2019 General rules and regulations 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 Changes to the text

Certain coverage items have been made clearer The coverage itself has not changed.

We have also corrected spelling mistakes and removed items that were listed twice. These changes are not detailed here.

Fertility treatment and in vitro fertilisation (IVF) Under ‘We use the Hunault score’, we have removed the text ‘Also, 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 only a reduced likelihood of becoming pregnant’.

DAISY players Some sections referred to ‘DAISY players and DAISY software’. This has been changed to ‘DAISY players’ (DAISY software is not covered).

Powered arm and leg prostheses The word ‘leg’ has been added to the sentence ‘These are electrically powered prostheses that replace the normal functions of your arm, hand or leg’.

Glasses and contact lenses with a medical indication The text ‘excluding personal contributions’ has been added to the table ‘Coverage under each health-care plan’. The term ‘contact lenses’ has been added to the text ‘lenses for glasses, filter lenses or contact lenses’.

Medical appliances for problems with hearing We had explained the personal contribution and its reimbursement in some sections. We have now removed these explanations, as you do not pay a personal contribution for these medical appliances.

Medical appliances for nursing and care in bed Under ‘Good to know’, we have added the correct reference to the official regulation for nursing and other care.

Medical appliances for vascular conditions Under ‘Excess’, it used to say ‘You do not pay an excess, because you get the medical appliance on loan’. This has been changed to ‘If you own the medical appliance, you pay an excess. However, you do not pay an excess if you get the medical appliance on loan.’

Compression stockings/sleeves Under ‘What is covered’, the word ‘arms’ has been added to the sentence ‘It helps your body carry the blood or lymph away from your legs and arms.’

2019 ONVZ general rules and regulations - 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 2019, as you have come to expect from us.

Our policy terms and conditions and other important information listed for you This booklet lists all general rules and regulations, and the coverage of the 2019 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 2019 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.

Yours faithfully,

Jean-Paul van Haarlem Chairman of the ONVZ Board

www.facebook.com/onvz

www.twitter.com/onvz

Introduction 3 Reader’s guide

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 basic rules and coverage for medical appliances are the rules and agreements that apply to medical appliances that come under the basic health-care plan.

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 7

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 26

Hospital and medical specialist 47

Nursing and other care 75

Exercise 88

Rehabilitation and recovery 106

Pregnancy, childbirth and children 117

Medication and diet 131

Oral and dental 142

Psychological health care 162

Contraceptives 168

Alternative/non-conventional 172

Hearing, vision and speech 175

Medical appliances 186

Skin and hair 190

Transportation 199

Health care abroad and travel 206

Compensation and aid 215

Wereldfit 221

Superfitaccident coverage rules and regulations 231

Wereldfitcomprehensive terms and conditions 236

Basic rules: medical appliances under the basic health-care plan 241

Coverage of medical appliances under the basic health-care plan 244

Coverage index 318

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 Internet: www.onvz.nl/contact

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 Internet: www.onvz.nl/contact

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

ONVZ complaints service For submitting a complaint ONVZ Klachtenservice Postbus 392 3990 GD Houten Netherlands Email: [email protected]

Contact details 6 ONVZ 2019 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 Policyholder, insured persons and holders of medical insurance cards 10 Which 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

2019 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 four sections:

1. ONVZ’s health-care plans 2. I’m a new ONVZ customer 3. I’m already insured 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 More information is available at: www.onvz.nl/vergoedingen/vergoedingen-a-z

2019 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

1. All of our health-care plans are restitution policies. They entitle you to reimbursement of the costs of health care and to our services. From this point on, we will use the terms ‘health-care plan’ and ‘reimbursement of the costs of health care’. Wherever we refer to ‘ONVZ’, ‘we’ or ‘us’, we mean ONVZ Ziektekostenverzekeraar N.V.1 when discussing the Vrije Keuze basic health-care plan, and ONVZ Aanvullende Verzekering N.V.1 when discussing supplementary health-care plans.

Our health-care plans are:

a. the Vrije Keuze basic health-care plan b. the 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. the 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 general rule 24.

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] (Zvw) can take out a Vrije Keuze basic health-care plan, or have this done for them.

4. The official term for the person who takes out a health-care plan is the policyholder. 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.

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

2019 ONVZ general rules and regulations - version 1.2 10 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 rules and regulations determine the health-care plan and the premium

6. The general rules and regulations and the coverage determine the 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 Vrije Keuze basic health-care plan general rules and regulations or coverage 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 when you take out your health-care plan.

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, 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 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

2019 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. Alternatively, you can send us the application form 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. We also ask the questions from general rule 13 for children. If you registered your child with us within 4 months of birth, we do not ask these questions.

When your health-care plan commences

15. The health-care policy 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 the following year. The following rules apply.

a. If you switch to ONVZ before 31 December, we will ensure that your ONVZ Vrije Keuze basic health-care plan starts right after your existing basic health-care plan finishes. If there are no special circumstances, your existing basic health-care plan will continue until 31 December inclusive. Your ONVZ Vrije Keuze basic health-care plan will then commence on 1 January.

If you are switching to ONVZ, our switch service will take care of everything for you: if you take out a Vrije Keuze basic health-care plan with us, we will cancel your existing basic health-care plan for you. If you also take out a supplementary health-care plan with us, we can cancel your existing supplementary health-care plan for you too. We will only do this once you have taken out your health-care plan with us,

b. If you take out an ONVZ Vrije Keuze basic health-care plan before 1 February, and you cancelled your basic health-care plan with a different health insurer before 1 January, your Vrije Keuze basic health- care plan will commence on 1 January in this instance too.

c. If you turn 18 and take out one or more health-care plans of your own, these plans will commence on the 1st 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 health-care plan from that date. You must make sure you take out the health-care plan(s) before you turn 18.

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.

for example if you used to live and work abroad, and have come to work in the Netherlands.

2019 ONVZ general rules and regulations - version 1.2 12 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.

You will, of course, need to cancel your old collective health-care plan in good time. The basic health- care plan can be cancelled up to 30 days after the commencement date of the new employment. The new collective health-care plan with us will commence on the 1st 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. 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 five instances above apply, the Vrije Keuze basic health-care plan will commence on the date on which we received your application. 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 your application 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 as set out in general rule 13, 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 can become a member of Vereniging ONVZ. When you take out an ONVZ Vrije Keuze basic health-care plan, you can 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.

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.

2019 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 the costs of health care in accordance with the rules and regulations that apply to that health-care plan. We give more information about this below.

I need health care

21. If you need health care, we use the following rules to determine whether we will reimburse the health care. Reimbursement is usually straightforward. The health-care provider requests reimbursement directly from ONVZ and ONVZ pays the health-care provider directly. You may not transfer your right to the reimbursement of health-care costs to a third party without our permission, nor may you use it as security for your payment of this third party’s invoice.

Let’s say you have a health-care plan with us and you need physiotherapy. Is this covered, and does the excess or a personal contribution apply?

22. Your health-care plan reimburses the costs of health care and entitles you to services listed under coverage on our website, providing the terms and conditions have been met. By this, we mean the general rules and regulations you are currently reading, along with the terms and conditions listed for the coverage on our website.

Example: The general rules and regulations state that we only cover health care for which you have a reasonable need. This is always the case, even if it is not repeated every time.

Coverage may be subject to the health-care provider having a particular field of specialisation, or to you gaining our permission before using the health-care provider.

23. The health-care plan reimburses the costs of health care for as long as you are insured with us. In other words, you must be insured with us on the date of treatment or (for example, in the case of a medicine) the date of dispensation stated on the invoice. If your health-care provider charges a single rate for the entire treatment, like with a DBC for 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 maximum amounts specified in the Reglement Zvw-pgb1 [Zvw-pgb regulations].

We always 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.

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)2. You must pay this amount yourself if you receive the health care concerned. The government sets the level of the personal contributions.

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/eigen-bijdrage

2019 ONVZ general rules and regulations - version 1.2 14 27. You will also need to pay the compulsory excess1. The government sets the level of the compulsory excess each year. In 2019, 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. In the case of medicines, this works differently. If you have paid the maximum personal contribution of €250, the basic health-care plan covers the remainder. These costs are then subject to the excess.

28. The excess applies from the 1st 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.

29. In addition to this compulsory excess per calendar year, you may also opt for a voluntary excess. This portion of your health-care costs will also not be reimbursed. and your premium will be discounted accordingly. The premium table2 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 of... But does apply to the costs 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 own primary-care admissions environment (district nursing) foot care for diabetes mellitus sufferers

programmes for quitting smoking

combined lifestyle intervention for overweight patients assessment of chronic use of prescription medication the medication itself by a designated pharmacist

obstetric care and maternity care associated health care, e.g. medicines, 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 (six 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 or your health-care provider claim the costs of health care that is subject to the excess, that health care counts towards the excess for the year of treatment. Sometimes the government requires the health-care provider to claim the consultations, tests and treatment in 1 go, for example with a DBC. If this the case, the DBC counts towards the excess for the year in which the DBC was opened.

1 More information is available at: www.onvz.nl/vergoedingen/eigen-risico 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

2019 ONVZ general rules and regulations - version 1.2 15 33. If you incur health-care costs in 2019 and your health-care provider does not invoice us until 2021 or later, we will not charge the compulsory excess. However, we reserve the right to charge the excess if we do not receive the invoices earlier as a result of something you do or do not do.

34. If you are only insured with us for part of the year, we will adjust the compulsory (and any voluntary) excess and the maximum personal contribution for medicines proportionally. We will calculate both 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. If you turn 18 part way through the year, we will also adjust the excess proportionally, but not the personal contribution, as this also applies when you are under 18.

Your health-care plan commences on 3 February. 33 days of the year have passed and there are 332 days remaining. Your excess is 332/365 of €385, i.e. €350.19. We round this off to €350.

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.

May be covered by a supplementary health-care Not covered by the Vrije Keuze basic 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]. • 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 activities designed to achieve a certain sporting level Extrafit and above (sports doctor only) or to improve sporting performance

2019 ONVZ general rules and regulations - version 1.2 16 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.

39. The supplementary health-care plans are subject to the two 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 two 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 three 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 indicate, for example, which health care you have received and who provided it. They must be written in Dutch, English, German, French or Spanish. Otherwise we can request a translation.

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. This includes preventive measures

2019 ONVZ general rules and regulations - version 1.2 17 c. If you send us the invoice electronically, for example through the ONVZ app or our website, you must keep the original invoice for 1 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.

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 six 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 two children. You must register 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 • join the Vereniging ONVZ collective health-care plan • 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 1 month, we will assume 1 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. You must notify us if you are held in custody, and how long it is for. You must also notify us when you are released from custody.

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. If you fail to cooperate, your invoices might not be reimbursed or you might have to pay back any reimbursement received.

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 If you fail to do this, your invoices might not be reimbursed.

2019 ONVZ general rules and regulations - version 1.2 18 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 make to recover (other) costs from the other party may not affect our rights in any way. Otherwise, you might have to pay back the health-care costs to us.

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 statement1. 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 information1. 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 terms and conditions 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 7 weeks, although it may be later than that. You may be able to cancel in such cases, as specified in general rule 63.

1 For this, see: www.onvz.nl/privacy

2019 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 5 other instances, during the course of the year:

a. If you are still in the ‘cooling-off period’ referred to in general rule 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 1 month of your previous employment ending. Cancellation will take effect on the 1st 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 in the meantime, as referred to in general rule 62. 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 one 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.

e. If the Nederlandse Zorgautoriteit [Dutch Health-Care Authority] (NZa) notifies you that we have viewed your medical details that were not intended for us. That is something that we will never do. We must receive notification of termination no later than 6 weeks after NZa informs the policyholder of the occurrence.

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 entitled to it, the Vrije Keuze basic health-care plan will end on the commencement date or the date on which you ceased to be entitled. If you have already paid premiums, we will refund these, less any health-care costs already reimbursed. If the health-care costs already reimbursed by us exceed the premiums paid by you, you will need to repay the difference to us.

You will not be entitled to a Vrije Keuze basic health-care plan if, for example: - you are in military service. In this case, you will be insured through SZVK; - you work in a different EU member state. In this case, you will need to take out a health-care plan in the country concerned.

66. Health-care plans will end the day after the day of the insured person’s death. We will repay or offset any overpaid premiums.

2019 ONVZ general rules and regulations - version 1.2 20 67. The Vrije Keuze basic health-care plan will also end in the event of our licence as a non-life insurer being revoked. We will tell you about this at least two months in advance.

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 you are in arrears with your premiums by 2 months, or with health-care costs, the excess or the personal contribution, 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]1. 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 general rule 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

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

2019 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 complaints service. 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 esolver your complaint through mediation. b. If this proves unsuccessful, you may refer your complaint to the Geschillencommissie [Disputes Committee].

Further information is available at www.skgz.nl/procedure.

You can refer your complaint to SKGZ in 2 ways:

a. By completing the online complaints form at www.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 one 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.

2019 ONVZ general rules and regulations - version 1.2 22 ONVZ coverage

Table of contents

ONVZ coverage

General practitioners and staying healthy 26 The general practitioner (general medical care) 27 Diagnostics for primary health care 28 Foot care for diabetes sufferers 30 Psychological health care with a general practitioner 32 Thrombosis service 33 Influenza vaccination 35 Combined lifestyle intervention for overweight patients 36 Quitting smoking 38 Preventive health-related courses 40 Preventive medical investigations and pharmacogenetic testing 42 Menopause consultant 44 Health check-up/sports check-up 45 Hospital and medical specialists 47 Medical specialist 48 Hospital admission 50 Plastic surgery 52 Fertility treatment 54 In vitro fertilisation (IVF) 55 Testing for hereditary diseases 57 Breast cancer: additional tests 59 Organ transplants and donation 60 Dialysis 61 Mechanical respiration 63 Provisionally approved treatments 64 Second opinion 66 Stay in a guest house 68 Childcare in case of hospital admission of a parent 70 Hospital admission: extra luxury and comfort 71 Hospital admission: assistance and extra services before and after 73 Nursing and other care 75 Nursing and other care at home 76 Individual budget under the Zorgverzekeringswet [Health Insurance Act] (Zvw-pgb) 78 Primary-care admissions 80 Carer relief 82 Help for carers 83 Domestic assistance 85 Hospice 86 Exercise 88 Physiotherapy/remedial therapy up to the age of 18 89 Physiotherapy/remedial therapy from the age of 18 91 Foot specialist treatment and podiatry/chiropody 93 Oedema and scar therapy 95 Exercise programmes in cases of chronic illness 97 Exercise programmes during and after cancer 99 Posture, movement and sport 100 Walking aids 102 Arch supports supplied by an orthopaedic technician 103 Swimming programmes aimed at keeping senior citizens fit 104 Rehabilitation and recovery 106 Rehabilitation (specialist medical) 107 Geriatric rehabilitation 108 Occupational therapy 110 Zorghotel 112 Health resort 113 Therapeutic camp for young people 114 Membership of a patients’ association or advocacy group 115 Pregnancy, childbirth and children 117 Antenatal screening 118 Pregnancy and childbirth 120 Maternity care 122 Maternity package 124 TENS device 126 Breastfeeding: breastfeeding specialist 127 Adoption care 128 Bed-wetting alarm 129 Medication and diet 131 Medicines, basic health-care plan 132 Medicines (supplementary health-care plans) 134 Over-the-counter medication and proton-pump inhibitors 136 Dietetics 138 Dietary preparations 140 Oral and dental 142 Dental health care up to the age of 18 143 Dental health care from the age of 18 145 Dental health care after an accident 148 Orthodontics up to the age of 18 150 Orthodontics from the age of 18 152 Dental prosthesis (‘prosthesis’) from the age of 18 153 Front-teeth replacement 155 Dental surgery from the age of 18 157 Specialist dental care 158 DiamondClean Smart electric toothbrush 160 Psychological health care 162 General basic mental health care (GGZ) 163 Specialist mental health care (GGZ) 165 Contraceptives 168 Contraceptives 169 Sterilisation and reversal operation 170 Alternative/non-conventional 172 Alternative/non-conventional medicine 173 Hearing, vision and speech 175 Audiological health care 176 Orthoptics 177 Health care for sensory impairment 179 Speech therapy 181 Glasses, (contact) lenses and laser eye treatment 182 Stuttering therapy 184 Medical appliances 186 Medical appliances 187 Support pessary 189 Skin and hair 190 Acne treatment 191 Cosmetic camouflage instruction 192 Electrical epilation and laser treatment 194 Psoriasis day treatment 195 Pedicure for people with diabetes and rheumatoid arthritis 197 Transportation 199 Medical transportation by ambulance 200 Other medical transportation 201 Travel costs for visiting ill people 204 Health care abroad and travel 206 Abroad: urgent health care 207 Abroad: non-urgent (scheduled) health care 209 Abroad: vaccinations and prophylactics 212 Compensation and aid 215 Reimbursement in exceptional cases 216 Aid for third-party claims for injury 217 Superfit accident coverage 219 Wereldfit 221 Wereldfit: hospital care in Belgium and Germany 222 Wereldfit: repatriation 223 Wereldfit: early return 225 Wereldfit: reimbursement in the event of death 227 Wereldfit: replacement driver 229 Superfitaccident coverage rules and regulations 231 Wereldfit comprehensive terms and conditions 236 Basic rules and coverage for medical appliances under the basic health-care plan 241 Basic rules: medical appliances under the basic health-care plan 242 Coverage of medical appliances under the basic health-care plan 245 General practitioners and staying healthy Coverage

The general practitioner (general medical care) Diagnostics for primary health care Foot care for diabetes sufferers Psychological health care with a general practitioner Thrombosis service Influenza vaccination Combined lifestyle intervention for overweight patients Quitting smoking Preventive health-related courses Preventive medical investigations and pharmacogenetic testing Menopause consultant 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. If necessary, they will give you a referral to the hospital’s A&E department.

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)

We also cover individual medical care for infectious diseases and/or tuberculosis if you go to a doctor of infectious diseases or tuberculosis. These doctors usually work at the municipal public health service (GGD).

Other coverage If you will be travelling, There is separate coverage for vaccinations and preventive medicines for travel.

Normally you can also go to your general practitioner for preventive medical investigations. If you would like to do more in terms of prevention, there is separate coverage for (other) preventive medical investigations, health check-ups, preventive health-related courses and influenza vaccinations. 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. They also specify that the basic health-care plan does not cover medical examinations for specific purposes, such as a driving licence or for employment.

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, because you are registered at the practice. 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. 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

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.

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 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 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.

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

We reimburse the annual foot check-up and the foot care described above as general medical care.

Whom to contact • a general practitioner or a nurse working under the responsibility of a general practitioner • a foot specialist. 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 the costs of the pedicurist will be included in the foot specialist’s invoice

If you have been assigned health-care profile ,1 the basic health-care plan only covers the annual foot check-up. 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. Your entitlements are stated in the coverage.

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

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], the Register Paramedische Voetzorg [Register for Allied Health Professionals for Foot Care] or in the register administered by KABIZ (Quality registration and accreditation for health-care professionals) Coverage under each health-care plan

Basic health-care plan 100% Foot check-up, for health-care profile 1 or higher Foot care, for health-care profile 2 or higher

Startfit No coverage

Extrafit €150 Foot specialist treatment for health-care profile 1 Maximum per calendar year, as per foot specialist treatment and podiatry/chiropody

Benfit €100/€250 For health-care profile 1: • Pedicure €100 • Foot specialist treatment €250 Maximum per calendar year, as per pedicure for people with diabetes and rheumatoid arthritis and foot specialist treatment and podiatry/chiropody

Optifit €200/100% For health-care profile 1: • Pedicure €200 • Foot specialist treatment 100% Maximum per calendar year, as per pedicure for people with diabetes and rheumatoid arthritis and foot specialist treatment and podiatry/chiropody

Topfit 100% Pedicure and foot specialist treatment for health-care profile 1 As per pedicure for people with diabetes and rheumatoid arthritis and foot specialist treatment and podiatry/chiropody

Superfit 100% Pedicure and foot specialist treatment for health-care profile 1 As per pedicure for people with diabetes and rheumatoid arthritis and foot specialist treatment and podiatry/chiropody

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. 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 health (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). The relevant coverage will then apply.

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.

What is not covered • exercise-related therapy • anonymous online treatment

Other coverage 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 (Extrafit 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 What you pay

No excess Psychological health care with a general practitioner is not subject to the excess, not even if the medical assistant for mental health (POH-GGZ) provides 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.

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 covers: • blood tests by the thrombosis service • tests to measure the blood clotting time • advice on medicines for preventing thrombosis

If you measure the coagulation times of your own blood, the basic health-care plan includes coverage for: • instruction in how to use the equipment and support with your readings

Other coverage The self-testing device and the related accessories and consumables come under the coverage for Medical appliances for thrombosis. 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 the Nationaal Programma Grieppreventie [National Influenza Prevention Programme]. Your general practitioner will usually send you a reminder.

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.

Combined lifestyle intervention for overweight patients

For a permanent improvement to your eating habits and level of exercise.

What is covered

If you are overweight, and therefore at a greater risk of illness, a combined lifestyle intervention may be just what you need. A combined lifestyle intervention (CLI) involves you working towards a permanently healthy lifestyle. It consists of advice and support in adopting a healthier diet and eating habits, getting more exercise and achieving behavioural change.

Usually through your general practitioner It is usually your general practitioner who discusses a CLI with you, but it could also be your medical specialist. If you wish to participate, they will refer you to a CLI provider2. That will often be a health-care provider with whom your general practitioner already collaborates (outside of the practice). This person will support you in a specially developed programme. Normally this will last around 2 years and much of the programme is done within a group. The exact duration and content vary depending on the programme. Your CLI provider will discuss that with you beforehand. The general practitioner or medical specialist who referred you will remain involved. Your provider, for example a lifestyle coach, will keep your general practitioner or medical specialist informed of your results.

Coaching is covered, the exercise is not Your CLI programme provider will motivate and coach you towards healthier behaviour, healthier exercise and healthier eating. For example, you will together look into what works best to get you exercising more, such as joining a walking club or other sports club. The activity itself is not part of the CLI, so you will have to pay for this yourself.

The basic health-care plan covers the CLI if you: • are aged over 16, and • are motivated to continue with the complete programme of around 2 years, and • have a BMI3 that 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

The basic health-care plan only reimburses combined lifestyle intervention programmes that we recognise4.

Supplementary exercise programmes (for all ages) The Benfit and higher supplementary health-care plans cover an exercise programme for adults who take part in a CLI and for children who are too young for a CLI. An exercise programme can be advantageous if you are taking part in a CLI, but have not yet managed to join in with a regular exercise activity, such as a walking club or other sports club, or for children who are too young for a CLI.

1 More information is available at: www.rivm.nl/Onderwerpen/G/Griep/Griepprik 2 That can be a lifestyle coach, physiotherapist, Cesar/Mensendieck remedial therapist or dietitian 3 To calculate your own BMI, divide your weight (in kilograms) by your height (in metres). Divide the result once more by your height (in metres). The result gives you your BMI 4 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 This kind of exercise programme involves training several times a week for a period of 3 to 4 months in a group. After that, you can use regular exercise options. Benfit and Optifit have a cap on the coverage provided in any 1 calendar year for exercise programmes as part of a CLI, in cases of chronic illness, and during and after cancer combined. See below for the maximum coverage provided. Topfit and Superfit provide full coverage for such exercise programmes.

Whom to contact For the combined lifestyle intervention: • a health-care provider who is listed on the register1 administered by BLCN2 • another health-care provider who is named in the combined lifestyle interventions3 that we recognise

For the exercise programme: • physiotherapist • Cesar or Mensendieck remedial therapist • Home-care organisation

Other coverage If, during the programme, you suffer from other complaints that require (further) treatment, such as movement- related problems or psychological issues, the general practitioner can refer you, for example, for physiotherapy or remedial therapy, dietetics, to the medical specialist or for psychological support such as general basic mental health care (GGZ). This can then take place alongside the CLI programme.

If you want to work on your lifestyle, but the combined lifestyle intervention is not for you, our Extrafit and higher supplementary health-care plans also cover preventive health-related courses for a ‘healthy weight’.

Coverage under each health-care plan

Basic health-care plan 100% Combined lifestyle intervention (CLI)

Startfit No coverage

Extrafit No coverage

Benfit €250 Maximum per calendar year For exercise programmes as part of a CLI, in cases of chronic illness and during and after cancer combined

Optifit €500 Maximum per calendar year For exercise programmes as part of a CLI, in cases of chronic illness, during and after cancer and during chemotherapy combined

Topfit 100% For exercise programmes as part of a CLI, in cases of chronic illness, and during and after cancer and during chemotherapy

Superfit 100% For exercise programmes as part of a CLI, in cases of chronic illness, and during and after cancer and during chemotherapy

1 For this, see: www.blcn.nl/zoek-een-leefstijlcoach 2 Beroepsvereniging Leefstijlcoaches Nederland [Dutch Association of Professional Lifestyle Coaches] 3 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 What you pay

No excess The CLI comes under general medical care and is therefore not subject to an excess. If your general practitioner refers you for other problems, for example to a dietitian or psychologist, the excess will apply. The exercise programme 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 care.

What you have to do yourself

You need our prior permission for the CLI We only reimburse the CLI if we have given permission1 before the programme starts.

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 The CLI programme must be proven to be effective. More information about this is available from your practitioner. Only lifestyle interventions of proven effectiveness are recognised by us2.

Our ZorgConsulent advisers are ready to help you find a provider If you are looking for a lifestyle coach or other CLI provider, your general practitioner can provide you with more information, but our ZorgConsulent advisers will also be happy to advise you. They can also answer your questions about the exercise programme.

We can request a statement from your health-care provider for the exercise programme We do this if we are unable to establish whether you meet the conditions for an exercise programme. Sometimes we are able to see that from your other claims, but due to privacy regulations we may not always be able to use them for that purpose (without your consent).

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 specialist3 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 Roken4 quality register of the Stop met Roken partnership

1 More information is available at www.onvz.nl/zelf-regelen/toestemming-vragen-voor-gli 2 If you have any questions or need a particular document, we would we happy to help. www.onvz.nl - +31 (0)30 639 62 22 3 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 4 More information is available at: www.kwaliteitsregisterstopmetroken.nl 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 cover: • laser therapy • Allen Carr training • De Opluchting training (video course, email course or one-day open course)

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 three 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 for any nicotine replacements and medicines associated with the treatment, or from a medical specialist, midwife or nursing specialist. The latter 3 must complete an application form1. Please enclose this form with your claim.

1 For this, see: www.znformulieren.nl/337936417/Formulieren?folderid=338591750&title=Stoppen+met+roken 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.

Preventive health-related courses

Getting fit and staying fit.

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 physiotherapist, Cesar/Mensendieck remedial therapist, the Vereniging Samen Bevallen [Giving Birth Together Association] or the YVLO Zwangerfit [YVLO Fitness in Pregnancy] course run by a pelvic physiotherapist, physiotherapist or Cesar/Mensendieck remedial therapist listed on the YVLO register2 • pregnancy yoga, run by a home-care organisation, pelvic physiotherapist, Cesar/Mensendieck remedial therapist, or by a qualified yoga instructor affiliated with the Vereniging Yogadocenten Nederland [Dutch Association of Yoga Instructors] • the Fit Mama! course, run by a home-care organisation, pelvic physiotherapist 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 Mirro3 online self-help and other modules aimed at identifying, reducing or preventing psychological conditions

1 More information is available at: www.borstvoedingnatuurlijk.nl 2 More information is available at: www.zwangerfit.nl/locaties 3 More information is available at: www.mirro.nl/account 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 www.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 by Oranjekruis [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] • basic course for Stop de bloeding – Red een leven [Stop the bleeding – Save a life] run by a certified instructor1

What is not covered • company first esponderr courses

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.

1 More information is available at: www.stopdebloedingredeenleven.nl/hoe/volg-de-cursus 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 and pharmacogenetic testing

Establishing your current state of health or finding out which medicine works best for you.

What is covered

Preventive medical investigations If you have a health problem, the medical investigations almost always come under the basic health-care plan, usually under the coverage for the General practitioner or Medical specialist.

Medical investigations can also be performed to detect an illness or other health risk if you are not (yet) experiencing any health problems. An example would be where you are concerned about an illness that runs in your family. This is known as a preventive medical investigation. If there is a medical reason for such an investigation in your case, it also comes under the 2 coverage items mentioned above, or under Testing for hereditary diseases, for instance. You can simply go to your general practitioner for that kind of preventive medical investigation. Your exact entitlements are shown in the other reimbursements, rather than below. You will usually have to pay an excess. If you want to undergo a preventive medical investigation for which you have no medical reason, the coverage you are reading about now applies to this. This involves preventive medical investigations covered by the supplementary health-care plan. It can be a targeted investigation, such as for cardiovascular disease, or a general physical examination. A doctor will discuss the results with you.

Some doctors advise against preventive medical investigations for which there is no medical 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.

Pharmacogenetic testing You can undergo pharmacogenetic testing in order to establish whether a particular medicine is likely to work for you and, if so, what dose is best for you. Your doctor can request the testing, or advise you who to contact. 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]. Your health-care provider will know whether that is the case. The ‘DNA passport’ also comes under this pharmacogenetic testing.

The Optifit supplementary health-care plan only covers preventive medical investigations without a medical reason, and reimburses 50% of the costs. Topfit and Superfit cover preventive medical investigations without a medical reason and pharmacogenetic testing in full. Coverage is always subject to a maximum per calendar year as stated below.

If investigations reveal anything that requires treatment, you may also be prescribed medication, in which case 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.

Whom to contact 1 for preventive medical investigations: general practitioner or medical specialist 2 for pharmacogenetic testing: laboratory for pharmacogenetic testing

What is not covered • population screening. This involves preventive medical investigations that the government provides, such as for breast cancer or bowel cancer. If you are eligible to take part in these, you will be notified automatically. The government funds these programmes • medical investigations for or through your employer or sports club

Other coverage Investigations in connection with a sport, such as investigations or examinations by a sports doctor, comes under Posture, movement and sport. There is also coverage for a health or sports check-up. Coverage under each health-care plan

Basic health-care plan No coverage Preventive medical investigations with medical grounds come under the coverage for the general practitioner or medical specialist

Startfit No coverage

Extrafit No coverage

Benfit No coverage

Optifit 50%, up to €250 Maximum per calendar year Only preventive medical investigations with no medical grounds

Topfit €500 Maximum per calendar year Preventive medical investigations with no medical grounds and pharmacogenetic testing

Superfit €750 Maximum per calendar year Preventive medical investigations with no medical grounds and pharmacogenetic testing

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 If you are arranging the testing yourself, 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.

For more information, please contact the ZorgConsulent Our ZorgConsulent advisers also have information about where you can go for the investigations. 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 coverage limit applies per calendar year for Benfit and Optifit. Topfit and Superfit provide full coverage.

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.

1 More information available at (in Dutch only): www.careforwomen.nl 2 More information available at (in Dutch only): www.overgangsconsulente.com 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.

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 several options. We have conveniently listed them for you in the health check-up document1.

To help you decide which check-up is best for you, our ZorgConsulent advisers can provide you with a more detailed explanation of the various check-ups.

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.

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.

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 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 adviser will provide information about the options and register you for the check-up. 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. The age limits are specified in the health check-up document1.

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 Hospital and medical specialists Coverage

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 Second opinion Provisionally approved treatments Stay in a guest house Childcare in case of hospital admission of a parent Hospital admission: extra luxury and comfort Hospital admission: assistance and extra services before and after Medical specialist

Medical specialists usually work in a hospital. This health care is therefore also referred to as hospital care.

What is covered

For specialist health care, you go to the medical specialist1. You always need to have a referral, which you will normally get from your general practitioner.

