Basic healthcare insurance Uitzendpolis 2016

What is important to know and which conditions apply?

Public healthcare insurance Uitzendpolis

2016

Eno Zorgverzekeraar N.V.

Eno Aanvullende Verzekeringen N.V.

These insurance conditions take effect on 01 January 2016. Previous insurance conditions will lapse with effect from that date. Contents Excess General provisions 5. When does the compulsory excess apply?...... 15 6. When does the voluntary excess apply?...... 15 Provisions which apply to the public healthcare 7. Which rules are applicable to compulsory insurance and the supplementary insurances and voluntary excess?...... 15

Invoices and payment Insurance cover general 1. How do we allocate the costs of care?...... 6 8. Which services are insured?...... 16 2. How do you submit an invoice?...... 6 9. Which restrictions apply in case 3. When do we pay?...... 7 of concurrence with other provisions?...... 16

Taking out and terminating insurances Cover and reimbursement in the Netherlands 4. How do you take out an insurance policy?...... 7 10. What is the cover in the Netherlands?...... 16 5. How long do you take out the insurance for?...... 7 11. How is the amount of reimbursement in the Netherlands 6. What happens if you change your mind?...... 7 calculated?...... 17 7. When does the insurance end?...... 8 8. How can you cancel the insurance?...... 8 Cover and reimbursement abroad 9. How does it work if you are insured through 12. What is the cover abroad?...... 17 the Healthcare Institute?...... 8 13. How is the amount of reimbursement abroad determined?..17 10. When may we cancel or suspend the insurance? ...... 9 11. What happens to your insurance if you are in detention?...... 9 Cover per care type General practitioner care...... 18 Premium Preventive foot care...... 18 12. How is the premium made up?...... 9 Medical specialist care (general) ...... 19 13. How must you pay the premium?...... 9 Second opinion...... 20 Transplant care...... 20 Important rules Rehabilitation care...... 21 14. Who are the insurances designed for?...... 9 Geriatric rehabilitation care...... 21 15. Which information requirements must you meet?...... 9 Dialysis without admission...... 22 16. What should you do if someone else is liable Artificial respiration...... 22 for the care costs?...... 10 Oncological examination in children...... 23 17. What limits to liability apply?...... 10 Thrombosis care...... 23 18. How do we handle your personal data?...... 10 Genetic advice...... 23 19. How do we act in case of fraud?...... 11 Audiological care...... 23 20. How can you become a member of the cooperative?...... 11 Sensory disability care...... 24 21. What restrictions apply in the case of exceptional Obstetric care...... 24 circumstances?...... 11 Maternity care...... 25 22. When are we allowed to amend the policy conditions?...... 11 Physiotherapy and remedial therapy...... 25 23. What is the process for requesting and granting Speech therapy...... 26 authorisation?...... 11 Occupational therapy...... 27 24. How can you submit a complaint?...... 12 Dietetics...... 27 Integrated care...... 27 Dental care...... 28 Orthodontics in special cases...... 29 Public healthcare insurance Medicinal care...... 29 In-patient care...... 31 Specific provisions for public Nursing without in-patient care...... 31 healthcare insurance Ambulance transport...... 32 Seated patient transport...... 33 Taking out and terminating public Basic mental healthcare...... 34 healthcare insurance Specialist mental healthcare...... 34 1. When can we refuse you?...... 13 Medical aids...... 35 2. What is the basis for the public healthcare insurance?...... 13 Giving up smoking...... 36 Conditional care...... 36 Premium 3. When do you not have to pay a premium?...... 13 4. What happens if you get behind on your payments?...... 14 Supplementary insurances Uitzendpolis Speciaal and Uitzendpolis No Risk Specific provisions for supplementary insurances

Taking out and cancelling supplementary insurance 1. When can you take out the supplementary insurance?...... 37 2. How do you take out supplementary insurance?...... 37 3. When does the supplementary insurance start?...... 37 4. When does the supplementary insurance end?...... 37

Premium 5. How is the premium made up?...... 38

Insurance cover general 6. When are you entitled to reimbursement?...... 38

Specific restrictions for supplementary insurance 7. When does a waiting time apply?...... 38 8. Which general restrictions apply to the insurance cover?...... 38 9. What restrictions apply in the case of exceptional circumstances?...... 38 10. Which restrictions apply in case of concurrence with other provisions?...... 38

Cover and reimbursement per care form Medically necessary repatriation...... 39 Transport of mortal remains...... 39 Emergency dental care in the Netherlands...... 39 Compulsory and voluntary excess...... 40

What do all the terms mean?...... 41 General provisions Provisions which apply to the public healthcare insurance and the supplementary insurances

The provisions in the General Provisions chapter apply to the right to reimbursement of that invoice lapses. In the public healthcare insurance and the supplementary that case, we will claim back any money reimbursed insurances. incorrectly; • the invoice is drawn up in Dutch, English, French, German, Invoices and payment Polish, Spanish or Turkish. If the invoice is drawn up in a different language, we may not process the invoice,

General provisions General 1. How do we allocate the costs of care? unless you enclose a certified translation of the invoice; The costs of care are allocated to the calendar year in • along with the invoice for medical expenses abroad, you which you received the care. If you received the care in two send a completed and signed Foreign Claim Form. The successive calendar years but the care has been charged as a Foreign Claim Form can be viewed and downloaded via single sum, the care is allocated to the calendar year in which www.hollandzorg.nl. Alternatively, we will send this to you the care started. on request. • the original invoice is clearly legible. The costs of a DBC (Diagnosis Treatment Combination) care product are allocated to the calendar year in which the DBC or Care-related invoices must be submitted within 12 months of the DBC care product commenced. the end of the calendar year in which you received the care. This means the treatment or delivery date and not the date 2. How do you submit an invoice? on which the invoice was issued. If the care is described as You are not supposed to receive an invoice for care provided DBC (care product), you must submit the invoice within 12 by a contracted care provider. A contracted care provider will months of the moment the DBC or the DBC care product is send the invoice directly to us. If you go to a non-contracted terminated. care provider, you can claim the invoice yourself. If you submit an invoice after the 12-month period, we may We will process an invoice if the following conditions have decide to reimburse the invoice partially or not at all. Invoices been met: submitted three years after the treatment or delivery or the • The invoice contains the name, address and profession date on which the DBC or DBC care product is terminated are of the care provider, invoice date, date on which the care never eligible for reimbursement. was provided and description of that care, name, date of birth and citizen's service number (BSN) or, failing that, the If you submit a hardcopy invoice, appendices or other national insurance number of the insured party. documents to us, we will not return them. If you so wish, we • The invoice is submitted in one of the following ways: will provide you with a certified copy of the documents we -- the original invoice has been handed in to us or received from you. submitted by post; or -- the electronic/scanned invoice is submitted via You are not permitted to transfer any current or future claims www.hollandzorg.nl (Mijn HollandZorg). In that case, against us to another natural person or legal entity. This you must - for verification purposes - keep the original ban must be interpreted as a stipulation with property-law invoice for a period of two years after having submitted consequences as referred to in Section 3:83, subsection 2, of the copy. We may ask you to send us the original invoice the Netherlands Civil Code. after all. If we do not receive the original invoice,

6 3. When do we pay? (policyholder) and the person to be insured a confirmation In principle, we will reimburse an invoice submitted by you of receipt for the additional information, stating the date on within 5 working days of receiving the invoice. All conditions which we received it. for (partial) reimbursement will have to be met by then. An invoice will take longer to process if it is not complete. The If the public healthcare insurance commences within four processing status can be followed via Mijn HollandZorg. months of the obligation to take out healthcare insurance coming into force, the public healthcare insurance will be We are entitled to pay the costs of care directly to the care backdated to the date on which the obligation to take out provider who has provided the care. Your entitlement to healthcare insurance arose. reimbursement is nullified by that payment. If, on the day of the request, the person to be insured already If we pay a care provider more than we are obliged to under has a health insurance contract, the public healthcare the insurance, you are deemed to have authorised us to collect insurance will commence on the later date on which you these additional costs. We may also charge you (insured party/ (policyholder) wish the public healthcare insurance to policyholder) for the amount paid in excess. You (insured commence. party/policyholder) must pay us the amount paid in excess. If the public healthcare insurance commences within We reimburse the costs of care and other amounts payable to a month of an earlier health insurance contract being you (insured party/policyholder) by transferring the money terminated through cancellation as of 1 January of a into the policyholder's bank account which we have in our calendar year or due to changes to the conditions subject to records. If you do not want this, please let us know in writing application of Section 7:940, subsection 4 of the Netherlands General provisions in good time. Your entitlement to reimbursement is nullified Civil Code, the public healthcare insurance will be backdated by the payment to the policyholder. to the day on which the earlier health insurance contract was terminated. We can set off the reimbursement of costs for care and other amounts payable to you (insured party/policyholder) against We will provide you (insured party/policyholder) with a policy premiums, interest, costs or other amounts owed to us. document as soon as possible after the insurance is taken out and subsequently at the start of each new calendar year. We deduct the statutory personal contribution from the reimbursement for the costs of care which falls under the If you (insured party/policyholder) have given us your consent public healthcare insurance, unless the statutory personal to send the policy document electronically, you (insured party/ contribution has already been settled with the care provider. policyholder) are entitled to withdraw that consent. You can do so as follows: We reimburse the costs of care in Euros. We use the exchange • in writing. Written requests must be addressed to rate applicable on the date on which the care was provided, HollandZorg, Polisadministratie, Antwoordnummer 30, 7400 where possible. VB Deventer (no stamp required); • by e-mail to [email protected]; • by completing the amendment form at Taking out and terminating www.hollandzorg.nl/wijzigen. insurances 5. How long do you take out the insurance for? 4. How do you take out an insurance policy? The insurance is taken out for one calendar year. If the You (insured party/policyholder) can make a request to take insurance commences during the course of a calendar year, it out public health insurance by sending us a fully completed is concluded for the remaining part of that calendar year. and signed request form. You can also do so by using the application form at www.hollandzorg.nl/aanmelden. We can The public healthcare insurance is tacitly renewed for one send a request form to you if you wish. calendar year on 1 January of each calendar year, unless it is terminated prematurely in the sense of these insurance The insurance commences on the day we receive your request conditions. to take out insurance. We will send you (policyholder) and the person to be insured a confirmation of receipt of the request, 6. What happens if you change your mind? stating the date on which we received it. You (policyholder) can change your mind after having taken out the insurance. In that case, you (policyholder) can If we are unable to establish whether or not the person to cancel the insurance within 14 days of receiving the initial be insured is obliged to take out public healthcare insurance, policy document. The insurance is then deemed not to have we will ask you (policyholder) for additional information. In commenced. This means we refund any premiums already that case, the public healthcare insurance for that person paid and you (insured party/policyholder) are obliged to repay to be insured commences on the day that we receive the us any healthcare costs paid by us. additional information and that information demonstrates the obligation to take out insurance. We will send you

7 You (policyholder) must cancel in one of the following ways: within 30 days of termination of employment. If we receive • in writing. Written requests must be addressed to the notice of cancellation before the starting date of the new HollandZorg, Polisadministratie, Antwoordnummer 30, 7400 health insurance, the public healthcare insurance ends on the VB Deventer (no stamp required); starting date of the new health insurance. This is usually the • by e-mail to [email protected]; day of commencement at your new employer if this is the • by completing the amendment form at first day of the calendar month, otherwise it will be the first www.hollandzorg.nl/wijzigen. day of the month after commencement of employment. In Verbal cancellations are not accepted. other cases, the insurance ends on the first day of the second calendar month following the day on which you (policyholder) 7. When does the insurance end? have cancelled. The insurance terminates on the day following that on which: • our licence entitling us to provide healthcare insurance These cancellation options do not apply for the public terminates. In that case, we will inform you (policyholder) of healthcare insurance if the outstanding premium and the termination date and reason no later than two months collection costs have not been paid and we have demanded before termination of the insurance; payment from you (policyholder) of one or more outstanding • you die. The insured party or your heirs are obliged to notify instalments for the premium payable, unless we have us of your death as soon as possible. suspended cover of the public healthcare insurance, or unless we have confirmed the cancellation to you (policyholder) In addition, the public healthcare insurance terminates on the within two weeks. day following that on which: • your obligation to take out insurance ends. You (insured/ You (policyholder) must cancel in one of the following ways: policyholder) must inform us of that fact as soon as • in writing. Written requests must be addressed to possible. If you were not subject to compulsory health HollandZorg, Polisadministratie, Antwoordnummer 30, 7400 insurance, we will terminate the public healthcare VB Deventer (no stamp required); insurance from the moment that your public healthcare • by e-mail to [email protected]; insurance incepted. We will set off the premium that has • by completing the amendment form at been paid against the care that has been reimbursed. The www.hollandzorg.nl/wijzigen. difference is either paid out or charged. Verbal cancellations are not accepted.

General provisions General • you, as a result of changes to our territory, reside outside our territory. If you (insured/policyholder) request us to provide insurance, we at the same time consider that request as a notice of 8. How can you cancel the insurance? termination of any other live, similar insurance contracts held You (policyholder) can cancel the insurance no later than with us. 31 December of any year with effect from 1 January of the following calendar year. If you (insured/policyholder) request another health insurer to provide insurance, we at the same time consider that request You (policyholder) can cancel the public healthcare insurance as a notice of termination of any other live, similar insurance of another person you have insured, and who is insured contracts held with us, from the moment that we receive a under a different health insurance. If we receive the notice copy of that request. of cancellation before the commencement date of the other health insurance, the public healthcare insurance of that 9. How does it work if you are insured other person terminates on the commencement date of the through the Healthcare Institute? other health insurance. In other cases, the public healthcare If you are insured through the Healthcare Institute within insurance of that other person ends on the first day of the the framework of measures against the uninsured, you can second calendar month following the day on which you cancel the public healthcare insurance. This is possible only (policyholder) cancelled the policy. in the two-week period from the date that the Healthcare Institute has notified you that you are insured. In addition, you You (policyholder) can cancel the insurance if we change must demonstrate that you have been given another health the insurance conditions to your disadvantage. This does insurance in the three-month period from the date of dispatch not apply if the change is the direct result of a change by the Healthcare Institute of the second administrative to a statutory regulation. We must receive the notice of penalty on account of being uninsured and the instruction to cancellation before the effective date of the change, or within take out insurance (or arrange for insurance to be taken out one month of us having announced the change. The insurance on your behalf) under a healthcare insurance policy. terminates on the day on which the change takes effect. If you are insured through the Healthcare Institute within the You (policyholder) can cancel the insurance if your framework of measures against the uninsured, you cannot participation in a group scheme ends through termination of cancel the public healthcare insurance during the first 12 your employment, and you (policyholder) take out new health months. During that period, the cancellation options under insurance and participate in a group scheme through your article 8 of these general provisions do not apply. new job immediately after that. This also applies to members of your family. We must receive the notice of cancellation

8 If you are insured through the Healthcare Institute within the framework of measures against the uninsured, we can Premium terminate the public healthcare insurance on account of an error if, in retrospect, it transpires that you were not obliged 12. How is the premium made up? to take out insurance. In that case, the public healthcare The premium is equal to the premium calculation basis, minus insurance is deemed not to have commenced. any discounts on account of a voluntary excess for example, or on account of participation in a group scheme. 10. When may we cancel or suspend the insurance? The premium calculation basis is shown in the Premium We can cancel or dissolve the insurance, or suspend cover of Appendix to these insurance conditions. the insurance: • if you (policyholder) have failed to pay the premium or other The premium calculation basis, any discounts and the amounts you (policyholder) owe us in a timely fashion. This premium due are set out in the policy. only applies if you (policyholder) have failed to make the full payment after having received a demand to pay within If the insurance does not come into force on the first day of the specified term, stating the consequences of failure a month, the premium will be calculated in proportion to the to pay. Cancellations or dissolutions on account of non- number of insured days in that month. payment will not be backdated. A suspension on account of non-payment ends on the day after that on which we have 13. How must you pay the premium? received the outstanding amount, including interest and You (policyholder) must pay your premiums in advance. Payment

costs; must be made before the first day of the period to which the General provisions • if you (insured party/policyholder) fail to give us any premium relates. We decide whether you can pay per month, per information or documents, or if you give us incomplete or six months or per year, and which form of payment is possible. incorrect information or documents that are relevant for the We can make other arrangements if it concerns a group scheme. execution of the public healthcare insurance and are or may be of detriment to us; If you fail to pay the premium or other amounts payable to us • if you (insured party/policyholder) have intentionally misled in time, we can charge you (insured party/policyholder) the us or if we would not have taken out any public healthcare statutory interest rate, collection costs and administration costs. insurance if we had been aware of the true state of affairs; • if you seriously misbehave towards us or our members of You (insured party/policyholder) are not entitled to set off staff. the premium payable or other amounts payable to us against any amounts we owe you. Neither are you (insured party/ In all cases, we will provide you (insured party/policyholder) policyholder) permitted to suspend payment if you (insured with proof of termination of the insurance. Upon termination party/policyholder) feel that we owe you (insured party/ of the public healthcare insurance, we will send you proof policyholder) an amount of money. of termination stating the details which we are required to provide under the Healthcare Insurance Act. In the event of the death of the insured party, any premium already paid relating to the period commencing on the day 11. What happens to your insurance if you are after the date of death will be refunded. in detention? The cover and obligation to pay premiums under the public healthcare insurance are suspended during the time you are Important rules detained. We cannot cancel or dissolve your public healthcare insurance as long as you are in detention. 14. Who are the insurances designed for? These insurance conditions are intended to be provided to Do not forget to state the starting and end dates of your all persons living in the Netherlands or abroad and who are detention. The starting date must be reported within one obliged to take out health insurance. month of the detention commencing. The end date must be reported within one month of the detention ending. The insurance is governed by the laws of the Netherlands. The report can be submitted by presenting a statement of detention from your penitentiary: 15. Which information requirements must you • by e-mail to [email protected]; or meet? • by post to HollandZorg, Polisadministratie, You (insured party/policyholder) are obliged: Antwoordnummer 30, 7400 VB Deventer (no stamp • to prove your identity when receiving care in a hospital required). or outpatients' department by means of a driver's licence, passport, Dutch identity card or an aliens document (proof If you in detention abroad, you must send us a statement from of ID as referred to in the Compulsory Identification Act the Minister of Foreign Affairs or a statement from the Dutch (Wet op de identificatieplicht)); probation service (Reclassering Nederland) as evidence of this • to ask the care provider treating you to notify the medical fact. advisor of the reason for treatment if the medical advisor requests such notification;

