2018 General rules and regulations and Coverage
ONVZ Coverage 2018 - version 1.2 1 The risk bearer for the ONVZ Vrije Keuze basic health-care plan is ONVZ Ziektekostenverzekeraar N.V. (Utrecht: Trade Register no. 30135168, AFM [Netherlands Authority for the Financial Markets] number 12000633); the risk of the supplementary health-care plans is borne by ONVZ Aanvullende Verzekering N.V. (Utrecht: Trade Register no. 30209308, AFM number 12001024), both located in Houten. Postbus 392, 3990 GD Houten, Netherlands. Telephone: +31 (0)30 639 62 22. Fax: +31 (0)30 635 12 75. Internet: www.onvz.nl ONVZ Coverage 2018 - version 1.2 Inspiring you for a happy and healthy life
Dear Sir/Madam,
Thank you for your confidence in ONVZ. We believe that you have made an excellent decision, because we at ONVZ stand for a happy and healthy life. We help and inspire you to make healthier choices all year round.
Of course, we are also here for you when you need health care. Just like in previous years, you will have complete freedom in choosing your health-care provider in 2018, as you have come to expect from us.
Our policy terms and conditions and other important information listed for you This booklet lists all policy terms and conditions of the 2018 ONVZ Vrije Keuze Zorgplan. It explains exactly what you can expect from us as an ONVZ policyholder, the services provided by ONVZ and how best to use them.
Your policy documents list your health-care plans and the terms and conditions that apply to you. These terms and conditions will apply as of 1 January 2018 and will be valid until any changes take effect.
Questions If you have any questions, please see the general information available at www.onvz.nl. Of course, you can also call our Service Centre on +31 (0)30 639 62 22. Lines are open from 8am to 6pm on working days.
Yours faithfully,
Jean-Paul van Haarlem Chairman of the ONVZ Board
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Introduction 3 Reader’s guide
The policy terms and conditions are broken down into general rules and regulations, and coverage.
The general rules and regulations apply to all ONVZ health-care plans. They provide details of things like when the health-care plan commences and how we reimburse the costs of health care.
The coverage describes the health care and services to which you are entitled, and what you need to do in order to get them.
If you would like to receive a copy of the general rules and regulations and coverage by email or by post, please call our Service Centre on +31 (0)30 639 62 22.
Reader’s guide 4 Table of contents
Contact details 6
General rules and regulations for our health-care plans 8
Introduction 9
ONVZ's health-care plans 10
I’m a new ONVZ customer 12
I’m already insured with ONVZ 14
I’m leaving ONVZ, or ONVZ has terminated the health-care plan 20
Coverage 23
General practitioner and staying healthy 27
Hospital and medical specialists 44
Nursing and other care 66
Exercise 74
Rehabilitation and recovery 93
Pregnancy, childbirth and children 109
Medication and diet 123
Oral and dental 134
Psychological health care 154
Contraceptives 160
Alternative/non-conventional 164
Hearing, vision and speech 168
Medical appliances 179
Skin and hair 184
Transportation 193
Health care abroad and travel 200
Accidents, claims and other 209
Wereldfit 215
Zorgplan 224
Comprehensive coverage: Superfit accident coverage 228
Comprehensive terms and conditions: Wereldfit 233
Coverage index 238
Contents 5 Contact details
ONVZ Postbus 392 3990 GD Houten Netherlands Telephone: +31 (0)30 639 62 22 Fax: +31 (0)30 635 12 75 Internet: www.onvz.nl
ONVZ Service Centre For general questions about your health-care plan Telephone: +31 (0)30 639 62 22 Available on working days between 8am and 6pm Email: [email protected]
ONVZ Machtigingen If you require authorisation in order to receive reimbursement for health-care costs Telephone: +31 (0)30 639 62 22 Available on working days between 8.30am and 5.30pm Email: [email protected]
ONVZ ZorgConsulent Information about treatment methods, help arranging health care and health-care mediation. Telephone: 0800 022 14 50 (free of charge). Available on working days between 8.30am and 5.30pm Email: [email protected]
ONVZ Kraamzorg Service Information on and requests for maternity care Telephone: +31 (0)88 668 97 05 Available on working days between 8.00am and 5.30pm Internet: www.onvz.nl/kraamzorg
ONVZ Zorgassistance Help with and advice on medical care in emergency situations Telephone: +31 (0)88 668 97 67 Available 24 hours a day
ONVZ Verhaalszaken Aid for claims against liable third parties for injury Telephone: +31 (0)30 639 62 64 Available on working days between 8.30am and 5pm
Transportation by taxi Telephone: 0900 333 33 30 Available on working days between 8.30am and 5pm
Contact details 6 ONVZ 2018 general rules and regulations
General rules and regulations for our health-care plans
Contents
Introduction 9
1. ONVZ’s health-care plans 10 About our health-care plans 10 Which general rules and regulations determine the health-care plan and the premium 11
2. I’m a new ONVZ customer 12 Taking out or applying for a health-care plan: as easy as 1-2-3 12 When your health-care plan commences 12 Other important considerations 13
3. I’m already insured with ONVZ 14 I need health care 14 I pay: personal contributions and excess 14 The health-care plan sometimes reimburses less, or nothing at all 16 I need to claim health-care costs 17 I pay the premium 18 Cooperation and provision of information 18 We use your personal data with care 19 I need to change my supplementary health-care plan 19 We may change the health-care plan 19
4. I’m leaving ONVZ, or ONVZ has terminated the health-care plan 20 Cancellation 20 Sometimes the Vrije Keuze basic health-care plan is terminated without cancellation 20 Sometimes we terminate the health-care plan 21 If you commit fraud 21 If you are dissatisfied or wish to make a complaint 22 Other important considerations 22
2018 ONVZ general rules and regulations - version 1.2 8 Introduction
These are the general rules and regulations that apply to ONVZ's Vrije Keuze basic health-care plan and ONVZ's Vrije Keuze supplementary health-care plans. Together with the coverage1, these specify what you are entitled to and what you need to do to get it. This document also explains the rules that apply to taking out this kind of health-care plan.
Our health-care plans reimburse the costs of health care and entitle you to our services.
These general rules and regulations are divided into 4 sections:
1. ONVZ’s health-care plans 2. I’m a new ONVZ customer 3. I already have a health-care plan with ONVZ 4. I’m leaving ONVZ, or ONVZ has terminated the health-care plan
Key items are highlighted in bold text, so you can quickly find what you are looking for.
1 All words underlined in the following text contain a hyperlink to the website.
2018 ONVZ general rules and regulations - version 1.2 9 1. ONVZ’s health-care plans
Nearly everyone in the Netherlands is required to take out a basic health-care plan. The basic health-care plan reimburses things like general practitioner and hospital appointments, dental care for children up to the age of 18, mental health care (GGZ) and transportation by ambulance. The government determines what the basic health- care plan covers.
ONVZ's basic health-care plan is the Vrije Keuze basic health-care plan. The Vrije Keuze basic health-care plan gives you complete freedom in choosing your health- care provider. ONVZ also has a range of supplementary health-care plans, each of which offers the same freedom of choice. These can be used to extend the coverage provided by the basic health-care plan, for example with physiotherapy, dental care from the age of 18 or alternative/non-conventional medicine.
About our health-care plans Restitution policies give you greater freedom of choice than 1. All of our health-care plans are restitution policies. They entitle you to reimbursement in-kind policies. of the costs of health care and to our services. From this point on, we will use the terms In-kind policies sometimes ‘health-care plan’ and ‘reimbursement of the costs of health care’. Wherever we refer require you to pay a significant to ‘ONVZ’, ‘we’ or ‘us’, we mean ONVZ Ziektekostenverzekeraar N.V.1 when discussing proportion of your health-care the Vrije Keuze basic health-care plan, and ONVZ Aanvullende Verzekering N.V.1 when costs yourself, for example if discussing supplementary health-care plans. you use a health-care provider with whom the health insurer Our health-care plans are: does not have a contract.
a. ONVZ’s Vrije Keuze basic health-care plan b. ONVZ’s supplementary health-care plans: • Vrije Keuze Startfit • Vrije Keuze Extrafit • Vrije Keuze Benfit • Vrije Keuze Optifit • Vrije Keuze Topfit • Vrije Keuze Superfit • Wereldfit • Zorgplan c. ONVZ’s supplementary dental health-care plans: • Tandfit A • Tandfit B • Tandfit C • Tandfit D • Tandfit Preventief
2. Our website www.onvz.nl and this booklet provide information about: • which health care is reimbursed by the health-care plans • who is allowed to provide that health care • which other terms and conditions apply
As long as you observe these conditions, you are free to choose your own health-care provider. The health-care plans reimburse the costs of medically necessary health care. The term ‘medically necessary’ is defined in point 24 below.
Policyholder, insured persons and holders of medical insurance cards
3. Anyone who is required to take out a basic health-care plan under the Zorgverzekeringswet [Health Insurance Act] can take out a Vrije Keuze basic health-care plan, or have this done for them.
1 The risk bearer for our ONVZ Vrije Keuze basic health-care plan is ONVZ Ziektekostenverzekeraar N.V. (trade register number 30135168, AFM [Netherlands Authority for the Financial Markets] number 12000633); the risk of our supplementary health-care plans and other insurance policies is borne by ONVZ Aanvullende Verzekering N.V. (trade register number 30209308, AFM [Netherlands Authority for the Financial Markets] number 12001024). Both are located in Houten. Postbus 392, 3990 GD Houten, Netherlands. Telephone: +31 (0)30 639 62 22. Fax: +31 (0)30 635 12 75. Internet: www.onvz.nl.
2018 ONVZ general rules and regulations - version 1.2 10 4. The official term for the person who takes out a health-care plan is thepolicyholder . Below we refer to this person as the ‘primary insured person’. A primary insured person can take out a health-care plan for himself/herself or for someone else, for example a partner or children. The person who is insured is referred to as the insured person. If you take out a health-care plan for yourself, you are the primary insured person and the insured person.
5. We will send the health-care policy to the primary insured person. This is proof of the health-care plan. The health-care policy will state the name(s) of the insured person(s) and the health-care plan(s) taken out.
Which general rules and regulations determine the health-care plan and the premium
6. The general rules and regulations and the coverage determine ONVZ’s Vrije Keuze basic health-care plan and supplementary health-care plans.
7. The Vrije Keuze basic health-care plan is also determined by the Zorgverzekeringswet [Health Insurance Act] and any regulations made by the government as a result of this, for example the Besluit zorgverzekering [Health Insurance Decree] and the Regeling zorgverzekering [Health Insurance Regulations].
8. In the event of a discrepancy between the general rules and regulations and the Zorgverzekeringswet [Health Insurance Act], the provisions of the law take precedence.
9. The Vrije Keuze basic health-care plan and the supplementary health-care plans are also based on the information you provide to us, for example on the application form.
10. The general rules and regulations are also accompanied by our premium table1, which lists the basic premiums for the health-care plans, along with the discounts and surcharges.
11. If you are insured under a collective health-care plan (other than in accordance with point 19), the general rules and regulations for that collective health-care plan will also apply. The terms and conditions for your collective health-care plan can be requested from the party who took out the health-care plan with ONVZ. This is often the employer.
1 www.onvz.nl
2018 ONVZ general rules and regulations - version 1.2 11 2. I’m a new ONVZ customer
If you would like to become an ONVZ customer, we look forward to welcoming you! You can switch health insurer on 1 January each year (and sometimes on other dates too). Our free switch service makes this easy to do.
Taking out or applying for a health-care plan: as easy as 1-2-3
12. You can take out the ONVZ Vrije Keuze basic health-care plan or an ONVZ Vrije Keuze supplementary or dental health-care plan yourself through our website. Simply send the application form back to us by post or email. You can also take out a health-care plan through your insurance adviser.
13. For some of our supplementary health-care plans, we will ask you questions about the health of the insured person(s). We use the answers to determine whether you can take out the supplementary health-care plan in question.
14. You can also take out a supplementary health-care plan for your child. However, the level of coverage provided is not allowed to exceed that of yourself, your partner or any other insured person aged 18 or above, who is specified on the health-care policy. Children are also not allowed to have Tandfit plans, as the basic health-care plan covers dental health care up to the age of 18. Point 13 also applies to children, unless your child was registered with us within 4 months of birth.
When your health-care plan commences
15. The health-care policy (proof of insurance) states the commencement date of your health-care plan.
16. An ONVZ Vrije Keuze basic health-care plan will usually commence on 1 January of If you are switching to ONVZ, the following year. The following rules apply. our switch service will take care of everything for you: if you take a. If you switch to ONVZ before 31 December, we will ensure that your ONVZ Vrije out a Vrije Keuze basic health- Keuze basic health-care plan starts right after your existing basic health-care plan care plan with us, we will cancel finishes. If there are no special circumstances, your existing basic health-care plan your existing basic health-care will continue until 31 December inclusive. Your ONVZ Vrije Keuze basic health-care plan for you. If you also take out plan will then commence on 1 January. a supplementary health-care plan with us, we can cancel b. If you take out an ONVZ Vrije Keuze basic health-care plan before 1 February, and your existing supplementary you cancelled your basic health-care plan with a different health insurer before health-care plan for you too. We 1 January, your Vrije Keuze basic health-care plan will commence on 1 January in will only do this once you have this instance too. taken out your health-care plan with us, c. If you turn 18 and take out one or more health-care plans of your own, these plans will commence on the first day of the month after the month in which you turn 18. The only exception is the Tandfit plan, which will commence on the day you turn 18, because most health care provided by a dentist ceases to be covered under the basic for example if you used to health-care plan from that date. You must make sure you take out the health-care live and work abroad, and plan(s) before you turn 18. have come to work in the Netherlands. d. If you have not yet taken out a basic health-care plan, but are required to do so under the Zorgwerzekeringswet [Health Insurance Act], and you take out an ONVZ Vrije Keuze basic health-care plan within 4 months of the date on which you were required to take out a basic health-care plan, the plan will commence on the date from which you were required to have a basic health-care plan. If you take out a Vrije Keuze basic health-care plan more than 4 months after the date on which you were required to take out a basic health-care plan, the plan will commence on the date we received your application.
e. If you change employers and join a new collective health-care plan as a result, providing the new collective health-care plan is with ONVZ, you may: • switch to us in the meantime, or • join the new collective health-care plan with us, if you were already insured with ONVZ.
2018 ONVZ general rules and regulations - version 1.2 12 You will, of course, need to cancel your old collective health-care plan in good time. Provided you do that, the new collective health-care plan with us will commence on the first day of the month after the month of cancellation. The commencement date of the new employment must be immediately subsequent to the end date of the previous employment. The basic health-care plan can be cancelled up to 30 days after the commencement date of the new employment. If you fail to cancel in good time, you can switch to us with effect from 1 January of the following year. f. If none of the 5 instances above apply, the Vrije Keuze basic health-care plan will commence on the date on which we received the application form. The commencement date may come after this date if the insured person is still insured under a different basic health-care plan.
In any case, if the application form is incomplete, the Vrije Keuze basic health-care plan will not commence until the date on which ONVZ is in possession of all the information required.
17. If you take out a supplementary health-care plan at the same time as a Vrije Keuze basic health-care plan, providing there is no screening procedure, the commencement date of the supplementary health-care plan will be subject to the same rules as the Vrije Keuze basic health-care plan. If there is a screening procedure, we will notify you of whether your application has been approved, along with the applicable commencement date. If you do not take out a Vrije Keuze basic health-care plan at the same time, your supplementary health-care plan will always commence on 1 January.
Other important considerations
18. Upon commencement of a new health-care plan, you have a cooling-off period of 14 days. This 14-day cooling-off period commences on the date you receive the health-care policy. During this period, you have the right to cancel without stating your reasons. Cancellation means, in effect, that the policy never existed. You will get a refund of any premiums paid and you will cease to be insured.
19. You become a member of Vereniging ONVZ. When you take out an ONVZ Vrije Keuze basic health-care plan, you become a member of Vereniging ONVZ. This association has a key voice within ONVZ. Each primary insured person can only become a member once, even where he/she takes out the Vrije Keuze basic health-care plan for someone else.
Membership will end when the Vrije Keuze basic health-care plan ends.
If you join a collective health-care plan other than the one for Vereniging ONVZ, you will not be a member. Instead, the party that has taken out the collective health-care plan with ONVZ (usually the employer) will be the member.
20. If you contact us by email or through social media, we reserve the right to respond using the same medium. We will not do this where privacy regulations forbid it, or where you indicate that you would like a response using a different medium. If you contact us through the website, we will respond by telephone or email.
2018 ONVZ general rules and regulations - version 1.2 13 3. I’m already insured with ONVZ
If you already have a health-care plan with ONVZ, you are entitled to reimbursement of Let's say you have a health- the costs of health care in accordance with the rules and regulations that apply to that care plan with us and you need health-care plan. We give more information about this below. physiotherapy. Is this covered, and does the excess or a personal contribution apply? I need health care
21. If you need health care, we use the following steps to determine whether we will reimburse the health care. Reimbursement is usually straightforward. The health-care Example: provider requests reimbursement directly from ONVZ and ONVZ pays the health-care The general rules and provider directly. regulations state that we only cover health care for which you 22. Your health-care plan reimburses the costs of health care and entitles you to have a reasonable need. This is services listed under coverage on our website, providing the terms and conditions always the case, even if it is not have been met. By this, we mean the general rules and regulations you are currently repeated every time. reading, along with the terms and conditions listed for the coverage on our website. Coverage may be subject to the 23. The health-care plan reimburses the costs of health care for as long as you are health-care provider having a insured with us. particular field of specialisation, In other words, you must be insured with us on the date of treatment or (for example, or to you gaining our permission in the case of a medicine) the date of dispensation stated on the invoice. If your before using the health-care health-care provider charges a single rate for the entire treatment, like with a DBC for provider. example, you will need to be insured with us on the date the treatment commences.
24. We will only reimburse the costs of health care: a. that you reasonably rely on in terms of its details and scope, and b. that, in terms of its details and scope, is considered safe and effective. This is the case if it has been shown to work effectively in theory and in practice. If this is not the case, the opinion of the health-care practice (i.e. the group of health-care providers as a whole) will be taken to establish what constitutes adequate health care. Furthermore, the health care must be effective for you. In other words, the health care must not be unnecessarily expensive or complicated.
25. The government sometimes sets the rate. The Nederlandse Zorgautoriteit [Dutch Health-Care Authority] (NZa) sets a fixed or maximum price for some forms of treatment. We reimburse either the fixed price or no more than the maximum price.
If the government has not set a fixed or maximum price, we reimburse the market price. ‘Market price’ means that your health-care provider’s invoice cannot be unreasonably high in comparison with what other health-care providers in the Netherlands charge for the same health care. Individual nursing and care budgets under the Zorgverzekeringswet [Health Insurance Act] (known as Zvw-pgb) are subject to the rates specified in theReglement Zvw-pgb1 [Zvw-pgb regulations].
I pay: personal contributions and excess
26. Sometimes you will need to pay a personal contribution. A statutory personal contribution applies to some health care provided under the Vrije Keuze basic health-care plan (e.g. maternity care at home, some medicines and dental prostheses). You must pay this amount yourself if you receive the health care concerned. The government sets the level of the personal contributions.
27. You will also need to pay a compulsory excess. The government sets the level of the compulsory excess each year. In 2018, it is €385. This portion of your health-care costs will not be reimbursed. The excess only applies to the Vrije Keuze basic health-care plan.
You do not pay an excess on the personal contribution. The process is as follows. When we receive an invoice from you, we first deduct your personal contribution. We then deduct the excess.
28. The excess applies from the first day of the month after the month in which you turn 18. An excess does not apply while you are under the age of 18, nor in the month of your 18th birthday.
1 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22.
2018 ONVZ general rules and regulations - version 1.2 14 29. In addition to this compulsory excess, you may also opt for a voluntary excess. You also pay this amount yourself and your premium will be discounted accordingly. The premium table lists the possible voluntary excess amounts, along with the applicable discounts. The compulsory excess is deducted from your health-care costs first of all, followed by the voluntary excess.
30. If you turn 18 and want a voluntary excess, you must tell us within 30 days of turning 18. If you fail to tell us in time, you will be able to choose a voluntary excess with effect from 1 January of the following year. Until that time, only the compulsory excess will apply.
31. Neither a compulsory nor a voluntary excess applies to certain types of health-care costs. This is explained in the table below.
The excess does not apply to the costs But does apply to the costs of... of... general medical care tests performed outside of the general practitioner’s practice, as prescribed by the general practitioner, if charged separately multidisciplinary primary health care for chronic conditions nursing and other care within the patient’s primary-care admissions own environment (district nursing) foot care for diabetes mellitus sufferers
preventive health-care programmes designated by ONVZ (e.g. help with quitting smoking) assessment of chronic use of prescription the medication itself medication by a designated pharmacist
associated health care, e.g. medicines, obstetric care and maternity care laboratory tests and ambulance transportation medical appliances on loan consumables and usage costs associated with the medical appliances if you were an organ or tissue donor, any check-ups, once the initial care period of 13 weeks (6 months in the case of liver transplants) has come to an end transportation costs incurred by you as an organ or tissue donor health care covered under a supplementary health-care plan
32. When you claim the costs of health care to which an excess or personal contribution applies, the health-care costs will be deducted from the excess that applied in the year in which you were treated. If the treatment runs over into a subsequent year, and all the costs are charged at the same time, the health-care costs will be deducted from the Your health-care plan excess that applied in the year in which treatment started. Personal contributions are commences on 3 February. also determined based on the year in which treatment started. 33 days of the year have passed and there are 33. If you incur health-care costs in 2018 and your health-care provider does not 332 days remaining. Your excess invoice us until 2020 or later, we will not charge the compulsory excess. However, is 332/365 of €385, i.e. €350.19. we reserve the right to charge the excess if we do not receive the invoices earlier as a We round this off to €350. result of something you do or do not do.
34. If you are only insured for part of the year, or if you turn 18 part way through the year, we will adjust the compulsory (and any voluntary) excess proportionally. We will calculate the excess in proportion to the number of days the health-care plan was in effect, or for which the premium was due. The result will be rounded off to the nearest whole euro.
2018 ONVZ general rules and regulations - version 1.2 15 The health-care plan sometimes reimburses less, or nothing at all
35. Sometimes you may need to visit a care administration office or the local council for health care or assistance. In this case, the Vrije Keuze basic health-care plan and supplementary health-care plans will not reimburse the health care or assistance. This will also be the case if you do not believe the health care or assistance provided by the care administration office or local council was adequate.
This relates to things like: • intensive care (Wet langdurige zorg [Long-term Care Act] (Wlz)) • assistance aimed at allowing you to stay at home for as long as possible (2015 Wet maatschappelijke ondersteuning [Social Support Act] (2015 Wmo)) • health care and assistance for young people (Jeugdwet [Youth Act]). This also includes mental health care for someone under the age of 18
36. The Vrije Keuze basic health-care plan will not reimburse the following health care and services either. The supplementary health-care plans may or may not reimburse these costs.
Not covered by the Vrije Keuze basic May be covered by a supplementary health-care plan health-care plan in part or in full Personal contributions payable under the • Wet langdurige zorg [Long-term Care Act] • 2015 Wet maatschappelijke ondersteuning [Social Support Act] and • Jeugdwet [Youth Act] Personal contributions in relation to population screening Medical examinations, e.g. for employment or for a driving licence
The issue of medical certificates
Influenza vaccination Benfit and above
Medication for illness during travel Startfit and above
Alternative/non-conventional medicine Extrafit and above
Costs incurred for paying invoices too late
Missed appointments (no-show)
Costs incurred as a result of war/civil war, insurrection and similar forms of conflict
37. If you incur health-care costs in relation to terrorist acts1, you may receive a reduced rate of reimbursement. We have reinsured these risks with the Nederlandse Herverzekeringsmaatschappij voor Terrorismeschaden N.V. [Dutch Reinsurance Company for Losses from Terrorist Acts] (NHT). This policy will reimburse up to a maximum of €1 billion per calendar year. If there are additional costs, the NHT will reimburse these in part. We will also reimburse the costs of health care to the same extent. If we have not insured the costs with the NHT, we will reimburse the costs to the same extent as if they had been insured with the NHT. If you do not live in the Netherlands, the costs of health care received as a result of terrorist acts will not be reimbursed.
38. The government may reimburse some health-care costs in exceptional circumstances, e.g. natural disasters. In that case, you will be entitled to additional reimbursement under the applicable laws.
1 Violent acts, malicious contamination or preparations to these ends, whereby it may be reasonably assumed that they are planned or carried out with an intent to realise political, religious or ideological objectives. Preventive measures are included herein.
2018 ONVZ general rules and regulations - version 1.2 16 39. The supplementary health-care plans are subject to the 2 restrictions below, but you will not notice these in practice. Insurers address them together wherever possible.
1. A supplementary health-care plan does not cover anything that is covered by another provision. Supplementary health-care plans only provide ‘extra’ coverage. In other words, they do not cover situations that are covered by another provision. They provide coverage over and above any coverage provided under another provision, up to the maximum cover. ‘Other provisions’ include other insurance policies, laws and/or arrangements.
2. A supplementary health-care plan will not provide coverage in the event of concurrence. Concurrence occurs when health care or the costs of health care are covered by 2 or more provisions at the same time, or would have been covered by the other provision, had the supplementary health-care plan not existed. It makes no difference whether the other provision commenced before or after the supplementary health-care plan.
40. A supplementary health-care plan will not reimburse the following health care either.
a. Health care that is prescribed or provided by: • the insured person to himself/herself • the insured person to a family member • a family member to an insured person within the family We will, however, reimburse the costs of this health care where we have given our prior permission.
b. If you have an in-kind basic health-care plan with a different health insurer and you use a health-care provider with whom your insurer does not have a contract, you will have to pay a (possibly significant) proportion of the costs of health care yourself in this situation. Your supplementary health-care plan will not reimburse this proportion.
I need to claim health-care costs
You have received treatment and are wondering what you need to do to claim reimbursement. Often this couldn’t be easier, as health-care providers will usually send us the invoice directly. If you receive an invoice yourself, there are various ways of sending it to us. Read on to find out more.
41. Many health-care providers send the invoice directly to us, and we pay the health- care provider directly. This fulfils our obligation to reimburse your invoice. If we pay the health-care provider more than you are entitled to, we may ask the health- care provider to repay the difference.
42. We may also ask you to repay our health-care costs. If we settle directly with your health-care provider, we will pay the invoice in full. We will do this even if you have to pay some of the invoice yourself on account of the excess or a personal contribution, or in the event that not everything is covered under your health-care plan. We will invoice you for the amount you have to pay yourself. You must pay this amount within 21 days.
43. If you forward the health-care provider’s invoice to us yourself, you must comply with the 3 rules below, otherwise we may not reimburse the costs.
a. You must send your invoices to us as soon as possible. We must be in receipt of them within 3 years. The 3 years start at the time you receive treatment, i.e. not at the time of making a claim.
b. The invoices you send us must be clear and legible. They must be written in Dutch, English, German, French or Spanish.
c. If you send us the invoice electronically, for example through the ONVZ app or our website, you must keep the original invoice for a year after we have received it. We may ask you to send us the original.
44. We may verify invoices from time to time. For example, we may check that you actually needed and received the health care in question.
2018 ONVZ general rules and regulations - version 1.2 17 I pay the premium
45. The primary insured person must pay the premiums for the insured persons in advance. You can pay monthly, quarterly, half-yearly or annually.
46. There is no premium for children up to the age of 18 insured under the 6 health- care plans below. • Vrije Keuze basic health-care plan • Vrije Keuze Startfit • Vrije Keuze Extrafit • Vrije Keuze Benfit • Vrije Keuze Optifit • Wereldfit
A special child premium applies to the Topfit and Superfit plans. You will pay the premium for up to 2 children. You must register the children yourself.
You start paying the premium from the month immediately after the child’s 18th birthday, at which point you will no longer be entitled to the child premium.
47. You pay the basic premium. You may qualify for discounts. The basic premium and discounts are listed in the premium table. You will qualify for a discount if you: • pay quarterly, half-yearly or annually, rather than monthly • opt for a voluntary excess, or • join the Vereniging ONVZ collective health-care plan, or • join another collective health-care plan
48. If you take out one of our supplementary health-care plan(s), but do not take out a Vrije Keuze basic health-care plan, you will pay a 50% surcharge on top of the premium.
If you live abroad, your premium may be subject to a special tax or levy. We will include this in our charge to you.
49. If we need to calculate the premium for part of a month, we will assume a month of 30 days.
50. You are not permitted to offset the premium you owe against any reimbursements you are due to receive from us.
51. Your health-care plan will be suspended during any custodial sentences. The government will arrange health care for you during any such periods. You will not be able to claim reimbursement of the costs of health care from us, nor will you have to pay us a premium.
Cooperation and provision of information
52. If we need information for checks or investigations, you must cooperate with us. You must ensure that our medical adviser or another member of staff is provided with the information requested, for example by the attending doctor. Privacy regulations apply in this case.
53. You must tell us within 1 month of major changes to your situation. Major changes include any events that we should be aware of in order to provide your health-care plan effectively. For example: • you move abroad or start working abroad • you have a new bank account number • you have had a child • you are no longer required to take out a basic health-care plan
54. If someone else is liable for your health-care costs, for example if you were involved in a road accident, or if your travel or other insurance covers the health-care costs, you must cooperate with us in our efforts to recover the costs of the health care from the other person or insurer. Any efforts you take to recover (other) costs from the other party may not affect our rights in any way.
2018 ONVZ general rules and regulations - version 1.2 18 We use your personal data with care
55. If you have a health-care plan with us (or have requested one), we will record your details in our administrative system. If you call us, we may record the conversation and store it in written form. Privacy regulations apply in this case. The applicable regulations are documented in the law, our code of conduct and our privacy statement. Please refer to our privacy statement for more information.
56. We are required to include your burgerservicenummer [personal identification number] (BSN) in our records. We are also required to use it in any contact we have with health-care providers.
57. We will use your information and recorded telephone calls: • to deliver and improve your health-care plan and our service • to satisfy legal requirements • for checks, analysis and (scientific or statistical) research • for marketing purposes • to prevent and tackle fraud and other forms of crime Occasionally we may also use medical details. We will only do this if required for the above purposes, with the exception of marketing. Please refer to our privacy statement for more information. The statement also includes information about your rights.
58. The Stichting CIS maintains a list of fraudsters. We reserve the right to check whether you appear on the list. We may also share your details with other insurers through the CIS, if there is good reason to do this. We use this information when processing applications for health-care plans and when dealing with claims. The CIS has its own privacy statement. Please refer to this at www.stichtingcis.nl.
59. In providing your health-care plans, we request your address and policy details from, and provide the same to, other parties, for example health-care providers and medical appliance suppliers. We do this electronically through Vecozo, the secure network for communication in health care, or through a secure email connection. This provides an easy and secure way of claiming reimbursement of the costs of health care from us. If you are a member of a collective health-care plan through your employer, we will share information with your employer in providing the health-care plan. For example, we may check whether you are (still) entitled to a premium discount.
If there are compelling reasons why we should not share your address, please tell us.
60. If you do not wish to receive any post, emails or other materials for marketing purposes, please let us know. We will then stop sending this information.
I need to change my supplementary health-care plan
61. If you switch to a different ONVZ supplementary health-care plan, any health-care costs already reimbursed under the old supplementary health-care plan will count towards the maximum reimbursement available under the new plan.
We may change the health-care plan
62. We reserve the right to change the general rules and regulations and the premium for the health-care plans. We will tell the primary insured person about any changes, including details of when the changes take effect. This will usually be on 1 January. If we change the basic premium, the new premium will usually take effect after seven weeks, although it may be later than that. You may be able to cancel in such cases, as described in point 63 below.
2018 ONVZ general rules and regulations - version 1.2 19 4. I’m leaving ONVZ, or ONVZ has terminated the health-care plan
Of course, we hope that you decide to stay with us. However, if you do decide to cancel the health-care plan, we explain below how and when you can do that.
Cancellation
63. The primary insured person can cancel the health-care plan each year. This can be done by letter, by email or through the website. If we receive notice of cancellation by 31 December, the health-care plan will end on 1 January of the following year.
The primary insured person is also able to cancel the plan in 4 other instances, during the course of the year:
a. If you are still in the ‘cooling-off period’ referred to in point 18.
b. If you change employers, and you are a member of a collective health-care plan with your previous and new employers. In this case, you must notify us of cancellation within a month of your previous employment ending. Cancellation will take effect on the first day of the following month. If you do not notify us in good time, the old health-care plan will continue until 1 January of the following year and the discount that applied to the collective health-care plan will no longer apply.
c. If the primary insured person has insured someone else, and this insured person takes out a new health-care plan. This can happen, for instance, in the case of divorce. The old health-care plan will end at the time when the new plan comes into effect. We must be in receipt of notice of cancellation at that time, otherwise the old health-care plan will continue in the month in which we receive the notice of cancellation, and the month after.
d. If we change the health-care plan or the premium, as referred to in point 62 above. The health-care plan will end on the date on which the change would have taken effect. In this case, you must notify us of cancellation before the change takes effect, or within 1 month of the primary insured person being notified of the change. It will not be possible to cancel the health-care plan if the change is the result of a change in the law, or where the change is to your advantage.
64. If CAK has taken out a health-care plan for you with us, you cannot cancel in the first 12 months. However, you can cancel at any point thereafter, even during the year. CAK is a government organisation that identifies individuals who have not taken out a basic health-care plan, but who are obliged to do so. Where necessary, CAK takes out a basic health-care plan on the individual's behalf, and chooses the insurer.
You can cancel any such health-care plan within 14 days, provided that you can demonstrate that you had already taken out a basic health-care plan elsewhere.
Sometimes the Vrije Keuze basic health-care plan is terminated without cancellation
65. If, after taking out a Vrije Keuze basic health-care plan, it emerges that you were not You will not be entitled to a Vrije entitled to it, the Vrije Keuze basic health-care plan will end on the commencement Keuze basic health-care plan if, date or the date on which you ceased to be entitled. If you have already paid for example: premiums, we will refund these, less any health-care costs already reimbursed. If the - you are in military service. In health-care costs already reimbursed by us exceed the premiums paid by you, you will this case, you will be insured need to repay the difference to us. through SZVK; - you work in a different EU 66. Health-care plans will end the day after the day of the insured person’s death. We will member state. In this case, repay any overpaid premiums. you will need to take out a health-care plan in the 67. The Vrije Keuze basic health-care plan will also end in the event of our licence as a non- country concerned. life insurer being revoked. We will tell you about this at least 2 months in advance.
2018 ONVZ general rules and regulations - version 1.2 20 Sometimes we terminate the health-care plan
68. If you or your partner lower the level of the supplementary health-care plan, we will lower the level of the supplementary health-care plan for your children too. If you or your partner cancel the supplementary health-care plan, we will cancel the supplementary health-care plan for your children too. We will not lower the level of the health-care plan or cancel it if an insured person aged 18 or above remains on the policy document, with a supplementary health-care plan equal to or higher than that of the children. If your Topfit plan is cancelled and you also have Tandfit ,D we will cancel your Tandfit D plan too. Tandfit D cannot be taken out without Topfit.
69. We will cancel your supplementary health-care plan(s) in the event that you cancel your basic health-care plan because you are no longer entitled to a basic health-care plan (in the Netherlands or abroad).
70. We will cancel the health-care plan(s) if you fail to pay the premium on time. We will take the following action before cancelling your health-care plan(s):
a. We will send you a reminder if you do not pay the premium (or do not pay it on time). We will also send you a reminder if you do not repay (or do not repay on time) any health-care costs advanced by us.
b. If the premium is 2 months in arrears, we will write to you with our proposal for a payment plan. If you do not accept our proposal and you do not pay the outstanding amount, we will cancel your health-care plan(s).
c. We may also cancel your health-care plan(s) if you do not repay (or do not repay on time) any health-care costs, excess or personal contributions advanced by us.
71. If you pay the premium quarterly, half-yearly or annually, and you do not pay (or not pay on time), we may decide that you have to pay monthly. The premium discount for quarterly, half-yearly or annual payment will cease to apply.
72. Any costs that we incur in pursuing premium payment or repayment of any costs advanced by us will be charged to you. This may include the costs of a debt collection agency or court costs.
73. We may also cancel the health-care plan if you commit fraud.
If you commit fraud
74. We will take action in the event of fraud. Fraud is where you deliberately break a rule or regulation or have someone else do the same, with a view to personal gain. This is the case if you take out or attempt to take out a health-care plan with us using incorrect or incomplete information, or if you obtain or attempt to obtain reimbursement or services from us when you are not entitled to them.
Examples of fraud include if you: • send us falsified documents • deliberately give us an incorrect view of your situation • make false statements in a claim • withhold any information we need
75. We will investigate any cases of suspected fraud in accordance with the Protocol Verzekeraars en Criminaliteit [Insurers and Criminality Protocol]. This protocol specifies the agreements insurers have made on how to tackle fraud.
76. In the event of fraud being established, we: • will not reimburse any fraudulent invoices • will ask you to pay us back any invoices that have been reimbursed incorrectly to you or your health-care provider • will charge you for the costs of investigating the fraud • may report the matter to the police • may add your details to the registers referred to in point 58 or have someone else do this • may cancel your health-care plans retrospectively with effect from the date on which the fraud took place • may refuse you for a new health-care plan for up to 5 years
2018 ONVZ general rules and regulations - version 1.2 21 If you are dissatisfied or wish to make a complaint
We will endeavour to serve you as well as possible. You may, however, be dissatisfied or disagree with a decision that we have made. If you wish to make a complaint, please follow the instructions below.
77. If you disagree with a decision that we have made, or are dissatisfied with our services, you can make a complaint to our customer service department. We will reply within 30 days.
78. If you are not happy with our reply, or we do not reply at all, you can refer your complaint to the complaints and disputes committee Stichting Klachten en Geschillen Zorgverzekeringen (SKGZ). The SKGZ procedure involves 2 steps:
a. The Ombudsman will, in the first instance, attempt to resolve your complaint through mediation. b. If this proves unsuccessful, you may refer your complaint to the Geschillencommissie [Disputes Committee].
Further information is available at skgz.nl/procedure.
You can refer your complaint to SKGZ in 2 ways:
a. By completing the online complaints form at skgz.nl/klacht-indienen b. By sending a letter to:
SKGZ Antwoordnummer 5518 3700 VB Zeist Netherlands
You will need to refer the complaint or dispute to SKGZ in good time. SKGZ has 4 different deadlines:
a. If you have had a reply from us, you can refer your complaint to the Ombudsman up to 1 year after we replied. b. If we did not reply, you can refer your complaint to the Ombudsman up to 13 months after your request to ONVZ. c. You can ask SKGZ to refer your complaint straight to the Geschillencommissie [Disputes Committee]. This can be done up to 1 year after the act (or omission) of ONVZ referred to in your complaint. If you did not notice the act (or omission) straight away, the deadline of 1 year begins from the point at which you could reasonably have been aware of it. d. If the Ombudsman has failed to resolve your problem to your satisfaction, and you would like to refer the complaint to the Geschillencommissie [Disputes Committee], you can do this up to 3 months after the Ombudsman has informed you of his response.
You may also have the right to bring your complaint before the civil court. In this case, you will no longer be able to refer your complaint to SKGZ.
79. If you are complaining because our forms are too complicated or superfluous, you may also contact the Nederlandse Zorgautoriteit [Dutch Health-Care Authority] (NZa). You can do this by telephone or by email.
Nederlandse Zorgautoriteit Information helpline: +31 (0)88 770 87 70 Email: [email protected]
Other important considerations
80. The health-care plan is subject to Dutch law.
2018 ONVZ general rules and regulations - version 1.2 22 ONVZ coverage Table of contents
ONVZ coverage
General practitioners and staying healthy 27 The general practitioner (general medical care) 28 Diagnostics for primary health care 29 Foot care for diabetes mellitus sufferers 31 Psychological health care with a general practitioner 33 Thrombosis service 34 Influenza vaccination 35 Preventive health-related courses 37 Preventive medical investigations 38 Quitting smoking 40 Health check-up/sports check-up 42
Hospital and medical specialists 44 Health care provided by a medical specialist 45 Hospital admission 46 Plastic surgery 48 Fertility treatment 50 In vitro fertilisation (IVF) 52 Testing for hereditary diseases 54 Breast cancer: additional tests 55 Organ transplants and donation 56 Dialysis 58 Mechanical respiration 60 Provisionally approved treatments 61 Stay in a guest house 63 Childcare in case of hospital admission of a parent 65
Nursing and other care 66 Nursing and other care 67 Individual budget under the Zorgverzekeringswet [Health Insurance Act] (Zvw-pgb) 69 Primary-care admissions 70 Hospice 72
Exercise 74 Physiotherapy and remedial therapy up to the age of 18 75 Physiotherapy and remedial therapy from the age of 18 77 Foot specialist treatment and podiatry/chiropody 79 Oedema and scar therapy 80 Exercise programmes in cases of chronic illness 82 Exercise programmes during and after cancer 84 Exercise programmes in cases of obesity 85 Therapies for posture and movement 87 Walking aids 89 Arch supports supplied by an orthopaedic technician 90 Swimming programmes aimed at keeping senior citizens fit 92
Rehabilitation and recovery 93 Rehabilitation (specialist medical) 94 Geriatric rehabilitation 96 Occupational therapy 98 Carer relief 99 Domestic assistance 101 Zorghotel 102 Health resort 103 Menopause consultant 104 Therapeutic camp for young people 106 Patient association membership 107
Pregnancy, childbirth and children 109 Antenatal screening 110 Pregnancy and childbirth 112 Maternity care 114 Maternity package 116 TENS device 118
ONVZ Coverage 2018 - version 1.2 24 Breastfeeding: breastfeeding specialist 119 Bed-wetting alarm 120 Adoption care 121
Medication and diet 123 Medicines (basic health-care plan) 124 Medicines (supplementary health-care plans) 126 Over-the-counter medication and proton-pump inhibitors 128 Dietetics 130 Dietary preparations 132
Oral and dental 134 Dental health care up to the age of 18 135 Dental health care from the age of 18 137 Dental health care after an accident 140 Orthodontics up to the age of 18 142 Orthodontics from the age of 18 144 Dental prosthesis (‘prosthesis’) from the age of 18 145 Front-teeth replacement 147 Dental surgery from the age of 18 149 Specialist dental care 150 DiamondClean Smart toothbrush 152
Psychological health care 154 General basic mental health care (GGZ) 155 Specialist mental health care (GGZ) 157
Contraceptives 160 Contraceptive devices 161 Sterilisation and reversal operation 162
Alternative/non-conventional 164 Alternative/non-conventional medicine 165
Hearing, vision and speech 168 Audiological health care 169 Orthoptics 170 Health care for sensory impairment 172 Speech therapy 174 Glasses, (contact) lenses and laser eye treatment 175 Stuttering therapy 177
Medical appliances 179 Medical appliances 180 Support pessary 182
Skin and hair 184 Acne treatment 185 Cosmetic skin camouflage treatment 186 Electrical epilation and laser treatment 188 Psoriasis day treatment 189 Pedicure for people with diabetes and rheumatoid arthritis 191
Transportation 193 Medical transportation by ambulance 194 Other medical transportation 195 Travel costs for visiting ill people 198
Health care abroad and travel 200 Abroad: urgent health care 201 Abroad: non-urgent (scheduled) health care 203 Abroad: vaccinations and prophylactics 206
Accidents, claims and other 209 Superfit accident coverage 210 Aid for third-party claims for injury 211
ONVZ Coverage 2018 - version 1.2 25 Reimbursement in exceptional cases 213
Wereldfit 215 Wereldfit: hospital care in Belgium and Germany 216 Wereldfit: repatriation 217 Wereldfit: early return 218 Wereldfit: reimbursement in the event of death 221 Wereldfit: replacement driver 222
Zorgplan 224 Hospital admission: extra luxury and comfort 225 Hospital admission: assistance and extra services before and after 227
Comprehensive coverage 229 Superfit accident coverage 229
ONVZ Coverage 2018 - version 1.2 26 General practitioners and staying healthy Coverage
The general practitioner (general medical care) Diagnostics for primary health care Foot care for diabetes mellitus sufferers Psychological health care with a general practitioner Thrombosis service Influenza vaccination Preventive health-related courses Preventive medical investigations Quitting smoking Health check-up/sports check-up The general practitioner (general medical care)
Health care starts with the general practitioner.