The medical specialist works 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 • additional diagnostic tests in the case of breast cancer • sterilisation and reversal operation

What is not covered • circumcision without medical necessity

Other coverage You are sometimes given the following treatments in hospital, but they are not part of the coverage that you are now reading: • dental surgery • specialist medical rehabilitation • specialist mental health care (GGZ)

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 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

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. No referral is needed in acute cases1.

You may need our prior permission We will only cover treatments specified on the limitatieve lijst machtigingen medisch specialistische zorg2 [exhaustive list of authorisations for specialist medical care]3 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 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.

A word of caution in relation to health care abroad Different guidelines may apply to health care and admissions abroad, and different coverage applies to urgent and non-urgent (scheduled) health care abroad. Please therefore contact our Service Centre first. This will help you avoid any nasty (financial) surprises later on. If you have Superfit and Wereldfit, you will need to contact the ZorgConsulent adviser for non-urgent health care and our Zorgassistance emergency centre for urgent health care.

1 Treatment that cannot be postponed, e.g. in a life-threatening situation 2 A list of treatments that will only be reimbursed if you have permission. This list is the same for all health insurers 3 More information is available at: www.onvz.nl/zelf-regelen/toestemming-vragen/toestemming-vragen-voor-medisch-specialistische-zorg You can also get a second opinion If you have any concerns or doubts about the diagnosis or proposed treatment, The basic health-care plan covers a second opinion by another medical specialist.

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.

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 specialist1 or dental surgeon2 require you to stay in the hospital overnight, we call this hospital admission.

The basic health-care plan covers hospital admission and associated health care: • nursing and other care • allied health care • medicines • medical appliances and dressings

The Superfit and Zorgplan supplementary health-care plans have coverage for making your stay more comfortable, for example with a private room. This is described in hospital admission: extra luxury and comfort.

Whom to contact • hospital • independent treatment centre3 • institution that specialises in a particular type of treatment, for example a lung clinic or a centre for epilepsy

Other coverage There are further types of health care for which you can be admitted. They are listed separately: • specialist mental health care (GGZ) • primary-care admissions • geriatric rehabilitation • health care for sensory impairment

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 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 3 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 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 As per hospital admission: extra luxury and comfort

Zorgplan €2,500 for extra comfort As per hospital admission: extra luxury and comfort

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. No referral is needed in acute cases1.

You may need our prior permission If you are admitted for treatments specified on the limitatieve lijst machtigingen medisch specialistische zorg2 [exhaustive list of authorisations for specialist medical care], we will only provide coverage where we have given our prior permission3.

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 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 treatment involved.

1 Treatment that cannot be postponed, e.g. in a life-threatening situation 2 A list of treatments that will only be reimbursed if you have permission. This list is the same for all health insurers 3 More information is available at: www.onvz.nl/zelf-regelen/toestemming-vragen/toestemming-vragen-voor-medisch-specialistische-zorg 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.

A word of caution in relation to admission abroad Different guidelines may apply to health care and admissions abroad, and different coverage applies to urgent and non-urgent (scheduled) health care abroad. If you plan to go abroad specifically for hospital admission, please contact our Service Centre first. This will help you avoid any nasty (financial) surprises later on. With Superfit and Wereldfit, you must contact the ZorgConsulent adviser in advance.

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 scars left after medical procedures.

The basic health-care plan only covers plastic surgery for: 1. physical disfigurement that gives rise to a demonstrable physical dysfunction1 2. other disfigurement2 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 removal of breast prostheses if that is medically necessary 5. the placement or replacement of breast prostheses following a full or partial mastectomy 6. 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) 7. 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 8. 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

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 or an independent treatment centre.

1 Example: You are unable to fully close your hand, making it difficult to pick up things 2 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 What is not covered • plastic surgery without medical necessity • the suction-assisted removal of fatty tissue (liposuction) from the abdomen • breast enlargement • 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 up to the age of 18 years • 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 up to the age of 18 years • In the case of a demonstrable physical dysfunction

Superfit 100% • Correction of the position of the ears up to the age of 18 years • In the case of a demonstrable physical dysfunction

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 health 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. No referral is needed in acute cases2.

You will usually need our prior permission We will only cover treatments specified on the limitatieve lijst machtigingen medisch specialistische zorg [exhaustive list of authorisations for specialist medical care]3 where we have given our prior permission. This requirement for prior permission4 also applies to coverage provided under the supplementary health-care plans.

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 Treatment that cannot be postponed, e.g. in a life-threatening situation 3 A list of treatments that will only be reimbursed if you have permission. This list is the same for all health insurers 4 More information is available at: www.onvz.nl/zelf-regelen/toestemming-vragen/toestemming-vragen-voor-medisch-specialistische-zorg

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 Topfit and Superfit supplementary health-care plans include coverage for additional IVF attempts.

What is not covered • costs of ovum donation

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 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.

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 fertility treatment that is standard practice for medical specialists. Simple when possible, and more complex when necessary.

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.

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.

In vitro fertilisation (IVF)

Fertilisation in a test tube.

What is covered

If you have failed to become pregnant over an extended period of time, the general practitioner can ultimately refer you for IVF or another fertility treatment 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 procedure. We reimburse IVF and ICSI1, if you have a medical indication for this treatment.

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.

1 Intracytoplasmic sperm injection An IVF or ICSI attempt has four 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 one or more occasions, of one or two 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. If you decide on a new treatment and start again with stage 1 or 2, this counts as a new attempt. 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

Age limits apply to this coverage. You must be under 43 at the start of an 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 time of the 1st or 2nd attempt, the basic health-care plan will only reimburse the costs if no more than 1 embryo is transferred each time.

Whom to contact For IVF or ICSI treatment, you will be referred to a hospital or independent treatment centre1 (fertility clinic).

If you wish to be treated abroad, the health care may not be covered in full. In order to be sure of the coverage provided, we recommend that you ask for our permission2 in advance. If you have Wereldfit, you must contact the ZorgConsulent adviser in advance.

What is not covered • techniques that have not been scientifically proven to be effective, such as assisted hatching, in vitro maturation and modified natural cycle IVF (MNC) • costs of ovum donation

Coverage under each health-care plan

Basic health-care plan 3 attempts at a continuing pregnancy Up to the age 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

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 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen What you pay

The excess The 1st, 2nd and 3rd IVF attempts are covered under the basic health-care plan and are subject to the excess. The 4th and subsequent attempts are provided under the supplementary health-care plan and are therefore not subject to an 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.

You will need our prior permission for the 4th attempt onwards Topfit and Superfit will only cover the 4th or subsequent attempts if we have given 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.

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.

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.

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.

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.

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.

Whom to contact • a clinical genetic centre. This is also known as a centre for hereditary diseases

1 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen/toestemming-vragen-voor-ivf-of-icsi What is not covered • tests to determine parentage

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

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.

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 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.

Diagnosis and treatment of breast cancer comes under the coverage for the Medical specialist. Although the basic health-care plan covers this health care, it does not cover the MammaPrint and Oncotype DX tests.

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 The additional tests come under the supplementary health-care plan. An excess does not apply.

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.

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 six months after discharge from hospital.

If your donor does not have a basic health-care plan (with us 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

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 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

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, egularr 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

Other coverage There are, however, also additional costs attached to home dialysis that you will have to pay out of your own pocket. If these are not covered under other statutory provisions, we cover: • modifications in and to the home needed for dialysis • reversal of the modifications when they are no longer needed • a weekly allowance to cover additional spending on water, power and maintenance This comes under coverage for Modifications in the home and other costs for home dialysis

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, you will want to prepare properly for that. Call our ZorgConsulent for details of your (coverage) options. You can also ask Nierpatiënten Vereniging Nederland1 (Dutch Kidney Patients’ Society) for advice.

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

1 More information is available at: www.nvn.nl/advies/vakantie 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.

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, medication or medical appliance may seem effective for a certain group of patients, but not enough research has been done to validate these effects. This health care therefore does not yet meet the practical and theoretical standard.

That said, the government can still choose to add the treatment, medication or medical appliance to the basic coverage for a certain period of time. Over that period, research is done to gather data on the effectiveness of the treatment.

If you are one of those patients for whom the treatment, medication or medical appliance may be effective, you can be reimbursed for this. However, this is conditional on you entering the clinical trial.

The voorwaardelijk toelating tot het basispakket1 [provisionally approved basic coverage] document specifies: • which health care has currently been provisionally approved as part of the basic coverage • which patients are eligible for the treatment, medication or medical appliance • which clinical trial you must enter to get the costs reimbursed • for how long the treatment, medication or medical appliance has been approved • which hospitals you can visit

Given that the government can approve new treatments, medicines or medical appliances every quarter, the document is subject to change over the year.

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.

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 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, medication or medical appliance only if you enter the clinical trial that is intended to verify the effectiveness. Your doctor decides whether or not you are eligible to participate in the trial. The treatment will be covered for a limited period only.

Coverage is not provided at all hospitals If you receive the treatment, medication or medical appliance at a hospital that is not taking part in the clinical trial, we will not cover the costs.

Second opinion

If you have any doubts about the necessity for a drastic treatment.

What is covered

If you have any doubts about the diagnosis that your general practitioner, medical specialist or other health- care provider has discussed with you, or about a proposed treatment, you can ask for an opinion from (another) doctor1: a second opinion. This doctor will only give his view and will not take over the treatment.

A second opinion is intended to ensure you are properly informed before making a decision about a treatment. It is important that you discuss your wish for a second opinion first with your own health-care provider, as you will return to that health-care provider after gaining the second opinion.

You always need a referral from a doctor to obtain a second opinion. That can be your primary health-care provider or your general practitioner.

The basic health-care plan reimburses a second opinion provided these 5 conditions are met: • it involves health care covered by the basic health-care plan, such as health care from a medical specialist. To find out whether health care is covered under the basic health-care plan, see the coverage • the diagnostics or the proposed treatment to which the second opinion relates is also covered by the basic health-care plan • the doctor carrying out the second opinion works in the same discipline as the primary health-care provider • you have a referral from the primary health-care provider or from your general practitioner • you go back to the primary health-care provider with the second opinion

Whom to contact • a doctor who works in the same discipline as the primary health-care provider

What is not covered • a second opinion about the extent to which you are incapacitated for work • costs for a copy of your medical file if the primary doctor or the hospital charges for this

Other coverage A second opinion about nursing and other care at home comes under this coverage.

1 In this coverage, we also mean by doctor: a dentist 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 whether or not the second opinion is subject to the excess depends on the treatment for which the second opinion is being obtained. If it is treatment by a general practitioner or obstetric care, the second opinion is not subject to your excess. If it is a second opinion about other treatment, the excess is applicable.

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 We only reimburse the second opinion if you have 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.

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, dentists, medical specialists and dental surgeons.

Our ZorgConsulent advisers are ready to help You can also consult our ZorgConsulent advisers for advice and information about getting a second opinion. 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 us. 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 us. 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 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% • 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% • 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 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 your 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, the ZorgConsulent will help you with all your childcare arrangements.

1 For this, see: www.landelijkregisterkinderopvang.nl/pp/StartPagina.jsf 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, This comes under the Hospital admission coverage.

Many hospitals offer extra comforts and services to make your stay a bit more pleasant. The Superfit and Zorgplan supplementary health-care plans reimburse the three facilities listed below. A maximum reimbursement applies per calendar year to all three facilities together. The admission to a hospital in the Netherlands, Belgium or Germany must be required in order for you to be examined or treated by the medical specialist.

We reimburse: 1. a single room you are given at your request, instead of having to share a hospital room/ward with others, i.e. not a single room that you are given because you have to be nursed separately, due to a risk of infection for example, or

compensation of €75 for each day of hospitalisation if the hospital provides private rooms on request, but none were available during your admission. In the Netherlands, this compensation applies to hospitals on our list1.

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 independent treatment centre2 in the Netherlands, Belgium or Germany • if you live outside of the Netherlands, Belgium or Germany: a hospital in any 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 not listed separately.

1 More information is available at: www.onvz.nl/overzicht-ziekenhuizen-onvz-zorgplan 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 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 €2,500 Maximum per calendar year

Superfit €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 See our list1 to find out which hospitals have private rooms for use on request. If this kind of room is not available during your admission, you submit a claim for €75 per day of hospitalisation using the private room form2.

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 overview1 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 If you use a private room in Belgium, Germany or another country, this can sometimes have consequences for the costs of your 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 pay these costs yourself.

1 For this, see: www.onvz.nl/overzicht-ziekenhuizen-onvz-zorgplan 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 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 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 Assistance, overnight stays, transportation Overnight stays: max. 2 nights, max. €100 per night Transportation: €0.27 per km

Superfit 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,

Nursing and other care Coverage

Nursing and other care at home Individual budget under the Zorgverzekeringswet [Health-Care Insurance Act] (Zvw-pgb) Primary-care admissions Carer relief Help for carers Domestic assistance Hospice Nursing and other care at home

Care that you receive at home. For example, nursing care for a wound, or care to help you get up, wash yourself and get dressed.

What is covered

If your medical situation means that you need nursing care and/or other care at home, the nurse or carer comes to you.

Nursing involves medical care, such as dressing a wound or giving an injection, but it includes other things as well, like monitoring the state of your health or coordinating with other health-care providers to make sure you receive the right care at the right time. Other care is help with everyday activities, such as showering, getting dressed and putting on compression stockings.

The basic health-care plan provides coverage for nursing and other care at home. In some cases, you will need to seek our prior permission.

A nurse will assess which care you need, and its frequency and duration. The nurse will do this at your home, where you live. This is also known as the ‘care needs assessment’. It is possible that part of the care you need is not subject to this coverage. For example, if it relates to domestic assistance, the local council has to arrange this. The nurse will also look at what you can do yourself and where, for example, a partner could help you. The nurse will record the primary agreements about how the care is to be organised in a care plan with you.

Generally, you will get a referral for the nurse from your general practitioner, or when you are discharged from hospital.

Care provision for children, and care for dementia or in the final stage of life can also come under this coverage. In that case, the following conditions also apply.

Nursing and other care for children under the age of 18 This coverage also applies to children under the age of 18, but usually only the nursing comes under the basic health-care plan for them. The other cares comes under the Jeugdwet [Youth Act] and the local council must arrange it.

In 3 situations, the other care also comes under the basic health-care plan. This is considered to be the case if: • the other care is required due to a medical condition1 • nursing, other care and intensive support2 are necessary at the same time • it involves the final stage of life, as set out below

A child nurse qualified to higher vocational (HBO) level will carry out the care needs assessment for nursing and any other care. Generally, you will get a referral for a child nurse from the paediatrician who is treating your child.

If your child attends a nurse-assisted day nursery or a nurse-assisted children’s care home, the basic health-care plan covers the stay and the care provided there. That only applies if your child needs continuous supervision, or if nursing care has to be available close at hand day and night.

Case management for dementia If someone suffering from dementia needs various types of care and support, someone is often needed to coordinate that: a case manager. This is a fixed contact person who makes sure that all the care is properly coordinated. Case management for dementia also comes under the coverage you are reading about now. The nurse who carries out the care needs assessment will decide whether case management is necessary.

Nursing and other care in the final stage of life In the final stage of life, care requirements can change. For example, additional attention may need to be given to easing pain. This care is also known as palliative terminal care. You can receive it at home, or in a hospice or halfway-house. The nurse will carry out the care needs assessment. In addition, your general practitioner or medical specialist, or an elderly medical care specialist or doctor for the mentally disabled, must have previously established that you need this care.

Whom to contact The care needs assessment must be performed by a nurse qualified to higher vocational (HBO) level or a child nurse qualified to higher vocational (HBO) level. This health care is provided by a nurse or a carer in individual health care, or, in the case of a child under the age of 18, by a child nurse.

1 For example: your child is given respiratory assistance or kidney dialysis 2 For example: child and family are supported in the provision of mechanical respiration Want greater control by using an individual budget under the Zorgverzekeringswet [Health-Care Insurance Act] (Zvw-pgb)? Your health-care provider will make sure you receive the care you need when you need it, and they will bill us directly. If you would prefer to manage this yourself, you can apply for an individual budget under the Zorgverzekeringswet [Health-Care Insurance Act] (Zvw-pgb). With a Zvw-pgb, you make agreements with health-care providers yourself, pay them yourself, and then put in a claim with us to get the costs reimbursed.

Other coverage • If you need to be admitted temporarily, but this does not have to be in a hospital, that normally comes under primary-care admissions.

• Care related to childbirth comes under pregnancy and childbirth care.

• In the case of children with a physical handicap, or with several physical problems at the same time, and in some other situations, the basic health-care plan covers other medical transportation from the home to a health-care provider and back.

Coverage under each health-care plan

Basic health-care plan 100% As per the indication of a nurse qualified to higher vocational (HBO) level

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 at home is not subject to the excess, not even if you receive the care as part of an individual budget under the Zorgverzekeringswet [Health Insurance Act] (Zvw-pgb).

No personal contribution You will not be charged a personal contribution for this care.

What you have to do yourself

You may need our prior permission If your health-care provider is on the Toestemmingsvrije zorgverleners V&V list1 [list of providers of nursing and other care for whom our permission is not required], we have made agreements about the health care and the permission required, and you do not have to do anything. If your health-care provider has not been included on the list, we only reimburse the nursing and other care if we have given permission2 in advance.

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/toestemming-vragen-voor-verpleging-en-verzorging-thuis 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 if you (also) need medical care. Simple when possible, and more complex when necessary.

Your care needs can be reassessed You can have your care needs reassessed by another 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 nurse. Also if we are unsure about the care needs identified by the first nurse, we can have your care needs reassessed.

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 more control over 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.

An individual budget is rather demanding, so together with you we will look into whether you are able to satisfy all the rules or have someone who is willing to shoulder the responsibilities on your behalf. The conditions for the individual budget are specified in the 2019 Reglement Zvw-pgb verpleging en verzorging2 [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 form2 and send it to us. The ‘nursing section’ of this form (part 1) 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. The ‘insured person’s section’ (part 2) has to be filled in by you. You need to specify how much you will be spending and which health-care providers you will be contracting.

As soon as we have received the form, 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 letter from us, specifying the maximum number of hours of care that will be covered. As soon as you have this authorisation letter, you will be able to enter into contracts with your health-care providers.

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 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

What you pay

No excess Nursing and other care at home is not subject to the excess, not even if you receive the care as part of an individual budget under the Zorgverzekeringswet [Health Insurance Act] (Zvw-pgb).

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 permission first Only if you have received an authorisation letter from us in advance 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 2019 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.

You may have to use a Zvw-pgb claim form You use this form2 to claim invoices from informal care providers and also for formal health-care providers with an AGB code starting with 91. You can claim invoices from other formal health-care providers without using that form.

1 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen/persoonsgebonden-budget-aanvragen 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 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 Zorgplan supplementary health-care plans 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. The following is not covered: wellness (such as fitness, yoga, swimming pool, sunbed) and personal expenses (hairdresser, pedicure, sports, music, catering).

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, for example. 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.

What is not covered • admission intended to relieve your carer (respite care). In such cases, you should turn to your local council’s health-care desk • primary-care admissions for rehabilitation or for care related to childbirth

Other coverage If your carer needs a break, carer relief could be a good idea.

1 This person must be qualified to higher vocational (HBO) level at minimum Coverage under each health-care plan

Basic health-care plan 100% 3 months, longer with our permission

Startfit No coverage

Extrafit No coverage

Benfit No coverage

Optifit No coverage

Topfit Additional facilities €50 per day Maximum, while admitted

Superfit Additional facilities 100% While admitted

Zorgplan Additional facilities 100% While admitted

What you pay

The excess Care provided by a general practitioner is not subject to the excess. However, the other health care that comes under the basic health-care plan, such as the actual stay at the primary-care facility, is subject to the excess. The additional facilities 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 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.

You may need our permission If your primary-care admission will be under three months, you do not need permission. After the third month, continued coverage of your primary-care admission is conditional on us having authorised1 it before the end of the third 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.

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 and the care provided is also covered by the basic health-care plan itself.

1 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen/toestemming-vragen-voor-eerstelijns-verblijf 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.

Carer relief

Whenever your carer is temporarily unable to take care of you, or you are a carer and are temporarily unable to provide any care.

What is covered

Informal care is care for chronically ill or disabled people provided by, for example, family members or friends. Maybe your carer is temporarily unable to take care of you, because he/she will be going on holiday or needs medical treatment. Or maybe you yourself are the carer, but you need a break.

In both cases, the local council for the person receiving the care is your first point of contact. The 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, and the carer has been providing informal care for at least 8 hours a week over a period of at least 3 months, the ZorgConsulent adviser can arrange a temporary replacement.

The Benfit and higher supplementary health-care plans cover carer relief arranged by the ZorgConsulent adviser. See below for the maximum coverage provided per calendar year.

If the informal care provider(s) and the person receiving the care are both (or all) insured with Benfit or higher, we will approve the reimbursement for this situation once per calendar year. If they do not have the same supplementary health-care plans, the highest cover applies.

Coverage under each health-care plan

Basic health-care plan No coverage

Startfit No coverage

Extrafit No coverage

Benfit €800 Maximum per calendar year

Optifit €1,200 Maximum per calendar year

Topfit €2,000 Maximum per calendar year

Superfit €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

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 to the ZorgConsulent adviser for carer relief in good time Otherwise we may not be able to arrange it for you on time, or you will not be reimbursed.

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.

Help for carers

Because you have to organise a lot as an informal carer.

What is covered

If you are intensively caring for a family member, friend or partner with an illness or disability for an extended period, you are a carer. As a carer, you yourself may also need some support.

A care adviser can help you to keep your life in balance. These advisers are trained to listen to your problems and they can also help you to set boundaries, expand or re-expand your social network, or better combine your carer duties with your regular job. Our ZorgConsulent advisers are trained as care advisers. They combine the support side of the job with their knowledge of the health-care system, so they can also advise you about health care and coverage.

A ‘care broker’ (mantelzorgmakelaar) can go a step further than the care adviser. A care broker can answer your questions and give advice on your situation, but can also take time-consuming administrative tasks off your hands when it comes to matters relating to health care, wellbeing or financial matters. The care broker will be familiar with the situation in your area and is therefore able to refer you to the right organisations.

The care adviser and care broker offer forms of carer support, which is provided by the local council under the 2015 Wet maatschappelijke ondersteuning [Social Support Act] (Wmo). The exact form of support will vary for each council, so your local council may have other forms of carer support.

If your local council does not offer any carer support or a care broker, and you have been providing informal care for at least 8 hours a week over a period of at least 3 months, you can contact the ZorgConsulent adviser for carer support if you have a Startfit or higher supplementary health-care plan. The Optifit and higher supplementary health-care plans also cover the care broker, who the ZorgConsulent adviser arranges for you. See below for the maximum coverage provided per calendar year.

Whom to contact • the ZorgConsulent adviser will arrange a care broker who is listed on the register of independent care brokers1 administered by BMZM2

1 For this, see: www.bmzm.nl/zelfstandig-mantelzorgmakelaars 2 Beroepsvereniging van Mantelzorgmakelaars [Professional Association of Care Brokers] Other coverage If you would like to join an advocacy group for informal carers, take a look at membership of a patients’ association or advocacy group.

Coverage under each health-care plan

Basic health-care plan No coverage

Startfit Carer support Through the ZorgConsulent

Extrafit Carer support Through the ZorgConsulent

Benfit Carer support Through the ZorgConsulent

Optifit Carer support + €350 for a care broker Through/via the ZorgConsulent, maximum amount per calendar year

Topfit Carer support + €500 for a care broker Through/via the ZorgConsulent, maximum amount per calendar year

Superfit Carer support + €750 for a care broker Through/via the ZorgConsulent, maximum amount 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

Always contact the ZorgConsulent The ZorgConsulent adviser can determine what carer support is offered by your local council and, together with you, look into what else is needed. The support from your local council takes precedence over the coverage provided by your supplementary health-care plan.

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. 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 following a hospital admission, 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. 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.

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 network1 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 at home. In some cases, hospice care is covered by the Wet langdurige zorg2 [Long-term Care Act] (Wlz) or the Wet maatschappelijke ondersteuning3 [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 additional facilities). Optifit and Topfit have a maximum reimbursement per day, for a maximum of 3 months. Superfit and Zorgplan cover the personal contribution in full.

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). CAK4 will send you a bill for the statutory personal contribution. We do not provide coverage for the statutory personal contribution.

1 More information is available at: www.netwerkpalliatievezorg.nl/Zorg-in-uw-regio 2 Wet langdurige zorg [Long-term Care Act] 3 Wet maatschappelijke ondersteuning [Social Support Act] 4 More information is available at: www.hetcak.nl/regelingen/zorg-vanuit-de-wlz 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 the personal contribution, maximum of 3 months

Topfit €50 per day For the personal contribution, 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. 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 Posture, movement and sport 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 • 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

Other coverage If you want to see a different kind of therapist, or have a health issue related to sport, there is also coverage for Posture, movement and sport.

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 physiotherapist, 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 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 Of the total of 12 sessions, up to 9 may be manual therapy sessions

Optifit 35 sessions Of the total of 35 sessions, up to 9 may be manual therapy sessions

Topfit 100% Maximum of 9 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.

You need our prior permission for treatment at a different surgery Physiotherapy or remedial therapy sessions are either at the therapist’s surgery or at your home. For sessions elsewhere, you need our prior permission1. 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. For example, they state that you will not be covered if the care is not effective. The same applies to physiotherapy or remedial therapy aimed at achieving a higher sporting level. In order to assess this, we can request (additional) information about your treatment programme.

1 More information is available at: www.onvz.nl/zelf-regelen/toestemming-vragen 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.

A different reimbursement applies from your 18th birthday That is physiotherapy from the age of 18. Sessions you had prior to turning 18 will count towards the maximum number of sessions covered.

Quality registers provide extra information We give you complete freedom of choice. You decide which health-care provider you go to. Quality registers1 contain information that can help you make a choice.

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 • COPD • 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 disease3. 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 COPD, the basic health-care plan covers supervised remedial therapy from the 1st session. A doctor must have established that you are suffering from COPD at GOLD4 class II or above, and the class that your symptoms come under. The basic health-care plan provides the following coverage: • class A, a maximum of 5 sessions, once, over a maximum period of 12 months • class B, a maximum of 27 sessions during the 1st 12-month period, and a maximum of 3 sessions per 12 months thereafter • class C and D, a maximum of 70 sessions during the 1st 12-month period, and a maximum of 52 sessions per 12 months thereafter

In cases of urinary incontinence, the basic health-care plan covers a maximum of 9 pelvic physiotherapy sessions, once, from the 1st 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.

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 A classification for the severity of vascular diseases (such as intermittent claudication). This ranges from stage 1 (no complaints) to stage 4 (necrosis) 4 A classification used worldwide for the severity of COPD. This ranges from class I (mild) to class IV (extremely severe) Whom to contact • physiotherapist • manual therapist1 • Cesar/Mensendieck remedial therapist • pelvic physiotherapist1 • geriatrics physiotherapist1 • oedema therapist1 • for the supplementary health-care plan: psychosomatic physiotherapist1 • 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 therapist2

Other coverage If you want to see a different kind of therapist, or have a health issue related to sport, there is also coverage for Posture, movement and sport.

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 • COPD: depending on the GOLD class, 0 to 70 sessions in the first 12 months, and 0 to 52 sessions per 12 months thereafter • Urinary incontinence: up to 9 sessions

Startfit 9 sessions

Extrafit 9 sessions

Benfit 12 sessions Of the total of 12 sessions, up to 9 may be manual therapy sessions

Optifit 35 sessions Of the total of 35 sessions, up to 9 may be manual therapy sessions

Topfit 100% Maximum of 9 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.

1 Must be registered as a physiotherapist specialising in children, manual therapist, pelvic physiotherapist, 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] 2 Must be registered as a full member of the Dutch Association of Skin Therapists What you have to do yourself

You need our prior permission for treatment at a different surgery Physiotherapy or remedial therapy sessions are either at the therapist’s surgery or at your home. For sessions elsewhere, you need our prior permission1. 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. For example, they state that you will not be covered if the care is not effective. The same applies to physiotherapy or remedial therapy aimed at achieving a higher sporting level. In order to assess this, we can request (additional) information about your treatment programme.

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.

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 We give you complete freedom of choice. You decide which health-care provider you go to. Quality registers2 contain information that can help you make a choice.

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, registerpodoloog3 [registered podiatrist/chiropodist], or podoposturaal therapeut3 [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, ortheses4, or nail braces.

The treatment provided by these health-care providers is called foot specialist treatment or podiatry/chiropody. Foot specialist treatment and podiatry/chiropody are both covered under Extrafit and higher supplementary health-care plans. Extrafit and Benfit cap coverage 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] • podoposturaal therapeut [podopostural therapist]3

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.

1 More information is available at: www.onvz.nl/zelf-regelen/toestemming-vragen 2 More information is available at: www.onvz.nl/kwaliteitsregisters 3 Must be in the register administered by KABIZ (Quality registration and accreditation for health-care professionals) 4 A medical appliance to maintain correct toe position, for example Coverage under each health-care plan

Basic health-care plan No coverage

Startfit No coverage

Extrafit €150 Maximum per calendar year

Benfit €250 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

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 supplementary health-care plans cover lymphoedema and scar therapy as physiotherapy, so you can go to a physiotherapist or an oedema therapist2 for treatment. The maximum number of sessions covered is as listed below.

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 therapist2 • 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 an oedema therapist in the quality register of the Royal Dutch Society for Physical Therapy or Stichting Keurmerk Fysiotherapie [Physiotherapy Quality Mark Foundation] 3 Must be a member of the Dutch Association of Skin Therapists 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 As per the coverage for physiotherapy up to the age of 18 or physiotherapy from the age of 18

Startfit From the age of 18: 9 sessions with an oedema therapist or a physiotherapist Maximum per calendar year As per the 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 therapist1 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 therapist1 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 therapist1 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 therapist1

Superfit 100% Full coverage for treatment by an oedema therapist, physiotherapist, or skin therapist1

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 Oedema therapy or physiotherapy sessions are either at the therapist’s surgery or at your home. For sessions elsewhere, you need our prior permission2. There must be medical grounds for treatment at a different location, such as a nursing home, school, or sports centre.

1 Must be a member of the Dutch Association of Skin Therapists 2 More information is available at: www.onvz.nl/zelf-regelen/toestemming-vragen 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 We give you complete freedom of choice. You decide which health-care provider you 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 higher supplementary health-care plans cover such exercise programmes in cases of chronic illness. 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 (as part of a combined lifestyle intervention) 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 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, during and after cancer, and during a combined lifestyle intervention for overweight patients combined

Optifit €500 Maximum per calendar year For exercise programmes in cases of chronic illness, during and after cancer and during chemotherapy, and during a combined lifestyle intervention for overweight patients combined

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.

Our ZorgConsulent is ready to help you If you want more information about exercise programmes, our ZorgConsulent advisers are ready to help.

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. 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 exercise programmes and for exercise programmes in cases of chronic illness and for exercise programmes in cases of obesity (as part of a combined lifestyle intervention) 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 combined is capped at €500. Topfit and Superfit provide full coverage for the programmes.

Other coverage During the treatment in hospital, you will get advice and support in this area. This comes under the Medical specialist coverage.

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 during a combined lifestyle intervention for overweight patients combined

Optifit €500 Maximum per calendar year For exercise programmes during and after cancer, during chemotherapy, in cases of chronic illness and during a combined lifestyle intervention for overweight patients combined

Topfit 100%

Superfit 100%

1 For this, see: www.fysionet-evidencebased.nl/index.php/beweeginterventies 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.

Our ZorgConsulent is ready to help you If you want more information about exercise programmes, our ZorgConsulent advisers are ready to help.