9 • to cooperate with us in obtaining all the information we You are not permitted to make arrangements with another require; person or the liability insurer of that other person which • to promptly inform us of all facts and circumstances that prejudice or may prejudice our chances of recovering the may be of importance to the correct execution of the public healthcare costs. This does not apply if you have received our healthcare insurance, including moving house, births, prior written consent. deaths, changes to bank or giro account numbers, or any facts or circumstances that have caused or may cause your If our chances of recovering the healthcare costs are public healthcare insurance to end. prejudiced as a result of your actions or omissions, we may hold you liable for the damage incurred by us and If you (insured party/policyholder) fail to meet the corresponding costs. information requirements set out in this article and the other insurance conditions, you are not entitled to the care if this is 17. What limits to liability apply? detrimental to our interests. We are not liable for damage or losses you (insured party/ policyholder) suffer as a result of the actions or omissions of a If we come to the conclusion that the public healthcare care provider who has or should have provided you with care. insurance will end or has ended, we will notify you (policyholder) of that fact as soon as possible, stating the Any liability on our part for damage or losses suffered as the reason and the date on which the insurance will end or has result of our own shortcomings in the execution of the public ended. healthcare insurance is limited to the amount of the costs that would have been borne by us in the event of the correct Our notifications to you (insured party/policyholder) apply execution of the public healthcare insurance. only if we have confirmed them in writing or, with your permission, by e-mail. If we use the most recent residential 18. How do we handle your personal data? address or e-mail address of you (insured party/policyholder) We record the personal data and execution data we receive held in our records, we will assume that you (insured party/ from you (insured party/policyholder) in our register of policyholder) have received the notification. personal data.

If you (insured party/policyholder) have given us your consent We use this data for the following purposes:

General provisions General to send notifications electronically, you (insured party/ • to conclude and execute the insurance policy; policyholder) are entitled to withdraw that consent. You can • scientific and statistical analyses; do so as follows: • to increase our customer portfolio and provide information • in writing. Written requests must be addressed to about our products; HollandZorg, Polisadministratie, Antwoordnummer 30, 7400 • to comply with statutory obligations; VB Deventer (no stamp required); • monitoring the safety and integrity of the financial sector, • by e-mail to [email protected]; including preventing and combating fraud; • by completing the amendment form at • conducting research into the quality of care as perceived by www.hollandzorg.nl/wijzigen. you.

16. What should you do if someone else is The processing of personal data is governed by the liable for the care costs? HollandZorg Privacy Regulations. You (insured party/ You may at times require care due to the actions of someone policyholder) can view and download these regulations at else, e.g. as a result of an accident. That person may be liable www.hollandzorg.nl/privacy. Alternatively, we will send this to to pay the costs of the care you consequently need. you on request.

If someone else may be liable to pay the costs of care provided In relation to a responsible acceptance, risk and fraud policy, to you, you are obliged to notify us of that fact. You can do so we can access your data at Stichting CIS, Bordewijklaan 2, 2591 as follows: XR The Hague, c/o Postbus 124, 3700 AC Zeist. The objective • by calling (0570) 687 123; of processing personal data at Stichting CIS is to manage • in writing. Address your letter to HollandZorg, Verhaal, risks for insurers and prevent fraud. More information about Antwoordnummer 30, 7400 VB Deventer (no stamp this and the Stichting CIS privacy regulations is available at required); www.stichtingcis.nl. • by e-mail to [email protected]; If relevant arrangements have been made with your care • by completing the 'accident claim' form at provider, the latter can consult your address details and policy www.hollandzorg.nl/schade. On our website you will details we have registered through the national Internet immediately be given a rough indication of whether it is portal VECOZO (Veilige Communicatie in de Zorg). This is possible for you yourself or us to recover the damages. necessary for the care provider in order to claim the costs of the care provided to you directly from us. You are obliged to provide us with the information we need to recover the costs of the care given to you from that other In some cases, your personal data may need additional person. protection, for instance because you are staying at a shelter. If you feel you need that additional protection, please let us

10 know. If we feel your notification is justified, we will take conflict, civil war, uprising, domestic riots, revolt and mutiny additional measures to protect your personal data. as referred to in article 3:38 of the Financial Supervision Act (Wet op het financieel toezicht). For the definitions of 19. How do we act in case of fraud? these terms, please refer to the text filed by the Netherlands If we identify behaviour which threatened, threatens or may Association of Insurers (Verbond van Verzekeraars in threaten the (financial) interests of our company, our staff, Nederland) on 2 November 1981 at the Registry of the District our customers or the continuity or integrity of the financial Court in The Hague. sector, we may record your personal data in the External Reference Register (EVR). This will be done in accordance with If the Minister of Finance makes use of the authority the rules of the Protocol Incident Warning system for Financial set out in article 18b, paragraph 1 of the Emergency Act Institutions. The protocol can be viewed and downloaded at on Financial Transactions (Noodwet financieel verkeer) www.hollandzorg.nl/fraude. Alternatively, we will send this and the need for care has come about due to any of the to you on request. The EVR is used by financial institutions to terrorist acts referred to in that act, you are entitled only assess the integrity of customers and business relations and to one or more services as long as the costs thereof are can be accessed by us from the central database of Stichting no higher than determined by the Minister of Finance. If CIS. the injury is caused by terrorism, the cover is limited to the amount of payment we receive subject to the claim to In the event of fraud: compensation from the Dutch Terrorism Risk Reinsurance • we may have your details recorded in the Fraud Information Company (Nederlandse Herverzekeringsmaatschappij System Holland (Fraude Informatie Systeem Holland) voor Terrorismeschade). A description of the definitions

(FISH) or other fraud identification systems recognised and the Terrorism Cover Clauses Sheet can be viewed at General provisions by the insurers. This will be done in accordance with the www.hollandzorg.nl/terrorismedekking. We can also send this rules of the FISH Protocol. The protocol can be viewed and to you on request. If we receive an additional contribution downloaded at www.hollandzorg.nl/fraude. Alternatively, by virtue of article 33 of the Healthcare Insurance Act we can send it to you on request; (Zorgverzekeringswet) or article 3.23 of the Healthcare • we may report the case to the police; Insurance Decree (Besluit zorgverzekering), you are also • we may recover the investigation costs we incurred in entitled to the additional reimbursement by virtue of these identifying and proving the fraud committed by you regulations. (insured party/policyholder); • we may terminate the insurance contract; 22. When are we allowed to amend the policy • you will not be entitled to a reimbursement of the care conditions? costs and we can demand that any compensations paid, We can change the insurance conditions with effect from a including the costs incurred to do so, are paid back. date to be set by us. A change to the premium calculation basis for the public healthcare insurance shall come into force 20. How can you become a member of the no earlier than six weeks after the date on which we have cooperative? informed you (policyholder) of that change. If you (insured party/policyholder) are of age, you (insured party/policyholder) automatically become a member of Ministerial regulations referred to in these insurance Coöperatie Eno U.A. when taking out public healthcare conditions may change during the course of a year. In that insurance. This does not apply if you (insured party/ case, the public healthcare insurance changes with effect from policyholder) have told us of your wish to opt out of this the date on which the change to the ministerial regulation in provision. The member's council of Coöperatie Eno U.A. takes question comes into force. decisions on a number of important issues. The member's council is elected from among the members. 23. What is the process for requesting and granting authorisation? Membership ceases upon death, cancellation or member In some cases you need authorisation from us for the right disqualification. to care or the reimbursement thereof. In that case, receiving the care is subject to our written authorisation. This is to Membership will be deemed to have been cancelled at the prevent problems afterwards. When assessing the request for moment that the last insurance with us has been terminated. authorisation, we verify whether the desired care meets the policy conditions. In that case, you will know if and how much 21. What restrictions apply in the case of reimbursement you will receive for the care in advance. If we exceptional circumstances? grant our authorisation, it is valid for one year, counting from You are not entitled to reimbursement of the costs of care in the date on which the written authorisation is granted. This the event of fraud, abuse or improper use of your insurance. authorisation may be valid for a shorter or longer period of This also applies if you attempt to mislead us by submitting time, if we explicitly mentioned that fact when we granted false statements or withholding facts or circumstances from the authorisation. us that could be important for assessing the costs or the entitlement to reimbursement. The request for consent always contains your name, address You are not entitled to reimbursement of the costs of care if and place of residence, as well as the name, address, place the injury is caused by, occurred during or ensues from armed of residence and profession of the care provider. For each

11 type of care, the specific conditions for the public healthcare decision. You (insured party/policyholder) should preferably insurance and the supplementary insurance explain which submit your request in one of the following ways: information should be included in the request. • written requests must be addressed to HollandZorg, Klachtencommissie, Antwoordnummer 30, 7400 VB Please send requests for consent to: Deventer (no stamp required); HollandZorg, Medisch adviseur, Antwoordnummer 30, 7400 VB • electronically by using the complaints form at Deventer (no stamp required). www.hollandzorg.nl/klachten.

If your care provider submits the request on your behalf, What if we do not respond to your request within six weeks please let us know that you agree with this. You can do so by or if you (insured party/policyholder) are not happy with signing the request. our response? In that case, you (insured party/policyholder) can present the dispute to the Healthcare Insurance We may invite you to explain your request during a Complaints and Disputes Foundation (Stichting Klachten consultation. en Geschillen Zorgverzekeringen - SKGZ), Postbus 291, 3700 AG Zeist, www.skgz.nl. This only applies if you (insured It is possible that, by virtue of the public healthcare insurance, party/policyholder) have not already presented the dispute you need care that requires authorisation and that you to a civil court. The SKGZ acts in accordance with its own have already received the authorisation for that care or the regulations. The SKGZ Ombudsman acts as the mediator in reimbursement thereof from your previous health insurer. the dispute. If mediation is impossible or yields no satisfactory In that case, the authorisation applicable to the period result, the SKGZ Disputes Committee can issue a binding issued by your previous health insurer is continued. The recommendation. For more information, visit www.skgz.nl. authorisation gives you a right to the care or, if applicable, to a reimbursement of the costs for the care in accordance You (insured party/policyholder) are entitled to submit a with the rules in our insurance conditions. Forwarding that dispute with us to the civil court at any time. authorisation to us suffices. If your previous health insurer did not specify a period, the authorisation remains valid for If you (insured party/policyholder) feel that a form we use a maximum of one year of the date the authorisation was is too complicated or unnecessary, you may ask us to review granted by your previous health insurer. that form. You (insured party/policyholder) should preferably

General provisions General submit your request in one of the following ways: You are not entitled to care which was authorised by your • written requests must be addressed to HollandZorg, previous health insurer if the care or the costs of the care Klachtencommissie, Antwoordnummer 30, 7400 VB the authorisation relates to is or are no longer insured in the Deventer (no stamp required); meantime. • electronically by using the complaints form at www.hollandzorg.nl/klachten. 24. How can you submit a complaint? If you (insured party/policyholder) disagree with a decision You (insured party/policyholder) can also submit complaints made by us within the framework of the public healthcare about the form we use to the Dutch Healthcare Authority insurance, you (insured party/policyholder) can ask us to (Nederlandse Zorgautoriteit). The Dutch Healthcare Authority reconsider such a decision. You (insured party/policyholder) will issue a binding recommendation. For more information, must submit your request within six weeks of receiving our visit www.nza.nl.

12 Public healthcare insurance Specific provisions for public healthcare insurance

The arrangements set out in the General Provisions chapter Decree (Besluit zorgverzekering) and the Healthcare Insurance apply to the public healthcare insurance and the supplementary Regulations (Regeling zorgverzekering). The public healthcare insurances. Further specific provisions apply to public healthcare insurance is also based on the application form completed by insurance. In this chapter, you can read what they are. you (policyholder) and agreements in connection with a group scheme you (policyholder) participate in.

Taking out and terminating The public healthcare insurance should be interpreted and applied in accordance with the Healthcare Insurance Act public healthcare insurance (Zorgverzekeringswet), the Healthcare Insurance Decree (Besluit zorgverzekering) and the Healthcare Insurance 1. When can we refuse you? Regulations (Regeling zorgverzekering) and the corresponding We are not obliged to provide public healthcare insurance if: explanation. • you already have health insurance; we cancelled your previous public healthcare insurance in If a provision in the insurance conditions fully or partly

• Public healthcare insurance the five years preceding the request to conclude the new contradicts a provision of the Healthcare Insurance Act, the public healthcare insurance on account of non-payment of Healthcare Insurance Decree or the Healthcare Insurance premiums or deliberate deception by you (insured party/ Regulations or the explanation, that provision or that part policyholder); of the provision in the policy conditions does not apply. The • the address of the person to be insured stated on the provision in the Healthcare Insurance Act, the Healthcare application for the public healthcare insurance is not Insurance Decree or the Healthcare Insurance Regulations recorded in the municipal Persons Database or differs applies instead. from the address of the person in the Persons Database. This provision does not apply if the person insured can All ministerial regulations or other appendixes referred to in do nothing about the discrepancy. It also does not apply these insurance conditions form part of the public healthcare if you (policyholder) submit the following to us with the insurance. application for the public healthcare insurance: -- a statement from the Social Security Bank (SVB) which shows that the insured person is insured under the Premium Exceptional Medical Expenses Act (AWBZ); -- an employer's statement and a wage slip, both no 3. When do you not have to pay a premium? older than one month, showing that the person to You (policyholder) must pay us premiums for the public be insured is liable to pay income tax as a result of healthcare insurance, except in the following cases: work performed under an employment contract in the • no premium is due by you (policyholder) for an insured party Netherlands (this provision applies from the day that the until the first day of the calendar month following the calendar Improvement of Default Measures Act (Wet verbetering month in which the insured party reaches the age of 18; wanbetalersmaatregelen) comes into force). • you (policyholder) do not have to pay us premium during the period that you have to pay the Healthcare 2. What is the basis for the public healthcare Institute an administrative premium. In that case, you insurance? will have premium arrears of more than six months. The public healthcare insurance is based on the Healthcare The administrative premium is 130% of the standard Insurance Act (Zorgverzekeringswet), the Healthcare Insurance premium referred to in the Care Allowance Act (Wet op de