What is covered
If you have health problems or questions about your health, your general practitioner will usually be your first port of call.
The general practitioner will discuss your queries and symptoms with you, and establish a diagnosis. Where necessary, the general practitioner will arrange for you to undergo blood tests or other tests. In most cases, the general practitioner will be able to treat you independently. Sometimes he/she may refer you to a different health-care provider, for example a physiotherapist or a specialist.
Sometimes you may be treated by different health-care providers Other health-care providers (medical assistants) usually work at the general practitioner's practice too, and they can include a nurse specialising in diabetes or lung conditions, or a psychologist. These assistants can treat you independently, under the responsibility of the general practitioner.
Collaboration for treatment of chronic conditions The general practitioner may also collaborate with health-care providers outside of the practice. They work together to ensure that you receive health care tailored to your situation, for example in the cases of diabetes mellitus, cardiovascular disease or COPD (chronic obstructive pulmonary disease). This is also known as a ‘care chain’.
Day and night If you need urgent health care outside of surgery hours, you can call the standby practice or out-of-hours practice.
In combination: general medical care This combination of health care is referred to as general medical care, and is covered under the basic health- care plan.
Other types of general medical care For some types of general medical care, different or additional terms and conditions may apply. They are therefore mentioned separately:
• foot care for diabetes sufferers • psychological health care with a general practitioner • quitting smoking • testing for food allergies in children • general medical care involving admission (primary care admission)
What is not covered • medical examinations for, for example, a driving licence or sport • pregnancy tests
Tip While individual medical care for infectious diseases and/or tuberculosis is covered under general medical care, you can also go to a doctor of infectious diseases or tuberculosis. These doctors usually work at the municipal public health service (GGD) in your region. Preventive health care in connection with travel is not included.
If you will be travelling, the supplementary health-care plans cover vaccinations and medicines for your trip, as well as the associated advice.
If you would like to do more in terms of prevention, the supplementary health-care plans cover preventive medical investigations, health check-ups, preventive health-related courses and influenza vaccinations.
ONVZ Coverage 2018 - version 1.2 28 Coverage under each health-care plan
Basic health-care plan 100%
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit No coverage
What you pay
The excess The excess does not apply to general medical care. However, it does apply to health care prescribed by the general practitioner, such as medicines and laboratory or other tests.
No personal contribution You will not be charged a personal contribution for this care.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this context, routine health care is defined as individually-tailored, integrated and continuous health care that is standard practice for general practitioners. Simple when possible, and more complex when necessary.
Diagnostics for primary health care
When the general practitioner or other primary health-care provider organises further tests in order to ensure that you are treated effectively.
What is covered
If you have health problems, you normally go to your general practitioner first. The general practitioner will discuss your questions and complaints with you. This may involve a physical examination. The general practitioner will try to establish exactly what is wrong and what is causing your symptoms, arriving at a diagnosis.
The general practitioner may need further tests to be performed in order to establish an accurate diagnosis, for example blood tests, an electrocardiogram or an X-ray. Often such tests can be done at the practice itself, in which case they will come under general medical care. If a test cannot be performed at the practice, the general practitioner will refer you to a laboratory, a blood test clinic or the outpatient clinic at a hospital.
ONVZ Coverage 2018 - version 1.2 29 The general practitioner will be notified of the results of the test, and can then treat you further.
Midwives and other primary health-care providers1 can also request similar tests and imaging in order to establish an accurate diagnosis. Consequently, this type of health care is known as diagnostics for primary care, or simply primary diagnostics.
The basic health-care plan will cover diagnostics where it involves: • a laboratory test, for example a blood or urine test • imaging, for example an X-ray or a scan • a functional test, for example an electrocardiogram or pulmonary function test
We only cover diagnostics where requested by: • your general practitioner • your midwife, if considered necessary in connection with health care for pregnancy and childbirth • a school doctor, if considered necessary in connection with health care for babies and children up to the age of 4 • an elderly medical care specialist or a doctor for the mentally disabled, if considered necessary in connection with health care during primary care admission • a doctor of infectious diseases or tuberculosis, if considered necessary in connection with individual health care in cases of or where there is a risk of these diseases
If a physiotherapist or corporate doctor considers that diagnostics are necessary, you must first visit your general practitioner.
The diagnostics will be performed by: • a primary diagnostics centre (EDC) • a collaborative partnership2 • a hospital • a school doctor, for diagnostic tests in the case of suspected allergy to cow's milk in children up to the age of 4
Different terms and conditions apply to diagnostics related to antenatal screening. For this reason, they are mentioned separately.
Coverage under each health-care plan
Basic health-care plan 100%
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit No coverage
1 Health-care providers that you are free to use without a referral, e.g. dentist, physiotherapist or dietitian 2 A collaborative partnership of hospitals that provide laboratory tests and other services to institutions and primary health- care providers
ONVZ Coverage 2018 - version 1.2 30 What you pay
The excess While the excess does not apply to general medical care, it does apply to primary diagnostics.
No personal contribution You will not be charged a personal contribution for this care.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this context, routine health care is defined as health care that is standard practice for general practitioners. Simple when possible, and more complex when necessary.
Foot care for diabetes mellitus sufferers
I suffer from diabetes. Which type of foot care is covered?
What is covered
If you suffer from diabetes mellitus, your feet are particularly vulnerable. Consequently, you can arrange to have your feet checked once a year. Your general practitioner will examine your feet and draw up a health-care profile. This can also be done by a foot specialist, medical specialist or elderly medical care specialist (nursing home doctor).
The health-care profile will address the vulnerability of your feet. The higher the profile, the more health care you need in order to prevent or treat wounds or ulcers on your feet (diabetes-related foot ulcers). There are 5 health-care profiles: 0, 1, 2, 3 and 4.
The basic health-care plan covers the annual foot check-up.
If the foot check-up has resulted in the assignment of health-care profile 2, 3 or ,4 the basic health-care plan will also cover the following foot care for the prevention or treatment of foot ulcers:
• provision of details about a healthy lifestyle aimed at preventing foot problems • routine targeted foot examinations • identification and treatment of skin and nail problems, and abnormalities in the shape and posture of your feet • advice about appropriate footwear
Whom to contact • a general practitioner or equivalent health-care provider working under the responsibility of a general practitioner • a foot specialist
We will cover this health care under general medical care. An excess will not apply.
Occasionally, a foot specialist may outsource elements of foot care to a pedicurist1. In this case, the foot specialist will continue to be ultimately responsible, and will also send the invoice.
If you have been assigned health-care profile ,1 the coverage provided under the basic health-care plan does not apply. The Extrafit and higher supplementary health-care plans include coverage for foot specialist treatment. The supplementary health-care plans Benfit and above also include coverage for a pedicurist.
1 With the DV (diabetic) specialism and registered in the Kwaliteitsregister Pedicures [Quality Register for Pedicurists]. Or a medical pedicurist registered in the Kwaliteitsregister Pedicures [Quality Register for Pedicurists] or the Register Paramedische Voetzorg [Register for Allied Health Professionals for Foot Care]
ONVZ Coverage 2018 - version 1.2 31 What is not covered • foot care if you have been assigned health-care profile 0 • general foot care such as the removal of callouses or the clipping of toenails
Coverage under each health-care plan
Basic health-care plan 100% For health-care profile 2 or higher
Startfit No coverage
Extrafit €150 Foot specialist treatment for health-care profile 1
Benfit €100/€250 For health-care profile 1: • Pedicure €100 • Foot specialist treatment €250
Optifit €200/100% For health-care profile 1: • Pedicure €200 • Foot specialist treatment 100%
Topfit 100% Pedicure and foot specialist treatment for health-care profile 1
Superfit 100% Pedicure and foot specialist treatment for health-care profile 1
What you pay
No excess This health care is provided under general medical care or a supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this context, routine health care is defined as health care that is standard practice for general practitioners. Simple when possible, and more complex when necessary.
ONVZ Coverage 2018 - version 1.2 32 Psychological health care with a general practitioner
Everyone feels a bit low from time to time, but sometimes professional help may be needed.
What is covered
If you have health problems, your general practitioner will usually be your first port of call. This also applies to psychological conditions.
A general practitioner can help you with minor psychological conditions, such as gloominess, bereavement or loneliness. General practitioner's practices often have a medical assistant for mental health1 (POH-GGZ), who has been trained to help people with psychological conditions. He/she may have discussions with you, as well as recommending online treatment programmes. You may also be prescribed medication.
The basic health-care plan covers psychological health care that is provided by a general practitioner or a medical assistant for mental health (POH-GGZ), for people of all ages.
During the discussions, the general practitioner or medical assistant for mental health (POH-GGZ) will also assess whether they are actually able to provide suitable treatment. It may be the case that you need more, or different types of, treatment, for example if your symptoms are the result of a psychological disorder. If this is the case, the general practitioner will refer you for general basic mental health care (GGZ) or specialist mental health care (GGZ).
If you are under the age of 18, the general practitioner will refer you for mental health care (GGZ) for young people. The local council is responsible for providing this health care. Your general practitioner will know which health-care providers you can be referred to.
We do not cover the following: • exercise-related therapy • anonymous online treatment
The supplementary health-care plans also cover other types of health care that may help you with psychological conditions, for example preventive health-related courses, such as running therapy or a sleep course (Extrafit and higher), and alternative/non-conventional medicine (Optifit and higher).
If you would like to quit smoking, you can get help with this too.
Coverage under each health-care plan
Basic health-care plan 100%
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit No coverage
1 Mental health care
ONVZ Coverage 2018 - version 1.2 33 What you pay
No excess The excess does not apply to general medical care. This is also the case if the health care is provided by a medical assistant for mental health (POH-GGZ).
No personal contribution You will not be charged a personal contribution for this care.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this context, routine health care is defined as health care that is standard practice for general practitioners. Simple when possible, and more complex when necessary.
Thrombosis service
If you take anticoagulants, you will need to have regular blood tests.
What is covered
In cases of thrombosis, the blood clots at the wrong time or in the wrong place and this can block the flow of blood through the blood vessels. Anticoagulants (blood thinners) counteract this.
If you take anticoagulants, you will need regular blood tests to check the clotting time of your blood. This will usually involve the thrombosis service, which has clinics where you can have a blood test, or the service can come to your home. If you would prefer to check the clotting time yourself, the thrombosis service can provide you with test equipment and help using it.
The basic health-care plan reimburses:
• blood tests by the thrombosis service • tests to measure the blood clotting time • advice on medicines for preventing thrombosis
If you check the clotting time yourself, the basic health-care plan also covers: • the self-test equipment and consumables such as test strips (this comes under medical appliances) • instruction in how to use the equipment and support with your readings
ONVZ Coverage 2018 - version 1.2 34 Coverage under each health-care plan
Basic health-care plan 100%
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit No coverage
What you pay
The excess This care is provided under the basic health-care plan, and is therefore subject to the excess.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You need to have a referral first You are required to have a referral from a doctor or medical specialist before the health care begins.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this context, routine health care is defined as health care that is standard practice for medical specialists. Simple when possible, and more complex when necessary.
Influenza vaccination
For avoiding the annual bout of influenza.
What is covered
Anyone can get influenza and some people are particularly vulnerable to its effects, for example anyone with a lung or heart condition or diabetes, as well as anyone over the age of 60. If you belong to any of these risk groups, you will be entitled to an influenza vaccination under theNationaal Programma Grieppreventie [National Influenza Prevention Programme]. Your general practitioner will usually send you a reminder.
ONVZ Coverage 2018 - version 1.2 35 If you do not belong to any of the risk groups, the Benfit and higher supplementary health-care plans include coverage for an influenza vaccination once per calendar year.
Whom to contact • a general practitioner or doctor • the municipal public health service (GGD) • a vaccination centre • a pharmacy, if you yourself are collecting the vaccine on prescription
Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit 100% Once per calendar year
Optifit 100% Once per calendar year
Topfit 100% Once per calendar year
Superfit 100% Once per calendar year
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
A prescription is required to pick up the vaccine from the pharmacy The health-care provider may ask you to collect the influenza vaccine from a pharmacy. In this case, you will need a prescription from your general practitioner or doctor.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
More information is available from the RIVM The Dutch National Institute for Public Health and the Environment (RIVM) has more information about the influenza vaccination and risk groups on its website1.
1 More information is available at: www.rivm.nl/Onderwerpen/G/Griep/Griepprik
ONVZ Coverage 2018 - version 1.2 36 Preventive health-related courses
ONVZ stands for a happy and healthy life, which is why we cover preventive health-related courses.
What is covered
A preventive health-related course can help you to stay healthy and avoid health problems. There are also courses that teach you how to cope with a condition, or, for example, prepare you for childbirth.
The Extrafit and higher supplementary health-care plans include coverage for preventive health-related courses. The courses involved are listed below, along with the maximum coverage per calendar year.
If you would like more information about preventive health-related courses, our ZorgConsulent advisers are ready to help.
Pregnancy • information seminars organised by the Vereniging Borstvoeding Natuurlijk1 [Association for Natural Breastfeeding] • courses run by a breastfeeding specialist • pregnancy courses, run by a home-care organisation, pelvic therapist, Cesar/Mensendieck remedial therapist or the Vereniging Samen Bevallen [Giving Birth Together Association], or the NVFB's [Pelvic Physiotherapy Association] Zwangerfit course run by an NVFB-registered pelvic or other physiotherapist • pregnancy yoga, run by a home-care organisation, pelvic therapist, Cesar/Mensendieck remedial therapist, or by a qualified yoga instructor affiliated with theVereniging Yogadocenten Nederland [Dutch Association of Yoga Instructors] • the Fit Mama! course, run by a home-care organisation, pelvic therapist or Cesar/Mensendieck remedial therapist
Weight control • courses that promote a healthy diet and weight control, run by a home-care organisation • courses run by a weight consultant affiliated with the Beroepsvereniging Gewichtsconsulenten Nederland [Dutch Association of Professional Weight Consultants] (BGN), or by a dietitian affiliated with the Nederlandse Vereniging Diëtisten [Dutch Association of Dietitians] (NVD) or the Diëtisten Coöperatie Nederland [Dutch Dietitians Cooperative] • Happy Weight • the Van Klacht naar Kracht, Bewegen op Recept and BigMove programmes, run by a health centre or the municipal public health service (GGD) (reimbursement of the personal contribution)
Mental fitness • assertiveness training for children up to the age of 16, run by a psychologist • the Kanjertraining course, run by an educationalist or psychologist from the Instituut Kanjertraining B.V. Almere • the Steviger in je schoenen staan course, run by the Instituut Stema Opleidingen en Coaching • the Sta Sterk course, developed by the Stichting Omgaan met Pesten • running therapy for the prevention of depression, delivered by a running therapist through Running VOF • Stichting Mirro2 online self-help and other modules aimed at identifying, reducing or preventing psychological conditions
Self-management • the Beter Slapen or Slapen kun je leren courses, run by a home-care organisation • the online Beter Slapen course, run by Somnio.eu • a course on learning to deal with a chronic illness in yourself or a family member, run by a home-care organisation, patient association or the municipal public health service (GGD) • a fall prevention course, run by a physiotherapist or remedial therapist (who may also be from a home-care organisation) • the online programme at Klikjebeter.nl
First aid • basic, refresher and advanced courses in first aid or first aid for children, run by an organisation affiliated with the KNV EHBO [Royal Netherlands First Aid Society] or the Nationale Bond EHBO [National First Aid Association], or certified byOranjekruis [Orange Cross], the Dutch Red Cross or NIKTA • basic first aid, first aid for children, first aid for adults and advanced first aid courses, run by Livis • basic courses in resuscitation or use of an AED (automated external defibrillator), certified by the Nederlandse Reanimatie Raad [Dutch Council for Resuscitation] and/or run by a resuscitation partner from the Hartstichting [Heart Foundation]
What is not covered • company first responder courses
1 More information is available at: www.borstvoedingnatuurlijk.nl 2 More information is available at: www.miro.nl/account
ONVZ Coverage 2018 - version 1.2 37 Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit €75 Maximum per calendar year
Benfit €150 Maximum per calendar year
Optifit €250 Maximum per calendar year
Topfit €325 Maximum per calendar year
Superfit €500 Maximum per calendar year
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Preventive medical investigations
Establishing your current state of health.
What is covered
If you have health problems, or questions about your health, your general practitioner will usually be your first port of call.
If you do not have a health problem, but would still like to establish your current state of health, you can do this by way of a preventive medical investigation.
The government may offer preventive medical investigations, known as population screening. For example, there are population screening programmes for breast cancer and bowel cancer. If you are eligible to take part in these, you will be notified automatically. The government funds these programmes, so they are not covered here.
ONVZ Coverage 2018 - version 1.2 38 You can also arrange your own preventive medical investigations. This will involve a physical examination to help identify any potential illness, disease or other risks to your health. A doctor will discuss the results with you.
You can also undergo preventive genetic tests in order to establish whether a particular medicine is likely to work for you and, if so, what dose is best for you. This is known as pharmacogenetic testing.
Some doctors advise against preventive medical investigations. For this reason, the government (the Dutch National Institute for Public Health and the Environment) and the Royal Dutch Medical Association have drawn up a list of the pros and cons. If you are in any doubt as to whether preventive investigations are appropriate in your case, our ZorgConsulent advisers can help by providing more information.
The Optifit supplementary health-care plan only covers ‘standard’ preventive medical investigations, and reimburses 50% of the costs. Topfit and Superfit cover standard preventive investigations and pharmacogenetic testing in full. All 3 plans are subject to a maximum level of coverage per calendar year, as stated below.
We will only cover pharmacogenetic testing where it involves a type of medicine that is new to you, and where testing is recommended by the KNMP [Royal Dutch Association of Pharmacists].
If investigations reveal anything that requires treatment, or you need another type of medication, this will nearly always be covered under the basic health-care plan. In this case, you will pay the excess and perhaps a personal contribution too.
If you need to undergo preventive investigations in connection with a sport, for example for diving certification, and you use a sports doctor for this, this will be covered under therapies for posture and movement.
Whom to contact • a general practitioner • a medical specialist
What is not covered • investigations organised for more than one person at the same time, for example through your employer or a sports club • population screening
Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit 50%, up to €250 Maximum per calendar year Excluding pharmacogenetic testing
Topfit €500 Maximum per calendar year Including pharmacogenetic testing
Superfit €750 Maximum per calendar year Including pharmacogenetic testing
ONVZ Coverage 2018 - version 1.2 39 What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
The invoice for preventive medical investigations must state that investigations performed by a general practitioner or medical specialist are involved
In the case of pharmacogenetic testing, you must have a prescription from your doctor Your doctor will also arrange the investigations for you.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
For more information, please contact the ZorgConsulent Our ZorgConsulent advisers also have information about where you can go for the investigations.
Quitting smoking
We all know that smoking is bad for our health. If you cannot decide whether to switch to electronic cigarettes (e-cigarettes) or quit altogether, we can support you in quitting smoking.
What is covered
If you would like to quit smoking, but cannot do it alone, your general practitioner, midwife or medical specialist1 can help you with brief, supportive advice.
For more intensive support, you can join a programme aimed at quitting smoking by changing your behaviour. Professionals help you by providing advice, personal coaching, telephone coaching and group courses, where necessary in combination with nicotine replacements such as nicotine patches, nicotine lozenges or chewable tablets, or with medicines such as Nortrilen, Zyban or Champix.
For a programme aimed at quitting smoking, you can go to: • a general practitioner • a nurse • a health-care provider listed on the Stoppen met roken2 quality register of the Stop met Roken partnership
The basic health-care plan reimburses: • brief, supportive advice, and • a programme aimed at quitting smoking, and the associated prescribed nicotine replacements and medicines, once per calendar year
If you would prefer to take part in one of the following programmes, this is possible too. The Optifit and higher supplementary health-care plans include coverage for: • laser therapy • Allen Carr training • De Opluchting training (video course, email course or one-day open course)
1 An anaesthetist, cardiologist, surgeon, cardiothoracic surgeon, dermatologist, gynaecologist, internist, ENT doctor, paediatrician, clinical geneticist, clinical geriatric specialist, pulmonologist, gastroenterologist, medical microbiologist, neurosurgeon, neurologist, nuclear medicine specialist, ophthalmologist, orthopaedic surgeon, pathologist, plastic surgeon, psychiatrist, radiologist, radiation therapist, rheumatologist, rehabilitation specialist, sports doctor or urologist 2 More information is available at: www.kwaliteitsregisterstopmetroken.nl
ONVZ Coverage 2018 - version 1.2 40 Coverage under each health-care plan
Basic health-care plan Programme aimed at quitting smoking Once a year, including nicotine replacement/medicines
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit 100% Laser therapy, Allen Carr training, De Opluchting training
Topfit 100% Laser therapy, Allen Carr training, De Opluchting training
Superfit 100% Laser therapy, Allen Carr training, De Opluchting training
What you pay
No excess An excess does not apply to a programme aimed at quitting smoking (including prescribed nicotine replacements and medicines), that is covered under the basic health-care plan. An excess does not apply either to the 3 programmes covered under the supplementary health-care plan.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
No referral needed You do not need a referral for a programme aimed at quitting smoking. This also applies to the 3 programmes covered under the supplementary health-care plan.
A prescription is needed for the nicotine replacements and medicines You will need a prescription from your general practitioner, medical specialist, midwife or specialist nurse for any nicotine replacements and medicines associated with the treatment. If someone other than your general practitioner prescribes the nicotine replacements or medicines, he/she must complete an application form1. Please enclose this form with your claim.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this context, routine health care is defined as health care that is standard practice for nurses, midwives, general practitioners and medical specialists. Simple when possible, and more complex when necessary.
1. Please refer to: www.znformulieren.nl/337936417/Formulieren?folderid=338591750&title=Stoppen+met+roken
ONVZ Coverage 2018 - version 1.2 41 Health check-up/sports check-up
For a better understanding of your current state of health.
What is covered
If you have health problems, or questions about your health, the general practitioner will usually be your first port of call.
If you do not have any symptoms, but would still like to establish your current state of health, you can do this by way of a health or sports check-up. The check-up assesses your current level of fitness and state of health. You will be given personal advice on how to stay healthy or improve your health. There are various places in the Netherlands that offer this service. The check-up will be performed by a physiotherapist.
To help you decide which check-up is best for you, please consult the information in the table below.
Element Health check-up Sports check-up
Medical screening and lifestyle questionnaire X X
BMI calculation X X
Body fat percentage calculation X X
Waist circumference measurement X
Pulmonary function test X
Blood pressure measurement X
Fitness test X
Fitness and health profile X
Examination of posture and musculoskeletal X system
Brief, individual advice X
Discussion of recommendations X
The Startfit and higher supplementary health-care plans include coverage for an annual health or sports check-up. This must be arranged through the ZorgConsulent.
ONVZ Coverage 2018 - version 1.2 42 Coverage under each health-care plan
Basic health-care plan No coverage
Startfit 100% Maximum of once per calendar year, through the ZorgConsulent
Extrafit 100% Maximum of once per calendar year, through the ZorgConsulent
Benfit 100% Maximum of once per calendar year, through the ZorgConsulent
Optifit 100% Maximum of once per calendar year, through the ZorgConsulent
Topfit 100% Maximum of once per calendar year, through the ZorgConsulent
Superfit 100% Maximum of once per calendar year, through the ZorgConsulent
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You need to arrange the check-up through the ZorgConsulent The ZorgConsulent will register you at your chosen location. You do not need a referral from a doctor.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
The check-up is not suitable for children under the age of 13.
ONVZ Coverage 2018 - version 1.2 43 Hospital and medical specialists Coverage
Health care provided by a medical specialist Hospital admission Plastic surgery Fertility treatment In vitro fertilisation (IVF) Testing for hereditary diseases Breast cancer: additional tests Organ transplants and donation Dialysis Mechanical respiration Provisionally approved treatments Stay in a guest house Childcare in case of hospital admission of a parent Health care provided by a medical specialist
Medical specialists usually work in a hospital. This health care is therefore also referred to as hospital care.
What is covered
A general practitioner or other health-care provider will refer you to a medical specialist1 for specialist health care.
Medical specialists work in a hospital, an independent treatment centre2 or in a private practice.
A medical specialist will usually conduct the initial consultation himself/herself. He/she will establish a diagnosis and discuss treatment with you. He/she will be your primary practitioner. After the initial consultation, the medical specialist may outsource elements of the health care to others, for example a scan or different tests. This all comes under specialist medical health care.
Where you are treated in a hospital, the primary practitioner may also be an emergency treatment doctor (at A&E), a specialist nurse or a physician assistant3. Even though these are not medical specialists, they do provide specialist medical health care.
The basic health-care plan covers specialist medical health care. It also covers any nursing, allied health care, medicines, medical appliances and dressings associated with your treatment.
If you need to be admitted, the basic health-care plan will cover the hospital admission.
For some types of treatment, additional terms and conditions may apply. For this reason, these types of treatment are mentioned separately: • plastic surgery • provisionally approved treatments • fertility treatment/IVF • dental surgery • specialist mental health care (GGZ) • additional diagnostic tests in the case of breast cancer • sterilisation and reversal operation
Coverage under each health-care plan
Basic health-care plan 100% Most hospital care
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit No coverage
1 An anaesthetist, cardiologist, surgeon, cardiothoracic surgeon, dermatologist, gynaecologist, internist, ENT doctor, paediatrician, clinical geneticist, clinical geriatric specialist, pulmonologist, gastroenterologist, medical microbiologist, neurosurgeon, neurologist, nuclear medicine specialist, ophthalmologist, orthopaedic surgeon, pathologist, plastic surgeon, psychiatrist, radiologist, radiation therapist, rheumatologist, rehabilitation specialist, sports doctor or urologist 2 Like a hospital, this is a facility for specialist medical care, but generally for non-urgent, less complex care that does not require admission to hospital 3 The physician assistant can perform some examinations, give injections, and prescribe medicine independently. He/she can also work under the direction of a medical specialist
ONVZ Coverage 2018 - version 1.2 45 What you pay
The excess This care is provided under the basic health-care plan, and is therefore subject to the excess.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You need to have a referral first Before consulting a medical specialist, you will need a referral from your general practitioner, another medical specialist, a school doctor, a corporate doctor, a doctor for the mentally disabled, an elderly medical care specialist or a nursing home doctor. In the case of pregnancy and childbirth, your referral may be from a midwife. A referral is not required for emergency health care.
You may need our prior permission We will only cover treatments specified on theLimitatieve lijst machtigingen medisch specialistische zorg [Exhaustive list of authorisations for specialist medical care]1 where we have given our prior permission.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
In the event of a waiting list, please contact one of our ZorgConsulent advisers You can ask the ZorgConsulent to help reduce the waiting time on your behalf. Our ZorgConsulent advisers can also help with other types of health-care mediation.
You can also get a second opinion If you have any concerns or doubts about the diagnosis or proposed treatment, you can ask your medical specialist for a referral for a second opinion. Once you have obtained the opinion of another specialist, you can discuss further treatment with your own medical specialist. The basic health-care plan covers a second opinion. You can also consult our ZorgConsulent advisers for advice and information about getting a second opinion.
We only cover routine health care that you actually need In this context, routine health care is defined as health care that is standard practice for medical specialists. Simple when possible, and more complex when necessary.
Hospital admission
Sometimes you will need to be admitted to hospital in order to get better.
What is covered
Minor operations and tests are usually performed in the outpatient clinic at a hospital or in day treatment, where you can go home the same day.
If extensive tests or treatment performed by a medical specialist2 or dental surgeon3 require you to stay in the hospital overnight, we call this hospital admission.
1 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22 2 An anaesthetist, cardiologist, surgeon, cardiothoracic surgeon, dermatologist, gynaecologist, internist, ENT doctor, paediatrician, clinical geneticist, clinical geriatric specialist, pulmonologist, gastroenterologist, medical microbiologist, neurosurgeon, neurologist, nuclear medicine specialist, ophthalmologist, orthopaedic surgeon, pathologist, plastic surgeon, psychiatrist, radiologist, radiation therapist, rheumatologist, rehabilitation specialist, sports doctor or urologist 3 Dental surgeons are listed in the register of the Wet BIG [Dutch Individual Health-Care Professions Act] as dental specialists for dental health care, dental surgery, and maxillofacial surgery
ONVZ Coverage 2018 - version 1.2 46 The basic health-care plan covers hospital admission and associated health care: • nursing and other care • allied health care • medicines • medical appliances and dressings You may be admitted to a hospital or an independent treatment centre1. This also includes institutions that specialise in a particular type of treatment or illness, for example an eye clinic, a rehabilitation centre or a centre for epilepsy.
If you are admitted to a mental health-care centre2, other terms and conditions apply. Admission to a mental health-care centre is therefore mentioned separately. The same applies to primary care admissions and geriatric rehabilitation.
The Superfit and Zorgplan supplementary health-care plans cover extra comfort during your admission, up to a maximum of €2,500 per calendar year.
Coverage under each health-care plan
Basic health-care plan 100% Up to 3 years
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit €2,500 for extra comfort • Single room or compensation of €75 per day if none available • Luxury package or comfort service • Additional bed and meals when your partner stays
Zorgplan €2,500 for extra comfort • Single room or compensation of €75 per day if none available • Luxury package or comfort service • Additional bed and meals when your partner stays
What you pay
The excess The excess applies to care under the basic health-care plan. No excess applies to care under the supplementary health-care plan.
No personal contribution You will not be charged a personal contribution for this care.
1 Like a hospital, this is a facility for specialist medical care, but generally for non-urgent, less complex care that does not require admission to hospital 2 A facility that has permission from the government to provide specialist mental health care (GGZ). For care that requires admission: a facility authorised to provide in-patient specialist mental health care
ONVZ Coverage 2018 - version 1.2 47 What you have to do yourself
You need to have a referral first Before consulting a medical specialist, you will need a referral from your general practitioner, another medical specialist, a school doctor, a corporate doctor, a doctor for the mentally disabled, an elderly medical care specialist or a nursing home doctor. In the case of pregnancy and childbirth, your referral may be from a midwife. A referral is not required for emergency health care.
You may need our prior permission If you are admitted for treatments specified on theLimitatieve lijst machtigingen medisch specialistische zorg [Exhaustive list of authorisations for specialist medical care]1, we will only provide coverage where we have given our prior permission.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We will cover up to 3 continuous years of admission In the event of the period of admission being interrupted, we will treat the admission as continuous, providing the interruption is for no more than 30 days. If the interruption is for a holiday or weekend leave, any such leave will count towards the three-year total.
We only cover admission for insured health care The basic health-care plan will only cover admission in connection with specialist medical treatment or dental surgery if the basic health-care plan covers the actual health care involved.
A word of caution in relation to admission abroad Different guidelines may apply to health care and admissions abroad, and different coverage applies to planned and unplanned health care abroad. If you plan to go abroad specifically for hospital admission, please contact our Service Centre first. This will help avoid any nasty surprises later on.
Plastic surgery
Where treatment of your appearance is medically necessary.
What is covered
Many people think that plastic surgery involves making changes to someone’s appearance so they look better. However, plastic surgery covers much more than this. It also covers operations that correct congenital abnormalities or repair the body following accidents, for example in the case of burns. Plastic surgery can also play a role in alleviating unsightly scars left after medical procedures.
Whom to contact Plastic surgery is usually performed by a plastic surgeon. However, other medical specialists such as an ophthalmologist or an ENT doctor can also perform operations involving plastic surgery.
These medical specialists work in a hospital, an independent treatment centre or in a private practice.
The basic health-care plan only covers plastic surgery for: 1. physical disfigurement that gives rise to a physical dysfunction2 2. other disfigurement3 resulting from disease, an accident or a medical procedure 3. paralysed or weak upper eye lids causing serious impairment of the field of vision or as a result of a congenital abnormality or chronic condition present at birth 4. the placement or replacement of breast prostheses following a full or partial mastectomy 5. the placement or replacement of breast prostheses if in your case, as a woman/transgender woman, the breast tissue has not developed properly (agenesis) or is missing (aplasia)
1 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22 2 Example: You are unable to fully close your hand, making it difficult to pick up things 3 A non-congenital seriously disfigured part of the body, which stands out immediately in every-day life, and which cannot be hidden by clothes or make-up. Example: burns, amputation
ONVZ Coverage 2018 - version 1.2 48 6. the following congenital abnormalities: cleft lip, jaw or palate, deformations of the facial skeleton, benign proliferation of blood vessels, lymph vessels or connective tissue, birth marks or deformations of the urinary tract/genitalia 7. treatment of primary features of genitals where sex reassignment surgery is required
In these cases, the basic health-care plan also covers nursing and other care, allied health care, medicines, medical appliances and dressings.
If you need to be admitted, the basic health-care plan will cover the hospital admission.
The Optifit and higher supplementary health-care plans include coverage for certain types of plastic surgery, where this is not covered under the basic health-care plan.
Optifit covers plastic surgery in the case of: • correction of the position of the ears, for children up to the age of 18 years • a demonstrable physical dysfunction, where this involves upper eyelid or abdominal correction or the replacement of breast prostheses
Topfit and Superfit include coverage for plastic surgery in the case of: • correction of the position of the ears, for children up to the age of 18 years • a demonstrable physical dysfunction
What is not covered • the suction-assisted removal of fatty tissue (liposuction) from the abdomen • abdominal correction (abdominoplasty) without medical necessity • removal of a breast prosthesis without medical necessity • breast enlargement • (any other) plastic surgery without medical necessity • reconstruction of the uvula (uvuloplasty) to combat snoring
For more information, please see the document entitled Plastische chirurgie1 [Plastic surgery].
Coverage under each health-care plan
Basic health-care plan In specific cases
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit 100% • Correction of the position of the ears in children • In the case of a demonstrable physical dysfunction: upper eyelid or abdominal correction or the replacement of breast prostheses
Topfit 100% • Correction of the position of the ears in children • In the case of a demonstrable physical dysfunction
Superfit 100% • Correction of the position of the ears in children • In the case of a demonstrable physical dysfunction
1 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22
ONVZ Coverage 2018 - version 1.2 49 What you pay
The excess The excess applies to care under the basic health-care plan. No excess applies to care under the supplementary health-care plan.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You need to have a referral first Before consulting a medical specialist, you will need a referral from your general practitioner, another medical specialist, a school doctor, a corporate doctor, a doctor for the mentally disabled, an elderly medical care specialist or a nursing home doctor. In the case of pregnancy and childbirth, your referral may be from a midwife. A referral is not required for emergency health care.
You will usually need our prior permission We will only cover treatments specified on theLimitatieve lijst machtigingen medisch specialistische zorg [Exhaustive list of authorisations for specialist medical care]1 where we have given our prior permission. This also applies to coverage provided under the supplementary health-care plans.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this context, routine health care is defined as health care that is standard practice for medical specialists. Simple when possible, and more complex when necessary.
In the event of a waiting list, please contact one of our ZorgConsulent advisers You can ask the ZorgConsulent to help reduce the waiting time on your behalf. Our ZorgConsulent advisers can also help with other types of health-care mediation.
Fertility treatment
If you cannot become pregnant.
What is covered
If you cannot become pregnant for medical reasons, but still want to have children and are under the age of 43, the basic health-care plan includes coverage for: • specialist medical tests and treatment • artificial insemination (AI) or intra-uterine insemination (IUI), using sperm from a donor where necessary • in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI), including freezing of embryos (cryopreservation) • associated medicines
The basic health-care plan does not include coverage for the costs of ovum donation.
1 More information is available at: www.onvz.nl/zelf-regelen/toestemming-vragen/toestemming-vragen-voor-medische- specialistische-zorg
ONVZ Coverage 2018 - version 1.2 50 Coverage under each health-care plan
Basic health-care plan 100% Up to the age of 43, 1st, 2nd and 3rd IVF attempts only
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit Additional IVF attempts 4th IVF attempt onwards, up to the age of 43
Superfit 100% IVF 4th IVF attempt onwards, up to the age of 43
What you pay
The excess This care is provided under the basic health-care plan, and is therefore subject to the excess.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You need to have a referral first Before consulting a medical specialist, you will need a referral from your general practitioner or another medical specialist.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
An age limit applies The basic health-care plan does not include coverage for fertility treatment where the woman is over 43 years of age. If you start an IVF attempt before you reach the age of 43, you will be able to complete that attempt.
We use the Hunault score The age of the woman and the quality of the sperm are key factors in determining the likelihood of pregnancy. The Hunault score provides an indication of the likelihood of success. Where the score indicates a good chance of becoming pregnant naturally, the basic health-care plan will only include coverage for fertility treatment if the woman has failed to become pregnant over an extended period of time.
This is also the case if you are single or homosexual, and want to have children. We will only cover the costs of fertility treatment in the case of fertility problems associated with medical reasons and where there is a poor likelihood of becoming pregnant.
ONVZ Coverage 2018 - version 1.2 51 We only cover routine health care that you actually need In this context, routine health care is defined as fertility treatment that is standard practice for medical specialists. Simple when possible, and more complex when necessary.
In vitro fertilisation (IVF)
Fertilisation in a test tube.
What is covered
In vitro fertilisation (IVF) involves fertilisation outside of the body. If, during IVF, a spermatozoon is injected into the ovum, this is known as an ICSI procedure1. This makes no difference to the coverage.
For IVF or ICSI treatment, you will be referred to a hospital or independent treatment centre2 (fertility clinic) licensed to perform these procedures.
Each time you wish to become pregnant, the basic health-care plan includes coverage for the 1st, 2nd and 3rd IVF or ICSI attempts. The Topfit and Superfit supplementary health-care plans include coverage for the 4th IVF or ICSI attempt onwards.
An IVF or ICSI attempt has 4 stages: • stage 1: hormone treatment for maturation of the ova • stage 2: collection of mature ova from the woman's ovaries (follicle aspiration) • stage 3: the laboratory stage, in which the ova are fertilised with spermatozoa and develop into embryos • stage 4: the transfer, on 1 or more occasions, of 1 or 2 embryos into the woman’s womb
If stage 2 is successful, the treatment will count as an attempt.
If this procedure does not result in a continuing pregnancy, the attempt will have been unsuccessful and a new attempt can be made. Any frozen embryos that remain from an earlier stage in the attempt can be transferred as part of the same attempt, as long as there is no continuing pregnancy.
If this procedure does result in a continuing pregnancy, the number of attempts will start over again. The next treatment will count as a new 1st attempt.
A continuing pregnancy is where the embryo survives for: • 12 weeks following the last menstruation, in the event of spontaneous pregnancy • 10 weeks after follicle aspiration • 9 weeks and 3 days in the case of implantation of a frozen embryo
The basic health-care plan and the supplementary health-care plans do not include coverage for new techniques such as assisted hatching, in vitro maturation and modified natural cycle IVF (MNC). There is also no coverage for the costs of ovum donation.
If you wish to be treated abroad, the health care may not be covered in full. In order to be sure of the coverage included, we recommend that you ask for our permission in advance3 or (in the case of Wereldfit) contact one of our ZorgConsulent advisers.
1 Intracytoplasmic sperm injection 2 Like a hospital, this is a facility for specialist medical care, but generally for non-urgent, less complex care that does not require admission to hospital 3 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen
ONVZ Coverage 2018 - version 1.2 52 Coverage under each health-care plan
Basic health-care plan 3 attempts for each pregnancy 1st, 2nd and 3rd attempt for each pregnancy, up to the age of 43
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit Additional attempts 4th attempt onwards, up to the age of 43
Superfit Additional attempts 4th attempt onwards, up to the age of 43
What you pay
The excess The excess applies to care under the basic health-care plan. No excess applies to care under the supplementary health-care plan.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You need to have a referral first Before consulting a medical specialist, you will need a referral from your general practitioner or another medical specialist.
You will need our prior permission for the 4th attempt onwards Topfit and Superfit will only cover the 4th or subsequent attempts if the treatment takes place in a hospital and with our prior permission1.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Age limits apply We will only cover IVF treatment if you are not yet 43 years old at the start of the attempt, i.e. if you start a new attempt after you reach the age of 43, this will not be covered. If you are under 38 at the start of the 1st or 2nd attempt, the basic health-care plan will only reimburse the costs if no more than one embryo is transferred each time.
1 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen
ONVZ Coverage 2018 - version 1.2 53 We use the Hunault score The age of the woman and the quality of the sperm are key factors in determining the likelihood of pregnancy. The Hunault score provides an indication of the likelihood of becoming pregnant. Where the score indicates a good chance of becoming pregnant naturally, the basic health-care plan will only include coverage for IVF treatment if the woman has failed to become pregnant over an extended period of time.