Posture, movement and sport

For exercising in a healthy way and keeping active.

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, or have a health issue related to sport, the supplementary health-care plans also cover consultations and treatments with other therapists or a sports doctor. The coverage provided is as follows.

Sports doctor The Extrafit and higher supplementary health-care plans cover the following health care by a sports doctor1: • 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.

Whom to contact • sports doctor • examination for diving: diving doctor2 • chiropractor3 • osteopath4 • “Eggshell method” (E.S. ®)5 manual therapist

1 For an examination for diving, this may also be a certified diving doctor 2 Must be listed on the register administered by the Stichting Certificering Actoren in de Sportgezondheidszorg [Foundation for the Certification of Sports Healthcare Professionals] (SCAS) or certified by the Nederlands Instituut Certificering DuikerArtsen [Dutch Institute for Certification of Diving Doctors] (NICDA) 3 Must be a full member of a professional organisation for chiropractors that is recognised by ONVZ 4 Must be a full member of a professional organisation for osteopaths that is recognised by ONVZ 5 Must be a member of the Vereniging van Manueel Therapeuten [Manual Therapists’ Association] (VMT) What is not covered • medical investigations and examinations for or through your employer or sports club

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/sports examination 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 doctor1 can also treat injuries with a medical cause, 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 in advance.

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 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 simple 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, tripod and tetrapod walking sticks, walking frames, rollators and serving trolleys

Topfit €100 for 5 kinds of walking aids Maximum per calendar year, for elbow crutches, tripod and tetrapod walking sticks, walking frames, rollators and serving trolleys

Superfit €200 for 5 kinds of walking aids Maximum per calendar year, for elbow crutches, tripod and tetrapod walking sticks, 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.

1 For this, see: www.hulpmiddelenwijzer.nl 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 Orthopaedic footwear and orthotics for footwear.

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.

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.

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 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. Rehabilitation and recovery Coverage

Rehabilitation (specialist medical) Geriatric rehabilitation Occupational therapy Zorghotel Health resort Therapeutic camp for young people Membership of a patients’ association or advocacy group

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. In that case, rehabilitation will be covered under these as well. If your situation is slightly more complex than that, you will be referred to a rehabilitation specialist for specialist medical rehabilitation. The coverage you are reading about now applies to this.

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.

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.

You may have to seek our prior permission for interdisciplinary specialist medical rehabilitation without admission If the rehabilitation specialist determines that specialist medical rehabilitation is indeed the right care option for you and you are not admitted for this, you may need prior permission in some cases.

If your health-care provider is on the list of Toestemmingsvrije revalidatiecentra2 [list of rehabilitation centres for which our permission is not required], we have made agreements about the rehabilitation care and the permission required, and you do not have to do anything. If your health-care provider has not been included on the list, we only reimburse the costs of the interdisciplinary specialist medical rehabilitation if we have given permission3 before treatment starts.

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 rehabilitation care that is standard practice for rehabilitation specialists. Simple when possible, and more complex when necessary.

Geriatric rehabilitation is subject to other conditions Geriatric rehabilitation is rehabilitation for elderly people who have been discharged from hospital.

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. In that case, the health care comes under this coverage.

Geriatric rehabilitation is especially for people of a certain age with multiple health problems. The coverage you are reading about now applies to this.

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 More information is available at: www.onvz.nl/zelf-regelen/toestemming-vragen/toestemming-vragen-voor-medisch- specialistische-revalidatie This kind of geriatric rehabilitation 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. The Topfit supplementary health care plan reimburses a maximum of €50 per day. Superfit and Zorgplan cover the additional facilities in full. The additional facilities 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).

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 Additional facilities €50 per day Maximum, while admitted

Superfit Additional facilities 100% While admitted

Zorgplan Additional 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.

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 (several health problems at the same time) and diminished learning and training ability, and which is intended to result in a return home. Simple when possible, and more complex when necessary.

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 do not reimburse the additional facilities in that case.

After the sixth month, you need permission We will cover this care for a maximum of six months. If you need geriatric rehabilitation for longer, we may approve that in special cases. Your doctor will usually request this permission on your behalf. We must receive the request before the end of the 6th month. The request must be accompanied by a medical indication and a substantiated explanation from your attending doctor.

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 Superfit supplementary health-care plans cover any additional 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.

What you have to do yourself

No referral needed You can go to the occupational therapist without a referral.

You need our prior permission for treatment at a different surgery Occupational therapy sessions are either at the occupational therapist’s surgery or at your home. For sessions elsewhere, you need 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.

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 We give you complete freedom of choice. You decide which health-care provider you go to. Quality registers2 contain information that can help you make a choice.

1 More information is available at: www.onvz.nl/zelf-regelen/toestemming-vragen 2 More information is available at: www.onvz.nl/kwaliteitsregisters Zorghotel

Regaining your strengths after illness or a medical treatment.

What is covered

If you are recovering from surgery or a physical illness, your doctor or the liaison nurse from the hospital will arrange for you to get a medical indication for the right health care if necessary. For example, for rehabilitation, geriatric rehabilitation (for elderly people) or primary-care admissions.

In cases of other recovery care, 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 may also offer, for example, nursing and physiotherapy. Not all zorghotels offer the same services.

At the beginning of your stay, the zorghotel’s nurse1 will set up a health-care plan in consultation with you. This will specify the purpose of your stay and the agreements made about your care.

The Topfit, Superfit and Zorgplan 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 rehabilitation or geriatric rehabilitation, primary-care admissions or care and support provided under the Wet langdurige zorg2 [Long-term Care Act] (Wlz) were indicated or could have been indicated.

Nursing, physiotherapy and other care are subject to the ‘regular’ cover.

Whom to contact • a zorghotel 3 recognised by us

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

What you pay

No excess This health care is provided under the supplementary health-care plan. An excess does not apply to this care.

1 This person must be qualified to higher vocational (HBO) level at minimum 2 Wet langdurige zorg [Long-term Care Act], through the care administration office 3 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 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 for a zorghotel from your doctor, as well as our prior permission We will cover a stay at a zorghotel only if we have given prior permission1 for it. Our permission applies for a fixed period of time. If you need to stay longer than expected, ask for permission for the longer period before the existing permission ends and explain why you have to stay longer in your 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.

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.

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

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 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 may also ask you for a statement from your rheumatologist or dermatologist We do this if we are unable to establish whether you suffer from rheumatoid arthritis or psoriasis. Sometimes we are able to see that from your previous claims, but due to privacy regulations we may not always be able to use them for that purpose (without your consent).

Therapeutic camp for young people

If your child has asthma, diabetes or another ailment.

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 and 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.

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.

Membership of a patients’ association or advocacy group

Answers to questions in cases of (chronic) illness or disability, or if you are a carer.

What is covered

Having a (chronic) illness or disability or being a carer may raise a lot of questions. A patients’ association or advocacy group 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 or advocacy group. To qualify for this coverage, the organisation 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

We also cover the membership fee for the Mezzo4 carers’ organisation.

Optifit provides a maximum reimbursement per calendar year for all membership costs combined. Topfit and Superfit cover the minimum membership fee in full.

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 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

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.

1 More information is available at: www.patientenfederatie.nl 2 More information is available at: www.iederin.nl 3 More information is available at: www.platformggz.nl/lpggz 4 More information is available at: www.mezzo.nl Pregnancy, childbirth and children Coverage

Antenatal screening Pregnancy and childbirth Maternity care Maternity package TENS device Breastfeeding: breastfeeding specialist Adoption care Bed-wetting alarm

Antenatal screening

Want to test your child for genetic defects before birth?

What is covered

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. You decide whether to have the antenatal screening done. To assist you in making this decision, the midwife, general practitioner or gynaecologist will (if you want) go through with you the types of antenatal screening that are available and what the advantages and disadvantages are. This discussion is referred to as ‘counselling’. Counselling is covered under the basic health- care plan.

Antenatal screening between the 9th and 14th weeks of pregnancy During this period, you can have a combination test1 or an NIPT2. You pay the costs yourself, unless the midwife, general practitioner or gynaecologist determines that there is a medical indication in your case. This could be because of your age, problems in a previous pregnancy or a hereditary condition in your family. Where a medical indication applies, the basic health-care plan will reimburse the combination test or the NIPT. In the case of the NIPT without a medical indication, a subsidy scheme applies. This brochure provides further information about that.

If the tests indicate that your unborn child has an increased risk of a condition, 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 antenatal follow-up tests in the case of an increased risk of a condition, or where there is another medical indication.

Antenatal screening around the 20th week of pregnancy At this stage of the pregnancy, you can have a 20-week ultrasound scan (routine ultrasonography (SEO), which is covered under the basic health-care plan. You do not need a separate medical indication for this. If the ultrasound scan suggests there is an indication for further investigation, such as an advanced ultrasound scan (GUO), the basic health-care plan will cover this as well.

The government has set up a website3 with information about antenatal screening.

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.

You can also have an NIPT 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 study4). 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 A combination of a blood test and a nuchal scan (through an ultrasound) on the unborn child. 2 Non-invasive prenatal test (a blood test) 3 More information is available at: www.onderzoekvanmijnongeborenkind.nl 4 More information is available at: www.meerovernipt.nl 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, you need a referral from your midwife, general practitioner or a medical specialist for the NIPT, GUO or antenatal follow-up tests.

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 antenatal screening that midwives and medical specialists ordinarily conduct as part of obstetric care. Simple when possible, and more complex when necessary.

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 combination test suggests an increased risk of a condition. This also applies 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. 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 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 at a birth centre, or in hospital without this being medically necessary 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 there. The basic health-care plan will cover obstetric care also in such cases. Please note: the personal contribution will then be higher. This is specified under maternity care. 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 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 Coverage under each health-care plan

Basic health-care plan 100% (excluding personal contribution)

Startfit No coverage

Extrafit No coverage

Benfit €250 Maximum, per birth, for personal contributions under the basic health-care plan and additional maternity care

Optifit €400 Maximum, per birth, for personal contributions under the basic health-care plan and additional maternity care

Topfit €550 Maximum, per birth, for personal contributions under the basic health-care plan and additional maternity care

Superfit €550 Maximum, per birth, for personal contributions under the basic health-care plan and additional maternity care

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. This personal contribution for maternity care is higher in the event of a hospital birth without medical necessity, or delivery at a birth centre.

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. No referral is needed in acute1 cases.

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.

1 Treatment that cannot be postponed, e.g. in a life-threatening situation 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 2 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 2 contributions: a. for maternity care at home: €4.40 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 €17.50 per person per day (so €35 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 €125 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 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 one 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.

The personal contribution • the statutory personal contribution of €4.40 per hour for maternity care at home • the statutory personal contribution of €17.50 per person per day • the costs in excess of €125 per person, per day for the birth centre, or for the hospital if you give birth there 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 our 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.

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 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.

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 our 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 our 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 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 our Kraamzorg Service

Benfit Once per delivery Supplied by our Kraamzorg Service

Optifit Once per delivery Supplied by our Kraamzorg Service

Topfit Once per delivery Supplied by our Kraamzorg Service

Superfit Once per delivery Supplied by our 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. 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. 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.

During the post-delivery period, the maternity nurse can help you with breastfeeding. This comes under the Maternity care coverage.

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: www.nvlborstvoeding.nl 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.

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. The maternity centre decides the number of hours according to a protocol and you pay a personal contribution. According to the protocol, you are not normally entitled to maternity care in the case of adoption of a child.

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

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 our 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.

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.

You do not need a referral for screening You can take your child directly to the paediatrician.

We provide coverage once per adopted child Even if you and your partner are both insured with us.

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.

The Extrafit and higher supplementary health-care plans do provide coverage for a bed-wetting alarm. You decide whether to rent or purchase the alarm. Extrafit, Benfit and Optifit 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

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.

Your child’s health-care plan determines the coverage If you purchase or hire a bed-wetting alarm for your child, this is covered by your child’s health-care plan, not yours. If the child’s name is included on the invoice, we can process your claim faster. Medication and diet Coverage

Medicines under the basic health-care plan Medicines in supplementary health-care plans Over-the-counter medication and proton-pump inhibitors Dietetics Dietary preparations

Medicines under the 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 with no marketing authorisation in the Netherlands that are produced in the Netherlands with government permission or obtained abroad.

4. During a temporary shortage of a medicine as specified under point 1: a eplacementr medicine sourced from abroad.

The coverage in points 2, 3 and 4 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 meet certain conditions. For example, if you have a particular medical indication. These medicines and the conditions are listed in appendix 21 to the Regeling zorgverzekering [Health Insurance Regulations]. Examples include over-the-counter medication3 and proton-pump inhibitors.

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. You never pay more than €250 per year for statutory contributions towards medicines. The Extrafit and higher supplementary health-care plans reimburse the statutory personal contributions up to a maximum amount per calendar year. This comes under coverage for Medicines in supplementary health-care plans.

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 or the smallest dosage dispensed for instance. The dispensing quantities are specified under Good to know.

You have the freedom to choose When it comes to medicines as well. We do 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 used in clinical studies • medicines that have not yet been approved • vaccinations and preventive medicines for your holiday or other travel • homeopathic and anthroposophic medicines

Other coverage Other conditions also apply for some medicines, so they are listed separately: • dietary preparations • provisionally approved medicines • over-the-counter medication and proton-pump inhibitors

1 This is available at https://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 Coverage under each health-care plan

Basic health-care plan 100% (excluding the personal contribution) Most medicines

Startfit No coverage

Extrafit The personal contribution As per medicines in supplementary health-care plans

Benfit The personal contribution As per medicines in supplementary health-care plans

Optifit The personal contribution As per medicines in supplementary health-care plans

Topfit The personal contribution As per medicines in supplementary health-care plans

Superfit The personal contribution As per medicines in supplementary health-care plans

What you pay

The excess This care is provided under the basic health-care plan, and is therefore subject to the excess. That is also the case where the basic health-care plan covers your statutory personal contributions above €250.

The personal contribution You will need to pay a statutory personal contribution for some medicines, but never more than €250 in total per calendar year. In addition, the basic health-care plan covers the statutory personal contributions.

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, orthodontist), midwife, specialist nurse (nurse practitioner) or physician assistant1.

For some medicines, you must request 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 geneesmiddelen2 [Permission for medicines] document, 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.

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 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.

You are given a set ‘dispensing quantity’ Per prescription, we will reimburse the costs of a medicine for: • 15 days or the smallest dosage dispensed for a medicine you have not taken before • 15 days for antibiotics for an acute ailment or for chemotherapy drugs (cytostatics) • a maximum of 1 month for sleep-inducing drugs (hypnotics) and anti-anxiety drugs (anxiolytics) • a maximum of 3 months for a medicine for a chronic illness • a maximum of 1 year for the contraceptive pill • a maximum of 1 month for medicines costing more than €1,000 per month during the titration period of 6 months • a maximum of 1 month in other cases If a medicine belongs to more than one category, the shortest period applies.

Medicines in 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. This comes under coverage for Medicines in basic health-care plans. 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 coverage’ and in ‘What is not covered’ below) • dressings where you are being treated by a doctor for a skin condition or wound, which does not come under the coverage for Dressings

Optifit, Topfit and Superfit also cover: • over-the-counter medication and proton-pump inhibitors for the first 15 days, or if you use them for less than 6 months • 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 and personal contributions covered by a manufacturer’s refund scheme2 • medicines for erectile dysfunction • medicines for fertility treatment under Extrafit and Benfit

Other coverage Other conditions (also) apply for some medicines, so they are listed separately: • homeopathic or anthroposophic medicines • vaccinations and preventive remedies for your holiday or other travel • contraceptives • over-the-counter medication and proton-pump inhibitors

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 see www.terugbetaalregeling.nl and www.hevoconsult.nl 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 • contraceptives • medicines for fertility treatment

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 • medicines for fertility treatment

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 covered by the basic health-care plan. The supplementary health-care plans reimburse these personal contributions, in accordance with the conditions below.

What you have to do yourself

You need a prescription from a doctor or other prescriber We only reimburse medicines, dressings and melatonin if they have been prescribed by your attending doctor, medical specialist, dentist, dental specialist (dental surgeon, orthodontist), midwife, specialist nurse (nurse practitioner) or physician assistant1.

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 or the smallest dosage dispensed for a medicine you have not taken before • 15 days for antibiotics for an acute ailment or for chemotherapy drugs (cytostatics) • a maximum of 1 month for sleep-inducing drugs (hypnotics) and anti-anxiety drugs (anxiolytics) • a maximum of 3 months for a medicine for a chronic illness • a maximum of 1 year for the contraceptive pill • a maximum of 1 month for medicines costing more than €1,000 per month during the titration period of 6 months • a maximum of 1 month in other cases If a medicine belongs to more than one category, the shortest period applies.

Medicines are sometimes included in hospital care In that case, you will receive the medicine in or from the hospital. The costs will not come under this category, in that case, but will be covered by the reimbursement for Medical specialists.

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. We refer to these as ‘over- the-counter medications’. Some proton-pump inhibitors are also over-the-counter medication, and can be purchased without a prescription.

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

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 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

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 cover: • the first 15 days that you use these medicines • over-the-counter medication and proton-pump inhibitors if you use them for less than 6 months See below for the maximum coverage provided per calendar year. The amount applies to the coverage below and the coverage for Medicines in supplementary health-care plans combined.

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 • 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 in case of chronic use

Startfit No coverage

Extrafit No coverage

Benfit No coverage

Optifit €4,540 For the first 15 days or temporary use over-the-counter medication/proton-pump inhibitors and other medicines in supplementary health-care plans combined

Topfit €4,540 For the first 15 days or temporary use over-the-counter medication/proton-pump inhibitors and other medicines in supplementary health-care plans combined

Superfit 100% For the first 15 days or temporary use 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.

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 they have been prescribed by your attending doctor, medical specialist, dentist, dental specialist (dental surgeon, orthodontist), midwife, specialist nurse (nurse practitioner) or physician assistant1.

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 3 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 BMI2 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.

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 To calculate your own BMI, divide your weight (in kilograms) by your height (in metres). Divide the result once more by your height (in metres). The result gives you your BMI If you still need support and advice after the 3 hours from the basic health-care plan, the Benfit and higher supplementary health-care plans reimburse the costs of extra medically-related dietetics from a dietitian. A coverage limit for additional dietetics applies per calendar year for Benfit and Optifit. Topfit and Superfit provide full coverage for additional 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

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.

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.

Quality registers provide extra information We give you complete freedom of choice. 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 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. You must satisfy 2 conditions however:

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 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 or doctor’s certificate You must have a prescription from your general practitioner or a dietary preparations doctor’s certificate1 from a doctor or medical specialist2, specialist nurse, physician assistant or dietitian for dietary preparations.

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 For this, see: www.znformulieren.nl/337936417/Formulieren?folderid=1300660227&title=Dieetpreparaat 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 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 • panoramic dental 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 will reimburse a maximum 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 basic health-care plan and the supplementary health-care plans do not cover: • the external bleaching of teeth and molars • gum shield • non-restorative treatment of milk teeth

The supplementary health-care plans do not cover: • general anaesthetic • MRA1 (mandibular repositioning appliance)

1 This comes under the coverage: MRA (mandibular repositioning appliance) 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. No referral is needed in acute cases1.

Sometimes you need permission in advance This applies to: • the 3rd and subsequent fluoride treatment(s) in the same calendar year • a panoramic dental X-ray • treatments by a dental surgeon specified on the limitatieve lijst machtigingen kaakchirurgie2 [exhaustive list of authorisations for dental surgery] • care provided under general anaesthetic • dentures costing more than €650 (including equipment and technical costs) per jaw • the replacement of a prosthesis less than 5 years old • implant-supported dentures, and the repair or rebasing (filling) of implant-supported dentures • care provided in a dental hospital

You need to request permission3 with a substantiated statement from your health-care provider. This must be accompanied by a treatment plan and budget.

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.

1 Treatment that cannot be postponed, e.g. in a life-threatening situation 2 A list of treatments that will only be reimbursed if you have permission. This list is the same for all health insurers 3 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen Good to know

The general rules and regulations always apply The general rules and regulations apply to all health care and to everyone. For example, they state that you will not be covered if the treatment is purely cosmetic, or if you do not turn up for a health-care appointment (‘no show’).

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. Your entitlements in that case are stated in the coverage.

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 (M40) • X-rays (X10) or assessment of X-rays (X11), but not for orthodontics • 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.

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 (M40) • X-rays (X10) or assessment of X-rays (X11), but not for orthodontics • sealing (application of a protective coating) (V30 or V35)

1 The codes in brackets are listed on the dentist’s invoice 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 (M40) • bacterial and enzyme testing (M32) • X-rays (X10) or assessment of X-rays (X11), but not for orthodontics • sealing (application of a protective coating) (V30 or V35)

Tandfit Preventief also covers 100% of the costs of most other codes for dental health care2 up to a maximum of €2,000 per calendar year. During the calendar year in which your Tandfit Preventief plan becomes effective, you can spend a maximum of €300 of that amount on fillings (all V codes except V30 and V35) and a maximum of €500 on gum treatments (periodontology, all T codes). If you already had Tandfit Preventief in 2018, the restriction for fillings and gum treatments does not apply to you. In that case, they are covered together with the other codes up to €2,000.

And: with Tandfit Preventief, you receive an electric toothbrush once every 3 years and a new brush head quarterly.

Tandfit Preventief does not reimburse the costs of (health care relating to): • crowns, bridges and inlays3 • prostheses • implants • root canal treatment • orthodontics

The following apply to Superfit, Tandfit A, B, C, D and Tandfit Preventief: Whom to contact • dentist • dental hygienist • prosthodontist

What is not covered • general anaesthetic • external bleaching and facings • MRA (mandibular repositioning appliance) • gum shield • equipment and technical costs for care that is not covered • dentist subscriptions

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 Coverage under each health-care plan

Basic health-care plan Limited coverage As per coverage for 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 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 and prevention (100%) + other dental health-care codes (100%, up to €2,000, of which in 1st year max. €300 for fillings and max. €500 for gum treatment) + electric toothbrush + brush heads Reimbursements: maximum per calendar year Toothbrush: once every 3 years Brush head: once quarterly No coverage for: crowns, bridges, root canal treatment, implants and prostheses

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. For example, they state that you will not be covered if the treatment is purely cosmetic, or if you do not turn up for a health-care appointment (‘no show’).

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 accident1, 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. What is covered is specified under 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. Your entitlements are stated in the coverage.

Extra coverage following an accident If the coverage listed above does not reimburse some or all of the care you need, 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 accident must have occurred while you were insured under 1 of these 6 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

1 In this coverage, we mean by accident: an unexpected, external, violent event that resulted in bodily injury to you Coverage under each health-care plan

Basic health-care plan Some cases Dental health care up to the age of 18, or (from the age of 18) as per dental surgeon, prosthesis, and specialist dental care

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 €10,000 Maximum, 1 accident per calendar year

What you pay

No 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 are required to seek our permission first We only reimburse the costs of dental health care following an accident if we have given permission1 in advance. For emergency treatment, you can also request permission retrospectively. 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 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 due to a serious condition, such as a congenital abnormality or a growth disorder. These are quite rare. Your entitlements are stated in the coverage for Specialist dental care. 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 as per the coverage you are reading about now.

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 up to the age of 18 for orthodontics. They 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 Coverage under each health-care plan

Basic health-care plan For serious conditions only As per specialist dental health care

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. Specialist dental care up to the age of 18 is not subject to the excess. However, over that age the excess is applicable.

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. They also specify that reimbursements from the past are counted if you change your supplementary health-care plan with us.

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.

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 us. If your treatment had already started before 2018, the applicable start date is: the 1st date of consultation or treatment in 2018. 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 due to serious conditions, such as a congenital abnormality or a growth disorder. These are quite rare. Your entitlements are stated in the coverage for Specialist dental care. 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 from the age of 18 as specified in the coverage you are reading about now. 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 For serious conditions only As per specialist dental health care

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. Specialist dental care is subject to an excess.

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 What you have to do yourself

You are required to seek our permission 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. They also specify that reimbursements from the past are counted if you change your supplementary health-care plan with us.

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.

If you are aged 18 or above, the basic health-care plan covers the costs of fully removable dentures 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.

The basic health-care plan covers 4 different types of fully removable dentures. 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 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 The percentage that the basic health-care plan does not reimburse is your statutory personal contribution. You must pay this yourself. The Superfit and Tandfit supplementary health-care plans reimburse all or part of this personal contribution as per the Dental health care: from the age of 18 coverage.

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 as per the coverage for Dental health care: from the age of 18.

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 2 months old, customising them is included in the purchase. You do not need to pay separately for this. If your dentures are more than 2 months old, the basic health-care plan includes coverage for: • repair and rebasing (filling): 90% (personal contribution 10%)

Whom to contact • dentist • prosthodontist

Other coverage If you are under the age of 18, The dentures and other prostheses come under Dental health care: up to the age of 18.

Coverage under each health-care plan

Basic health-care plan Depending on type: 75% to 92% Full dentures with repair/rebasing

Superfit €1,600 Maximum per calendar year

For the personal contribution, implants, partial dentures and other dental health care as per dental health care: from the age of 18

Tandfit A €250 Maximum per calendar year

For 75% of: the personal contribution, implants, partial dentures and other dental health care as per dental health care: from the age of 18

Tandfit B €750 Maximum per calendar year

For 75% of: the personal contribution, implants, partial dentures and other dental health care as per dental health care: from the age of 18

Tandfit C €1,500 Maximum per calendar year

For 75% of: the personal contribution, implants, partial dentures and other dental health care as per dental health care: from the age of 18

Tandfit D €1,500 Maximum per calendar year

For the personal contribution, implants, partial dentures and other dental health care as per dental health care: from the age of 18

Tandfit Preventief No coverage What you pay

The excess The fully removable denture comes under the basic health-care plan and is therefore subject to the excess. No excess applies to care under the supplementary health-care plan.

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.

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) costing more than €650 (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 in a dental hospital

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 Superfit and Tandfit supplementary health-care plans reimburse the care (in part) if performed by a dentist. This comes under dental health care: from the age of 18.

If, besides missing incisors or canines, you have other serious tooth problems as well, the front-teeth replacement may come under specialist dental care.

Whom to contact • 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 Coverage under each health-care plan

Basic health-care plan 100% Until the age of 23 (if necessity was determined before 18th birthday)

Superfit Limited coverage As per dental health care: from the age of 18

Tandfit A Limited coverage As per dental health care: from the age of 18

Tandfit B Limited coverage As per dental health care: from the age of 18

Tandfit C Limited coverage As per dental health care: from the age of 18

Tandfit D Limited coverage As per dental health care: from the age of 18

Tandfit Preventief Limited coverage As per dental health care: from the age of 18

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 are required to seek our permission 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 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 What you have to do yourself

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. No referral is needed in acute cases1.

Sometimes you need permission from us in advance We will only cover treatments specified on the limitatieve lijst machtigingen kaakchirurgie2 [exhaustive list of authorisations for dental surgery] where we have given our prior permission3.

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. Or tooth problems caused by chemotherapy or Sjögren’s syndrome.

2. If you have a non-dental physical or psychological condition. For example: serious Parkinson’s, an intellectual disability 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.

Sometimes: implants If you will be receiving a fully removable implant-supported prosthesis (dentures), the implants are covered under specialist dental care if you have a very shrunken, toothless jaw.

1 Treatment that cannot be postponed, e.g. in a life-threatening situation 2 A list of treatments that will only be reimbursed to you after permission. This list is the same for all health insurers 3 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen/toestemming-vragen-voor-kaakchirurgie 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 dental health care: from the age of 18

Tandfit A The personal contribution As per dental health care: from the age of 18

Tandfit B The personal contribution As per dental health care: from the age of 18

Tandfit C The personal contribution As per dental health care: from the age of 18

Tandfit D The personal contribution As per dental health care: from the age of 18

Tandfit Preventief The personal contribution As per dental health care: from the age of 18

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.

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 are required to seek our permission first 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 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 brush heads 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.

1 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen/toestemming-vragen-voor-bijzondere-tandheelkunde 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 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.

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.

The brush is guaranteed for 3 years The guarantee takes effect when you receive the brush and is subject to terms and conditions1. You can request your proof of guarantee from our Service Centre. Please contact Philips for the guarantee.

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 Psychological health care Coverage

General basic mental health care (GGZ) Specialist mental health care (GGZ)

General basic mental health care (GGZ)

If you have mild psychological problems.

What is covered

If you have psychological problems, your general practitioner or corporate doctor will be your first port of call. If your doctor suspects you have a psychological disorder, he/she will refer you for general basic mental health care (GGZ) or in the event of serious complaints, for specialist mental health care (GGZ).

The coverage you are reading about now applies to general basic mental health care (GGZ). The treatment usually consists of consultations with a health psychologist1 or psychotherapist. Treatment over the internet is another possibility.

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, draw up a treatment plan together with you, and organise this treatment. He/she can also engage other practitioners, ensuring sound cooperation and coordination, and is responsible for managing your case. Those eligible for the role of treatment coordinator are specified under ‘Whom to contact’.

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 cover: treatment of work-related problems2 or relationship problems and adjustment disorders3.

The Optifit and higher supplementary health-care plans cover the treatment of work-related or relationship problems and adjustment disorders, for all ages, 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: • an independent health-care provider as specified under 1, 2, 3 or 4 below • a treatment coordinator at a mental health-care centre as specified under 1, 2, 3, 4, 5, 6 or 7 below

If the health care is covered by the supplementary health-care plan, you can contact: • health-care providers as specified under 1, 2, 3, 8 or 9 below

1. health psychologist1 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 8. paediatric psychologist, registered with the Dutch Association of Psychologists (NIP) or the Stichting Kwaliteitsregister Jeugd [Youth Quality Register Foundation] (SKJ) 9. 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]. This act specifies other treatment coordinators than those under the basic health-care plan. If treatment needs to be continued with the ‘old’ treatment coordinator (a paediatric psychologist) after the patient’s 18th birthday, we will cover this 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 • admission • 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 ggz4 [Dynamic summary of psychological interventions within mental health care]

1 Also: health psychologist 2 Burn-out and severe stress, for example 3 This is the case if someone is having difficulty emotionally adjusting to a new situation, for instance after a death or divorce 4 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 Other coverage In some cases, the general practitioner will be able to treat you independently. That comes under psychological health care with a general practitioner.

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 (only under supplementary health-care plans), the referral may also be from a school doctor. No referral is needed in acute cases.

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 your health-care provider suspects this to be the case. 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.

Your health-care provider must have a statute of standards This statute of standards sets out the quality standards that the health-care provider satisfies and how health care is organised. The statute of standards is available on the health-care provider’s website.

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 you have serious psychological problems.

What is covered

For serious psychological problems, you receive a referral for specialist mental health care (GGZ). The treatment usually consists of consultations with a psychiatrist or psychotherapist for instance. If necessary, you will be admitted to a mental health-care centre or the psychiatric ward of a hospital.

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, draw up a treatment plan together with you, and organise this treatment. He/she can also engage other practitioners, ensuring sound cooperation and coordination, and is responsible for managing your case. Those eligible for the role of treatment coordinator are specified under ‘Whom to contact’.

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. 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 • an independent health-care provider as specified under 1, 2, 3 or 4 below • a mental health-care centre or a hospital psychiatric ward. Your treatment coordinator there can be any of the 8 health-care providers listed below, but only numbers 1 and 4 in the case of admission. However, they can give permission for you to keep the treatment coordinator you had prior to your admission

1. clinical psychologist 2. psychotherapist 3. clinical neuropsychologist 4. psychiatrist 5. health psychologist1 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

1 Also: health psychologist Transitional arrangement for 18-year-olds Mental health care for people under the age of 18 is covered by the Jeugdwet [Youth Act]. This act specifies other treatment coordinators than those under the basic health-care plan. If treatment needs to be continued with the ‘old’ treatment coordinator (a paediatric psychologist) after the patient’s 18th birthday, we will cover this 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 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 work-related problems1 or relationship problems and adjustment disorders2 • 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 ggz3 [Dynamic summary of psychological interventions within mental health care]

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

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.