13 zorgtoeslag). costs, rises to six monthly premiums or more. We will refrain from making the notification if you (insured 4. What happens if you get behind on your party/policyholder) have disputed the premium arrears payments? with us within four weeks of having been notified by us. 4.1 No more than ten working days after our records indicate arrears of two month's premium in the payment 4.5 If you (insured party/policyholder) have disputed the of the public healthcare insurance, we will make premium arrears with us within the period specified you (policyholder) a proposal to agree a repayment above, but your complaint is not upheld, we will notify arrangement. The repayment arrangement will at least you (insured/policyholder) that we will make the entail the following: notification referred to in 4.7 if the premium debt, • you (policyholder) authorise us to collect future premiums exclusive of interest and collection costs, rises to six automatically or a party from whom you (policyholder) monthly premiums or more. We will refrain from making periodically receive payment is instructed to pay us the the notification if you (insured party/policyholder), amount of the future premiums on your behalf and to within four weeks of having been notified by us, have deduct this from the payments made to you; submitted a dispute in respect of the premium arrears to • arrangements with regard to repaying your debts, SKGZ, Postbus 291, 3700 AG Zeist, www.skgz.nl, or to the including interest and collection costs, in connection civil court. with the public healthcare insurance and the repayment instalments; 4.6 If the repayment arrangement takes effect due to the • our promise that we will not terminate or suspend the premium arrears, exclusive of interest and collection public healthcare insurance during the term of the costs, having risen to four monthly premiums, we will repayment arrangement on account of the existence refrain from making the notification referred to in 4.7 for of debts, including interest and collection costs, in as long as the future premiums are paid. connection with the public healthcare insurance. This promise will be withdrawn if you (policyholder) revoke 4.7 Once the premium debt, exclusive of interest and the authorisation or instruction or fail to honour the collection costs, has risen to six monthly premiums or agreement. more, we will notify the Healthcare Institute and you (insured party/policyholder) accordingly. As part of that 4.2 If you (policyholder) took out the public healthcare notification, we will include the personal details required insurance for another party, then our offer includes by the Healthcare Institute for the execution of article our willingness to accept the cancellation of the public 34a of the Health Insurance Act. We will further state healthcare insurance of that other party, with effect that we have acted in accordance with the procedure from the date on which the repayment arrangement referred to in 4.4 to 4.7. We will refrain from making the commences, subject to the following conditions: notification referred to in the first sentence of 4.7: • the insured party has taken out other health insurance • if the premium arrears have been disputed within the on the day on which the repayment arrangement period referred to in 4.4 but we have not yet received a commences; and, response; • if the insured party has taken out the health insurance • for a period of four weeks as referred to in 4.5; with us (public healthcare insurance) and has authorised • if a dispute in respect of the premium arrears has been us to automatically collect future premiums each month submitted to the SKGZ or the civil court within the or has instructed a party from whom the insured party period referred to in 4.5 and no final and irreversible receives periodic payments (e.g. the employer) to pay decision has yet been made; us the amount of the future premiums on behalf of the • if you (policyholder) have applied to a debt counsellor insured party and to deduct this from the payments as referred to in article 48 of the Consumer Credit made to the insured party; in that case, we will send a Act, such as a municipal authority or municipal copy of our proposal to the insured party. credit institution and demonstrate that, within that Public healthcare insurance Public healthcare framework, a written agreement has been concluded in 4.3 At the same time as the proposal referred to in 4.1, we order to service your debt; will send you (policyholder) a letter stating that you • if your address is not shown in the Persons Database (policyholder) have four weeks to accept the proposal. or if the address we have for you in our records does It will also state what the consequences will be if the correspond with your address in the Persons Database. proposal is not accepted and the premium arrears, This does not apply if the discrepancy is the result excluding interest and collection costs, have risen to of the exceptional situations described in article 1, six or more months' premium. We will also remind you bullet point three of the Specific Provisions for Public (policyholder) of the option of debt counselling. Healthcare Insurance. (this provision applies from the day that the Improvement of Default Measures Act 4.4 Once the premium debt, exclusive of interest and (Wet verbetering wanbetalersmaatregelen) comes into collection costs, has risen to four monthly premiums or force) more, we will notify you (insured party/policyholder) of 4.8 We will immediately notify the Healthcare Institute and our intention to make a notification as referred to in 4.7, you (insured party/policyholder) of the date on which: if the premium debt, exclusive of interest and collection • the debts by virtue of the public healthcare insurance

14 have been repaid or cancelled; the manner prescribed by the Healthcare Insurance Act • the debt management scheme for natural persons (Zorgverzekeringswet). The basic principle is the indexation referred to in the Bankruptcy Act is declared applicable; of the minimum wage referred to in article 8.1.a of the • the written agreement referred to under 4.7, point four, Minimum Wage and Minimum Holiday Allowance Act (Wet has been concluded or a debt settlement has been minimumloon en minimumvakantiebijslag). The amount agreed in which at least you (policyholder) and we are calculated is rounded down to a multiple of € 5. participants. 6. When does the voluntary excess apply? For insured parties aged 18 or older, you (policyholder) can opt for a voluntary excess. The higher the voluntary excess, Excess the lower the premium. The voluntary excess amounts which can be selected and the associated premiums are shown in 5. When does the compulsory excess apply? the Premium Appendix to these insurance conditions. The If you are eighteen or older, you are subject to a compulsory selected voluntary excess is stated on the policy document. excess. The extent of this compulsory excess is stated in the premium appendix to these insurance conditions. If an insured turns 18 and you (policyholder) did not opt for voluntary excess previously, we will calculate the premium for The following are excluded from the compulsory excess: the public healthcare insurance of that insured without policy • the costs of obstetric and maternity care; excess. • the costs of general practitioner care. The costs of examinations which the care providers appointed by us for The following are excluded from the voluntary excess: general practitioner care ask others to perform, and which • the costs of obstetric and maternity care; are invoiced separately, such as laboratory tests, do fall • the costs of general practitioner care. The costs of under the compulsory excess. examinations which the care providers appointed by us to • the costs of registering with a general practitioner or with a perform general practitioner care ask others to carry out, GP centre; and which are invoiced separately, such as laboratory tests, • the costs of preventive foot care; do fall under the voluntary excess. • the costs of integrated care; • the costs of registering with a general practitioner or with a • the costs of nursing and care without in-patient care; GP centre; • if you are a transplant donor, the costs of follow-up checks • the costs of preventive foot care; on you after the period has lapsed during which the costs • the costs of integrated care; of care provided to you in connection with the admission • the costs of nursing and care without in-patient care; for the selection and removal of the transplant material • if you are a transplant donor, the costs of follow-up checks referred to in section e of the article on transplant care are on you after the period has lapsed during which the costs Public healthcare insurance payable under the health insurance of the recipient of the of care provided to you in connection with the admission transplant material; for the selection and removal of the transplant material • if you are the donor and the recipient of the transplant referred to in section e of the article on transplant care are material is entitled to (reimbursement of the costs of) payable under the health insurance of the recipient of the transplant care by virtue of a health insurance contract, the transplant material; costs of transport as referred to in the article on transplant • if you are the donor and the recipient of the transplant care, under i and j; material is entitled to (reimbursement of the costs of) • the costs of medicines or aids designated by us and the transplantation care by virtue of a health insurance costs of care provided to you by a care provider appointed contract, the costs of transport as referred to in the article by us in that regard. The designated medicines, aids and on transplantation care, under i and j. care providers are listed in the overview 'Designated Care Not Applicable to the Compulsory Excess'. The up- We may decide to drop one or more of the voluntary excesses to-date overview can be viewed and downloaded at offered by us. If you (policyholder) have taken out public www.hollandzorg.nl/eigenrisico. Alternatively, we will send healthcare insurance with a voluntary excess of this kind, you this to you on request. (policyholder) can opt for public healthcare insurance with a • the costs of care provided to you if you have followed a lower voluntary excess or without a voluntary excess. programme, designated by us, for diabetes, depression, cardiovascular diseases, chronic obstructive lung disease, 7. Which rules are applicable to compulsory obesity or giving up smoking. In that case, the costs and voluntary excess? must relate to the disease for which you followed that Per calendar year, the costs of care remain payable by you until programme. The designated programmes are listed in the the extent of the compulsory and possible voluntary excess in overview 'Designated Care Not Subject to Compulsory that calendar year is reached. Statutory personal contributions Excess'. The up-to-date overview can be viewed and and other costs of care that remain payable by you do not count downloaded at www.hollandzorg.nl/eigenrisico. when establishing whether the limit of the excess has been Alternatively, we will send this to you on request. reached, unless the Minister has stipulated otherwise. If we have paid the costs of care to a care provider directly, The compulsory excess is indexed on an annual basis, in without deducting the compulsory excess or any voluntary

15 excess from that payment, you (insured party/policyholder) responsible and adequate care in the discipline in question. must pay us this excess yourself. You are only entitled to care, if you may reasonably be Healthcare costs are initially charged against the compulsory regarded as being dependent on that care in terms of content excess. The healthcare costs are then charged against any and scope. The care to be provided should be effective and not voluntary excess. unnecessarily expensive or unnecessarily complicated. If your public healthcare insurance does not commence or end on 1 January of a calendar year, the compulsory excess The insurance conditions state whether or not a statutory and any voluntary excess in that calendar year are set lower, personal contribution applies, per type of care. The statutory in proportion to the number of days insured. The calculated personal contribution exists in addition to the compulsory amount is rounded off to whole Euros. and, if applicable, voluntary excess.

It may be that you (policyholder) have taken out public 9. Which restrictions apply in case of healthcare insurance with a voluntary excess, and that the concurrence with other provisions? amount of the voluntary excess changes during the course You are not entitled to the care if you are entitled to that care or of the calendar year. In that case, the final voluntary excess reimbursement of the cost thereof by law or pursuant to other for that calendar year is calculated as follows: the amount of legal provisions. The law and other legal provisions include each of the voluntary excesses is determined in proportion the Youth Act, Social Support Act 2015, municipal provisions in to the number of days insured in the year to which that relation to these acts and the Long-Term Care Act. voluntary excess relates. The excesses determined are added up together and divided by the total number of days insured The same applies if you do not want to exercise the right to in that calendar year. The calculated amount is rounded off to care or the reimbursement of costs of the care by virtue of whole Euros. that act or the legal provision.

Insurance cover general Cover and reimbursement 8. Which services are insured? in the Netherlands You are entitled to: • the care (nonmonetary) described further down in the 10. What is the cover in the Netherlands? policy conditions of the public health insurance, with the You are entitled to care in the Netherlands if: exception of physiotherapy, occupational therapy and • all conditions in connection with that care have been met speech therapy; before you receive that care. In addition to the general • reimbursement of costs for physiotherapy, occupational terms and conditions, many types of care are also subject therapy and speech therapy (refund) described further to specific conditions, such as the need for a referral, a down in the insurance conditions of the public health prescription or our prior written authorisation before you insurance. Whenever the general clauses (the clauses that receive the care. The policy conditions refer to the general do not form part of the section Insurance claims per type of terms and conditions in the chapters General Provisions and care) in these insurance conditions refer to 'entitlement to Specific Provisions for the public healthcare insurance. The care', for these types of care this should read 'entitlement to specific conditions that apply to a certain type of care are reimbursement of the costs of care'. stated per type of care; and • provision of information and mediation by us in order • the care provider from whom you receive the care has been to obtain care, if you ask us to do so. You can do so via appointed by us. The insurance conditions stipulate which www.hollandzorg.nl/zorgadvies. You can also contact our care providers they are per type of care. It is often a group Care Advice Line on (0)570 687 123. of care providers with a particular licence, registration or training. In some cases it is a specific care provider. Public healthcare insurance Public healthcare In principle, you must use the care provided by contracted care • You may still receive care from a care provider not providers. Contracted care providers are listed at appointed by us: www.hollandzorg.nl/zorgzoeker. You can also contact our Care -- if we have granted our written authorisation, prior to you Advice Line on (0)570 687 123. receiving the care; or -- if a care provider provides the care under the If the care provided by a contracted care provider is not responsibility of the practitioner in charge that has available, not available in time or only at a great distance been appointed by us and the care is charged by the from your place of residence or temporary place of residence practitioner in charge or the institution the practitioner abroad, you are still entitled to reimbursement of the costs in charge works for. Specific conditions may be stipulated of care from a non-contracted care provider. The extent of per type of care and which a secondary practitioner must the reimbursement is described further down in the policy meet; and conditions. • you receive the care at a location which may be regarded The content and scope of the care are partially determined as customary, given the nature of the care and the by the state of the art and practice. If there is no such circumstances. benchmark, it is determined by that which is regarded as

16 11. How is the amount of reimbursement in training to care providers in the Netherlands. Qualifications the Netherlands calculated? that meet Directive 2001/19/EC, OJ EC L206 for physicians, You are entitled to care provided by a contracted care provider dentists, obstetricians, nurses and dispensing chemists in the Netherlands, subject to a maximum of the rate we have who are trained in one of the EU countries, are deemed to agreed with that care provider. In some cases, the agreement comply with this. between us and the care provider ends the moment you receive care from that care provider. In that case, you are Please contact our emergency centre if you require care entitled to reimbursement of the costs of the remaining care when abroad. You should always contact them if you need to be provided by this care provider subject to a maximum of urgent medical assistance. Our emergency centre will help the competitive rate which applies for that care in the you find care. They can also give you information about the Netherlands (the competitive Dutch rate). reimbursement of the care.

Contracted care providers are listed at 13. How is the amount of reimbursement www.hollandzorg.nl/zorgzoeker. You can also contact our Care abroad determined? Advice Line on (0)570 687 123. If you reside or are temporarily staying in an EU, EEA or Treaty country other than the Netherlands, which also includes a You are entitled to reimbursement of the costs of care temporary stay for scheduled care, you are entitled, for care provided by a non-contracted care provider in the provided by a non-contracted care provider in that country or Netherlands: another EU, EEA or Treaty country, at your discretion: a. if we apply a maximum rate for that care, subject to a a. to reimbursement of the costs of the care you would maximum of the rate we have stipulated. The insurance have received from us if this care was provided by a non- conditions state whether or not we apply a maximum contracted care provider in the Netherlands, i.e.: reimbursement for non-contracted care, per type of care. i) if we apply a maximum rate for that care, subject The rates list can be viewed and downloaded at to a maximum of the rate we have stipulated. The www.hollandzorg.nl/tarieven. We can also send it to you insurance conditions state whether or not we apply if you wish; a maximum reimbursement for non-contracted care, b. if we do not apply a maximum rate for that care, subject per type of care. The rates list can be viewed and to a maximum of the competitive rate which applies to downloaded at www.hollandzorg.nl/tarieven. We can that care in the Netherlands (the competitive Dutch rate). also send it to you on request; The reimbursement referred to under (a) does not apply ii) if we do not apply a maximum rate for that care, if the contracted care provider cannot provide the care, subject to a maximum of the competitive rate cannot provide it in time or only at a great distance from which applies to that care in the Netherlands (the your place of residence. In that case, you are entitled to the competitive Dutch rate); reimbursement referred to under (b). b. to care or reimbursement of the costs of care in Public healthcare insurance accordance with the statutory regulations of the social healthcare insurance of that country, if that applies to Cover and reimbursement abroad you by virtue of the provisions of the applicable European social security regulations or the relevant treaty. 12. What is the cover abroad? The reimbursement referred to under i) does not apply if the You are entitled to care abroad if: contracted care provider cannot provide the care, cannot • all conditions in connection with that care have been met provide it in time or only at a great distance from your place before you receive that care. The right to care abroad is of residence or your temporary place of residence abroad. In subject to the same conditions as those for the right to that that case, you are entitled to the reimbursement referred to care in the Netherlands. This includes having a referral or a under ii) or (b). prescription or our prior written authorisation. The policy conditions refer to the general terms and conditions in the If you reside or are temporarily staying in an EU, EEA or Treaty chapters General Provisions and Specific Provisions for the country other than the Netherlands, which also includes a public healthcare insurance. The specific conditions that temporary stay for scheduled care, you are entitled, for care apply to a certain type of care are stated per type of care; and provided by a contracted care provider in that country or • we have granted you our written consent before you another EU, EEA or Treaty country, at your discretion: receive the care if it concerns care with hospitalisation • to care provided by a contracted care provider, subject of at least one night. This does not apply if the care in to a maximum of the rate we have agreed with that question is medically essential care. In this case, medically care provider. In some cases, the agreement between us necessary care is given to mean unforeseen care that and the care provider ends the moment you receive care cannot reasonably be postponed until after returning to the from that care provider. In that case, you are entitled to Netherlands; and reimbursement of the costs of the remaining care to be • the care provider giving the care holds qualifications, under provided by this care provider subject to the maximum the laws of the country where the care provider has his competitive Dutch rate. business address, that are equal to qualifications that apply • to care or reimbursement of the costs of care in accordance with to the care providers we appoint in the Netherlands. In the statutory regulations of the social healthcare insurance many cases, care providers abroad have received different of that country, by virtue of the provisions of the applicable

17 European social security regulations or the relevant treaty. Are the costs deducted from the compulsory and voluntary Contracted care providers are listed at excess? www.hollandzorg.nl/zorgzoeker. You can also contact our Care The costs of general practitioner care do not count towards Advice Line on (0)570 687 123. the compulsory and, if applicable, voluntary excess. The compulsory and, if applicable, voluntary excess do include If you reside or are temporarily staying in a country that is not the costs of laboratory testing in a hospital or independent an EU, EEA or Treaty country, which also includes a temporary laboratory at the request of a general practitioner. stay for scheduled care, you are entitled to reimbursement of the costs of care in that country: Preventive foot care a. if we apply a maximum rate for that care, subject to a What is covered? maximum of the rate we have stipulated. The insurance You are entitled to preventive foot care provided by general conditions state whether or not we apply a maximum practitioners and medical specialists if you have Diabetes reimbursement for non-contracted care, per type of Mellitus type I or II. Preventive foot care encompasses the care. The rates list can be viewed and downloaded at total package of activities within care profiles 1 to 4, as www.hollandzorg.nl/tarieven. We can also send it to you if described in the ‘2014 Care Module for the Prevention of you wish; Diabetic Foot Ulcers’. An individual care plan will determine b. if we do not apply a maximum rate for that care, subject the actual number of treatments you will receive. to a maximum of the competitive Dutch rate. The reimbursement referred to under (a) does not apply if the When screening the feet of diabetes sufferers, the Simm's contracted care provider cannot provide the care, cannot provide classification is used in order to express the risk of the feet it in time or only at a great distance from your place of residence being affected. The preventive foot care comprises: or your temporary place of residence abroad. In that case, you are • annual foot check, consisting of case history, examination entitled to the reimbursement referred to under (b). and risk inventory; • frequent specific foot examinations, the ensuing diagnosis We reimburse the costs of care in Euros. We use the exchange and treatment of skin and nail problems and deviations rate applicable on the date on which the care was provided, in the foot shape and position and the treatment of risk where possible. factors. To qualify, you must have a moderately increased (Simm's Classification 1) or increased risk (Simm's The submission of invoices for care received abroad is subject to Classification 2 and 3) of inflammation, artery problems and the conditions set out in article 2 of the General Provisions. For loss of sensation in your feet; instance, the invoice must be drawn up in Dutch, English, French, • information and encouragement to modify your lifestyle as German, Polish, Spanish or Turkish and contain a description part of the treatment; of the care provided. If the invoice is drawn up in a different • advice on suitable footwear. language, you must also enclose a certified translation of the Based on the Simm’s Classification and other factors, foot care invoice. Without such a translation, we may decide not to process to diabetics is subdivided in the care profiles. the invoice. Along with the invoice for care received abroad, you must send a completed and signed Foreign Claim Form. The Non-therapeutic actions, such as the removal of calluses for Foreign Claim Form can be downloaded via www.hollandzorg.nl. cosmetic or therapeutic reasons and the cutting of toenails, Alternatively, we will send this to you on request. do not fall under preventive foot care.