This is also the case if you are single or homosexual, and want to have children. We will only cover the costs of IVF treatment in the case of fertility problems associated with medical reasons and where there is only a reduced likelihood of becoming pregnant.
Medicines are included in the hospital's costs You therefore do not collect the medicines yourself from a pharmacy and do not pay for them separately.
We only cover routine health care that you actually need In this context, routine health care is defined as health care that is standard practice for medical specialists. Simple when possible, and more complex when necessary.
Testing for hereditary diseases
Am I at risk of a hereditary disease and could I pass it on?
What is covered
Testing for hereditary diseases can tell you whether you have or are at risk of a hereditary disease or condition, and whether or not you can pass this condition on. You will go to a clinical genetic centre or centre for hereditary diseases for the tests.
Testing may involve medical investigations, laboratory tests and family tree research. Advice and psychosocial support in relation to hereditary diseases are also included.
We will also reimburse the costs of testing people other than yourself, if such tests are necessary in order to give you advice. The other people tested may then also receive advice.
The basic health-care plan includes coverage for the testing for, and provision of advice on, hereditary diseases.
Coverage under each health-care plan
Basic health-care plan 100% Testing for and advice on hereditary diseases
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit No coverage
ONVZ Coverage 2018 - version 1.2 54 What you pay
The excess This care is provided under the basic health-care plan, and is therefore subject to the excess.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You need to have a referral first Before you go to the clinical genetic centre, you need to get a referral from the general practitioner, the corporate doctor or a medical specialist1.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this context, routine health care is defined as health care that is standard practice for medical specialists. Simple when possible, and more complex when necessary.
Breast cancer: additional tests
A greater level of certainty in choosing a follow-up treatment.
What is covered
If you have been diagnosed with breast cancer, you will decide on your treatment together with your medical specialist. Chemotherapy may also be one of your options.
If there are doubts about whether chemotherapy would work in your case, a MammaPrint or Oncotype DX test may help you and the medical specialist in deciding on your treatment.
These tests look at gene activity in the tumour and the test results show the likelihood of metastasis or relapse of the tumour.
You can discuss with your medical specialist whether either of these tests would be appropriate in your case, which depends on the kind of breast cancer, the stage and the characteristics of the tumour.
Although the basic health-care plan covers specialist medical health care in cases of breast cancer, it does not (yet) cover the MammaPrint and Oncotype DX tests.
1 An anaesthetist, cardiologist, surgeon, cardiothoracic surgeon, dermatologist, gynaecologist, internist, ENT doctor, paediatrician, clinical geneticist, clinical geriatric specialist, pulmonologist, gastroenterologist, medical microbiologist, neurosurgeon, neurologist, nuclear medicine specialist, ophthalmologist, orthopaedic surgeon, pathologist, plastic surgeon, psychiatrist, radiologist, radiation therapist, rheumatologist, rehabilitation specialist, sports doctor or urologist
ONVZ Coverage 2018 - version 1.2 55 The Extrafit and higher supplementary health-care plans do provide coverage for these tests, provided either test is prescribed by your medical specialist.
Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit MammaPrint and Oncotype DX
Benfit MammaPrint and Oncotype DX
Optifit MammaPrint and Oncotype DX
Topfit MammaPrint and Oncotype DX
Superfit MammaPrint and Oncotype DX
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You need a prescription from your medical specialist You do not need to do anything to arrange the test. Your attending medical specialist will arrange it for you.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Organ transplants and donation
Need a new organ or tissue? Or are you an organ or tissue donor for someone else?
What is covered
An organ transplant involves replacing a poorly functioning or entirely dysfunctional organ in a ‘recipient’ with the same organ from another person, i.e. the donor. A donor can be a living person, such as in cases of a kidney transplant or a transplant of a portion of the liver. Tissue transplants are also fairly common, such as skin or cornea transplants.
ONVZ Coverage 2018 - version 1.2 56 If you are the recipient of an organ or tissue, the basic health-care plan will cover: • donor selection • harvesting the organ or tissue from the donor • examination, preservation and transport of the organ or tissue for the transplant, if harvested from a deceased donor • the actual organ or tissue transplant • all health care for the donor that is covered by the basic health-care plan and relates to their admission to hospital for selection and harvesting of the organ or tissue. This coverage is provided up to 13 weeks after discharge from hospital following the procedure. In the case of a liver transplant, this period is extended to 6 months after discharge from hospital
If your donor does not have a basic health-care plan (with ONVZ or another health insurer) himself or herself, perhaps because he/she lives abroad, your basic health-care plan will also cover:
• 2nd class travel in public transport in the Netherlands from and to the facility where all health care specified above for the donor is provided. Such travel may also be by car if medically necessary • the donor’s travel costs to the Netherlands and back, if the donor lives abroad and a kidney, bone marrow or liver transplant is to take place in the Netherlands. We will also cover other costs incurred by the donor due to the fact that he/she lives abroad. Accommodation costs in the Netherlands and possible loss of income are not covered
If you are the donor, the basic health-care plan will cover the costs of 2nd class travel in public transport to and from the facility where all health care specified above for the donor is provided. Such travel may also be by car if medically necessary.
The tissue and organs will be transplanted at a hospital in: • the Netherlands • another EU/EEA member state1 • another country where the donor resides, provided the donor and the recipient are spouses, registered partners or first-degree, second-degree or third-degree blood relatives
Coverage under each health-care plan
Basic health-care plan 100% Also most health care for the donor
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit No coverage
1 Together with the Netherlands, the following member states make up the European Union: Austria, Belgium, Bulgaria, Croatia, Cyprus (Greek part), Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Poland, Portugal, Romania, Slovenia, Slovakia, Spain, Sweden and the United Kingdom. Switzerland is considered equal to the above. The EEA member states (signatories to the EEA Agreement) are Iceland, Liechtenstein and Norway
ONVZ Coverage 2018 - version 1.2 57 What you pay
The excess If you are the recipient of an organ or tissue, care for both you and your donor comes under the basic health- care plan, and is therefore subject to the excess. If you are the donor, you will not pay an excess for: • check-ups after the period of 13 weeks (or 6 months in case of a liver transplant) • travel to and from the facility where the covered health care for the donor is provided
No personal contribution You will not be charged a personal contribution for this care.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this context, routine health care is defined as transplant care that is standard practice for medical specialists. Simple when possible, and more complex when necessary.
Dialysis
When your kidneys no longer work adequately.
What is covered
Your kidneys filter waste out of your blood and regulate the volume of bodily fluids. If your kidney function has reduced to below 10%, your life is in danger. You may be eligible for a transplant. If not, you will be prescribed a treatment that replaces kidney function, which is called dialysis.
There are 2 forms of dialysis: • Hemodialysis (HD). This is when a machine, i.e. an artificial kidney, is connected to a blood vessel. The blood is subsequently routed through the artificial kidney, which filters waste and excess fluids from the blood. After that, the blood flows back into the body. • Peritoneal dialysis (PD). With this kind of dialysis, the patient’s own peritoneum is used as a natural filter to remove waste and excess fluids from the blood. Through a catheter, a special liquid is pumped into the abdomen to absorb the waste and fluids. This liquid then flows out of the abdomen.
Dialysis is performed at a hospital or a dialysis centre. Dialysis at home is also an option.
The basic health-care plan covers both forms of dialysis and associated health care: • examinations, treatment and nursing in relation to dialysis • medicines • psychosocial support
In the case of dialysis at home, you will generally be supported by the hospital or dialysis centre where you are normally treated. This is also covered under the basic health-care plan. This support can include: • training and psychosocial support for you and the family members or carers who help you with the home dialysis • dialysis equipment with fittings, regular checks and maintenance, and parts replacement as and when necessary • chemicals, fluids and other items (such as a dialysis chair) • expert help from, for example, a nurse
ONVZ Coverage 2018 - version 1.2 58 There are, however, also additional costs attached to home dialysis that you will have to pay out of your own pocket. If not covered under other (statutory) provisions, the basic health-care plan will also cover the following based on the Reglement Hulpmiddelen [Medical Appliance Regulations]1: • modifications in and to the home needed for dialysis • reversing the modifications when they are no longer needed • weekly allowance to cover additional spending on water, power and maintenance: HD 3x a week: €45.86 HD 4-5x a week: €73.53 HD 6-7x a week: €96.09 CCPD2 (=APD3): €40.38 CAPD4: €28.72
Coverage under each health-care plan
Basic health-care plan 100% At a health-care facility or at home
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit No coverage
What you pay
The excess This care is provided under the basic health-care plan, and is therefore subject to the excess.
No personal contribution You will not be charged a personal contribution for this care.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this context, routine health care is defined as health care that is standard practice for medical specialists. Simple when possible, and more complex when necessary.
Dialysis while on holiday abroad If you would like to go on holiday abroad, rest assured, even if you are on dialysis, you can still go. Call our ZorgConsulent for details of your (coverage) options. You can also ask Nierpatiënten Vereniging Nederland5 (Dutch Kidney Patients’ Society) for advice.
1 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22 2 Continuous Cyclic Peritoneal Dialysis 3 Automated Peritoneal Dialysis 4 Continuous Ambulatory Peritoneal Dialysis 5 More information is available at: www.nvn.nl/advies/vakantie
ONVZ Coverage 2018 - version 1.2 59 Mechanical respiration
When you need help breathing.
What is covered
When you are very ill (with lung disease) or in a coma, you may not be able to breathe (fully) on your own. That is when a respirator can take over your breathing. This is often referred to as mechanical respiration, which is generally performed at the hospital.
In some cases, mechanical respiration may be needed for a long time, or perhaps even for the rest of someone’s life. In those cases, there are also mechanical respiration options available outside the hospital, such as at a respiratory centre or a nursing home.
If possible given your medical situation, you can also get the respiratory assistance at home. A home respiration care provider will help you and your family members or carers. There are 4 such providers in the Netherlands, each with their own coverage area.
The home respiration care provider will set up the respiration equipment for you at your home. The nursing staff will teach you, your family members or your carers how to use the equipment. The home respiration care provider will furthermore provide all specialist medical care and medicines you need with the respiration care.
The basic health-care plan covers mechanical respiration: • at the hospital or a respiratory centre • at home with all care and support from a home respiration care provider
Coverage under each health-care plan
Basic health-care plan 100% At a health-care facility or at home
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit No coverage
What you pay
The excess This care is provided under the basic health-care plan, and is therefore subject to the excess.
No personal contribution You will not be charged a personal contribution for this care.
ONVZ Coverage 2018 - version 1.2 60 Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this context, routine health care is defined as health care that is standard practice for medical specialists. Simple when possible, and more complex when necessary.
Provisionally approved treatments
Taking part in clinical trials.
What is covered
The government decides which treatments are covered by the basic health-care plan. The covered treatments are sometimes referred to as ‘the basic coverage’.
Given that health care keeps developing, the government does not enter into great detail for all treatments. A general rule for the basic coverage is that treatments covered by it must be up to current ‘practical and theoretical standards’. If a new treatment meets these standards, it can be added to the basic coverage, without the law having to be changed every time.
The Dutch National Health Care Institute monitors and publishes about the state of the art in medical science, ensuring transparency as to what is and what is not included in the basic coverage at any time.
Sometimes, a certain treatment may seem effective for a certain group of patients, but not enough research has been done to validate these effects. The treatment does therefore not yet meet the practical and theoretical standard.
That said, the government can still choose to add the treatment to the basic coverage for a certain period of time. Over that period, researchers can gather data on the effectiveness of the treatment.
If you are one of those patients for whom the treatment may be effective, you will be entitled to coverage for the treatment, medicine or medical appliance. This is, however, conditional on you entering the clinical trial.
The following treatments and medicines are currently part of the basic coverage on provisional approval: • autologous stem cell transplants for breast cancer • sacral neuromodulation in cases of serious constipation • dendritic cell therapy for skin cancer • neurostimulation for chronic cluster headaches • PTED surgery for hernias in the lower back • autologous fat transfer (AFT) for breast reconstruction after breast cancer • TIL therapy in case of metastatic skin cancer • HIPEC treatment for bowel cancer • treatment with Fampyra for adult multiple sclerosis (MS) patients • treatment with belimumab for the autoimmune disease SLE • HIPEC treatment for metastatic stomach cancer
The Voorwaardelijk toelating tot het basispakket1 [Provisionally approved basic coverage] document specifies for each treatment: • which patients are eligible for the treatment or medicine • which clinical trial you must enter to get the costs reimbursed • for how long the treatment or medicine has been approved • at what hospitals you can get the treatment or medicine
Given that the government can approve new treatments, medicines or medical appliances every quarter, the document is subject to change over the year.
1 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22
ONVZ Coverage 2018 - version 1.2 61 Coverage under each health-care plan
Basic health-care plan 100% If you enter the clinical trial
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit No coverage
What you pay
The excess This care is provided under the basic health-care plan, and is therefore subject to the excess.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You need to have a referral first Before you go to the hospital, you need a referral from your general practitioner, a medical specialist, a school doctor, a corporate doctor, a doctor for the mentally disabled, an elderly medical care specialist or a nursing home doctor.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
The basic health-care plan will cover the treatment only as part of the clinical trial and within the approval period The basic health-care plan will cover the treatment or medicine only if you enter the clinical trial that is intended to verify the effectiveness of the treatment or medicine. Your doctor decides whether or not you are eligible to enter the trial. The treatment will be covered for a limited period only.
Coverage is not provided at all hospitals If you receive provisionally approved treatment at a hospital that is not taking part in the clinical trial, we will not cover the costs.
ONVZ Coverage 2018 - version 1.2 62 Stay in a guest house
Being close by when your child or a family member has been admitted to hospital.
What is covered
A hospital admission can be very disruptive and confusing. If your child is admitted to hospital, you, as a parent, will probably want to be close by. And if you are the one who is admitted to hospital, you might want to have a family member close by.
This is precisely why many hospitals have a guest house, such as the Ronald McDonald Houses. These guest houses allow parents and family members to spend the night close to the hospital.
Stays at a hospital guest house are charged at a daily rate. In the following, we will refer to these costs as overnight costs. Guest houses sometimes refer to their charges as a ‘personal contribution’.
Under the Extrafit, Benfit and Optifit supplementary health-care plans, we cover overnight costs in 2 cases. Topfit and Superfit also provide coverage in a 3rd case.
Hospital admission of a child aged under 18 If your child is treated at or admitted to the hospital, the child’s Extrafit or higher supplementary health-care plan will cover the parent's overnight costs, provided that the parent is also insured with ONVZ. Extrafit, Benfit and Optifit cover up to €12.50 per day, up to a maximum of €260 per calendar year. Topfit and Superfit provide complete coverage for overnight costs.
Hospital admission from the age of 18 If you are aged 18 or above, the Extrafit and higher supplementary health-care plans will cover the overnight costs of 1 family member during your hospital admission. This family member must, however, also be insured with ONVZ. Extrafit, Benfit and Optifit cover up to €25 per day. Topfit and Superfit provide complete coverage for overnight costs.
After a transplant or cancer treatment If you have Topfit or Superfit coverage, we will also cover the overnight costs for you and a companion: • after a transplant • in case of chemotherapy, radiotherapy or immunotherapy for cancer
Whom to contact • the hospital’s guest house • a Ronald McDonald House
ONVZ Coverage 2018 - version 1.2 63 Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit Overnight costs for parents in cases of treatment or admission of a child + in cases of admission of an adult (up to a maximum) • €12.50 per day up to €260 per calendar year for parents in cases of treatment or admission of a child • €25 per day for a family member in cases of admission of an adult
Benfit Overnight costs for parents in cases of treatment or admission of a child + in cases of admission of an adult (up to a maximum) • €12.50 per day up to €260 per calendar year for parents in cases of treatment or admission of a child • €25 per day for a family member in cases of admission of an adult
Optifit Overnight costs for parents in cases of treatment or admission of a child + in cases of admission of an adult (up to a maximum) • €12.50 per day up to €260 per calendar year for parents in cases of treatment or admission of a child • €25 per day for a family member in cases of admission of an adult
Topfit 100% Full coverage for: • overnight costs for parents in cases of treatment or admission of a child • overnight costs for a family member in cases of admission of an adult • overnight costs after a transplant or oncological treatment
Superfit 100% Full coverage for: • overnight costs for parents in cases of treatment or admission of a child • overnight costs for a family member in cases of admission of an adult • overnight costs after a transplant or oncological treatment
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
The hospital can inform you about your options Alternatively, you can check the hospital’s website for details. Information about the Ronald McDonald Houses is available from the Ronald McDonald Kinderfonds1 (Children’s Fund).
1 For this, see: www.kinderfonds.nl
ONVZ Coverage 2018 - version 1.2 64 Childcare in case of hospital admission of a parent
No need to worry about childcare while you are in hospital.
What is covered
If you are a parent of a child aged under 12 and you are admitted to hospital for 4 or more consecutive days, the Topfit and Superfit supplementary health-care plans will cover childcare costs, provided the child has the same supplementary health-care plan. Coverage takes effect on the 4th day of hospital admission and is capped at €25 per child per working day. Coverage will end after 60 working days.
Whom to contact • childcare provider listed on the Landelijk Register Kinderopvang en Peuterspeelzalen1 [National Childcare and Pre-School Playgroup Register] (LRKP)
Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit €25 per working day Maximum, from the 4th day of hospital admission up to 60 working days
Superfit €25 per working day Maximum, from the 4th day of hospital admission up to 60 working days
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
If you do not have childcare yet, our ZorgConsulent will help you make the right choice If you do not yet have a contract with an official childcare facility, theZorgConsulent will help you with all your childcare arrangements.
1 For this, see: www.landelijkregisterkinderopvang.nl/pp/StartPagina.jsf
ONVZ Coverage 2018 - version 1.2 65 Nursing and other care Coverage
Nursing and other care Individual budget under the Zorgverzekeringswet [Health-Care Insurance Act] (Zvw-pgb) Primary-care admissions Hospice Nursing and other care
District nursing services come to your home to help you with your medicine or dress a wound, for example. Or to help you get up, wash yourself and get dressed.
What is covered
The government wants to help you live at home as long as possible. Whenever you need care, you will receive it in your own environment. Nursing and other care at home is an example of that.
Nursing is medical care, such as dressing a wound or giving an injection, while other care is help with everyday activities, such as showering, getting dressed, and putting on compression stockings. Together, these two forms of care are referred to as district nursing, which is the term we will use in the following.
District nursing is intended for anyone who needs nursing or other care at home due to medical reasons, such as people who have just been discharged from hospital or elderly people with medical problems. District nursing is intended for all ages, i.e. for children and adults alike. It can also include care during people’s final life stage.
Generally, you will get a referral for district nursing care from your general practitioner, or when you are discharged from hospital. It will always start with an intake meeting with a district nurse to go over your situation, establish your care needs, and to see what you can still do yourself or with the help of others. The district nurse will record all this information in a care plan with you.
The basic health-care plan provides coverage for nursing and other care at home.
When it comes to nursing and other care for children with complex physical problems or a physical disability, home care will not always be possible. If the child needs to be under constant supervision, or nursing care has to be on hand at all times, the basic health-care plan will also cover a stay at a nurse-assisted day nursery or a nurse-assisted children's care home.
Whom to contact A home-care organisation, or an independent nurse, specialist nurse, or carer. The district nurse who makes the care plan with you must at least be qualified to higher vocational (HBO) level. For care provided to people aged up to 18, this can also be a child nurse qualified to higher vocational (HBO) level.
Want greater control by using an individual budget under the Zorgverzekeringswet [Health-Care Insurance Act] (Zvw-pgb)? In principle, the home-care organisation or independent care provider will make all the arrangements for you. They will make sure you receive the care you need when you need it, and they will bill us directly. However, you can choose to make some, or even all, of the arrangements yourself. This would mean that you make appointments with care providers yourself, pay them yourself, and then put in a claim with us to get the costs reimbursed. If you want to do it this way, please apply for an individual budget under the Zorgverzekeringswet [Health-Care Insurance Act] (Zvw-pgb) with us.
Tip • Whenever living at home is temporarily not possible because of the care you need, primary care admission cover will apply.
• Care related to childbirth does not come under district nursing care, but instead under pregnancy and childbirth care.
• In case of intensive child care1 and some other situations, the basic health-care plan covers medical transportation from the home to a care provider and back.
1 This means: you need nursing and other care for complex physical problems or a physical disability. You also need constant medical supervision or nursing care on hand at all times
ONVZ Coverage 2018 - version 1.2 67 Coverage under each health-care plan
Basic health-care plan 100% As per the medical indication determined by the district nurse or medical specialist
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit No coverage
What you pay
No excess Nursing and other care is not subject to the excess.
No personal contribution You will not be charged a personal contribution for this care.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this context, routine nursing care is defined as the care that is standard practice for nurses and carers. Simple when possible, and more complex when necessary.
Your care needs can be reassessed You can have your care needs reassessed by another district nurse or a child nurse. Such a reassessment will be covered by the basic health-care plan, albeit only if it is performed with our prior permission1. We reserve the right to assign a different district nurse or child nurse. Also if we are unsure about the care needs identified by the district nurse or child nurse, we can have your care needs reassessed.
If you need nursing and other care outside the Netherlands, please apply for it in advance You can do so using the application form2 or by contacting the ZorgConsulent.
1 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen 2 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22
ONVZ Coverage 2018 - version 1.2 68 Individual budget under the Zorgverzekeringswet [Health-Care Insurance Act] (Zvw-pgb)
Greater control of your nursing and other home care.
What is covered
If you are entitled to nursing and other care at home, and you want maximum control of the care you receive, you can apply for an individual budget under the Zorgverzekeringswet [Health-Care Insurance Act] (Zvw-pgb). This budget allows you to contract health-care providers yourself, including informal care providers such as family members or acquaintances.
With an individual budget, you will not only be personally in charge of contracting, scheduling and paying health-care providers, you also have to make sure that the care you receive is of good quality and that the various health-care providers mutually align the care they provide. Plus, we will require you to account for your spending of the individual budget.
Given the strings attached to an individual budget under the Zorgverzekeringswet [Health-Care Insurance Act] (Zvw-pgb), it is not available to everyone. You have to meet certain requirements, or have someone who is willing to shoulder the responsibilities on your behalf. The conditions for the individual budget are specified in the 2018 Reglement Zvw-pgb verpleging en verzorging [Zvw-pgb regulations for nursing and other care]. These regulations also specify what kind of health-care providers you can use and the maximum rates you can agree to pay.
If you want to apply for an individual budget under the Zorgverzekeringswet [Health-Care Insurance Act] (Zvw- pgb), please fill in the application form1 and send it to us. Part of this form will have to be filled in by a nurse qualified to higher vocational (HBO) level, or by a child nurse qualified to higher vocational (HBO) level in case of a patient who has not yet reached the age of 18. You will also be required to make a budget plan specifying how much you will be spending and which health-care providers you will be contracting. Please enclose this plan with the application form.
As soon as we have received the form and your budget plan, we will call you for what is known as a ‘conscious- choice talk’ to discuss your application and check whether everything is clear to both of us.
We will generally have our decision ready for you within 6 weeks. If we accept your application, you will receive an authorisation statement, specifying the maximum number of hours of care that will be covered. As soon as you have this authorisation statement, you will be able to enter into contracts with your health-care providers.
Coverage under each health-care plan
Basic health-care plan 100% On approval
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit No coverage
1 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22
ONVZ Coverage 2018 - version 1.2 69 What you pay
No excess Nursing and other care is not subject to the excess.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You are required to seek our authorisation first Only if you have received an authorisation statement from us will we cover nursing and other care through an individual budget under the Zorgverzekeringswet [Health-Care Insurance Act] (Zvw-pgb). Please refer to the section on applying for an individual budget1 for details on how to request authorisation.
You are personally responsible for ensuring you get the right health care Therefore, make sure you read the Reglement Zvw-pgb verpleging en verzorging [Zvw-pgb regulations for nursing and other care] carefully, which covers everything you need to consider.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Primary-care admissions
When you temporarily need more care than you can receive at home, such as when you are recovering from severe pneumonia.
What is covered
If you cannot receive the care you need at home, but there is no need for you to be hospitalised (any longer) either, or if your medical situation needs to be monitored closely, your general practitioner or a specialist may decide to have you admitted to a primary-care facility.
While admitted, you will receive general medical care, as well as nursing and other care as necessary. The idea is to work towards a return home and receive care there. Things are different in case of care during the final life stage.
In that case, you will always be assigned a primary practitioner, which is a general practitioner, elderly medical care specialist or doctor for the mentally disabled. The general practitioner will compile a care plan and be the point of contact for you and those close to you.
The basic health-care plan will cover primary-care admissions. This includes other care that is related to your admission, i.e. to the medical grounds for admission:
• nursing and other care • allied health care such as physiotherapy • medicines • medical appliances and dressings
The Topfit, Superfit and Zorgplansupplementary health-care plans also cover additional facilities associated with your stay, such as a greater choice of meals, a bed in your room for your partner, WiFi, a newspaper every day, a TV or tablet, and extra coffee and tea in your room.
1 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen/zvw-pgb-aanvragen
ONVZ Coverage 2018 - version 1.2 70 Whom to contact The doctor who is having you admitted knows where you can go for a primary-care admission. This may be a special ward at a nursing home or a district hospital ward. There are also hospitals that have what are known as ‘general practitioner beds’ for primary-care patients referred by a general practitioner. There is at least a nurse1 on hand 24 hours a day.
We do not cover the following We will not cover primary-care admissions if they are intended only to relieve the carer (respite care). In such cases, you should turn to your local council's health-care desk.
Primary-care admissions are not covered when they are intended for rehabilitation or for care related to childbirth.
Coverage under each health-care plan
Basic health-care plan 100% 3 months, longer with ONVZ permission
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit Extra facilities €50 per day Maximum, while admitted
Superfit Extra facilities 100% While admitted
Zorgplan Extra facilities 100% While admitted
What you pay
The excess Care provided by a general practitioner is not subject to the excess. However, other health care and the actual stay at the primary care facility is subject to the excess.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
Your general practitioner or a medical specialist must have established medical grounds for admission. The general practitioner will assess whether this is the right medical option for you. If it is, you will get a medical indication. If you are discharged from hospital, the medical indication can also be determined by a medical specialist.
1 He/she must be level 4 or higher
ONVZ Coverage 2018 - version 1.2 71 You may need our permission If your primary-care admission will be under 3 months, you do not need permission. After the 3rd month, continued coverage of your primary-care admission is conditional on us having authorised1 it before the end of the 3rd month.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We will cover up to 3 continuous years of admission In the event of the period of admission being interrupted, we will treat the admission as continuous, providing the interruption is for no more than 30 days. If the interruption is for a holiday or weekend leave, any such leave will count towards the three-year total.
The basic health-care plan covers admission to a primary-care facility only for insured health care The basic health-care plan covers admission to a primary-care facility only if necessary for general medical care provided by general practitioners and the care provided is also covered by the basic health-care plan itself.
Hospice
Spending the final life stage in a home environment.
What is covered
If you are seriously ill, you can opt to spend the final stage of your life at a hospice, where carers and volunteers provide care and support in a homelike environment. Hospice care is intended to ease pain and discomfort.
Every hospice has different care options. There are hospices that provide fairly straightforward care, which are sometimes referred to as a palliative-care facility, and there are also hospices that provide complex care. The Dutch palliative care network2 can tell you exactly which hospices there are near you and what they can offer.
The coverage provided for hospice care depends on your personal situation, as well as on the hospice. It may be covered by the basic health-care plan as a primary-care admission or as nursing and other care. In some cases, hospice care is covered by the Wet langdurige zorg3 [Long-term Care Act] (Wlz) or the Wet maatschappelijke ondersteuning4 [Social Support Act] (Wmo). The hospice will be able to tell you whether you qualify for such coverage. You can ask our ZorgConsulent for help.
In almost all cases, you will pay a personal contribution to the hospice, to cover things such as your meals there. At some hospices, you can also ‘order’ additional facilities, such as an extra bed and meals for your partner, or extra coffee, tea or fruit in your room. The Optifit and higher supplementary health-care plans, as well as the Zorgplan, will reimburse this personal contribution (including extra facilities) up to the maximum amounts listed below.
If your stay at a hospice is covered under the Wet langdurige zorg [Long-term Care Act] (Wlz) or the Wet maatschappelijke ondersteuning [Social Support Act] (Wmo), you will most likely also be required to pay a statutory personal contribution to the hospice. The statutory personal contribution is payable for all care and support provided under the Wet langdurige zorg [Long-term Care Act] (Wlz) or the Wet maatschappelijke ondersteuning [Social Support Act] (Wmo). CAK5 will send you a bill for the statutory personal contribution. We do not provide coverage for the statutory personal contribution.
1 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen/toestemming-vragen-voor-eerstelijns-verblijf 2 More information is available at: www.netwerkpalliatievezorg.nl/Zorg-in-uw-regio 3 Wet langdurige zorg [Long-term Care Act] 4 Wet maatschappelijke ondersteuning [Social Support Act] 5 More information is available at: www.hetcak.nl/regelingen/zorg-vanuit-de-wlz
ONVZ Coverage 2018 - version 1.2 72 Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit €25 per day For a maximum of 3 months
Topfit €50 per day For a maximum of 3 months
Superfit 100% Full coverage for personal contribution
Zorgplan 100% Full coverage for personal contribution
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
The personal contribution A personal contribution may be payable in case of care provided under the Wet langdurige zorg [Long-term Care Act] (Wlz) or the Wet maatschappelijke ondersteuning [Social Support Act] (Wmo).
What you have to do yourself
The Centrum Indicatiestelling Zorg [Care Needs Assessment Centre] (CIZ), your general practitioner or a medical specialist must have determined a medical indication for hospice care The medical indication must be enclosed with the claim.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
ONVZ Coverage 2018 - version 1.2 73 Exercise Coverage
Physiotherapy and remedial therapy up to the age of 18 Physiotherapy and remedial therapy from the age of 18 Foot specialist treatment and podiatry/chiropody Oedema and scar therapy Exercise programmes in cases of chronic illness Exercise programmes during and after cancer Exercise programmes in cases of obesity Therapies for posture and movement Walking aids Arch supports supplied by an orthopaedic technician Swimming programmes aimed at keeping senior citizens fit Physiotherapy and remedial therapy up to the age of 18
When movement is difficult or hurts.
What is covered
If you have physical symptoms whenever you move or that are caused by your posture, a physiotherapist or a remedial therapist can find out what the problem is and treat and support you as you recover. The recovery process will often include exercises for you to do, which will also serve to prevent recurrence of symptoms. You can do these exercises either at home or at a gym.
The basic health-care plan covers physiotherapy and remedial therapy for insured persons aged up to 18.
If you need treatment on account of an ailment that is on the list of chronic ailments for physiotherapy1, the basic health-care plan will cover all sessions. If the list specifies a maximum treatment period, coverage under the basic health-care plan will cease as soon as the period has ended.
In case of ailments that are not on the list of chronic ailments for physiotherapy1, the basic health-care plan will cover a maximum of 9 sessions per medical indication per calendar year. If you do notice improvement after these 9 sessions, but the symptoms have not yet gone away, the basic health-care plan will cover another 9 sessions. Prior to the start of such a 2nd series of sessions, you need a referral from your general practitioner or medical specialist.
The supplementary health-care plan covers extra physiotherapy and remedial therapy sessions. The maximum number of sessions per year is as listed below.
Whom to contact • physiotherapist • physiotherapist specialising in children2 • manual therapist2 • Cesar/Mensendieck remedial therapist • pelvic physiotherapist2 • geriatrics physiotherapist2 • oedema therapist2 • for the supplementary health-care plan: psychosomatic physiotherapist2 • in case of the ailments ‘lymphoedema’ and ‘scar tissue on the skin, whether or not the result of trauma’, as included on the list of chronic ailments for physiotherapy, you can also see a skin therapist3
1 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22 2 Must be registered as a physiotherapist specialising in children, manual therapist, pelvic therapist, geriatrics physiotherapist, oedema therapist, or psychosomatic physiotherapist in the quality register of the Royal Dutch Society for Physical Therapy or Stichting Keurmerk Fysiotherapie [Physiotherapy Quality Mark Foundation] 3 Must be registered as a full member of the Dutch Association of Skin Therapists
ONVZ Coverage 2018 - version 1.2 75 Coverage under each health-care plan
Basic health-care plan 18 sessions; in case of some ailments all sessions • List of chronic ailments for physiotherapy: full coverage (up to maximum treatment duration) • Other medical indications: 9 sessions, and 9 additional sessions on referral
Startfit 9 sessions
Extrafit 9 sessions
Benfit 12 sessions
Optifit 35 sessions Of the total of 35 sessions, up to 18 may be manual therapy sessions.
Topfit 100% Maximum of 18 manual therapy sessions
Superfit 100% Maximum of 18 manual therapy sessions
What you pay
No excess Up to the age of 18, there is no excess.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
In some cases, you need to have a referral If you are being treated for an ailment that is not on the list of chronic ailments for physiotherapy and the health care provided is covered by the basic health-care plan, you will need a referral for the 2nd series of 9 sessions. Ask your general practitioner or a medical specialist for the referral.
Treatment at a different surgery? Make sure you get prior permission Physiotherapy or remedial therapy sessions are either at the therapist’s surgery or at your home. For sessions elsewhere, you need our prior permission. There must be medical grounds for treatment at a different location, such as at a school, (medical) day nursery, or Centrum voor Jeugd en Gezin [Youth and Family Centre].
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
If you are turning 18 this year From the moment you turn 18, physiotherapy from the age of 18 will apply. Sessions you had prior to turning 18 will count towards the maximum number of sessions covered.
ONVZ Coverage 2018 - version 1.2 76 Quality registers provide extra information With ONVZ, the choice is all yours. You decide which health-care provider you go to. Quality registers1 contain information that can help you make a choice.
We only cover routine health care that you actually need In this context, routine health care is defined as the care that is standard practice for physiotherapists and remedial therapists. Simple when possible, and more complex when necessary.
Physiotherapy and remedial therapy from the age of 18
When movement is difficult or hurts.
What is covered
If you have physical symptoms whenever you move or that are caused by your posture, a physiotherapist or a remedial therapist can find out what the problem is and treat and support you as you recover. The recovery process will often include exercises for you to do, which will also serve to prevent recurrence of symptoms. You can do these exercises either at home or at a gym.
The basic health-care plan covers physiotherapy and remedial therapy for insured persons aged 18 and above in the event of: • ailments on the list of chronic ailments for physiotherapy2 • stage-2 intermittent claudication • osteoarthritis in the knee or hip joint • urinary incontinence
If you need treatment on account of an ailment that is on the list of chronic ailments for physiotherapy2, the basic health-care plan will provide coverage from the 21st session. The basic health-care plan does not cover the first 20 sessions. If the list specifies a maximum treatment period, coverage under the basic health-care plan will cease as soon as the period has ended.
In cases of stage-2 intermittent claudication (constriction of arteries in the legs), the basic health-care plan covers supervised remedial therapy (walking therapy), from the first session. A doctor must have established that you are suffering from stage-2 peripheral artery disease. The basic health-care plan covers a maximum of 37 sessions over a maximum period of 12 months.
In cases of osteoarthritis in the knee or hip joint, the basic health-care plan covers supervised remedial therapy from the first session. The basic health-care plan covers a maximum of 12 sessions over a period of 12 months.
In cases of urinary incontinence, the basic health-care plan covers a maximum of 9 pelvic physiotherapy sessions, from the first session.
Any additional physiotherapy and remedial therapy sessions are covered under the supplementary health- care plans. The maximum number of sessions per year is as listed below. You can use these sessions if the basic health-care plan does not (yet) provide coverage.
Whom to contact • physiotherapist • physiotherapist specialising in children3 • manual therapist3 • Cesar/Mensendieck remedial therapist • pelvic physiotherapist3 • geriatrics physiotherapist3 • oedema therapist3 • for the supplementary health-care plan: psychosomatic physiotherapist3 • in case of the ailments ‘lymphoedema’ and ‘scar tissue on the skin, whether or not the result of trauma’, as included on the list of chronic ailments for physiotherapy, you can also see a skin therapist4
1 More information is available at: www.onvz.nl/kwaliteitsregisters 2 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22 3 Must be registered as a physiotherapist specialising in children, manual therapist, pelvic therapist, geriatrics physiotherapist, oedema therapist, or psychosomatic physiotherapist in the quality register of the Royal Dutch Society for Physical Therapy or Stichting Keurmerk Fysiotherapie [Physiotherapy Quality Mark Foundation] 4 Must be registered as a full member of the Dutch Association of Skin Therapists
ONVZ Coverage 2018 - version 1.2 77 Coverage under each health-care plan
Basic health-care plan In specific cases • List of chronic ailments for physiotherapy: coverage from the 21st session (up to the maximum treatment duration) • Stage-2 intermittent claudication: maximum of 37 sessions over 12 months • Osteoarthritis in the knee or hip joint: maximum of 12 sessions over 12 months • Urinary incontinence: up to 9 sessions
Startfit 9 sessions
Extrafit 9 sessions
Benfit 12 sessions
Optifit 35 sessions Of the total of 35 sessions, up to 18 may be manual therapy sessions
Topfit 100% Maximum of 18 manual therapy sessions
Superfit 100% Maximum of 18 manual therapy sessions
What you pay
The excess The excess applies to care under the basic health-care plan. No excess applies to care under the supplementary health-care plan.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
Treatment at a different surgery? Make sure you get prior permission Physiotherapy or remedial therapy sessions are either at the therapist’s surgery or at your home. For sessions elsewhere, you need our prior permission. There must be medical grounds for treatment at a different location, such as a nursing home, school, or sports centre.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Sessions before the age of 18 count towards the maximum If you turned 18 this year, physiotherapy coverage from the age of 18 will apply from this year onwards. Sessions you had prior to turning 18 will count towards the maximum number of sessions.
Quality registers provide extra information With ONVZ, the choice is all yours. You decide which health-care provider you go to. Quality registers1 contain information that can help you make a choice.
1 More information is available at: www.onvz.nl/kwaliteitsregisters
ONVZ Coverage 2018 - version 1.2 78 We only cover routine health care that you actually need In this context, routine health care is defined as the care that is standard practice for physiotherapists and remedial therapists. Simple when possible, and more complex when necessary.
Foot specialist treatment and podiatry/chiropody
When your feet are killing you.
What is covered
If you have general foot pain or physical problems due to abnormal foot posture or the way you walk, you can go to a foot specialist, registerpodoloog [registered podiatrist/chiropodist], or podoposturaal therapeut [podopostural therapist] for help. Such a specialist will examine your feet and treat your symptoms. If necessary, you will be fitted with podiatric arch supports, ortheses1, or nail braces.
Foot specialist treatment and podiatry/chiropody are both covered under Extrafit and higher supplementary health-care plans. With Extrafit and Benfit, coverage is capped at a maximum amount per calendar year. Optifit, Topfit and Superfit provide full coverage for such treatment.
Whom to contact • foot specialist • registerpodoloog [registered podiatrist/chiropodist]2 • podoposturaal therapeut [podopostural therapist]2
If you are diabetic, foot care may not be included in this coverage, but may instead come under foot care for diabetes sufferers. This will be the case if your general practitioner has assigned you health-care profile 2 or higher following the annual foot check-up. In that case, a foot specialist will be your only option.
Arch supports supplied by an orthopaedic technician are listed separately.
Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit €150 • Maximum per calendar year • For foot care in cases of diabetes only with health-care profile 1
Benfit €250 • Maximum per calendar year • For foot care in cases of diabetes only with health-care profile 1
Optifit 100%
Topfit 100%
Superfit 100%
1 A medical appliance to maintain correct toe position, for example 2 Must be in the register administered by KABIZ (Quality registration and accreditation for health-care professionals)
ONVZ Coverage 2018 - version 1.2 79 What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
No referral needed You can go to the health-care provider directly.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this context, routine health care is defined as the health care that is standard practice for foot specialists, registerpodologen [registered podiatrists/chiropodists], or podoposturale therapeuten [podopostural therapists]. Simple when possible, and more complex when necessary.
Oedema and scar therapy
If you have a painful lymphoedema or scar, treatment by an oedema therapist, physiotherapist, or a skin therapist may help.
What is covered
Lymph vessels drain fluid from your body. In case of reduced function due to surgery, radiotherapy, or another cause, you may develop a build-up of fluid, which is called oedema. This can lead to painful swelling and stiff joints, making it harder to move your limbs. Lymphoedema therapy can help drain the excess fluid.
Scars, too, can impair movement, or cause other kinds of discomfort. This is when scar massage may bring relief, as it loosens up the scar tissue and stimulates blood flow.
If you need lymphoedema or scar therapy, read on to find out about the coverage we provide. This depends on the health-care plan you have taken out and the therapist you see.
The basic health-care plan covers physiotherapy and remedial therapy for ailments on the list of chronic ailments for physiotherapy1. ‘Lymphoedema’ and ‘scar tissue on the skin, whether or not the result of trauma’ are on that list, meaning that these ailments are covered by the basic health-care plan. Up to the age of 18, all sessions are covered. If you are over 18, the basic health-care plan will provide coverage from the 21st session onwards. The first 20 sessions are not covered by the basic health-care plan.
If you have a supplementary health-care plan, the first 20 sessions may also be covered, depending on the therapist you select.
The Startfit and higher supplementary health-care plans cover lymphoedema and scar therapy as physiotherapy, so you can go to a physiotherapist or an oedema therapist for treatment. The maximum number of sessions covered is as listed below.
1 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22
ONVZ Coverage 2018 - version 1.2 80 The Extrafit and higher supplementary health-care plans also cover lymphoedema and scar therapy by a skin therapist, albeit only if a doctor has established that the ailment: • has a negative effect on your day-to-day functioning, or • seriously impairs your movement, personal care, or your mobility
Whom to contact • physiotherapist • oedema therapist1 • skin therapist2
Coverage under each health-care plan
Basic health-care plan Up to age 18: all sessions, from the age of 18: from the 21st session onwards
Startfit From the age of 18: 9 sessions with an oedema therapist or a physiotherapist Maximum per calendar year This comes under coverage for physiotherapy from the age of 18
Extrafit From the age of 18: 9 sessions with an oedema therapist or physiotherapist, and all sessions with a skin therapist Maximum per calendar year Treatment by an oedema therapist or practitioner comes under coverage for physiotherapy from the age of 18
Benfit From the age of 18: 12 sessions with an oedema therapist or physiotherapist, and all sessions with a skin therapist Maximum per calendar year Treatment by an oedema therapist or practitioner comes under coverage for physiotherapy from the age of 18
Optifit From the age of 18: 35 sessions with an oedema therapist or physiotherapist, and all sessions with a skin therapist Maximum per calendar year Treatment by an oedema therapist or practitioner comes under coverage for physiotherapy from the age of 18
Topfit 100% Full coverage for treatment by an oedema therapist, physiotherapist, or skin therapist
Superfit 100% Full coverage for treatment by an oedema therapist, physiotherapist, or skin therapist
What you pay
The excess The excess applies to care under the basic health-care plan. No excess applies to care under the supplementary health-care plan.