1 Burn-out and severe stress, for example 2 This is the case if someone is having difficulty emotionally adjusting to a new situation, for instance after a death or divorce 3 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 In some cases, you must have permission in advance for admission This applies to: • 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 • admission for 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 your health-care provider suspects this to be the case. 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 specialist mental health care (GGZ) that is standard practice for psychiatrists and clinical psychologists and that has been proven effective. Simple when possible, and more complex when necessary.

Your health-care provider must have a statute of standards This statute of standards sets out the quality standards that the health-care provider satisfies and how health care is organised. The statute of standards is available on the health-care provider’s website.

A word of caution in relation to admission abroad The guidelines that apply to specialist mental health care and admissions abroad may be different to in the Netherlands. It is possible that not everything will be insured. Please contact our Service Centre first. This will help you avoid any nasty (financial) 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 us. Your health-care provider knows how this works.

We will cover up to three 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.

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 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen/toestemming-vragen-voor-opname-ggz Contraceptives Coverage

Contraceptives Sterilisation and reversal operation

Contraceptives

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 coverage you are reading about now applies to this.

The diaphragm and copper intrauterine device are medical appliances, not medicines. They are covered under Medical appliances: contraceptive devices.

The basic health-care plan covers contraceptive medicines 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 from the age of 21.

Whom to contact • pharmacy • dispensing practice

What is not covered • condoms

Other coverage • You purchase an intrauterine device yourself, but have it fitted (and removed) by a general practitioner or a midwife. These costs are covered under The general practitioner. Fitting and removal can also be carried out in the hospital or an independent treatment centre. This comes under the Medical specialist coverage. In this case, you do not purchase the intrauterine device yourself and we do not reimburse it separately. • The Optifit and higher supplementary health-care plans also reimburse sterilisation.

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% 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. The Benfit 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.

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 only cover the costs of sterilisation. Topfit and Superfit also provide coverage for a reversal. A coverage limit applies for Benfit and Optifit. Once this has been reached, we do not cover further costs of care, not even in a subsequent year. Topfit and Superfit provide full coverage.

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 Coverage under each health-care plan

Basic health-care plan No coverage

Startfit No coverage

Extrafit No coverage

Benfit Male sterilisation: €350 Female sterilisation: €1,000 Maximum, for the entire term of the health-care plan No coverage for reversal operation

Optifit Male sterilisation: €400 Female sterilisation: €1,200 Maximum, for the entire term of the health-care plan 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.

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. 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 consultations and treatments aimed at curing an ailment. See below for the maximum coverage provided per consultation or treatment. We reimburse a maximum of 1 consultation or treatment per day.

The Optifit and higher supplementary health-care plans also cover registered1 homeopathic and anthroposophic medicines and laboratory and other tests necessary for your treatment.

A maximum reimbursement applies per calendar year for the consultations and treatments, and (with Optifit and higher) medicines and laboratory and other tests combined.

Whom to contact • doctor • practitioner who has full membership of a professional organisation2 that is recognised by us and satisfies the PLATO (Platform Opleiding, Onderwijs en Organisatie [Training, Education and Organisation Platform]) requirements3. • for medicines: pharmacy or dispensing general practitioner’s practice

Coverage under each health-care plan

Basic health-care plan No coverage

Startfit No coverage

Extrafit €30 per consultation or treatment, up to €400 Maximum per treatment/calendar year No medicines or lab and other testing

Benfit €30 per consultation or treatment, up to €500 Maximum per treatment/calendar year No medicines or lab and other testing

Optifit €65 per consultation or treatment + lab and other testing + registered medicines combined max. €750 Maximum per treatment/calendar year

Topfit €65 per consultation or treatment + lab and other testing + registered medicines combined max. €1,000 Maximum per treatment/calendar year

Superfit €75 per consultation or treatment + lab and other testing + registered medicines combined max. €1,500 Maximum per treatment/calendar year

1 These have been given an RVG or RVH number by the Medicines Evaluation Board (CBG) 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 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

Please ensure that your health-care provider is a doctor, or a full member of a professional organisation that is recognised by us and satisfies the PLATO Platform( Opleiding, Onderwijs en Organisatie [Training, Education and Organisation Platform]) requirements We do not reimburse health care given by other care providers.

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.

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 the doctor or practitioner as part of their profession. Simple when possible, and more complex when necessary. We do not reimburse activities that are not aimed at curing an ailment. This applies to yoga and mindfulness, for instance.

We reimburse up to a maximum of the usual rates for the professional group You can usually find these on the internet. 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 coverage for Hearing aids and tinnitus maskers applies to this.

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. 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 come under the coverage for the Medical specialist.

The orthoptist can also work independently, in the hospital or his/her own practice. the coverage you are reading about now applies to this. If this is so, you can visit the orthoptist directly, without a referral.

The basic health-care plan 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. Coverage under each health-care plan

Basic health-care plan 100% For 5 conditions

Startfit No coverage

Extrafit No coverage

Benfit €500 Maximum per calendar year

Optifit €750 Maximum per calendar year

Topfit €1,000 Maximum per calendar year

Superfit €1,500 Maximum per calendar year

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 do not need a referral for an independent orthoptist You must have a referral in advance for the ophthalmologist. In such cases, Medical specialist coverage will apply.

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. 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 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 need to have a referral first 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)1 • in the event of a visual impairment, a medical specialist must refer you in accordance with the guidelines on Visusstoornissen, revalidatie en verwijzing [Visual Impairments, rehabilitation and referral] published by the Nederlands Oogheelkundig Gezelschap [Dutch Ophthalmological Association] (NOG)2. 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 permission3 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 Federatie van Nederlandse Audiologische Centra [Federation of Dutch Audiological Centres] 2 More information is available at: www.oogheelkunde.org 3 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen 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 three 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.

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 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.

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.

Quality registers provide extra information We give you complete freedom of choice. You decide which health-care provider you go to. Quality registers1 contain information that can help you make a choice.

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 Glasses and contact lenses with medical indication.

1 More information is available at: www.onvz.nl/kwaliteitsregisters 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 glasses1 • 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 • glasses and contact lenses: optician • laser eye treatment and implanted lenses: a hospital or independent treatment centre2

What is not covered • contact lens fluid • frame for glasses without lenses • glasses case and other accessories • eye test (refraction test) and eye check-ups, fitting costs and adjustment costs • diving masks • laser treatment of eye floaters3

Coverage under each health-care plan

Basic health-care plan Only with a medical indication As per Glasses and contact lenses with a medical indication.

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 Glasses to counter double vision 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 Laser treatment to eliminate spots you see floating in your field of vision 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. They also specify that reimbursements from the past are counted if you change your supplementary health-care plan with us.

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 include coverage for stuttering therapy. A reimbursement limit applies per insured person for Extrafit, Benfit and Optifit. Topfit and Superfit provide full coverage.

Whom to contact • stuttering therapy institute

What is not covered • overnight stay • meals during the therapy

Other coverage You can also go to a speech therapist if you have a stutter. This comes under the Speech therapy coverage. 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

No referral needed You can go to the institute 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 care that is standard practice for institutes for stuttering therapy. Simple when possible, and more complex when necessary. 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 for longer. There are many kinds of medical appliances and different ways in which you can get their costs reimbursed. For some medical appliances, you need to go to your local council or the care administration office.

The coverage you are reading about now applies to medical appliances that come under the basic health-care plan. The basic health-care plan reimburses medical appliances and dressings that are necessary while you are recovering from an illness or condition, or have to live with an illness or condition. The medical appliances or groups of medical appliances to which this applies are listed below under ‘Coverage of medical appliances under the basic health-care plan’. You can click through to the coverage from this list. Your entitlements and the conditions they are subject to are specified there. This includes things like whether you need a prescription or have to request prior permission, and the implications for the excess and personal contribution.

The medical appliances basic rules and regulations are always applicable to these medical appliances. These rules and regulations include conditions such as you must always use and maintain your medical appliances carefully. What do to if replacement, repair and maintenance are needed is also specified.

If the coverage states that you have to pay a statutory personal contribution for the medical appliance, the Benfit and higher supplementary health-care plans reimburse that statutory personal contribution. See below for the maximum coverage provided per calendar year.

Coverage of medical appliances under the basic health-care plan • breast prostheses • glasses and contact lenses with a medical indication • CPAP machine • DAISY players • hearing aids and tinnitus maskers • service dogs • medical appliances for diabetes • medical appliances for skin conditions • medical appliances for pain management (TENS) • medical appliances for respiratory conditions • medical appliances for problems with movement • medical appliances for urinary and bowel incontinence • medical appliances for problems with hearing • medical appliances for speech disorders • medical appliances for problems with sight • medical appliances for thrombosis • medical appliances for vascular conditions • medical appliances for nursing and care in bed • medical appliances: contraceptive devices • incontinence products • infusion pump • syringes and injection pens to self-administer medicine • protective headgear • short-term loan of medical appliances for problems with movement • MRA (mandibular repositioning appliance) • orthoses • orthopaedic footwear and orthotics for footwear • personal alarm system • wigs • prostheses • compression stockings/sleeves • dressings • post-op shoes • feeding pump and feeding tube • modifications in the home and other costs for home dialysis • oxygen therapy equipment

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 Other coverage The medical appliances listed above are covered by the basic health-care plan. Certain other medical appliances are covered by the supplementary health-care plans, which are not subject to the basic rules and regulations for medical appliances. • glasses, contact lenses and laser eye treatment • walking aids • bed-wetting alarm • support pessary • arch supports • dressings for a skin disorder or wound

Coverage under each health-care plan

Basic health-care plan 100% (excluding personal contribution) As per ‘Coverage of medical appliances under the basic health-care plan’

Startfit No coverage

Extrafit No coverage

Benfit €250 For statutory personal contributions

Optifit €500 For statutory personal contributions

Topfit €1,000 For statutory personal contributions

Superfit Statutory personal contributions 100%

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 some cases, the medical appliance is reimbursed through the hospital If the medical appliance is part of a treatment provided by a medical specialist, or it was implanted, it comes under the Medical specialist coverage. We do not reimburse it separately.

No Medical Appliance Regulations as of 2019 They were applicable up to and including 2018. What you are entitled to in 2019 is specified in the basic rules and regulations for medical appliances and in the ‘Coverage of medical appliances under the basic health-care plan’ in the above list.

The government has a useful list of medical appliances This is the medical appliances guide1. If you have any further questions, our Service Centre can provide you with further assistance.

1 More information is available at: www.hulpmiddelenwijzer.nl 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, this comes under the Medical specialist coverage.

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.

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. Skin and hair Coverage

Acne treatment Cosmetic camouflage instruction 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 treating active acne. Treatment of scars from healed acne is not included. The coverage applies up to the age of 21, except under the Superfit plan, which also covers care from the age of 21.

Extrafit and Benfit cap coverage 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) 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 invoice We do not reimburse invoices that do not specify the 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 We give you complete freedom of choice. You decide which health-care provider you go to. Quality registers1 contain information that can help you make a choice.

Cosmetic camouflage instruction

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. We call that cosmetic camouflage instruction. You decide on the best products to use in mutual consultation and you practice applying, fixing and removing them.

If you have a seriously disfiguring skin abnormality on your face or throat, the Extrafit and higher supplementary health-care plans will cover the cosmetic camouflage instruction. Topfit and Superfit also cover the costs of cosmetic camouflage instruction if there is some other medical reason.

Extrafit, Benfit and Optifit cap coverage at a maximum amount of €70 per calendar year. Topfit and Superfit provide maximum coverage is €120 per calendar year. We will reimburse a maximum of 2 hours of lessons per calendar year.

Whom to contact • skin therapist2 • beautician3

What is not covered • beauty treatment • cosmetic camouflage products for home use

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) Coverage under each health-care plan

Basic health-care plan No coverage

Startfit No coverage

Extrafit €70 Maximum per calendar year, for maximum of 2 lessons

Benfit €70 Maximum per calendar year, for maximum of 2 lessons

Optifit €70 Maximum per calendar year, for maximum of 2 lessons

Topfit €120 Maximum per calendar year, for maximum of 2 lessons

Superfit €120 Maximum per calendar year, for maximum of 2 lessons

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 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 We give you complete freedom of choice. 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 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 €150 Maximum, for the entire term of the health-care plan

Benfit €350 Maximum, for the entire term of the health-care plan

Optifit €750 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) 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 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. They also specify that reimbursements from the past are counted if you change your supplementary health-care plan with us.

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 We give you complete freedom of choice. 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 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. 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, 3 or 4 following the annual foot check-up, the basic health-care plan covers you as per Foot care for diabetes sufferers

If you have diabetes and were assigned health-care profile 1, or if you have rheumatoid arthritis, the coverage below applies.

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 coverage 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 in the Register Paramedische Voetzorg2 [Register for Allied Health Professionals for Foot Care] or in the register administered by KABIZ (Quality registration and accreditation for health-care professionals)3.

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, in accordance with foot care for diabetes sufferers.

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: https://stipezo.nl/register 3 For this, see: www.kabiz.nl/raadplegenregister What you pay

No excess Pedicurist care for diabetes (health-care profile 1) and rheumatoid arthritis comes under the supplementary health-care plans. 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 (health-care profile 1) or rheumatoid arthritis. Simple when possible, and more complex when necessary.

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) (such as a nursing home or a facility for disabled persons) 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)

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 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 are undergoing kidney dialysis 2. you are undergoing oncological treatments 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 and the associated appointments, such as consultations, tests and check-ups) • 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]

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 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.

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. This is dependent on how often you have to travel and the distance being travelled. If you believe this applies to you or you want us to work it out for 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 €103 per calendar year. 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 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 €103 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.

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 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen-voor-zittend-ziekenvervoer Car transportation is based on the optimum route We calculate the number of kilometres using the Routenet route planner1. We only reimburse the kilometres actually travelled by you.

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 transportation2. The form tells you what documents you need to send.

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.

What is not covered • the costs of travel to other facilities, for instance to a nursing home or mental health-care facility • parking charges and other additional costs

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%

1 For this, see: www.routenet.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 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.

Our calculation is based on the optimum route We calculate the number of kilometres using the Routenet route planner1.

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 people2. 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 For this, see: www.routenet.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 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, the coverage shown below applies to urgent health care provided abroad. 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. For health care which you already knew you needed, or which can wait until you return to your own country, the coverage provided is in accordance with Abroad: 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. Two important restrictions apply: • We cover up to a maximum of what the health 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. • 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.

For urgent health care abroad, the Wereldfit and Superfit supplementary health-care plans 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. However, you must contact the Zorgassistance emergency centre in advance.

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 buitenland 2 [Limits of health care abroad] document.

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. We reimburse up to the statutory rate in the country where you receive the care 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.

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 We’d be happy to help.

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 Coverage under each health-care plan

Basic health-care plan 100% as per 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 statutory or market rate in the country concerned

Extrafit Health care as per Extrafit coverage Up to the statutory or market rate in the country concerned

Benfit Health care as per Benfit coverage Up to the statutory or market rate in the country concerned

Optifit Health care as per Optifit coverage Up to the statutory or market rate in the country concerned

Topfit Health care as per Topfit coverage Up to the statutory or market rate in the country concerned

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, up to the statutory or market rate in the country concerned • Health care that comes under the Superfit plan, up to the statutory or market rate in the country concerned • 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 up to the statutory or market rate in the country concerned • 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 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 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

Please contact our Zorgassistance emergency centre If you urgently need health care abroad, we recommend that you contact our Zorgassistance emergency centre. 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, the requirement that invoices must be clear and written in Dutch, English, German, French or Spanish, and the exchange rate we use for invoices in a currency other than the euro.

Wereldfit or 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 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

If you would like to go abroad for treatment, 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 Abroad: urgent health care.

Coverage of non-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 this care abroad. However, there are 3 important conditions: • we cover up to a maximum of what the health 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. • 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. • 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, 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. However, you must contact the ZorgConsulent in advance. For other health care that comes under the basic health-care plan and that you receive in an EU/EEA member state or a treaty country, 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.

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 state1 or in Switzerland and you receive the health care in another EU/EEA member state or Switzerland, 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 form2 when you visit the health-care provider. You can request this form from us. Request it in good time before receiving the treatment. We need 5 working days to assess your request.

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, the coverage offered by the supplementary health-care plans or Tandfit plans also applies to health care you receive abroad. The same conditions and coverage limits apply as in the Netherlands. The supplementary health-care plans and Tandfit plans 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 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. We’d be happy to help.

1 For this, see: www.onvz.nl/vergoedingen/zorg-in-het-buitenland/verdragslanden-voor-zorg 2 For this, see: www.onvz.nl/zelf-regelen/toestemming-vragen/toestemming-vragen-voor-niet-spoedeisende-zorg-buitenland 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 the ZorgConsulent, in an EU/EEA member state or a treaty country, up to double the amount that applies for this care in the Netherlands (including basic health-care plan coverage) • 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 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 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 • to seek permission1, if you could also have this 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 the requirement that invoices must be clear and written in Dutch, English, German, French or Spanish, and the exchange rate we use for invoices in a currency other than the euro.

Wereldfit or 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 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.

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.

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.

Common infectious diseases in foreign countries include: • hepatitis A and B • diphtheria, tetanus and polio (DTP) • yellow fever • typhoid • cholera • meningococci • rabies • malaria

1 For this, see: www.onvz.nl/zelf-regelen-toestemming-vragen The Startfit and higher supplementary health-care plans cover the costs of consultations, vaccinations and preventive medicines (such as malaria tablets) for these 11 common infectious diseases. For Startfit, Extrafit, Benfit and Optifit, a maximum reimbursement per calendar year applies. Topfit and Superfit provide complete coverage for vaccinations and preventive medicines. The vaccinations can also be to prevent other ‘foreign’ infectious diseases as advised by the LCR1 (Landelijk Coördinatiecentrum Reizigersadvisering) [National Coordination Centre for Advice to Travellers].

Whom to contact • a general practitioner • pharmacy • the municipal public health service (GGD) • a vaccination centre • thuisvaccinatie.nl2

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 11 common infectious diseases Maximum per calendar year

Extrafit €75 for 11 common infectious diseases Maximum per calendar year

Benfit €75 for 11 common infectious diseases Maximum per calendar year

Optifit €100 for 11 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.

1 More information is available at: www.lcr.nl 2 For this, see: www.thuisvaccinatie.nl/zorgverzekeraars/onvz What you have to do yourself

A prescription is required to pick up preventive medicines and vaccines from the pharmacy If you are getting malaria tablets for instance, or the health-care provider is asking you to collect a vaccine, we only reimburse these where they are prescribed by a doctor and provided by a licensed pharmacist or a dispensing practice.

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 preventive medicines generally advised by the Landelijk Coördinatiecentrum Reizigersadvisering [National Coordination Centre for Advice to Travellers] for the country you will be travelling to. Compensation and aid Coverage

Reimbursement in exceptional cases Aid for third-party claims for injury Superfit accident coverage

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 After our permission Our decision states what you will be reimbursed for

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 are required to seek our permission first In order to assess your request, we need a written explanation from your 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.

Wait for our decision In principle, we will not give our permission if you have already started receiving the health care.

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, we offer 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 us then tries to recover your loss from the person who caused the accident or that person’s insurer.

The Verhaalsbijstand-service [Aid for third-party claims service] rules1 explain 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 our Verhaalszaken (third-party claims) department by calling +31 (0)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 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 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 and touch), you will receive a certain percentage of €20,000, the maximum payout that applies per accident. The applicable percentages are listed in the Superfit accident coverage rules. The payout in the case of death is €5000.

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.

The full terms and conditions are listed in the Superfit accident coverage rules1.

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.

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 What you have to do yourself

Report an accident as soon as possible If you have been in an accident for which you wish to request compensation, 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. 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 a Wereldfit or Superfit supplementary health-care plan, you are entitled to more generous coverage in Belgium and Germany. For medical specialist 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, 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. 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 Wereldfit and Superfit plans, you will also be reimbursed for the cost of medical transportation 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 Medical specialist.

What is not covered • Chefarzt (medical specialist in Germany) and ereloon (doctor’s fee in Belgium), as well as any related costs • alternative/non-conventional health care

Other coverage Superfit and Zorgplan cover the costs of extra luxury and comfort during your stay at a hospital, 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 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

Superfit No coverage

Wereldfit Medical specialist in a hospital in Belgium or Germany 100%, medical transportation (After guidance by the ZorgConsulent)

1 Transportation which, for medical reasons, cannot occur using public transport. Such transport is necessary for the purposes of medical investigation/tests or treatment. 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

If you have to be taken elsewhere after an accident or illness.

What is covered

If you become seriously ill while on holiday, or are seriously injured in an accident, Abroad: urgent health 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 supplementary health-care plans.

Wereldfit and Superfit cover: • transportation to a country designated by our Zorgassistance emergency centre, 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

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, the additional costs will be reimbursed under the Wereldfit and Superfit plans.

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 Medically necessary repatriation in the event of serious illness or injury; visitor • Repatriation to the country designated by the Zorgassistance emergency centre • 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 the Zorgassistance emergency centre • 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.

No personal contribution You will not be charged a personal contribution for these services.

What you have to do yourself

You must always contact the Zorgassistance emergency centre before you incur any costs, unless this is not possible. Our Zorgassistance emergency centre is always available on +31 (0)88 668 97 67. We will reimburse telephone costs incurred when calling our emergency centre 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. Our Zorgassistance emergency centre 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 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 if you have to return from abroad. If you are travelling in your country of residence, we only reimburse the additional transport costs.

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. If you were travelling in your country of residence, we will reimburse transportation up to a maximum €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 or Wereldfit plan, the Wereldfit coverage for reimbursement in the event of death applies 3 First and second-degree family members • First 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. • Second 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 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 (abroad) that 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 • in country of residence, transportation only (max. €500)

Wereldfit Extra travel and accommodation costs (abroad) that 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 • in country of residence, transportation only (max. €500)

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 always contact the Zorgassistance emergency centre before you incur any costs, unless this is not possible. Our Zorgassistance emergency centre is always available on +31 (0)88 668 97 67. We will reimburse telephone costs incurred when calling our emergency centre 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.

Our Zorgassistance emergency centre will arrange travel and accommodation. If you make the travel and accommodation arrangements yourself, the costs may not be reimbursed in full. Wereldfit: reimbursement in the event of death

Support for a far-reaching event.

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: • funeral in the country where the person passed away, and travel, including the return journey, for the partner and first and second-degree1 family members, up to a maximum of €7,500 in total, or • transportation of the physical remains to a country chosen by the next of kin

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 away2, you are covered for the additional costs of transportation 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.

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 First and second-degree family members • First 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. • Second 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 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

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 always contact the Zorgassistance emergency centre before you incur any costs, unless this is not possible. Our Zorgassistance emergency centre is always available on +31 (0)88 668 97 67. We will reimburse telephone costs incurred when calling our emergency centre 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.

Our Zorgassistance emergency centre 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.

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 our Zorgassistance emergency centre before you incur any costs Our Zorgassistance emergency centre is always available on +31 (0)88 668 97 67. We will reimburse telephone costs incurred when calling our emergency centre 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.

Our Zorgassistance emergency centre will arrange the replacement driver If you organise the replacement driver yourself, the costs may not be reimbursed in full. Superfit accident coverage rules and regulations

Superfit accident coverage rules and regulations

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. suffocation, drowning, sun stroke, thermoplegia, frostbite, burning (except as the result of radiation), cauterisation or electric discharge; 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 €5000. 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 Superfit accident coverage rules and regulations 2019 - version 1.2 232 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 easonabler 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 Superfit accident coverage rules and regulations 2019 - version 1.2 233 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 Superfit accident coverage rules and regulations 2019 - version 1.2 234 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 noteceive r 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 esultr of extraordinary circumstances

ONVZ Superfit accident coverage rules and regulations 2019 - version 1.2 235 Wereldfit Comprehensive terms and conditions 2019

Wereldfit Comprehensive terms and conditions 2019

We reimburse the health care and services listed below provided the terms and conditions have been met. The general rules and regulations also apply. The (maximum) reimbursements are per insured person, unless stated otherwise.

You must always contact our Zorgassistance emergency centre before you incur any costs, unless this is not possible. Not doing this may have consequences for the reimbursement of costs. This does not apply to Abroad: non-urgent (scheduled) health care.

You can also contact us for advice on medical care.

Our Zorgassistance emergency centre is always available on +31 (0)88 668 97 67. We reimburse telephone costs incurred when calling the emergency centre 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.

First and second-degree family members • 1st degree: 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

Prevailing market rate We define prevailing market rate as an amount charged by the health-care provider that is not unreasonably high when compared with the amount charged by other health-care providers in the country where the treatment takes place.

Emergency health care Medically necessary treatment that cannot be postponed because immediate intervention is required from a medical point of view and that could not have been foreseen on departure.

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.

Medical transportation Transportation that is necessary for medical tests or medical treatment and that, on medical grounds, cannot occur using public transport.

2. Who is insured? The health-care policy will state the name of the insured person. This person must (also) have a basic health- care plan.

3. Where and for how long are you insured? You are insured abroad if you go abroad for a period of up to 180 days. You are also insured in your country of residence, but not in the town/city where you live, in cases of at least 1 paid overnight stay. You are insured for a maximum of 180 consecutive days.

4. Requirements for health-care providers For health care in a country outside the Netherlands, the health-care provider must be on the registers used by the government. If there is no such register in the country in question, the health-care provider must be on the register of the recognised professional organisation, if there is one. The health care provided must be considered common practice within the profession.

ONVZ Wereldfit 2019 - version 1.2 237 5. Medical details You give permission to the medical adviser at our Zorgassistance emergency centre to transfer information to our medical adviser. This might be information relating to the treatment or repatriation, for instance.

6. Transportation (medical or otherwise) If transportation (medical or otherwise) is involved, we will reimburse the costs of appropriate transportation. For air transportation, we reimburse economy class, unless this is not possible. For transportation by car, we will reimburse €0.27 per kilometre. In calculating the amount to be reimbursed, we assume the optimum route is taken. Costs associated with transportation, for example parking charges, will not be reimbursed.

7. Accommodation If accommodation is involved, we will reimburse the costs of overnight stays and meals 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, we will reimburse the costs of the following (after contact with our Zorgassistance emergency centre): • health care that remains at the insured person’s own expense. This only applies where the health care comes under the basic health-care plan and 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 • medicines registered in the Netherlands or abroad that are not covered under the basic health-care plan or a supplementary health-care plan • substances that are classified in the Netherlands as ‘non-medicine’ Niet( Geneesmiddel) up to a maximum of €250 per calendar year, or up to a maximum of €350 per calendar year if Wereldfit is included in your Superfit plan. • medical appliances and dressings used in the treatment • medical transportation to take the insured person to and from the health-care provider, in full

2. Repatriation We 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 our Zorgassistance emergency centre, with the prescribed medical supervision • if repatriation is medically necessary but not yet possible, the 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 1 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

Our Zorgassistance emergency centre will arrange travel and accommodation.

Additional services

1. Search and rescue If, as a result of illness or an accident, the insured person finds himself/herself in an emergency situation involving essential search or rescue, we will reimburse the search and rescue costs up to a maximum of €25,000.

2. Transportation and accommodation 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, we reimburse the additional costs of transportation and accommodation incurred by the insured person.

Transportation and accommodation for insured travel companions We 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 the insured person We reimburse the additional costs of transportation and accommodation incurred by the insured person if a pre-booked return journey cannot take place on the scheduled date because of his or her medical condition.

ONVZ Wereldfit 2019 - version 1.2 238 Transportation and accommodation for visitors If the insured person is admitted for an anticipated minimum of 5 days, or for a life-threatening situation, we will reimburse once the additional costs of transportation and accommodation for 2 people for a maximum 8 days in order to visit the insured person. If, for medical reasons, the insured person cannot return home after those 8 days, we reimburse (in total) a maximum of 15 days’ transportation and accommodation.

3. Early return Arrangements for returning from abroad In the following 5 cases, we reimburse once: • 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

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: Wereldfit: reimbursement 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

Our Zorgassistance emergency centre will arrange travel and accommodation.

Arrangements for returning in country of residence If you stay in your country of residence, the same arrangements apply as for returning from abroad, but in the case referred to in point 4, we reimburse additional costs of transportation for a maximum €500 per event. You can arrange transportation yourself in the country of residence.

4. Replacement driver We will reimburse the costs of a replacement driver, if: • for medical reasons the driver is no longer able to drive, and • the motor vehicle used still works properly, and • the other travel companions cannot drive the motor vehicle

If you are travelling in your own motor vehicle, we 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, we will reimburse the costs of the replacement driver to the nearest drop-off point.

Our Zorgassistance emergency centre will arrange the replacement driver.

5. Guarantee, advance payments and shipping of medicines Our Zorgassistance emergency centre will arrange, at your request: • guarantee on direct payment of health-care costs to the health-care provider, if the costs are reimbursed under your basic health-care plan with us or the Wereldfit plan • the necessary advance payments of the health-care costs • if possible, the shipping of essential medicines if they are not available at your location, if the costs are reimbursed through your basic health-care plan or supplementary health-care plan with us

Arrangements in the event of death

In the event of the death of the insured person during a trip, we will reimburse the costs of: • funeral in the country where the person passed away, and travel, including the return journey, for 1st and 2nd-degree family members, up to a maximum of €7,500 in total. Or alternatively, transportation of the physical remains to a country chosen by the next of kin (no maximum amount) • 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 1st and 2nd-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 1 person to support a travel companion or family member of the insured deceased person, including return journey

Our Zorgassistance emergency centre will arrange travel and accommodation.

ONVZ Wereldfit 2019 - version 1.2 239

Scheduled health care

1. We reimburse the costs of specialist medical care in accordance with the coverage under Medical specialist in the basic health-care plan 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 amount in the country where treatment is taking place. This includes the coverage provided by the basic health-care plan.

We do not reimburse: • 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

You must contact the ZorgConsulent before the treatment. He or she will help you in your choice of 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. If we are reimbursing treatment in accordance with 1, we also reimburse medical transportation from your home address in the Netherlands and back, but only if you are a passenger yourself.

ONVZ Wereldfit 2019 - version 1.2 240 Basic rules Medical appliances under the basic health-care plan

Basic rules: medical appliances under the basic health- care plan

These basic rules are divided into 3 sections:

1. I need a medical appliance 2. I am getting a medical appliance for the first time 3. I am using a medical appliance

Key items are highlighted in bold text, so you can quickly find what you are looking for.

I need a medical appliance

1. If you need a medical appliance, we will determine whether the costs of that medical appliance are covered based on the following: • the general rules and regulations1 • the basic rules for medical appliances, which you are currently reading • the coverage for medical appliances • the coverage for the particular medical appliance you need These 4 types of rules and regulations always apply.

2. A medical appliance must be suitable for the purpose for which it is intended: it must be ‘adequate’. This is an addition to general rule 241, which states, in short, that we reimburse the costs of healthcare that you reasonably rely on and that is considered safe and effective.

If your medical appliance is no longer adequate, you can submit a request to us for its repair, modification or replacement. You do this in the same way as you submit a request for permission. You can read more about requesting permission under basic rule 3.

You are entitled to a standard medical appliance (‘off the rack’) as long as this is adequate for your situation. Sometimes a standard medical appliance is not adequate, in which case you will be entitled to a tailor-made medical appliance. Your supplier or health-care provider will have to explain to us why a standard medical appliance will not work in your situation.

