LEGAL

Health Care Insurance – What Choices Do You Have to Make?

As of January 1, 2006, all residents of the Netherlands are obligated to arrange their own health care insurance. As you can read in our article on page 8, to pay for the insurance, everyone pays a fixed contribution of approximately € 1,200 and an income-dependent contribution.

Reimbursement
The income-dependent contribution is compensated by your employer, and is due up to a maximum amount that is determined annually. If you are unemployed or self-employed, you receive no such compensation. 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. Children are covered free of charge and the government offers financial assistance (called zorgtoeslag) to persons whose income lies below a certain level.

Comparative Shopping
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. You may change insurance companies every year; visit www.zorgplanet.nl to compare insurance companies and coverage. Issues that are of interest to look at when doing comparative shopping are: how much own risk you can take out, 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 the 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.

Exceptional Medical Expenses Act
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 resides and works in the Netherlands legally 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
We mention dental care here separately because it is no longer 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
Also medication deserves special attention: in your policy you are likely to find something along the lines of “we only cover GVS medication”. This is a consequence of 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. You can, however, discuss with your doctor and/or pharmacist whether a cheaper – and equally as effective – alternative is available. 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 these extra costs as well as the cost of homeopathic/alternative medication.

Pregnancy and Childbirth
During pregnancy, you visit a midwife with increasing frequency up to and including delivery; this is 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.
As of June 4, 2008, pregnant self-employed mothers will have a right to 16-weeks of paid pregnancy leave, based on the Zelfstandig en Zwangerregeling (Self-Employed and Pregnant Regulation). How much you receive depends on the number of hours you worked in self-employment the previous yearYou also have a right to this benefit if you work for your partner / spouse (’s company).

Students
Students will often find that their host institution has made sure that they are insured – as everyone is required by law to have health insurance – though you should verify this, of course. Special arrangements for students are available.