No personal contribution You will not be charged a personal contribution for this care.
1 Must be registered as an oedema therapist in the quality register of the Royal Dutch Society for Physical Therapy or Stichting Keurmerk Fysiotherapie [Physiotherapy Quality Mark Foundation] 2 Must be a member of the Dutch Association of Skin Therapists
ONVZ Coverage 2018 - version 1.2 81 What you have to do yourself
Treatment at a different surgery? Make sure you get prior permission Oedema therapy or physiotherapy sessions are either at the therapist’s surgery or at your home. For sessions elsewhere, you need our prior permission. There must be medical grounds for treatment at a different location, such as a nursing home, school, or sports centre.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this context, routine health care is defined as the health care that is standard practice for oedema therapists, physiotherapists, and skin therapists in treating lymphoedema or scars. Simple when possible, and more complex when necessary.
Quality registers provide extra information With ONVZ, the choice is all yours. You decide which therapist to go to. Quality registers1 contain information that can help you make a choice.
Exercise programmes in cases of chronic illness
Staying as fit as possible.
What is covered
If you have a chronic illness or ailment, such as osteoarthritis, osteoporosis, COPD, or diabetes, GP or hospital care also includes healthy lifestyle advice.
An additional exercise programme can help you keep your fitness levels up and prevent further symptoms.
The Benfit and highersupplementary health-care plans cover such exercise programmes in cases of chronic ailments. An exercise programme must meet the standards set by the Royal Dutch Society for Physical Therapy2 for exercise interventions.
Benfit and Optifit have a cap on the coverage provided in any one calendar year for exercise programmes in cases of chronic ailments, during and after cancer and in cases of obesity combined. See below for the maximum coverage provided. Topfit and Superfit provide full coverage for such exercise programmes.
Whom to contact • physiotherapist certified by KNGF (Royal Dutch Society for Physical Therapy) or a Mensendieck/Cesar remedial therapist
1 More information is available at: www.onvz.nl/kwaliteitsregisters 2 For this, see: www.fysionet-evidencebased.nl/index.php/beweeginterventies
ONVZ Coverage 2018 - version 1.2 82 Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit €250 Maximum per calendar year For exercise programmes in cases of chronic illness, in cases of obesity and during and after cancer
Optifit €500 Maximum per calendar year For exercise programmes in cases of chronic illness, in cases of obesity, during and after cancer and during chemotherapy
Topfit 100%
Superfit 100%
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You need a prescription from a doctor Before you can start with an exercise programme, you need a prescription from your attending doctor. Please enclose the prescription with your claim.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Our ZorgConsulent is ready to help you If you want more information about exercise programmes, our ZorgConsulent advisers are ready to help.
ONVZ Coverage 2018 - version 1.2 83 Exercise programmes during and after cancer
How to keep your fitness levels up during and after your treatment.
What is covered
Cancer treatment may impact on your physical fitness. Before you leave the hospital, you will get advice and support in this area. An additional exercise programme to work on your fitness can help speed up your recovery. These kinds of programmes also focus on handling the stress involved, as well as your diet and perhaps even your return to work.
The Benfit and higher supplementary health-care plans cover: • exercise programmes that meet the Royal Dutch Society for Physical Therapy’s ‘oncology’ standard1 • rehabilitation programmes during cancer by a physiotherapist, or a Cesar or Mensendieck remedial therapist. The programme will last a maximum of 3 months and involve twice-weekly group-based workout sessions
Benfit coverage is capped at €250 for these 2 exercise programmes and for exercise programmes in cases of chronic illness and in cases of obesity combined.
The Optifit and higher supplementary health-care plans also cover 3 exercise programmes organised by a physiotherapist or a sports medical advice centre during chemotherapy. The 3 exercise programmes in question are the following: • CytoFys • OncoMove • Sportplan TegenKracht
Optifit coverage for all exercise programmes jointly is capped at €500. Topfit and Superfit provide full coverage for the programmes.
Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit €250 Maximum per calendar year For exercise programmes during and after cancer, in cases of chronic illness and in cases of obesity
Optifit €500 Maximum per calendar year For exercise programmes during and after cancer, during chemotherapy, in cases of chronic illness and in cases of obesity
Topfit 100%
Superfit 100%
1 See: www.fysionet-evidencebased.nl/index.php/beweeginterventies
ONVZ Coverage 2018 - version 1.2 84 What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You need to have a prescription first Before you can start with an exercise programme, you need a prescription from your attending doctor. Please enclose the prescription with your claim.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Our ZorgConsulent is ready to help you If you want more information about exercise programmes, our ZorgConsulent advisers are ready to help.
Exercise programmes in cases of obesity
Losing weight responsibly with lasting results.
What is covered
If you are obese, an exercise programme can help you get into an active and healthy lifestyle. Work towards lasting weight loss by joining an exercise group and working out several times a week for a period of 3 to 4 months. After that, you can use regular exercise options.
The Benfit and higher supplementary health-care plans cover an exercise programme in cases of obesity, albeit only based on a doctor’s prescription. The prescription must confirm that: • your BMI1 is 30kg/m2 or higher, or • your BMI is 25-30kg/m2 in combination with an increased risk of cardiovascular disease, an increased risk of type II diabetes or evidence of another obesity-related condition
Benfit and Optifit have a cap on the coverage provided in any one calendar year for an exercise programme in cases of obesity, chronic illness, and during and after cancer. See below for the maximum coverage provided. Topfit and Superfit provide full coverage for such exercise programmes.
The exercise programme may in some cases be prescribed alongside other care, such as dietetics or psychological health care. These are jointly referred to as a combined lifestyle intervention. For more information, please ask the ZorgConsulent.
Whom to contact • physiotherapist • Cesar or Mensendieck remedial therapist • home-care organisation
1 Weight-to-height ratio. Your BMI is calculated by dividing your weight in kilos by your height in metres and then dividing the result again by your height in metres
ONVZ Coverage 2018 - version 1.2 85 Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit €250 Maximum per calendar year For exercise programmes in cases of obesity, in cases of chronic illness and during and after cancer
Optifit €500 Maximum per calendar year For exercise programmes in cases of obesity, in cases of chronic illness, during and after cancer and during chemotherapy
Topfit 100%
Superfit 100%
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You need to have a prescription first Before you can start with an exercise programme, you need a prescription from your general practitioner, corporate doctor, or medical specialist. Please enclose the prescription with your claim.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
ONVZ Coverage 2018 - version 1.2 86 Therapies for posture and movement
Feeling a bit stiff?
What is covered
If you have physical symptoms whenever you move or that are caused by your posture, you can go to a physiotherapist or a remedial therapist. The care they provide may be covered by either the basic health-care plan or a supplementary health-care plan.
If you want to see a different kind of therapist, the supplementary health-care plans also cover other posture and movement therapy options. The coverage provided is as follows.
Sports doctor The Extrafit and higher supplementary health-care plans cover the following health care by a sports doctor: • sports-medical investigation • sports-medical and exercise advice • sports-medical support • preventive medical investigations • sports examination
Chiropractic therapy, osteopathy and manual therapy The Benfit and higher supplementary health-care plans also reimburse: • chiropractic therapy • osteopathy • “Eggshell method” (E.S. ®) manual therapy
A maximum reimbursement applies per calendar year to sports doctors, chiropractic therapy, osteopathy and “Eggshell method” (E.S. ®) manual therapy as listed below.
Whom to contact • sports doctor • chiropractor1 • osteopath2 • "Eggshell method" (E.S. ®) manual therapy3
1 Must be a full member of a professional organisation for chiropractors that is recognised by ONVZ 2 Must be a full member of a professional organisation for osteopaths that is recognised by ONVZ 3 Must be a member of the Vereniging van Manueel Therapeuten [Manual Therapists’ Association] (VMT)
ONVZ Coverage 2018 - version 1.2 87 Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit €100, sports doctor only Maximum per calendar year
Benfit €500 for sports doctors, chiropractic therapy, osteopathy and “Eggshell method” (E.S. ®) manual therapy combined Maximum per calendar year
Optifit €750 for sports doctors, chiropractic therapy, osteopathy and “Eggshell method” (E.S. ®) manual therapy combined Maximum per calendar year
Topfit €1,000 for sports doctors, chiropractic therapy, osteopathy and “Eggshell method” (E.S. ®) manual therapy combined Maximum per calendar year
Superfit €1,500 for sports doctors, chiropractic therapy, osteopathy and “Eggshell method” (E.S. ®) manual therapy combined Maximum per calendar year
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this context, routine health care is defined as the health care that is standard practice for a sports doctor, chiropractor, osteopath or “Eggshell” manual therapist. Simple when possible, and more complex when necessary.
In some cases, treatment by a sports doctor is covered by the basic health-care plan A sports doctor can also treat injuries such as a torn meniscus or a damaged knee. In such cases, medical specialist coverage will apply. To qualify for coverage, you need a referral from your general practitioner.
1 See: www.hulpmiddelenwijzer.nl
ONVZ Coverage 2018 - version 1.2 88 Walking aids
When you have trouble walking.
What is covered
If you have trouble walking, walking aids such as crutches or a rollator may bring relief.
The basic health-care plan does not cover walking aids.
The Extrafit and higher supplementary health-care plans do provide coverage for walking aids. Extrafit and Benfit cover only elbow crutches. Optifit and higher plans also cover a walking aid with 3 or 4 legs, a walking frame, rollator, and a serving trolley. Check the medical appliances guide1 for examples of these and other walking aids.
Coverage is subject to a maximum per calendar year. You decide whether to buy or hire the walking aid.
Whom to contact • supplier of medical appliances
Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit €50 for elbow crutches Maximum per calendar year
Benfit €50 for elbow crutches Maximum per calendar year
Optifit €100 for 5 kinds of walking aids Maximum per calendar year, for elbow crutches, walking aids, walking frames, rollators and serving trolleys
Topfit €100 for 5 kinds of walking aids Maximum per calendar year, for elbow crutches, walking aids, walking frames, rollators and serving trolleys
Superfit €200 for 5 kinds of walking aids Maximum per calendar year, for elbow crutches, walking aids, walking frames, rollators and serving trolleys
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
ONVZ Coverage 2018 - version 1.2 89 What you have to do yourself
You need a prescription from your general practitioner or medical specialist Please enclose the prescription with your claim.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this context, routine health care covers the medical appliances that are normally prescribed for your walking condition. Simple when possible, and more complex when necessary.
Arch supports supplied by an orthopaedic technician
When your feet need a little extra support.
What is covered
Arch supports are insoles that are intended to provide extra support for your feet.
There are various specialists who can supply arch supports, including a foot specialist, a podiatrist/chiropodist or an orthopaedic technician.
If you are getting your arch supports from a foot specialist or a podiatrist/chiropodist, they will come under the coverage provided for foot specialist treatment and podiatry/chiropody.
Arch supports supplied by an orthopaedic technician are covered as specified in this section.
The Extrafit and higher supplementary health-care plans provide coverage for arch supports supplied by an orthopaedic technician. Extrafit and Benfit cap coverage at a maximum amount per calendar year. Optifit, Topfit and Superfit provide full coverage for arch supports.
Orthopaedic shoe adjustments come under the coverage for medical appliances1.
1 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22
ONVZ Coverage 2018 - version 1.2 90 Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit €100 Maximum per calendar year
Benfit €150 Maximum per calendar year
Optifit 100%
Topfit 100%
Superfit 100%
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You need a prescription from your doctor (except with Superfit) For Extrafit, Benfit, Optifit and Topfit, you need a prescription from your doctor before you have arch supports fitted. We will ask either you or your health-care provider for the prescription.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
ONVZ Coverage 2018 - version 1.2 91 Swimming programmes aimed at keeping senior citizens fit
Keeping up your fitness levels.
What is covered
Regular exercise is the best way to stay fit. One particular benefit of aquatic exercise is that it is gentle on your muscles and joints and keeps them flexible.
Many swimming pools have exercise groups for the over-50s and over-65s. Under the guidance of a certified instructor, you will exercise once or several times a week in a heated pool.
The Topfit and Superfit supplementary health-care plans cover swimming programmes for senior citizens and the over-50s up to a maximum of €50 per calendar year.
Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit €50 Maximum per calendar year
Superfit €50 Maximum per calendar year
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
ONVZ Coverage 2018 - version 1.2 92 Rehabilitation and recovery Coverage
Rehabilitation (specialist medical) Geriatric rehabilitation Occupational therapy Carer relief Domestic assistance Zorghotel Health resort Menopause consultant Therapeutic camp for young people Patient association membership Rehabilitation (specialist medical)
If illness or an accident has led to mobility problems, rehabilitation will get you back to your daily activities as well as possible.
What is covered
Mobility problems can often be solved through physiotherapy, remedial therapy or occupational therapy. If your situation is slightly more complex than that, you will be referred to a rehabilitation specialist for specialist medical rehabilitation.
For specialist medical rehabilitation, you can go either to the hospital’s outpatient clinic or to a rehabilitation centre.
The rehabilitation specialist will start off by determining the medical indication, assessing whether specialist medical rehabilitation is indeed the right care option for you. If it is, the rehabilitation specialist will take care of your specialist medical rehabilitation.
The rehabilitation specialist may also conclude that you need intensive treatment by a team of health-care providers, which is called interdisciplinary specialist medical rehabilitation. If this is the case, it will be stated in the indication.
The basic health-care plan covers specialist medical rehabilitation under the guidance of a rehabilitation specialist.
The basic health-care plan covers interdisciplinary specialist medical rehabilitation only if all of the following conditions are met:
• you have communication, intellectual or behavioural difficulties due to a disorder or an impairment in your musculoskeletal system, or due to a condition of the central nervous system • you have problems in several areas (such as mobility, personal care and communication), and these problems are interrelated • treatment by a team of health-care providers is expected to lead to better results in preventing, reducing or overcoming disability • primary health care (by a general practitioner, physiotherapist or other medical professional) will yield insufficient results • interdisciplinary specialist medical rehabilitation will enable you to keep functioning independently or retain the level of independence that is possible given your impairments • ultimate responsibility for the organisation and quality of rehabilitation care will lie with a rehabilitation specialist
If you are already in a process of interdisciplinary specialist medical rehabilitation, and the rehabilitation specialist expects admission to lead to better or faster results than continuing on an outpatient basis, the basic health-care plan will also cover the costs involved in admission to hospital or a rehabilitation centre.
ONVZ Coverage 2018 - version 1.2 94 Coverage under each health-care plan
Basic health-care plan 100% Rehabilitation and medically necessary admission
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit No coverage
What you pay
The excess This care is provided under the basic health-care plan, and is therefore subject to the excess.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You need to have a referral first Before you see a rehabilitation specialist, you need a referral from your general practitioner, the corporate doctor or a medical specialist1.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Geriatric rehabilitation is subject to other conditions Geriatric rehabilitation is rehabilitation for elderly people who have been discharged from hospital.
We only cover routine health care that you actually need In this context, routine health care is defined as rehabilitation care that is standard practice for rehabilitation specialists. Simple when possible, and more complex when necessary.
ONVZ Coverage 2018 - version 1.2 95 Geriatric rehabilitation
Rehabilitation if you are of a certain age and have just been discharged from hospital.
What is covered
If you need rehabilitation, you will receive physiotherapy, remedial therapy or occupational therapy. And if you need specialist rehabilitation care, you will enter a specialist medical rehabilitation programme.
Geriatric rehabilitation is especially for people of a certain age with multiple health problems.
This kind of care is indicated when you, after hospitalisation or having undergone specialist treatment in hospital, are not fit to return home right away and ‘regular’ rehabilitation would be too hard for you. This means that, to qualify for geriatric rehabilitation, one of the following 2 situations must apply in your case:
• You have been admitted to hospital for treatment by a medical specialist1, such as in cases of a broken hip or after suffering a stroke. The geriatric rehabilitation starts within a week after you were discharged from hospital.
• Sudden health problems have led to you losing mobility or no longer being able to take care of yourself. You have already been treated by a medical specialist, such as in the hospital's A&E department or at an outpatient clinic for elderly care (geriatrics), but this has not solved your health problems.
In almost all cases, your doctor or the liaison nurse will discuss the option of geriatric rehabilitation with you while you are still in hospital.
For geriatric rehabilitation, you will be admitted to an institution under the Wet langdurige zorg [Long-term Care Act] (Wlz), or a similar institution, where you will be under the care of a team made up of specialists such as a physiotherapist, an occupational therapist and a nurse. An elderly medical care specialist (nursing home doctor) will, together with you, compile a treatment plan and make sure the care is tailored to your situation.
The idea is for you to recover such that you can return to your home situation. Sometimes, this will be a gradual process where you may, for example, be able to sleep at home and come to the institution for therapy during the day.
In principle, the basic health-care plan covers geriatric rehabilitation for a maximum 6 months.
At some institutions, you can order additional facilities. Such facilities are covered under the Topfit, Superfit and Zorgplan supplementary health-care plans. They must, however, be related to your stay at the institution, such as a greater choice of meals, a bed in your room for your partner, WiFi, a newspaper every day, a TV or tablet, and extra coffee and tea in your room. The following is not covered: wellness (such as fitness, yoga, swimming pool, sunbed) and personal expenses (hairdresser, pedicure, sports, music, catering).
1 An anaesthetist, cardiologist, surgeon, cardiothoracic surgeon, dermatologist, gynaecologist, internist, ENT doctor, paediatrician, clinical geneticist, clinical geriatric specialist, pulmonologist, gastroenterologist, medical microbiologist, neurosurgeon, neurologist, nuclear medicine specialist, ophthalmologist, orthopaedic surgeon, pathologist, plastic surgeon, psychiatrist, radiologist, radiation therapist, rheumatologist, rehabilitation specialist, sports doctor or urologist
ONVZ Coverage 2018 - version 1.2 96 Coverage under each health-care plan
Basic health-care plan 100% Maximum of 6 months
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit Extra facilities €50 per day Maximum, while admitted
Superfit Extra facilities 100% While admitted
Zorgplan Extra facilities 100% While admitted
What you pay
The excess The excess applies to care under the basic health-care plan. No excess applies to care under the supplementary health-care plan.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You need an indication If you have been admitted to hospital, your medical specialist will determine the medical indication, in consultation with an elderly medical care specialist. If you have not been admitted to hospital, a clinical geriatric specialist or elderly medical care internist will determine the medical indication based on a geriatric examination.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
This coverage is not provided if you live at an institution under the Wlz If you were staying at an institution under the Wet langdurige zorg [Long-term Care Act] (Wlz) prior to admission to hospital and you were treated there, you will return to that institution for treatment after you have been discharged from hospital. This is not covered by the basic health-care plan, but instead by the Wet langdurige zorg [Long-term Care Act].
We only cover routine health care that you actually need In this context, routine health care is defined as the geriatric rehabilitation care that is standard practice for elderly medical care specialists in treating people suffering from vulnerability, complex multi-morbidity
ONVZ Coverage 2018 - version 1.2 97 and diminished learning and training ability, and which is intended to result in a return home. Simple when possible, and more complex when necessary.
After the 6th month, you need permission We will cover this care for a maximum of 6 months. If you need geriatric rehabilitation for longer, we may approve that in special cases. Either you or your attending doctor will have to request permission for continued rehabilitation before the end of the 6th month.
Occupational therapy
When daily activities have become difficult.
What is covered
If you have trouble doing your daily activities due to physical or psychological problems, an occupational therapist can help you get back to an independent lifestyle as much as possible.
Together with the occupational therapist, you will work on making those things you struggle with possible again. The occupational therapist will give advice, instructions, training, or treatment to help you achieve your goals.
The basic health-care plan covers a maximum of 10 hours of occupational therapy per calendar year.
The Topfit and higher supplementary health-care plans cover any occupational therapy sessions beyond that number.
Coverage under each health-care plan
Basic health-care plan 10 hours
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit 100%
Superfit 100%
What you pay
The excess The first 10 hours are covered by the basic health-care plan, and are subject to the excess. If you continue with occupational therapy after those 10 hours under a supplementary health-care plan, such continued therapy will not be subject to the excess.
No personal contribution You will not be charged a personal contribution for this care.
ONVZ Coverage 2018 - version 1.2 98 What you have to do yourself
No referral needed You can go to the occupational therapist without a referral.
Treatment at a different surgery? Make sure you get prior permission Occupational therapy sessions are either at the occupational therapist’s surgery or at your home. For sessions elsewhere, you need our prior permission.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this context, routine health care is defined as the health care that is standard practice for occupational therapists and which is intended to improve your ability to look after yourself. Simple when possible, and more complex when necessary.
Quality registers provide extra information With ONVZ, the choice is all yours. You decide which health-care provider you go to. Quality registers1 contain information that can help you make a choice.
Carer relief
Whenever your carer is temporarily unable to take care of you.
What is covered
Informal care is care for chronically ill or disabled people provided by, for example, family members or friends. In the event that your carer is temporarily unable to take care of you, because he/she will be going on holiday or needs medical treatment, your local council will arrange for carer support and carer relief under the 2015 Wet maatschappelijke ondersteuning [Social Support Act] (Wmo).
If you are not entitled to help from your local council, the Benfit and higher supplementary health-care plans will cover carer relief, on the condition that you have the ZorgConsulent arrange the carer relief for you. The maximum number of days of carer relief per calendar year is as listed below.
1 More information is available at: www.onvz.nl/kwaliteitsregisters
ONVZ Coverage 2018 - version 1.2 99 Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit 8 days Maximum per calendar year
Optifit 8 days Maximum per calendar year
Topfit 16 days Maximum per calendar year
Superfit 24 days Maximum per calendar year
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
The Wmo takes precedence First ask your local council whether you would be eligible for help under the Wet maatschappelijke ondersteuning [Social Support Act] (Wmo).
Always apply for carer relief in good time Otherwise we may not be able to arrange it for you on time.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
ONVZ Coverage 2018 - version 1.2 100 Domestic assistance
When you have just come out of hospital and are unable to do the housekeeping.
What is covered
If you are unable to run your household, your local council’s health-care desk should be your first port of call. In situations where you are unable to manage on your own, it is the council’s responsibility to arrange support for you under the 2015 Wet maatschappelijke ondersteuning [Social Support Act] (Wmo).
If the council denies your application for domestic assistance, the Optifit and higher supplementary health-care plans will cover the domestic assistance you need after a hospital stay. This coverage is subject to a maximum number of hours, as specified below.
We will cover domestic assistance only if • the assistance immediately follows a hospitalisation of at least four days, and • you are aged over 18, and • it is arranged by the ZorgConsulent
Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit 9 hours Maximum, after hospitalisation
Topfit 18 hours Maximum, after hospitalisation
Superfit 30 hours Maximum, after hospitalisation
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
Make sure you apply for domestic assistance before you are discharged from hospital Otherwise the ZorgConsulent may not be able to arrange it for you on time.
ONVZ Coverage 2018 - version 1.2 101 Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We do not provide coverage for personal contributions If you do receive domestic assistance under the Wet maatschappelijke ondersteuning [Social Support Act], you will be liable to pay a personal contribution, for which we will not reimburse you.
Zorghotel
Regaining your strengths after illness or a medical treatment.
What is covered
If you are recovering from surgery or a physical illness, you qualify for nursing and other care at home. If you need more extensive health care, you will get a referral for a primary-care admission. This is covered under the basic health-care plan.
In other cases, a zorghotel, which is also known as a recuperation home, may be an option for you. A zorghotel is a lot like a regular hotel, but one where your recovery is the staff’s primary concern. A zorghotel provides health-care services, such as nursing or physiotherapy sessions. Not all zorghotels offer the same services.
The Topfit and Superfit supplementary health-care plans provide coverage for a stay at a zorghotel. Stays on account of recovery from a psychiatric condition are not covered, and neither are cases where admission to a primary-care facility was indicated or could have been indicated.
Nursing, physiotherapy and other care are subject to the 'regular’ cover.
Whom to contact • a zorghotel recognised by ONVZ1
Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit 100% In a zorghotel recognised by ONVZ
Superfit 100% In a zorghotel recognised by ONVZ
Zorgplan 100% In a zorghotel recognised by ONVZ
1 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22
ONVZ Coverage 2018 - version 1.2 102 What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You need a medical indication determined by your doctor, as well as our prior permission We will cover a stay at a zorghotel only if we have given prior permission for it. Please enclose the indication when asking for our permission1.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Health resort
If you suffer from rheumatoid arthritis or psoriasis.
What is covered
In cases of rheumatoid arthritis or psoriasis, a stay at a health resort offers a real chance of alleviating your condition. At a health resort, you will enter a personalised course of treatment, tailored to your particular medical condition.
The Topfit and Superfit supplementary health-care plans cover treatment and stays at a health resort up to a maximum of €500 per calendar year.
1 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen
ONVZ Coverage 2018 - version 1.2 103 Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit €500 Maximum per calendar year, in cases of rheumatoid arthritis or psoriasis
Superfit €500 Maximum per calendar year, in cases of rheumatoid arthritis or psoriasis
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We cover only care relating to these ailments We will look at your claims history to check whether you suffer from rheumatoid arthritis or psoriasis. We may also ask you for a statement from your rheumatologist or dermatologist.
Menopause consultant
Extra support during menopause.
What is covered
During the menopause, your body changes due to changes in hormone levels, which may lead to hot flushes, mood swings and sleep problems. A menopause consultant can help you with information, advice, and care during this period in your life.
The Benfit and higher supplementary health-care plans cover information, advice and care provided by a menopause consultant.
A reimbursement limit applies per calendar year for Benfit and Optifit. Topfit and Superfit provide full coverage.
ONVZ Coverage 2018 - version 1.2 104 Whom to contact A menopause consultant who is a member of: • Care for Women1, or • Vereniging Verpleegkundig OvergangsConsulenten [Medical Menopause Consultants’ Association]2
Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit €120 Maximum per calendar year
Optifit €250 Maximum per calendar year
Topfit 100%
Superfit 100%
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this context, routine health care is defined as care that is standard practice for menopause consultants. Simple when possible, and more complex when necessary.
1 More information is available at: careforwomen.nl 2 More information is available at: overgangsconsulente.com
ONVZ Coverage 2018 - version 1.2 105 Therapeutic camp for young people
If your child has asthma, diabetes or another ailment, he/she can attend a therapeutic camp and meet peers with the same condition.
What is covered
A therapeutic camp is an active holiday camp for children who suffer from diabetes mellitus, asthma or obesity. At such a camp, your child will meet peers with the same condition. Medical experts will support your child as he/she works on managing his/her condition and learns how to deal with the illness or ailment.
In most cases, participants will be charged a personal contribution. If your child has the Extrafit or a higher supplementary health-care plan, the personal contribution is covered.
Extrafit covers the personal contribution only for a therapeutic camp in cases of asthma. Benfit and higher plans also cover the personal contribution for a therapeutic camp in cases of diabetes, obesity, a serious rash (constitutional eczema) or cancer.
Extrafit coverage is subject to a maximum reimbursement per day or a maximum number of days. Benfit coverage is subject to a maximum amount per calendar year, for 1 camp. Optifit coverage is subject to a maximum amount per calendar year. Topfit and Superfit coverage the personal contribution in full.
Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit €6 per day in cases of asthma Maximum, up to 42 sessions a year
Benfit €250 (in cases of any one of 5 ailments) Maximum, once per calendar year In cases of asthma, diabetes, obesity, constitutional eczema, or cancer
Optifit €300 (in cases of any one of 5 ailments) Maximum per calendar year In cases of asthma, diabetes, obesity, constitutional eczema, or cancer
Topfit 100% (in cases of any one of 5 ailments) In cases of asthma, diabetes, obesity, constitutional eczema, or cancer
Superfit 100% (in cases of any one of 5 ailments) In cases of asthma, diabetes, obesity, constitutional eczema, or cancer
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
ONVZ Coverage 2018 - version 1.2 106 Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Patient association membership
Answers to questions in cases of (chronic) illness or disability.
What is covered
Having a (chronic) illness or disability may raise a lot of questions. A patients’ association can help you with information to answer those questions and bring you into contact with others who are in a similar situation.
The Optifit and higher supplementary health-care plans cover the minimum membership fee for a patients’ association. Optifit caps coverage at a maximum amount per calendar year. Topfit and Superfit cover the minimum membership fee in full. To qualify for this cover, the patients’ association must be affiliated with: • Patiëntenfederatie Nederland [Federation of Patients in the Netherlands]1, or • Ieder(in) [Umbrella organisation for people with a physical disability, mental disability, or chronic illness]2, or • the MIND Landelijk Platform Psychische Gezondheid [MIND National Psychological Health-Care Platform]3
Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit €25 Maximum, per calendar year
Topfit 100% The minimum membership fee
Superfit 100% The minimum membership fee
What you pay
No excess This coverage is provided under a supplementary health-care plan. An excess does not apply.
No personal contribution You will not be charged a personal contribution for this care.
1 More information is available at: www.patientenfederatie.nl 2 More information is available at: iederin.nl 3 More information is available at: www.platformggz.nl/lpggz
ONVZ Coverage 2018 - version 1.2 107 What you have to do yourself
We will ask for proof of membership and payment Please enclose a copy of the proof of membership and the bill when putting in your claim.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
ONVZ Coverage 2018 - version 1.2 108 Pregnancy, childbirth and children Coverage
Antenatal screening Pregnancy and childbirth Maternity care Maternity package TENS device Breastfeeding: breastfeeding specialist Bed-wetting alarm Adoption care Antenatal screening
Want to test your child for genetic defects before birth?
What is covered
If you are pregnant, your midwife, general practitioner or gynaecologist will discuss the option of antenatal screening with you, expounding the pros and cons. This is what is referred as counselling.
Antenatal screening is a test during pregnancy to determine the likelihood of the unborn child having a disorder such as Down’s syndrome or spina bifida.
Antenatal screening will initially consist of a blood test between the 10th and 14th week of pregnancy and an ultrasound in the 20th week (routine ultrasonography).
The blood test can be either an NIPT (non-invasive prenatal test) or part of a combination test. The NIPT is purely a blood test. A combination test also includes a nuchal scan (through an ultrasound) on the unborn child.
The government has set up a website1 with information about antenatal screening.
If these tests show that there is a heightened chance of your unborn child having a certain disorder, such as Down’s syndrome, the test will be referred to as a positive combination test or a positive NIPT. Your midwife, general practitioner or gynaecologist will then go over your options for antenatal follow-up tests, such as chorionic villus sampling, amniocentesis, or a more extensive ultrasound (advanced ultrasound scan, GUO). These follow-up tests can provide greater certainty.
The basic health-care plan covers:
• counselling • routine ultrasonography (SEO): the 20-week ultrasound scan
If the midwife, general practitioner or gynaecologist determines a medical indication, the basic health-care plan will also cover:
• the combination test • GUO (advanced ultrasound scan) • the NIPT. We will also cover this after a positive combination test • antenatal follow-up tests, such as chorionic villus sampling or amniocentesis. We will also cover this after a positive combination test or NIPT
There is a medical indication when, for example, a hereditary disease was found during a previous pregnancy or when a congenital abnormality runs in the family.
More about the NIPT During pregnancy, your blood contains the DNA of your unborn child. An NIPT will examine your blood and determine the chance of your child having Down’s, Edwards’ or Patau’s syndrome.
The blood sample for the NIPT will be taken near where you live, while the blood will be examined at one of the Netherlands’ University Medical Centres. You will receive the test results from your midwife who oversaw the NIPT.
Since 1 April 2017, an NIPT can also be performed without a medical indication. In that case, it will not be covered under your basic health-care plan, but instead under the NIPT subsidy scheme. To qualify for this subsidy, you have to take part in scientific research (the TRIDENT-2 study2). If the NIPT is conducted under this subsidy scheme, you will be charged a personal contribution of €175. We do not cover this personal contribution.
1 More information is available at: www.onderzoekvanmijnongeborenkind.nl 2 More information is available at: www.meerovernipt.nl
ONVZ Coverage 2018 - version 1.2 110 Coverage under each health-care plan
Basic health-care plan 100%
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit No coverage
What you pay
The excess The excess does not apply to:
• counselling • routine ultrasonography (SEO) • the combination test based on a medical indication • advanced ultrasound scan (GUO) • chorionic villus sampling • amniocentesis
The NIPT based on a medical indication is subject to the excess.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
In some cases, you need to have a referral If you have not had the combination test first, coverage for the NIPT, GUO or antenatal follow-up tests is conditional on referral by your midwife, general practitioner or a medical specialist.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
You can have the NIPT outside the Netherlands We will only cover the NIPT if there is a medical indication for it or after a positive combination test, including if you have the NIPT abroad. The subsidy scheme does not cover NIPTs performed outside the Netherlands. If you have the NIPT in Belgium, for example, without a medical indication, you will have to pay for it yourself. However, if there is a medical indication, we will cover the NIPT performed abroad up to the same amount as it would have cost in the Netherlands.
We only cover routine health care that you actually need In this context, routine health care is defined as the antenatal screening that midwives and medical specialists ordinarily conduct as part of obstetric care. Simple when possible, and more complex when necessary.
ONVZ Coverage 2018 - version 1.2 111 Pregnancy and childbirth
Are you pregnant?
What is covered
A pregnancy is an exciting time in your life with many new experiences. It is also a time when you have to make all kinds of arrangements – in the home, maternity leave, maternity care – and you may have numerous questions.
A midwife is the person to turn to with questions. If you are pregnant you can make an appointment with a midwife without a referral. The midwife will answer your questions, support you during the pregnancy and prepare you for labour. Some general practitioners can also provide obstetric care. If yours is one of them, you can choose to go to your general practitioner instead of a midwife.
Very early on in the pregnancy, your midwife or general practitioner will discuss the possibility of antenatal screening with you. They will also ask you where you want to give birth: at home, at a birth centre or in hospital.
If you develop medical problems during your pregnancy, such as high blood pressure or gestational diabetes, your general practitioner or midwife will refer you to a gynaecologist. You will also be referred to a gynaecologist if there is an increased risk of complications during pregnancy or labour in your case. The gynaecologist will then take over from the midwife or general practitioner, and you will give birth in hospital.
The basic health-care plan covers obstetric care by a general practitioner, midwife or gynaecologist. We provide coverage for the entire pregnancy including check-ups after childbirth. The extent of the coverage depends on where you give birth. There are 3 options:
1. Home birth If you would prefer to give birth in your trusted home environment, the basic health-care plan will cover obstetric care by the midwife or general practitioner. If there are complications and you have to give birth at the hospital after all, we will cover that as well. In that case, situation 3 will apply.
2. Giving birth in hospital without this being medically necessary, or at a birth centre If you would prefer to have extra medical care close to home, you can choose to give birth at the hospital’s outpatient clinic without this being medically necessary, or at a birth centre1. In most cases, your own midwife or general practitioner will support and help you during labour. The basic health-care plan will cover obstetric care also in such cases. Please note: the personal contribution for maternity care will then be higher. In case of complications that mean that you have to give birth in hospital, situation 3 will apply. The personal contribution will then not apply.
3. Hospital birth based on a medical indication If there is a risk of complications during labour or you are already under a gynaecologist’s supervision, you will give birth at the hospital’s outpatient clinic based on a medical indication. Your gynaecologist will help you through labour. The basic health-care plan covers obstetric care by a gynaecologist. In the event that hospital admission is needed, we will also cover that.
The Extrafit and higher supplementary health-care plans cover preventive health-related courses that can help you stay fit during pregnancy and prepare for labour. The Extrafit and higher supplementary health-care plans reimburse the costs of a maternity package from ONVZ Kraamzorg Service. The Benfit and higher supplementary health-care plans also cover additional maternity care and breastfeeding support. The Optifit and higher supplementary health-care plans also cover the costs of a TENS device for pain treatment and relief during childbirth.
What is not covered • sterile water injections • surgical dressings and sterile hydrophilic gauze during labour • hotel facilities or other luxury care at the birth centre
1 Sometimes called a birth hotel or birth clinic
ONVZ Coverage 2018 - version 1.2 112 Coverage under each health-care plan
Basic health-care plan 100% (excluding personal contribution)
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit No coverage
What you pay
The excess Although the excess does not apply to obstetric care in itself, it does apply to associated care, such as medication, laboratory tests or medical transportation by ambulance.
The personal contribution Obstetric care is not subject to a personal contribution, but maternity care is.
What you have to do yourself
You need a referral for gynaecological care Before you see a gynaecologist, you need a referral from your general practitioner or midwife. This does not apply in cases where urgent health care is required, such as when complications develop during a home birth
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this context, routine health care is defined as obstetric care that is standard practice for midwives and medical specialists. Simple when possible, and more complex when necessary.
ONVZ Coverage 2018 - version 1.2 113 Maternity care
Extra care for mother and child during those special first weeks.
What is covered
If you do not experience any complications during your pregnancy, you can choose where to give birth: at home, at a birth centre1 or in hospital. If there are complications, the delivery will take place in hospital. No matter where you give birth, you are entitled to maternity care after delivery.
If you give birth at home or at a birth centre, your midwife or general practitioner will attend at the delivery. A maternity nurse or nurse will assist the midwife or general practitioner during the delivery. We refer to that as ‘childbirth assistance’. This does not count as maternity care, but as obstetric (midwife) care.
After the delivery, the maternity nurse will look after you and your newborn. After delivery, she will help with the care of your baby and provide information and advice. If you spend the days following the birth at home, the maternity nurse will also do some light housekeeping.
The basic health-care plan reimburses:
• registration and initial interview by the maternity centre or birth centre • assistance provided by a nurse or maternity nurse during delivery (childbirth assistance), up to a maximum of two hours after delivery of the placenta • maternity care after the birth
The number of hours of maternity care you receive depends on your personal situation and where you give birth. The maternity centre or birth centre determines this on the basis of a protocol. You receive a minimum of 24 hours and maximum of 80 hours. This is divided over a maximum of 10 days from the delivery. The days you spend in hospital are deducted from this number.
You pay statutory personal contributions for maternity care. There are two contributions: a. for maternity care at home: €4.30 per hour b. for maternity care if you give birth at an outpatient clinic without this being medically necessary or for maternity care at a birth centre. This consists of 2 parts: 1. a fixed amount of €17 per person per day (so €34 for the mother and 1 child) 2. a variable amount on top of this: the extra costs if the rate charged by the hospital or birth centre is more than €122.50 per person per day
Here is a quick overview of the possible situations.
1. You have given birth at home. The maternity centre decides the number of hours of maternity care, in that case. In doing so, they look at what you and your baby need. The personal contribution applies to this (see a).
2. You have given birth in hospital without this being medically necessary and the delivery was without complications. You and your baby will be able to go home quickly. The maternity centre decides the number of hours of maternity care. In doing so, they look at what you and your baby need. The higher personal contribution (see b.) applies to the day of delivery. After that, the personal contribution (see a.) applies to the maternity care at home.
3. You have given birth at a birth centre without any medical problems. In this case, you and your newborn can usually stay for a couple of days. The birth centre decides the number of hours of maternity care to which you are still entitled upon returning home. Note: the higher personal contribution (see b.) applies to the days you remain at the facility. If you also receive maternity care at home, the personal contribution (see a.) applies to this.
4. You have given birth in hospital because of a medical indication or you and your baby have spent fewer than 10 days in hospital. In that case, the number of hours of maternity care will be determined once you go home. You do not pay any personal contribution for the days spent in hospital. The personal contribution (see a.) applies to the maternity care at home.
If you adopt a baby or use a surrogate, the baby is also entitled to maternity care.
1 Sometimes called a birth hotel or birth clinic
ONVZ Coverage 2018 - version 1.2 114 The Benfit and higher supplementary health-care plans reimburse up to a maximum amount per delivery:
• the higher personal contribution (see b.) in the event of a hospital birth or delivery at a birth centre without medical necessity • the personal contribution (see a.) for maternity care at home • incubator aftercare after the arrival at home of a baby who spent more than 4 days in an incubator or who was in an incubator during hospital admission of 8 or more days • additional maternity care if, because of medical reasons, you need more maternity care than covered under the basic health-care plan • deferred maternity care if the maternity care cannot start during the 10 days after the birth of your baby. This kind of maternity care always involves fewer care days and hours than normal maternity care
The Extrafit and higher supplementary health-care plans reimburse the costs of a maternity package from ONVZ Kraamzorg Service.
If you adopt a baby younger than 1 year, the Benfit and higher supplementary health-care plans also reimburse the costs of adoption care.
What is not covered
• hotel facilities or other luxury care at the birth centre • transportation costs that the maternity centre or maternity nurse charges separately. These costs are already included in the maternity care rate
Coverage under each health-care plan
Basic health-care plan 100% (excluding personal contribution) According to the Landelijk Indicatie Protocol Kraamzorg (an instrument used in the Netherlands to calculate the extent of the required maternity care)
Startfit No coverage
Extrafit No coverage
Benfit €250 Maximum per delivery, for the personal contribution under the basic health-care plan and extra maternity care
Optifit €400 Maximum per delivery, for the personal contribution under the basic health-care plan and extra maternity care
Topfit €550 Maximum per delivery, for the personal contribution under the basic health-care plan and extra maternity care
Superfit €550 Maximum per delivery, for the personal contribution under the basic health-care plan and extra maternity care
What you pay
No excess The excess does not apply to maternity care.
ONVZ Coverage 2018 - version 1.2 115 The personal contribution • The statutory personal contribution of €4.30 per hour for maternity care at home • The statutory personal contribution of €17 per person per day. Also, the costs in excess of €122.50 per person, per day for the hospital if you give birth there or at a birth centre without medical necessity
The Benfit and higher supplementary health-care plans reimburse the personal contributions up to a maximum amount per delivery.
What you have to do yourself
Apply for the maternity care on time This can easily be done online or by telephone. Simply call ONVZ Kraamzorg Service on +31 (0)88 668 97 05. They can also help you with other questions about maternity care.