3. You will usually need our prior permission to get a medical appliance. In the medical appliances coverage section, you can see whether this applies to your medical appliance. The supplier is often allowed to give permission on our behalf; your supplier and our Service Centre can tell you if this is the case.

If your supplier cannot give permission on our behalf, you will need to ask our permission3 yourself. You can send your request to us using the contact form or by post.

If you would prefer for the supplier not to arrange your request due to privacy concerns, you can also send your request to our medical adviser using the contact form or by post. The medical adviser has a duty of confidentiality. Simply include ‘t.a.v. de medisch adviseur’ (Attn medical adviser) on the contact form or envelope.

4. In the medical appliances coverage section, there is a description of each medical appliance or type of medical appliance that is covered under the health-care plan. If more than one type of medical appliance is included in that group, each one is listed separately under ‘Details of each medical appliance’. If you need a different medical appliance that is not listed but that comes under the group description, you will need to receive our permission in advance. You can read more about requesting permission under basic rule 3 and in the reimbursement section under the medical appliance concerned.

I am getting a medical appliance for the first time

5. If you are getting a medical appliance for the first time, it will be ready for immediate use. If the medical appliance has a manual, you will receive this, and if it needs batteries or a charger, you will get these too the first time round.

6. You get a medical appliance on loan, or you purchase it yourself. ‘On loan’ means that we or the supplier remain the owner of the medical appliance and that you can use it for as long as you need it. If you purchase the medical appliance yourself, you are the owner. In the coverage section for your medical appliance, you can read whether you purchase the medical appliance yourself or are given it on loan.

1 See www.onvz.nl/vergoedingen/algemene-regels for more information. 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

2019 ONVZ basic rules: medical appliances under the basic health-care plan – version 1.2 242 7. If you are getting a medical appliance on loan, we pay for its purchase (either by the supplier or us), maintenance and repair. We also reimburse the costs of the consumables, i.e. the items you need to use the medical appliance and which you throw away when you start using a new item. Batteries are not considered consumables.

When you are given a medical appliance on loan, the supplier delivers this to your home.

8. You do not pay an excess for a medical appliance on loan, but you do for the consumables needed for that appliance. You always pay an excess when you purchase a medical appliance yourself.

9. You can also purchase a medical appliance that is normally provided on loan, but you must request permission from us in advance. This is because additional conditions may apply. When requesting the medical appliance, please state that you wish to purchase it yourself. We reimburse the prevailing market price for the simplest form of the medical appliance. You can read more about the prevailing market price under general rule 25. If you purchase the medical appliance normally provided on loan yourself, you are the owner and you will need to pay the excess.

10. If your medical appliance often needs to be maintained or repaired and you would otherwise have to do without one for an extended period, we also reimburse the cost of a spare medical appliance. This only applies if you would be severely restricted in carrying out your daily activities if you did not have the medical appliance. You must always request permission from us in advance for a spare medical appliance.

11. If you no longer need the medical appliance you have been given on loan, you must return it to the supplier.

I am using a medical appliance

12. We do not reimburse the normal costs of using a medical appliance. These are costs like the cost of batteries or the power used by a medical appliance. However, there are a few exceptions where we do reimburse the costs of normal use. You can read whether this applies to your medical appliance in the medical appliances coverage section.

13. If you need to have your medical appliance replaced or modified before the end of its expected service life, we only reimburse the cost of replacement or modification if your medical appliance no longer works properly. The expected service life is the period that a medical appliance is expected to last (at least).

You will need to receive our permission in advance for replacement before the end of the expected service life. In the case of replacement, you will also need to meet the requirements we set for getting a medical appliance for the first time.

You can see the expected service life (if applicable) in the medical appliances coverage section.

14. You must use the medical appliance carefully and keep it maintained. Otherwise, if a medical appliance needs to be replaced or repaired due to careless use, we will not reimburse the cost of replacement or repair. This also applies to having to reinstall hardware and/or software when this has crashed as a result of you not handling it with care.

2019 ONVZ basic rules: medical appliances under the basic health-care plan – version 1.2 243 Coverage Medical appliances under the basic health-care plan Contents

Coverage of medical appliances under the basic health-care plan

Wigs 246 Prostheses 247 Breast prostheses 250 Medical appliances for respiratory conditions 251 CPAP machine 254 MRA 255 Oxygen therapy equipment 257 Medical appliances for problems with movement 259 Orthopaedic footwear and orthotics for footwear 263 Short-term loan (of medical appliances for problems with movement) 265 Orthoses 268 Glasses and contact lenses with a medical indication 269 Medical appliances for problems with sight 271 Hearing aids and tinnitus maskers 274 Medical appliances for problems with hearing 276 Medical appliances for skin conditions 279 Dressings 281 Post-op shoes 283 Medical appliances for urinary and bowel incontinence 284 Incontinence products 287 Medical appliances: contraceptive devices 289 Medical appliances for nursing and care in bed 290 Syringes and injection pens to self-administer medicine 293 Medical appliances for vascular conditions 295 Compression stockings 296 Medical appliances for diabetes 298 Infusion pump 301 Protective headgear 302 Feeding pump and feeding tube 304 Medical appliances for speech disorders 306 Personal alarm system 307 Medical appliances for pain management (TENS) 309 Medical appliances for thrombosis 310 Modifications in the home and other costs for home dialysis 312 DAISY players 313 Service dogs 315

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 245 Wig

For when you lose your hair (temporarily or permanently) as the result of a medical condition or treatment.

Coverage under each health-care plan

Basic health-care plan €436 Maximum, per wig

Startfit No coverage

Extrafit No coverage

Benfit €100 Maximum per calendar year, towards the amount you have to pay yourself

Optifit €150 Maximum per calendar year, towards the amount you have to pay yourself

Topfit €250 Maximum per calendar year, towards the amount you have to pay yourself

Superfit 100%

This coverage is part of the coverage for medical appliances. The provisions that apply to medical appliances in general apply to wigs as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

What is covered

A wig is a replacement for your natural hair and can be made of human or animal hair or synthetic fibre.

A wig is covered under the basic health-care plan if you have gone partially or entirely bald as the result of a medical treatment or condition.

What is not covered • hairpieces like toupees for classic male pattern baldness • regular headwear like hats, caps and bandanas

Whom to contact • any wig supplier

What you pay

Excess Because you own the wig, you pay an excess.

Personal contribution If the wig costs more than €436, you pay any amount above this yourself.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 246 What you have to do yourself

You must have a prescription You get the prescription for the wig from your attending doctor or an oncology nurse.

You must request our permission first We only cover the costs of a wig if you have obtained permission for this from us in advance. The supplier is often allowed to give permission on our behalf; your supplier and our Service Centre can tell you if this is the case.

If your supplier cannot give permission on our behalf, you will need to ask our permission yourself. You can send your request to us using the contact form or by post.

Our permission is required for replacement or modification within 1 year The expected service life of a wig is 1 year. If you need to have your wig replaced or modified before a year has passed, we only reimburse the cost of replacement or modification if your wig is no longer usable. You must request our permission for this in advance.

Good to know

The official coverage specified in the Health Insurance Regulations applies A wig comes under the definition given in Article 2.6(a) in conjunction with 2.8 of the Regeling zorgverzekering [Health Insurance Regulations], i.e. ‘an external appliance that provides full support to or replaces anatomical properties of parts of the human body or provides cover for such’. This description also applies to breast prostheses and other prostheses.

Prostheses

For when you need a medical appliance to replace or cover a part of your body.

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

This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to prostheses as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 247 What is covered

A prosthesis is an external medical appliance used to replace or cover a part of your body

The basic health-care plan covers prostheses intended to replace: • arms and hands, legs and feet, shoulders, hips and the pelvis • vocal chords

If your prosthesis requires a liner or stump sock, we cover the costs of these as well. And if it needs batteries or a charger, we will cover that too.

The basic health-care plan also covers prostheses intended to replace or cover: • the eye; this includes scleral shell prostheses1 and scleral lenses without visual correction • the face, including nose and ears

Under ‘Details of each medical appliance’, you can see which medical appliances are part of this category.

Other coverage Voice prostheses placed during surgery in hospital are covered under the Medical specialist section.

Scleral shell prostheses with visual correction are covered under the Problems with sight section.

Whom to contact • any supplier of prostheses

What you pay

Excess If you own the medical appliance, you pay an excess. However, you do not pay an excess if you get the medical appliance on loan. You can read whether you own the medical appliance or whether it is given to you on loan under ‘Details of each medical appliance’.

Personal contribution You do not pay a personal contribution for these medical appliances.

What you have to do yourself

You must have a prescription Under ‘Details of each medical appliance’, you can read which health-care provider prescribes the medical appliance.

Sometimes you must request permission in advance In some cases, we only cover the costs of the medical appliance concerned if you have obtained permission from us in advance. You can read under ‘Details of each medical appliance’ which medical appliances this applies to. The supplier is often allowed to give permission on our behalf; your supplier and our Service Centre can tell you if this is the case.

If your supplier cannot give permission on our behalf, you will need to ask our permission yourself. You can send your request to us using the contact form or by post.

Our permission is required for replacement or modification within the expected service life An expected service life has been determined for some medical appliances. You can read under ‘Details of each medical appliance’ which medical appliances this applies to. If you need to have your medical appliance replaced or modified before the end of its expected service life, we only reimburse the cost of replacement or modification if your medical appliance no longer works properly. You must request our permission for this in advance.

1 A scleral shell prosthesis is a thin prosthetic eye designed to be worn over part of the eye(ball). It looks similar to a contact lens

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 248 Details of each medical appliance

Prostheses for arms and hands, shoulders, hips and the pelvis These are artificial body parts that fully or partially restore the normal functions of your arms and hands, shoulders, hips or pelvis.

The following applies to this medical appliance: • you need a prescription from the medical specialist • you must obtain our permission in advance • you pay an excess, because you own the medical appliance • the expected service life is at least 3 years

Prostheses for legs and feet These are artificial body parts that fully or partially restore the normal functions of your legs and/or feet.

The following applies to this medical appliance: • you need a prescription from the medical specialist • you must obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan. If you are under the age of 16, you will own the medical appliance. In either case, you do not need to pay an excess • the expected service life is at least 3 years, or at least 2 years if you are under the age of 16

Powered arm and leg prostheses These are electrically powered prostheses that replace the normal functions of your arm, hand or leg.

The following applies to this medical appliance: • you need a prescription from the medical specialist • you must obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan • the expected service life is at least 5 years

Stump socks Stump socks are placed over the stump of the residual limb, making it more comfortable to wear a prosthesis. They protect the skin from the pressure and reduce the friction from the movement of the prosthesis.

The following applies to this medical appliance: • you need a prescription from your attending doctor • you do not need to obtain our permission in advance • you pay an excess, because you own the medical appliance • you are entitled to a maximum of 6 stump socks per year

Liner A liner works as a cushion between the skin and the inside of the socket.

The following applies to this medical appliance: • you need a prescription from the medical specialist • you must obtain our permission in advance • you pay an excess, because you own the medical appliance • the expected service life is 1 year

Voice prostheses These are medical appliances that enable you to speak again after your larynx has been removed.

The following applies to this medical appliance: • you need a prescription from the medical specialist • you do not need to obtain our permission in advance • you pay an excess, because you own the medical appliance

Ocular prostheses, scleral shell prostheses and scleral lenses without visual correction These are medical appliances that replace a missing eye or cover the front of the eyeball.

The following applies to this medical appliance: • you need a prescription from your attending ophthalmologist • you do not need to obtain our permission in advance • you pay an excess, because you own the medical appliance

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 249 Facial prostheses (including nose and ears) These are medical appliances that fully or partially replace or cover your face, nose and/or ears.

The following applies to this medical appliance: • you need a prescription from the medical specialist • you must obtain our permission in advance • you pay an excess, because you own the medical appliance • the expected service life is at least 5 years

Good to know

The official coverage specified in the Health Insurance Regulations applies Prostheses come under the definition given in Article 2.6(a) in conjunction with 2.8 of theRegeling zorgverzekering [Health Insurance Regulations], i.e. ‘an external appliance that provides full support to or replaces anatomical properties of parts of the human body or provides cover for such’. This description also applies to breast prostheses and wigs.

Breast prostheses

For when you lose a breast to an illness or as the result of a condition or treatment.

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

This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to breast prostheses as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

What is covered

A breast prosthesis is an artificial breast that replaces a breast (or part of a breast) that is missing.

The basic health-care plan covers an external breast prosthesis if all or part of your mammary gland is missing, because it has been removed during surgery for example.

What is not covered • bras, adhesive strips or closure strips for a breast prosthesis

Other coverage Breast implants placed by a surgeon are covered under the Medical specialist section.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 250 Whom to contact • any supplier of breast prostheses

What you pay

Excess Because you own the breast prosthesis, you pay an excess.

Personal contribution You do not pay a personal contribution for the breast prosthesis.

What you have to do yourself

You must have a prescription You get the prescription for the breast prosthesis from your attending doctor or nursing specialist.

Our permission is required for replacement within 1 year The expected service life of a breast prosthesis is 1 year. If you need to have your breast prosthesis replaced before a year has passed, we only reimburse the costs if the breast prosthesis is no longer usable. You must request our permission for this in advance.

Good to know

The official coverage specified in the Health Insurance Regulations applies Breast prostheses come under the definition given in Article 2.6(a) in conjunction with 2.8 of theRegeling zorgverzekering [Health Insurance Regulations], i.e. ‘an external appliance that provides full support to or replaces anatomical properties of parts of the human body or provides cover for such’. This description also applies to other prostheses and to wigs.

Medical appliances for respiratory conditions

For when you need help breathing properly.

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

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 251 This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to medical appliances for respiratory conditions as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

What is covered

There are various medical appliances that can help you when you have difficulty breathing, like spacers/valved holding chambers used for administering medication you need to inhale, or devices that suction mucous to clear your airways. The basic health-care plan covers external medical appliances that address or alleviate respiratory problems.

Under ‘Details of each medical appliance’, you can see which medical appliances are part of this category.

The basic health-care plan also covers the substances that these medical appliances administer, like oxygen, for example, and other substances that are certified in accordance with the Wet op de medische hulpmiddelen [Medical Appliances Act]. These must be intended to help the patient breathe.

What is not covered • medical appliances for chronic respiratory support

Other coverage Other medical appliances can also help a person suffering from respiratory problems. These are covered under the following sections: • oxygen therapy equipment • CPAP machine • MRA (mandibular repositioning appliance)

Mechanical respiration equipment (for when you are not able to breathe on your own) is covered under the Mechanical respiration section.

Whom to contact • any supplier of medical appliances for respiratory conditions

What you pay

Excess If you own the medical appliance, you pay an excess. However, you do not pay an excess if you get the medical appliance on loan. You can read whether you own the medical appliance or whether it is given to you on loan under ‘Details of each medical appliance’.

Personal contribution You do not pay a personal contribution for these medical appliances.

What you have to do yourself

You must have a prescription Under ‘Details of each medical appliance’, you can read which health-care provider prescribes the medical appliance.

Sometimes you must request permission in advance In some cases, we only cover the costs of the medical appliance concerned if you have obtained permission from us in advance. You can read under ‘Details of each medical appliance’ which medical appliances this applies to. The supplier is often allowed to give permission on our behalf; your supplier and our Service Centre can tell you if this is the case.

If your supplier cannot give permission on our behalf, you will need to ask our permission yourself. You can send your request to us using the contact form or by post.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 252 Details of each medical appliance

Spacers/valved holding chambers and accessories Medical appliances for inhalation of medicines.

The following applies to this medical appliance: • you need a prescription from your attending doctor or respiratory nurse • you do not need to obtain our permission in advance • you pay an excess, because you own the medical appliance

Nebulisers and accessories Medical appliances to administer medicines in the form of a mist to be inhaled.

The following applies to this medical appliance: • you need a prescription from your attending doctor or respiratory nurse • you must obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Positive expiratory pressure (PEP) device Medical appliance to help you cough up phlegm.

The following applies to this medical appliance: • you need a prescription from the attending doctor or paediatrician • you do not need to obtain our permission in advance • you pay an excess, because you own the medical appliance

Mucus suction aspirator Medical appliance to remove mucus from the mouth or throat.

The following applies to this medical appliance: • you need a prescription from the medical specialist • you do not need to obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Tracheal cannula with stoma filter/protector A tracheal cannula is a tube inserted through a hole in the throat to the windpipe, and a stoma filter/protector keeps the windpipe from drying out as quickly.

The following applies to this medical appliance: • you need a prescription from the medical specialist • you do not need to obtain our permission in advance • you pay an excess, because you own the medical appliance

Airway clearance device Medical appliance to help loosen mucus from the lungs by means of vibrations.

The following applies to this medical appliance: • you need a prescription from your attending doctor • you do not need to obtain our permission in advance • you pay an excess, because you own the medical appliance

Good to know

The official coverage specified in the Health Insurance Regulations applies Medical appliances for respiratory conditions come under the definition of Article 2.6(b) in conjunction with 2.9 of the Regeling zorgverzekering [Health Insurance Regulations], i.e. ‘an external appliance used to eliminate or alleviate the consequences of disorders of the respiratory system’. This description also applies to CPAP machines, MRAs and oxygen therapy equipment.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 253 CPAP machine

For when you need help with your breathing while you sleep.

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

This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to CPAP machines as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

What is covered

CPAP stands for continuous positive airway pressure. A CPAP machine is a medical appliance used to treat sleep apnoea1, a sleep disorder that causes you to stop breathing repeatedly and for more than 10 seconds while asleep. This can be caused by your tongue obstructing your airway, for instance, or your brain failing to give enough signals to inhale. A CPAP machine blows continuously pressurised air through a mask down your throat, keeping your airways open while you sleep or giving you a signal to breathe. It ensures that you continue breathing through the night.

The basic health-care plan covers a CPAP machine if you have moderate to severe sleep apnoea. You will first have to go through a trial period with good results.

What is not covered • medical appliances for chronic respiratory support • medical appliances that are only intended to reduce snoring

Other coverage Other medical appliances can also help a person suffering from respiratory problems. These are covered under the following sections: • medical appliances for respiratory conditions • oxygen therapy equipment • MRA (mandibular repositioning appliance)

Whom to contact • any supplier of CPAP machines

1 The form of sleep apnoea we refer to here is obstructive sleep apnoea (OSA)

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 254 What you pay

Excess You do not pay an excess, because you get the medical appliance on loan.

Personal contribution You do not pay a personal contribution for this medical appliance.

What you have to do yourself

You must have a prescription You get the prescription for the CPAP machine from your pulmonologist, ENT doctor or neurologist.

You must request our permission first We only cover the costs of a CPAP machine if you have obtained permission for this from us in advance. The supplier is often allowed to give permission on our behalf; your supplier and our Service Centre can tell you if this is the case.

If your supplier cannot give permission on our behalf, you will need to ask our permission yourself. You can send your request to us using the contact form or by post.

Our permission is required for replacement within 5 years The expected service life of a CPAP machine is 5 years. If you need to have your CPAP machine replaced before 5 years have passed, we only reimburse the cost of replacement if your old machine no longer works properly. You must request our permission for this in advance.

Good to know

The official coverage specified in the Health Insurance Regulations applies CPAP machines come under the definition of Article 2.6(b) in conjunction with 2.9 of the Regeling zorgverzekering [Health Insurance Regulations], i.e. ‘an external appliance used to eliminate or alleviate the consequences of disorders of the respiratory system’. This description also applies to other medical appliances for respiratory conditions, MRAs and oxygen therapy equipment.

MRA (mandibular repositioning appliance)

For when you need help with your breathing while you sleep.

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

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 255 This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to an MRA as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

What is covered

MRA stands for mandibular repositioning appliance. An MRA is used to treat sleep apnoea1, a sleep disorder that causes you to stop breathing repeatedly and for more than 10 seconds while asleep. This occurs, for example, when the tongue and soft palate relax during sleep and obstruct the airway. An MRA pushes the lower jaw forward, keeping the airway unobstructed while you sleep.

The basic health-care plan covers an MRA if you are being treated for mild to moderate sleep apnoea or if a CPAP machine does not work for you.

What is not covered • medical appliances that are only intended to reduce snoring

Other coverage Other medical appliances can also help a person suffering from respiratory problems. These are covered under the following sections: • medical appliances for respiratory conditions • oxygen therapy equipment • CPAP machine

Whom to contact • all MRA suppliers or a dentist, dental surgeon or orthodontist recognised by the Nederlandse Vereniging voor Tandheelkundige Slaapgeneeskunde [Dutch Association of Dental Sleep Disorder Specialists] (NVTS)

What you pay

Excess You pay an excess because you own the medical appliance.

Personal contribution You do not pay a personal contribution for this medical appliance.

What you have to do yourself

You must have a prescription You get the prescription for the MRA from your pulmonologist or ENT doctor.

You must request our permission first We only cover the costs of an MRA if you have obtained permission for this from us in advance. The supplier is often allowed to give permission on our behalf; your supplier and our Service Centre can tell you if this is the case.

If your supplier cannot give permission on our behalf, you will need to ask our permission yourself. You can send your request to us using the contact form or by post.

Our permission is required for replacement or modification within 5 years The expected service life of an MRA is 5 years. If you need to have your MRA replaced or modified before 5 years have passed, we only reimburse the cost of replacement or modification if your MRA no longer works properly. You must request our permission for this in advance.

Good to know

The official coverage specified in the Health Insurance Regulations applies MRAs come under the definition of Article 2.6(b) in conjunction with 2.9 of the Regeling zorgverzekering [Health Insurance Regulations], i.e. ‘an external appliance used to eliminate or alleviate the consequences of disorders of the respiratory system’. This description also applies to other medical appliances for respiratory conditions, CPAP machines and oxygen therapy equipment.

1 The form of sleep apnoea we refer to here is obstructive sleep apnoea (OSA)

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 256 Oxygen therapy equipment

For when you need help getting enough oxygen.

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

This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to oxygen therapy equipment as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

What is covered

You use oxygen therapy equipment when you need more oxygen. The basic health-care plan covers oxygen therapy equipment that addresses or alleviates respiratory problems. There are various types of oxygen therapy equipment: • oxygen concentrators, which are intended for home use, take in air and concentrate the oxygen from it. Portable oxygen concentrators are also available for use outside the home • oxygen cylinders hold pressurised oxygen, making them portable and easy to take with you • systems that hold liquid oxygen (LOX) in a main oxygen tank that is decanted into a portable vacuum flask. Oxygen from the LOX system can be used both at home and when away from home You do not get to decide which oxygen therapy system to use. Your attending doctor and the supplier determine this based on your needs.

The basic health-care plan also covers the substances that this oxygen therapy equipment administers, like oxygen, for example, and other substances that are certified in accordance with the Wet op de medische hulpmiddelen [Medical Appliances Act].

If your oxygen therapy system uses electricity, we reimburse €0.06 per hour of use of the oxygen therapy system. The supplier of the medical appliance must keep a record of all hours of use.

If you are using oxygen therapy equipment and are planning a trip abroad, it is not always easy to take along sufficient oxygen. You may not even be allowed to take your equipment along, like if you are flying for example. In these cases, we also reimburse the costs of oxygen you buy while abroad, up to the price that applies in the Netherlands. We do not reimburse costs above this amount, nor do we cover other costs; these would fall under the coverage specified in the Abroad: non-urgent scheduled health care section. You can arrange the supply of oxygen for while you are abroad through your supplier.

What is not covered • medical appliances for chronic respiratory support

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 257 Other coverage Other medical appliances can also help a person suffering from respiratory problems. These are covered under the following sections: • medical appliances for respiratory conditions • CPAP machine • MRA (mandibular repositioning appliance)

Whom to contact • any supplier of oxygen therapy equipment

What you pay

Excess Because you get oxygen therapy equipment on loan, you do not pay an excess for it. However, you do pay an excess for the €0.06 per hour for electricity.

Personal contribution You do not pay a personal contribution for oxygen therapy equipment.

What you have to do yourself

You must have a prescription You get the prescription for the oxygen therapy equipment from your attending doctor.

You must request our permission first We only cover the costs of oxygen therapy equipment if you have obtained permission for this from us in advance. The supplier is often allowed to give permission on our behalf; your supplier and our Service Centre can tell you if this is the case.

If your supplier cannot give permission on our behalf, you will need to ask our permission yourself. You can send your request to us using the contact form or by post.

Good to know

The official coverage specified in the Health Insurance Regulations applies Oxygen therapy equipment comes under the definition of Article 2.6(b) in conjunction with 2.9 of theRegeling zorgverzekering [Health Insurance Regulations], i.e. ‘an external appliance used to eliminate or alleviate the consequences of disorders of the respiratory system’. This description also applies to other medical appliances for respiratory conditions, MRAs and CPAP machines.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 258 Medical appliances for problems with movement

For when you cannot get around easily.

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

This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to medical appliances for problems with movement as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

What is covered

If you have a motor impairment, i.e. a serious medical condition that limits the movement of a body part and/ or adversely affects your posture, and if it is necessary to correct the effects of this condition, an orthosis may help. These are used to help with spinal deformities, for example, or foot problems, paralysis, bone fractures and injury to tendons.

If an orthosis does not help your condition adequately (or at all) and you are still restricted in 1 of the movements listed below, we also cover the costs of medical appliances to correct or improve this. • walking • use of your hand and arm • changing your position or remaining in a particular position (your body posture) • using a device for communication

Under ‘Details of each medical appliance’, you can see which medical appliances are part of this category.

What is not covered • medical appliances for tasks in the home, like adapted kitchen utensils for example • simple medical appliances to help you eat and drink • simple medical appliances to help you walk • a riser-recliner chair to help you get up off the chair more easily, with no further medical function • a helmet to help reshape the form of a baby or child’s misshapen head (corrective helmet)

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 259 Other coverage Other medical appliances can also help a person suffering from movement restrictions. These are covered under the following sections: • simple mobility aids • orthopaedic footwear and orthotics for footwear • orthoses • DAISY players and service dogs (mobility assistance dogs). These medical appliances can be used to alleviate problems with movement • short-term loan of medical appliances provided to you temporarily • medical appliances for nursing and care in bed

Whom to contact • any supplier of medical appliances for problems with movement

What you pay

Excess If you own the medical appliance, you pay an excess. However, you do not pay an excess if you get the medical appliance on loan. You can read whether you own the medical appliance or whether it is given to you on loan under ‘Details of each medical appliance’.

Personal contribution You do not pay a personal contribution for these medical appliances.

What you have to do yourself

You must have a prescription Under ‘Details of each medical appliance’, you can read which health-care provider prescribes the medical appliance.

You must request our permission first We only cover the costs of these medical appliances if you have obtained permission from us in advance. You can read under ‘Details of each medical appliance’ which medical appliances this applies to. The supplier is often allowed to give permission on our behalf; your supplier and our Service Centre can tell you if this is the case.

If your supplier cannot give permission on our behalf, you will need to ask our permission yourself. You can send your request to us using the contact form or by post.

Our permission is required for replacement or modification within the expected service life An expected service life has been determined for some medical appliances. You can read under ‘Details of each medical appliance’ which medical appliances this applies to. If you need to have your medical appliance replaced or modified before the end of its expected service life, we only reimburse the cost of replacement or modification if your medical appliance no longer works properly. You must request our permission for this in advance.

Details of each medical appliance

Robotic arm and dynamic arm support These are medical appliances to rectify insufficient arm, hand and finger functioning.

The following applies to this medical appliance: • you need a prescription with instructions from the medical specialist • you must obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Robot manipulator This is a medical appliance that can help you with your tasks of daily living.

The following applies to this medical appliance: • you must have a prescription from the rehabilitation specialist and a written statement from the occupational therapist advising the use of this appliance • you must obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan • the expected service life is 5 years

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 260 Mechanical feeding aid This is a mechanical medical appliance that can help feed you.

The following applies to this medical appliance: • you need a prescription from your attending doctor • you must obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Foot-propelled ‘trippelstoel’ chairs Because this agile chair on wheels glides smoothly across the floor, you can move about easily while having your hands free to do what you need to do or while carrying something along.

The following applies to this medical appliance: • you must have a prescription from the attending doctor and a written statement from the occupational therapist advising the use of this appliance • you must obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Gait trainer or seated scooter These are medical appliances that can help you when you can no longer walk more than a short distance outdoors.

The following applies to this medical appliance: • you must have a prescription from the attending doctor and a written statement from the occupational therapist advising the use of this appliance • you must obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Adapted table or adapted chair An adapted table is one that is height-adjustable for use by wheelchair users. An adapted chair is one you use because sitting normally is no longer possible.

The following applies to this medical appliance: • you must have a prescription from the attending doctor and a written statement from the occupational therapist advising the use of this appliance • you must obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan • the expected service life is 5 years

Home automation system Medical appliances that help you use the telephone, for example, or control the lights, doors or curtains.

The following applies to this medical appliance: • you need a prescription from your attending doctor • you must obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Adaptive computer equipment Medical appliances that help you use your computer, like ones that use head or eye movements, for example.

The following applies to this medical appliance: • you need a prescription from your attending doctor • you must obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Automatic page turner Medical appliance that automatically turns the pages of a book or magazine.

The following applies to this medical appliance: • you need a prescription from your attending doctor • you must obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Adapted telephone operated remotely This is a telephone you can use through your home automation system.

The following applies to this medical appliance: • you need a prescription from your attending doctor • you must obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 261 Telephone handset holder This is a medical appliance that helps you if you cannot hold the telephone on your own.

The following applies to this medical appliance: • you need a prescription from your attending doctor • you must obtain our permission in advance • if the holder costs €250 or less, you pay an excess because you will then own this appliance. If it costs more than this, you do not pay an excess because you get the appliance on loan

Speed dialler The medical appliance helps you dial the number you need.

The following applies to this medical appliance: • you need a prescription from your attending doctor • you must obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Stand aids, dynamic seating and bed orthosis These are medical appliances that help you correct your posture or get into a comfortable position.

The following applies to this medical appliance: • you must have a prescription from the medical specialist and, for a replacement, from the attending doctor • you must obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Anti-decubitus cushions This is a cushion that prevents or provides relief for decubitus ulcers (pressure sores).

The following applies to this medical appliance: • you need a prescription from your attending doctor • you must obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Good to know

The official coverage specified in the Health Insurance Regulations applies Medical appliances for problems with movement come under the definition of Article 2.6(e) in conjunction with Article 2.12 of the Regeling zorgverzekering [Health Insurance Regulations], i.e. ‘an external appliance relating to disorders of the locomotor system’. This description also applies to orthopaedic footwear, temporary transfer aids, orthoses, DAISY players and a service dog (mobility assistance dog) when these are intended to alleviate problems with movement.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 262 Orthopaedic footwear and orthotics for footwear

For when you need specially adapted footwear.

Coverage under each health-care plan

Basic health-care plan 100% (excluding personal contribution)

Startfit No coverage

Extrafit No coverage

Benfit €250 Maximum per calendar year for personal contributions

Optifit €500 Maximum per calendar year for personal contributions

Topfit €1,000 Maximum per calendar year for personal contributions

Superfit 100% Of the personal contribution

The coverage for orthopaedic footwear and orthotics for footwear is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to orthopaedic footwear and orthotics for footwear as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

Our supplementary health-care plans cover the personal contributions up to the amount stated above. This reimbursement applies to all medical appliances for which you have to pay a personal contribution.

What is covered

Orthopaedic footwear is footwear that has been made or adapted specially for your feet, because you are not able to wear regular (‘off-the-rack’) footwear. This category also includes semi-orthopaedic footwear. You may not need orthopaedic footwear as such, perhaps special orthotics that can be used with regular, off-the-rack footwear will suffice.