Preventive foot care can be part of integrated care. The Cover per care type conditions for the right to integrated care are stated in the article about integrated care. Preventive foot care can also be General practitioner care part of medical specialist care. The conditions for the right What is covered? to medical specialist care are stated in the article on medical Public healthcare insurance Public healthcare You are entitled to general practitioner care. General specialist care (general). practitioner care is care such as general practitioners generally provide. This type of care does not include the preventive flue What should you keep in mind? jab. Laboratory testing in a hospital or independent laboratory The following care providers are permitted to provide this at the request of a general practitioner is not included in the type of care: care either. for care profile 1: • a general practitioner who is independently established or What should you keep in mind? works in a general practitioner services structure or a GP General practitioners are entitled to provide this type of care. centre; The general practitioner may be independently established or • a podiatrist; work in a general practitioner services structure, a GP centre • a pedicure provider. or care group. for care profiles 2 to 4: Is there a statutory personal contribution? • a general practitioner who is independently established or There is no statutory personal contribution for GP care. works in a general practitioner services structure or a GP

18 centre; malformation of the facial bone structure, benign morbid • a podiatrist. growth of blood vessels, lymphatic vessels or connecting tissue, birth marks or malformation of the urinary organs You need a referral from a general practitioner or medical and genitals; specialist in order to receive foot care from a chiropodist or a • primary sexual characteristics in the event of established podiatrist. The referral must state the type of diabetes and the transsexuality. care profile. Medical specialist care does not include: If a non-contracted care provider provides the care, you must • The fourth or subsequent IVF attempt per ongoing include a copy of the referral when you submit the first pregnancy to be realised. An IVF attempt is regarded an invoice. The invoice must show which type of care has been attempt only when a follicle puncture is successful. Only provided. attempts that are subsequently abandoned count towards the number of attempts. Within the meaning of this Is there a statutory personal contribution? document, a viable pregnancy is: There is no statutory personal contribution for preventive foot -- a pregnancy lasting at least ten weeks, calculated from care. the moment that a follicle puncture succeeded; -- in the event that frozen embryos are re-implanted, Are the costs deducted from the compulsory and voluntary a pregnancy of at least nine weeks and three days, excess? calculated from the moment that the frozen embryos are The costs of preventive foot care do not count towards the re-implanted; compulsory and, if applicable, voluntary excess. -- a spontaneous pregnancy of twelve weeks after the date of the last menstruation. Do you have to pay extra for non-contracted care? An IVF attempt after a viable pregnancy is regarded as a We apply a maximum reimbursement for preventive foot care new, first attempt, even if that pregnancy was terminated provided by a non-contracted care provider. In that case, the prematurely; reimbursement is limited to the rates in accordance with the • the first and second IVF attempt, provided you are younger rates list for non-contracted care. The rates list can be viewed than 38 and one or more embryos are re-placed; and downloaded at www.hollandzorg.nl/tarieven. We can also • fertility-related care if you are a woman aged 43 or older. send it to you if you wish. If the rates of the non-contracted If the IVF treatment began before you turned 43, you are care provider are higher than our listed maximum rates, the entitled to completion of that attempt. If the IVF attempt difference will be at your expense. began on 31 December 2012 at the latest and you were aged 43 or older at that point, you are also entitled to completion Medical specialist care (general) of that IVF attempt. What is covered? paralysed or slack upper eyelids other than resulting from a

• Public healthcare insurance You are entitled to medical specialist care (general). Medical birth defect or a chronic disorder present at birth; specialist care is care such as medical specialists generally • liposuction of the stomach; provide. • the operative placement and operative replacement of a breast prosthesis other than after a full or partial breast This type of care also comprises: amputation; • medical aids which you receive as part of an admission or • the operative removal of a breast prosthesis without medical specialist treatment, provided they form (or are medical grounds; supposed to form) part of that admission or treatment. • treatment for snoring with uvuloplasty; • medicines you receive within the framework of an admission • treatment aimed at reversing the sterilisation of the insured or medical specialist treatment, provided they form (or are party (either man or woman); supposed to form) part of that admission or treatment. • treatments aimed at the circumcision of a male insured • conditionally permitted specialist medical care party; included on the Conditionally Permitted Care • an abdominal wall correction (abdominal plastic surgery), list. This list can be viewed and downloaded via except in the case of mutilation or serious functional www.hollandzorg.nl/voorwaardelijkezorg. We can also send disability; it to you if you wish. • treatment of asymmetrical distortion of the back of the head (plagiocephaly) and central flattening of the back of Plastic surgery (treatment of a plastic surgical nature) is only the head (brachycephaly) in young children using a cranial included under medical specialist care if it is carried out in remodelling helmet where there is no premature fusing of order to correct: the cranial sutures (craniosynostosis); • defects in your appearance related to demonstrable physical • Opdivo (nivolumab), insofar as prescribed within the functional disorders; framework of treating lung cancer; • mutilation resulting from a disease, accident or medical • laboratory testing at the request of an alternative care operation; provider. • paralysed or slack upper eyelids resulting from a birth defect or a chronic disorder present at birth; What should you keep in mind? • the following congenital defects: cleft lip, jaw and palate, Hospitals, medical specialists or dental surgeons who work

19 outside a hospital and independent treatment centres can Second opinion provide this type of care. What is covered? You are entitled to a second opinion. A second opinion is a You need a referral from a general practitioner, medical diagnosis by or advice about medical care to be provided by a specialist, obstetrician, youth doctor, doctor for the mentally care provider other than the care provider who made the initial disabled, specialist geriatrics doctor, sports doctor, company diagnosis or gave the initial advice. The other care provider has doctor or dentist. This condition does not apply in the case of to operate in the same discipline as the original care provider. unforeseen care that cannot reasonably be postponed. You must present the second opinion to the original care provider, who remains in control of your treatment. In order to be reimbursed for treatments on the 'Pre- Authorisation List', you must have received written What should you keep in mind? consent from us before receiving the care. The 'Pre- You need a referral from a general practitioner or medical Authorisation List' can be viewed and downloaded at specialist. www.hollandzorg.nl/toestemming. We can also send it to you if you wish. Transplant care What is covered? When applying for care, you must include a report from the You are entitled to transplant care as set out under a. below doctor in attendance, including the medical diagnosis/diagnoses, and to reimbursement of the costs of transplant care as set a description of the current problem, the proposed treatment out under b. to h. below. Transplantation care comprises: plan (care activity) and, if possible, appropriate photographs. a. transplants of tissue and organs, if the transplant is carried out in an EU or EEA country. If the transplant is Is there a statutory personal contribution? carried out in a country other than an EU or EEA country, There is no statutory personal contribution for specialist the donor must reside in that country and be your medical care. spouse, registered partner or a blood relation of the first, second or third degree; Are the costs deducted from the compulsory and voluntary b. the costs of specialist medical care in relation to excess? selection of the donor; If you are aged 18 or older, the costs count towards the c. the costs of specialist medical care in relation to the compulsory and, if applicable, voluntary excess. operative removal of the transplant material from the chosen donor; Do you have to pay extra for non-contracted care? d. the costs of examination, preservation, removal and We apply a maximum reimbursement for medical specialist transport of the transplant material from a deceased care provided by a non-contracted care provider. In that case, donor in relation to the aforementioned transplant; the reimbursement is limited to the rates in accordance with e. the costs of the care received by the donor during a the rates list for non-contracted care. The rates list can be period of no more than thirteen weeks after being viewed and downloaded at www.hollandzorg.nl/tarieven. We discharged from the institution where the donor was can also send it to you if you wish. If the rates of the non- admitted for selection or removal of the transplant contracted care provider are higher than our listed maximum material. This only applies if the care is related to that rates, the difference will be at your expense. admission. In the case of a liver transplant, a six-month instead of a thirteen-week period applies; Contracted care providers are listed at f. the costs of transport of the donor by the lowest class www.hollandzorg.nl/zorgzoeker. You can also contact our Care of public transport within the Netherlands or, if and Advice Line on (0)570 687 123. insofar as medically necessary, transport by car within the Netherlands, related to the selection, admission and discharge from the hospital and to the care referred to in subparagraph e. This does not apply if the donor has Public healthcare insurance Public healthcare health insurance. In that instance, the transport is at the expense of the donor's health insurance; g. the costs of transport to and from the Netherlands of a donor who resides abroad, in connection with the transplant of a kidney, bone marrow or liver to an insured party in the Netherlands. This does not apply if the donor has health insurance. In that instance, the transport is at the expense of the donor's health insurance; h. other costs of the transplant if they relate to the donor residing abroad. This does not include the accommodation expenses in the Netherlands and loss of income.

If someone else by virtue of health insurance is entitled to (reimbursement of the costs of) transplantation care and you are the donor, you are entitled to reimbursement of the costs of:

20 i. transport of you in the lowest class of public transport There is no statutory personal contribution for rehabilitation care. within the Netherlands or, if and insofar as medically necessary, transport by car within the Netherlands, in Are the costs deducted from the compulsory and voluntary connection with the selection, admission and discharge excess? from hospital and the care referred to in subparagraph e; If you are aged 18 or older, the costs count towards the j. transport of you to and from the Netherlands if you compulsory and, if applicable, voluntary excess. reside abroad, in connection with the transplant of a kidney, bone marrow or liver to an insured in the Do you have to pay extra for non-contracted care? Netherlands; We apply a maximum reimbursement for rehabilitation care provided by a non-contracted care provider. In that case, the What should you keep in mind? reimbursement is limited to the rates in accordance with the Hospitals can provide this type of care. rates list for non-contracted care. The rates list can be viewed and downloaded at www.hollandzorg.nl/tarieven. We can also You need a referral from a medical specialist. This condition send it to you if you wish. If the rates of the non-contracted does not apply in the case of unforeseen care that cannot care provider are higher than our listed maximum rates, the reasonably be postponed. difference will be at your expense.

Is there a statutory personal contribution? Contracted care providers are listed at There is no statutory personal contribution for transplant care. www.hollandzorg.nl/zorgzoeker. You can also contact our Care Advice Line on (0)570 687 123. Are the costs deducted from the compulsory and voluntary excess? Geriatric rehabilitation care If you are aged 18 or older, the costs count towards the What is covered? compulsory and, if applicable, voluntary excess. This does not You are entitled to geriatric rehabilitation care. Geriatric apply in the following situations. rehabilitation includes integrated and multidisciplinary rehabilitation care provided by specialists in geriatric If you are the donor, the costs of care for you are payable medicine. This involves treatment related to vulnerability, by the health insurance of the recipient of the transplant complex multi-morbidity and a decrease in learning and material referred to in this provision under ‘What is covered’, trainability. Care is aimed at reducing functional limitations in under e. If the period stated therein has expired, the costs of such a way that you can return to the home situation. follow-up checks you are submitted to are payable by your You are only entitled to the care if: basic health insurance. In that case, they are excluded from • you were hospitalised (you must have been admitted) at compulsory and, if applicable, voluntary excess. the start of the care; or the care is provided within one week of your hospitalisation

• Public healthcare insurance If you are the donor and the recipient of the transplant in connection with specialist medical care and the material is entitled to (reimbursement of the costs of) admission to the hospital was not preceded by a stay at transplant care by virtue of a health insurance contract, the a nursing home; this does not apply if you suffer from costs of transport as referred to in the article on transplant an acute condition causing acute mobility disorders care, under i and j are not included in the compulsory and, if or impaired self-reliance and you received specialist applicable, voluntary excess. medical care for that acute disorder prior to the geriatric rehabilitation care. Rehabilitation care What is covered? The duration of care does not exceed six months. In special You are entitled to rehabilitation care. Rehabilitation care cases, we may permit a longer period. comprises examinations, advice and treatment of a medical specialist, paramedical, behavioural science and rehabilitational What should you keep in mind? nature. You must need the care in order to prevent, reduce or Hospitals, rehabilitation centres and nursing homes can overcome a handicap. It must concern a handicap that is the provide this type of care. result of disorders or restrictions in the locomotor apparatus or a disorder of the central nerve system that leads to restrictions You need a referral from a general practitioner, medical in communication, intellect or behaviour. A multidisciplinary specialist, doctor for the mentally disabled or specialist team of experts, under the management of a medical specialist, geriatrics doctor. provides this type of care. For the right to geriatric care for a period longer than six What should you keep in mind? months you will need to have our written consent before the Hospitals and rehabilitation centres can provide this type of care. period of six months has elapsed. When applying for care you You need a referral from a general practitioner, medical will need to send us the following details: the reason why it is specialist, youth doctor, doctor for the mentally disabled, not possible to return home after a six-month rehabilitation sports doctor or specialist geriatrics doctor. period and the treatment plan for the further treatment, including the prognosis for recuperation and return to the Is there a statutory personal contribution? home situation and the expected duration of the further

21 treatment. There is no statutory personal contribution for dialysis care.

Is there a statutory personal contribution? Are the costs deducted from the compulsory and voluntary There is no statutory personal contribution for geriatric excess? rehabilitation care. If you are aged 18 or older, the costs count towards the compulsory and, if applicable, voluntary excess. Are the costs deducted from the compulsory and voluntary excess? Do you have to pay extra for non-contracted care? If you are aged 18 or older, the costs count towards the We apply a maximum reimbursement for dialysis care compulsory and, if applicable, voluntary excess. provided by a non-contracted care provider. In that case, the reimbursement is limited to the rates in accordance with the Do you have to pay extra for non-contracted care? rates list for non-contracted care. The rates list can be viewed We apply a maximum reimbursement for geriatric and downloaded at www.hollandzorg.nl/tarieven. We can also rehabilitation care provided by a non-contracted care send it to you if you wish. If the rates of the non-contracted provider. In that case, the reimbursement is limited to the care provider are higher than our listed maximum rates, the rates in accordance with the rates list for non-contracted difference will be at your expense. care. The rates list can be viewed and downloaded at www.hollandzorg.nl/tarieven. We can also send it to you if The contracted dialysis centres are listed at you wish. If the rates of the non-contracted care provider are www.hollandzorg.nl/zorgzoeker. You can also contact our Care higher than our listed maximum rates, the difference will be Advice Line on (0)570 687 123. at your expense. Artificial respiration Contracted care providers are listed at What is covered? www.hollandzorg.nl/zorgzoeker. You can also contact our Care You are entitled to artificial respiration. The artificial Advice Line on (0)570 687 123. respiration can be carried out at a respiratory centre or at home, on the advice and under the responsibility of a Dialysis without admission respiratory centre. What is covered? You are entitled to reimbursement of the costs of dialysis If the artificial respiration is carried out at a respiratory centre, care. Dialysis care comprises non-clinical blood dialysis this type of care comprises: (haemodialysis) and abdominal irrigation (peritoneal dialysis). • the necessary artificial respiration; The dialysis care may take place in a dialysis centre or at your • the medical specialist care, the medicinal care and the home. nursing and care related to the artificial respiration.

You are entitled to reimbursement of the costs of: If the artificial respiration is carried out at home, this type of • home dialysis equipment and accessories; care comprises: • the regular inspection and maintenance of the dialysis • the medical specialist and medicinal care related to the equipment and the chemicals and liquids required for the artificial respiration; dialysis; • the equipment needed for artificial respiration. This will • the other consumables reasonably required for home be provided to you by the respiratory centre ready for use dialysis; before each treatment. • training by the dialysis centre of those carrying out or assisting with the home dialysis; What should you keep in mind? • the required expert assistance from the dialysis centre. Respiratory centres can provide this type of care.

In addition, you are entitled to reimbursement of: You need a referral from a general practitioner or medical Public healthcare insurance Public healthcare • the costs of reasonable adjustments to be made in and specialist. around the home, and the costs of restoring the house to its original condition. This is subject to the condition Is there a statutory personal contribution? that no reimbursement is provided under other statutory There is no statutory personal contribution for artificial regulations; respiration. • other reasonable costs directly related to home dialysis. This is subject to the condition that no reimbursement is Are the costs deducted from the compulsory and voluntary provided under other statutory regulations. excess? If you are aged 18 or older, the costs count towards the What should you keep in mind? compulsory and, if applicable, voluntary excess. The care must be provided under the final responsibility of a medical specialist. Oncological examination in children You need a referral from a medical specialist. What is covered? Insured parties up to the age of 18 are entitled to central Is there a statutory personal contribution? (reference) diagnostics, coordination and registration of bodily

22 material sent in. the other persons may also be given advice.