You need a medical certificate for incubator aftercare, additional maternity care and deferred maternity care If you need incubator aftercare or additional or deferred maternity care, you must get a certificate from your attending doctor or midwife indicating the medical necessity. Send this certificate along with your claim form.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Maternity care according to the Landelijk Indicatie Protocol Kraamzorg The maternity centre or birth centre decides the number of hours of maternity care according to the Landelijk Indicatie Protocol Kraamzorg (an instrument used in the Netherlands to calculate the extent of the required maternity care)1.
We only cover routine health care that you actually need In this context, routine health care is defined as maternity care that is standard practice for maternity nurses. Simple when possible, and more complex when necessary.
Maternity package
The maternity package, essential for childbirth.
What is covered
The maternity package contains products that are essential for a home birth, such as mattress protectors and underpads. It also contains products for after delivery, such as maternity towels, for instance. So the maternity package is useful to have at home even if you plan to give birth at a birth centre or hospital.
The Extrafit and higher supplementary health-care plans reimburse the costs of the maternity package from ONVZ Kraamzorg Service. If you have arranged maternity care through us, you will automatically receive the package at your home address during your 34th week of pregnancy, at the latest. You do not need to do anything.
If you did not arrange maternity care through us, you can request the package from the ONVZ Kraamzorg Service. The telephone number is +31 (0)88 668 97 05. We will make sure the package is delivered to your home address.
1 For this, see: www.knov.nl/samenwerken/a-tot-z
ONVZ Coverage 2018 - version 1.2 116 The maternity package contains:
• 1 mattress protector/bed canvas • 1 maternity mattress pad 60 x 90cm • 10 underpads 60 x 60cm • 2 boxes of wound compresses 8.5 x 5cm • 10 wound compresses 10 x 10cm • 1 bottle of alcohol 70% (100ml) • 1 sterile umbilical clip • 2 packs of maternity towels • 1 pack of sanitary towels • 1 pack of nappy liners • 2 pairs of stretch knickers • 1 roll of nappy tape • 1 pack of zigzag cotton wool
Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit Once per delivery Supplied by the ONVZ Kraamzorg Service
Benfit Once per delivery Supplied by the ONVZ Kraamzorg Service
Optifit Once per delivery Supplied by the ONVZ Kraamzorg Service
Topfit Once per delivery Supplied by the ONVZ Kraamzorg Service
Superfit Once per delivery Supplied by the ONVZ Kraamzorg Service
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
You can also buy a maternity package yourself If your health-care plan does not cover the maternity package, you can purchase one yourself at a pharmacy or online at www.natalis.nl.
ONVZ Coverage 2018 - version 1.2 117 TENS device
Less pain during labour.
What is covered
Are you worried about the pain during labour? The TENS device can alleviate labour pains. Small electrical pulses intercept pain signals to the brain.
You can rent or buy a TENS device. The Optifit and higher supplementary health-care plans reimburse a maximum of €75 per delivery.
You can also request the TENS device through the ZorgConsulent. The device will then be sent to your home and you are free to keep it.
Whom to contact • supplier of TENS devices • ZorgConsulent
Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit €75 Maximum, per delivery
Topfit €75 Maximum, per delivery
Superfit €75 Maximum, per delivery
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
ONVZ Coverage 2018 - version 1.2 118 Breastfeeding: breastfeeding specialist
A good start for your child.
What is covered
Breastfeeding sounds like it should be simple. But in practice, it is not always as easy as it sounds (straight away). There could be difficulties with achieving a good latch, or low milk supply.
If you receive maternity care, the maternity nurse can help you with breastfeeding. If you cannot turn to a maternity nurse with your questions, you can contact a breastfeeding specialist. A breastfeeding specialist can also help in special situations, if your child has a disability, for instance.
You usually receive this care after delivery, but you can also consult with a breastfeeding specialist during pregnancy.
The Benfit and Optifit supplementary health-care plans reimburse a maximum of 2 and 4 consultations, respectively, per delivery. Topfit and Superfit reimburse all consultations with a breastfeeding specialist.
Whom to contact • a breastfeeding specialist with full membership of the Nederlandse Vereniging van Lactatiekundigen1 [Dutch Association of Breastfeeding Specialists] (NVL)
What is not covered • breastfeeding aids, such as special bottles
Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit 2 consultations Maximum, per delivery
Optifit 4 consultations Maximum, per delivery
Topfit 100%
Superfit 100%
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
1 For this, see: search.nvlborstvoeding.nl
ONVZ Coverage 2018 - version 1.2 119 Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this context, routine health care is defined as the care that is standard practice for breastfeeding specialists. Simple when possible, and more complex when necessary.
Bed-wetting alarm
Dry through the night.
What is covered
If your child wets the bed, a bed-wetting alarm can help. The device wakes your child if the sensor underwear become wet.
If your child has the Extrafit or a higher supplementary health-care plan, the bed-wetting alarm is covered. You decide whether to rent or purchase the alarm. Extrafit and Benfit cap coverage at a maximum amount of €85. Topfit and Superfit provide full coverage for the costs of a bed-wetting alarm.
Whom to contact • supplier of bed-wetting alarms
Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit €85 Maximum, for 3-month rental or purchase, once per insured person
Benfit €85 Maximum, for 3-month rental or purchase, once per insured person
Optifit €85 Maximum, for 3-month rental or purchase, once per insured person
Topfit 100% Rental or purchase, once per insured person
Superfit 100% Rental or purchase, once per insured person
ONVZ Coverage 2018 - version 1.2 120 What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Adoption care
Giving your adopted child the best.
What is covered
If you are adopting a child, you may have questions about care, feeding or other matters faced by new parents. During the first weeks after birth, a maternity nurse can help you. Perhaps you would also like to check your child’s health by way of medical screening.
The basic health-care plan covers maternity care. This could also be care for an adopted child. The maternity centre decides the number of hours according to a protocol and you pay a personal contribution.
If your adopted child is younger than 12 months and is insured with us, the Benfit and higher supplementary health-care plans cover:
• the costs of additional maternity care • the personal contribution for maternity care under the basic health-care plan • the costs of medical screening by a paediatrician
Coverage is subject to a maximum per adopted child. The amount is stated below.
Whom to contact • for medical screening: a paediatrician • for maternity care: a maternity centre
ONVZ Coverage 2018 - version 1.2 121 Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit €250 Maximum, per adopted child
Optifit €400 Maximum, per adopted child
Topfit €550 Maximum, per adopted child
Superfit €550 Maximum, per adopted child
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
Apply for maternity care This can easily be done online or by telephone. Simply call ONVZ Kraamzorg Service on +31 (0)88 668 97 05. They can also help you with other questions about maternity care.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
You do not need a referral for screening You can take your child directly to the paediatrician.
We only cover routine health care In this context, routine health care is defined as maternity care and medical screening that is standard practice for maternity nurses and paediatricians. Simple when possible, and more complex when necessary.
We provide coverage once per adopted child Even if you and your partner are both insured with us.
ONVZ Coverage 2018 - version 1.2 122 Medication and diet Coverage
Medicines (basic health-care plan) Medicines (supplementary health-care plans) Over-the-counter medication and proton-pump inhibitors Dietetics Dietary preparations Medicines (basic health-care plan)
Is my medicine covered?
What is covered
The basic health-care plan covers prescription medicines and the associated pharmacy services. Sometimes you will need to pay a personal contribution. Everything you need to know is explained below.
The basic health-care plan covers the following medicines:
1. The medicines designated by the government and listed in appendix 11 to the Regeling zorgverzekering [Health Insurance Regulations]. Nearly all the medicines usually prescribed in the Netherlands are included in this.
2. Medicines that the pharmacy produces on a small scale (‘magistral preparations’) or has produced by a third party (‘resold preparations’). This cannot be a medicine that is identical or almost identical to a medicine that is not covered under point 1.
3. Medicines that do not (yet) have marketing authorisation in the Netherlands. The attending doctor has permission from the government to have the medicine produced in the Netherlands or imported. This does not happen often.
The coverage in points 2 and 3 applies only for rational pharmacotherapy. This means that scientific testing has found the medicine to work and that it is also effective. The situation for resold preparations is explained in the document on resold pharmacy and other preparations2.
Some medicines are covered under the basic health-care plan only if you have a particular indication. These medicines and the indications are listed in appendix 21 to the Regeling zorgverzekering [Health Insurance Regulations]. Examples include over-the-counter medication and proton-pump inhibitors3.
What about my medicine? If you know the name of your medicine or its active ingredient, you can check medicijnkosten.nl and find out at a glance whether the medicine is covered by the basic health-care plan and what the maximum coverage is.
And the personal contribution? The government determines the maximum amount we can reimburse for a medicine. The actual price may be higher. In that case, you will need to pay the difference yourself. This is the statutory personal contribution. The Extrafit and higher supplementary health-care plans reimburse these statutory personal contributions up to a maximum amount per calendar year.
Whom to contact • pharmacy • dispensing practice
For each prescription, the pharmacy will give you a set ‘dispensing quantity’. For a medicine you are taking for the first time, this will be a 15-day supply, for instance. The dispensing quantities are specified under Good to know.
You have the freedom to choose When it comes to medicines as well. ONVZ does not have a ‘preference policy’, but your medicine may also not be unnecessarily expensive.
The following are not covered by the basic health-care plan: • medicines for research • medicines that have not yet been approved or that are still being subjected to clinical testing
Other reimbursements Other conditions (also) apply for some medicines, so they are listed separately:
• dietary preparations • vaccinations and preventive remedies for your holiday or other travel • provisionally approved medicines • over-the-counter medication and proton-pump inhibitors
1 This is available at: wetten.overheid.nl 2 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22 3 Medicines you can buy from the chemist’s or pharmacy without a prescription
ONVZ Coverage 2018 - version 1.2 124 Coverage under each health-care plan
Basic health-care plan 100% (excluding the personal contribution) Most medicines
Startfit No coverage
Extrafit The personal contribution Under medicines (supplementary health-care plan)
Benfit The personal contribution Under medicines (supplementary health-care plan)
Optifit The personal contribution Under medicines (supplementary health-care plan)
Topfit The personal contribution Under medicines (supplementary health-care plan)
Superfit The personal contribution Under medicines (supplementary health-care plan)
What you pay
The excess This care is provided under the basic health-care plan, and is therefore subject to the excess.
The personal contribution You will need to pay a statutory personal contribution for some medicines.
What you have to do yourself
You must have a prescription for the medicine We only reimburse medicines if they have been prescribed by your attending doctor, medical specialist, dentist, dental specialist (dental surgeon), midwife, specialist nurse (nurse practitioner) or physician assistant1.
For some medicines, you must have permission in advance There are some medicines for which we only provide reimbursement if we have given permission in advance. This is the case for the medicines in the Toestemming geneesmiddelen [Permission for medicines] document2, and for the medicines for which there is no marketing authorisation as yet (stated in point 3). The Toestemming geneesmiddelen [Permission for medicines] document also tells you how to apply for permission.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Some medicines come under specialist medical care You do not pay separately for medicines you receive during the course of your care from a medical specialist or during hospital admission. They are included in the bill from the hospital.
1 The physician assistant can perform some examinations, give injections, and prescribe medicine independently. He/she can also work under the direction of a medical specialist 2 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22
ONVZ Coverage 2018 - version 1.2 125 You are given a set ‘dispensing quantity’ Per prescription, we will reimburse the costs of a medicine for: • 15 days for a medicine you have not taken before • 15 days for antibiotics for an acute ailment or for chemotherapy drugs (cytostatics) • a maximum of 3 months for a medicine for a chronic illness, except sleep-inducing drugs (hypnotics) and anti-anxiety drugs (anxiolytics) • a maximum of 1 year for the contraceptive pill • a maximum of 1 month for medicines costing more than €1,000 per month and for sleep-inducing drugs and anti-anxiety drugs after the titration period • a maximum of 1 month in other cases If a medicine belongs to more than one category, the shortest period applies.
Medicines (supplementary health-care plans)
A supplement to the coverage under the basic health-care plan.
What is covered
The basic health-care plan covers the most common medicines for which you have a prescription. In some cases, you may be required to pay a personal contribution.
The Extrafit and higher supplementary health-care plans cover:
• the personal contribution • most of the registered medicines that the basic health-care plan does not cover (the exceptions are listed in ‘other reimbursements’ below) • dressings for covering or bandaging a skin condition or wound used under the responsibility of your doctor, if they are not covered by the medical appliances reimbursement
Optifit, Topfit and Superfit also cover:
• over-the-counter medication and proton-pump inhibitors not covered by the basic health-care plan • melatonin of 0.3mg or more per unit
We also cover the dispensation and guidance from the pharmacy1.
The amounts listed below are the maximum amounts reimbursed under the Extrafit, Benfit, Optifit and Topfit plans per calendar year. Superfit covers the full costs of care.
Whom to contact • pharmacy • dispensing practice
What is not covered • medicines covered by a manufacturer’s refund scheme2
Other reimbursements Other conditions (also) apply for some medicines, so they are listed separately:
• homeopathic or anthroposophic medicines. These come under alternative/non-conventional medicine • vaccinations and preventive remedies for your holiday or other travel • contraceptive medicines • over-the-counter medication and proton-pump inhibitors • medicines for fertility treatment
1 More information is available at: www.onvz.nl/vergoedingen/kosten-apotheekzorg 2 You can have the manufacturer refund the costs of or your statutory personal contribution for certain medicines. We do not reimburse these costs or personal contributions, not even if the manufacturer says that you need to ask us for reimbursement first. For more information, please seeterugbetaalregeling.nl and hevoconsult.nl
ONVZ Coverage 2018 - version 1.2 126 Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit €100 Maximum per calendar year for • personal contributions • registered medicines • pharmacy services • dressings No coverage for • over-the-counter medication and proton-pump inhibitors • contraceptive medicines
Benfit €200 Maximum per calendar year for • personal contributions • registered medicines • pharmacy services • dressings No coverage for • over-the-counter medication and proton-pump inhibitors
Optifit €4,540 Maximum per calendar year for • personal contributions • registered medicines • melatonin of 0.3mg or more • pharmacy services • dressings
Topfit €4,540 Maximum per calendar year for • personal contributions • registered medicines • melatonin of 0.3mg or more • pharmacy services • dressings
Superfit 100% For • personal contributions • registered medicines • melatonin of 0.3mg or more • pharmacy services • dressings
What you pay
The excess The excess only applies to the basic health-care plan. You do not pay an excess for medicines and care services under the supplementary health-care plans.
The personal contribution You will need to pay a statutory personal contribution for some medicines. The supplementary health-care plans reimburse these personal contributions, in accordance with the conditions below.
ONVZ Coverage 2018 - version 1.2 127 Here's how it works
What you have to do yourself You need a prescription from a doctor or other prescriber Medicines, dressings and melatonin are only reimbursed on the basis of a prescription from the attending doctor, medical specialist, dentist, dental specialist (dental surgeon), midwife, specialist nurse (nurse practitioner) or physician assistant.
Medicines are sometimes included in hospital care In that case, you will receive the medicine in or from the hospital. You will not be given a prescription. The costs will not come under this category, in that case, but will be covered by the reimbursement for medical specialists.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
You are given a set ‘dispensing quantity’ Per prescription, we will reimburse the costs of a medicine for: • 15 days for a medicine you have not taken before • 15 days for antibiotics for an acute ailment or for chemotherapy drugs (cytostatics) • a maximum of 3 months for a medicine for a chronic illness, except sleep-inducing drugs (hypnotics) and anti-anxiety drugs (anxiolytics) • a maximum of 1 year for the contraceptive pill • a maximum of 1 month for medicines costing more than €1,000 per month and for sleep-inducing drugs and anti-anxiety drugs after the titration period • a maximum of 1 month in other cases If a medicine falls under more than one category, the shortest period applies.
Over-the-counter medication and proton-pump inhibitors
Do you make chronic use of over-the-counter medications or proton-pump inhibitors?
What is covered
For most medicines, you take a prescription to the pharmacy. There are also medicines for which you do not need a prescription and you can buy them at a chemist’s or at the supermarket. These are ‘over-the-counter medications’. Some (but not all) proton-pump inhibitors are also over-the-counter medications.
The basic health-care plan covers the costs of the following over-the-counter medications and proton-pump inhibitors: 1. laxatives 2. calcium tablets 3. anti-allergy remedies 4. antidiarrhoeal medicines 5. remedies to alleviate dry eyes 6. medicines to promote gastric emptying (prokinetic agents) 7. medicines other than those listed in 1 to 6, with the same active ingredient and in the same form of administration 8. proton-pump inhibitors and combination preparations incorporating a proton-pump inhibitor
You must satisfy 3 conditions however: • you must have a prescription for the medicine • you must need the medicine for 6 months or longer for a chronic condition and this must be stated on the prescription • you must collect the medicine from the pharmacy or dispensing general practitioner’s practice
ONVZ Coverage 2018 - version 1.2 128 The basic health-care plan provides reimbursement of the costs of these medicines from the 16th day that you use them.
The Optifit and higher supplementary health-care plans include coverage as follows, up to the maximum reimbursement per calendar year: • the first 15 days that you use these medicines • over-the-counter medication and proton-pump inhibitors if not covered by the basic health-care plan
What about my medicine? If you know the name of your medicine or its active ingredient, you can check medicijnkosten.nl and find out at a glance whether the medicine is covered by the basic health-care plan and what the maximum coverage is.
Whom to contact We only reimburse the costs of over-the-counter medicines and proton-pump inhibitors if you collect them from a: • pharmacy • dispensing practice
Note This reimbursement is part of the reimbursement for medicines. The conditions set out there also apply. For instance, you will sometimes be required to pay a personal contribution.
Coverage under each health-care plan
Basic health-care plan 100%, from the 16th day onwards Some over-the-counter medication and proton-pump inhibitors
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit €4,540 First 15 days Over-the-counter medication/proton-pump inhibitors
Topfit €4,540 First 15 days Over-the-counter medication/proton-pump inhibitors
Superfit 100% First 15 days Over-the-counter medication/proton-pump inhibitors
What you pay
The excess The excess applies to care under the basic health-care plan. No excess applies to care under the supplementary health-care plan.
The personal contribution You will need to pay a statutory personal contribution for some over-the-counter medication and proton-pump inhibitors.
ONVZ Coverage 2018 - version 1.2 129 What you have to do yourself
You need a prescription from a doctor or other prescriber We only reimburse over-the-counter medication and proton-pump inhibitors if you have a prescription from your attending doctor, a medical specialist, dentist, dental specialist (dental surgeon), midwife, specialist nurse (nurse practitioner) or physician assistant.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Dietetics
If you need advice on nutrition and health.
What is covered
Are you overweight, or perhaps underweight, as the result of illness, an eating disorder or food allergies? Or do you have other symptoms relating to nutrition, such as intestinal problems, high blood pressure or high cholesterol? A dietitian provides information and advice on nutrition, diet and eating habits. We call this dietetics.
We reimburse the costs of dietetics in three situations: • as part of the care chain in the event of chronic illness • if an insured person is overweight • if there is some other medical cause
If you have a chronic illness such as diabetes mellitus, cardiovascular disease or chronic pulmonary problems (COPD), you may receive care provided in a care chain, through the general practitioner. This chain means that multiple health-care providers work together closely to provide you with care. The dietitian is part of this chain as well.
If you are overweight, you can get care from the dietitian if: • your BMI1 is at least 30kg/m2, or • your BMI is between 25 and 30kg/m2 and you are also at a higher risk because of an illness, for instance (such as cardiovascular disease)
If you have some other medical reason for consulting a dietitian, the general practitioner can give you a referral. You can also consult a dietitian on your own initiative. A referral is not required.
The basic health-care plan covers the costs of a maximum of 3 hours of medically-related dietetics treatment from a dietitian per calendar year. If the care from the dietitian is part of your care chain, the basic health-care plan covers that care as well. Care provided in the care chain does not count towards the maximum of 3 hours.
If 3 hours is not enough and you need more guidance and advice, the Benfit and higher supplementary health-care plans reimburse the costs of extra medically-related dietetics from a dietitian. A reimbursement limit applies per calendar year for Benfit and Optifit. Topfit and Superfit provide full coverage for dietetics.
Even if you do not have a medical reason but want to change your eating habits, the Extrafit and higher supplementary health-care plans include coverage for preventive health-related courses.
What is not covered • food, meal replacements or diet products • dietetics as part of sports-medical advice
1 Weight-to-height ratio. Your BMI is calculated by dividing your weight in kilos by your height in metres and then dividing the result again by your height in metres
ONVZ Coverage 2018 - version 1.2 130 Coverage under each health-care plan
Basic health-care plan 3 hours Maximum per calendar year
Startfit No coverage
Extrafit No coverage
Benfit €120 Maximum per calendar year
Optifit €200 Maximum per calendar year
Topfit 100%
Superfit 100%
What you pay
The excess The excess usually applies to dietetics under the basic health-care plan. Only if the dietetics is provided as part of the care chain does the excess not apply. An excess never applies to dietetics under the supplementary health-care plan.
No personal contribution You will not be charged a personal contribution for this care.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Quality registers provide extra information With ONVZ, the choice is all yours. You decide which health-care provider you go to. Quality registers1 contain information that can help you make a choice.
You do not pay an excess for the Beter Eten programme The Beter Eten programme guides you towards healthy nutrition and a healthy lifestyle. If you follow this kind of programme, you do not pay an excess for the hours of care from the dietitian.
We only cover routine health care that you actually need In this context, routine health care is defined as the dietetics that is standard practice for dietitians if there is a medical reason for the care. Simple when possible, and more complex when necessary.
1 More information is available at: www.onvz.nl/kwaliteitsregisters
ONVZ Coverage 2018 - version 1.2 131 Dietary preparations
If you cannot take in enough nutrients with a regular or modified diet.
What is covered
Dietary preparations are food products in a different form and with a different composition to normal food, such as drip or tube feeding or liquid nutrition, for instance. They are prescribed in the event of illness or malnutrition.
Dietary preparations are not diet products. Diet products include gluten-free pasta, sugar-free jam or meal replacement bars, for instance, which you can buy at the supermarket or chemist’s.
The basic health-care plan does provide coverage for dietary preparations, but not for diet products. However, you must satisfy two conditions.
The 1st condition is: • you have a metabolic disorder, uptake disorder (resorption disorder) or food allergy, or • you are malnourished because of an illness or there is a risk that this could happen and this has been quantified using an officially confirmed measuring instrument, or • you need dietary preparations in accordance with the guidelines of doctors and dietitians
The 2nd condition is: • modified normal nutrition, and types of special nutrition other than dietary preparations, are not effective enough for you
The reimbursement is provided for polymer, oligomer, monomer and modular dietary preparations. These terms refer to the molecular structure of the dietary preparation.
Whom to contact • pharmacy • dispensing practice • specialist supplier
Coverage under each health-care plan
Basic health-care plan 100% In certain situations
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit No coverage
ONVZ Coverage 2018 - version 1.2 132 What you pay
The excess This care is provided under the basic health-care plan, and is therefore subject to the excess.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You must have a prescription You must have a prescription for dietary preparations from your general practitioner or medical specialist1, specialist nurse, physician assistant or dietitian.
Sometimes you must request permission in advance If your general practitioner sends a prescription directly to your pharmacy, the pharmacist assesses whether the dietary preparation is reimbursed. You do not need to request permission separately in that case.
If someone else prescribes the dietary preparation, you must ask for permission in advance with a doctor’s certificate for dietary preparations2.
We have agreements with many suppliers that they can give permission on our behalf. In that case, you send the prescription from the general practitioner or the doctor’s certificate directly to the supplier. Your supplier knows whether this applies to them as well. You can also inquire with us.
If the supplier cannot give permission3 on our behalf, you send the prescription from the general practitioner or the completed doctor’s certificate for dietary preparations to us. We then review the request.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
1 An anaesthetist, cardiologist, surgeon, cardiothoracic surgeon, dermatologist, gynaecologist, internist, ENT doctor, paediatrician, clinical geneticist, clinical geriatric specialist, pulmonologist, gastroenterologist, medical microbiologist, neurosurgeon, neurologist, nuclear medicine specialist, ophthalmologist, orthopaedic surgeon, pathologist, plastic surgeon, psychiatrist, radiologist, radiation therapist, rheumatologist, rehabilitation specialist, sports doctor or urologist 2 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22 3 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen
ONVZ Coverage 2018 - version 1.2 133 Oral and dental Coverage
Dental health care up to the age of 18 Dental health care from the age of 18 Dental health care after an accident Orthodontics up to the age of 18 Orthodontics from the age of 18 Dental prosthesis (‘prosthesis’) from the age of 18 Front-teeth replacement Dental surgery from the age of 18 Specialist dental care DiamondClean Smart toothbrush Dental health care up to the age of 18
For strong and healthy teeth.
What is covered
Good dental health care at a young age prevents problems later on. If you are younger than 18, the basic health-care plan covers the costs of the most common dental treatments. These are:
• check-ups (preventive dental examination), once per year • extra check-ups if needed • incidental consultations • periodontal scaling • fluoride treatment of the permanent teeth, twice per year • extra fluoride treatments if needed • sealing (application of a protective coating) • treatment of gum problems • anaesthetic • root canal treatment • fillings • care for problems with the mandibular joint • removable dental prostheses (such as a dental plate or dentures) • surgical dental assistance, with the exception of implants • X-rays, except those for orthodontics
If you need to be admitted by the dental surgeon, the basic health-care plan also covers the hospital admission.
The Optifit and higher supplementary health-care plans include coverage for general dental care up to the age of 18 not covered by the basic health-care plan. Optifit caps coverage at a maximum amount of €500 per calendar year. Topfit and Superfit provide full coverage.
For dental health care from the age of 18, orthodontics up to the age of 18, front-teeth replacement and specialist dental care, other conditions (also) apply. For this reason, they are listed separately.
Whom to contact For care under the basic health-care plan, you can contact a: • dentist • dental hygienist • prosthodontist • a dental surgeon (oral and maxillofacial surgeon)
For care under the supplementary health-care plans, you can contact a: • dentist • prosthodontist
What is not covered • the bleaching of teeth and molars • MRA (mandibular repositioning appliance) • gum shield • the supplementary health-care plans do not reimburse the costs of general anaesthetic
ONVZ Coverage 2018 - version 1.2 135 Coverage under each health-care plan
Basic health-care plan 100% Usual dental health care
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit €500 General dental health care
Topfit 100% General dental health care
Superfit 100% General dental health care
What you pay
No excess Up to the age of 18, there is no excess.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You must have a referral in advance for the dental surgeon Before you go to the dental surgeon, you must have a referral from your general practitioner, dentist, medical specialist or school doctor. A referral is not required for emergency health care.
Sometimes you need permission in advance This applies to: • care provided in a dental hospital • care provided under general anaesthetic • the following 3 treatments from a dental surgeon: (1) gum treatment (periodontal care) (2) jaw surgery (osteotomy) (3) the placement of dental implants • a prosthesis costing more than €650 (including equipment and technical costs) per jaw if produced by the dentist • a prosthesis costing more than €500 (including equipment and technical costs) per jaw if produced by the prosthodontist • the replacement of a prosthesis less than 5 years old • implant-supported dentures, and the repair or rebasing (filling) of implant-supported dentures
You need to request permission1 with a substantiated statement from your health-care provider. This must be accompanied by a treatment plan and budget.
1 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen
ONVZ Coverage 2018 - version 1.2 136 If the health-care provider comes to you, you must have a statement from your doctor You receive dental health care at the health-care provider’s practice. We only reimburse the costs of dental health care provided elsewhere if you have advice from your doctor for this. Send the advice along with the claim form or keep it if the health-care provider submits claims to us directly.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this case, routine health care is the dental health care that is standard practice for dentists. Simple when possible, and more complex when necessary.
Dental health care from the age of 18
For healthy teeth in a healthy mouth.
What is covered
From the age of 18, most ‘regular’ health care provided by a dentist or dental hygienist is not covered by the basic health-care plan. From that age, you are only insured for the dental surgeon, prostheses, front-teeth replacement and specialist dental care.
The Superfit supplementary health-care plan and Tandfit A, B, C, D and Preventief dental health-care plans do cover regular dental health care if you are 18 years or older. The reimbursements provided are listed below, for each health-care plan. A different reimbursement applies to orthodontics.
Superfit Superfit covers 100% of the costs of general dental health care (including equipment and technical costs) up to a maximum of €1,600 per calendar year. The personal contribution you pay for prostheses or specialist dental care is covered by this as well.
Tandfit A Tandfit A covers 75% of the costs of general dental health care (including equipment and technical costs) up to a maximum of €250 per calendar year. The personal contribution you pay for prostheses or specialist dental care is covered by this as well, but orthodontics is not.
Tandfit B Tandfit B covers 100% of the costs of the following preventive treatments: • check-ups (C11)1 • preventive information and/or instruction (M01) • consultation for evaluation of prevention (M02) • dental cleaning (M03) • fluoride treatment (M10 or M20) • X-rays, not for orthodontics (X10) • sealing (application of a protective coating) (V30 or V35)
Tandfit B also covers 75% of the costs of other general dental health care (including equipment and technical costs). Personal contributions paid for prostheses or specialist dental care are covered by this as well, but orthodontics is not.
The total reimbursement for preventive treatments and other dental health care combined is a maximum of €750 per calendar year.
1 The codes in brackets are listed on the dentist's invoice
ONVZ Coverage 2018 - version 1.2 137 Tandfit C Tandfit C covers 100% of the costs of the following preventive treatments: • check-ups (C11)1 • preventive information and/or instruction (M01) • consultation for evaluation of prevention (M02) • dental cleaning (M03) • fluoride treatment (M10 or M20) • X-rays, not for orthodontics (X10) • sealing (application of a protective coating) (V30 or V35)
Tandfit C also covers 75% of the costs of other general dental health care (including equipment and technical costs). Personal contributions paid for prostheses or specialist dental care are covered by this as well, but orthodontics is not.
The total reimbursement for preventive treatments and other dental health care combined is a maximum of €1,500 per calendar year.
Tandfit D Tandfit D covers 100% of the costs of general dental health care (including equipment and technical costs) up to a maximum of €1,500 per calendar year. Personal contributions paid for prostheses or specialist dental care are covered by this as well, but orthodontics is not.
Tandfit Preventief Tandfit Preventief covers 100% of the costs of the following preventive treatments: • check-ups (C11)1 • consultations (C13) • supplementary medical history (C22) • surcharge for treatment at home (C80) • preventive information and/or instruction (M01) • consultation for evaluation of prevention (M02) • dental cleaning (M03) • fluoride treatment (M10 or M20) • bacterial and enzyme testing (M32) • X-rays, not for orthodontics (X10) • sealing (application of a protective coating) (V30 or V35)
Tandfit Preventief also covers 100% of the costs of (other) general dental health care2 up to a maximum of €2,000 per calendar year.
And: with Tandfit Preventief, you receive an electric toothbrush once every 3 years and a prevention package quarterly.
Tandfit Preventief does not reimburse the costs of (health care relating to): • crowns, bridges and inlays3 • prostheses • implants • root canal treatment • orthodontics
Tandfit Preventief also does not reimburse the costs of: • dentist subscriptions • hourly rates for specialist dental care • equipment and technical costs for care that is not covered
Whom to contact • dentist • dental hygienist • prosthodontist
What is not covered • general anaesthetic • the bleaching of teeth and molars • MRA (mandibular repositioning appliance) • gum shield
Accidents If you have had an accident that caused damage to your teeth, there is separate coverage for dental health care after an accident.
1 The codes in brackets are listed on the dentist's invoice 2 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22 3 Inlays are custom-made fillings
ONVZ Coverage 2018 - version 1.2 138 Coverage under each health-care plan
Basic health-care plan Limited coverage Only the dental surgeon, prostheses, front-teeth replacement and specialist dental care
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit €1,600 (100%) Maximum per calendar year General dental health care (100%)
Tandfit A €250 (75%) Maximum per calendar year General dental health care (75%)
Tandfit B €750 (75% - 100%) Maximum per calendar year Check-ups & prevention 100% General dental health care 75%
Tandfit C €1,500 (75% - 100%) Maximum per calendar year Check-ups & prevention 100% General dental health care 75%
Tandfit D €1,500 (100%) Maximum per calendar year General dental health care (100%)
Tandfit Preventief Check-ups & prevention (100%) General dental health care (100%, up to €2,000) Electric toothbrush, prevention packages Reimbursements: maximum per calendar year Toothbrush: once every 3 years Prevention package: once quarterly No coverage for: crowns, bridges, root canal treatment, implants and prostheses
ONVZ Coverage 2018 - version 1.2 139 What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care. Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Health-care costs incurred abroad are reimbursed at the rate that applies in the Netherlands If you receive health care outside the Netherlands, we reimburse what the care would have cost in the Netherlands. If the bill is denominated in a different currency, we will convert the amount to euros. We use the exchange rate in effect on the last working day of the month prior to the month in which you received the care.
We only cover routine health care that you actually need In this case, routine health care is the dental care that is standard practice for dentists. Simple when possible, and more complex when necessary.
Dental health care after an accident
A ball in the face while playing sports. An accident on your bicycle.
What is covered
If your teeth have been damaged as the result of an accident, the basic health-care plan, your supplementary health-care plan or your Tandfit plan may reimburse the costs of the dentist or dental surgeon. This depends on what health-care plan you have and your age.
Under the age of 18 If you are under 18, the basic health-care plan covers most dental health care. This can also include care you need following an accident. The Optifit and higher supplementary health-care plans include coverage for general dental care not covered by the basic health-care plan. The reimbursements provided are listed in dental health care up to the age of 18.
If you are aged 18 or above, From the age of 18, most ‘regular’ health care provided by a dentist or dental hygienist is not covered by the basic health-care plan. From that age, you are only insured as standard for the dental surgeon, prostheses, and specialist dental care. The Superfit and Tandfit A, B, C, D and Preventief supplementary health-care plans do cover general dental health care from the age of 18.
Extra coverage following an accident Superfit and Tandfit A, B, C, D and Preventief also reimburse the costs of dental treatment that is necessary following an accident. This also covers equipment and technical costs, for a crown or prosthesis, for instance. Coverage is subject to a maximum per calendar year. The amount is stated below.
The accident must have occurred while you were insured under 1 of these 5 health-care plans and you must have received the treatment within 1 year of the accident.
Whom to contact • dentist • dental hygienist • prosthodontist
What is not covered • general anaesthetic
ONVZ Coverage 2018 - version 1.2 140 Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit €5,000 Maximum, 1 accident per calendar year
Tandfit A €2,500 Maximum, 1 accident per calendar year
Tandfit B €5,000 Maximum, 1 accident per calendar year
Tandfit C €5,000 Maximum, 1 accident per calendar year
Tandfit D €5,000 Maximum, 1 accident per calendar year
Tandfit Preventief €5,000 Maximum, 1 accident per calendar year
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You are required to seek our authorisation first We only reimburse the costs of dental health care following an accident if we have given permission1 in advance. You do not need permission for urgent care. In order to assess your request, we need a written explanation from your health-care provider. This must be accompanied by a treatment plan and budget.
1 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen
ONVZ Coverage 2018 - version 1.2 141 Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this case, routine health care is the dental care that is standard practice for dentists. Simple when possible, and more complex when necessary.
Orthodontics up to the age of 18
For teeth that do their job well.
What is covered
If you have difficulty biting and chewing because your teeth and molars are not well aligned, or because of some abnormality in your jaw, you have what we call a ‘functional abnormality’. This can often be remedied by orthodontics. Orthodontics involves improving the position of the teeth using braces.
The basic health-care plan covers the costs of orthodontics only if necessary for specialist dental care. This is the care provided for serious conditions, such as a growth disorder. These are quite rare. The basic health-care plan does not reimburse the costs of ‘regular’ orthodontics.
The Benfit and higher supplementary health-care plans reimburse orthodontics up to the age of 18.
Benfit covers a maximum of €750 in the first 12 months from the start of the treatment and a maximum of €750 in the 12 months following that. The reimbursement stops 2 years after the start of the treatment, therefore, or when you turn 18.
Optifit covers a maximum of €1,000 in the first 12 months after the treatment starts, up to €1,000 in the subsequent 12 months and up to €1,000 in the 12 months after that. The reimbursement stops 3 years after the start of the treatment, therefore, or when you turn 18.
Topfit and Superfit provide full coverage for orthodontics. With Benfit and Optifit, the reimbursement stops when you turn 18. Topfit and Superfit also include reimbursement for orthodontics from the age of 18.
The dental health-care plans do not reimburse the costs of orthodontics.
Whom to contact • dentist • orthodontist1
What is not covered • orthodontics mainly for aesthetic purposes
1 Orthodontists are listed in the register of the Wet BIG [Dutch Individual Health-Care Professions Act] as dental specialists for dento-maxillary orthopaedics
ONVZ Coverage 2018 - version 1.2 142 Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit €1,500 From the start of treatment: 1st 12 months maximum of €750 2nd 12 months maximum of €750
Optifit €3,000 From the start of treatment: 1st 12 months maximum of €1,000 2nd 12 months maximum of €1,000 3rd 12 months maximum of €1,000
Topfit 100%
Superfit 100%
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We determine the start date when we receive the first claim We look at the date of the consultation or treatment in that case. If the orthodontist finds during a first consultation that it would be better for your child to wait before getting braces, it could make sense financially to pay for that consultation yourself if you have Benfit or Optifit. Otherwise the 2 or 3-year reimbursement period will start counting down before treatment really starts. Tell the orthodontist you will be paying personally in that case, because many orthodontists send the claim directly to ONVZ.
We only cover routine health care that you actually need In this case, routine health care is the orthodontic care that is standard practice for dentists and orthodontists to correct a functional abnormality. Simple when possible, and more complex when necessary.
ONVZ Coverage 2018 - version 1.2 143 Orthodontics from the age of 18
Being able to bite and chew properly is important for your overall health.
What is covered
If you have difficulty biting and chewing because your teeth and molars are not well aligned, or because of some abnormality in your jaw, you have what we call a ‘functional abnormality’. This can often be remedied by orthodontics. Orthodontics involves improving the position of the teeth using braces.
The basic health-care plan covers the costs of orthodontics only if necessary for specialist dental care. This is the care provided for serious conditions, such as a congenital abnormality or a growth disorder. These are quite rare. The basic health-care plan does not reimburse the costs of ‘regular’ orthodontics.
If you are aged 18 or above and require braces, the Topfit and Superfit supplementary health-care plans reimburse orthodontics up to the age of 18. Topfit will reimburse a maximum of €500 per calendar year. Superfit covers the full costs of orthodontics.
Whom to contact • dentist • orthodontist1
What is not covered • orthodontics mainly for aesthetic purposes
Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit €500 Maximum per calendar year
Superfit 100%
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
1 Orthodontists are listed in the register of the Wet BIG [Dutch Individual Health-Care Professions Act] as dental specialists for dento-maxillary orthopaedics
ONVZ Coverage 2018 - version 1.2 144 What you have to do yourself
You are required to seek our authorisation first We only reimburse the costs of orthodontics if we have given permission1 in advance. In order to assess your request, we need a written explanation from your health-care provider. This must be accompanied by a treatment plan and budget.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this case, routine health care is the care that is standard practice for dentists and orthodontists. Simple when possible, and more complex when necessary.
Dental prosthesis (‘prosthesis’) from the age of 18
Dentures, implant-supported dentures, prostheses...an overview.
What is covered
Of course you try to keep your own teeth healthy for as long as possible, but at some point your dentist may recommend that you get dentures. This is also called a prosthesis or prosthetic.
The reimbursement differs for partial dentures or full dentures. If you have partial dentures, you still have several teeth or molars in your jaw. The partial dentures replace the missing teeth or molars. Full dentures replace all the teeth and molars in the jaw. You could have full dentures for the lower jaw, the upper jaw or for both jaws.
The basic health-care plan covers the costs of full, removable dentures from the age of 18, i.e. dentures that you can put in and take out yourself. The basic health-care plan does not reimburse the costs of partial dentures.
Different types of full, removable dentures are covered. Here is an overview.
(1) The immediate prosthesis. These are temporary dentures that you receive after all teeth and molars have been pulled. You wear these until the mouth has healed.
(2) A regular prosthesis (not implant-supported). These are dentures that you receive after the immediate prosthesis. They are also called a ‘replacement prosthesis’.
(3) An overdenture (not implant-supported). These are dentures placed over your own tooth roots.
(4) Implant-supported dentures.
You receive partial reimbursement. This is a percentage of the total costs, including equipment and technical costs, i.e. the costs of the dentist or prosthodontist and the equipment and technical costs. With implant- supported dentures, the magnets, pins or press studs that stick out above the gum (‘the fixed part of the superstructure’) also count towards the total costs.
The percentage that we do not reimburse is your statutory personal contribution. You must pay this yourself. The Superfit and Tandfit supplementary health-care plans reimburse part of this personal contribution. The basic health-care plan covers these percentages of the total costs (including equipment and technical costs): • dentures (1), (2) or (3) for the upper and/or the lower jaw: 75% (personal contribution 25%) • implant-supported dentures (4) for the lower jaw: 90% (personal contribution 10%) • implant-supported dentures (4) for the upper jaw: 92% (personal contribution 8%) • a combination of (1), (2) or (3) in one jaw and (4) in the other jaw: 83% (personal contribution 17%)
1 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen
ONVZ Coverage 2018 - version 1.2 145 What is the situation with implants? When you first get implant-supported dentures, implants must be fitted. The basic health-care plan covers the costs of the implants only if you have a very shrunken jaw without teeth. In that case, the fitting of the implants comes under specialist dental care. If you do not have a seriously shrunken, toothless jaw, the Superfit or Tandfit supplementary health-care plans reimburse the costs of having the implants fitted by the dentist.
If the dentures no longer fit or are broken You can have them repaired or rebased (filled) by a prosthodontist or dentist. If your dentures are less than two months old, customising them is included in the purchase. You do not need to pay separately for this. If your dentures are more than two months old, the basic health-care plan includes coverage for:
• repair and rebasing (filling): 90% (personal contribution 10%)
Whom to contact • dentist • prosthodontist
Coverage under each health-care plan
Basic health-care plan Depending on type: 75% to 92% Full dentures with repair/rebasing
Superfit €1,600 Personal contribution, implants, partial dentures
Tandfit A €250 75% of personal contribution, implants and partial dentures
Tandfit B €750 75% of personal contribution, implants and partial dentures
Tandfit C €1,500 75% of personal contribution, implants and partial dentures
Tandfit D €1,500 Personal contribution, implants, partial dentures
Tandfit Preventief No coverage
What you pay
The excess This care is provided under the basic health-care plan, and is therefore subject to the excess.