If you have a motor impairment, i.e. a serious medical condition that limits the movement of a body part and/ or adversely affects your posture, and if you need orthopaedic footwear or orthotics for footwear to correct this, the basic health-care plan covers the footwear or orthotics if you need to use these on a permanent basis. So the basic health-care plan does not reimburse the costs of these if you do not need them permanently, or just need them while playing sports.

What is not covered • regular footwear (‘off-the-rack’)

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 263 Other coverage Other medical appliances can also help a person suffering from movement restrictions. These are covered under the following sections: • medical appliances for problems with movement • orthoses • DAISY players and service dogs (mobility assistance dogs). These medical appliances can be used to alleviate problems with movement • short-term loan of medical appliances provided to you temporarily • medical appliances for nursing and care in bed • arch supports (supplementary health-care plan)

Whom to contact • any supplier of orthopaedic (and/or semi-orthopaedic) footwear and orthotics for footwear

What you pay

Excess You pay an excess, because you own the orthopaedic/semi-orthopaedic footwear or the orthotics for footwear.

Personal contribution You will sometimes be required to pay a personal contribution. You can read under ‘Details of each medical appliance’ which medical appliances this applies to.

What you have to do yourself

You must have a prescription Under ‘Details of each medical appliance’, you can read which health-care provider prescribes the medical appliance.

You must request our permission first We only cover the costs of these medical appliances if you have obtained permission from us in advance. You can read under ‘Details of each medical appliance’ which medical appliances this applies to. The supplier is often allowed to give permission on our behalf; your supplier and our Service Centre can tell you if this is the case.

If your supplier cannot give permission on our behalf, you will need to ask our permission yourself. You can send your request to us using the contact form or by post.

Our permission is required for replacement or modification within the expected service life An expected service life has been determined for some medical appliances. You can read under ‘Details of each medical appliance’ which medical appliances this applies to. If you need to have your medical appliance replaced or modified before the end of its expected service life, we only reimburse the cost of replacement or modification if your medical appliance no longer works properly. You must request our permission for this in advance.

Details of each medical appliance

Orthopaedic/semi-orthopaedic footwear This is adapted footwear for you to wear when you are not able to wear regular footwear.

The following applies to this medical appliance: • you need a prescription from the medical specialist • you must obtain our permission in advance • you pay an excess, because you own the medical appliance • you pay a personal contribution of €131 per pair, or €65.50 per pair if you are under the age of 16 • the expected service life is 18 months or 6 months if you are under the age of 16

Second pair of orthopaedic/semi-orthopaedic footwear This is an extra pair of orthopaedic/semi-orthopaedic footwear.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 264 The following applies to this medical appliance: • you need a prescription from your attending doctor • you must obtain our permission in advance • you pay an excess, because you own the medical appliance • you pay a personal contribution of €131 per pair, or €65.50 per pair if you are under the age of 16 • the expected service life is 18 months or 6 months if you are under the age of 16 • you may request a spare pair after you have had the original pair of orthopaedic/semi-orthopaedic footwear for 3 months

Orthotics for footwear These are orthopaedic inserts worn inside regular (‘off-the-rack’) footwear.

The following applies to this medical appliance: • you need a prescription from the medical specialist • you must obtain our permission in advance • you pay an excess, because you own the medical appliance

Orthopaedic modifications to regular footwear This is off-the-rack footwear that has undergone orthopaedic modifications.

The following applies to this medical appliance: • you need a prescription from the medical specialist • you must obtain our permission in advance • you pay an excess, because you own the medical appliance • you are entitled to reimbursement of the related costs no more than 4 times per year

Good to know

The official coverage specified in the Health Insurance Regulations applies Orthopaedic footwear comes under the definition of Article 2.6(e) in conjunction with Article 2.12 of the Regeling zorgverzekering [Health Insurance Regulations], i.e. ‘an external appliance relating to disorders of the locomotor system’. This description also applies to medical appliances for problems with movement, temporary transfer aids, orthoses, DAISY players and a service dog (mobility assistance dog) when these are intended to alleviate problems with movement.

Short-term loan (of medical appliances for problems with movement)

For when you have trouble with movement and temporarily need a medical appliance to address this limitation.

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

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 265 This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to short-term loan (of medical appliances for problems with movement) as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

What is covered

If you have a motor impairment, i.e. a serious medical condition that limits the movement of a body part and/ or adversely affects your posture, and if this makes it difficult for you to wash yourself, go to the toilet, move from one surface to another or get around, we also cover the costs of medical appliances to correct or improve this if you just need them temporarily. We call this ‘short-term loan’, with a ‘short term’ being no more than 26 weeks. This term can be extended, however, if your personal situation so requires.

If you have difficulty getting around, the basic health-care plan does not cover all medical appliances, just wheelchairs and threshold ramps.

If you need the medical appliance permanently or for a longer period of time, you can request it through your local council.

Under ‘Details of each medical appliance’, you can see which medical appliances are part of this category.

What is not covered • medical appliances for tasks in the home, like adapted kitchen utensils for example • simple medical appliances to help you eat and drink • simple medical appliances to help you walk, like elbow crutches, walking frames, rollators or serving trolleys • a riser-recliner chair to help you get up off the chair more easily, with no further medical function • a helmet to help reshape the form of a baby or child’s misshapen head (corrective helmet)

Other coverage Other medical appliances can also help a person suffering from movement restrictions. These are covered under the following sections: • medical appliances for problems with movement • orthopaedic footwear and orthotics for footwear • orthoses • DAISY players and service dogs (mobility assistance dogs). These medical appliances can be used to alleviate problems with movement • medical appliances for nursing and care in bed

Whom to contact • any supplier of medical appliances on short-term loan

What you pay

Excess You do not pay an excess, because you get the medical appliance on loan.

Personal contribution You do not pay a personal contribution for these medical appliances.

What you have to do yourself

You must have a prescription Under ‘Details of each medical appliance’, you can read which health-care provider prescribes the medical appliance.

Details of each medical appliance

Wheelchair This medical appliance helps you get around when you cannot walk (or cannot walk very well) for a while.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 266 The following applies to this medical appliance: • you need a prescription from your attending doctor • you do not need to obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Elevated leg rest This medical appliance can be mounted to a wheelchair to support a leg cast.

The following applies to this medical appliance: • you need a prescription from your attending doctor • you do not need to obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Threshold/bridge ramps These are medical appliances that provide safe access over elevated thresholds and other obstacles.

The following applies to this medical appliance: • you need a prescription from your attending doctor • you do not need to obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Transfer board, turntable and lift systems These are medical appliances that help you move from one surface to another, like from a wheelchair to your bed or car seat for example.

The following applies to this medical appliance: • you need a prescription from your attending doctor or the district nurse • you do not need to obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Pressure relief ring This is a medical appliance that relieves pain when you are sitting.

The following applies to this medical appliance: • you need a prescription from your attending doctor • you do not need to obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Toilet seat riser, commode chair, portable shower chair and bath board These are medical appliances that help you use the toilet, shower and bath.

The following applies to this medical appliance: • you need a prescription from your attending doctor or the district nurse • you do not need to obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Good to know

The official coverage specified in the Health Insurance Regulations applies Medical appliances for problems with movement come under the definition of Article 2.6(e) in conjunction with Article 2.12 of the Regeling zorgverzekering [Health Insurance Regulations], i.e. ‘an external appliance relating to disorders of the locomotor system’. This description also applies to orthopaedic footwear, temporary transfer aids, orthoses, DAISY players and a service dog (mobility assistance dog) when these are intended to alleviate problems with movement.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 267 Orthoses

When your body needs a little extra support.

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

This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to orthoses as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

What is covered

An orthosis is an external medical appliance that you wear to correct your body position or the abnormal movement of your joints or spine. This could be a support corset, splint or a brace for example.

If you have a motor impairment, i.e. a serious medical condition that limits the movement of a body part and/ or adversely affects your posture, like a deformed spine, paralysis, a bone fracture or an injury to a tendon for example, and if you need an orthosis to correct this, the basic health-care plan covers the orthosis if you need to use this on a permanent basis. So an orthosis that you need temporarily, or just need while playing sports, is not covered.

What is not covered • simple orthoses, like arch supports

Other coverage Other medical appliances can also help a person suffering from movement restrictions. These are covered under the following sections: • medical appliances for problems with movement • orthopaedic footwear and orthotics for footwear • DAISY players and service dogs (mobility assistance dogs). These medical appliances can be used to alleviate problems with movement • short-term loan of medical appliances provided to you temporarily • medical appliances for nursing and care in bed • arch supports (supplementary health-care plan only)

Whom to contact • any supplier of orthoses

What you pay

Excess You pay an excess, because you own the orthosis.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 268 Personal contribution You do not pay a personal contribution for the orthosis.

What you have to do yourself

You must have a prescription For the orthosis, you need a prescription from the medical specialist. Your attending doctor also writes the prescription for a replacement orthosis.

You must request our permission first We only cover the costs of the orthosis if you have obtained permission from us in advance. The supplier is often allowed to give permission on our behalf; your supplier and our Service Centre can tell you if this is the case.

If your supplier cannot give permission on our behalf, you will need to ask our permission yourself. You can send your request to us using the contact form or by post.

Our permission is required for replacement or modification of your orthosis within 2 years The expected service life of the orthosis is 2 years. If you need to have your orthosis replaced or modified before 2 years have passed, we only reimburse the cost of replacement or modification if your orthosis no longer works properly. You must request our permission for this in advance.

Good to know

The official coverage specified in the Health Insurance Regulations applies Orthoses come under the definition of Article 2.6(e) in conjunction with Article 2.12 of theRegeling zorgverzekering [Health Insurance Regulations], i.e. ‘an external appliance relating to disorders of the locomotor system’. This description also applies to other medical appliances for problems with movement, temporary transfer aids, orthopaedic shoes (including semi-orthopaedic shoes), DAISY players and a service dog (mobility assistance dog) when these are intended to alleviate problems with movement.

Glasses and contact lenses with a medical indication

For when you are not able to see well without a medical appliance, due to an accident, illness or ailment.

Coverage under each health-care plan

Basic health-care plan 100% (excluding personal contributions)

Startfit No coverage

Extrafit No coverage

Benfit €250 Maximum per calendar year for personal contributions

Optifit €500 Maximum per calendar year for personal contributions

Topfit €1,000 Maximum per calendar year for personal contributions

Superfit 100% Of the personal contributions

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 269 The coverage for glasses and contact lenses is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to glasses and contact lenses with a medical indication as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

Our supplementary health-care plans cover the personal contributions up to the amount stated above. This reimbursement applies to all medical appliances for which you have to pay a personal contribution.

What is covered

Many people are long-sighted or short-sighted and wear glasses or contact lenses every day to correct their vision. The costs of such are not covered under the basic health-care plan. This is different, however, if the glasses or contact lenses are required as a result of an accident, illness or ailment, in which case we say there is a medical indication (i.e. medical grounds) for the prescription. In this case, the basic health-care plan will cover the costs in certain situations.

Contact lenses are covered if 1 of the following situations applies to you: • your vision needs to be corrected due to a medical ailment or trauma, and contact lenses work better for you than glasses in helping to make your vision clearer or improve the quality of your vision • you are younger than 18 and you are short-sighted with at least −6.00

Lenses for glasses or filter lenses are covered under the basic health-care plan if you are younger than 18 and 1 of the following situations applies to you: • we would reimburse the costs of contact lenses because you have a medical indication, but you prefer glasses • either 1 or both of your eyes have been operated on to address a problem with the lens(es) • due to your long-sightedness, your eyes turn inward as you try to focus (accommodative esotropia)

What is not covered • lenses for glasses or filter lenses if you are 18 or older • frames for glasses

Other coverage Other medical appliances can also help a person suffering from vision problems. These are covered under the following sections: • medical appliances for problems with sight • DAISY players and service dogs (guide dogs). These medical appliances can be used to alleviate problems with sight • glasses, contact lenses and laser eye treatment (supplementary health-care plan only)

Whom to contact • any supplier of lenses for glasses, filter lenses and contact lenses

What you pay

Excess If you own the medical appliance, you pay an excess.

Personal contribution For lenses for glasses or filter lenses, you pay a personal contribution of €58.50 per lens up to a maximum of €117 per calendar year. For contact lenses, this is €58.50 per lens if you can continue wearing them for longer than 1 year, otherwise €58.50 per lens per calendar year up to a maximum of €117 per calendar year.

What you have to do yourself

You must have a prescription You need a prescription from your ophthalmologist for the lenses for glasses, filter lenses or contact lenses.

You must request our permission first We only cover the costs of the lenses for glasses or filter lenses if you have obtained permission from us in advance. The supplier is often allowed to give permission on our behalf; your supplier and our Service Centre can tell you if this is the case.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 270 If your supplier cannot give permission on our behalf, you will need to ask our permission yourself. You can send your request to us using the contact form or by post.

Good to know

The official coverage specified in the Health Insurance Regulations applies Lenses for glasses, filter lenses and contact lenses with a medical indication come under the definition of Article 2.6(f) in conjunction with Article 2.13 of the Regeling zorgverzekering [Health Insurance Regulations], i.e. ‘an external appliance relating to visual impairments’. This description also applies to other medical appliances for problems with sight, as well as service dogs and DAISY players.

Medical appliances for problems with sight

For when you have trouble seeing without help.

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

This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to medical appliances for problems with sight as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

What is covered

There are various medical appliances that can help you when you have problems with your sight. The basic health-care plan covers the following: • medical appliances that help overcome or reduce difficulties with reading, writing or using devices for electronic communication and/or information transfer devices • medical appliances that help overcome or reduce difficulties with orientation or getting around obstacles

Under ‘Details of each medical appliance’, you can see which medical appliances are part of this category.

What is not covered • simple reading and writing aids, like a magnifying glass or line reader

Other coverage Other medical appliances can also help a person suffering from vision problems. These are covered under the following sections: • glasses and contact lenses with a medical indication • DAISY players • service dogs (guide dogs)

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 271 Whom to contact • any supplier of medical appliances for vision problems

What you pay

Excess If you own the medical appliance, you pay an excess. However, you do not pay an excess if you get the medical appliance on loan. You can read whether you own the medical appliance or whether it is given to you on loan under ‘Details of each medical appliance’.

Personal contribution You do not pay a personal contribution for these medical appliances.

What you have to do yourself

You must have a prescription Under ‘Details of each medical appliance’, you can read which health-care provider prescribes the medical appliance.

You will usually need our prior permission We usually only cover the costs of these medical appliances if you have obtained permission from us in advance. You can read under ‘Details of each medical appliance’ which medical appliances this applies to. The supplier is often allowed to give permission on our behalf; your supplier and our Service Centre can tell you if this is the case.

If your supplier cannot give permission on our behalf, you will need to ask our permission yourself. You can send your request to us using the contact form or by post.

Our permission is required for replacement or modification within the expected service life An expected service life has been determined for some medical appliances. You can read under ‘Details of each medical appliance’ which medical appliances this applies to. If you need to have your medical appliance replaced or modified before the end of its expected service life, we only reimburse the cost of replacement or modification if your medical appliance no longer works properly. You must request our permission for this in advance.

Details of each medical appliance

Special low vision aids like telescopic glasses, a magnifying glass or an illuminated magnifier These medical appliances can help you when your glasses or contact lenses are no longer enough.

The following applies to this medical appliance: • you must have a prescription from your ophthalmologist or the regional institute for the blind and visually impaired • you must obtain our permission in advance • if the medical appliance costs €250 or less, you pay an excess because you will then own this appliance. If it costs more than this, you do not pay an excess because you get the appliance on loan

Electronic desktop magnifier This is a device that enlarges and projects printed text and images onto a screen so that you can see and read printed matter again.

The following applies to this medical appliance: • you need a prescription from the medical specialist • you must obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Refreshable braille display with accessories If you are visually impaired, this device lets you use a typewriter or computer monitor all the same.

The following applies to this medical appliance: • you need a prescription from the medical specialist • you must obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 272 Font magnification software for the computer This is software that increases the font size for written text. The following applies to this medical appliance: • you need a prescription from your attending doctor • you must obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Input and output devices for the computer These are special peripherals that help you use your computer, like a keyboard with extra-large keys for example.

The following applies to this medical appliance: • you need a prescription from your attending doctor • you must obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Text-to-speech software for mobile phone This is software that can read out menu options, the names of callers and text.

The following applies to this medical appliance: • you need a prescription from your attending doctor • you must obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Dictation machine This device can be used to record spoken text.

The following applies to this medical appliance: • you need a prescription from your attending doctor • you must obtain our permission in advance • you pay an excess, because you own the medical appliance

Reading machine for printed text This device scans printed text and reads it back to the user.

The following applies to this medical appliance: • you need a prescription from your attending doctor • you must obtain our permission in advance • you pay an excess, because you own the medical appliance

Reading machine for TV subtitles This device reads out subtitles on TV.

The following applies to this medical appliance: • you need a prescription from your attending doctor • you must obtain our permission in advance • you pay an excess, because you own the medical appliance

White cane This medical appliance is used to scan the surroundings for obstacles or orientation points.

The following applies to this medical appliance: • you need a prescription from your attending doctor • you do not need to obtain our permission in advance • you pay an excess, because you own the medical appliance • the expected service life is 3 years

Good to know

The official coverage specified in the Health Insurance Regulations applies Lenses for glasses and filter lenses with a medical indication come under the definition of Article 2.6(f) in conjunction with Article 2.13 of the Regeling zorgverzekering [Health Insurance Regulations], i.e. ‘an external appliance relating to visual impairments’. This description also applies to glasses and contact lenses with a medical indication, service dogs and DAISY players.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 273 Hearing aids and tinnitus maskers

For when you have trouble hearing.

Coverage under each health-care plan

Basic health-care plan 100% (excluding personal contribution)

Startfit No coverage

Extrafit No coverage

Benfit €250 Maximum per calendar year for personal contributions

Optifit €500 Maximum per calendar year for personal contributions

Topfit €1,000 Maximum per calendar year for personal contributions

Superfit 100% Of the personal contributions

The coverage for hearing aids and tinnitus maskers is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to hearing aids and tinnitus maskers as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

Our supplementary health-care plans cover the personal contributions up to the amount stated above. This reimbursement applies to all medical appliances for which you have to pay a personal contribution.

What is covered

When you think of devices to help with hearing problems, you will generally think of a hearing aid right away, or perhaps a tinnitus masker if you suffer from ‘ringing in the ears’. If you have serious hearing loss or serious tinnitus, we will cover the cost of a hearing aid or tinnitus masker. We consider serious hearing loss to be a loss of 35dB or more, based on an average of your hearing ability at the frequencies of 1000Hz, 2000Hz and 4000Hz, as measured by your audiologist.

If you are entitled to a hearing aid, but would prefer to have a simple ‘assistive listening device’, we will cover the costs of this device.

If you do not meet the conditions for hearing loss or serious tinnitus, we will reimburse the costs of a hearing aid, tinnitus masker or simple assistive listening device all the same in exceptional situations. We refer to this as an ‘exceptional personal health-care need’.

We also have a brochure1 with plenty of useful information on hearing aids.

What is not covered • a hearing aid based in full or in part on an implant

Other coverage Other medical appliances can also help a person suffering from hearing problems. These are covered under the following sections: • medical appliances for problems with hearing • service dogs (hearing dogs)

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

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 274 Other audiological health care comes under the Audiological health care coverage. This involves things like having your hearing tested, for example, and getting advice on a hearing aid and the use of the device.

Hearing aids of which all or a part are surgically implanted come under the Medical specialist coverage.

Whom to contact • any audiologist

What you pay

Excess You pay an excess, because you own the hearing or listening aid.

Personal contribution You will sometimes be required to pay a personal contribution for these medical appliances. You can read under ‘Details of each medical appliance’ which medical appliances this applies to.

What you have to do yourself

You must have a prescription For the hearing aids, you must have a prescription from your ENT doctor or an audiological centre. In the case of age-related hearing loss (presbycusis)1, your general practitioner can also write the prescription.

You must request our permission first We only cover the costs of these medical appliances if you have obtained permission from us in advance. The supplier is often allowed to give permission on our behalf; your supplier and our Service Centre can tell you if this is the case.

If your supplier cannot give permission on our behalf, you will need to ask our permission yourself. You can send your request to us using the contact form or by post.

Our permission is required for replacement or modification within the expected service life An expected service life has been determined for some medical appliances. You can read under ‘Details of each medical appliance’ which medical appliances this applies to. If you need to have your medical appliance replaced or modified before the end of its expected service life, we only reimburse the cost of replacement or modification if your medical appliance no longer works properly. You must request our permission for this in advance.

Details of each medical appliance

Hearing aids Medical appliances that help you hear better.

The following applies to this medical appliance: • you must have a prescription from your ENT doctor or an audiological centre. In the case of age-related hearing loss (presbycusis), your general practitioner can also write the prescription • you must obtain our permission in advance • you pay an excess, because you own the medical appliance • you pay a personal contribution amounting to 25% of the purchase price. However, you do not have to pay a personal contribution if you are under the age of 18 • the expected service life is 5 years

Ear domes/moulds An ear dome or ear mould is the bit of the hearing aid that you wear inside your ear.

The following applies to this medical appliance: • you must have a prescription from your ENT doctor or an audiological centre. In the case of age-related hearing loss (presbycusis), your general practitioner can also write the prescription • you must obtain our permission in advance • you pay an excess, because you own the medical appliance • you pay a personal contribution amounting to 25% of the purchase price, but this does not apply if you are younger than 18 • the expected service life is 24 months or 6 months if you are under the age of 16

1 If you are 67 or older and are hard of hearing

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 275 Tinnitus masker This medical appliance generates and emits a sound (‘white noise’) that helps mask the perceived sound (such as ringing) in your ear(s).

The following applies to this medical appliance: • you must have a prescription from your ENT doctor or an audiological centre • you must obtain our permission in advance • you pay an excess, because you own the medical appliance • you pay a personal contribution amounting to 25% of the purchase price, but this does not apply if you are younger than 18 • the expected service life is 5 years

Simple assistive listening devices If you are not yet ready (or are unable) to wear a hearing aid, these relatively simple devices can help you follow a conversation, for example.

The following applies to this medical appliance: • you must have a prescription from your ENT doctor or an audiological centre • you must obtain our permission in advance • you pay an excess, because you own the medical appliance

Good to know

The official coverage specified in the Health Insurance Regulations applies Hearing and listening aids come under the definition of Article 2.6(c) in conjunction with Article 2.10 of the Regeling zorgverzekering [Health Insurance Regulations], i.e. ‘an external appliance relating to hearing disorders’. This description also applies to hearing aids and service dogs (hearing dogs).

Your audiologist must comply with 2 protocols We only reimburse the costs of hearing aids if your audiologist complies with the most recent Hoorprotocol en indicatieformat [Hearing aid protocol and indication format] and Keuzeprotocol Zorgverzekeraars Nederland [Selection protocol for health Insurers in the Netherlands]. Your audiologist can tell you more. You can view these protocols on our website or our Service Centre can provide a copy on request.

Medical appliances for problems with hearing

For when you have trouble hearing.

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

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 276 The coverage for medical appliances for problems with hearing is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to medical appliances for problems with hearing as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations. In the following, we will refer to these collectively as ‘hearing and listening aids’.

What is covered

When you think of devices to help with hearing problems, you will generally think of a hearing aid right away. However, there are many more types of hearing and listening aids, such as ones that can help when you use your mobile phone or watch TV, or one that can alert you when an alarm in your house goes off. Below, you can see which types of hearing and listening aids we cover.

It could be that you have serious hearing loss or serious tinnitus and use a hearing aid, simple listening aid or a tinnitus masker and are still unable to hear well or are unable to effectively use communications equipment. In that case, we reimburse the costs of medical appliances that offer additional help, like personal FM systems, hearing (induction) loops and warning systems. Under ‘Details of each medical appliance’, you can see which medical appliances are part of this category. We also reimburse these medical appliances when used instead of a hearing aid, tinnitus masker or simple listening device.

We consider serious hearing loss to be a loss of 35dB or more, based on an average of your hearing ability at the frequencies of 1000Hz, 2000Hz and 4000Hz, as measured by your audiologist.

If you do not meet the conditions for hearing loss or serious tinnitus, we will reimburse the costs of the system or device that helps you to hear better all the same in exceptional situations. We refer to this as an ‘exceptional personal health-care need’.

If you have a hearing impairment and need a medical appliance at your place of work or learning, we also cover the costs of certain devices or systems that can be used to adapt your working or learning environment. The device/system must meet the 3 following conditions: • the device/system is meant for you personally and is an addition to the hearing aid or bone conduction hearing device you already have • the device/system is connected to your hearing aid or bone conduction hearing device wirelessly • you need the device/system to do your work or take part in classes

What is not covered • a hearing aid based in full or in part on an implant

Other coverage Other medical appliances can also help a person suffering from hearing problems. These are covered under the following sections: • hearing aids and tinnitus maskers • service dogs (hearing dogs)

Other audiological health care comes under the Audiological health care coverage. This involves things like having your hearing tested, for example, and getting advice on a hearing aid and the use of the device.

Hearing aids of which all or a part are surgically implanted come under the Medical specialist coverage.

Whom to contact • any audiologist • any other supplier of hearing and listening aids

What you pay

Excess If you own the medical appliance, you pay an excess. However, you do not pay an excess if you get the medical appliance on loan. You can read whether you own the medical appliance or whether it is given to you on loan under ‘Details of each medical appliance’.

Personal contribution You do not pay a personal contribution for these medical appliances.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 277 What you have to do yourself

You must have a prescription Under ‘Details of each medical appliance’, you can read which health-care provider prescribes the medical appliance.

You must request our permission first We only cover the costs of these medical appliances if you have obtained permission from us in advance. You can read under ‘Details of each medical appliance’ which medical appliances this applies to. The supplier is often allowed to give permission on our behalf; your supplier and our Service Centre can tell you if this is the case.

If your supplier cannot give permission on our behalf, you will need to ask our permission yourself. You can send your request to us using the contact form or by post.

Our permission is required for replacement or modification within the expected service life An expected service life has been determined for some medical appliances. You can read under ‘Details of each medical appliance’ which medical appliances this applies to. If you need to have your medical appliance replaced or modified before the end of its expected service life, we only reimburse the cost of replacement or modification if your medical appliance no longer works properly. You must request our permission for this in advance.

Details of each medical appliance

Hearing (induction) loop, personal FM system or infrared hearing system These are systems and devices that transmit sound wirelessly to your hearing aid.

The following applies to this medical appliance: • you must have a prescription from your ENT doctor or an audiological centre • you must obtain our permission in advance • you pay an excess, because you own the medical appliance • the expected service life is 5 years

Text telephone and videophone These are phones that offer text or video as a means of phone communication.

The following applies to this medical appliance: • you must have a prescription from your ENT doctor or an audiological centre • you must obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Wake-up and warning devices (alerters) These are medical appliances that detect the sound of the doorbell, telephone or smoke alarm and transmit a signal to a strobe light or vibration system.

The following applies to this medical appliance: • you must have a prescription from your ENT doctor or an audiological centre • you must obtain our permission in advance • you pay an excess, because you own the medical appliance

Radio aid with accessories This is a system that receives the voice of the speaker and transmits this directly to your hearing aid.

The following applies to this medical appliance: • you must have a prescription from your medical specialist or an audiological centre • you must obtain our permission in advance • you pay an excess, because you own the medical appliance

Good to know

The official coverage specified in the Health Insurance Regulations applies Hearing and listening aids come under the definition of Article 2.6(c) in conjunction with Article 2.10 of the Regeling zorgverzekering [Health Insurance Regulations], i.e. ‘an external appliance relating to hearing disorders’. This description also applies to hearing aids and service dogs (hearing dogs).

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 278 Your audiologist or other supplier must comply with 2 protocols We only reimburse the cost of hearing aids if your audiologist or other supplier complies with the most recent Hoorprotocol en indicatieformat [Hearing aid protocol and indication format] and Keuzeprotocol Zorgverzekeraars Nederland [Selection protocol for health Insurers in the Netherlands]. Your audiologist or supplier can tell you more. You can view these protocols on our website or our Service Centre can provide a copy on request.

Medical appliances for skin conditions

For when your skin needs support due to an illness or ailment.

Coverage under each health-care plan

Basic health-care plan 100% (excluding personal contribution)

Startfit No coverage

Extrafit No coverage

Benfit €250 Maximum per calendar year for personal contributions

Optifit €500 Maximum per calendar year for personal contributions

Topfit €1,000 Maximum per calendar year for personal contributions

Superfit 100% Of the personal contributions

The coverage for medical appliances for skin conditions is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to medical appliances for skin conditions as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

Our supplementary health-care plans cover the personal contributions up to the amount stated above. This reimbursement applies to all medical appliances for which you have to pay a personal contribution.

What is covered

You may occasionally have a skin condition where your skin could use some extra support. You can read here about when you are covered for custom-made hypoallergenic shoes and heel protectors to prevent or relieve pressure sores.

These are only covered by the basic health-care plan if you have 1 of the following ailments: • a complex wound, or a high risk of developing such • a chronic skin condition • serious scarring if this causes a demonstrable physical disorder or you are disfigured by it

A complex wound is one for which the healing process is not progressing normally due to an illness or ailment. Other factors may also play a role, i.e.: • you cannot properly care for the wound due to your social situation • your health-care provider does not have the expertise or skill required to properly care for the wound • your health-care facility is not doing enough in terms of wound management and your wound is not being properly treated as a result

We reimburse the costs of custom-made hypoallergenic shoes if regular (off-the-rack) hypoallergenic shoes will not reasonably suffice in your situation.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 279 What is not covered • regular hypoallergenic shoes (‘off-the-rack’) • over-the-counter medication • salves, unless used specifically for complex wounds or serious scarring

Other coverage Other medical appliances can also help a person suffering from a skin condition. These are covered under the following sections: • dressings • post-op shoes • medical appliances for nursing and care in bed. The medical appliances must be used specifically to prevent/treat pressure sores

Whom to contact • any supplier of these medical appliances

What you pay

Excess You pay an excess, because you own these medical appliances.

Personal contribution You will sometimes be required to pay a personal contribution for these medical appliances. You can read under ‘Details of each medical appliance’ which medical appliances this applies to.

What you have to do yourself

You must have a prescription Under ‘Details of each medical appliance’, you can read which health-care provider prescribes the medical appliance.

You must request our permission first We only cover the costs of these medical appliances if you have obtained permission from us in advance. You can read under ‘Details of each medical appliance’ which medical appliances this applies to. The supplier is often allowed to give permission on our behalf; your supplier and our Service Centre can tell you if this is the case.

If your supplier cannot give permission on our behalf, you will need to ask our permission yourself. You can send your request to us using the contact form or by post.

Our permission is required for replacement or modification within the expected service life An expected service life has been determined for some medical appliances. You can read under ‘Details of each medical appliance’ which medical appliances this applies to. If you need to have your medical appliance replaced or modified before the end of its expected service life, we only reimburse the cost of replacement or modification if your medical appliance no longer works properly. You must request our permission for this in advance.

Details of each medical appliance

Custom-made hypoallergenic shoes Shoes that have been made specially for you because you have an allergic reaction to certain substances.

The following applies to this medical appliance: • you need a prescription from your dermatologist • you must obtain our permission in advance • you pay an excess, because you own the medical appliance • you pay a personal contribution of €131 per pair, or €65.50 per pair if you are under the age of 16 • the expected service life is 18 months or 6 months if you are under the age of 16

Spare pair of hypoallergenic shoes An extra pair of hypoallergenic shoes.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 280 The following applies to this medical appliance: • you need a prescription from your dermatologist • you must obtain our permission in advance • you pay an excess, because you own the medical appliance • you pay a personal contribution of €131 per pair, or €65.50 per pair if you are under the age of 16 • the expected service life is 18 months or 6 months if you are under the age of 16

Heel protectors to prevent/relieve pressure sores Heel protectors to prevent or treat pressure sores (in medical terms ‘decubitus ulcers’).

