Deciphering the Dutch Health Insurance System

Bringing It Back to Simpler Terms

Medical insurance is one of those matters that the Dutch have devoted particular thought to – meaning that the outcome is characteristically complex. It is a topic that requires some discipline to decipher, yet it is also a very important one, with considerable consequences if you fail to deal with it correctly. Trying to read up about it requires becoming familiar with terms that even the average Dutch person will have a hard time grasping, let alone explaining to you. In this article, we cover the most important rules and terminology in order to help you figure out what your options and your obligations are.

Financing Your Insurance

All residents of the Netherlands are obligated to arrange health insurance in order to be able to legally reside in the Netherlands. To pay for this, everyone pays a fixed contribution of approximately € 1,200 and an income-dependent contribution. This income-dependent contribution is compensated by your employer, who pays it directly to the tax authorities. If you are self-employed, you receive no such compensation. Instead you receive an annual preliminary assessment for the amount you owe, which is based on what the tax authorities estimate you will be earning that year. If you end up paying too much, you will be reimbursed after the final tax assessment over the year in question. Also if you are receiving a benefit or old age pension, you pay an income-dependent contribution – whether this is compensated, depends on your social security institution or pension plan. If you are unemployed, you receive no compensation.

The government offers financial assistance (called zorgtoeslag) to persons whose income lies below a certain level, to help pay the premium.

Children

Children are covered free of charge.

Acceptance Obligation

All insurance companies are obligated to accept all applications, regardless of age, gender or health. The cost of a basic insurance is pretty much the same across the board; doing a little comparative shopping becomes worth your while if you are interested in additional coverage. However, keep in mind that insurance companies are not obligated to take you on for additional coverage – in other words, they may refuse you. You can change insurance companies every year; visit www.zorgplanet.nl or www.zorgkiezer.nl to compare insurance companies and coverage. Zorgplanet.nl will soon be offering English-language information on their website.

Issues that are of interest to look at when doing comparative shopping are: the amount of the deductible (eigen risico, or ‘own risk’), what the coverage is if you are abroad and fall ill or otherwise require medical care, level of dental care offered, alternative therapies, etc. Another very important issue is described in the next paragraph.

Insurance in Kind or Restitution

When you are arranging your insurance, you will run into the terms ‘natura polis’ or ‘restitutie polis’. If you take out a natura policy, your insurance will pay your medical bills directly. However, they will only pay out these bills to medical service providers they have entered into a contract with (you are free to select your own huisarts, or GP), which means that you must verify that such a contract exists between the medical care provider you wish to select and your insurance company before you make use of his or her services – or else run the risk of paying the bill yourself.

The restitutie policy is slightly more expensive, but does give you freedom of choice as to whom you wish to turn to for medical assistance. With the restitution policy, you pay the bill yourself and then submit it for compensation with your insurance company.

Some insurance companies offer a combination of the two types of insurances.

Deductible – ‘Own Risk’

For 2012, there is a fixed minimum deductible of € 220. It does not apply to children until the age of 18, visits to theGP, visits to the midwife, maternity care, or dental care for children / persons until the age of 21. You can also opt for a voluntary deductible of up to € 500 a year.

By increasing the amount of the deductible, you can decrease the income-independent part of your contribution.

Exceptional Medical Expenses

The AWBZ is a national insurance scheme that insures persons against risks that cannot be covered by individual insurance – its name translates into ‘Exceptional Medical Expenses Act’. Everyone who legally resides and works in the Netherlands has a right to coverage by this insurance. It is meant to cover steep medical expenses that are not covered by a regular health insurance and that are simply not affordable, such as long-term home care, or admittance to a nursing home or a home for disabled persons. The same health care insurance company with which you have placed your ‘regular’ health insurance also takes on your personal coverage by this insurance. You owe a social security contribution to pay for the AWBZ, which is calculated over – and withheld from – your salary and some types of benefits. You also owe a contribution for this insurance over income from self-employment.

Dental Care

Dental care is not included in any basic package (with the exception of dental care for children up to the age of 18 and ‘specialist’ dental care, including dentures). You must take out an additional dental policy to cover standard dental care.

Medication

In your policy you are likely to find something along the lines of “we only cover GVS medication”. This refers to an arrangement whereby types of medication have been ‘clustered’, after which a maximum price has been determined for this cluster. If you are prescribed medication, then the cluster-specific maximum price is covered by the insurance. If your medication is more expensive than that, you will have to pay the difference.

Homeopathic medicine is not covered by the ‘GVS’-system, so that you will have to pay for it yourself. Check with your insurance company whether you can take out an additional policy to cover more expensive medicine as well as the cost of homeopathic/alternative medication.

On the website www.mijnmedicijnvergoeding.nl you can check whether your medication is covered by your insurance company. You click on Worden mijn medicijnen vergoed? (is my medication covered?), then on the next page you type in the name of the medication, the amount you take a day and a year, followed by the name of your insurance company. The site will tell you which of the company’s insurance packages cover the medication and how much you will have to contribute yourself.

Pregnancy and Childbirth

During pregnancy, you visit a midwife with increasing frequency up to and including delivery; this is covered by your insurance. At least two ultrasounds, if they are medically required, are also covered.

In principle, in the Netherlands, a home delivery is fully covered by your insurance. The costs of a hospital delivery are fully covered if your midwife, GP or specialist has determined that, for health and safety reasons, the baby should be delivered in the hospital. This is called a bevalling op medische indicatie. If you voluntarily choose to have your baby in the hospital (called a poliklinische bevalling), you will have to pay a contribution in the costs, though some insurance companies offer the option of additional voluntary insurance to cover these expenses.

Students

Students will often find that their host institution has made sure that they are insured. Be sure to verify this. Special packages for students are available.