The personal contribution You pay a statutory personal contribution of 8, 10, 17 or 25% for this care. The Superfit and Tandfit A, B, C and D supplementary health-care plans reimburse all or part of this personal contribution.
ONVZ Coverage 2018 - version 1.2 146 What you have to do yourself
You often need permission in advance We only reimburse the following care if we have given permission in advance: • dentures 1, 2 or 3 from the dentist costing more than €650 (including equipment and technical costs) per jaw • dentures 1, 2 or 3 from the prosthodontist costing more than €500 (including equipment and technical costs) per jaw • the replacement of dentures 2 or 3 if they are less than 5 years old • the implant-supported dentures (4) • the repair or rebasing of implant-supported dentures • care provided by a dental hospital (even if the costs are below €650 or €500)
You need to request permission1 with a substantiated statement from your health-care provider. This must be accompanied by a treatment plan and budget.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this case, routine health care is the dental health care that is standard practice for dentists. Simple when possible, and more complex when necessary.
Front-teeth replacement
If you are missing your permanent incisors or canines and are younger than 23.
What is covered
If your permanent incisors or canines did not develop, or if they were lost in an accident, it is possible to (re) insert incisors or canines. This is usually done with an implant and crown.
The basic health-care plan covers the costs of replacing one or more entirely missing permanent incisors or canines. This must be done using non-plastic material such as a crown or bridge. Implants needed for this are also covered.
The dentist must have determined prior to your 18th birthday that this would be necessary for you. The reimbursement stops when you turn 23.
If the necessity was not determined until after you turned 18, or if an incisor or canine is only partially missing, the basic health-care plan does not include coverage for the care. The Superfitand Tandfit A, B, Cand D supplementary health-care plans reimburse the care (in part) if performed by a dentist.
If, besides missing incisors or canines, you have other serious tooth problems as well, the front-teeth replacement may come under specialist dental care.
You can contact a: • dentist • dental surgeon2
1 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen 2 Dental surgeons are listed in the register of the Wet BIG [Dutch Individual Health-Care Professions Act] as dental specialists for dental health care, dental surgery, and maxillofacial surgery
ONVZ Coverage 2018 - version 1.2 147 Coverage under each health-care plan
Basic health-care plan 100% Until the age of 23 (if necessity was determined before 18th birthday)
Superfit No coverage
Tandfit A No coverage
Tandfit B No coverage
Tandfit C No coverage
Tandfit D No coverage
Tandfit Preventief No coverage
What you pay
The excess This care is provided under the basic health-care plan, and is therefore subject to the excess from the age of 18.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You are required to seek our authorisation first We only reimburse the costs of this care if we have given permission1 before treatment starts. You need to request permission with a substantiated statement from your health-care provider. This must be accompanied by a treatment plan, budget and X-ray of your teeth.
In some cases, you need to have a referral If you need to visit the dental surgeon or dental hospital for this care, you must have a referral from your general practitioner or dentist.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this case, routine health care is the dental health care that is standard practice for dentists and dental specialists. Simple when possible, and more complex when necessary.
1 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen
ONVZ Coverage 2018 - version 1.2 148 Dental surgery from the age of 18
For specialist dental health care.
What is covered
For specialist dental health care, you go to an oral and maxillofacial surgeon, sometimes abbreviated as OMS or OMFS. This specialist is usually referred to as a dental surgeon, which is the term we will use in the following.
The dental surgeon works at a hospital or independent treatment centre1. You cannot go to the dental surgeon directly: you always need a referral. You get this referral from the dentist, for instance if you have a difficult- to-remove wisdom tooth, or from the orthodontist, if you have jaw problems. Your general practitioner or a medical specialist could also refer you.
The basic health-care plan covers the costs of surgical dental care. We also reimburse the X-ray examinations needed for this. If you need to be admitted, the basic health-care plan also covers the hospital admission.
Whom to contact • dental surgeon2
What is not covered • surgery on the gums (periodontal surgery) • the pulling of teeth or molars if the dentist is able to do this • implants (except if this involves specialist dental care)
If you need to go to the dental surgeon for a serious condition, such as a congenital abnormality, this can come under specialist dental care. If you are under the age of 18, the reimbursement for dental health care up to the age of 18 applies.
Coverage under each health-care plan
Basic health-care plan 100%
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit No coverage
What you pay
The excess This care is provided under the basic health-care plan, and is therefore subject to the excess.
No personal contribution You will not be charged a personal contribution for this care.
1 Like a hospital, this is a facility for specialist medical care, but generally for non-urgent, less complex care that does not require admission to hospital 2 Dental surgeons are listed in the register of the Wet BIG [Dutch Individual Health-Care Professions Act] as dental specialists for dental health care, dental surgery, and maxillofacial surgery
ONVZ Coverage 2018 - version 1.2 149 What you have to do yourself
Sometimes you need permission from us in advance We only reimburse the following treatments if we have given permission1 in advance: • the pulling of teeth and molars under anaesthetic • jaw surgery (osteotomy) • care provided in a dental hospital
In order to assess your request, we need a written explanation from your health-care provider. This must be accompanied by a treatment plan and budget, and, if taken, X-rays or other photos of your jaw and teeth.
You need to have a referral first Before you go to the dental surgeon, you must have a referral from your dentist, orthodontist, general practitioner or medical specialist. A referral is not required for emergency health care.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this case, routine health care is the surgical dental care of a specialist nature that is standard practice for dental surgeons. Simple when possible, and more complex when necessary.
Specialist dental care
When ordinary dental care is not enough.
What is covered
For healthy teeth that work properly, most people can get by with the ‘regular’ care provided by the dentist and dental hygienist.
Sometimes this care is not enough. For instance, because you have a particular condition of the teeth, jaw or mouth, or because you have a physical or psychological condition. In these kinds of cases, additional or different dental health care may be necessary. We refer to this care as ‘specialist dental care’.
Only in special situations The basic health-care plan covers specialist dental care in 3 situations:
1. If you have a serious developmental disorder, growth disorder or non-congenital abnormality of the teeth, jaw or mouth. For instance: certain teeth or molars are missing due to a genetic cause.
2. If you have a non-dental physical or psychological condition. For example: serious Parkinson’s or extreme anxiety.
3. If you must receive a medically necessary treatment, which will not result in a good outcome without specialist dental care. For example: an organ transplant or heart operation for which the mouth must be rendered free of infection.
If situation 1 or 2 applies to you, you will only be reimbursed the costs of the care if your teeth cannot or cannot continue to function in the manner normal for you without the specialist dental care. The basic health- care plan covers the costs of the specialist dental care required to ensure that you recover or maintain the dental functioning that is normal for you.
If situation 3 applies to you, the basic health-care plan covers the specialist dental care needed to facilitate the other treatment as well as the care aimed at ensuring that your teeth continue to function in the manner that is normal for you.
1 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen
ONVZ Coverage 2018 - version 1.2 150 Sometimes: implants If you will be receiving a full, removable implant-supported prosthesis (dentures), the implants are covered under specialist dental care if you have a very shrunken, toothless jaw.
Usually not: orthodontics Orthodontics are only covered under specialist dental care if: • you have a very serious developmental disorder or growth disorder of the teeth, jaw or mouth, and • that disorder must also be treated by health-care providers other than a dentist or orthodontist
If necessary: admission If this care requires that you be admitted, the basic health-care plan also covers the hospital admission.
Please note: you usually pay a personal contribution This applies if you are 18 years or older and you are also receiving care that is not directly related to situation 1, 2 or 3 at the same time as the specialist dental care. For example: if you have serious Parkinson’s and a cavity is being filled. In that case, you will pay as a personal contribution the amount you would have had to pay if you had received ‘regular’ treatment for that cavity.
If you have a Superfit or Tandfit supplementary health-care plan, the personal contribution comes under Dental health care from the age of 18.
Whom to contact • dentist • dental surgeon • orthodontist • dental hospital
Coverage under each health-care plan
Basic health-care plan 100% In special situations, sometimes with a personal contribution
Superfit The personal contribution As per Superfit coverage
Tandfit A The personal contribution As per Tandfit A coverage
Tandfit B The personal contribution As per Tandfit B coverage
Tandfit C The personal contribution As per Tandfit C coverage
Tandfit D The personal contribution As per Tandfit D coverage
Tandfit Preventief The personal contribution As per Tandfit Preventief coverage
What you pay
The excess This care is provided under the basic health-care plan, and is therefore subject to the excess from the age of 18.
ONVZ Coverage 2018 - version 1.2 151 The personal contribution You pay a personal contribution for dental treatments that are not directly related to the condition.
What you have to do yourself
You must always request permission from us in advance In order to assess your request1, we need a written explanation2 from your health-care provider. This must be accompanied by a treatment plan and, if taken, X-rays or other photos of your jaw and teeth. Please note: we can revoke permission if you do not follow the health-care provider’s instructions (for instance: if you fail to wear braces).
In some cases, you need to have a referral If you need to visit the dental surgeon or dental hospital for this care, you must have a referral for this from your dentist, general practitioner, medical specialist, school doctor, doctor for the mentally disabled, elderly medical care specialist or nursing home doctor.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this case, routine health care is the care that is standard practice for dentists and dental specialists. Simple when possible, and more complex when necessary.
DiamondClean Smart toothbrush
The first step towards healthy teeth is good brushing. And what’s the secret to good brushing? The DiamondClean Smart toothbrush.
What is covered
Tandfit Preventief provides excellent coverage for preventive and other dental health care.
If you have Tandfit Preventief, you also receive:
• a Philips DiamondClean Smart 9300 toothbrush (black), with glass charger, travel case and app, once every 3 years • 1 starter pack with 3 brush heads: Premium Plaque Defense, Premium Gum Care and Premium White, for thorough plaque removal, for healthier gums and white teeth • a prevention package with a new brush head every 3 months
When you receive the toothbrush You will receive the DiamondClean Smart once your Tandfit Preventief plan has been finalised. The prevention package will be sent to your home address automatically.
Questions If you have any questions about your health-care plan, don’t hesitate to call us. We’d be happy to help. If you have any questions about the toothbrush, please call Philips on 0900 202 11 77.
The brush is guaranteed for 3 years The guarantees takes effect when you receive the brush and is subject to terms and conditions2. Your proof of guarantee will be available on MijnONVZ from March 2018. If you need it earlier, please use the packing slip or serial number. Please contact Philips for the guarantee. The telephone number is given above.
1 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen 2 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22
ONVZ Coverage 2018 - version 1.2 152 Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit No coverage
Tandfit A No coverage
Tandfit B No coverage
Tandfit C No coverage
Tandfit D No coverage
Tandfit Preventief 1 toothbrush every 3 years, 1 brush head quarterly
What you pay
No excess The DiamondClean Smart comes under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You do not pay a personal contribution for the DiamondClean Smart.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Delivery is only possible in the Netherlands and Belgium If you move to another country, you will no longer receive the brush heads. You can, however, continue to use the DiamondClean Smart and your Tandfit Preventief plan will remain in effect.
If you do not pay your premium, you will no longer be entitled to the brush The brush remains property of ONVZ.
ONVZ Coverage 2018 - version 1.2 153 Psychological health care Coverage
General basic mental health care (GGZ) Specialist mental health care (GGZ) General basic mental health care (GGZ)
If you have a psychological disorder.
What is covered
If you have psychological problems, your general practitioner or corporate doctor will be your first port of call. He/she will talk to you and discuss what care is most appropriate for dealing with your problems. If your doctor suspects you have a psychological disorder, he/she will refer you for general basic mental health care (GGZ) for treatment by a psychotherapist or health psychologist1, for example.
You receive general basic mental health care (GGZ) in individual sessions. Sometimes an online programme constitutes part of the treatment.
You are always assigned a treatment coordinator. He/she is the first point of contact for you and those close to you. The treatment coordinator will establish a diagnosis and then draw up a treatment plan, together with you. He/she can also engage other practitioners, ensuring sound cooperation and coordination, and is responsible for managing your case.
Your health-care provider works in accordance with a statute of standards Since 1 January 2017, this has been mandatory for all mental health-care providers. This statute of standards2 sets out the quality standards that the health-care provider must satisfy and how the care is organised for you. The statute of standards is available on the health-care provider’s website.
The basic health-care plan reimburses the costs of general basic mental health care (GGZ) if you are 18 or older, but only if your doctor suspects that you have a psychological disorder or such a disorder has already been ascertained.
The basic health-care plan does not reimburse: • treatment of an adjustment disorder. This is the case if someone is having difficulty emotionally adjusting to a new situation, for instance after a death or divorce • treatment of burn-out or severe stress, or other work-related complaints • treatment of relationship problems
The Optifit and higher supplementary health-care plans cover general basic mental health care (GGZ) for all ages in the event of an adjustment disorder or work or relationship problems, up to a maximum amount per calendar year.
Whom to contact If the health care is covered by the basic health-care plan, you can contact a mental health-care centre. Your treatment coordinator is one of the health-care providers listed in points 1 to 7. You can also go to a health- care provider with an independent practice. This could be one of the health-care providers listed in points 1 to 4.
1. health psychologist 2. clinical psychologist 3. psychotherapist 4. clinical neuropsychologist 5. specialist mental health-care nurse 6. for dementia: elderly medical care specialist or clinical geriatric specialist 7. for addiction or gambling problems: addiction specialist
If the health care is covered by the supplementary health-care plan, you can contact: • health psychologist • clinical psychologist • paediatric psychologist, registered with the Dutch Association of Psychologists (NIP) or the Stichting Kwaliteitsregister Jeugd [Youth Quality Register Foundation] (SKJ) • general remedial educationalist, registered with the Dutch Association of Psychologists (NIP) or the Stichting Kwaliteitsregister Jeugd [Youth Quality Register Foundation] (SKJ)
Transitional arrangement for 18-year-olds Mental health care for people under the age of 18 is covered by the Jeugdwet [Youth Act]. A paediatric psychologist or general remedial educationalist can be the treatment coordinator. The care transfers to the basic health-care plan when the person turns 18. The paediatric psychologist or general remedial educationalist cannot be a treatment coordinator for care under the basic health-care plan, but it can sometimes be beneficial to have treatment continue with the same treatment coordinator. If you are receiving
1 Also: health-care psychologist 2 This must have been drawn up in accordance with the model statute of standards for mental health care, as included in the Dutch National Health Care Institute’s Register van kwaliteitsstandaarden (Quality Standards Register)
ONVZ Coverage 2018 - version 1.2 155 treatment from a paediatric psychologist or general remedial educationalist on your 18th birthday, we reimburse the costs of continuing this treatment for a maximum of 12 months. The government does not permit a longer period. During this time, the treatment can either be concluded or handed over to a treatment coordinator under the basic health-care plan.
What is not covered • treatment of fear of flying • treatment of learning disorders, such as dyslexia • inpatient treatment • care which has not been proven, or adequately proven, to be effective. You can find more information on which treatments are regarded as effective in the Dynamisch overzicht psychologische interventies ggz [Dynamic summary of psychological interventions within mental health care]1
Coverage under each health-care plan
Basic health-care plan 100% For diagnosed or suspected psychological disorders
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit €500 Maximum per calendar year For adjustment disorders and work and relationship problems
Topfit €1,000 Maximum per calendar year For adjustment disorders and work and relationship problems
Superfit €1,500 Maximum per calendar year For adjustment disorders and work and relationship problems
What you pay
The excess The excess applies to care under the basic health-care plan. No excess applies to care under the supplementary health-care plan.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You need to have a referral first Before you go to the health-care provider, you must have a referral from your general practitioner or corporate doctor. For adjustment disorders, the referral may also be from a school doctor. No referral is needed in acute cases.
1 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22
ONVZ Coverage 2018 - version 1.2 156 If you are receiving specialist mental health-care treatment (GGZ), your treatment coordinator can also refer you to general basic mental health care (GGZ). You will not need to go to your general practitioner to get the referral.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
A psychological disorder according to the DSM Mental health care comes under the basic health-care plan, but only in cases of a psychological disorder or where the referrer suspects that the person has such a disorder. All psychological disorders are described in the ‘Diagnostic and Statistical Manual of Mental Disorders’, DSM. This is an international standard for categorising psychological disorders. DSM-5 is the version currently in use.
We only cover routine health care that you actually need In this case, routine health care is the general basic mental health care (GGZ) that is standard practice for clinical psychologists and that has been proven effective. Simple when possible, and more complex when necessary.
In the event of a waiting list, please contact the ZorgConsulent You can ask the ZorgConsulent to help reduce the waiting time on your behalf. Our ZorgConsulent advisers can also help with other types of health-care mediation.
Specialist mental health care (GGZ)
If serious or complex psychological problems require an intensive approach.
What is covered
If you have psychological problems, your first port of call is usually the general practitioner. He/she discusses with you what the best solution is for your problems. You can often be treated by the general practitioner or in general basic mental health care (GGZ)1. If your psychological problems are too serious or complex for this, the general practitioner will refer you to a psychiatrist, psychotherapist or mental health-care centre for specialist mental health care. You can also get this kind of referral from your general basic mental health-care practitioner (GGZ).
You are always assigned a treatment coordinator. He/she is the first point of contact for you and those close to you. The treatment coordinator will establish a diagnosis and then draw up a treatment plan, together with you. He/she can also engage other practitioners, ensuring sound cooperation and coordination, and is responsible for managing your case.
The basic health-care plan covers specialist mental health care (GGZ) if you are 18 or older.
If admission is necessary for a good treatment result, the basic health-care plan will cover this as well, along with any nursing and other care, allied health care, medicines and medical devices and dressings that may be required.
Admission may be to a mental health-care centre2 or to a hospital psychiatric department. If organised daytime activities are provided during the admission, we also cover the costs of these daytime activities and the required transport.
Whom to contact A mental health-care centre or a hospital psychiatric department. Your treatment coordinator is one of the health-care providers listed in points 1 to 8. If you are admitted for the treatment, the treatment coordinator must be a psychiatrist (4) or clinical psychologist (1). He/she can arrange with the treatment coordinator you had prior to admission that you will keep the same treatment coordinator during admission.
You can also go to a health-care provider with an independent practice. This could be one of the health-care providers listed in points 1 to 4.
1 Mental health care 2 A facility that has permission from the government to provide specialist mental health care (GGZ). For care that requires admission: a facility authorised to provide in-patient specialist mental health care
ONVZ Coverage 2018 - version 1.2 157 1. clinical psychologist 2. psychotherapist 3. clinical neuropsychologist 4. psychiatrist 5. health psychologist 6. specialist mental health-care nurse 7. for dementia: elderly medical care specialist or clinical geriatric specialist 8. for addiction or gambling problems: addiction specialist
A statute of standards is always available on your health-care provider’s website. This statute of standards sets out how the care is organised for you.
Transitional arrangement for 18-year-olds Mental health care for people under the age of 18 is covered by the Jeugdwet [Youth Act]. A paediatric psychologist or general remedial educationalist can be the treatment coordinator. The care transfers to the basic health-care plan when the person turns 18. The paediatric psychologist or general remedial educationalist cannot be a treatment coordinator for care under the basic health-care plan, If you are receiving treatment from a paediatric psychologist or general remedial educationalist on your 18th birthday, we reimburse the costs of continuing this treatment for a maximum of 12 months. The government does not permit a longer period. During this time, the treatment must either be concluded or handed over to a treatment coordinator under the basic health-care plan.
What is not covered • treatment of simple psychological disorders that can be treated in general basic mental health care (GGZ) or with psychological health care with a general practitioner • treatment of adjustment disorders1 • treatment of burn-out and severe stress, or other work-related complaints • treatment of relationship problems • care which has not been proven, or adequately proven, to be effective. You can find more information on which treatments are regarded as effective in the Dynamisch overzicht psychologische interventies ggz [Dynamic summary of psychological interventions within mental health care]2
Coverage under each health-care plan
Basic health-care plan 100% For diagnosed or suspected psychological disorders
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit No coverage
1 This is the case if someone is having difficulty emotionally adjusting to a new situation, for instance after a death or divorce 2 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22
ONVZ Coverage 2018 - version 1.2 158 What you pay
The excess This care is provided under the basic health-care plan, and is therefore subject to the excess.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You need to have a referral first Before you go to the health-care provider, you must have a specific referral from your general practitioner or a medical specialist. This means that the general practitioner or medical specialist believes that the specialist mental health care (GGZ) is the most appropriate form of treatment. No referral is needed in acute cases.
If you are receiving general basic mental-health care treatment (GGZ), your treatment coordinator can refer you to specialist mental health care (GGZ). You will not need to go to your general practitioner to get the referral.
You sometimes need permission for admission This applies: • to admission for treatment of: alcohol-related disorders, other substance-related disorders or eating disorders. For emergency care, permission must be requested (by you or on your behalf) within the first month of treatment • to admissions of longer than 1 year. You must submit a request no later than in the 10th month Your health-care provider can request the permission1 for you.
If you have the request sent to the attention of our medical adviser, it will be examined and assessed by him/her.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
A psychological disorder according to the DSM Mental health care comes under the basic health-care plan, but only in cases of a psychological disorder or where the health-care provider suspects that you have such a disorder. All psychological disorders are described in the ‘Diagnostic and Statistical Manual of Mental Disorders’, DSM. This is an international standard for categorising psychological disorders. DSM-5 is the version currently in use.
A word of caution in relation to admission abroad Different guidelines may apply to specialist mental health care and admissions abroad. If admission to a mental health-care facility abroad has been planned in advance, it is possible that not everything will be insured. Please contact our Service Centre first. This will help avoid any nasty surprises later on.
Your invoice may list a diagnosis If you do not want this information to appear, you can sign a privacy statement together with your practitioner and send it to ONVZ. Your health-care provider knows how this works.
We will cover up to 3 continuous years of admission In the event of the period of admission being interrupted, we will treat the admission as continuous, providing the interruption is for no more than 30 days. If the interruption is for a holiday or weekend leave, any such leave will count towards the three-year total.
We only cover routine health care that you actually need In this case, routine health care is the specialist mental health care (GGZ) that is standard practice for psychiatrists and clinical psychologists. Simple when possible, and more complex when necessary.
In the event of a waiting list, please contact the ZorgConsulent You can ask the ZorgConsulent to help reduce the waiting time on your behalf. Our ZorgConsulent advisers can also help with other types of health-care mediation.
1 See: www.onvz.nl/zelf-regelen/toestemming-vragen/toestemming-vragen-voor-opname-ggz
ONVZ Coverage 2018 - version 1.2 159 Contraceptives Coverage
Contraceptive devices Sterilisation and reversal operation Contraceptive devices
To prevent pregnancy.
What is covered
Contraceptive devices are means for preventing pregnancy.
Most contraceptive devices are medicines, such as the pill, injection, patch and hormonal intrauterine device. The diaphragm and copper intrauterine device are medical appliances.
The basic health-care plan covers contraceptive medicines and medical appliances up to the age of 21.
The basic health-care plan covers contraceptive medicines from the age of 21 as well, but only in the event of these 2 indications:
• endometriosis (condition affecting the uterine tissue) • menorrhagia (heavy menstrual bleeding), if this causes anaemia
The Benfit and higher supplementary health-care plans reimburse contraceptive medicines and medical appliances from the age of 21.
Whom to contact • pharmacy • dispensing practice
An intrauterine device is fitted by a general practitioner or a midwife. You can also have it fitted in hospital. In that case, you do not purchase it yourself; the intrauterine device comes under care provided by the medical specialist in that case. We do not reimburse it separately.
The Optifit and higher supplementary health-care plans also reimburse sterilisation.
What is not covered • condoms
Coverage under each health-care plan
Basic health-care plan Up to the age of 21, 100%; from the age of 21, only in the event of certain conditions
Startfit No coverage
Extrafit No coverage
Benfit 100%
Optifit 100%
Topfit 100%
Superfit 100%
ONVZ Coverage 2018 - version 1.2 161 What you pay
The excess The excess applies to care under the basic health-care plan. No excess applies to care under the supplementary health-care plan.
The personal contribution A statutory personal contribution sometimes applies to contraceptive medicines. Please see medicijnkosten.nl to find out whether a statutory personal contribution applies. TheBenfit and higher supplementary health-care plans reimburse the personal contribution.
What you have to do yourself
You must have a prescription We only reimburse contraceptive medicines if they have been prescribed by a doctor, general practitioner, medical specialist, midwife, specialist nurse (nurse practitioner) or physician assistant1. You can purchase the copper intrauterine device and diaphragm (contraceptive medical appliances) from the pharmacy without a prescription.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Sterilisation and reversal operation
To prevent pregnancy, or make it possible again.
What is covered
If you do not want any (more) children, sterilisation is usually a permanent way of preventing pregnancy. Both women and men can undergo sterilisation. For men, the operation is called a ‘vasectomy’. A reversal can sometimes undo the sterilisation.
The Benfit and higher supplementary health-care plans cover the costs of sterilisation. Topfit and Superfit also provide coverage for a reversal.
Whom to contact • a medical specialist • for a vasectomy: a general practitioner
1 The physician assistant can perform some examinations, give injections, and prescribe medicine independently. He/she can also work under the direction of a medical specialist
ONVZ Coverage 2018 - version 1.2 162 Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit 100% sterilisation No coverage for reversal operation
Optifit 100% sterilisation No coverage for reversal operation
Topfit 100% for sterilisation and reversal operation
Superfit 100% for sterilisation and reversal operation
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You must have a referral in advance for the medical specialist If you go to the medical specialist for sterilisation or a reversal, you must have a referral from your general practitioner.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care In this case, routine health care is the care that is standard practice for the general practitioner or medical specialist for sterilisation or reversal. Simple when possible, and more complex when necessary.
ONVZ Coverage 2018 - version 1.2 163 Alternative/non-conventional Coverage
Alternative/non-conventional medicine Alternative/non-conventional medicine
A supplement to regular treatments.
What is covered
Alternative/non-conventional medicine involves tests and treatments that have not, or not yet, been proven by science to be effective.
The basic health-care plan does not cover the costs of alternative/non-conventional medicine.
The Extrafit and higher supplementary health-care plans cover alternative tests and treatments. The maximum reimbursement depends on which supplementary health-care plan you have, as does which health-care providers you can contact. For Extrafit, you can contact a doctor that provides alternative/non- conventional medicine. This includes a doctor who practices acupuncture1. Benfit also reimburses the costs of an acupuncturist who is not a doctor. Optifit, Topfit and Superfit also reimburse the costs of other health-care providers who are not doctors. We refer to health-care providers who are not doctors as ‘practitioners’. This covers acupuncturists as well. A practitioner must always have full membership of a professional organisation that is recognised by us2 and must satisfy the PLATO (Platform Opleiding, Onderwijs en Organisatie [Training, Education and Organisation Platform]) requirements3.
The Optifit and higher supplementary health-care plans also cover registered4 homeopathic and anthroposophic medicines and laboratory and other tests. A reimbursement limit applies per calendar year and you must have a prescription from your doctor or practitioner.
An overview is provided below.
Extrafit • you can visit: a doctor • up to 20 treatments per calendar year • up to €27 per treatment • no coverage for medicines and laboratory and other tests
Benfit • you can visit: a doctor or an acupuncturist • up to 20 treatments per calendar year • up to €27 per treatment • no coverage for medicines and laboratory and other tests
Optifit • you can visit: a doctor or a practitioner (including an acupuncturist) • for treatment by a doctor: up to €85 per treatment, up to €750 per calendar year • for treatment by a practitioner: up to €65 per treatment, up to €250 per calendar year • up to €250 for laboratory and other tests and registered homeopathic and anthroposophic medicines combined
Topfit • you can visit: a doctor or a practitioner (including an acupuncturist) • for treatment by a doctor: up to €85 per treatment, up to €1,000 per calendar year • for treatment by a practitioner: up to €65 per treatment, up to €500 per calendar year • up to €500 for laboratory and other tests and registered homeopathic and anthroposophic medicines combined
Superfit • you can visit: a doctor or a practitioner (including an acupuncturist) • for treatment by a doctor: up to €85 per treatment, up to €1,250 per calendar year • for treatment by a practitioner: up to €65 per treatment, up to €500 per calendar year • up to €750 for laboratory and other tests and registered homeopathic and anthroposophic medicines combined
1 An acupuncturist listed in the register of the Wet BIG [Dutch Individual Health-Care Professions Act] as a doctor 2 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22 3 More information is available at: www.onvz.nl/vergoedingen/plato-eisen 4 These have been given an RVG or RVH number by the Medicines Evaluation Board (CBG)
ONVZ Coverage 2018 - version 1.2 165 Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit €27 per treatment, max. 20 x (doctor) Maximum per treatment/calendar year No medicines or lab and other testing
Benfit €27 per treatment, max. 20 x (doctor or acupuncturist) Maximum per treatment/calendar year No medicines or lab and other testing
Optifit €85 per treatment, max. €750 (doctor) €65 per treatment, max. €250 (acupuncturist or other practitioner) €250 for lab and other testing and medicines Maximum per treatment/calendar year
Topfit €85 per treatment, max. €1,000 (doctor) €65 per treatment, max. €500 (acupuncturist or other practitioner) €500 for lab and other testing and medicines Maximum per treatment/calendar year
Superfit €85 per treatment, max. €1,250 (doctor) €65 per treatment, max. €500 (practitioner) €750 for lab and other testing and medicines Maximum per treatment/calendar year
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
If the health-care provider is not a doctor, he/she must have full membership of a professional organisation that is recognised by us and must satisfy the PLATO (Platform Opleiding, Onderwijs en Organisatie [Training, Education and Organisation Platform]) requirements We only reimburse the care from these health-care providers: • doctor • practitioner who has full membership of a professional organisation included on our list of recognised professional organisations1 and who also satisfies the PLATO Platform( Opleiding, Onderwijs en Organisatie [Training, Education and Organisation Platform]) requirements2
For laboratory tests and medicines, you must have a prescription from your doctor or practitioner
You must collect medicines from the pharmacy or dispensing general practitioner’s practice We do not reimburse the costs of registered homeopathic and anthroposophic medicines that you collect elsewhere.
1 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22 2 More information is available at: www.onvz.nl/vergoedingen/plato-eisen
ONVZ Coverage 2018 - version 1.2 166 Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only reimburse the routine health care that you need and no more than 1 treatment per day In this case, routine health care is the care that is standard practice for doctors and practitioners of alternative/ non-conventional medicine as part of their profession. Simple when possible, and more complex when necessary.
We reimburse up to a maximum of the usual rates for the professional group If the professional organisation has standard rates, we will base our reimbursement on these rates.
ONVZ Coverage 2018 - version 1.2 167 Hearing, vision and speech Coverage
Audiological health care Orthoptics Health care for sensory impairment Speech therapy Glasses, (contact) lenses and laser eye treatment Stuttering therapy Audiological health care
I can hear the conversation, but cannot understand it clearly. Sound familiar?
What is covered
Hearing problems arise gradually, due to old age, for instance, or suddenly, as the result of illness. If your hearing problems are bothering you, the general practitioner or another health-care provider can refer you to an audiological centre.
An audiological centre is a facility where a team of specialists in hearing and related problems, such as speech problems, work.
The basic health-care plan covers audiological health care provided by an audiological centre. This includes: • hearing test • advice on buying a hearing aid • information on the use of the hearing aid • psychosocial care if you need this because of your hearing problem • help in diagnosing speech and language disorders in children
If you need a hearing aid, the medical appliances reimbursement applies to this1.
Coverage under each health-care plan
Basic health-care plan 100% At an audiological centre
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit No coverage
What you pay
The excess This care is provided under the basic health-care plan, and is therefore subject to the excess.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You need to have a referral first Before you go to the audiological centre, you must have a referral from a general practitioner, corporate doctor, school doctor, elderly medical care specialist, paediatrician or ENT doctor.
1 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22
ONVZ Coverage 2018 - version 1.2 169 Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this case, routine health care is the audiological care that is standard practice for medical specialists. Simple when possible, and more complex when necessary.
Orthoptics
A lazy eye, cross-eyed...the orthoptist helps you see straight.
What is covered
If you or your child have a lazy eye, suffer from crossed eyes or seeing double, or have problems seeing clearly, you can go to an orthoptist. This health-care provider examines and treats eye conditions relating to vision and the position of and cooperation between the eyes. We call this care orthoptics.
We cover the costs of orthoptics for children and adults.
Most orthoptists work in the ophthalmology department of a hospital, or at an eye clinic. If the general practitioner refers you or your child to the ophthalmologist, you will often see an orthoptist as well. The orthoptist carries out part of the tests for the ophthalmologist. In that case, tests and treatment by the orthoptist are part of specialist medical care.
The orthoptist can also work independently, in the hospital or his/her own practice. If this is so, you can visit the orthoptist directly, without a referral.
The basic health-care plan covers care that the orthoptist provides if you are being treated by an ophthalmologist. The basic health-care plan also reimburses care provided by an independent orthoptist, but only where this involves tests for and treatment of the 5 conditions below: • lazy eye (amblyopia) • crossed eyes (strabismus) • double vision (diplopia) • eye strain (asthenopia) • problems seeing clearly (refractive errors)
If you want to go to the orthoptist for other problems, for instance because you have problems reading or headaches, this is possible too. The Benfit and higher supplementary health-care plans reimburse orthoptics up to a maximum amount per calendar year.
If you visit an orthoptist who practices independently, ask him/her to include the indication on the invoice, so that we can process your claim faster.
ONVZ Coverage 2018 - version 1.2 170 Coverage under each health-care plan
Basic health-care plan 100% For 5 conditions
Startfit No coverage
Extrafit No coverage
Benfit €500
Optifit €750
Topfit €1,000
Superfit €1,500
What you pay
The excess The excess applies to care under the basic health-care plan. No excess applies to care under the supplementary health-care plan.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You usually need to have a referral in advance If you visit the ophthalmologist, you must have a referral for this from your general practitioner, another medical specialist, school doctor, corporate doctor, doctor for the mentally disabled, elderly medical care specialist or nursing home doctor.
If you visit an orthoptist who practices independently, you need a referral from your general practitioner or a medical specialist for the care that comes under the supplementary health-care plan. For care covered by the basic health-care plan, you do not need a referral.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this case, routine health care is the care that is standard practice for ophthalmologists and orthoptists. Simple when possible, and more complex when necessary.
ONVZ Coverage 2018 - version 1.2 171 Health care for sensory impairment
Functioning as independently as possible with hearing, vision or language problems.
What is covered
If you have serious problems with your vision or hearing or serious difficulties with speech or language, health care for sensory impairment is the care that helps you function as independently as possible.
The care can consist of investigating the impairment, but could also be focused on eliminating or compensating for it, by helping you learn braille or sign language, for instance. Family members or carers can be included in the treatment, so that they can also learn sign language, for instance. Learning to cope psychologically with the impairment is also part of the care.
You are not usually admitted for this care.
Health care for sensory impairment is provided by a team of specialists from different disciplines, for instance: a psychologist, a general remedial educationalist and an occupational therapist. We call this multidisciplinary.
The basic health-care plan reimburses the costs of multidisciplinary health care for sensory impairment if you have 1 or more of the following 3 impairments: • you are deaf or hard of hearing (auditory impairment) • you are blind or partially sighted (visual impairment) • you are younger than 23 and have serious difficulties with speech and/or language (a communicative impairment resulting from a language development disorder)
If the treatment can only be successful with temporary admission, the basic health-care plan also covers the admission.
If you are blind or partially sighted and need help getting around, we may reimburse the costs of other medical transportation for you.
Whom to contact A facility for health care for sensory impairment. The facility must be ISO or HKZ-certified and must be legally approved for care or affiliated with VIVIS1 or SIAC2.
The care is provided by a multidisciplinary team.
What is not covered • assistance with daily life (e.g. a sign language interpreter) • complex, long-term and lifelong health care for adult deaf/blind and pre-lingual deaf people3
1 More information is available at: www.vivis.nl 2 More information is available at: www.siac.nu 3 People who are deaf from birth or a very young age, before language development begins
ONVZ Coverage 2018 - version 1.2 172 Coverage under each health-care plan
Basic health-care plan 100% The health care and medically necessary admission
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit No coverage
What you pay
The excess This care is provided under the basic health-care plan, and is therefore subject to the excess.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You must have a referral in advance Before you go to the health-care provider, you must have a referral. • In the event of an auditory or communicative impairment, a medical specialist or clinical physician of audiology from an audiological centre must refer you in accordance with the guidelines published by the Federatie van Nederlandse Audiologische Centra [Federation of Dutch Audiological Centres] (FENAC) • In the event of a visual impairment, a medical specialist must refer you in accordance with the guidelines onVisusstoornissen, revalidatie en verwijzing [Visual Impairments, rehabilitation and referral] published by the Nederlands Oogheelkundig Gezelschap [Dutch Ophthalmological Association] (NOG)1. Adults with a simple rehabilitation need do not need a new referral
If you have a new need for care after this initial referral, but nothing has changed in terms of your condition, your general practitioner or school doctor can also refer you.
You must have permission in advance for admission If you need to be admitted for the care, we must give permission2 for this in advance. You need to request permission with a substantiated statement from the main health-care provider.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
1 More information is available at: www.oogheelkunde.org 2 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen
ONVZ Coverage 2018 - version 1.2 173 We only cover routine health care that you actually need In this context, routine health care is the multidisciplinary care aimed at learning to deal with, counteracting or compensating for the impairment, with the goal of helping you to live as independently as possible. Simple when possible, and more complex when necessary.
We will cover up to 3 continuous years of admission In the event of the period of admission being interrupted, we will treat the admission as continuous, providing the interruption is for no more than 30 days. If the interruption is for a holiday or weekend leave, any such leave will count towards the 3-year total.
Speech therapy
For problems with the voice or speech.
What is covered
If something goes wrong with an everyday matter like speaking, breathing or swallowing, this can have a major impact on your life. For children, this can even get in the way of their development.
The speech therapist deals with problems with the voice, speaking and swallowing in both children and adults. Stuttering is a common example of this kind of problem. Other problems include often being hoarse or swallowing the wrong way, or being unable to pronounce certain words or sounds. The care provided by a speech therapist is called speech therapy.
The basic health-care plan covers speech therapy that has a medical purpose. This means that the treatment must be related to the functioning of, for instance, the muscles in your mouth, your vocal cords or your respiration.
The basic health-care plan does not reimburse: • treatment of dyslexia • treatment of language problems caused by a dialect or because you have a different native language • treatment to support education • music therapy
Whom to contact • speech therapist
There are 4 types of treatment for which you can only go to a specialist speech therapist. These treatments are: • treatment of stuttering • treatment of aphasia • infant speech therapy • the Hanen parent programme
The specialist speech therapists are included in the registers of the NVLF1 (Dutch Association for Speech Therapy and Phoniatrics).
1 More information is available at: www.nvlf.nl/paginas/openbaar/vakgebied/kwaliteit/kwaliteitsregisters/nvlf-registers
ONVZ Coverage 2018 - version 1.2 174 Coverage under each health-care plan
Basic health-care plan 100%
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit No coverage
What you pay
The excess This care is provided under the basic health-care plan, and is therefore subject to the excess.
No personal contribution You will not be charged a personal contribution for this care.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Quality registers provide extra information With ONVZ, the choice is all yours. You decide which speech therapist you go to. Quality registers1 contain information that can help you make a choice.
We only cover routine health care that you actually need In this case, routine health care is the care that is standard practice for speech therapists. Simple when possible, and more complex when necessary.
Glasses, (contact) lenses and laser eye treatment
Can you no longer see clearly?
What is covered
The basic health-care plan reimburses the costs of lenses for glasses and contact lenses only if these are required for a medical indication, for instance because you have an eye condition. In that case, they are covered under medical appliances.
1 More information is available at: www.onvz.nl/kwaliteitsregisters
ONVZ Coverage 2018 - version 1.2 175 If you do not have a medical indication, but you need glasses or contact lenses because you are short-sighted or long-sighted, or you are considering laser eye treatment, the Optifit and higher supplementary health-care plans cover:
• lenses for glasses with or without a frame • prism glasses • contact lenses, night lenses, toric lenses • implantable lenses • laser eye treatment • repair of glasses
The lenses for glasses and contact lenses must be prescription or corrective lenses.
Reimbursement is subject to a maximum per 2 consecutive calendar years. Reimbursements made in the previous calendar year will count towards the maximum reimbursement in the current calendar year. In other words, we will never reimburse more than the maximum reimbursement less the reimbursement made last year. The maximum reimbursement for the 2-year period is stated below.
Whom to contact • optician • hospital or independent treatment centre1
What is not covered • contact lens fluid • frame for glasses without lenses • glasses case and other accessories • fitting costs, adjustment costs, eye tests • treatment by an optometrist2 (optometry) • diving masks • laser treatment of eye floaters3
Coverage under each health-care plan
Basic health-care plan Only with a medical indication As per medical appliances coverage
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit €175 Maximum per 2 consecutive calendar years for lenses for glasses, contact lenses and laser eye treatment together
Topfit €350 Maximum per 2 consecutive calendar years for lenses for glasses, contact lenses and laser eye treatment together
Superfit €500 Maximum per 2 consecutive calendar years for lenses for glasses, contact lenses and laser eye treatment together
1 Like a hospital, this is a facility for specialist medical care, but generally for non-urgent, less complex care that does not require admission to hospital 2 An optometrist often works at the optician’s, or in a hospital, and investigates the health of your eyes 3 Laser treatment to eliminate spots you see floating in your field of vision
ONVZ Coverage 2018 - version 1.2 176 What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
Put in a claim for the frame and lenses together when you get new glasses If you get new glasses, claim for these as a whole. We do not provide reimbursement for frames without the lenses.
Make sure that invoice details are complete The following must appear on the invoice for glasses or contact lenses: • name and date of birth • type of lenses for glasses or contact lenses • correction or strength • details of the frame • cost of the lenses for glasses, contact lenses and frame • if you receive a discount: the components to which this applies
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Reimbursement will change from 2018 From now on, the maximum reimbursement applies to 2 consecutive calendar years. When you submit a claim, we also look at how much you were reimbursed in the previous calendar year. We will ‘look back’ for the first time in 2019, so bear in mind that you will not receive any further reimbursement in 2019 if you use up the maximum reimbursement stated above in 2018.
Stuttering therapy
Does your stutter stop you from getting your message across?
What is covered
A stutter prevents you from speaking fluently. You repeat sounds or words, or freeze up when speaking. Stuttering therapy can often help. Examples of stuttering therapy include the Del Ferro method, the McGuire programme and the BOMA method.