The following applies to this medical appliance: • you need a prescription from your attending doctor or the wound care nurse • you must obtain our permission in advance • you pay an excess, because you own the medical appliance

Good to know

The official coverage specified in the Health Insurance Regulations applies Medical appliances for skin conditions come under the definition of Article 2.6(k) in conjunction with Article 2.18 of Regeling zorgverzekering [Health Insurance Regulations], i.e. ‘medical devices used for disorders in the functions of the skin’. This description also applies to dressings and post-op shoes.

Dressings

For when you have a skin condition and the affected area needs to be dressed.

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

This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to dressings as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

What is covered

Dressings come in all shapes and sizes, from simple gauze, cotton wool, plasters and tape to tubular bandages, mesh bandages, crepe bandages and bandage contact lenses (without vision correction).

These dressings are only covered by the basic health-care plan if you have 1 of the following ailments: • a complex wound, or a high risk of developing such • a chronic skin condition • serious scarring if this concerns a demonstrable physical disorder or disfigurement

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 281 A complex wound is one for which the healing process is not progressing normally due to an illness or ailment. Other factors may also play a role, i.e.: • you cannot properly care for the wound due to your social situation • your health-care provider does not have the expertise or skill required to properly care for the wound • your health-care facility is not doing enough in terms of wound management and your wound is not being properly treated as a result

What is not covered • dressings for short-term use or for non-complex wounds • dressings that are comparable to over-the-counter dressings or dressings that are only used during treatment in a hospital. You can see which dressings these are on the list of dressings1.

Other coverage Other medical appliances can also help a person suffering from a skin condition. These are covered under the following sections: • medical appliances for skin conditions • post-op shoes • medical appliances for nursing and care in bed • dressings for simple wounds

Whom to contact • any supplier of dressings

What you pay

Excess Because you own the dressing(s), you pay an excess.

Personal contribution You do not pay a personal contribution for the dressing(s).

What you have to do yourself

You must have a prescription Under ‘Details of each medical appliance’, you can read which health-care provider prescribes the medical appliance.

You must request our permission first We only cover the costs of dressings if you have obtained permission for this from us in advance. The supplier is often allowed to give permission on our behalf; your supplier and our Service Centre can tell you if this is the case.

If your supplier cannot give permission on our behalf, you will need to ask our permission yourself. You can send your request to us using the contact form or by post.

Details of each medical appliance

Bandage contact lenses (without vision correction) This is a contact lens that, rather than correcting your vision, protects your eye.

The following applies to this medical appliance: • you need a prescription from your ophthalmologist • you must obtain our permission in advance • you pay an excess, because you own the medical appliance

Dressings Medical appliance to cover (dress) a wound, for example.

The following applies to this medical appliance: • you need a prescription from your attending doctor or specialist nurse • you must obtain our permission in advance • you pay an excess, because you own the medical appliance

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

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 282 Good to know

The official coverage specified in the Health Insurance Regulations applies Dressings come under the definition of Article 2.6(k) in conjunction with Article 2.18 ofRegeling zorgverzekering [Health Insurance Regulations], i.e. ‘medical devices used for disorders in the functions of the skin’. This description also applies to other medical appliances for skin conditions and to post-op shoes.

Post-op shoes

For when you cannot wear regular shoes, because your feet are bandaged.

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

This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to post-op shoes as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

What is covered

Post-op shoes are special shoes you can wear when you cannot wear your regular shoes, because your feet are bandaged. Because they are easy to put on (and take off), you are quickly ready to go. And they come in all sorts of shapes and sizes.

We reimburse the costs of post-op shoes if 1 of the following situations applies to you. Due to your medical condition, your feet need to be bandaged and you are not able to wear regular shoes. • you have a problem with the skin, nerves or blood vessels of your feet • you are recovering from part of your foot being amputated • your foot has been damaged as the result of a wound or operation

You are only covered for regular (off-the-rack) post-op shoes: these come in so many sorts and sizes that there is no need to have them custom-made.

What is not covered • insoles

Other coverage Other medical appliances can also help a person suffering from a skin condition. These are covered under the following sections: • medical appliances for skin conditions • dressings • medical appliances for nursing and care in bed

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 283 Whom to contact • any supplier of post-op shoes

What you pay

Excess Because you own the dressing(s), you pay an excess.

Personal contribution You do not pay a personal contribution for the dressing(s).

What you have to do yourself

You must have a prescription You get the prescription for the post-op shoes from your attending doctor or nursing specialist.

Good to know

The official coverage specified in the Health Insurance Regulations applies Post-op shoes come under the definition of Article 2.6(k) in conjunction with Article 2.18 ofRegeling zorgverzekering [Health Insurance Regulations], i.e. ‘medical devices used for disorders in the functions of the skin’. This description also applies to other medical appliances for skin conditions and to dressings.

Medical appliances for urinary and bowel incontinence

To get you through the day and night without care.

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

This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to medical appliances for urinary and bowel incontinence as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 284 What is covered

If you have limited or no control over your bladder or bowel as the result of an illness, ailment or treatment, or if you are unable to urinate or defecate in the normal manner, the basic health-care plan covers medical appliances that can help you in this situation. Appliances include catheters, drainage bags, rectal irrigation systems and stoma pouches and support products.

Under ‘Details of each medical appliance’, you can see which medical appliances are part of this category.

If you have a stoma, the basic health-care plan also covers the costs of medical appliances you can use to protect your skin, as well as the stoma support products specified under ‘Details of each medical appliance’.

In special cases, the basic health-care plan also covers protective pads or sheets for beds/chairs. We refer to this as an ‘exceptional personal health-care need’. A special case would be where the loss of blood, exudate (seepage from an area of inflammation), urine or faeces presents a hygiene problem of such an extent that only a pad or sheet can protect you.

What is not covered • cleaning supplies and deodorants (e.g. air fresheners) • products that protect your skin if you do not have a stoma • clothing, with the exception of fixation pants (net pants) • bed-wetting alarm (basic health-care plan) • waterproof/incontinence mattress

Other coverage Other medical appliances can also help a person suffering from urinary or bowel incontinence. These are covered under the following sections: • incontinence products (absorbent and washable materials) • bed-wetting alarm (supplementary health-care plan) • medicines, if you have a stoma and you use these to protect your skin

Whom to contact • any supplier of medical appliances for urinary and bowel incontinence

What you pay

Excess You pay an excess, because you own these medical appliances.

Personal contribution You do not pay a personal contribution for these medical appliances.

What you have to do yourself

You must have a prescription Under ‘Details of each medical appliance’, you can read which health-care provider prescribes the medical appliance.

You must request our permission first We only cover the costs of these medical appliances if you have obtained permission from us in advance. You can read under ‘Details of each medical appliance’ which medical appliances this applies to. The supplier is often allowed to give permission on our behalf; your supplier and our Service Centre can tell you if this is the case.

If your supplier cannot give permission on our behalf, you will need to ask our permission yourself. You can send your request to us using the contact form or by post.

Details of each medical appliance

Urine drainage bags Medical appliance to collect urine when using a catheter.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 285 The following applies to this medical appliance: • you need a prescription from your attending doctor or the specialist stoma/continence care nurse • you must obtain our permission in advance • you pay an excess, because you own the medical appliance

Urinary catheter A narrow, flexible tube used to empty the bladder and direct the urine to the drainage bag.

The following applies to this medical appliance: • you need a prescription from your attending doctor or the specialist stoma/continence care nurse • you must obtain our permission in advance • you pay an excess, because you own the medical appliance

Rectal irrigation system The medical appliance is used to irrigate (rinse) the bowels with lukewarm water.

The following applies to this medical appliance: • you need a prescription from your attending doctor or the specialist stoma/continence care nurse • you must obtain our permission in advance • you pay an excess, because you own the medical appliance

Stoma pouches and support products These are medical appliances used with a stoma (a surgically created opening in the abdomen to help redirect the contents of the bowels or bladder).

The following applies to this medical appliance: • you need a prescription from your attending doctor or the specialist stoma/continence care nurse • you must obtain our permission in advance. If you will be using more of these items than the maximum quantity we state below, make sure you get prior permission • you pay an excess, because you own the medical appliance • you are entitled to reimbursement for a maximum quantity (as shown below)

1-piece colostomy pouch max. 4 pouches per day

2-piece colostomy pouch max. 4 base plates per day / max. 4 pouches per day

1-piece stoma plug max. 4 plugs per day

2-piece stoma plug max. 1 base plate and 4 plugs per day

1-piece ileostomy pouch max. 2 pouches per day

2-piece ileostomy pouch max. 4 base plates per week / max. 2 pouches per day

1-piece urostomy pouch max. 2 pouches per day

2-piece urostomy pouch max. 4 base plates per week / max. 2 pouches per day

continence stoma (adhesive 2 to 6 per day, depending on prescription dressing and catheters)

irrigation system sets 1st year: max. 2 sets, after that max. 1 set per year

irrigation pump max. 1 irrigation pump per year, max. 1 irrigation sleeve per day, and after each irrigation max. 2 stoma plasters or colostomy pouches

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 286 Protective pads/sheets These are pads or sheets to protect your bed, chair and wheelchair from blood, exudate (seepage), urine or bowel matter.

The following applies to this medical appliance: • you need a prescription specifying the reasons from your attending doctor or the specialist stoma/ continence care nurse • you must obtain our permission in advance • you pay an excess, because you own the medical appliance

Good to know

The official coverage specified in the Health Insurance Regulations applies Medical appliances for problems with urinary and bowel incontinence come under the definition of Article 2.6(d) in conjunction with Article 2.11 of the Regeling zorgverzekering [Health Insurance Regulations], i.e. ‘an external appliance to be used during urination and defecation’. This includes incontinence products as well.

Incontinence products

To get you through the day and night without care.

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

This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to incontinence products as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

What is covered

We define incontinence products as absorbent or washable materials that can be used for urinary or bowel incontinence. These products can be either disposable or washable.

We reimburse the cost of incontinence products if you have limited or no control over your bladder or bowel as the result of an illness, ailment or treatment, and if you meet the following requirements: • for children aged 3 or 4: due to an illness or ailment, it is not expected that they will be potty-trained • for children aged 5 or older, and for adults: the child or adult has long-term incontinence due to an illness or ailment

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 287 In this context, long-term incontinence means: • bowel incontinence has been a problem for more than 2 weeks; urinary incontinence has been a problem for more than 2 months • the patient needs extra support during pelvic floor exercises or bladder training • it has become clear that the illness or ailment causing the urinary or bowel incontinence will not heal/ resolve itself, or that the incontinence cannot be resolved by pelvic floor or bladder training

The continence care nurse will decide during the initial talk with your supplier which incontinence products you need and the quantity needed. The basic health-care plan covers the quantity determined.

What is not covered • cleaning supplies and deodorants (e.g. air fresheners) • clothing, with the exception of fixation pants (net pants) • protective pads or sheets for mattresses and/or chairs/wheelchairs if you do not have an exceptional health- care need • incontinence products if the need for these is short term, like after an operation or pregnancy, or when needed for nocturnal bedwetting

Other coverage Other medical appliances can also help a person suffering from urinary or bowel incontinence. These are covered under the following sections: • medical appliances for urinary and bowel incontinence

Whom to contact • any supplier of incontinence products

What you pay

Excess You pay an excess, because you own these medical appliances.

Personal contribution You do not pay a personal contribution for these medical appliances.

What you have to do yourself

You must have a prescription You get the prescription for the incontinence products from your attending doctor, physician assistant, specialist nurse, urology-continence-stoma care nurse or continence care nurse.

You must request our permission first We only cover the costs of incontinence products if you have obtained permission for this from us in advance. The supplier is often allowed to give permission on our behalf; your supplier and our Service Centre can tell you if this is this case.

If your supplier cannot give permission on our behalf, you will need to ask our permission yourself. You can send your request to us using the contact form or by post.

Good to know

The official coverage specified in the Health Insurance Regulations applies Incontinence products come under the definition of Article 2.6(d) in conjunction with Article 2.11 of the Regeling zorgverzekering [Health Insurance Regulations], i.e. ‘an external appliance to be used during urination and defecation’. This includes medical appliances for urinary and bowel incontinence.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 288 Contraceptive devices

A diaphragm or a copper intrauterine device (IUD) to prevent pregnancy

Coverage under each health-care plan

Basic health-care plan 100% up to the age of 21

Startfit No coverage

Extrafit No coverage

Benfit No coverage Contraceptive medicines are covered

Optifit No coverage Contraceptive medicines are covered

Topfit No coverage Contraceptive medicines are covered

Superfit No coverage Contraceptive medicines are covered

This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to contraceptive devices as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

What is covered

A diaphragm and the copper intrauterine device (IUD) are medical appliances intended to prevent pregnancy. The coverage provisions you are currently reading apply to these medical appliances. There are other types of contraceptives, such as the contraceptive pill, contraceptive injection and hormonal intrauterine device. These are covered under the Contraceptive medicines section.

The basic health-care plan covers the costs of a copper IUD or diaphragm if you are under the age of 21. The supplementary health-care plans cover the costs of a copper IUD or diaphragm for insured persons aged 21 or older.

What is not covered • condoms

Other coverage You can have the IUD fitted (and removed) by your general practitioner or midwife. The costs for this are covered under The general practitioner (general medical care). You will need to purchase the IUD yourself at the pharmacy or from another medical appliance supplier and bring it along with you when you visit the GP or midwife. If you have the GP insert the IUD, you do not pay an excess. However, you do have to pay the excess if the midwife fits the IUD for you.

You can also have the IUD fitted and removed by a medical specialist at the hospital or independent treatment centre, though you will need a referral for this from your GP. This then comes under the Medical specialist coverage. In that case, you do not have to purchase the IUD yourself and take it with you. Both the IUD and the fitting procedure are claimed under 1 DBC. You will need to pay an excess in this case.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 289 If you would prefer a contraceptive medicine instead, These are covered under the Contraceptive medicines section.

Whom to contact • a general practitioner • pharmacy • any other supplier of contraceptives

What you pay

Excess You pay an excess, because you own these medical appliances. You do not pay an excess for contraceptive medicines covered by the supplementary health-care plans.

Personal contribution You do not pay a personal contribution for contraceptive devices.

What you have to do yourself

You need to have a prescription in some cases You need to have a prescription for contraceptive medicines. You get the prescription from your doctor.

Good to know

The official coverage specified in the Health Insurance Regulations applies Contraceptive devices come under the definition of Article 2.6(i) in conjunction with Article 2.16 of the Regeling zorgverzekering [Health Insurance Regulations], i.e. ‘medical appliances used to prevent conception’.

Medical appliances for nursing and care in bed

For when you need medical appliances while receiving nursing and care at home.

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

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 290 This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to medical appliances for nursing and care in bed as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

What is covered

Medical appliances are sometimes needed to ensure you can get proper nursing and care in bed, or so that you can continue to live independently but still safely. This might be a nursing care bed (a specially adapted bed), for example, or extra support while getting in and out of bed.

The basic health-care plan only covers the costs of a nursing care bed and the related mattress if you meet the following 3 conditions: • you need nursing and care in bed and there are medical grounds (a medical indication) for this • you are being assisted with basic ADLs in bed, or this is being combined with nursing and care. ADL stands for activities of daily living. These are things like getting dressed and undressed and washing • you need assistance and nursing several times during the day

If you are receiving nursing and other care in bed and other medical appliances are needed for this, the basic health-care plan covers the cost of these, but only if they are specified under ‘Details of each medical appliance’.

We only reimburse the bed pads or protective sheets if using these is the only way to address hygiene problems presented by blood or wound seepage.

If there are no medical grounds for receiving nursing and care in bed, you may still qualify for coverage of these medical appliances, as long as you need the medical appliances in order to remain living independently.

Other coverage Medical appliances that you need on a short-term basis because you are having trouble getting around are covered in the Short-term loan section. These could be needed, for example, because you are unable to wash yourself at present, or you cannot get in and out of bed for the time being.

Whom to contact • any supplier of these medical appliances

What you pay

Excess If you own the medical appliance, you pay an excess. However, you do not pay an excess if you get the medical appliance on loan. You can read whether you own the medical appliance or whether it is given to you on loan under ‘Details of each medical appliance’.

Personal contribution You do not pay a personal contribution for these medical appliances.

What you have to do yourself

You must have a prescription You get the prescription for the medical appliances for nursing and care in bed from your attending doctor or the district nurse.

Sometimes you must request permission in advance In some cases, we only cover the costs of the medical appliance concerned if you have obtained permission from us in advance. You can read under ‘Details of each medical appliance’ which medical appliances this applies to. The supplier is often allowed to give permission on our behalf; your supplier and our Service Centre can tell you if this is the case.

If your supplier cannot give permission on our behalf, you will need to ask our permission yourself. You can send your request to us using the contact form or by post.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 291 Details of each medical appliance

Nursing care bed (including mattress) This is a specially adapted bed for use when a regular bed would make nursing and caring very difficult, or make it hard for you to continue to live independently.

The following applies to this medical appliance: • you need a prescription from your attending doctor, a wound care nurse or the district nurse • you must obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Beds, mattresses and mattress toppers designed to treat or prevent pressure sores These are medical appliances that help relieve pressure when you are bedridden for a longer period of time, making you more comfortable in bed.

The following applies to this medical appliance: • you need a prescription from your attending doctor, a wound care nurse or the district nurse • you must obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Blanket cradles, bed rails, bed back rests, over bed pole hoists (a ‘trapeze’), ceiling supports and ‘portals’ Accessories to attach to or use around your bed.

The following applies to this medical appliance: • you need a prescription from your attending doctor or the district nurse • you do not need to obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Infusion stand (drip stand) This stand is used to hang your drip bag while you are receiving infusion therapy.

The following applies to this medical appliance: • you need a prescription from your attending doctor or the district nurse • you do not need to obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Bed tables This is a table that you can use in bed to eat a meal, read, write or use a computer.

The following applies to this medical appliance: • you need a prescription from your attending doctor or the district nurse • you do not need to obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Glide sheets These sheets are an aid in helping to shift or turn around in bed.

The following applies to this medical appliance: • you need a prescription from your attending doctor or the district nurse • you do not need to obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Foot boards, bed extenders and bed risers These medical appliances are used to make adjustments to your bed.

The following applies to this medical appliance: • you need a prescription from your attending doctor or the district nurse • you do not need to obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Bedpan This is for when you cannot or may not leave the bed to use the toilet.

The following applies to this medical appliance: • you need a prescription from your attending doctor or the district nurse • you do not need to obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 292 Protective pads/sheets for beds These are medical appliances used to protect your mattress.

The following applies to this medical appliance: • you need a prescription from your attending doctor or the district nurse • you do not need to obtain our permission in advance • you pay an excess, because you own the medical appliance

Good to know

The official coverage specified in the Health Insurance Regulations applies Medical appliances for nursing and care in bed come under the definition of Article 2.6(j) in conjunction with Article 2.17 of the Regeling zorgverzekering [Health Insurance Regulations], i.e. ‘medical appliances related to nursing and care in bed’.

Syringes and injection pens to self-administer medicine

For when you need to use syringes or injection pens on an ongoing basis.

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

This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to syringes and injection pens to self-administer medicine as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

What is covered

The syringes and injection pens are used to inject medicine directly into the body.

The basic health-care plan covers the costs of syringes and injection pens and the related accessories if you have an ailment for which you need to receive medicine by injection on an ongoing basis. This must be an ailment other than diabetes.

If you have a serious motor impairment or cannot see (well enough), and if you cannot handle a regular syringe or injection pen as a result, the basic health-care plan covers the costs of specially adapted syringes or injection pens suitable for your ailment. You must meet the condition listed above, i.e. you have an ailment for which you need to receive medicine by injection on an ongoing basis.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 293 Other coverage If you are diabetic, syringes and injection pens for use in administering insulin are covered under the Medical appliances for diabetes section.

If you use syringes or injection pens to inject medicine covered by the hospital, these come under the Medical specialist coverage.

Whom to contact • any supplier of syringes, injection pens and the related accessories

What you pay

Excess You pay an excess, because you own these medical appliances.

Personal contribution You do not pay a personal contribution for these medical appliances.

What you have to do yourself

You must have a prescription You get the prescription for the syringes or injection pens from your attending doctor.

You must request our permission first We only cover the costs of syringes, injection pens and the related accessories if you have obtained permission from us in advance. The supplier is often allowed to give permission on our behalf; your supplier and our Service Centre can tell you if this is the case.

If your supplier cannot give permission on our behalf, you will need to ask our permission yourself. You can send your request to us using the contact form or by post.

Good to know

The official coverage specified in the Health Insurance Regulations applies Syringes and injection pens come under the definition of Article 2.6(j) in conjunction with Article 2.19 of the Regeling zorgverzekering [Health Insurance Regulations], i.e. (simply) ‘syringes’. Though not specified in the title, this includes injection pens as well.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 294 Medical appliances for vascular conditions

For when your veins and lymphatic vessels are not functioning properly.

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

This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to medical appliances for vascular conditions as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

What is covered

Your veins and arteries carry your blood to all parts of your body: the arteries bring oxygenated blood from the heart to all your organs and tissues, while the veins return the blood to the heart, after much of the waste has been filtered along the way. Lymphatic vessels carry ‘lymph’, a fluid that picks up toxins from the tissues and delivers these to the lymph nodes to be destroyed. This keeps these toxins out of the blood stream.

However, sometimes the veins and lymphatic vessels do not work effectively and you need the help of certain medical appliances. The basic health-care plan only covers the costs of these medical appliances if you meet the following 2 conditions: • the veins or lymphatic vessels are unable to transport blood or lymph fluid as well as needed • you need a medical appliance over the long term to address the problem

Under ‘Details of each medical appliance’, you can see which medical appliances are part of this category.

Other coverage Compression stockings, compression sleeves and simple donning and doffing aids can help if you suffer from vascular problems. These are covered under the Compression stockings/sleeves section.

Whom to contact • any supplier of these medical appliances

What you pay

Excess If you own the medical appliance, you pay an excess. However, you do not pay an excess if you get the medical appliance on loan. You can read whether you own the medical appliance or whether it is given to you on loan under ‘Details of each medical appliance’.

Personal contribution You do not pay a personal contribution for these medical appliances.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 295 What you have to do yourself

You must have a prescription Under ‘Details of each medical appliance’, you can read which health-care provider prescribes the medical appliance.

You must request our permission first We only cover the costs of these medical appliances if you have obtained permission from us in advance. You can send your request to us using the contact form or by post.

Details of each medical appliance

Ort.O.Mate This electric medical appliance allows a compression stocking wearer to take these off unassisted.

The following applies to this medical appliance: • you need a prescription from your attending doctor • you must obtain our permission in advance • you pay an excess, because you own the medical appliance

Compression therapy aids These are medical appliances to treat lymphoedema.

The following applies to this medical appliance: • you must have a prescription from your attending doctor and a report with a treatment plan written by the physiotherapist • you must obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Good to know

The official coverage specified in the Health Insurance Regulations applies Medical appliances for vascular conditions come under the definition of Article 2.6(m) of theRegeling zorgverzekering [Health Insurance Regulations], i.e. ‘an external appliance to be used for ongoing correction support in cases of loss of function of the veins affecting the transport of blood and the loss of function in the lymphatic vessels affecting the transport of lymph’. This also applies to compression stockings and compression sleeves.

Compression stockings/sleeves

For when your veins and lymphatic vessels are not functioning properly.

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

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 296 This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to compression stockings as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

What is covered

Since a compression stocking or compression sleeve places extra pressure on all or part of your leg or arm, it helps your body carry the blood or lymph away from your legs and arms. This can prevent thrombosis or oedema, for example, or help alleviate the symptoms of rheumatoid arthritis. Compression stockings and sleeves are available in 4 compression classes. Class 1 stockings/sleeves offer light support, while class 4 stockings/sleeves place a lot more pressure on your leg or arm and are therefore suitable for treating serious ailments.

The basic health-care plan only covers compression stockings or compression sleeves in class 2, 3 or 4. These are also called ‘therapeutic elastic garments’. You must satisfy 2 conditions: • the veins or lymphatic vessels in your arms or legs are unable to transport blood or lymph fluid as well as needed on their own • to address this problem, you need compression class 2, 3 or 4 compression stocking(s) or sleeve(s) on an ongoing basis

If you are unable to put the stocking on and take it off on your own, the basic health-care plan also covers a device to help you with this.

What is not covered • support stockings/sleeves in compression class 1 • support stockings to be worn after varicose vein surgery

Other coverage If you need help from a caregiver or nurse when putting on and taking off stockings, because you are unable to do this on your own, even with a donning and doffing aid, this care comes under the Nursing and other care coverage.

If you are prescribed the compression stockings/sleeve as part of post-op care or other care received at a hospital, this comes under the Medical specialist coverage.

Whom to contact • any supplier of compression stockings, compression sleeves and donning and doffing aids

What you pay

Excess You pay an excess, because you own these medical appliances.

Personal contribution You do not pay a personal contribution for these medical appliances.

What you have to do yourself

You must have a prescription You get the prescription for the compression stockings, compression sleeves and/or donning and doffing aids from your attending doctor. You can also get the prescription for the donning and doffing aid from your physiotherapist or occupational therapist.

You must request our permission first We only cover the costs of compression stockings, compression sleeves and/or donning and doffing aids if you have obtained permission from us in advance. The supplier is often allowed to give permission on our behalf; your supplier and our Service Centre can tell you if this is the case.

If your supplier cannot give permission on our behalf, you will need to ask our permission yourself. You can send your request to us using the contact form or by post.

Our permission is required for replacement of the simple donning and doffing aid within 2 years The expected service life of the donning and doffing aid is 2 years. If you need to have this aid replaced before 2 years have passed, we only reimburse the cost of replacement or modification if your donning and doffing aid no longer works properly. You must request our permission for this in advance.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 297 You are entitled to 2 pairs or 2 items per year If you are getting compression stockings or compression sleeves for the first time, we will reimburse the cost of 1 stocking/sleeve, or 1 pair of stockings/sleeves. After 3 months, you are entitled to 2 new individual stockings/ sleeves or 2 new pairs. After 1 year, you are entitled to 2 new individual stockings/sleeves or 2 new pairs once a year thereafter.

Good to know

The official coverage specified in the Health Insurance Regulations applies Compression stockings, compression sleeves and donning and doffing aids come under the definition of Article 2.6(m) of the Regeling zorgverzekering [Health Insurance Regulations], i.e. ‘an external appliance to be used for ongoing correction support in cases of loss of function of the veins affecting the transport of blood and the loss of function in the lymphatic vessels affecting the transport of lymph’. This description also applies to other medical appliances for vascular conditions.

Medical appliances for diabetes

For when your body is unable to control your blood glucose level on its own.

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

This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to medical appliances for diabetes as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

What is covered

When you have diabetes, your body is unable to properly control the blood glucose (sugar) level. This occurs when it produces too little or no insulin, or when the body fails to respond to the insulin it produces. There is help, however, in the form of medical appliances you can use to measure your blood glucose level, and ones to administer the insulin needed.

The basic health-care plan covers medical appliances for diabetes if one of the following situations applies to you: • you have type 1 diabetes and are being treated with insulin • you have type 2 diabetes and the medicines you are taking are no longer working well enough and, as a result, your doctor is considering putting you on insulin

If you are entitled to medical appliances for diabetes, and if you cannot handle the standard medical appliances for diabetes due to a disability, the basic health-care plan covers the costs of specially adapted medical appliances for diabetes.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 298 Under ‘Details of each medical appliance’, you can see which medical appliances are part of this category.

What is not covered • replacement batteries or replacement chargers

Other coverage The insulin you administer using these medical appliances comes under the Medicines coverage under the basic health-care plan.

Strips to measure ketones in urine come under the Medical specialist coverage.

Whom to contact • any supplier of medical appliances for diabetes

What you pay

Excess You pay an excess, because you own these medical appliances.

Personal contribution You do not pay a personal contribution for these medical appliances.

What you have to do yourself

You must have a prescription Under ‘Details of each medical appliance’, you can read which health-care provider prescribes the medical appliance.

You must request our permission first We only cover the costs of these medical appliances for diabetes if you have obtained permission from us in advance. The supplier is often allowed to give permission on our behalf; your supplier and our Service Centre can tell you if this is the case.

If your supplier cannot give permission on our behalf, you will need to ask our permission yourself. You can send your request to us using the contact form or by post.

Our permission is required for replacement within the expected service life An expected service life has been determined for some medical appliances. You can read under ‘Details of each medical appliance’ which medical appliances this applies to. If you need to have your medical appliance replaced before the end of its expected service life, we only reimburse the cost of replacement or modification if your medical appliance no longer works properly. You must request our permission for this in advance.

In some cases, you are given a maximum quantity For certain medical appliances, you will receive a limited quantity, which is expected to last you for a certain period of time. You can see under ‘Details of each medical appliance’ which medical appliances this applies to, the maximum quantity supplied and how long these supplies must last. If you need more than this maximum quantity, you will need to ask our permission for this in advance.

Details of each medical appliance

Blood sampling device Lancing device to prick your finger to get a sample of blood you can use to measure your blood glucose level.

The following applies to this medical appliance: • you need a prescription from your attending doctor or the nurse specialising in diabetes • you must obtain our permission in advance • you pay an excess, because you own the medical appliance • the expected service life is 2 years

Lancets for blood sampling These are medical appliances you place in the lancing device to prick your finger to get a drop of blood you can use to measure the level of glucose in your blood.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 299 The following applies to this medical appliance: • you need a prescription from your attending doctor or the nurse specialising in diabetes • you must obtain our permission in advance • you pay an excess, because you own the medical appliance • you are entitled to reimbursement for a maximum quantity of lancets1

Blood glucose meter This is a medical appliance used to measure the concentration of glucose in a blood sample.

The following applies to this medical appliance: • you need a prescription from your attending doctor or the nurse specialising in diabetes • you must obtain our permission in advance • you pay an excess, because you own the medical appliance • the expected service life is 3 years

Test strips These are little strips of plastic onto which the blood is placed, after which the strip is placed into the blood glucose meter.

The following applies to this medical appliance: • you need a prescription from your attending doctor or the nurse specialising in diabetes • you must obtain our permission in advance • you pay an excess, because you own the medical appliance • you are entitled to reimbursement for a maximum quantity of test strips1

Insulin pens This is an injection pen to self-administer insulin.

The following applies to this medical appliance: • you need a prescription from your attending doctor or the nurse specialising in diabetes • you must obtain our permission in advance • you pay an excess, because you own the medical appliance • the expected service life is 3 years • you are entitled to 1 spare insulin pen

Insulin pump with accessories This small device, which is attached to your body by a narrow tube called a cannula, gives your body regular small doses of insulin.

The following applies to this medical appliance: • you need a prescription from the medical specialist or nurse specialising in diabetes • you must obtain our permission in advance • you pay an excess, because you own the medical appliance • the expected service life is 4 years

Good to know

The official coverage specified in the Health Insurance Regulations applies Medical appliances for diabetes come under the definition of Article 2.6(o) ofRegeling zorgverzekering [Health Insurance Regulations], i.e. ‘external appliances used to monitor and regulate glucose metabolism disorders’.