What should you keep in mind? What should you keep in mind? Stichting Kinderoncologie Nederland (Skion) can provide this Centres for genetic advice can provide this type of care. type of care. You need a referral from a general practitioner, medical You need a referral from a general practitioner, medical specialist, doctor for the mentally disabled or specialist specialist or doctor for the mentally disabled. geriatrics doctor.

Is there a statutory personal contribution? Is there a statutory personal contribution? There is no statutory personal contribution for research into There is no statutory personal contribution for genetic advice. cancer in children. Are the costs deducted from the compulsory and voluntary Are the costs deducted from the compulsory and voluntary excess? excess? If you are aged 18 or older, the costs count towards the There is no compulsory or voluntary excess for insured parties compulsory and, if applicable, voluntary excess. under the age of 18. Audiological care Thrombosis care What is covered? What is covered? You are entitled to audiological care. Audiological care You are entitled to thrombosis care. Thrombosis care comprises: comprises: • testing the hearing function; • regular blood tests for you; • advising on the hearing aid to be purchased; • the laboratory tests required to determine the coagulation • information on the use of the aid; time of your blood under the responsibility of a thrombosis • psychosocial care, if necessary, related to problems of service; impaired hearing; • supplying you with equipment and accessories with which • assistance in establishing a diagnosis in the event of speech you can measure the coagulation time of your blood; and language disorders in children. • your training for measuring the coagulation time of your blood and using the appropriate equipment, and the What should you keep in mind? assistance you receive when taking these measurements; Audiological centres can provide this type of care. • giving you advice regarding the use of medicines to influence the coagulation. You need a referral from a general practitioner, medical specialist, youth doctor, doctor for the mentally disabled or Public healthcare insurance What should you keep in mind? specialist geriatrics doctor. Thrombosis services can provide this type of care. Is there a statutory personal contribution? You need a referral from a general practitioner or medical There is no statutory personal contribution for audiological care. specialist. Are the costs deducted from the compulsory and voluntary Is there a statutory personal contribution? excess? There is no statutory personal contribution for thrombosis If you are aged 18 or older, the costs count towards the care. compulsory and, if applicable, voluntary excess.

Are the costs deducted from the compulsory and voluntary Do you have to pay extra for non-contracted care? excess? We apply a maximum reimbursement for audiological care If you are aged 18 or older, the costs count towards the provided by a non-contracted care provider. In that case, the compulsory and, if applicable, voluntary excess. reimbursement is limited to the rates in accordance with the rates list for non-contracted care. The rates list can be viewed Genetic advice and downloaded at www.hollandzorg.nl/tarieven. We can also What is covered? send it to you if you wish. If the rates of the non-contracted You are entitled to genetic advice. Genetic advice comprises: care provider are higher than our listed maximum rates, the • the investigation into and of hereditary defects by means difference will be at your expense. of genealogical research, chromosome tests, biochemical diagnosis, ultrasound examinations and DNA tests; The contracted audiological centres are listed at • giving you advice about the heredity of disorders/defects or www.hollandzorg.nl/zorgzoeker. You can also contact our Care an apparent increased risk thereof; Advice Line on (0)570 687 123. • psychosocial guidance in connection with the advice on the Sensory disability care heredity of disorders/defects; What is covered? • the examination of persons other than yourself, should this You are entitled to sensory disability care. You qualify for be required for the advice to be given to you. In that case, this if you suffer from a serious impairment in your vision or

23 hearing or suffer from serious speech/linguistic difficulties. Is there a statutory personal contribution? Sensory disability care comprises of multidisciplinary There is no statutory personal contribution for sensory care aimed at learning to live with, the removal of or disability care. the compensation of the impairment, with the objective of allowing you to live as independently as possible. Are the costs deducted from the compulsory and voluntary excess? Multidisciplinary care means that various disciplines If you are aged 18 or older, the costs count towards the are involved in the treatment with simultaneous and/or compulsory and, if applicable, voluntary excess. successive interventions in the treatment process. Do you have to pay extra for non-contracted care? The care consists of: We apply a maximum reimbursement for sensory disability • diagnostic examination; care provided by a non-contracted care provider. In that case, • interventions aimed at learning to live with the impairment the reimbursement is limited to the rates in accordance with from a psychological viewpoint; the rates list for non-contracted care. The rates list can be • interventions that remove or compensate the impairment, viewed and downloaded at www.hollandzorg.nl/tarieven. We thereby increasing your self-reliance. can also send it to you if you wish. If the rates of the non- contracted care provider are higher than our listed maximum The care also includes 'secondary' treatment of parents/ rates, the difference will be at your expense. carers, children and adults close to you. They learn skills in your interest. 'Secondary' treatment is covered by your health Contracted care providers are listed at insurance. www.hollandzorg.nl/zorgzoeker. You can also contact our Care Advice Line on (0)570 687 123. Impaired vision The right to care in connection with impaired vision is subject to: Obstetric care • visual acuity of <0.3 in the best eye; What is covered? • range of vision <30 degrees; or You are entitled to obstetric care. Obstetric care includes care • visual acuity between 0.3 and 0.5 in the best eye in such as obstetricians generally provide. combination with related, serious impairments in the daily functioning. This type of care also comprises prenatal screening. Prenatal screening includes: Impaired hearing • counselling (explanations about the prenatal screening for The right to care in connection with impaired hearing is congenital defects when you are pregnant); subject to: • the ’20-week ultrasound scan’ (a structural ultrasound • you suffer from a threshold loss in the audiogram of at least examination in the second term of pregnancy); 35 dB, obtained by averaging the hearing loss at frequencies • the combination test, if there are medical grounds to do so. of 1000, 2000 and 4000 Hz, or The combination test consists of the NT scan (nuchal scan) • you suffer from a threshold loss in excess of 25 dB when and serum test (blood test); measuring in accordance with the Fletcher index, the • the NIPT, if there are medical grounds to do so. If a average loss at frequencies of 500, 1000 and 2000 Hz. combination test reveals a significant risk of the baby having Down syndrome, Edwards syndrome or Patau Speech and linguistic difficulties syndrome, this also constitutes medical grounds; You qualify for the right to care in connection with serious • invasive diagnostics (villus testing or amniocentesis), if speech and linguistic difficulties if you are aged 22 or under. there are medical grounds to do so. If a combination test You need to suffer from serious difficulty in acquiring or NIPT reveals a significant risk of the baby having Down your native language due to neurobiological and/or syndrome, Edwards syndrome or Patau syndrome, this also neuropsychological factors. Other (psychiatric, physiological, constitutes medical grounds. neurological) issues need to be subordinate to the language Public healthcare insurance Public healthcare development disorder. What should you keep in mind? The following care providers are permitted to provide this What should you keep in mind? type of care: Centres for sensory disability care can provide this type of • obstetricians; care. • general practitioners; • a hospital; You need a first referral from a medical specialist or a clinical • a birth centre which has been contracted for this purpose physical audiologist. You need a second or subsequent referral by us; from a medical specialist, clinical physical audiologist, a youth • echoscopic centres, for echoscopic examinations only. doctor or GP. Prenatal screening may only be provided if the care provider referred to above: • is a licensee by virtue of the Population Screening Act; or • has a cooperation agreement with a regional centre that is a licensee under the Population Screening Act.

24 For obstetric care in a hospital, you need a referral from a apply if there are medical grounds. general practitioner, medical specialist or obstetrician. Are the costs deducted from the compulsory and voluntary Contracted care providers are listed at excess? www.hollandzorg.nl/zorgzoeker. You can also contact our Care The costs of maternity care do not count towards the Advice Line on (0)570 687 123. compulsory and, if applicable, voluntary excess.

Is there a statutory personal contribution? Do you have to pay extra for non-contracted care? The use of a hospital delivery room, if there are no medical We apply a maximum reimbursement for maternity care grounds, is subject to a statutory personal contribution. For provided by a non-contracted care provider. In that case, the the calculation of the statutory personal contribution, the use reimbursement is limited to the rates in accordance with the of the delivery room is deemed to fall under maternity care. rates list for non-contracted care. The rates list can be viewed and downloaded at www.hollandzorg.nl/tarieven. We can also Are the costs deducted from the compulsory and voluntary send it to you if you wish. If the rates of the non-contracted excess? care provider are higher than our listed maximum rates, the The costs of obstetric care do not count towards the difference will be at your expense. compulsory and, if applicable, voluntary excess. The compulsory and, if applicable, voluntary excess do include Contracted care providers are listed at the costs of laboratory tests in a hospital or independent www.hollandzorg.nl/zorgzoeker. You can also contact our Care laboratory at the request of the care provider for obstetric Advice Line on (0)570 687 123. care. Physiotherapy and remedial therapy Maternity care What is covered? What is covered? You are entitled to reimbursement of physiotherapy You are entitled to maternity care. Maternity care is care such and remedial therapy. Physiotherapy is care such as as maternity carers generally provide to mother and child in physiotherapists generally provide. Remedial therapy is care connection with childbirth. The care only comprises the care such as remedial therapists generally provide. during the first ten days after the day the child is born. 18 or older The actual number of hours of maternity care are established If you are 18 or older, you are entitled to: by the care provider in consultation with the obstetrician • physiotherapy or remedial therapy for a disorder on a and ourselves. The National Maternity Care Indication list stipulated by the Minister (Appendix 1 to the Health Protocol ('Landelijk Indicatieprotocol Kraamzorg') serves as Insurance Decree (Besluit zorgverzekering)), the List of the guiding principle for determining the number of hours disorders for long-term physiotherapy and remedial therapy. Public healthcare insurance and days. The number of hours and days partly depend The right to reimbursement starts after the 21st treatment. on the family composition and the presence of volunteer Some disorders on the List are subject to a maximum aid. The protocol can be viewed and downloaded at treatment term. If you receive physiotherapy or remedial www.hollandzorg.nl/kraamzorg. Alternatively, we will send therapy for a disorder and that therapy is subject to a this to you on request. maximum term, you are entitled to the care until the end of the maximum term. What should you keep in mind? • pelvic physiotherapy in connection with incontinence, The following care providers are permitted to provide this subject to a maximum of nine treatments (only once). type of care: • a maternity carer; Younger than 18 • a hospital; If the insured party is younger than 18, the insured party • a birth centre which has been contracted for this purpose is entitled to physiotherapy or remedial therapy for a by us. disorder on a list stipulated by the Minister (Appendix 1 to the Health Insurance Decree (Besluit zorgverzekering)), the In order to receive maternity care, you must register with us. If List of disorders for long-term physiotherapy and remedial you register before the twentieth week of pregnancy, we will therapy. Some disorders on the List are subject to a maximum have ample time to arrange adequate care. This registration treatment term. If the insured party receives physiotherapy can be made via our Care Advice Line on telephone number or remedial therapy for a disorder and that therapy is subject +31 (0)570 68 687 123 or by completing the registration form to a maximum term, the insured party is entitled to the care on www.hollandzorg.nl/zorgadvies. until the end of the maximum term.

Is there a statutory personal contribution? If the insured party is younger than 18, the insured party is, Maternity care at home is subject to a statutory personal in cases other than those mentioned above, also entitled to contribution of € 4.20 per hour. Maternity care at an physiotherapy and remedial therapy for disorders that are institution, for both mother and child, is subject to a statutory not on the List of disorders for long-term physiotherapy and personal contribution of € 16.50 per day, plus the sum of the remedial therapy. In those cases, the insured party is entitled rate of the institution in excess of € 119 per day. This does not to a maximum of nine treatments per calendar year. If those

25 treatments do not give the desired result, the insured party is Do you have to pay extra for non-contracted care? entitled to a maximum of nine extra treatments for the same We apply a maximum reimbursement for physiotherapy disorder. and remedial therapy provided by a non-contracted care provider. In that case, the reimbursement is limited to the The insured party is only entitled to children's physiotherapy if rates in accordance with the rates list for non-contracted the insured party is younger than 18. care. The rates list can be viewed and downloaded at www.hollandzorg.nl/tarieven. We can also send it to you if The List of disorders for physiotherapy and remedial therapy you wish. If the rates of the non-contracted care provider are can be viewed at www.hollandzorg.nl/fysiotherapie. We can higher than our listed maximum rates, the difference will be also send it to you if you wish. at your expense.

What should you keep in mind? Contracted care providers are listed at The following care providers are permitted to provide this www.hollandzorg.nl/zorgzoeker. You can also contact our Care type of care: Advice Line on (0)570 687 123. • a physiotherapist may provide general physiotherapy; • a pelvic therapist may provide pelvic physiotherapy; Speech therapy • a geriatric physiotherapist may provide geriatric What is covered? physiotherapy; You are entitled to reimbursement of speech therapy. Speech • a children's physiotherapist may provide children's therapy is care such as speech therapists generally provide, physiotherapy; as long as the care has a medical objective and recovery or • physiotherapists and skin therapists may provide scar improvement of the speech function or power of speech treatment; can be expected from the treatment. This type of care also • a manual therapist may provide manual physiotherapy; comprises stuttering therapy. It does not include treatment of • an oedema therapist and a skin therapist may provide language development disorders related to dialect or another oedema therapy and lymph drainage; native language. • a remedial therapist (Cesar or Mensendieck exercise therapy) may provide remedial therapy; What should you keep in mind? • a children's remedial therapist may provide children's • Preverbal speech therapy may only be provided by a speech remedial therapy. therapist who is listed on the NVLF's preverbal speech therapy register. You need a referral from a general practitioner or medical • Aphasia therapy may only be provided by a speech therapist specialist: who is listed on the NVLF's Aphasia register. • for treatment of a complaint on the List of disorders for • the Hanen parent programme may only be delivered by a physiotherapy and remedial therapy; speech therapist who is listed on the NVLF's Hanen parent • for treatment by a pelvic physiotherapist in connection with programme register. urine incontinence. • individual stutter therapy may only be provided by a The referral must contain an explanation which clearly speech therapist who is listed on the NVLF's stutter therapy demonstrates the need for that type of physiotherapy. If you register. go to a non-contracted care provider, you must include a copy • integrated stutter care may only be provided by a speech of the referral when you submit the first invoice. therapist or stutter therapist who is listed on the NVLF's integrated stutter care register. In order to be entitled to reimbursement of the costs of care by a non-contracted care provider, you must include a A speech therapist can also provide the other types of care. statement from your care provider when submitting the first invoice. This statement must list any historic physiotherapy You need a referral from a general practitioner, medical or remedial therapy received for that same disorder. This specialist, remedial educationalist, a geriatrics specialist Public healthcare insurance Public healthcare does not apply if the insured is under the age of 18 or if it or youth doctor. This does not apply to care provided by a concerns the costs of pelvic physiotherapy in connection with contracted care provider who has successfully completed the incontinence. Direct Access course. In that case, no referral is needed.

Is there a statutory personal contribution? Care providers who have successfully There is no statutory personal contribution for physiotherapy completed the Direct Access course are listed on and remedial therapy. www.kwaliteitsregisterparamedici.nl and have ´DT´ status. Contracted care providers are listed at Are the costs deducted from the compulsory and voluntary www.hollandzorg.nl/zorgzoeker. You can also contact our Care excess? Advice Line on (0)570 687 123. If you are aged 18 or older, the costs count towards the compulsory and, if applicable, voluntary excess. You must enclose a copy of the referral when submitting the invoice.

26 Is there a statutory personal contribution? with the rates list for non-contracted care. The rates list can There is no statutory personal contribution for speech therapy. be viewed and downloaded at www.hollandzorg.nl/tarieven. We can also send it to you if you wish. If the rates of the non- Are the costs deducted from the compulsory and voluntary contracted care provider are higher than our listed maximum excess? rates, the difference will be at your expense. If you are aged 18 or older, the costs count towards the compulsory and, if applicable, voluntary excess. The contracted dialysis centres are listed at www.hollandzorg.nl/zorgzoeker. You can also contact our Care Do you have to pay extra for non-contracted care? Advice Line on (0)570 687 123. We apply a maximum reimbursement for speech therapy provided by a non-contracted care provider. In that case, the Dietetics reimbursement is limited to the rates in accordance with the What is covered? rates list for non-contracted care. The rates list can be viewed You are entitled to dietetics, subject to a maximum of three and downloaded at www.hollandzorg.nl/tarieven. We can also hours of treatment per year. Dietetics includes advice on send it to you if you wish. If the rates of the non-contracted nutrition and eating habits given for a medical purpose, such care provider are higher than our listed maximum rates, the as dieticians generally provide. difference will be at your expense. What should you keep in mind? Contracted speech therapists are listed at Dieticians can provide this type of care. www.hollandzorg.nl/zorgzoeker. You can also contact our Care Advice Line on (0)570 687 123. You need a referral from a general practitioner, medical specialist, youth doctor or specialist geriatrics doctor. This Occupational therapy does not apply to care provided by a contracted care provider What is covered? who has successfully completed the Direct Access course. In You are entitled to reimbursement of occupational therapy, that case, no referral is needed. subject to a maximum of ten hours of treatment per year. Occupational therapy is care provided by occupational Care providers who have successfully therapists. The aim of occupational care is to improve and completed the Direct Access course are listed on restore self-care and independence. www.kwaliteitsregisterparamedici.nl and have ´DT´ status. Contracted care providers are listed at What should you keep in mind? www.hollandzorg.nl/zorgzoeker. You can also contact our Care Occupational therapists can provide this type of care. Advice Line on (0)570 687 123.