The Extrafit and higher supplementary health-care plans cover stuttering therapy at an institute for stuttering therapy. A reimbursement limit applies per insured person for Extrafit, Benfit and Optifit. Topfit and Superfit provide full coverage.
What is not covered • overnight stay • meals during the therapy
You can also go to a speech therapist if you have a stutter. This comes under the speech therapy coverage, which is provided under the basic health-care plan.
ONVZ Coverage 2018 - version 1.2 177 Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit €350 Maximum, once per insured person
Benfit €350 Maximum, once per insured person
Optifit €500 Maximum, once per insured person
Topfit 100%
Superfit 100%
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You do not need a referral.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this case, routine health care is the care that is standard practice for institutes for stuttering therapy. Simple when possible, and more complex when necessary.
ONVZ Coverage 2018 - version 1.2 178 Medical appliances Coverage
Medical appliances Support pessary Medical appliances
If you need medical appliances for treatment, nursing, rehabilitation or other care.
What is covered
Medical appliances are aids to make day-to-day life with an illness or condition easier. They can also make it possible for you to live at home longer. There are medical appliances that come under the basic health- care plan, and there are also medical appliances for which you must apply to your local council or the care administration office. The medical appliances guide1 tells you who you need to contact. If you have any further questions, our Service Centre can provide you with further assistance.
The basic health-care plan covers medical appliances that are related to recovering from or living with an illness or condition. Examples include prostheses, dressings, hearing aids and insulin pens.
The Reglement Hulpmiddelen [Medical Appliance Regulations]2 tell you which medical appliances and dressings are covered by the basic health-care plan and what conditions apply.
Many medical appliances require that you have a referral or permission. This is indicated for each medical appliance in the table in the regulations. This table also indicates whether you need to pay a personal contribution and what the maximum reimbursement is.
The Benfit and higher supplementary health-care plans reimburse the statutory personal contribution. See below for the maximum coverage provided per calendar year.
You purchase some medical appliances, while others are given to you on loan. This is also indicated in the table. You can also purchase the medical appliances given on loan, in which case the excess applies.
If you are reimbursed the costs of the medical appliance, the costs of repair, adjustment and replacement in the event of normal use will also be reimbursed.
A separate reimbursement applies to some medical appliances. You can find this information under: • contraceptive devices • glasses, (contact) lenses and laser eye treatment • walking aids • bed-wetting alarm • support pessary • arch supports • dressings
1 More information is available at: www.hulpmiddelenwijzer.nl 2 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22
ONVZ Coverage 2018 - version 1.2 180 Coverage under each health-care plan
Basic health-care plan 100% as per the Reglement Hulpmiddelen [Medical Appliance Regulations]1.
Startfit No coverage
Extrafit No coverage
Benfit €250 For statutory personal contributions, of which a maximum of €100 for wigs
Optifit €500 For statutory personal contributions, of which a maximum of €150 for wigs
Topfit €1,000 For statutory personal contributions, of which a maximum of €250 for wigs
Superfit 100% Statutory personal contributions
What you pay
The excess If a medical appliance is covered by the basic health-care plan and you are given it to keep, you will need to pay the excess. For medical appliances given on loan and medical appliances under the supplementary health- care plans, you do not pay an excess.
The personal contribution You will need to pay a statutory personal contribution for some medical appliances. The amount of the personal contribution can be found in the Reglement Hulpmiddelen [Medical Appliance Regulations].
What you have to do yourself
You need a prescription for many medical appliances The Reglement Hulpmiddelen [Medical Appliance Regulations]1 indicate which medical appliances require a prescription and who must establish the medical indication.
You may need our prior permission The Reglement Hulpmiddelen [Medical Appliance Regulations]1 indicate which medical appliances require permission and how you need to request this permission.
Some suppliers can grant permission on our behalf. If you go to one of these suppliers, the supplier will assess your request. If you want to know which suppliers we have made agreements with, please contact our Service Centre.
If you choose a supplier with whom we have not made any agreements, you will need to request the permission2 from us. Send your request to us using the contact form.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
1 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22 2 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen
ONVZ Coverage 2018 - version 1.2 181 Medical appliances are delivered ready for use The medical appliances are supplied including batteries or charging equipment, and you are instructed on how to use them. This means you know how they work and can start using them immediately.
We only reimburse the usual medical appliances These are the medical appliances and dressings described in the Reglement Hulpmiddelen [Medical Appliance Regulations]. You are entitled to the standard version of the medical appliance, or if this is not efficient, to a custom medical appliance.
Support pessary
A solution for pelvic floor problems in women.
What is covered
If you have pelvic floor problems, such as a prolapse of your bladder or uterus, a support pessary can provide relief or alleviate your problems.
The Extrafit and higher supplementary health-care plans cover the costs of a support pessary if fitted by the general practitioner.
Whom to contact • a general practitioner
If you go to the hospital because of serious symptoms, the care provided there comes under the care from the medical specialist.
Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit 100%
Benfit 100%
Optifit 100%
Topfit 100%
Superfit 100%
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
ONVZ Coverage 2018 - version 1.2 182 Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this context, routine health care is defined as health care that is standard practice for general practitioners. Simple when possible, and more complex when necessary.
ONVZ Coverage 2018 - version 1.2 183 Skin and hair Coverage
Acne treatment Cosmetic skin camouflage treatment Electrical epilation and laser treatment Psoriasis day treatment Pedicure for people with diabetes and rheumatoid arthritis Acne treatment
The right treatment for acne.
What is covered
Acne is an infection of the sebaceous glands on the face, chest or back. If you suffer from acne often or for long periods of time, the general practitioner can treat you or refer you to a dermatologist.
The dermatologist can prescribe acne treatment by a skin therapist or beautician. In that case, you the dermatologist will continue to treat you (if necessary) and you will also go to the skin therapist or beautician.
The treatment you receive there is tailored to your situation, which is why the skin therapist or beautician first puts together a health-care profile for you. This indicates what type of acne you have, what treatments are necessary and who will provide the care.
The Extrafit and higher supplementary health-care plans cover the costs of the acne treatment. The coverage applies up to the age of 21, except under the Superfit plan, which also covers care from the age of 21.
With Extrafit and Benfit, coverage is capped at a maximum amount per calendar year. Optifit, Topfit and Superfit provide full coverage for such treatment.
Whom to contact • skin therapist1 • beautician2.
Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit €250 Maximum per calendar year, up to the age of 21
Benfit €500 Maximum per calendar year, up to the age of 21
Optifit 100% Up to the age 21
Topfit 100% Up to the age 21
Superfit 100% All ages
1 Must be a member of the Dutch Association of Skin Therapists 2 Must be a member of the Algemene Nederlandse Branche Organisatie Schoonheidsverzorging [General Dutch Trade Association for Beauty Care] (ANBOS)
ONVZ Coverage 2018 - version 1.2 185 What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You must also send a prescription from your dermatologist You send this prescription together with your first claim.
Your health-care profile must be stated on the claim. We only reimburse the invoices that state your health-care profile.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Quality registers provide extra information With ONVZ, the choice is all yours. You decide which health-care provider you go to. Quality registers1 contain information that can help you make a choice.
Cosmetic skin camouflage treatment
Learn to hide a disfiguring skin abnormality.
What is covered
If you have scars or birthmarks on your face or throat, you may want to hide these using professional cosmetics. A skin therapist or beautician can teach you how to do this.
If you have a seriously disfiguring skin abnormality on your face or throat, theExtrafit and higher supplementary health-care plans cover the costs of instruction for camouflaging these areas. Topfit and Superfit also cover the costs of instruction if there is some other medical reason.
Extrafit and Benfit cap coverage at a maximum amount per calendar year. The Optifit and higher supplementary health-care plans cover the full costs of instruction for cosmetic skin camouflage treatment.
We also cover the costs of the camouflage products you are instructed to use. However, you must purchase these from the skin therapist or beautician.
Whom to contact • skin therapist2 • beautician3
What is not covered • beauty treatment
1 More information is available at: www.onvz.nl/kwaliteitsregisters 2 Must be a member of the Dutch Association of Skin Therapists 3 Must be a member of the Algemene Nederlandse Branche Organisatie Schoonheidsverzorging [General Dutch Trade Association for Beauty Care] (ANBOS)
ONVZ Coverage 2018 - version 1.2 186 Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit €250 Maximum per calendar year Instruction and camouflage products
Benfit €500 Maximum per calendar year Instruction and camouflage products
Optifit 100% Instruction and camouflage products
Topfit 100% Instruction and camouflage products
Superfit 100% Instruction and camouflage products
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You must have a prescription from your general practitioner for the instruction Please enclose the prescription with your claim.
Instruction and camouflage products must be listed separately on the invoice The costs of the instruction and the products may not be listed as a single amount, therefore, and the individual prices of the different products must also be shown.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this case, routine health care is the care that is standard practice for skin therapists and beauticians for camouflaging serious skin abnormalities. Simple when possible, and more complex when necessary.
Quality registers provide extra information With ONVZ, the choice is all yours. You decide which skin therapist or beautician you go to. Quality registers1 contain information that can help you make a choice.
1 More information is available at: www.onvz.nl/kwaliteitsregisters
ONVZ Coverage 2018 - version 1.2 187 Electrical epilation and laser treatment
A solution for excessive facial hair.
What is covered
If you suffer from excessive facial hair, you can have the hair removed through electrical epilation or laser treatment. Removal of ‘normal hair growth’, as experienced by most people, is not covered.
However, if you suffer from excessive facial hair growth (i.e. more than ‘normal’), the Extrafit and higher supplementary health-care plans cover the costs of electrical epilation and laser treatment. Excessive hair growth can be caused by conditions like hirsutism or hypertrichosis. With these conditions, you have hair where other people do not have any, or you have a conspicuous amount of hair.
Coverage is subject to a maximum. Once this has been reached, we do not cover further costs of care, not even in a subsequent year.
Whom to contact • skin therapist1 • beautician2 • a medical specialist
What is not covered • removal of hair from the neck or other parts of the body
Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit €250 Maximum, for the entire term of the health-care plan
Benfit €500 Maximum, for the entire term of the health-care plan
Optifit €1,000 Maximum, for the entire term of the health-care plan
Topfit €1,500 Maximum, for the entire term of the health-care plan
Superfit €2,000 Maximum, for the entire term of the health-care plan
1 Must be a member of the Dutch Association of Skin Therapists 2 Must be a member of the Algemene Nederlandse Branche Organisatie Schoonheidsverzorging [General Dutch Trade Association for Beauty Care] (ANBOS)
ONVZ Coverage 2018 - version 1.2 188 What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You must have a prescription from your general practitioner You send this prescription together with your first claim.
The invoice must state which area was treated We only cover the costs of facial treatments.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this case, routine health care is the care that is standard practice for skin therapists, beauticians and medical specialists for disfiguring excessive hair. Simple when possible, and more complex when necessary.
Quality registers provide extra information With ONVZ, the choice is all yours. You decide which health-care provider you go to. Quality registers1 contain information that can help you make a choice.
Psoriasis day treatment
There is still no cure for psoriasis, but the symptoms can be treated.
What is covered
Psoriasis is a chronic skin condition that causes pain and itching. For treatment, you go to the general practitioner or medical specialist. This care comes under the basic health-care plan.
For supplementary treatment you can go to a psoriasis day treatment centre, where you receive light therapy or bath therapy, for instance.
The Extrafit, Benfit and Optifit supplementary health-care plans cover the costs of this care up to a maximum of €500 per calendar year. Topfit and Superfit provide full coverage.
Whom to contact • psoriasis day treatment centre
1 More information is available at: www.onvz.nl/kwaliteitsregisters
ONVZ Coverage 2018 - version 1.2 189 Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit €500 Maximum per calendar year
Benfit €500 Maximum per calendar year
Optifit €500 Maximum per calendar year
Topfit 100%
Superfit 100%
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
Sometimes you need a prescription from your doctor This applies to the Extrafit, Benfit and Optifit plans. We can request this prescription from you or your health- care provider. With Topfit and Superfit, you do not need a prescription.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this case, routine health care is the care that is standard practice for psoriasis day treatment centres. Simple when possible, and more complex when necessary.
ONVZ Coverage 2018 - version 1.2 190 Pedicure for people with diabetes and rheumatoid arthritis
Good foot care is important for people with diabetes and rheumatoid arthritis.
What is covered
If you suffer from diabetes mellitus or rheumatoid arthritis, your feet are particularly vulnerable. Good foot care can prevent problems.
If you have diabetes and your general practitioner has assigned you health-care profile 2 following the annual foot check-up. the basic health-care plan covers foot care.
The basic health-care plan does not cover the costs of foot care if you have rheumatoid arthritis, or if you have diabetes and were assigned health-care profile 1.
The Benfit and higher supplementary health-care plans reimburse foot care by a pedicurist in that case. We also cover the costs of ortheses and nail braces that are needed for this.
A reimbursement limit applies per calendar year for Benfit and Optifit. Topfit and Superfit provide full coverage.
Whom to contact • a pedicurist with the DV (diabetic) specialism • a pedicurist with the RV (rheumatoid arthritis) specialism • medical pedicurist The pedicurist must be listed on the Kwaliteitsregister Pedicures [Quality Register for Pedicurists]1. The medical pedicurist may also be listed on the Register Paramedische Voetzorg [Register for Allied Health Professionals for Foot Care]2.
What is not covered • general foot care such as the removal of callouses or the clipping of toenails
Coverage under each health-care plan
Basic health-care plan Foot care for diabetes sufferers If you have health-care profile 2 or higher
Startfit No coverage
Extrafit No coverage
Benfit €100 Maximum per calendar year For diabetes (only health-care profile 1) or rheumatoid arthritis
Optifit €200 Maximum per calendar year For diabetes (only health-care profile 1) or rheumatoid arthritis
Topfit 100% For diabetes (only health-care profile 1) or rheumatoid arthritis
Superfit 100% For diabetes (only health-care profile 1) or rheumatoid arthritis
1 For this, see: www.kwaliteitsregisterpedicures.nl 2 For this, see: stipezo.nl/register
ONVZ Coverage 2018 - version 1.2 191 What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
Ailment (and health-care profile) must be stated on the invoice The invoice from the pedicurist must indicate whether the foot care was for diabetes or for rheumatoid arthritis. And if it was for diabetes, the invoice must also indicate which health-care profile you have.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this case, routine health care is the foot care that is standard practice for pedicurists in treating diabetes or rheumatoid arthritis. Simple when possible, and more complex when necessary.
ONVZ Coverage 2018 - version 1.2 192 Transportation Coverage
Medical transportation by ambulance Other medical transportation Travel costs for visiting ill people Medical transportation by ambulance
If someone's life is in danger, call an ambulance on the emergency number 112. The basic health-care plan covers that.
What is covered
Medical transportation by ambulance is medically necessary transportation in an ambulance vehicle. This often involves emergency transportation in the event of an accident or heart attack, for instance, but the ambulance can also be used in non-emergency situations. For instance, to transfer you from a hospital to a nursing home if you must remain lying down while being transported.
The basic health-care plan covers transportation by ambulance over distances of up to 200 kilometres (one- way) if the use of public transport, a taxi or a private car would be medically irresponsible. In an emergency situation, such as an accident, the basic health-care plan also covers transport by (trauma) helicopter.
This transportation must be:
• to a health-care provider or facility where you will be provided with care covered by the basic health-care plan • to a facility where you will be admitted with an indication under the Wet langdurige zorg [Long-term Care Act] (Wlz) • from a facility providing care under the Wet langdurige zorg [Long-term Care Act] (Wlz) to a health-care provider or facility if you will be receiving tests or treatment there under the Wlz. Treatment also includes measuring for and fitting a prosthesis • if you are younger than 18: to a health-care provider or facility for mental health care in accordance with the Jeugdwet [Youth Act]
In all these situations, the basic health-care plan also covers transport back to your home, or, if you cannot (yet) be at home independently, to the place where you will be looked after.
What is not covered • medical transportation by ambulance to daytime activities at a facility providing care under the Wet langdurige zorg [Long-term Care Act] (Wlz) (such as a nursing home or facility for disabled persons)
If you cannot travel on your own, but do not need transport by ambulance, other medical transportation may be covered in some cases.
Coverage under each health-care plan
Basic health-care plan 100% Up to 200 kilometres
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit No coverage
ONVZ Coverage 2018 - version 1.2 194 What you pay
The excess This care is provided under the basic health-care plan, and is therefore subject to the excess.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You must request permission for journeys of further than 200 kilometres or using a different mode of transport If, in a non-emergency situation, you need to be transported further than 200km or a different mode of transport must be used, we may give permission for this in special cases. You or your attending doctor must request the permission1 in advance. No advance permission is required in emergency situations.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Other medical transportation
Can I take a taxi to the hospital?
What is covered
Sometimes there is a medical reason why you cannot travel to the hospital or health-care provider for treatment yourself. You may be wheelchair-bound or partially sighted, for instance. The transportation used in such cases is referred to as ‘other medical transportation’.
The basic health-care plan reimburses other medical transportation in the 5 situations below:
1. you have to go and receive kidney dialysis 2. you have to go and receive oncological treatment involving chemotherapy, immunotherapy or radiation (radiotherapy) 3. you can only get around in a wheelchair 4. you have limited vision and cannot get around without assistance 5. you are younger than 18 and you have intensive child care2
This transportation must be:
• to a health-care provider or facility where you will be provided with care covered by the basic health-care plan (for 1 and 2: for the treatment itself) • to a facility where you will be admitted with an indication under the Wet langdurige zorg [Long-term Care Act] (Wlz) • from a facility providing care under the Wet langdurige zorg [Long-term Care Act] (Wlz) to a health-care provider or facility if you will be receiving tests or treatment there under the Wlz. Treatment also includes measuring for and fitting a prosthesis
The basic health-care plan also covers transport back to your home, or, if you cannot (yet) be at home independently, to the place where you can be looked after.
1 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen 2 This means: you need nursing and other care for complex physical problems or a physical disability. You also need constant medical supervision or nursing care on hand at all times
ONVZ Coverage 2018 - version 1.2 195 We cover the costs of other medical transportation over distances of up to 200 kilometres (one-way). If you have received permission from us for treatment that is more than 200 kilometres away, we will also cover the further distance.
The basic health-care plan also covers transportation of a companion to accompany a child who is under the age of 16, and older than that, if assistance is required. If 2 companions are needed, we only cover the costs if you have obtained permission for this from us in advance.
The reimbursement under the basic health-care plan is: • car: €0.30 per kilometre • public transport: full coverage, based on 2nd-class fare • (wheelchair) taxi: full coverage
If none of the situations in 1 to 5 applies to you but you need medical transportation for a long period of time because of an illness or ailment, reimbursement can sometimes be possible based on what is known as the hardheidsclausule1. If you believe this applies to you, please contact us.
If you are a donor and will be donating an organ or tissue to another person, separate regulations apply for the reimbursement of transportation in the event of organ transplants.
If you have been admitted to a mental health-care facility and daytime activities are part of the treatment, transportation to the daytime activities is covered by this reimbursement as well.
Medical transportation coverage under the basic health-care plan is subject to a personal contribution of €101. The Extrafit and higher supplementary health-care plans reimburse this personal contribution.
If the basic health-care plan does not cover your transportation, the Benfit and higher supplementary health- care plans reimburse the costs of other medical transportation within the Netherlands to a medical treatment and back, if you: • are unable, for medical reasons, to use public transport, and • the basic health-care plan covers the treatment
The Superfit and Zorgplan supplementary health-care plans also reimburse transportation in the event of hospital admission and upon your discharge from a Dutch hospital. The reimbursement under the supplementary health-care plans is: • car: €0.27 per kilometre • transportation by taxi: full coverage
Transportation by taxi If you opt to travel by taxi, make it easy for yourself and choose the service offered by Transvision. Transvision arranges the taxi transportation for you and invoices us directly for the costs. Your doctor must fill in part 1 of the application form for other medical transportation2 in advance. We can request the completed statement from you. You can call Transvision between 8.30am and 5pm Monday to Friday, on 0900 333 33 30 (€0.15 per minute).
What is not covered • parking charges and other additional costs • the costs of transportation of a companion if you are not travelling at the same time, for example if you are admitted and the companion travels home alone • transportation if you go to a facility providing care under the Wet langdurige zorg [Long-term Care Act] (Wlz) for daytime activities
1 More information is available at: www.zorginstituutnederland.nl/Verzekerde+zorg/h/hardheidsclausule-bij-vervoer-zvw 2 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22
ONVZ Coverage 2018 - version 1.2 196 Coverage under each health-care plan
Basic health-care plan Certain cases, with personal contribution By public transportation, car or taxi
Startfit No coverage
Extrafit Personal contribution
Benfit Personal contribution + medical transportation By car or taxi
Optifit Personal contribution + medical transportation By car or taxi
Topfit Personal contribution + medical transportation By car or taxi
Superfit Personal contribution + medical transportation + transportation upon hospital admission and discharge By car or taxi
Zorgplan Upon hospital admission and discharge By car or taxi
What you pay
The excess The excess applies to other medical transportation that comes under the basic health-care plan. No excess applies to other medical transportation that comes under the supplementary health-care plan.
The personal contribution The statutory personal contribution of €101 per calendar year.
You do not pay this personal contribution: • if you must be transported from one facility to another during admission that is covered by the basic health- care plan or the Wet langdurige zorg [Long-term Care Act] (Wlz) • if you have been admitted to a facility providing care under the Wet langdurige zorg [Long-term Care Act] (Wlz) and must go to a health-care provider for specialist test or specialist treatment which is covered by the basic health-care plan • if you have been admitted with an indication under the Wet langdurige zorg [Long-term Care Act] (Wlz) and you must go to a health-care provider for dental treatment covered by the Wlz
What you have to do yourself
You are required to seek our permission first See the section on permission for other medical transportation1 to find out how that works. You can also use this page to request permission for transportation over a distance greater than 200 kilometres, transportation using a different mode of transport or transportation with a companion/an extra companion.
1 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen
ONVZ Coverage 2018 - version 1.2 197 Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Claim expenses using the claim form for other medical transportation If you want to claim the costs of medical transportation, you can do so easily using the claim form for other medical transportation1. The form tells you what documents you need to send.
Car transportation is based on the optimum route We calculate the number of kilometres using the Routenet route planner2. We only reimburse the kilometres actually travelled by you.
Travel costs for visiting ill people
If your partner or child has been admitted to hospital.
What is covered
If your partner or child has been admitted to hospital, you will want to visit as frequently as possible.
If a family member also insured with ONVZ has been admitted to hospital for 8 or more consecutive days, the Benfit and higher supplementary health-care plans will cover your travel costs.
Coverage takes effect on the 8th day of hospital admission and is €0.27 per kilometre. Whether you travel by taxi, car or public transport does not matter for the coverage.
We cover the kilometres between your home address and the hospital, which must be in the Netherlands or no more than 60 kilometres from the Dutch border.
A coverage limit applies per calendar year for Benfit and Optifit. Topfit and Superfit provide full coverage of travel costs.
To calculate the number of kilometres, we assume the optimum route according to the Routenet route planner2.
What is not covered • the costs of travel to other facilities, for instance to a nursing home or mental health-care facility • costs associated with transportation, for example parking charges
1 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22 2 For this, see: www.routenet.nl
ONVZ Coverage 2018 - version 1.2 198 Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit €150 Maximum per calendar year
Optifit €250 Maximum per calendar year
Topfit 100%
Superfit 100%
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We ask for a statement of admission You can get this from the hospital. It indicates when your family member was admitted and for how long.
Claim expenses using the claim form for travel costs for visiting ill people If you want to claim the travel costs for visiting your admitted family member, you can easily do so using the claim form for travel costs for visiting ill people1. Please also send the statement of admission, the transport ticket, the statement from your public transport chip card or the invoice from the taxi.
1 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22
ONVZ Coverage 2018 - version 1.2 199 Health care abroad and travel Coverage
Abroad: urgent health care Abroad: non-urgent (scheduled) health care Abroad: vaccinations and prophylactics Abroad: urgent health care
If you are unexpectedly in need of health care while abroad.
What is covered
If you urgently need health care abroad, for instance after an accident or due to sudden illness, you are entitled to urgent health care. This is health care that you must receive immediately, which could not have been foreseen when you departed on your trip and which also cannot wait until you are back in your own country. This therefore does not involve health care which you already knew you needed, or which can wait until you return to your own country, as this comes under non-urgent (scheduled) health care.
Coverage of urgent health care depends on whether the care comes under the basic health-care plan or under a supplementary plan, and on the country in which you receive care and what supplementary health-care plan(s) you have. An overview is provided below.
Health care covered by the basic health-care plan If the coverage states that the basic health-care plan provides coverage for the health care, that is also the case if you receive that care urgently while abroad. 2 important restrictions apply: • We cover up to a maximum of what the health care would have cost in the Netherlands. Health care outside the Netherlands is often more expensive than in the Netherlands. • Not all health care provided abroad meets the conditions that apply under the basic health-care plan. If the health care does not satisfy these conditions, you will not be reimbursed.
If you have Wereldfit or Superfit, broader coverage applies. For urgent health care abroad, Wereldfit and Superfit supplement the reimbursement provided by the basic health-care plan up to the statutory or prevailing market rate in the country where you receive the care. This means you do not need to pay the difference yourself if the health care is more expensive than in the Netherlands.
Health care covered by the supplementary health-care plan If you have a supplementary health-care plan, the coverage offered by the supplementary health-care plan or Tandfit plan also applies to health care you receive abroad, even if that health care is provided urgently. The same conditions and coverage limits apply as in the Netherlands. If you unexpectedly or urgently need the health care abroad, the supplementary health-care plans reimburse up to a maximum of the statutory rate in that country, or if there is no statutory rate, the prevailing market rate in that country. The Tandfit plans cover up to a maximum of what the health care would have cost in the Netherlands.
Alternatively: you can opt for coverage in accordance with the local rules and regulations If you live in a country that is an EU/EEA member state or a treaty country1 and you receive the urgent health care in another EU/EEA member state or a treaty country, you can also opt for coverage under the local rules and regulations in this case. You can read about how this works in the Grens aan zorg in het buitenland2 document.
Whom can I contact? What are the terms and conditions? Health care abroad is subject to the same terms and conditions that apply to health care provided in the Netherlands, so check the coverage to find out which health-care providers can treat you and which conditions apply. Alternatively, call our Service Centre where the staff can tell you anything you need to know.
1 For this, see: www.onvz.nl/vergoedingen/zorg-in-het-buitenland/verdragslanden-voor-zorg 2 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22
ONVZ Coverage 2018 - version 1.2 201 Coverage under each health-care plan
Basic health-care plan 100% (applying Dutch rates) Health care that comes under the basic health-care plan, up to what the care would have cost in the Netherlands
Startfit Health care as per Startfit coverage Up to the local rate abroad
Extrafit Health care as per Extrafit coverage Up to the local rate abroad
Benfit Health care as per Benfit coverage Up to the local rate abroad
Optifit Health care as per Optifit coverage Up to the local rate abroad
Topfit Health care as per Topfit coverage Up to the local rate abroad
Superfit Supplement on top of basic health-care plan coverage + Health care as per Superfit coverage
• Supplement on top of basic health-care plan coverage if the health care is more expensive than in the Netherlands • Health care that comes under the Superfit plan, up to the local rate abroad • Registered medicines • Non-medicines, max. €350 per calendar year • Medical transportation to the health-care provider
Wereldfit Supplement on top of basic health-care plan coverage • Supplement on top of basic health-care plan coverage if the health care is more expensive than in the Netherlands • Registered medicines • Non-medicines, max. €250 per calendar year • Medical transportation to the health-care provider
Tandfit A Health care as per Tandfit A coverage Up to what the care would have cost in the Netherlands
Tandfit B Health care as per Tandfit B coverage Up to what the care would have cost in the Netherlands
Tandfit C Health care as per Tandfit C coverage Up to what the care would have cost in the Netherlands
Tandfit D Health care as per Tandfit D coverage Up to what the care would have cost in the Netherlands
Tandfit Preventief Health care as per Tandfit Preventief coverage Up to what the care would have cost in the Netherlands
ONVZ Coverage 2018 - version 1.2 202 What you pay
The excess If the health care you receive is subject to an excess in the Netherlands, you will need to pay this excess if you receive the care abroad. The excess does not apply, however, if you opt for coverage under the local rules and regulations.
The personal contribution If you would be required to pay a personal contribution for health care in the Netherlands, this also applies if you receive the health care abroad. If you opt for coverage in accordance with the local rules and regulations, you will need to pay the personal contribution if this is required under these local rules and regulations.
What you have to do yourself
If you are admitted to hospital, contact ONVZ Zorgassistance If you are admitted to a hospital abroad, we recommend that you contact ONVZ Zorgassistance. Under the Superfit and Wereldfit plans, this is a requirement.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Wereldfitor Superfit? See the ‘Comprehensive terms and conditions’ as well For Wereldfit, only the most important terms and conditions are shown above. Your coverage is based on the ‘Comprehensive terms and conditions: Wereldfit’. This also applies if you have taken out the Superfit plan, as Wereldfit is part of this.
We pay in euros If the amount on your invoice is in a different currency, we will convert the amount to euros. We use the exchange rate in effect on the last working day of the month prior to the month in which you received the care.
We only cover routine health care that you actually need This must be health care that would normally be provided. Simple when possible, and more complex when necessary.
Abroad: non-urgent (scheduled) health care
Do you require health care and do you want to have this provided in another country?
What is covered
The coverage shown below applies to non-urgent (scheduled) health care provided abroad, i.e. a treatment that is not needed immediately but can be scheduled to take place later. For health care that is immediately required (i.e. urgent), coverage is provided under urgent health care abroad.
Coverage depends on whether the non-urgent care comes under the basic health-care plan or under a supplementary plan, and on the country you intend to receive the care in and what supplementary health-care plan(s) you have taken out. An overview is provided below.
Health care covered by the basic health-care plan If the coverage states that the basic health-care plan provides coverage for the health care, you can also receive this care abroad. However, there are 3 important conditions: • The basic health-care plan only covers costs for health care provided abroad up to the amount that the care would have cost in the Netherlands. It is not uncommon that health care provided abroad is more expensive than this care in the Netherlands. If this is the case, you will have to pay the difference yourself.
ONVZ Coverage 2018 - version 1.2 203 • Not all health care provided abroad meets the conditions that apply under the basic health-care plan. because it is not considered routine health care, for example. In this case, you will not be reimbursed for this care. • The conditions that apply in the Netherlands also apply abroad. If you need a referral for this health care, or permission for example, this also applies to health care you receive abroad.
Be sure to contact the ZorgConsulent in advance, as he or she can give you all the details.
If you need health care that is not available in the Netherlands, or if you would have to wait too long for this care given your medical condition, we can help you receive the right care abroad. In this case, too, please contact the ZorgConsulent. If you do not contact us in advance and if we could have arranged the health care for you, you will have to pay the difference if this health care was more expensive abroad.
For hospital care in a hospital in Belgium or Germany, the Wereldfit and Superfit supplementary health-care plans supplement the reimbursement provided by the basic health-care plan. However, you must contact the ZorgConsulent in advance. For health care that comes under the basic health-care plan and that you receive in an EU/EEA member state or a treaty country1, the Superfit plan supplements the reimbursement provided by the basic health-care plan up to double the amount that applies for this care in the Netherlands.
If you live in a country that is an EU/EEA member state or a treaty country and you receive the health care in another EU/EEA member state or a treaty country, it is sometimes possible to be reimbursed in accordance with the local rules and regulations. That can work in your favour if the health care there is more expensive than it is in the Netherlands. You should note that you will need to present an S2 form when you visit the health-care provider. You can request this form from us2.
Health care covered by the supplementary health-care plan If you would like to go abroad for care that comes under your supplementary health-care plan, we will cover up to a maximum of what the health care would have cost in the Netherlands, and up to double this amount if you have the Superfit plan and receive the health care in an EU/EEA member state or a treaty country. If the health care you receive abroad is more expensive than this, you will have to pay the difference.
Whom can I contact? What are the terms and conditions? Health care abroad is, in principle, subject to the same terms and conditions that apply to health care provided in the Netherlands, so check the coverage to find out which health-care providers can treat you and which conditions apply. Alternatively, call our Service Centre.
1 For this, see: www.onvz.nl/vergoedingen/zorg-in-het-buitenland/verdragslanden-voor-zorg 2 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22
ONVZ Coverage 2018 - version 1.2 204 Coverage under each health-care plan
Basic health-care plan Health care as per basic health-care plan coverage Up to what the care would have cost in the Netherlands
Startfit Health care as per Startfit coverage Up to what the care would have cost in the Netherlands
Extrafit Health care as per Extrafit coverage Up to what the care would have cost in the Netherlands
Benfit Health care as per Benfit coverage Up to what the care would have cost in the Netherlands
Optifit Health care as per Optifit coverage Up to what the care would have cost in the Netherlands
Topfit Health care as per Topfit coverage Up to what the care would have cost in the Netherlands
Superfit Health care as per Superfit coverage, hospital care in hospitals in Belgium and Germany 100%, supplement on top of basic health-care plan coverage for care in another EU/EEA member state or a treaty country • Hospital care in hospitals in Belgium and Germany 100%, under guidance of ZorgConsulent, in an EU/EEA member state or a treaty country, up to double the amount that applies for this care in the Netherlands • Other health care that comes under the basic health-care plan: in an EU/EEA member state or a treaty country, up to double the amount that applies for this care in the Netherlands (including the coverage under the basic health- care plan) • Health care that comes under the Superfit plan: in another EU/EEA member state or a treaty country, up to double the amount that applies for this care in the Netherlands; for all other countries, the same amount that applies in the Netherlands
Wereldfit Specialist medical care in Belgium or Germany, 100% After guidance by ZorgConsulent
Tandfit A Health care as per Tandfit A coverage Up to what the care would have cost in the Netherlands
Tandfit B Health care as per Tandfit B coverage Up to what the care would have cost in the Netherlands
Tandfit C Health care as per Tandfit C coverage Up to what the care would have cost in the Netherlands
Tandfit D Health care as per Tandfit D coverage Up to what the care would have cost in the Netherlands
Tandfit Preventief Health care as per Tandfit Preventief coverage Up to what the care would have cost in the Netherlands
ONVZ Coverage 2018 - version 1.2 205 What you pay
The excess If the health care you receive is subject to an excess in the Netherlands, you will need to pay this excess if you receive the care abroad. The excess does not apply, however, if you opt for coverage under the local rules and regulations.
The personal contribution If you would be required to pay a personal contribution for health care in the Netherlands, you will also need to pay it if you receive the care abroad. If you opt for coverage in accordance with the local rules and regulations, you will need to pay the personal contribution if this is required under these local rules and regulations.
What you have to do yourself
You need to contact us in advance: • If you need health care that you cannot receive, or cannot receive soon enough in the Netherlands, contact the ZorgConsulent. • If you would like us to send you an S2 form, contact the ZorgConsulent. • If you want to receive specialist medical care at a hospital in Belgium or Germany and are covered by the Wereldfit or Superfit plan, contact the ZorgConsulent. • If you need our prior permission1 for particular health care provided in the Netherlands.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Wereldfitor Superfit? See the ‘Comprehensive terms and conditions’ as well For Wereldfit, only the most important terms and conditions are shown above. Your coverage is based on the ‘Comprehensive terms and conditions: Wereldfit’. This also applies if you have taken out the Superfit plan, as Wereldfit is part of this.
Working or living abroad? You need to let us know If you are planning to go abroad to live or work, either temporarily or for good, this may affect your basic health-care plan. This is why you need to let us know, so we can tell you whether or not you are entitled to keep your health-care plan.
We pay in euros If the amount on your invoice is in a different currency, we will convert the amount to euros. We use the exchange rate in effect on the last working day of the month prior to the month in which you received the care.
We only cover routine health care that you actually need This must be health care that would normally be provided. Simple when possible, and more complex when necessary.
Abroad: vaccinations and prophylactics
When you want to avoid the risk of contracting an infectious disease while travelling.
What is covered
In some countries, there is an increased risk of contracting an infectious disease, like hepatitis or malaria for example. You can have a vaccination or take medicine (like antimalarials) to prevent this.
1 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen
ONVZ Coverage 2018 - version 1.2 206 Common infectious diseases in foreign countries include: • hepatitis A and B • DTP • yellow fever • typhoid • cholera • meningococci • rabies • malaria
The Startfit and higher supplementary health-care plans cover the costs of vaccinations for these common infectious diseases and antimalarial medicine. For Startfit, Extrafit, Benfit and Optifit, a maximum reimbursement per calendar year applies. Topfit and Superfit provide complete coverage for vaccinations and antimalarial medicine. The vaccinations can also be to prevent other ‘foreign’ infectious diseases.
For a consultation and the vaccinations or medicines to prevent contracting infectious diseases, you can visit the municipal public health service (GGD) or another vaccination centre, your general practitioner, the pharmacy or the home vaccination service thuisvaccinatie.nl.
What is not covered • cost of the vaccination booklet • administrative costs • brochures • DEET • ORS (to treat dehydration)
Coverage under each health-care plan
Basic health-care plan No coverage
Startfit €75 for 8 common infectious diseases Maximum per calendar year
Extrafit €75 for 8 common infectious diseases Maximum per calendar year
Benfit €75 for 8 common infectious diseases Maximum per calendar year
Optifit €100 for 8 common infectious diseases Maximum per calendar year
Topfit 100% for all infectious diseases
Superfit 100% for all infectious diseases
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
ONVZ Coverage 2018 - version 1.2 207 What you have to do yourself
A prescription is required to pick up the vaccine from the pharmacy It’s possible that the health-care provider will ask you to pick up the vaccine form the pharmacy. In this case, you will need a prescription from your general practitioner or doctor.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
We only cover routine health care that you actually need In this context, routine health care means the vaccinations or antimalarial medicine generally advised for the country you will travelling to.
ONVZ Coverage 2018 - version 1.2 208 Accidents, claims and other Coverage
Superfit accident coverage Aid for third-party claims Reimbursement in exceptional cases Superfit accident coverage
When an accident has permanent consequences.
What is covered
No one wants it to happen of course. But if you are involved in an accident and suffer a permanent injury, you will receive a payout under the Superfit plan, even in the case of death.
If, as a result of the accident, you suffer permanent loss or permanent impairment of limbs or other parts of the body or sensory functions (hearing, sight, taste, smell), you will receive a certain percentage of €20,000, the maximum payout that applies per accident. The applicable percentages are listed in the Comprehensive coverage: Superfit accident coverage section. The payout in the case of death is €5,000.
There are situations in which you will not be entitled to a payout, for example if the accident occurred while playing a dangerous sport or if you were driving while over the legal alcohol limit.
You can read all the terms and conditions in the Comprehensive coverage: Superfit accident coverage section1.
Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit In the event of a permanent injury involving a body part or sensory function, and in the event of death: • Per accident: a maximum of €20,000 in the event of loss of, or reduced function in a body part or sensory function • Death: €5,000
What you pay
No excess This coverage is provided under a supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution.
1 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22
ONVZ Coverage 2018 - version 1.2 210 What you have to do yourself
Report an accident as soon as possible If you have been in an accident resulting in an injury that comes under this accident coverage, you need to report this to us as soon as possible, and in any case within 30 days of the accident.
You have to help in your own recovery Make sure you get medical treatment for your injury as soon possible.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Aid for third-party claims for injury
Have you had to pay costs relating to an accident yourself?
What is covered
The ‘regular’ coverage provided by the basic health-care plan and the supplementary health-care plans apply to injuries received during an accident too. But this is not to say that all costs are covered. You may have to pay an excess or personal contribution, for example, or perhaps you have lost wages. You may also feel that you are entitled to compensation for pain and suffering.
You can use your legal expenses insurance of course, but if you don’t have this, ONVZ offers an ‘aid for third- party claims service’ to help you get reimbursed for your out-of-pocket expenses and lost wages and receive compensation for pain and suffering. A lawyer or claims representative engaged by ONVZ then tries to recover your loss from the person who caused the accident or that person’s insurer.
The Reglement Verhaalsbijstand-service [Aid for third-party claims service regulations]1 explains what this service entails and the conditions that apply.
The Startfit and higher supplementary health-care plans reimburse a maximum of €12,500 (per accident) in aid for third-party claims. The costs of court proceedings also come under this coverage.
If you only have the basic health-care plan, we can still provide you with information on how you can recover the costs incurred.
What is not covered • other costs you incur outside the scope of the aid for third-party claims service
Questions Simply contact the ONVZ Verhaalszaken (third-party claims) department by calling +31 30 639 62 64 or sending an email to [email protected]. We would be happy to help.
1 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22
ONVZ Coverage 2018 - version 1.2 211 Coverage under each health-care plan
Basic health-care plan No coverage
Startfit €12,500 Maximum, per accident
Extrafit €12,500 Maximum, per accident
Benfit €12,500 Maximum, per accident
Optifit €12,500 Maximum, per accident
Topfit €12,500 Maximum, per accident
Superfit €12,500 Maximum, per accident
What you pay
No excess This service is provided under the supplementary health-care plan. An excess does not apply.
No personal contribution You will not be charged a personal contribution for this service.
What you have to do yourself
If any medical costs are the result of an accident, let us know This will enable us to can see whether another party is liable for the costs incurred. Tick the ‘ongeval’ (accident) box when you make a claim, or send us a completed third-party claim questionnaire1 if you know that a hospital or other health-care provider will be billing us for the costs directly.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
1 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22
ONVZ Coverage 2018 - version 1.2 212 Reimbursement in exceptional cases
What is covered
The basic health-care plan and the supplementary health-care plans cover the costs of the health care listed in the coverage for each of these.
In special cases, the basic health-care plan also covers other health care. This must be health care that is expected to provide the same or a better result than the health care that is normally covered under this plan. You must always request permission from us in advance. The health care concerned may not be care that is not covered by law or that is never insured.
An example: the coverage states that we cover the costs of a particular type of operation; however, you can get the same result, without the operation, through a different treatment that is not listed under the coverage. In this case, you can ask us to reimburse the other treatment.
The ZorgConsulent can tell you more about the possibilities.
If you then decide to request permission for this other treatment, we will let you know our decision as soon as possible and explain which health care we are willing to reimburse and the conditions that apply.
Coverage under each health-care plan
Basic health-care plan On approval from ONVZ
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit No coverage
What you pay
The excess An excess may apply.
The personal contribution A personal contribution may apply.
What you have to do yourself
You must always request permission from us in advance In order to assess your request, we need a written explanation from your health-care provider.