1 If you have diabetes, we reimburse at most the costs of: 1. 50 test strips/lancets once only (50 extra if necessary) if the medicines you are taking seem to be no longer working well enough and you may have to start using insulin 2. 100 test strips/lancets per 3 months if you need an insulin injection 1-2 times per day 3. 400 test strips/lancets per 3 months if you need 3 or more insulin injections per day or use an insulin pump

If your condition is difficult to manage or you are under the age of 18, we may give permission for more than 400 test strips/ lancets per 3 months

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 300 Infusion pump

For when you need a medical appliance to self-administer medicine at home.

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

This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to an infusion pump as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

What is covered

An infusion pump is a medical appliance that delivers medications directly into your body in controlled amounts. These are commonly used in hospitals, but can be used in a home setting as well.

The basic health-care plan only covers the cost of the external, ambulatory (portable) infusion pump and the related consumables if you meet the following conditions: • you need to self-administer a medicine directly into your bloodstream at home • you need this medicine on an ongoing basis • this medicine is covered under the basic health-care plan. You can see which medicines are covered in the Medicines (basic health-care plan) coverage section

Consumables include items like cannulae (connecting tubes), adhesive tape, disinfectants and needles.

What is not covered • replacement batteries

Other coverage Medical appliances used to administer insulin are covered under the Medical appliances for diabetes coverage.

An infusion pump you use to administer medicine as part of a hospital treatment comes under the Medical specialist coverage.

Whom to contact • any supplier of infusion pumps

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 301 What you pay

Excess You do not pay an excess, because you get the infusion pump on loan. However, you do pay an excess for the consumables you use with your infusion pump, because you own the consumables.

Personal contribution You do not pay a personal contribution for the infusion pump.

What you have to do yourself

You must have a prescription For the infusion pump, you need a prescription from your attending medical specialist.

You must request our permission first We only cover the costs of an infusion pump if you have obtained permission for this from us in advance. The supplier is often allowed to give permission on our behalf; your supplier and our Service Centre can tell you if this is the case.

If your supplier cannot give permission on our behalf, you will need to ask our permission yourself. You can send your request to us using the contact form or by post.

Good to know

The official coverage specified in the Health Insurance Regulations applies An infusion pump comes under the definition of Article 2.6(p) in conjunction with Article 2.22 of theRegeling zorgverzekering [Health Insurance Regulations], i.e. ‘portable, external infusion pumps’.

Protective headgear

For when your head needs extra protection due to you suffering episodes of impaired consciousness.

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

This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to protective headgear as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 302 What is covered

Impaired consciousness is a change in the state of the brain that makes a person unable or slow to respond to external stimuli, or makes him or her respond in an unusual way. This can occur as the result of a metabolic disorder or epilepsy, which may cause a person to fall and/or lose consciousness.

During a seizure or fall, special headgear can protect the skull of a person suffering such a disorder. The basic health-care plan will cover protective headgear if you: • have regularly recurring episodes of impaired consciousness and cannot be treated for this • need headgear to protect your skull against fracturing or other injury, or to prevent a previously sustained injury or a cranial defect from becoming worse.

What is not covered • seizure dogs • detection and alerting systems

Whom to contact • any supplier of protective headgear

What you pay

Excess Because you own the protective headgear, you pay an excess.

Personal contribution You do not pay a personal contribution for these medical appliances.

What you have to do yourself

You must have a prescription You get the prescription for the protective headgear from your attending doctor.

You must request our permission first We only cover the costs of the protective headgear if you have obtained permission from us in advance. The supplier is often allowed to give permission on our behalf; your supplier and our Service Centre can tell you if this is the case.

If your supplier cannot give permission on our behalf, you will need to ask our permission yourself. You can send your request to us using the contact form or by post.

Our permission is required for replacement within 18 months The expected service life of the protective headgear is 18 months. If you need to have your protective headgear replaced before 18 months have passed, we only reimburse the cost of replacement if your current protective headgear no longer works properly. You must request our permission1 for this in advance.

Good to know

The official coverage specified in the Health Insurance Regulations applies Protective headgear comes under the definition of Article 2.9(g) of Regeling zorgverzekering [Health Insurance Regulations], i.e. ‘medical appliances relating to impaired consciousness’.

1 For this, see: https://www.onvz.nl/zelf-regelen/toestemming-vragen

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 303 Feeding pump and feeding tube

For when you are unable to eat normally or need additional nutrition.

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

This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to a feeding pump and feeding tube as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

What is covered

Tube feed can be administered in 3 ways: through the mouth, directly to the gastrointestinal tract or into the bloodstream. This coverage only applies to medical appliances used to administer the tube feed directly into the stomach. There are 2 medical appliances that do this: feeding tubes and feeding pumps.

The basic health-care plan covers a feeding tube (only if it is placed when the insured person is not in hospital) and the feeding pump (both with accessories/consumables) if you meet the following conditions: • you have an illness or ailment affecting your digestive tract (stomach or intestines), as a result of which you cannot eat normal food • you need a feeding tube or feeding pump to ensure that you get sufficient nutrition

Accessories and consumables include items like clamps, extension tubes, bottles and feeding pump frames/ infusion stands. If you receive your nutrients directly into the bloodstream through an IV catheter, the basic health-care plan also covers the infusion pump and consumables like sterile gloves and tongue depressors.

Under ‘Details of each medical appliance’, you can see which medical appliances are part of this category.

What is not covered • replacement batteries or replacement chargers

Other coverage An infusion pump for administering nutrients directly into the bloodstream while in hospital, and feeding tubes (with accessories/consumables) that are placed while you are in the hospital are covered under the Medical specialist section. This also applies to an infusion pump you are provided on a short-term basis, like when waiting for an operation, or while receiving palliative care.

The tube feed you are given through the feeding tube or feeding pump comes under the Dietary preparations coverage.

Eating aids are covered under Medical appliances for problems with movement.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 304 Whom to contact • any supplier of feeding tubes and feeding pumps

What you pay

Excess If you own the medical appliance, you pay an excess. However, you do not pay an excess if you get the medical appliance on loan. You can read whether you own the medical appliance or whether it is given to you on loan under ‘Details of each medical appliance’.

Personal contribution You do not pay a personal contribution for these medical appliances.

What you have to do yourself

You must have a prescription Under ‘Details of each medical appliance’, you can read which health-care provider prescribes the medical appliance.

You must request our permission first We only cover the costs of a feeding tube and feeding pump if you have obtained permission for this from us in advance. The supplier is often allowed to give permission on our behalf; your supplier and our Service Centre can tell you if this is the case.

If your supplier cannot give permission on our behalf, you will need to ask our permission yourself. You can send your request to us using the contact form or by post.

Details of each medical appliance

Feeding tube with accessories A narrow tube through which tube feed (liquid nourishment) is administered.

The following applies to this medical appliance: • you need a prescription from your attending doctor • you must obtain our permission in advance • you pay an excess, because you own the medical appliance

Feeding pump with accessories Medical appliance that pumps the tube feed through the feeding tube.

The following applies to this medical appliance: • you need a prescription from your attending doctor or the dietitian • you must obtain our permission in advance • you do not pay an excess, because you get the medical appliance on loan

Good to know

The official coverage specified in the Health Insurance Regulations applies The tube feeding set comes under the definition of Article 2.6(r) in conjunction with Article 2.24 of the Regeling zorgverzekering [Health Insurance Regulations], i.e. ‘medical appliances for administering nourishment’.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 305 Medical appliances for speech disorders

For when you need a medical appliance because you are unable to speak.

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

This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to medical appliances for speech disorders as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

What is covered

There are various medical appliances that can help you when you have little or no clear speech, like an alphabet board or symbol board, software for tablets, or a text telephone for example.

The basic health-care plan only covers the cost of the external medical appliances for speech disorders if you meet the following conditions: • you have a serious speech or language disorder • you have little or no clear speech as a result • you need a medical appliance to help you deal with this

What is not covered • phones, tablets, laptops and computers on which software aimed at helping those with a speech disorder has been installed • medical appliances to help with stuttering

Other coverage If you need a medical appliance to help you vocalise or increase the level of your voice, this comes under the prostheses coverage.

Whom to contact • any supplier of medical appliances for speech disorders

What you pay

Excess You do not pay an excess, because you get the medical appliance on loan.

Personal contribution You do not pay a personal contribution for these medical appliances.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 306 What you have to do yourself

You must have a prescription You get the prescription for the medical appliance for speech disorders from your attending doctor.

You must request our permission first We only cover the costs of these medical appliances if you have obtained permission from us in advance. You can send your request to us using the contact form or by post.

Good to know

The official coverage specified in the Health Insurance Regulations applies Medical appliances for speech disorders come under the definition of Article 2.6(s) of the Regeling zorgverzekering [Health Insurance Regulations], i.e. ‘an external medical appliance relating to and used to compensate for speech disorders’.

Personal alarm system

For when you are unable to use the telephone in an emergency situation.

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

This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to personal alarm systems as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

What is covered

A personal alarm system is a device you can use to ‘call’ for help in an emergency situation if you cannot reach or use the telephone. If you are able to fend for yourself on a daily basis but you have a higher-than-average risk of finding yourself in an emergency situation (because you have a serious heart condition for example), this is a device that can help you continue to live independently.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 307 The basic health-care plan only covers the costs of a personal alarm system if you meet the following 5 conditions: • you have a physical disability • you have a higher-than-average chance of finding yourself in an emergency situation due to an illness, ailment or disability • should such an emergency arise, you will need to call for medical or technical assistance immediately to prevent medical complications • in such emergency situations, you would be unable to operate a cordless or mobile phone • you spend long stretches of time on your own, meaning that there is no one who can help you

A personal alarm system consists of a base station placed in the home and a wireless wearable (generally a pendant) with an alarm button. When you press this button in an emergency, this alerts the emergency response centre, where the operator will alert a family member, neighbour or your informal or professional carer.

What is not covered • ongoing subscription charges • key boxes • replacement batteries or replacement chargers • monitoring equipment to prevent cot death

Other coverage The local council will sometimes reimburse the cost of a personal alarm system if you have a ‘social indication’, i.e. you do not feel safe or secure on your own and are afraid of falling. In such a situation, there is no medical indication for the personal alarm.

If you have an indication under the Wet langdurige zorg [Long-term Care Act], the costs of your personal alarm system will be covered by your health-care provider.

Whom to contact • any supplier of personal alarm systems

What you pay

Excess You do not pay an excess, because you get the personal alarm system on loan.

Personal contribution You do not pay a personal contribution for these medical appliances.

What you have to do yourself

You must have a prescription You get the prescription for the personal alarm system from your attending doctor.

You must request our permission first We only cover the costs of a personal alarm system if you have obtained permission for this from us in advance. You can request permission using a medical indication form1, which you will need to have your doctor complete. The supplier is often allowed to give permission on our behalf; your supplier and our Service Centre can tell you if this is the case.

If your supplier cannot give permission on our behalf, you will need to ask our permission yourself. You can send your request to us using the contact form or by post.

Good to know

The official coverage specified in the Health Insurance Regulations applies Alarm systems come under the definition of Article 2.6(t) in conjunction with Article 2.26 of the Regeling zorgverzekering [Health Insurance Regulations], i.e. ‘medical appliances for communication, information transfer and signalling’. This description also applies to DAISY players.

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

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 308 Medical appliances for pain management (TENS)

For when you are constantly in pain and you cannot get sufficient relief through medicine.

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

This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to medical appliances for pain management (TENS) as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

What is covered

TENS stands for transcutaneous electrical nerve stimulation. A TENS device delivers small electrical impulses to the affected part of your body in order to reduce pain.

The basic health-care plan covers the cost of a TENS device and its accessories and consumables if you meet the following 3 conditions: • you have non-stop pain • the pain cannot be treated any other way • the TENS device proved to be effective for you during a trial period

Accessories and consumables include items like electrodes (pads), electrode gel, adhesives, leads and a carry pouch.

What is not covered • replacement batteries

Other coverage The use of a TENS device during the trial period comes under the Medical specialist coverage.

If you would like to make use of a TENS device during childbirth, that is covered by the TENS device coverage.

Whom to contact • any supplier of TENS devices

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 309 What you pay

Excess You pay an excess, because you own the TENS device.

Personal contribution You do not pay a personal contribution for these medical appliances.

What you have to do yourself

You must have a prescription For the TENS device, you need a prescription from your attending doctor or medical specialist.

You must request our permission first We only cover the costs of a TENS device if you have obtained permission for this from us in advance. The supplier is often allowed to give permission on our behalf; your supplier and our Service Centre can tell you if this is the case.

If your supplier cannot give permission on our behalf, you will need to ask our permission yourself. You can send your request to us using the contact form or by post.

Good to know

The official coverage specified in the Health Insurance Regulations applies A TENS device comes under the definition of Article 2.6(y) of the Regeling zorgverzekering [Health Insurance Regulations], i.e. ‘external electrical nerve stimulation devices to treat chronic pain, and the related accessories and consumables’.

Medical appliances for thrombosis

For when you have a blood clotting issue.

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

This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to medical appliances for thrombosis as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 310 What is covered

Thrombosis occurs when blood in the body clots when it should not. Such a clot can have serious consequences, such as blocking a vein in your leg, or dislodging and obstructing blood vessels in the lungs (causing a pulmonary embolism), or vessels in the heart (causing a heart attack) or in the brain (causing a stroke). Checking the time it takes the blood to coagulate (clot) can help reduce the risk. Self-testing devices (also called point-of-care coagulometers or INR test meters), can be used to test how fast the blood clots. These determine the International Normalized Ratio (INR) level, and if the results are not what they should be, the dosage of the anticoagulant can be adjusted.

The basic health-care plan covers the cost of a self-testing device and the related accessories and consumables if you meet the following 2 conditions: • you have an illness or ailment that poses an increased risk of thrombosis • you need a self-testing device on a long-term basis, or you are unable to visit the thrombosis service due to your work

Accessories and consumables include test strips, a lancing device with lancets and the quality control solution specific to the self-testing device.

Other coverage Anticoagulants come under the Medicines (basic health-care plan) coverage.

If you have your blood tested by the thrombosis service, or if they have given you a self-testing device to test your INR levels at home, this comes under the Thrombosis service coverage. The thrombosis service also provides you with the training you need to use the self-testing device, guidance on the measurements and advice on the use of anticoagulant medicines.

Whom to contact • any supplier of an INR self-testing device

What you pay

Excess You pay an excess, because you own the self-testing device.

Personal contribution You do not pay a personal contribution for these medical appliances.

What you have to do yourself

You must have a prescription You get the prescription for the self-testing device from your attending doctor.

You must request our permission first We only cover the costs of self-test equipment if you have obtained permission for this from us in advance. You can send your request to us using the contact form or by post.

Good to know

The official coverage specified in the Health Insurance Regulations applies Medical appliances for thrombosis come under the definition of Article 2.6(n) of the Regeling zorgverzekering [Health Insurance Regulations], i.e. ‘an external appliance used for disorders in the functions of the haematological system’.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 311 Modifications in the home and other costs for home dialysis

For when you have a medical indication for dialysis at home.

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

This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to modifications to the home and other costs for home dialysis as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

What is covered

With dialysis, waste products and excess fluid are removed from the blood when the kidneys stop working properly. Dialysis can be done in the hospital, at a dialysis clinic or at home.

If you need dialysis at home, it could be that your home will need to be modified, permanently or temporarily. The basic health-care plan covers modifications to the home needed for dialysis, and it also covers the costs of reversing the modifications when they are no longer needed.

You also receive a weekly allowance to help cover the extra costs (of water and electricity). Below you can see the amount of this weekly allowance for the various situations.

Haemodialysis 1 to 3 times a week: €45.86 per week Haemodialysis 4 to 5 times a week: €73.53 per week Haemodialysis 6 to 7 times a week: €96.09 per week CAPD1: €28.72 per week CCPD2: €40.38 per week

You claim the weekly allowance using the home dialysis claim form3.

Other coverage The equipment for home dialysis is supplied by the hospital or dialysis clinic and is covered under the Dialysis coverage.

What is not covered • you do not get a weekly allowance for weeks when you are not carrying out dialysis at home, because you are in hospital or on holiday. You must indicate this on the claim form

Whom to contact • contractors who can modify your home to prepare it for the dialysis treatments

1 Continuous Ambulatory Peritoneal Dialysis 2 Continuous Cyclic Peritoneal Dialysis 3 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

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 312 What you pay

Excess The covered costs of modifications to your home and other covered costs are subject to the excess.

Personal contribution You do not pay a personal contribution towards the covered costs of modifications to your home and other covered costs.

What you have to do yourself

You must have a prescription You get the prescription for the modifications to your home and the weekly allowance for the costs of electricity for home dialysis from your attending doctor.

You must request our permission first In some cases, we only cover the costs of the medical appliance concerned if you have obtained permission1 from us in advance. You will need to send an itemised quotation for the home modifications along with your request. You can send your request to us using the contact form or by post.

Good to know

The official coverage specified in the Health Insurance Regulations applies Home modifications and other costs for home dialysis come under the definition of Article 2.6(hh) in conjunction with Article 2.29 of the Regeling zorgverzekering [Health Insurance Regulations], i.e. ‘costs associated with home dialysis’.

DAISY players

For when you are unable to read without the assistance of a medical appliance.

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

This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to a DAISY player as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

1 More information is available at: https://www.onvz.nl/zelf-regelen/toestemming-vragen

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 313 What is covered

DAISY stands for Digital Accessible Information SYstem. You can use a DAISY player to listen to books or magazines and many of these devices even allow you to ‘flip through the pages’. DAISY players are commonly used by people with a motor impairment, dyslexia or visual impairment who, as a result, cannot read printed text on their own (or not easily).

There are various types of DAISY players. A table-top model is a larger, sturdier player with speakers and a built-in CD player. A portable DAISY player is much smaller (making it easier to carry with you) and works with a memory card. A third option is an online DAISY player with internet access to audio files. Which model is suitable for you depends on the reason why you need the DAISY player, the form of spoken material and your age.

The basic health-care plan covers the costs of the DAISY player if you meet the following 3 conditions: • you have a serious medical condition that limits the movement of a body part and/or adversely affects your posture (i.e. a ‘motor impairment’), or you are blind or visually impaired, or no further progress can be made in the treatment of your dyslexia • due to this condition or disability you are unable to read unaided • other medical appliances do not work well enough in your situation and you need a DAISY player to be able to read

What is not covered • CDs, or other devices or files containing audiobooks, audio textbooks or magazines in audio form • subscriptions to any of the above • DAISY software

Other coverage There are various medical appliances that can help you if you have difficulty reading due to a motor impairment. These are covered under the Medical appliances for problems with movement and the Orthoses sections.

There are also various medical appliances that can help you if you have a visual impairment. These are covered under the Medical appliances for problems with sight and the Glasses and contact lenses with a medical indication sections.

Local councils sometimes cover the costs of dyslexia treatment.

If you mainly need the DAISY player for work or to follow courses, you can request it through the Dutch Employee Insurance Agency UWV.

Whom to contact • any supplier of DAISY players

What you pay

Excess You pay an excess, because you own the DAISY player.

Personal contribution You do not pay a personal contribution for these medical appliances.

What you have to do yourself

You must have a prescription You get the prescription for the DAISY player from your attending doctor.

If you need the DAISY player because no further progress can be made in the treatment of your dyslexia, you must have a statement from a remedial educationalist or health psychologist. A statement from your general practitioner or educational institution will not suffice.

You must request our permission first We only cover the costs of a DAISY player if you have obtained permission for this from us in advance. The supplier is often allowed to give permission on our behalf; your supplier and our Service Centre can tell you if this is the case.

If your supplier cannot give permission on our behalf, you will need to ask our permission yourself. You can send your request to us using the contact form or by post.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 314 Our permission is required for replacement within 5 years The expected service life of a DAISY player is 5 years. If you need to have your DAISY player replaced before 5 years have passed, we only reimburse the costs of replacement if your DAISY player no longer works properly. You must request our permission1 for this in advance.

Good to know

The official coverage specified in the Health Insurance Regulations applies In connection with motor impairment, DAISY players come under the definition of Article 2.6(e) in conjunction with Article 2.12 of the Regeling zorgverzekering [Health Insurance Regulations], i.e. ‘an external appliance relating to disorders of the locomotor system’. This description also applies to medical appliances for problems with movement, orthopaedic footwear, temporary transfer aids, orthoses and a service dog (mobility assistance dog) when these are intended to alleviate problems with movement.

In connection with visual impairment, DAISY players come under the definition of Article 2.6(f) in conjunction with Article 2.13 of the Regeling zorgverzekering, i.e. ‘an external appliance relating to visual impairments’. This description also applies to medical appliances for vision problems, glasses and contact lenses with a medical indication and a service dog (guide dog) when these are intended to alleviate problems with sight.

In connection with dyslexia, the DAISY players come under the definition of Article 2.6(t) in conjunction with Article 2.26 of the Regeling zorgverzekering, i.e. ‘a medical appliance for communication, information transfer and signalling’. This description also applies to personal alarm systems.

Service dogs

For when you are unable to move, see or hear without the help of a dog.

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

This coverage is part of the coverage for Medical appliances. The provisions that apply to medical appliances in general apply to service dogs as well, i.e. the basic rules for medical appliances apply, as do the general rules and regulations.

1 For this, see: https://www.onvz.nl/zelf-regelen/toestemming-vragen

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 315 What is covered

A service dog is a dog that has been specially trained to help people with serious disabilities go about their daily business. There are various types of service dogs: a guide dog can assist you if you are blind; a hearing dog can help if you are deaf; and a mobility assistance dog is trained to provide assistance if you have mobility issues. Below, we explain the situations in which we reimburse the costs of a service dog.

Guide dog A guide dog helps you get about safely, both at home and outdoors in pedestrian traffic and around vehicular traffic. They can help you navigate around obstacles and warn you when something unexpected arises.

We reimburse the costs of a guide dog if you meet the following conditions: • you are blind or have a visual impairment that is so severe that you are unable to live independently at home or take part in society without the help of a guide dog • you cannot live independently at home or take part in society through the use of other medical appliances covered under the Medical appliances for problems with sight, Glasses and contact lenses with a medical indication and/or DAISY players coverage

Hearing dog A hearing dog alerts you to important sounds in your environment such as a smoke alarm at home or the siren of a passing ambulance in traffic.

We reimburse the costs of a hearing dog if you meet the following conditions: • you are completely deaf and, as a result, you have problems with mobility and are limited in your ability to carry out activities of daily living (ADLs) • these problems cannot be fully addressed using the medical appliances listed under the coverage for Medical appliances for problems with hearing, or for Hearing aids • you need a hearing dog to provide support with mobility and ADLs by alerting you to sounds in the environment

Mobility assistance dog A mobility assistance dog helps you carry out activities of daily living (ADLs) like turning on and off lights, opening and closing doors, bringing you objects you need and doing the washing.

We reimburse the costs of a mobility assistance dog if you meet the following conditions: • you have a serious ailment and, as a result, you have problems with mobility and are limited in your ability to carry out ADLs • these problems cannot be fully addressed using the medical appliances listed under the coverage for Medical appliances for problems with movement, Orthoses, Orthopaedic footwear and/or DAISY players • you therefore need a mobility assistance dog because such a dog makes a significant contribution to your mobility and completion of ADLs

For all service dogs We also provide a care allowance of a maximum of €260 per 3 months for food, medical and other care for your guide dog, your hearing dog or your mobility assistance dog. You receive this care allowance in the month after the 3-month period to which the allowance applies, so in April you receive the allowance for January, February and March, for instance.

What is not covered • a service dog if the problems posed by your ailment can be sufficiently addressed through the use of other medical appliances • a service dog for any other conditions like epilepsy, PTSS, autism or diabetes

Other coverage There are many other medical appliances that can help a person who has problems with sight, hearing or mobility.

Other medical appliances for vision problems are covered under the Medical appliances for problems with sight, Glasses and contact lenses with a medical indication and DAISY players coverage.

Other medical appliances for hearing impairments are covered under the Medical appliances for problems with hearing and Glasses and contact lenses with a medical indication coverage.

Other medical appliances for problems with movement are covered under the Medical appliances for problems with movement, Orthopaedic footwear, Orthoses, Short-term loan (of medical appliances for problems with movement) and Daisy players coverage.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 316 Whom to contact • for a guide dog: a recognised training centre for guide dogs • for a hearing dog: a recognised training centre for hearing dogs • for a mobility assistance dog: a recognised training centre for mobility assistance dogs

What you pay

Excess You do not pay an excess, because you always get the service dog on loan. However, you do pay an excess for the 3-monthly €260 care allowance.

Personal contribution You do not pay a personal contribution for a service dog.

What you have to do yourself

You must have a prescription You must have both a medical needs assessment referral [medische indicatiestelling] and an in-practice assessment referral [praktische indicatiestelling]: the medical needs assessment referral states that you need a service dog, because other medical appliances are not effective in your situation, and the in-practice assessment referral states that a service dog will truly help you in practice. • You get the medical needs assessment referral for a guide dog from a regional institute for the blind and visually impaired, and the in-practice needs assessment referral is issued by a recognised training centre for guide dogs. • You get the medical needs assessment referral for a hearing dog from your occupational therapist, and the in-practice needs assessment referral is issued by a recognised training centre for hearing dogs. • You get the medical needs assessment referral for a mobility assistance dog from your occupational therapist, and the in-practice needs assessment referral is issued by a recognised training centre for mobility assistance dogs.

You must request our permission first We only cover the costs of a service dog if you have obtained permission for the dog from us in advance. You can send your request to us using the contact form or by post. However, the training centre will often request this permission on your behalf.

Good to know

The official coverage specified in the Health Insurance Regulations applies Mobility assistance dogs come under the definition of Article 2.6(e) in conjunction with Article 2.12 of the Regeling zorgverzekering [Health Insurance Regulations], i.e. ‘an external appliance relating to disorders of the locomotor system’. This description also applies to medical appliances for problems with movement, orthopaedic footwear, temporary transfer aids, orthoses and DAISY players when these are intended to alleviate problems with movement.

Guide dogs come under the definition of Article 2.6(f) in conjunction with Article 2.13 of theRegeling zorgverzekering, i.e. ‘an external appliance relating to visual impairments’. This description also applies to medical appliances for vision problems, glasses and contact lenses with a medical indication and DAISY players when these are intended to alleviate problems with sight.

Hearing dogs come under the definition of Article 2.6(c) in conjunction with Article 2.10 of theRegeling zorgverzekering [Health Insurance Regulations], i.e. ‘an external appliance relating to hearing disorders’. This description also applies to other medical appliances for hearing impairments and to hearing aids.

2019 ONVZ coverage of medical appliances under the basic health-care plan – version 1.2 317 Index Coverage

Coverage Index

A Abroad: non-urgent (scheduled) health care 209 Abroad: urgent health care 207 Abroad: vaccinations and prophylactics 212 Acne treatment 191 Adoption, health care upon 128 Aid for third-party claims for injury 217 Alternative/non-conventional medicine 173 Ambulance, medical transportation by 200 Antenatal screening 118 Arch supports supplied by an orthopaedic technician 103 Audiological health care 176

B Bed wetting alarm 129 Breast cancer: additional tests 59 Breast prostheses 250 Breastfeeding: breastfeeding specialist 127

C Carer relief 82 Childcare in case of hospital admission of a parent 70 Combined lifestyle intervention for overweight patients 36 Compression stockings 296 Contraceptives 169 Cosmetic camouflage instruction 192 CPAP machine 254

D DAISY players 313 Dental health care after an accident 148 Dental health care from the age of 18 145 Dental health care up to the age of 18 143 Dental prosthesis (‘prosthesis’) from the age of 18 153 Dental surgery from the age of 18 157 Diagnostics for primary health care 28 Dialysis 61 DiamondClean Smart electric toothbrush 160 Dietary preparations 140 Dietetics 138 Domestic assistance 85 Dressings 281

E Electrical epilation and laser treatment 194 Exercise programmes during and after cancer 99 Exercise programmes in cases of chronic illness 97

F Feeding pump and feeding tube 304 Fertility treatment 54 Foot care for diabetes sufferers 30 Foot specialist treatment and podiatry/chiropody 93 Front-teeth replacement 155

2019 ONVZ A-Z coverage 319 G General basic mental health care (GGZ) 163 General practitioner 27 Geriatric rehabilitation 108 Glasses and contact lenses with a medical indication 269 Glasses, (contact) lenses and laser eye treatment 182 Guest house 68

H Health care for sensory impairment 179 Health care upon adoption 128 Health check-up/sports check-up 45 Health resort 113 Hearing aids and tinnitus maskers 274 Help for carers 83 Hereditary diseases, testing for 57 Hospice 86 Hospital admission 50 Hospital admission: assistance and extra services before and after 73 Hospital admission: extra luxury and comfort 71

I In vitro fertilisation (IVF) 55 Incontinence products 287 Individual budget under the Zorgverzekeringswet [Health Insurance Act] (Zvw-pgb) 78 Influenza vaccination 35 Infusion pump 301

M Maternity care 122 Maternity package 124 Mechanical respiration 63 Medical appliances 187 Medical appliances for diabetes 298 Medical appliances for nursing and care in bed 290 Medical appliances for pain management (TENS) 309 Medical appliances for problems with hearing 276 Medical appliances for problems with movement 259 Medical appliances for problems with sight 271 Medical appliances for respiratory conditions 251 Medical appliances for skin conditions 279 Medical appliances for speech disorders 306 Medical appliances for thrombosis 310 Medical appliances for urinary and bowel incontinence 284 Medical appliances for vascular conditions 295 Medical appliances: contraceptive devices 289 Medical specialist 48 Medicines, basic health-care plan 132 Medicines, supplementary health-care plans 134 Membership of a patients’ association or advocacy group 115 Menopause consultant 44 Modifications in the home and other costs for home dialysis 312 MRA 255

N Nursing and other care at home 76

2019 ONVZ A-Z coverage 320 O Occupational therapy 110 Oedema and scar therapy 95 Organ transplants and donation 60 Orthodontics from the age of 18 152 Orthodontics up to the age of 18 150 Orthopaedic footwear and orthotics for footwear 263 Orthoptics 177 Orthoses 268 Other medical transportation 201 Over-the-counter medication and proton-pump inhibitors 136 Oxygen therapy equipment 257

P Pedicure for people with diabetes and rheumatoid arthritis 197 Personal alarm system 307 Physiotherapy/remedial therapy from the age of 18 91 Physiotherapy/remedial therapy up to the age of 18 89 Plastic surgery 52 Post-op shoes 283 Posture, movement and sport 100 Pregnancy and childbirth 120 Preventive health-related courses 40 Preventive medical investigations and pharmacogenetic testing 42 Primary-care admissions 80 Prostheses 247 Protective headgear 302 Provisionally approved treatments 64 Psoriasis day treatment 195 Psychological health care with a general practitioner 32

Q Quitting smoking 38

R Rehabilitation (specialist medical) 107 Reimbursement in exceptional cases 216

S Second opinion 66 Service dogs 315 Short-term loan (of medical appliances for problems with movement) 265 Specialist dental care 158 Specialist mental health care (GGZ) 165 Speech therapy 181 Stay in a guest house 68 Sterilisation and reversal operation 170 Stuttering therapy 184 Superfit accident coverage, Superfit accident coverage rules and regulations 219, 232 Support pessary 189 Swimming programmes aimed at keeping senior citizens fit 104 Syringes and injection pens to self-administer medicine 293

T TENS device 126 Therapeutic camp for young people 114 Thrombosis service 33 Travel costs for visiting ill people 204

2019 ONVZ A-Z coverage 321 W Walking aids 102 Wereldfit: early return 225 Wereldfit: hospital care in Belgium and Germany 222 Wereldfit: reimbursement in the event of death 227 Wereldfit: repatriation 223 Wereldfit: replacement driver 229 Wigs 246

Z Zorghotel 112

2019 ONVZ A-Z coverage 322 De Molen 66 Postbus 392 3990 GD Houten 030 639 62 22

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