You need a referral from a general practitioner, medical Is there a statutory personal contribution? Public healthcare insurance specialist, youth doctor, specialist geriatrics doctor or a There is no personal contribution for dietetics. company doctor. This does not apply to care provided by a contracted care provider who has successfully completed the Are the costs deducted from the compulsory and voluntary Direct Access course. In that case, no referral is needed. excess? If you are aged 18 or older, the costs count towards the Care providers who have successfully compulsory and, if applicable, voluntary excess. completed the Direct Access course are listed on www.kwaliteitsregisterparamedici.nl and have Do you have to pay extra for non-contracted care? ´DT´ status. Contracted care providers are listed at We apply a maximum reimbursement for dietetics provided www.hollandzorg.nl/zorgzoeker. You can also contact our Care by a non-contracted care provider. In that case, the Advice Line on (0)570 687 123. reimbursement is limited to the rates in accordance with the You must enclose a copy of the referral when submitting the rates list for non-contracted care. The rates list can be viewed invoice. and downloaded at www.hollandzorg.nl/tarieven. We can also send it to you if you wish. If the rates of the non-contracted Is there a statutory personal contribution? care provider are higher than our listed maximum rates, the There is no statutory personal contribution for occupational difference will be at your expense. therapy. Contracted care providers are listed at Are the costs deducted from the compulsory and voluntary www.hollandzorg.nl/zorgzoeker. You can also excess? contact our Care Advice Line on (0)570 687 123. If you are aged 18 or older, the costs count towards the compulsory and, if applicable, voluntary excess. Integrated care What is covered? Do you have to pay extra for non-contracted care? You are entitled to integrated care. Integrated care is provided We apply a maximum reimbursement for occupational within the framework of vascular risk management, chronic therapy provided by a non-contracted care provider. In that obstructive pulmonary disease (COPD) and asthma and for case, the reimbursement is limited to the rates in accordance persons aged 18 and older suffering from Diabetes Mellitus

27 type 2. • plaque removal; • a maximum of two fluoride treatments per year from the What should you keep in mind? moment that the adult teeth emerge. The insured party is A contracted care group is authorised to provide the care. entitled to reimbursement of costs several times a year only if this is desirable from a dental point of view; Contracted care providers are listed at • sealing; www.hollandzorg.nl/zorgzoeker. You can also contact our Care • periodontal care; Advice Line on (0)570 687 123. • anaesthesia; • endodontic care; You need a referral from a general practitioner or medical • restoration of the dental elements with plastic materials; specialist. • gnathological care; • removable prostheses; Is there a statutory personal contribution? • tooth replacement using non-plastic materials and fitting of There is no statutory personal contribution for integrated care. dental implants if these serve to replace one or more missing permanent incisors or canines which have not grown or a Are the costs deducted from the compulsory and voluntary tooth or teeth missing as a direct result of an accident; excess? • dental surgery with the exception of fitting dental implants; The costs do not count towards the compulsory and, if • X-rays, with the exception of X-rays for orthodontic care. applicable, voluntary excess. 18 or older Dental care If you are aged 18 or older, you are, in addition to all-age What is covered? dental care, entitled to: You are entitled to dental care. Dental care (oral care) includes • dental surgery of a specialist nature and the associated care such as dentists generally provide. X-rays, with the exception of periodontal surgery, fitting a dental implant and uncomplicated extractions; All ages • removable full prostheses for the upper and/or lower jaw. You are entitled to dental care if: • you have a serious development disorder, growth disorder What should you keep in mind? or acquired deformation of the dental and oral system. The Dentists and centres for special dentistry can provide this type disorder or deformation must be of such a serious nature, of care. that without that care you are unable to retain or acquire dental function equal to that which you would have had if A dental surgeon can provide surgical dental care of a the disorder or deformation had not occurred. specialist nature. For the care provided by a dental surgeon, you need a referral from a general practitioner, dentist or In that case, the fitting of a dental implant and the fitting orthodontist. of the permanent part of the suprastructure (the click system) is also included in the care. The care includes fitting Removable (full) prostheses can also be made and fitted by a dental implant and fitting the permanent part of the a dental prosthesis maker. For the care provided by a dental suprastructure if you have a seriously shrunken edentate prosthesis maker you need a referral from a dentist. jaw and this serves to secure a removable prosthesis. An oral hygienist may only provide the following care: • you suffer from a non-dental physical or mental disorder. preventive oral care (all M codes), non-complex periodontal The disorder must be of such a nature, that without that assistance (T11, T12, T22, T31 to T33, T52, T54, T56, T57, T60, T61, care you are unable to retain or acquire dental function T91 to T93, T96), performing simple fillings (V30, V35, V40, V50, equal to that which you would have had if the disorder had V71, V72, V81, V82, V91, V92) and anaesthetic (A10 and A15). not occurred. Codes are shown next to each type of treatment, the so-called Public healthcare insurance Public healthcare performance codes. These have been formulated by the Dutch • medical treatment will demonstrably fail to have an Healthcare Authority. You can view them and download the adequate result without that care and without that other list at www.nza.nl. care you cannot retain or acquire dental function equal to that which you would have had if such disorder had not A number of forms of dental care are subject to our written occurred. consent before you receive the care. They are: • gnathologic care if the insured is younger than 18; Younger than 18 • tooth replacement care with non-plastic materials if the If the insured party is younger than 18, the insured party, in insured is younger than 18; addition to all-ages dental care, is also entitled to: • the care described under the heading 'All ages'; • periodic preventive dental check-up once a year. The insured • treatment under anaesthetic; party is entitled to a reimbursement of the costs several • osteotomy and combined orthodontia and osteotomy times a year only if this is necessary from a dental point of treatment; view; • fitting a dental implant; • occasional dental examination; • surgical dental assistance of a specialist nature if it requires

28 hospitalisation; • the manufacture and fitting of a complete dental You need a referral from a dentist. prosthesis. This does not apply to care by a contracted care provider, unless this care provider indicates that in your You must obtain our written authorisation, prior to you situation authorisation from us is needed. This is the case receiving the care. Requests for care must be accompanied by in the event of early replacement and if the costs are higher a written, substantiated treatment plan by the care provider, than we have agreed with the care provider; stating the medical diagnosis/diagnoses and the performance • care provided by a centre for special dentistry. codes, plus X-rays and any models made of the teeth.

Requests for care must be accompanied by a written, Is there a statutory personal contribution? substantiated treatment plan by the care provider, stating the There is no statutory personal contribution for orthodontics in medical diagnosis/diagnoses and the performance codes, plus exceptional cases. X-rays and any models made of the teeth. Are the costs deducted from the compulsory and voluntary Contracted care providers are listed at excess? www.hollandzorg.nl/zorgzoeker. You can also contact our Care If you are aged 18 or older, the costs count towards the Advice Line on (0)570 687 123. compulsory and, if applicable, voluntary excess.

Is there a statutory personal contribution? Medicinal care If you are 18 or older, you must pay a statutory personal What is covered? contribution: You are entitled to medicinal care. Medicinal care • for care which falls under the heading 'All ages', if it relates (pharmaceutical care) includes the provision of: to a removable full dental prosthesis or a removable full • the following registered medicines: prosthesis to be fitted on dental implants. In that case, the -- the registered medicines contained in appendix 1 amount of the statutory personal contribution is € 125 per (not those in appendix 2) of the Healthcare Insurance full dental prosthesis (per jaw); Regulations (Regeling zorgverzekering); • for a removable full prosthesis for the upper and/or lower -- the registered medicines contained in appendix 2 jaw. In that case, the statutory personal contribution of the Healthcare Insurance Regulations (Regeling amounts to 25% of the costs. This does not apply if your zorgverzekering). Appendix 2 of the Healthcare Insurance right to reimbursement of the costs for this care falls under Regulations (Regeling zorgverzekering) contains the heading 'All ages'; additional conditions per medicine for the provision of • for care that falls under the heading 'All ages', if the care in that medicine. You are only entitled to reimbursement of question is not directly related to the referral for specialist the costs of these medicines if the conditions contained dental care. In that case, the extent of the statutory in appendix 2 of the Healthcare Insurance Regulations Public healthcare insurance personal contribution is the maximum amount that the (Regeling zorgverzekering) for the medicine in question care provider would have charged if there was no right to have been met; reimbursement of the costs under the heading 'All ages'. • the following non-registered medicines in case of rational This means that you are in fact entitled to a reimbursement pharmacotherapy: of only the additional costs associated with that type of -- medicines that are prepared on a small scale at a care. dispensing chemist's pharmacy by or on behalf of that dispensing chemist (magistral preparations); Are the costs deducted from the compulsory and voluntary -- medicines that are sold following an order on the excess? initiative of a doctor, which are intended to be used by If you are aged 18 or older, the costs count towards the you under his supervision, if: compulsory and, if applicable, voluntary excess. ·· these medicines have been prepared in the Netherlands by a manufacturer with a licence for preparing medicines Orthodontics in special cases pursuant to the Medicines Act (Geneesmiddelenwet), and What is covered? prepared in accordance with the specifications of that Orthodontia is care of an orthodontic nature such as dentists doctor; or generally provide. You are entitled to orthodontics if you have ·· if these medicines are sold in another EU or EEA country a serious development or growth disorder of the dental and or in a third country, and are imported into Dutch territory oral system. The orthodontic procedure must be necessary in at the request of that doctor if you suffer from an illness order for you to retain or acquire dental function equal to that suffered by no more than 1 in 150,000 inhabitants in the which you would have had if the disorder had not occurred. Netherlands; The disorder or deformation must be of such a nature that • the following dietary preparations: additional diagnosis or additional treatment from disciplines -- dietary preparations as referred to in appendix 2 other than dentistry is required. of the Healthcare Insurance Regulations (Regeling zorgverzekering). You are only entitled to reimbursement What should you keep in mind? of the costs of the dietary preparations contained in Orthodontists and centres for special dentistry are permitted appendix 2 of the Healthcare Insurance Regulations to provide this type of care. (Regeling zorgverzekering) if the relevant conditions

29 contained in appendix 2 of the Healthcare Insurance You need a prescription. A GP, a medical specialist, an Regulations (Regeling zorgverzekering) have been met. orthodontist, a dentist, an obstetrician, a doctor for the mentally disabled, a sports doctor or a specialist geriatrics Medicinal care also includes the advice and support which doctor can issue a prescription for most medicines. This dispensing chemists generally provide for the assessment and is subject to the condition that the prescribed medicine responsible use of prescribed medicines. is related to the care that the prescribing party generally provides. Medicinal care does not include: • medicines to prevent travel sickness; Separate rules apply to the medicines contained in appendix 2 • medicines for research (medicines as defined in article of the Healthcare Insurance Regulations (Regeling 40, paragraph 3, subparagraph b of the Medicines Act zorgverzekering). The care providers that can issue (Geneesmiddelenwet)); prescriptions for these medicines are listed in the Pharmacy • medicines that are (virtually) equivalent to a registered Regulations (Reglement Farmacie), per medicine. You can view medicine not included in appendix 1 of the Healthcare and download the Pharmacy Regulations at Insurance Regulations (Regeling zorgverzekering); www.hollandzorg.nl/geneesmiddelen. Alternatively, we will • medicines that are still being used for clinical testing and send this to you on request. which are made available for distressing cases (medicines as defined in article 40, paragraph 3, subparagraph b of the Consent or dispensing chemist's instruction Medicines Act (Geneesmiddelenwet)); In order for you to be entitled to some medicines contained in • medicines you receive as part of an admission or medical appendix 2 of the Healthcare Insurance Regulations (Regeling specialist treatment, provided they form (or are supposed zorgverzekering), you must have received our written consent to form) part of that admission or treatment. In that case, before receiving the care. You must enclose a copy of the those medicines form part of that care. prescription with your request.

Appendices 1 and 2 of the Healthcare Insurance Regulations For the right to other medicines contained in appendix 2, (Regeling zorgverzekering) can be viewed and downloaded at the dispensing chemist or dispensing general practitioner www.hollandzorg.nl/geneesmiddelen. We can also send it to must determine that right on the basis of a doctor's note or you if you wish. dispensing chemist's instruction.

How long do we reimburse medicines? These conditions are outlined in the Pharmacy Regulations We do not issue medicines in unlimited quantities. Per (Reglement Farmacie) per medicine. You can view and prescription, you are entitled to medicines for a maximum download the Pharmacy Regulations at period of: www.hollandzorg.nl/geneesmiddelen. Alternatively, we will • fifteen days, in case of a new type of medicine for you; send this to you on request. • 1 course or 30 days, in case of antibiotics or chemotherapy to combat acute conditions; Authorisation for magistral preparations • three months, if it concerns medicines for the treatment of Magistral preparations are non-registered medicines that are chronic disorders, with the exception of benzodiazepines, prepared at a single chemist and then supplied to another hypnotic drugs and anxiolytic drugs that cost more than chemist. Reimbursement for certain magistral preparations € 500 per month. The care provider issuing the prescription indicated by us is subject to our written authorisation, prior determines whether it concerns a chronic disorder; to you receiving the care. The magistral preparations for • twelve months, in case of the contraceptive pill (oral which authorisation is required are listed in the ‘Magistral contraceptives); Preparations Schedule’. This schedule can be viewed and • one month in all other cases. downloaded via www.hollandzorg.nl. Alternatively, we will send this to you on request. When submitting the request for What should you keep in mind? authorisation, you should include a copy of the prescription, Public healthcare insurance Public healthcare Dispensing chemists and dispensing general practitioners can a report from the attending physician, including the medical provide this type of care. diagnosis/diagnoses, a description of the current problem and the proposed treatment plan. Dietary preparations can also be provided by suppliers of dietary preparations. Is there a statutory personal contribution? You must pay a statutory personal contribution for a medicine classified into a group of interchangeable medicines if the purchase price is higher than the reimbursement limit. A statutory personal contribution is also due when a medicine is prepared from a medicine for which a statutory personal contribution is due. The Healthcare Insurance Regulations (Regeling zorgverzekering) stipulate how the personal contribution is calculated.

Are the costs deducted from the compulsory and voluntary

30 excess? care or geriatric rehabilitation care; If you are aged 18 or older, the costs count towards the • a psychiatric hospital, if you are receiving specialist medical compulsory and, if applicable, voluntary excess. mental care; • respiratory centres, if you are receiving artificial respiration; The provision of contraceptives and medication assessment as • centres for genetic advice, if you are receiving genetic stipulated under the conditions in the overview 'Designated advice; Care Not Applicable to Compulsory Excess' are exempted • a nursing home for geriatric rehabilitation care. from the compulsory excess. The up-to-date overview can be viewed and downloaded at www.hollandzorg.nl/eigenrisico. You need a referral from a general practitioner, medical Alternatively, we will send this to you on request. specialist, dentist or obstetrician. This condition does not apply in the case of unforeseen care that cannot reasonably Do you have to pay extra for non-contracted care? be postponed. We apply a maximum reimbursement for medicinal care provided by a non-contracted care provider. In that case, the Your stay for the following types of admission is subject to our reimbursement is limited to the rates in accordance with the written consent before you are admitted: rates list for non-contracted care. The rates list can be viewed • plastic surgery; and downloaded at www.hollandzorg.nl/tarieven. We can also • surgical dental care of a specialist nature; send it to you if you wish. If the rates of the non-contracted • specialist mental healthcare. You must enclose (a copy of) care provider are higher than our listed maximum rates, the the treatment plan with your request. difference will be at your expense. Is there a statutory personal contribution? Contracted care providers are listed at There is no statutory personal contribution for admissions. www.hollandzorg.nl/zorgzoeker. You can also contact our Care Advice Line on (0)570 687 123. Are the costs deducted from the compulsory and voluntary excess? In-patient care If you are aged 18 or older, the costs count towards the What is covered? compulsory and, if applicable, voluntary excess. You are entitled to a stay and the corresponding nursing, caring or paramedic care. A stay is an admission for an Nursing without in-patient care uninterrupted period of no more than 1095 days (three years). What is covered? The stay must be required on medical grounds in connection Nursing without in-patient care includes care such as nurses with general medical specialist care, plastic surgery, generally provide. You are entitled to nursing without in- rehabilitation care, geriatric rehabilitation, transplantation patient care if the care is in connection with your need for care, artificial respiration, obstetric care, specialist medical medical specialist care (general), plastic surgery, surgical Public healthcare insurance mental care, genetic advice or surgical dental care of a dental care of a specialist nature, rehabilitation care, geriatric specialist nature. rehabilitation, transplantation care, artificial respiration or An interruption of the admission for a maximum period specialist medical mental care, general practitioner care, basic of thirty days is not regarded as an interruption to the medical mental care, obstetric care, sensory disability care or uninterrupted period. However, the duration of the paramedical care, or if you have an increased risk in relation to interruption does not count in the calculation of the 1095 that care. days, except for weekend and holiday leave. Interruptions for weekend and holiday leave are included in the calculation of The care consists of nursing (care provision) and care, as the 1095 days. well as indicating, coordinating, signalling, coaching and preventing. The care does not include: • stays you require in connection with a psychiatric disorder The care does not include: or impairment if you are younger than 18; • nursing and care during your stay at a hospital or other • stays in connection with the temporary takeover of care to institution; release a family caregiver (respite care); • maternity care; • stays in connection with a psychiatric disorder or • care if the insured is younger than 18, except in the event of impairment if that stay commenced prior to 1 January 2014. intensive paediatric care.

