.I. to be level II or III) paid at the local rate.) |
|
AIRFARE AND OVERSEAS ACCOMODATIONS ARE NOT COVERED FOR LEVEL I, III OR IV
|
|
| Additional Overseas Benefits | |
| Overseas hospital – patient room and board amount. For emergency and medically necessary care | Reasonable and customary charges as approved by the G.E.H.I. Management Committee. |
| Overseas hospital – patient intensive care unit daily amount | Reasonable and customary charges as approved by the G.E.H.I. Management Committee. |
| Airfare – per fiscal year** | $3,000.00 |
| Overseas Lodging and Food Expenses for approved/medically necessary care** | Up to a maximum of $140.00 per day, for the patient or approved travel companion, if the patient is hospitalized. Maximum of 60 days or $8,400.00 per fiscal year. (Must submit hotel and food receipts) |
| Overseas Transportation** | $100.00 per approved medical visit (Must submit receipts) |
| Air Ambulance | 100% of the negotiated rate |
| Repatriation | Up to $4,000.00 toward the cost of transporting the body of a deceased person back to Bermuda providing the insured person expired within 3 months of the date on which he/she left Bermuda. |
| ** this is only covered if the policyholder is referred by a local specialist and pre-approved by G.E.H.I. | |
| Miscellaneous | |
| Physiotherapeutic and Mechanical Aids to Rehabilitation | 80% of total cost (Pre-approval required from G.E.H.I.) (Durable medical equipment) |
| Skilled Nursing | Per the approved Fee Schedule (Must be physician referred and pre-approved by G.E.H.I.) |
| Note: Policyholders must submit original claims for reimbursement within four month deadline, to avoid any potential denial of claims. | |
Exclusions under the Plan
- Cosmetic procedures including consultations and all associated therapies
- Vasectomy reversal
- Treatment for sexual impotence; including medication
- Any treatment for infertility (including but not limited to consultation, testing and medication administration and all their treatment therapies)
Should you need further assistance, please contact a G.E.H.I. representative by calling 298-7157.
Adding or Removing Dependants
You can add or delete dependants from your coverage by completing the
If you are adding a dependant, you will also need to complete the
This form to be completed by the insured on behalf of any dependent person applying to join the GEHI plan under the same policy of the insured.