ONVZ Coverage 2018 - version 1.2 213 Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Wait for our decision In principle, we will not give our permission if you have already started receiving the health care.
ONVZ Coverage 2018 - version 1.2 214 Wereldfit Coverage
Wereldfit: hospital care in Belgium and Germany Wereldfit: repatriation Wereldfit: early return Wereldfit: reimbursement in the event of death Wereldfit: replacement driver Wereldfit: hospital care in Belgium and Germany
When you go to the hospital in Belgium or Germany.
What is covered
For specialist medical care, your general practitioner will give you a referral to a medical specialist. In such cases, in the Netherlands the medical specialist coverage will apply. The basic health-care plan almost always cover these costs.
If you are going abroad to receive care from a medical specialist, this comes under abroad: non-urgent (scheduled) health care. The basic health-care plan covers up to a maximum of what the care would have cost in the Netherlands. If the cost of the health care you receive abroad is more expensive than this, you will have to pay the difference.
If you have Wereldfit or Superfit, you are entitled to more generous coverage in Belgium and Germany. For treatment provided by a medical specialist in a hospital in Belgium or Germany, the Wereldfit and Superfit plans supplement the coverage provided under the basic health-care plan up to the statutory rate that applies in that country. This means you do not need to pay the difference yourself if the health care is more expensive than in the Netherlands.
However, you must contact the ZorgConsulent in advance. He or she will help you choose which hospital to go to in Belgium or Germany.
Under the Wereldfitand Superfit plans, you will also be reimbursed for the cost of medical transportation1 from your home address in the Netherlands to the hospital in Belgium or Germany by taxi, by car (max. €0.27 per km) or by plane (economy class).
Whom can I contact? What are the terms and conditions? Health care abroad is subject to the same terms and conditions that apply to health care provided in the Netherlands. The terms and conditions are listed under health care provided by a medical specialist.
What is not covered • Chefarzt (medical specialist in Germany) and ereloon (doctor's fee in Belgium), as well as any related costs
Tip Superfit and Zorgplan cover the costs of extra luxury and comfort during your stay at a hospital, and assistance and extra service before and after your hospital admission. This also applies in Belgium and Germany.
Coverage under each health-care plan
Basic health-care plan Up to a maximum of what the care would have cost in the Netherlands as per abroad: non-urgent (scheduled) health care
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
1 Transportation which, for medical reasons, cannot occur using public transport. Such transport is necessary for the purposes of medical investigation/tests or treatment.
ONVZ Coverage 2018 - version 1.2 216 Superfit Medical specialist in a hospital in Belgium or Germany 100%, medical transportation After guidance by the ZorgConsulent
Wereldfit Medical specialist in a hospital in Belgium or Germany 100%, medical transportation After guidance by the ZorgConsulent
What you pay
The excess If the health care you receive is subject to an excess in the Netherlands, you will need to pay this excess if you receive this care in Belgium or Germany.
The personal contribution If you would be required to pay a personal contribution for health care in the Netherlands, you will also need to pay it if you receive the care in Belgium or Germany.
What you have to do yourself
You must contact the ZorgConsulent in advance He or she will help you choose which hospital to go to.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
See the ‘Comprehensive terms and conditions: Wereldfit’ as well Only the most important terms and conditions are shown above. Your coverage is based on the ‘Comprehensive terms and conditions: Wereldfit’. This also applies if you have taken out the Superfit plan, as Wereldfit is part of this.
We only cover routine health care that you actually need This must be health care that would normally be provided by medical specialists. Simple when possible, and more complex when necessary.
Wereldfit: repatriation
What is covered
If you become seriously ill while on holiday, or are seriously injured in an accident, urgent care will cover you for the medical care you need.
You may need to be transported to another location, for further treatment or further recovery for example. We refer to that as ‘repatriation’. The costs of repatriation, where this is medically required, are covered under the Wereldfit and Superfit plans.
We reimburse:
• transportation to a country designated by ONVZ Zorgassistance, including the prescribed medical supervision along the way • additional costs of accommodation if you need to be moved but that is not yet possible • if someone comes to visit you during this period, travel and accommodation for one person on one occasion
ONVZ Coverage 2018 - version 1.2 217 If, after having been ill or injured, you are allowed to return home but this is no longer possible with the originally planned means of transport, because you missed your flight, for example, or need to return home by another means, the additional costs will be reimbursed under the Wereldfit and Superfit plans.
Maximum reimbursements apply. For transportation: car €0.27 per km, economy class flight. And for accommodation: €150 per day. Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit Medically necessary repatriation in the event of serious illness or injury; visitor • Repatriation to the country designated by ONVZ Zorgassistance • Accommodation if repatriation is not yet possible • Travel and accommodation for one person coming to visit you • Extra costs incurred by having to use alternative transport
Wereldfit Medically necessary repatriation in the event of serious illness or injury; visitor • Repatriation to the country designated by ONVZ Zorgassistance • Accommodation if repatriation is not yet possible • Travel and accommodation for one person coming to visit you • Extra costs incurred by having to use alternative transport
What you pay
No excess These services are provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for these services.
What you have to do yourself
You must contact ONVZ Zorgassistance before you incur any costs Unless this is not possible. ONVZ Zorgassistance is always available on +31 (0)88 668 97 67. We will reimburse telephone costs incurred when calling ONVZ Zorgassistance from abroad.
ONVZ Coverage 2018 - version 1.2 218 Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
See the ‘Comprehensive terms and conditions’ as well Only the most important terms and conditions are shown above. Your coverage is based on the ‘Comprehensive terms and conditions: Wereldfit’. This also applies if you have taken out the Superfit plan, as Wereldfit is part of this.
ONVZ Zorgassistance will arrange the travel and accommodation If you make the travel and accommodation arrangements yourself, the costs may not be reimbursed in full.
Superfit also provides accident coverage This accident coverage applies when you are involved in an accident and suffer a permanent injury.
Wereldfit: early return
When you fall ill or are injured while travelling, or when a serious situation arises back home.
What is covered
If you unexpectedly need to return home while travelling, under the Wereldfit and Superfit supplementary plans you will be reimbursed for the extra travel and accommodation expenses.
This coverage applies in the following 5 situations:
1. you are unable to reach the planned destination due to you or your travel companion1 falling ill or becoming injured 2. a travel companion falls seriously ill or is injured during a serious accident 3. a travel companion without2 Superfit of Wereldfit coverage passes away 4. a family member3 or member of your household appears to be seriously ill, has had a serious accident, or has passed away 5. your home, home contents or business has been seriously damaged
If you later wish to continue your trip and this is still within the originally planned period for your trip, we will also cover the (return) travel costs to the planned destination.
Maximum reimbursements apply. For transportation: 2 people to visit the insured person: car €0.27 per km, economy class flight. And for accommodation: €150 per day. In the event of situation 4, in your country of residence we only reimburse transport, and only up to a maximum of €500.
1 The person with whom the insured person booked or planned a travel or rental package and with whom the insured person had a family, friendship or business-related connection prior to departure 2 For the travel companion with the Superfit of Wereldfit plan, the terms and conditions of ‘Wereldfit: reimbursement in the event of death’ apply 3 First and second-degree family members • 1st degree: your partner, parents, adopted parents, foster parents, step-parents, parents-in-law, children, adopted children, foster children, stepchildren, sons-in-law and daughters-in-law. If the child, adopted child, foster child or stepchild is younger than 16 years of age, a supervisor is also implied here. The partners with whom parents and children cohabit are also included • 2nd degree: brothers including their children, sisters including their children, grandparents, grandchildren, stepbrothers, stepsisters, brothers-in-law and sisters-in-law. The partners with whom brothers, sisters, grandparents, grandchildren, stepbrothers and stepsisters cohabit are also included
ONVZ Coverage 2018 - version 1.2 219 Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit Extra travel and accommodation costs you incur when you have to return home unexpectedly If a travel companion or a family member back home becomes ill or passes away, or if your home or business is damaged
Wereldfit Extra travel and accommodation costs you incur when you have to return home unexpectedly If a travel companion or a family member back home becomes ill or passes away, or if your home or business is damaged
What you pay
No excess These services are provided under the supplementary health-care plan. An excess does not apply.
No personal contribution You will not be charged a personal contribution for these services.
What you have to do yourself
You must contact ONVZ Zorgassistance before you incur any costs, unless this is not possible. ONVZ Zorgassistance is always available on +31 (0)88 668 97 67. We will reimburse telephone costs incurred when calling ONVZ Zorgassistance from abroad.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
See the ‘Comprehensive terms and conditions’ as well Only the most important terms and conditions are shown above. Your coverage is based on the ‘Comprehensive terms and conditions: Wereldfit’. This also applies if you have taken out the Superfit plan, as Wereldfit is part of this.
ONVZ Zorgassistance will arrange travel and accommodation If you make the travel and accommodation arrangements yourself, the costs may not be reimbursed in full.
ONVZ Coverage 2018 - version 1.2 220 Wereldfit: reimbursement in the event of death
What is covered
No one wants it to happen of course. However, if a person insured under the Superfit or Wereldfit plan passes away while travelling, these supplementary health-care plans reimburse:
• transportation of the physical remains to a country chosen by the next of kin, or • burial or cremation in the country where the person passed away, and travel, including the return journey, for the partner and first and second-degree family members, up to a maximum of €7,500 in total
Superfit and Wereldfit also reimburse travel, including the return journey, and a maximum of 7 days’ accommodation: • for 2 first and second-degree family members to the place where the insured deceased person is being held, and • for 1 person to provide comfort and support to a travel companion or family member of the insured deceased person
If you are insured under the Superfit or Wereldfit plan and your travel companion passes away1, you are covered for the (extra) costs of travel and accommodation you incur, due to having to return home later than planned for example. A maximum of 30 days’ accommodation will be reimbursed.
Maximum reimbursements apply. For transportation: 2 people to visit the insured person: car €0.27 per km, economy class flight. And for accommodation: €150 per day.
Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit Repatriation of physical remains or burial or cremation, extra costs of travel and accommodation for travel companion, costs of family coming over • Repatriation of physical remains or burial or cremation, up to a maximum of €7,500 • Travel and accommodation for 2 people to the place where the body is being held • Travel and accommodation for 1 person to support a travel companion/ family member of the deceased • Travel and max. 30 days’ accommodation for insured travel companion
1 The person with whom the insured person booked or planned a travel or rental package and with whom the insured person had a family, friendship or business-related connection prior to departure
ONVZ Coverage 2018 - version 1.2 221 Wereldfit Repatriation of physical remains or burial or cremation, (extra) costs of travel and accommodation, costs of family coming over • Repatriation of physical remains or burial or cremation, up to a maximum of €7,500 • Travel and accommodation for 2 people to the place where the body is being held • Travel and accommodation for 1 person to support a travel companion/ family member of the deceased • Travel and max. 30 days’ accommodation for insured travel companion
What you pay
No excess These services are provided under the supplementary health-care plan. An excess does not apply.
No personal contribution You will not be charged a personal contribution for these services.
What you have to do yourself
You must contact ONVZ Zorgassistance before you incur any costs, unless this is not possible. ONVZ Zorgassistance is always available on +31 (0)88 668 97 67. We will reimburse telephone costs incurred when calling ONVZ Zorgassistance from abroad.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
See the ‘Comprehensive terms and conditions’ as well Only the most important terms and conditions are shown above. Your coverage is based on the ‘Comprehensive terms and conditions: Wereldfit’. This also applies if you have taken out the Superfit plan, as Wereldfit is part of this.
ONVZ Zorgassistance will arrange travel and accommodation If you make the travel and accommodation arrangements yourself, the costs may not be reimbursed in full.
Superfit also provides accident coverage This accident coverage provides a payment in the event of death resulting from an accident.
Wereldfit: replacement driver
If the original driver is unable to drive back.
What is covered
If you are travelling by car, in a motorhome or on a motorcycle and the driver is no longer able to drive, what then?
If the driving cannot be taken over by a travel companion, the Superfit and Wereldfit supplementary plans cover the costs of a replacement driver who will drive the car, motorhome or motorcycle back to your place of residence or, in the case of a hired vehicle, to the closest pick-up and return location.
ONVZ Coverage 2018 - version 1.2 222 Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit Replacement driver To place of residence, or to closest pick-up and return location
Wereldfit Replacement driver To place of residence, or to closest pick-up and return location
What you pay
No excess This service is provided under the supplementary health-care plan. An excess does not apply.
No personal contribution You will not be charged a personal contribution for this service.
What you have to do yourself
Always contact ONVZ Zorgassistance before you incur any costs ONVZ Zorgassistance is always available on +31 (0)88 668 97 67. We will reimburse telephone costs incurred when calling ONVZ Zorgassistance from abroad.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
See the ‘Comprehensive terms and conditions’ as well Only the most important terms and conditions are shown above. Your coverage is based on the ‘Comprehensive terms and conditions: Wereldfit’. This also applies if you have taken out the Superfit plan, as Wereldfit is part of this.
ONVZ Zorgassistance will arrange the replacement driver If you arrange the replacement driver yourself, it is possible that the costs will not be reimbursed or not reimbursed in full.
ONVZ Coverage 2018 - version 1.2 223 Zorgplan Coverage
Hospital admission: extra luxury and comfort Hospital admission: assistance and extra services before and after Hospital admission: extra luxury and comfort
You do not really need it but it is nice to have: more privacy, comfort and repose during your hospital stay
What is covered
If you are suddenly and unexpectedly admitted to a hospital, or if you are scheduled to be admitted to a hospital for surgery, for example, the basic health-care plan will cover the hospital admission.
Many hospitals offers extra comforts and services to make your stay a bit more pleasant. The Superfit and Zorgplan supplementary health-care plans reimburse the 3 facilities listed below. A maximum reimbursement applies per calendar year to all 3 facilities together. The admission must be to a hospital in the Netherlands, Belgium or Germany and it must be required in order for you to be examined or treated by the medical specialist.
We reimburse:
1. a private room. If the hospital has private rooms but you are unable to make use of these, you will be entitled to compensation of €75 for each day of hospitalisation;
2. the luxury package that the hospital offers. This might include: • calling from a landline telephone in your room, to numbers in the Netherlands • a refrigerator filled with a range of drinks • complimentary newspaper or magazine • coffee and tea for visitors • higher quality meals or extra snacks • use of a TV and internet
3. an extra bed in the room or extra meals if your partner is allowed to stay with you during your stay.
Whom to contact • a hospital or an independent treatment centre1 in the Netherlands, Belgium or Germany • if you live in a country other than the Netherlands, Belgium or Germany: a hospital in another country
What is not covered • this coverage does not apply if you are admitted to a mental health-care centre or the psychiatric ward of a hospital
Assistance and extra service before admission and after discharge are listed separately.
1 Like a hospital, this is a facility for specialist medical care, but generally for non-urgent, less complex care that does not require admission to hospital
ONVZ Coverage 2018 - version 1.2 225 Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit €2,500 Maximum per calendar year
ONVZ Zorgplan €2,500 Maximum per calendar year
What you pay
No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.
No personal contribution You will not be charged a personal contribution for this care.
What you have to do yourself
You request the private room yourself To arrange this, contact the admissions office of the hospital where you want to be treated.
Submit a claim for compensation using the private room form If the hospital has private rooms but you are unable to make use of these, you can claim the compensation of €75 for each day of hospitalisation you are entitled to using the private room form1.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Do you want to know which hospitals offer private rooms? To find out, see our overview2 of Dutch hospitals that offer private rooms. Whether you will actually be able to make use of a private room depends on the availability at the time of your admission.
At a hospital outside the Netherlands Staying in a private room in Belgium, Germany or another country may have consequences for the costs of treatment. A medical specialist (a Chefarzt in Germany), for example, often charges more. The additional costs for fees and treatment are not covered and you will need to pay these yourself.
1 If you have any questions or need a particular document, we would be happy to help. www.onvz.nl - +31 (0)30 639 62 22 2 For this, see: www.onvz.nl/overzicht-ziekenhuizen-onvz-zorgplan
ONVZ Coverage 2018 - version 1.2 226 Hospital admission: assistance and extra services before and after
When faced with having to go to the hospital, a little extra help or advice is hardly a luxury.
What is covered
If you are suddenly and unexpectedly admitted to a hospital, or if you are scheduled to be admitted to a hospital for surgery, for example, the basic health-care plan will cover the hospital admission.
Being admitted to a hospital can be an unnerving experience. Perhaps you are worried about the actual hospitalisation, or maybe about what happens after. In that case, it can be comforting to know that transportation to the hospital has been arranged, or that there is someone who can help and advise you on what happens after you are discharged.
The Superfit and Zorgplan supplementary health-care plans reimburse the costs of assistance and extra service during the period leading up to your admission to the hospital and once you return home. The admission to the hospital must be required in order for you to be examined or treated by the medical specialist.
The following costs will be reimbursed if you are admitted to hospital:
1. help from the Zorgassistent, who will: • contact you for an initial interview prior to hospitalisation • arrange transportation to the hospital • meet you at the hospital and help you find your way around (if desired) • answer your care-related questions • stay in touch with you by telephone, consult with the doctors and staff, or come and visit you (if desired) • assist you when you are discharged • arrange transportation when you are discharged
The first 3 items are, of course, not an option if you are admitted to the hospital suddenly and unexpectedly.
2. transportation to and from the hospital;
3. immediately after being discharged from the hospital: up to 2 nights for yourself in a guest house, zorghotel or other (paid) overnight accommodation at or near the hospital, up to a maximum of €100 per night. This will allow you an additional day to recover near the hospital, for example if you feel that you have been discharged a little too soon. If you need to be at the hospital before 10am and live more than 50km away, you can also opt to use one of these overnight stays immediately before admission;
4. additional care and services arranged through the ONVZ ZorgConsulent after discharge from hospital. For example: • a meals service • medical appliances that you may need at home for a speedy recovery • help with the housekeeping or childcare • carer relief
Hospitalised in Belgium or Germany? If you live in the Netherlands and are admitted to a hospital in Belgium or Germany, we will not reimburse assistance by the Zorgassistent (1), but we will reimburse transportation, overnight stays and services provided by the ZorgConsulent (2, 3 and 4).
If you live in Belgium or Germany and are admitted to a hospital there, we will reimburse transportation and the overnight stays (2 and 3). The ZorgConsulent can advise you on your care after you have left the hospital, but generally cannot arrange this for you.
What is not covered • this coverage does not apply if you are admitted to a mental health-care centre or the psychiatric ward of a hospital
ONVZ Coverage 2018 - version 1.2 227 Coverage under each health-care plan
Basic health-care plan No coverage
Startfit No coverage
Extrafit No coverage
Benfit No coverage
Optifit No coverage
Topfit No coverage
Superfit Assistance, overnight stays, transportation Overnight stays: max. 2 nights, max. €100 per night Transportation: €0.27 per km
ONVZ Zorgplan Assistance, overnight stays, transportation Overnight stays: max. 2 nights, max. €100 per night Transportation: €0.27 per km
What you pay
No excess These services are provided under the supplementary health-care plan. An excess does not apply.
No personal contribution You will not be charged a personal contribution for these services.
What you have to do yourself
Please contact the ZorgConsulent If you already know the date of admission, contact the ZorgConsulent to find out about possible assistance and extra services.
How to arrange transportation You can ask the ZorgConsulent to arrange transportation for you or make your own arrangements by calling 0900 333 33 30.
Good to know
The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. They specify things such as coverage exclusions and changes you have to let us know about.
Have you been admitted to a hospital outside the Netherlands, Belgium or Germany? If so, we are sorry to say that you will not be able to make use of the assistance, extra transportation or overnight stays. Of course, you can still call our ZorgConsulent for help with your questions about the hospitalisation.
ONVZ Coverage 2018 - version 1.2 228 Superfit accident coverage Comprehensive coverage Superfit accident coverage
Paragraph 1 Definitions
Beneficial entitlement You are the beneficiary for all payments. In the event of your death, payment will be made directly to your estate.
Injury Physical injury that can be established medically and objectively, where the injury in question is the direct result of an accident.
Accident A sudden, external violent impact to the body, outside your control, causing injury or death. Accident includes: a. acute poisoning, unless this is caused by abuse of medicines, stimulants, intoxicants, narcotics or other drugs b. infection by pathogens c. involuntary intake of substances or objects affecting the digestive tract, the airways, the eyes or the ears d. infected wounds, blood poisoning or tetanus occasioned by an accident e. suffocation, drowning, sun stroke, thermoplegia, frostbite, burning (except as the result of radiation), cauterisation or electric discharge f. exhaustion, starvation, dehydration or sun stroke as the result of a natural disaster g. sprains, dislocations and tears of the muscles and ligaments, where the injury occurs suddenly h. complications or aggravation of injuries as the direct result of first aid or urgent medical treatment provided by a qualified health professional i. injury occasioned by reasonable self-defence within the bounds of the law j. murder, manslaughter, assault, or attempts at any of these, hostage-taking or acts of terrorism k. injury occasioned during amateur sport, including preparations for and participation in competitive events, except: • as defined in Paragraph 3(1)(j) • for the sports listed in Paragraph 3(1)(k)
The following are not regarded as an accident or the result of an accident: abdominal hernia or prolapsed intervertebral disc (spinal disc herniation).
Paragraph 2 What is covered?
Insured sums For each accident, ONVZ will pay the insured amount in the event of death or will pay a maximum of the insured amount in the event of permanent loss (or loss of function) of one or more limbs or other parts of the body or sensory functions.
Payment in the event of death In the event of death, the insured amount is €5,000. ONVZ will pay out this amount in the event of death resulting from an accident.
Payment in the event of permanent loss (or loss of function) a. Entitlement to payment: In the event of permanent loss or permanent impairment of limbs or other parts of the body or sensory functions, ONVZ will pay a maximum of €20,000 if this is the result of an accident. If the insured person dies before invalidity can be established, ONVZ will not pay an amount in respect of permanent invalidity. b. Existing impairment/infirmity: If any loss (or loss of function) or impairment of limbs/parts of the body or sensory functions already existed before the accident, ONVZ will only pay if the loss (or loss of function) or impairment as a result of the accident exceeds the loss (or loss of function) or permanent impairment of limbs/parts of the body or sensory functions that existed before the accident.
ONVZ Coverage 2018 - version 1.2 230 Paragraph 3 Further exclusions
1. No coverage is provided if the accident was the result of, or could be partly attributed to: a. poor health or a mental or physical defect b. poor health due to infection with pathogens, with the exception of the provisions of Paragraph 1 in the definition of accident c. allergic reactions, other than those occasioned by an event as referred to in Paragraph 1 in the definition of an accident d. suicide or attempted suicide e. committing or being accomplice to a crime f. recklessness, except where injury is incurred as a result of an attempt to rescue a person or animal, or to divert impending danger g. being under the influence of alcohol, intoxicants, stimulants or other such substances to such an extent that it is impossible to care for oneself as well as usual h. a fight, except reasonable self-defence within the bounds of the law i. being in an aircraft, unless you were a passenger on an aircraft designed for passengers and flown by a qualified pilot and at the time of the accident this aircraft was being used by: • a company authorised to run an airline • a private company j. sport for which payment is received k. ‘dangerous’ sports, such as boxing, wrestling, ice hockey, rugby, mountaineering, bobsleighing, parasailing, hang-gliding, parachuting, ice sailing, ski jumping, ‘extreme’ ski jumping and freestyle skiing l. preparation for and participation in races or record attempts involving motor vehicles, go- karts, horses, bicycles or motorboats m. professional work with industrial timber-processing equipment n. ignoring official warnings not to travel to specific countries o. nuclear reactions
2. Psychological trauma No payment will be made for loss of mental or cognitive function. a. This exclusion is not classed as loss in accordance with generally-accepted neurological understanding, if it is caused by a demonstrably serious organic impairment of the central nervous system. b. Neither will payment be made for whole or partial loss of function, or whole or partial impairment of limbs/parts of the body or sensory functions if such loss of function or impairment is the result of a psychological trauma.
Paragraph 4 Level of payment
1. Death In the event of death, ONVZ will pay the insured amount. ONVZ will deduct from this amount any earlier payment for permanent loss (or loss of function), or permanent disability or loss of sensory functions. ONVZ will not demand repayment of any earlier payments.
2. Permanent loss (or loss of function) In the event of permanent loss (or loss of function), ONVZ will pay the following percentages of the insured amount, up to a maximum of the insured amount.
• For permanent full loss or permanent full impairment of the limbs/parts of the body or sensory functions listed below: an arm up to the shoulder joint: 75% an arm up to the elbow joint: 65% an arm between the elbow and shoulder joint: 65% an arm between the wrist and elbow joint: 60% a hand up to the wrist: 60% a leg up to the hip joint: 70% a leg up to the knee joint: 60% a leg between the knee and hip joint: 60% a leg between the ankle and knee joint: 50% a foot up to the ankle: 50% a thumb: 25% an index finger: 15% a middle finger: 15% a ring finger or little finger: 15%
ONVZ Coverage 2018 - version 1.2 231 for permanent full loss or permanent full impairment of more than one finger of a hand, ONVZ will pay a maximum of 60% of the insured amount. a big toe: 10% a toe other than the big toe: 5% sight in one eye: 30% sight in both eyes: 100% hearing in one ear: 20% hearing in both ears: 50% sense of smell/taste: 20% loss of sexual potency, unless the terms of Paragraph 3(2) apply: 25%
• For one of the injuries listed below (or combination thereof): total loss of mental functions, unless the terms of Paragraph 3(2) apply: 100% loss of both arms or hands: 100% loss of both legs or feet: 100% loss of one arm or hand, together with one leg or foot: 100%
• In the event of partial loss or partial impairment of limbs/parts of the body or sensory functions as described above, ONVZ will pay a portion of the aforementioned payment percentages in proportion to the level of loss or impairment. This partial loss (or loss of function) or partial impairment must be established in accordance with generally-accepted medical standards. Partial loss of smell or taste is not considered to be a handicap.
• In the event of permanent loss or permanent impairment of limbs/parts of the body or sensory functions as a result of an injury or combination of injuries not specifically described above, the following shall apply. The percentage to be paid shall equal the percentage of permanent loss or permanent impairment as established in accordance with generally-accepted medical standards. Your profession or occupation will not be taken into consideration.
Paragraph 5 Establishing the percentage to be paid
1. ONVZ will establish the percentage to be paid on the basis of the ‘recognised situation’, where possible within two years of the accident.
2. If, after medical treatment has been terminated, no ‘recognised situation’ has yet been established, ONVZ will pay statutory interest on the payment from the day on which the medical treatment is terminated until the day on which payment is made.
If a medical examination establishes that no ‘recognised situation’ yet exists, a new medical examination will be conducted by order of ONVZ within five years of the date of the accident. Any invalidity established at that point will form the basis for establishing the level of payment.
Paragraph 6 Existing condition(s)
1. If the consequences of an accident are increased by poor health or mental or physical defects that already existed before the accident, ONVZ will pay out no more than would be paid to a person without that condition who suffered a similar accident.
2. The terms set out under 1 do not apply if the circumstances in question are solely and directly the result of an earlier accident suffered by you during the term of this health-care plan.
Paragraph 7 Medical appraisal
If ONVZ deems medical appraisal necessary in order to establish the percentage to be paid, you will be obliged to cooperate. In such cases, you will be required to undergo a medical examination conducted by a doctor appointed by ONVZ in an institution or establishment appointed by ONVZ. The medical appraisal will take place in the Netherlands. ONVZ will reimburse the costs.
ONVZ Coverage 2018 - version 1.2 232 Paragraph 8 What to do in the event of an accident
1. Notification An accident that may lead to payment must be reported to ONVZ as soon as possible, but at least within thirty days. This should include an accurate description of the accident and, where possible, the cause and consequences of the accident.
2. Obligations after an accident a. You are obliged to seek medical attention as soon as possible after an accident, and to give full cooperation to enhance your recovery. b. You are obliged to provide all information, to the best of your knowledge, to ONVZ or to a doctor appointed by ONVZ. c. The beneficiary/beneficiaries will not receive payment unless they cooperate with all measures ONVZ deems necessary in establishing the cause of death (e.g. permission for a post mortem).
3. ONVZ is entitled to refuse payment if these obligations are not observed. If notification is given later than specified under 1, you will retain entitlement to a payment if you can demonstrate that: • the loss or impairment of limbs/parts of the body or sensory function is the sole result of an accident • the consequences of an accident have not been aggravated by illness, infirmity or abnormal constitution or state of mind • you have complied with instructions given by the attending doctor • notification was delayed as the result of extraordinary circumstances
ONVZ Coverage 2018 - version 1.2 233 Wereldfit Comprehensive terms and conditions 2018 Wereldfit Comprehensive terms and conditions 2018
ONVZ will reimburse the costs of health care and other services, as described below. The general rules and regulations also apply to this health care and other services.
ONVZ reimburses invoices from health-care providers in euros. This reimbursement will be based on the exchange rate that applied on the last working day of the month before that in which the health care or service was received.
If more than one person is covered by the same health-care plan, the (maximum) levels of coverage will apply for each insured person, unless otherwise specified.
You must contact ONVZ Zorgassistance before you incur costs as referred to in the Wereldfit health-care plan, unless this is not reasonably possible. Not doing this may have consequences for the reimbursement of costs. This does not apply to scheduled care.
You can also contact ONVZ Zorgassistance for advice on medical care.
ONVZ Zorgassistance is always available on +31 (0)88 668 97 67. ONVZ will reimburse telephone costs incurred when calling ONVZ Zorgassistance from abroad.
Additional general rules and regulations
1. Definitions for the purposes of this clause
Abroad Any country other than the country in which you are normally resident.
Emergency health care Medically necessary treatment that could not have been reasonably foreseen upon departure and that cannot be deferred since, from a medical perspective, immediate intervention is required.
First and second-degree family members • 1st degree: your partner, parents, adopted parents, foster parents, step-parents, parents-in-law, children, adopted children, foster children, stepchildren, sons-in-law and daughters-in-law. If the child, adopted child, foster child or stepchild is younger than 16 years of age, a supervisor is also implied here. The partners with whom parents and children cohabit are also included. • 2nd degree: brothers including their children, sisters including their children, grandparents, grandchildren, stepbrothers, stepsisters, brothers-in-law and sisters-in-law. The partners with whom brothers, sisters, grandparents, grandchildren, stepbrothers and stepsisters cohabit are also included.
Medical transportation Transportation which, for medical reasons, cannot occur using public transport. Such transport is necessary for the purposes of medical investigation/tests or treatment.
Prevailing market rate In the context of these terms and conditions, ONVZ defines prevailing market rate as an amount charged by the health-care provider which is not unreasonably high when compared with the amount charged by other health-care providers in the country where the treatment takes place.
Travel companion The person with whom the insured person booked or planned a travel or rental package and with whom the insured person had a family, friendship or business-related connection prior to departure.
2. Who is insured? The people specified on the policy documents are insured if they also have a health-care plan as referred to in the Zorgverzekeringswet [Health Insurance Act].
3. Where are you insured? You are insured in foreign countries. You are also insured in your country of residence, but only in cases of at least one paid overnight stay (this does not apply to scheduled health care).
ONVZ Wereldfit 2018 - version 1.2 235 4. For how long are you insured? You are insured if you go abroad for a period of up to 180 days (this does not apply to scheduled health care). You are insured for the same period in your country of residence (not in the town/city where you live) in cases of at least one paid overnight stay.
5. Requirements for health-care providers For health care in a country outside the Netherlands, the health-care provider must be listed on the appropriate registers as maintained by the government. If there is no such register in the country in question, the health-care provider must be listed on the register of the recognised professional organisation, if there is one. The health care provided must be considered common practice within the profession.
6. Medical details You grant ONVZ Zorgassistance’s medical adviser permission to pass on all relevant details to ONVZ’s medical adviser where necessary. This includes information about the cause and background of treatment and/or repatriation.
7. Transportation (medical or otherwise) ONVZ will reimburse the costs of transportation: Where transportation by aeroplane is involved, the costs of an economy class flight will be reimbursed, unless this is not reasonably possible. For transportation by car, ONVZ will reimburse €0.27 per kilometre. In calculating the amount to be reimbursed, ONVZ assumes the optimum route is taken. Costs associated with transportation, for example parking charges, will not be reimbursed.
8. Inpatient treatment ONVZ will reimburse the costs (including the overnight stay and meals) in the cases listed below, up to a maximum of €150 per person per day.
Emergency health care
1. In the event of acute illness or an accident suffered by the insured person, ONVZ will reimburse the costs of the following (after contact with ONVZ): • health care that remains at the insured person's own expense. This only applies where the costs come under the basic health-care plan and are higher than the amount that would have been reimbursed if the health care had been provided in the Netherlands. The reimbursement will be limited to the statutory rate or prevailing market rate. This includes the coverage provided by the basic health-care plan or other health-care insurance • medicines registered in the Netherlands or abroad that are not covered under the basic health-care plan or other health-care insurance • substances that are classified in the Netherlands as ‘non-medicine’ (Niet Geneesmiddel) up to a maximum of €250 per calendar year. If Wereldfit is part of your Superfit health-care plan the maximum is €350 • medical appliances and dressings used in the treatment • medical transportation to take the insured person to and from the health-care provider
2. Repatriation ONVZ will reimburse: • in the case of serious injury caused by an accident or serious illness, the medically necessary repatriation of the insured person to the country designated by ONVZ Zorgassistance, with the prescribed medical supervision • if repatriation is medically necessary but not yet possible, the essential additional costs of accommodation incurred by the insured person requiring repatriation • if repatriation is medically necessary but not yet possible, the costs of transportation and accommodation for one person to visit the insured person who requires repatriation, once only • additional costs of transportation if you cannot return home using the anticipated means of transportation due to illness or injury
ONVZ Zorgassistance will arrange the transportation and accommodation for you.
Additional services
1. Search and rescue If, as a result of illness or an accident, you find yourself in an emergency situation involving essential search or rescue, ONVZ will reimburse the search and rescue costs up to a maximum of €25,000.
ONVZ Wereldfit 2018 - version 1.2 236 2. Transportation to the hospital in the event of admission for emergency care If a travel companion is admitted to hospital If a travel companion is admitted to hospital or cannot return home for other medical reasons, ONVZ reimburses the additional costs of transportation and accommodation incurred by the insured person.
Transportation and accommodation for insured travel companions ONVZ will reimburse the additional transportation costs of insured travel companions to the hospital where the insured person has been admitted. Additional accommodation costs of insured travel companions in connection with the hospitalisation of the insured person will also be reimbursed.
Transportation and accommodation for visitors The following reimbursement only applies in the event of admission of the insured person that is expected to last longer than 5 days or in the event of a life-threatening situation. ONVZ will reimburse, once only, the additional costs of transportation and accommodation for up to two people to visit the insured person. Accommodation costs will be reimbursed for up to 8 days. After that, accommodation costs will be reimbursed for up to 15 days, but only if the insured person is not able to return home for medical reasons.
3. Early return Coverage In the case of: 1. your own or a travel companion's illness or injury preventing you from reaching the planned destination 2. a travel companion's serious illness or serious injury caused by an accident 3. the death of a travel companion (in the event of the death of an insured travel companion see: Arrangements in the event of death) 4. the death of, diagnosis of a serious illness in or serious accident of the insured person's first or second- degree family member or a member of the insured person's household 5. serious material damage to the insured person's home, home contents or company ONVZ will reimburse, once only: • the additional transportation and accommodation costs that you have to incur in relation to your return journey • the transportation and accommodation costs you incur in relation to your return to the planned destination within the originally planned period for your trip
ONVZ Zorgassistance will arrange the transportation and accommodation for you.
Arrangements for family circumstances in your country of residence Contrary to the above, the following will apply if you stay in your country of residence. In cases referred to in point 4, the costs of necessary transportation within the country of residence will be reimbursed up to a maximum of €500 per event.
4. Replacement driver ONVZ will reimburse the costs of a replacement driver if: • the motor vehicle used still works, but the driver is unable to drive • the other travel companions cannot (reasonably) drive the motor vehicle
If you are travelling in your own motor vehicle, ONVZ will reimburse the costs of the replacement driver to take you to the town/city where you live. If you are travelling in a hired motor vehicle, ONVZ will reimburse the costs of the replacement driver to the nearest drop-off point.
ONVZ Zorgassistance will arrange the replacement driver.
5. Guarantee, advance payments and shipping of medicines ONVZ Zorgassistance will arrange, at your request: • guarantee on direct payment of health-care costs to the health-care provider, if the costs are reimbursed under the basic health-care plan or the Wereldfit plan • the necessary advance payments, if the costs are reimbursed as described above • if possible, the shipping of essential medicines if they are not available at your location, if the costs are reimbursed as described above
ONVZ Wereldfit 2018 - version 1.2 237 Arrangements in the event of death
In the event of the death of the insured person during a trip, ONVZ will reimburse the costs of: • transportation of the physical remains to the country chosen by the next of kin, or burial or cremation, as well as travel, including the return journey, for first and second-degree family members, up to a maximum of €7,500 • the additional transportation costs in connection with the return journey and additional accommodation costs of the insured travel companions, up to and including the day of repatriation of the physical remains or the day after the funeral, up to a maximum of 30 days • transportation and accommodation for a maximum of 7 days for 2 first and second-degree family members to the place where the insured deceased person is presented for viewing, including the return journey • transportation and accommodation for a maximum of 7 days for one person to support a travel companion or family member of the insured deceased person
ONVZ Zorgassistance will arrange the transportation and accommodation.
Scheduled health care
1. ONVZ will reimburse the costs of specialist medical care in accordance with the coverage under the basic health-care plan (see: Health care provided by a medical specialist) when it is provided in a hospital in Belgium or Germany. This only applies where the costs are higher than the amount that would have been reimbursed if the health care had been provided in the Netherlands. The reimbursement will be limited to the statutory rate or prevailing market rate. This includes the coverage provided by the basic health-care plan or another health-care plan.
However, prior to the treatment you must contact the ONVZ ZorgConsulent that has helped you in your selection of a health-care provider. The ZorgConsulent is available on workdays from 8.30am to 5.30pm on the following number: 0800 022 14 50 (free of charge within the Netherlands), or through [email protected].
2. Exclusions The above reimbursement excludes the costs of: • use of a Chefarzt (medical specialist in Germany) and ereloon(supplementen) (doctor's fee (and any supplements) in Belgium), or associated costs • alternative/non-conventional health care
3. ONVZ will also reimburse the costs of medical transportation for treatment for which the costs are reimbursed under point 1 above. ONVZ will reimburse the cost of medical transportation from your home address in the Netherlands to the hospital in Belgium or Germany and back again.
ONVZ Wereldfit 2018 - version 1.2 238 Index Coverage Index
A Abroad: non-urgent (scheduled) health care 203 Abroad: urgent health care 201 Abroad: vaccinations and prophylactics 206 Acne treatment 185 Adoption, health care upon 121 Aid for third-party claims for injury 211 Alternative/non-conventional medicine 165 Ambulance, medical transportation by 194 Antenatal screening 110 Arch supports 90 Audiological health care 169
B Bed wetting alarm 120 Breast cancer: additional tests 55 Breastfeeding: breastfeeding specialist 119
C Carer relief 99 Childcare 65 Contraceptive medicines 161 Cosmetic skin camouflage treatment 185
D Dental health care after an accident 140 Dental health care from the age of 18 137 Dental health care up to the age of 18 135 Dental prosthesis (‘prosthesis’) from the age of 18 145 Dental surgery from the age of 18 149 Diagnostics for primary health care 29 Dialysis 58 DiamondClean Smart electric toothbrush 152 Dietary preparations 132 Dietetics 130 Domestic assistance 101
E Electrical epilation and laser treatment 188 Exercise programmes during and after cancer 84 Exercise programmes in cases of chronic illness 82 Exercise programmes in cases of obesity 85
F Fertility treatment 50 Foot care for diabetes mellitus sufferers 31 Foot specialist treatment and podiatry/chiropody 79 Front-teeth replacement 147
G General basic mental health care (GGZ) 155 General practitioner 28 Geriatric rehabilitation 96
Index 240 Glasses, (contact) lenses and laser eye treatment 175 Guest house 63
H Health care for sensory impairment 172 Health check-up/sports check-up 42 Health resort 103 Hereditary diseases, testing for 54 Hospice 72 Hospital admission 46 Hospital admission: assistance and extra services before and after 227 Hospital admission: extra luxury and comfort 225
I Individual budgets (Pgb) 69 Influenza vaccination 35 IVF 52
M Maternity care 114 Maternity package 116 Mechanical respiration 60 Medical appliances 180 Medical specialist 45 Medicines (basic health-care plan) 124 Medicines (supplementary health-care plans) 126 Menopause consultant 104
N Nursing and other care 67
O Occupational therapy 98 Oedema and scar therapy 80 Organ transplants and donation 56 Orthodontics up to the age of 18 142 Orthodontics from the age of 18 144 Orthoptics 170 Other medical transportation 195 Over-the-counter medication and proton-pump inhibitors 128
P Patient association membership 107 Pedicure for people with diabetes and rheumatoid arthritis 191 Physiotherapy/remedial therapy from the age of 18 77 Physiotherapy/remedial therapy up to the age of 18 75 Plastic surgery 48 Pregnancy and childbirth 112 Preventive health-related courses 37 Preventive medical investigations 38 Primary care admissions 70 Provisionally approved treatments 61 Psoriasis day treatment 189 Psychological health care with a general practitioner 33
Q Quitting smoking 40
Index 241 R Rehabilitation (specialist medical) 94 Reimbursement in exceptional cases 213
S Specialist dental care 150 Specialist mental health care (GGZ) 157 Speech therapy 174 Sterilisation and reversal operation 162 Stuttering therapy 177 Superfit accident coverage; Comprehensive coverage: Superfit accident coverage 210, 230 Support pessary 182 Swimming programmes aimed at keeping senior citizens fit 92
T TENS device 118 Therapeutic camp for young people 106 Therapies for posture and movement 87 Thrombosis service 34 Travel costs for visiting ill people 198
W Walking aids 89 Wereldfit: early return 219 Wereldfit: hospital care in Belgium and Germany 216 Wereldfit: reimbursement in the event of death 221 Wereldfit: repatriation 217 Wereldfit: replacement driver 222
Z Zorghotel 102
Index 242
De Molen 66 Postbus 392 3990 GD Houten 030 639 62 22
www.onvz.nl www.linkedin.com/company/onvz www.facebook.com/onvz www.twitter.com/onvz ONVZ Coverage 2018 - version 1.2