What should you keep in mind? Personal budget The following care providers can provide accommodation for Instead of the right to care, you may qualify for a personal your stay: budget. In that case, you will receive funds to purchase the • hospitals, if you are receiving medical specialist care and nursing yourself. The right to a personal budget care, rehabilitation care, geriatric rehabilitation care, is subject to special conditions. They are defined in the transplantation care, artificial respiration, obstetric care, Personal District Nursing Regulations. The Personal District specialist medical mental care or surgical dental care of a Nursing Regulations can be viewed and downloaded on specialist nature; www.hollandzorg.nl/wijkverpleging. Alternatively, we will send • rehabilitation centres, if you are receiving rehabilitation this to you on request. (The right to the personal budget applies

31 from the day that the necessary amendment to the Healthcare care. The rates list can be viewed and downloaded at Insurance Act (Zorgverzekeringswet) comes into force). www.hollandzorg.nl/tarieven. We can also send it to you if you wish. If the rates of the non-contracted care provider are What should you keep in mind? higher than our listed maximum rates, the difference will be You or your legal representative must have signed a care at your expense. plan. The same applies in the event of adjustments made in the care plan. The care plan must at least state the type, Contracted care providers are listed at scope, frequency and intended duration of the required home www.hollandzorg.nl/zorgzoeker. You can also contact our Care nursing without in-patient care, the performances and include Advice Line on (0)570 687 123. a motivation. The care plan must also involve the contribution of your social network. Ambulance transport What is covered? If the medical specialist who is treating you finds it medically You are entitled to ambulance transport. Ambulance transport necessary for you to receive nursing or care not accompanied is patient transport by ambulance over a distance of no more by a stay under the responsibility and direct management of than 200 kilometres: the medical specialist, you require a needs assessment or terms a. to a care provider that will provide you with care which of reference from the medical specialist, explaining the nature, is covered, in full or in part, by your public healthcare scope, frequency and duration of the necessary medical specialist insurance; home nursing or care. The care plan must correspond with the b. to an institution where you will be staying, which stay nursing and care deemed necessary by the medical specialist. is covered, in full or in part, by the Long-Term Care Act (Wlz). This does not include transport for care received at A district nurse and nursing specialist are permitted to define an institution for part of the day; the indication for your care and draw up a care plan. c. to a person from whom or an institution in which an insured person under the age of eighteen will receive The following care providers are permitted to provide the mental health care the costs of which are fully or remaining care: partially payable by the Municipal Executive responsible • a nursing specialist; under the Youth Law. • a district nurse; d. from an institution defined in subparagraph b, to: • institutions that provide nursing or care at home. 1. a person or institution where you are given an examination or receive care, the costs of which are You must obtain our written authorisation, prior to you fully or partially covered by the Long-Term Care Act receiving the care: (Wlz); • for reimbursement for nursing without in-patient care 2. a person or institution for measuring and fitting provided by a non-contracted care provider. You must a prosthesis the cost of which is fully or partially enclose a copy of the care plan with your request; covered by the Long-Term Care Act (Wlz); • for reimbursement for nursing without in-patient care e. to your home or another home if you cannot reasonably abroad. Along with the request, you must send a copy of receive the necessary care at your home, if you the care plan and a quote for the care, explaining what type are coming from one the care providers defined in of care it concerns, the costs and the period for the care subparagraphs a to d. provided abroad; • for reimbursement of palliative home care, provided it is A distance of more than 200 kilometres also falls under not needed for more than three months. You must enclose a ambulance transport, if we have given our written consent for copy of the care plan with your request. that, before the transport takes place. If the care plan changes, you need to obtain our written authorisation again prior to you receiving the care. Transport by a mode of transport other than an ambulance may also fall under ambulance transport. This is the case if Public healthcare insurance Public healthcare Is there a statutory personal contribution? transport by ambulance is not possible and we have given There is no statutory personal contribution for nursing our prior written consent for transport by a different mode of without in-patient care. transport designated by us.

Are the costs deducted from the compulsory and voluntary What should you keep in mind? excess? Ambulance transport providers can provide this type of care. The costs of home nursing without in-patient care do not count towards the compulsory and, if applicable, voluntary In two cases, the ambulance transport is subject to our excess. written consent before you are transported. They are: • transport over a distance of more than 200 km; Do you have to pay extra for non-contracted care? • transport by a mode of transport other than an ambulance. We apply a maximum reimbursement for nursing without in-patient care provided by a non-contracted care provider. In that case, the reimbursement is limited to the rates in accordance with the rates list for non-contracted

32 Consent is not required in the case of unforeseen care that What applies in exceptional circumstances? cannot reasonably be postponed. Seated patient transport also includes transport in other cases if you rely on transport for a long period of time in When submitting the request, you should include a report connection with the treatment of a long-term illness or from the attending physician, including the medical disorder and it would be extremely unreasonable towards diagnosis/diagnoses, a description of the current problem and you if that transport were not reimbursed. We use various a substantiation of the request. data in order to determine if you are nevertheless entitled to reimbursement of transport. To that end, we use the Is there a statutory personal contribution? following formula: (the number of weeks the treatment There is no statutory personal contribution for ambulance takes) x (the number of times per week you need transport transport. for the treatment) x (the single travel distance in kilometres for transport to the care provider) x 0.25. If the sum of Are the costs deducted from the compulsory and voluntary this calculation is 250 or higher, you are entitled to a excess? reimbursement. If you are aged 18 or older, the costs count towards the compulsory and, if applicable, voluntary excess. Seated patient transport also includes the transport of a companion. It must be medically necessary for the insured Seated patient transport party to have a companion, or the insured party must be What is covered? under the age of sixteen. In special cases, we can give our You are entitled to seated patient transport. Seated patient written consent for the transport of two companions. transport is transport by car, other than by ambulance, or public transport, over a maximum single travel distance of Transport by a mode of transport other than a car or public 200 kilometres: transport may also fall under seated patient transport. This is a. to a care provider that will provide you with care which the case if transport by car or public transport is not possible is covered, in full or in part, by your public healthcare and we have given our written consent for transport by a insurance; different mode of transport, designated by us. b. to an institution where you will be staying, which stay is covered, in full or in part, by the Long-Term Care Act A distance of more than 200 kilometres also falls under (Wlz). This does not include transport for care received at seated patient transport, provided we have given our written an institution for part of the day; consent. c. from an institution defined in subparagraph b, to: 1. a person or institution where you are given an What should you keep in mind? examination or receive care, the costs of which are fully For this type of transport, you can use your own car or that of or partially covered by the Long-Term Care Act (Wlz); someone else. You can also use a taxi firm or public transport Public healthcare insurance 2. a person or institution for measuring and fitting provider. a prosthesis the cost of which is fully or partially covered by the Long-Term Care Act (Wlz); You need a prescription from a general practitioner or medical d. to your home or another house, if it is reasonably specialist. impossible for you to receive the necessary care at your home, if you come from one of the care providers referred The reimbursement of transport is subject to our written to in subparagraphs a to c or a person with whom or an consent before you are transported. institution at which an insured person under the age of 18 will receive mental healthcare, the costs of which When requesting transport, you must give the reason for your are fully or partially payable by the Municipal Executive request and enclose the prescription. responsible under the Youth Law; Is there a statutory personal contribution? on the condition that one of the following reasons applies: Seated patient transport is subject to a maximum statutory • you have to undergo dialysis; personal contribution of € 98 per calendar year. The statutory • you have to undergo oncological treatment with personal contribution does not apply: chemotherapy or radiotherapy; • to transport from an institution where you are admitted at • you are only able to move about in a wheelchair; the cost of the public healthcare insurance or the Long- • your eyesight is so poor that you cannot move about Term Care Act (Wlz) to another institution where you are unaided; admitted at the cost of the public healthcare insurance • the insured person is younger than 18 and relies on or the Long-Term Care Act (Wlz) where you will undergo a intensive childcare. specialist examination or specialist treatment that cannot be provided at the former institution; The reimbursement for seated patient transport by car is € • to transport from an institution as referred to in subparagraph 0.30 per kilometre. The reimbursement for the use of public a to a person or institution where you will undergo a specialist transport applies only to the lowest class of the mode of examination or specialist treatment, at the cost of the public public transport. healthcare insurance, that cannot be provided at the former institution, and transport back to that institution;

33 • to transport from an institution where you have been • remedial educationalists; admitted at the cost of the Long-Term Care Act (Wlz), to • care providers entered in the register of the Dutch a person or institution where you will undergo dental Psychological Association (Nederlands instituut van treatment, at the cost of the Long-Term Care Act (Wlz), that psychologen (NIP)) as NIP child and youth psychologists. cannot be provided at the former institution, and transport back to that institution. The following care providers may deliver the care under the ultimate responsibility of the practitioner in charge: Are the costs deducted from the compulsory and voluntary • a care provider who is also permitted to provide the care as excess? a practitioner in charge; If you are aged 18 or older, the costs count towards the • a specialist mental health nurse. compulsory and, if applicable, voluntary excess. You need a referral from a general practitioner, medical Do you have to pay extra for non-contracted care? specialist, doctor for the mentally disabled, specialist geriatrics We apply a maximum reimbursement for patient transport doctor or youth doctor. This condition does not apply in the case provided by a non-contracted taxi firm. In that case, the of unforeseen care that cannot reasonably be postponed. reimbursement is limited to the rates in accordance with the rates list for non-contracted care. The rates list can be viewed Is there a statutory personal contribution? and downloaded at www.hollandzorg.nl/tarieven. We can also There is no statutory personal contribution for basic mental send it to you if you wish. If the rates of the non-contracted healthcare. care provider are higher than our listed maximum rates, the difference will be at your expense. Are the costs deducted from the compulsory and voluntary excess? Contracted taxi firms are listed at If you are aged 18 or older, the costs count towards the www.hollandzorg.nl/zorgzoeker. You can also contact our Care compulsory and, if applicable, voluntary excess. Advice Line on (0)570 687 123. Do you have to pay extra for non-contracted care? Basic mental healthcare We apply a maximum reimbursement for basic mental What is covered? healthcare provided by a non-contracted care provider. In that You are entitled to basic mental healthcare. Basic mental case, the reimbursement is limited to the rates in accordance healthcare is general medical mental healthcare such as with the rates list for non-contracted care. The rates list can psychiatrist clinical psychologists generally provide. be viewed and downloaded at www.hollandzorg.nl/tarieven. The care is divided into the following care products: We can also send it to you if you wish. If the rates of the non- • General Basic Mental Healthcare Short; contracted care provider are higher than our listed maximum • General Basic Mental Healthcare Medium; rates, the difference will be at your expense. • General Basic Mental Healthcare Intensive; • General Basic Mental Healthcare Chronic; Contracted care providers are listed at • Incomplete treatment process. www.hollandzorg.nl/zorgzoeker. You can also contact our Care The care products may consist of different components, Advice Line on (0)570 687 123. such as: intake, diagnosis, treatment by means of individual interviews, group sessions or Internet treatment, effects Specialist mental healthcare measurements, reporting and consultation. What is covered? You are entitled to specialist mental healthcare. Specialist Basic mental healthcare does not include: mental healthcare is specialist medical mental healthcare • the care you require in connection with a psychiatric such as psychiatrist clinical psychologists generally provide. disorder or impairment if you are younger than 18; • treatment of post-traumatic disorders. A post-traumatic Specialist mental healthcare does not include: Public healthcare insurance Public healthcare disorder is understood to mean ongoing psychological • the care you require in connection with a psychiatric symptoms that impede everyday functioning at home or disorder or impairment if you are younger than 18; at work following a traumatic event or change (a stressful • treatment of post-traumatic disorders. A post-traumatic disorder situation); is understood to mean ongoing psychological symptoms that • help with work and relationship problems; impede everyday functioning at home or at work following a • indicated prevention in the case of depression, panic and traumatic event or change (a stressful situation); anxiety disorders and problematic alcohol abuse. • help with work and relationship problems; • indicated prevention in the case of depression, panic and What should you keep in mind? anxiety disorders and problematic alcohol abuse. The following care providers can provide basic mental healthcare as the practitioner in charge: What should you keep in mind? • healthcare psychologists; The following care providers can provide specialist mental • clinical psychologists; healthcare as the practitioner in charge: • psychotherapists; • clinical psychologists; • psychiatrists; • psychiatrists;

34 • psychotherapists; are supposed to form part of that admission or treatment. • an institution which provides specialist medical mental In that case, those medical aids form part of that care. In healthcare, such as a psychiatric hospital, a hospital case of transmural care at home, the aids and required (PAAZ, PAAcZ or PUK) or institution for non-residential accessories (which belong to the main unit) are also mental healthcare. In that case, a clinical psychologist, a included in the medical aids; In this situation, the dressings psychiatrist or a psychotherapist must provide the specialist do fall under the medical aids; mental healthcare as the practitioner in charge. • medical aids and dressings you are entitled to pursuant A condition is that the care provider works together with to the Long-Term Care Act (Wlz), the Social Support other disciplines (i.e. works in a multidisciplinary context). Act (Wet maatschappelijke ondersteuning), the Work and Income (Capacity for Work) Act (Wet inkomen naar You need a referral from a general practitioner, medical arbeidsvermogen (WIA)); specialist, doctor for the mentally disabled, specialist geriatrics • the costs of normal use of medical aids such as energy doctor or youth doctor. This condition does not apply in the case consumption and batteries, unless stipulated otherwise in of unforeseen care that cannot reasonably be postponed. these insurance conditions.

Reimbursement for specialist mental healthcare by a non- What should you keep in mind? contracted care provider in combination with a stay is subject In principle, you must use the care provided by contracted care to our written authorisation, prior to you receiving the care. providers. You must enclose (a copy of) the treatment plan with your request. Contracted care providers are listed at www.hollandzorg.nl/zorgzoeker. You can also contact our Care Is there a statutory personal contribution? Advice Line on (0)570 687 123. There is no statutory personal contribution for specialist medical mental healthcare. You can also opt for care provided by a non-contracted care provider. The Medical Devices Regulations (Reglement Are the costs deducted from the compulsory and voluntary hulpmiddelen) set out which care providers can provide the excess? care in that case. If you are aged 18 or older, the costs count towards the compulsory and, if applicable, voluntary excess. You need a prescription in order to qualify for medical aids.

Do you have to pay extra for non-contracted care? The Medical Devices Regulations (Reglement hulpmiddelen) We apply a maximum reimbursement for specialist mental outline, per category of medical aids, which care provider can healthcare provided by a non-contracted care provider. In that issue the prescription. case, the reimbursement is limited to the rates in accordance Public healthcare insurance with the rates list for non-contracted care. The rates list can The Medical Devices Regulations (Reglement hulpmiddelen) be viewed and downloaded at www.hollandzorg.nl/tarieven. set out in which cases you need our written consent before you We can also send it to you if you wish. If the rates of the non- receive the care, and which conditions the request must meet. contracted care provider are higher than our listed maximum rates, the difference will be at your expense. Is there a statutory personal contribution? Some medical aids are subject to a statutory personal Contracted care providers are listed at contribution. This is defined in the Medical Devices www.hollandzorg.nl/zorgzoeker. You can also contact our Care Regulations (Reglement hulpmiddelen). Some medical aids Advice Line on (0)570 687 123. are subject to a statutory maximum reimbursement. The statutory personal contribution also includes the costs that Medical aids exceed that statutory maximum reimbursement and which What is covered? therefore remain payable by you. You are entitled to medical aids (care in kind). Medical aids means functioning aids and dressings designated in the Are the costs deducted from the compulsory and voluntary Medical Devices Regulations (Reglement Hulpmiddelen). excess? These regulations define the scope of this type of care. The If you are aged 18 or older, the costs count towards the compulsory regulations also stipulate whether you become the owner of and, if applicable, voluntary excess. This does not apply to medical the medical aids or are given them on loan. Other conditions aids you are given on loan, with the exception of the consumables for the right to care and the use of the medical aids are also or usage costs associated with those medical aids. contained in the regulations. Do you have to pay extra for non-contracted care? You can view and download the Medical Aids Regulation at If the medical aids are available from a contracted care www.hollandzorg.nl/hulpmiddelen. Alternatively, we will send provider in time, but you buy or hire the medical aid or this to you on request. dressing from a non-contracted care provider, we will apply a The cover for medical aids does not include: maximum reimbursement. • medical aids and dressings you receive as part of an admission or medical specialist treatment if they form or In that case, a medical aid or dressing that we would normally

35 sell to you is reimbursed up to a maximum of 75% of the costs Is there a statutory personal contribution? we would incur if you would have received the care from a There is no statutory personal contribution for giving up contracted care provider. In that case, we also reimburse a smoking. maximum of 75% of any repair costs in connection with the medical aid. Are the costs deducted from the compulsory and voluntary excess? The costs of a medical aid that we would normally give on If you are aged 18 or older, the costs count towards the loan are in that case reimbursed per calendar year. We will compulsory and, if applicable, voluntary excess. reimburse a maximum of 75% of the costs we would incur for providing that care on loan in that calendar year. The Counselling for giving up smoking as part of general reimbursement is in proportion to the number of days you are practitioner care, medical specialist care, obstetric care or entitled to that care and actually have the medical aid at your basic mental healthcare is subject to the provisions relating to disposal in that calendar year. the excess for those types of care.

The contracted care providers can be found at Conditional care www.hollandzorg.nl/zorgzoeker. You can also contact our Care What is covered? Advice Line on (0)570 687 123. You are entitled to conditional care and services designated by ministerial regulation (article 2.2 of the Healthcare Giving up smoking Insurance Regulations (Regeling zorgverzekering)) subject to What is covered? the applicable conditions, insofar as the care and services in You are entitled to a programme to give up smoking. This question are responsible in nature. type of care comprises a medical care programme, possibly in combination with medicines, aimed at a change in behaviour Conditionally permitted care is included on the Conditionally with the objective of giving up smoking. You are only entitled Permitted Care list. This list can be viewed and downloaded to medicines that relate to giving up smoking when they form via www.hollandzorg.nl/voorwaardelijkezorg. We can also part of the programme. The care is limited to one programme send it to you if you wish. This includes specific treatment per calendar year. for chronic, non-specific, lower back trouble, the treatment of therapy-resistant hypertension using percutaneous renal Counselling for giving up smoking can also form part of denervation and treatment of cerebrovascular accident general practitioner care, medical specialist care, obstetric using intra-arterial thrombolysis, treatment of an infected care or basic mental healthcare. In that case, the right to pancreatic necrosis by means of a transluminal endoscopic counselling for giving up smoking is also subject to the approach and the performance of autological stem cell conditions for those types of care. These conditions are set transplantation to treat serious therapy refractory Crohn's out in the articles for that type of care, namely: general disease. These treatments fall under medical specialist care practitioner care, specialist medical care (general), obstetric (general). The conditions for the right to these treatments are care and basic mental healthcare. stated in the article on medical specialist care (general).

What should you keep in mind? If expensive and orphan drugs or other types of care are The care providers on the 'Giving up smoking counselling list' allowed conditionally during the term of the public health are authorised to provide this type of care. The 'Giving up insurance, the right to that care is subject to the conditions smoking counselling list' can be viewed and downloaded at laid down in the relevant ministerial regulation. www.hollandzorg.nl/stoppenmetroken. We can also send it to you if you wish. Are the costs deducted from the compulsory and voluntary excess? Care providers designated in the articles for those types If you are aged 18 or older, the costs count towards the of care are authorised to provide counselling for giving compulsory and, if applicable, voluntary excess. This does not Public healthcare insurance Public healthcare up smoking as part of general practitioner care, medical apply if the care forms part of the care referred to in articles specialist care, obstetric care or basic mental healthcare. 5 and 6 of the specific provisions of the public healthcare insurance. In order to qualify for reimbursement of medicines within the framework of the programme, you need to enclose a completed and signed Giving up Smoking Application Form along with the first invoice. The application form can be viewed and downloaded at www.hollandzorg.nl. Alternatively, we will send this to you on request.

36 Supplementary insurances Uitzendpolis Speciaal and Uitzendpolis No Risk

Specific provisions for supplementary insurances

The agreements in the General Provisions chapter are 2. How do you take out supplementary applicable to the public healthcare insurance and the insurance? supplementary insurances, unless they explicitly apply only to Your employer applies for the supplementary insurance the public healthcare insurance. The Uitzendpolis Speciaal and on your behalf. This is possible if you have authorised your the Uitzendpolis No Risk are also subject to specific provisions. employer accordingly. In this chapter, you can read what they are. If provisions apply to a specific supplementary insurance, this is explicitly stated. 3. When does the supplementary insurance All appendices referred to in these insurance conditions form start? part of the supplementary insurance. If the application is incomplete, the supplementary insurance will commence at a later date. In that case, the supplementary insurance commences on the day on which we receive the Taking out and cancelling complete application. supplementary insurance If you do not apply simultaneously with a request to take out public health insurance for the same person, the 1. When can you take out the supplementary supplementary insurance commences on 1 January of the next insurance? calendar year. The following acceptance conditions apply to taking out an Uitzendpolis Speciaal or Uitzendpolis No Risk. If you (policyholder) submit a request to take out • you (policyholder) can only take out an Uitzendpolis supplementary insurance for someone else, we assume Speciaal or Uitzendpolis No Risk if the person you that by doing so, you (policyholder) have authorised us (policyholder) want to insure also has public health to terminate the supplementary healthcare insurance insurance at the time of the supplementary insurance that person has with the previous health insurer. If you coming into force. (policyholder) do not want this, you (policyholder) must notify • you (policyholder) and the person to be insured do not us in writing when making the application. have any payment arrears with or have been expelled in the past by Eno Zorgverzekeraar N.V. or Eno Aanvullende 4. When does the supplementary insurance Verzekeringen N.V.; end?

• you (policyholder) and the remaining person(s) to be In addition to the reasons for termination contained in the Supplementary insurances insured, at the inception date of the HollandZorg Long Stay General Provisions chapter, the supplementary insurance Insurance, must form part of a group scheme of persons terminates on the day following that on which: approved by us for whom an Uitzendpolis Speciaal or a) the group scheme referred to in article 1, Specific Uitzendpolis No Risk can be taken out. conditions supplementary insurance Uitzendpolis Speciaal and Uitzendpolis No Risk, ends; We reserve the right to refuse the provision of supplementary b) the employment contract between you (insured party/ insurance for other reasons. policyholder) and the employer terminates; c) if you (insured party/policyholder), for reasons other than those given under b, no longer meet the conditions for

37 participation as described in the group scheme within the care provided during that six-month period. The six-month meaning of article 1, Specific conditions supplementary waiting period does not apply if the supplementary insurance is insurance Uitzendpolis Speciaal and Uitzendpolis No Risk. taken out at the same time as the public healthcare insurance or if the supplementary insurance takes effect on 1 January.

Premium Alongside this general waiting time, specific waiting times may apply per insured care form. 5. How is the premium made up? You (policyholder) must pay us premium, except for the period 8. Which general restrictions apply to the that cover for the supplementary insurance is suspended, insurance cover? because you are serving a custodial sentence. You are not entitled to reimbursement of the costs of care: • provided abroad, unless explicitly stated otherwise in these insurance conditions; Insurance cover general • that falls within the scope of the compulsory policy excess or voluntary policy excess, unless explicitly stated otherwise 6. When are you entitled to reimbursement? in these insurance conditions; The content and scope of the care are partially determined • if they are subject to the statutory personal contribution, by the state of the art and practice. If there is no such unless explicitly stated otherwise in these insurance benchmark, it is determined by that which is regarded as conditions; responsible and adequate care in the discipline in question. • which is required due to your own negligence or intention; • for injury sustained during your participation in a crime; You are only entitled to reimbursement of the costs of care if: • for injury sustained during and partly the result of playing • you have complied with all the conditions set by us; competitive sport abroad; • the care in question may reasonably be regarded as • for injury sustained and partly the result of practising necessary for you in terms of content and scope. The care dangerous sports or professional or semi-professional sport; to be provided must be effective and not unnecessarily • for injury sustained during and partly the result of expensive or unnecessarily complicated; mountaineering of a nature which would be challenging for • you receive the care at a location which may be regarded an untrained person; as customary, given the nature of the care and the • for injury sustained during winter sports except sledging, circumstances. skating, cross-country skiing and on-piste downhill skiing. • for search, rescue and recovery. You are not entitled to a higher level of reimbursement of the cost of care exceeding the actual cost paid for that care. 9. What restrictions apply in the case of exceptional circumstances? You may only receive the care from a care provider designated You are not entitled to reimbursement of the costs of care by us. Which care providers may deliver the care is specified for if the harm is caused by, occurred during or ensues from each type of care. You are entitled to reimbursement of the costs a nuclear reaction. This exclusion does not apply to harm of care provided by a care provider not appointed by us, provided caused by radioactive nuclides which are located outside a we have given our consent before you receive the care. nuclear facility and are used or intended for use for industrial, commercial, agricultural, medical, scientific or security For some forms of care, we set a maximum rate per session purposes. The above is subject to a valid permit having been or treatment from a non-contracted care provider. The issued by the central government for the manufacture, use, maximum rates do not apply to care from contracted care storage and disposal of radioactive substances. The provisions providers. The care providers contracted by us can be found of the previous three sentences do not apply if somebody else at www.hollandzorg.nl/zorgzoeker. If our contract with a care is liable for the injury caused, pursuant to Dutch law or the provider ends during the period you are receiving care from law of another country. that care provider, you retain the right to reimbursement for the rest of the treatment programme as if the care provider 10. Which restrictions apply in case of were still contracted by us. concurrence with other provisions? You are not entitled to reimbursement of the costs of care: If you have to pay VAT on that care, the reimbursement also • if you are entitled to reimbursement of the costs of that covers those costs. care by virtue of another agreement, law or other provision; • if you would be entitled to reimbursement of the costs of that care by virtue of that other agreement, law or other Specific restrictions for provision if your supplementary insurance had not been in existence. supplementary insurance No excess or personal contribution applicable to that other agreement, law or other provision is ever covered by the 7. When does a waiting time apply? supplementary insurance. After taking out a supplementary insurance, there is a waiting time of six months. You are not entitled to reimbursement for

Supplementary insurances Supplementary 38 Cover and reimbursement per care form Medically necessary repatriation

Uitzendpolis Speciaal Uitzendpolis No Risk 100% 100%

What is covered? to obtain locally or is medically irresponsible or because local You are entitled to transport of yourself and the organisation treatment is more expensive than in the Netherlands or your of such transport: country of origin. Social reasons such as family reunion and i. from the country you are temporarily staying in to the language problems are not included. Netherlands or your country of origin; ii. from the Netherlands to your country of origin. You retain entitlement to this cover for a 14-day period after The country where you are temporarily staying and your country termination of your supplementary insurance. of origin have to be in geographical Europe. Transport of family members and other travel companions does not fall under this. What should you keep in mind? Furthermore, there has to be a medical need for the transport. We will arrange the repatriation. To that end, you or your representative has to contact the HollandZorg emergency line: A medical need arises if, in our opinion, treatment in your +31 (0)570 687 110; country of origin is medically required because it is difficult

Transport of mortal remains

Uitzendpolis Speciaal Uitzendpolis No Risk 100% 100%

What is covered? You are entitled to this cover for a 14-day period after You are entitled to transport of your mortal remains from the termination of your supplementary insurance. place of death in the Netherlands or a country of temporary stay to your country of origin and the arrangements for What should you keep in mind? that transport. Transportation is defined as: the costs of the We will arrange the transport. To that end, your representative transport itself (the ticket) and the additional costs necessary has to contact the HollandZorg emergency line: +31 (0)570 687 for transport (compulsory embalming, transport coffin, etc.). 110; The country where you are temporarily staying and your country of origin have to be in geographical Europe.

Emergency dental care in the Netherlands

Uitzendpolis Speciaal Uitzendpolis No Risk

a maximum of € 200 per calendar year a maximum of € 200 per calendar year

What is covered? What should you keep in mind? You are entitled to reimbursement of the costs for urgent A dentist can provide all types of care. A dental prosthetics dental treatment in the Netherlands. maker may only perform technical procedures.

Here, urgent care is given to mean unforeseen care that Contracted care providers are listed at www.hollandzorg.nl. cannot reasonably be postponed. It concerns care that is You can also contact our Customer Service on (0)570 687 123.

intended to alleviate acute pain and ensure sufficient chewing Supplementary insurances capacity. A dental overhaul is not urgent care. For every usual treatment a description of the care is available. The Dutch Care Authority provides is. Only treatments with a description of care as referred to in HollandZorg's Operations list for urgent dental care qualify for reimbursement. The HollandZorg's Operations list for urgent oral care can be found on www.hollandzorg.nl. We can also send it to you if you wish.

Compulsory and voluntary excess

39 Uitzendpolis Speciaal Uitzendpolis No Risk - 100%

What is covered? You are entitled to reimbursement of the costs that have been charged to your compulsory excess and your voluntary excess.

Supplementary insurances Supplementary 40 What do all the terms mean?

In these insurance conditions, the following terms are defined as Pelvic physiotherapy follows: Care generally provided by pelvic physiotherapists.

Supplementary insurance Pelvic physiotherapist The agreement for non-life insurance concluded or to be A physiotherapist who is entered as a pelvic physiotherapist in concluded with Eno Aanvullende Verzekeringen NV. This non-life a register jointly appointed by the KNGF and Zorgverzekeraars insurance covers a risk of a need for healthcare or other services, Nederland. in addition to the cover provided by the public health insurance. Dental insurance also falls under this, unless explicitly stated BRP otherwise. Persons Database.

Ambulance Youth welfare agency A motor vehicle as referred to in Article 1, paragraph 1b of the An agency as defined in article 4 of the Youth Care Act (Wet op Provisional Ambulance Care Act. de Jeugdzorg).

Dispensing general practitioner Centre for special dentistry A general practitioner who, pursuant to article 61, paragraph 10 A university or other centre considered by us to be equivalent or 11 of the Medicines Act, has been granted a licence to dispense to a university for providing dental care in special cases where medicines. treatment by a team or special skills are required.

Dispensing chemist Centre for genetic advice A chemist who is entered in the register of established A centre with a permit under the Special Medical Procedures Act dispensing chemists as defined in article 61, paragraph 5 of the (Wet op bijzondere medische verrichtingen) for the application of Medicines Act. clinical genetic research and genetic advice and which qualifies as such, insofar as required by or pursuant to the Healthcare Doctor Institutions Eligibility Act (Wet toelating zorginstellingen). A doctor registered as such in accordance with the conditions defined in article 3 of the Individual Health Care Professions Act Group scheme (Wet BIG). An agreement between us and an employer or legal entity which is not an employer and which looks after the interests of a group Doctor for the mentally disabled of people. The employees or the persons of that group enjoy the A doctor registered as a doctor for the mentally disabled in the benefits under the agreement if they meet the conditions set KNMG's Board of Registration of general practitioners, specialist out in the agreement. We refer to such employees or persons as geriatric doctors and doctors for the mentally disabled. participants.

Audiological centre DBC (care product) A centre that provides audiological care and which qualifies as DBC is the abbreviation for diagnostic treatment combination. such pursuant to the law, insofar as required. A DBC or DBC care product describes the finished process of (medical) specialised care, as set out in decisions by the Dutch Basic mental healthcare Care Authority, by means of a DBC service code or care product General basic mental healthcare. code. The DBC procedure commences when the insured party reports his care requirement and is completed at the end of Public healthcare insurance the treatment or after the maximum number of days the DBC The HollandZorg public health insurance, which is a health (care product) can be 'open' if the treatment has not yet been insurance. completed by that time.

Respiratory centre Diagnosis A centre that provides artificial respiration and which qualifies as The examination into the nature, cause and seriousness of a such pursuant to the law, insofar as required. A respiratory centre disorder. may be affiliated to a hospital, but not necessarily so. Dialysis centre Company doctor A centre that provides dialysis care and which qualifies as such, A doctor who is entered as a company doctor in the KNMG's insofar required, pursuant to the law. A dialysis centre may be Board of Registration of Doctors of Social Medicine register and affiliated to a hospital, but not necessarily so. acts on behalf of the employer or the Working Conditions Service (Arbodienst) with which the employer is affiliated.

41 Dietary preparations Contracted care provider Polymeric, oligomeric, monomeric and modular dietary A care provider with whom we have concluded an agreement. preparations. This agreement outlines arrangements such as the ability to claim directly for the care provided and the quality of the care. Dietician Contracted care providers are listed at www.hollandzorg.nl. You A dietician who complies with the requirements of the Dieticians, can also contact our Care Advice Line on (0)570 687 123. Occupational Therapists, Speech Therapists, Oral Hygienists, Remedial Therapists, Orthoptists and Podiatrists Decree and is Geographical Europe entered in the Paramedics Quality Register. The mainland of Europe (the European peninsula), with the exception of Belarus, the Ukraine, the Russian Federation, Echoscopic centre Moldavia, the European part of Turkey and the European part of An institution for prenatal screening which holds a licence Kazakhstan. pursuant to the Population Screening Act (Wet op het bevolkingsonderzoek). Registered medicine A medicine for which a trade licence or a parallel trade EEA country licence has been granted pursuant to the Medicines Act A country party to the Agreement on the European Economic (Geneesmiddelenwet) or pursuant to regulation 726/2004/EC, OJ Area: Liechtenstein, Norway and Iceland. EC L136.

Occupational therapist Geriatrics physiotherapist An occupational therapist who complies with the requirements A physiotherapist who is entered as a geriatric physiotherapist of the Dieticians, Occupational Therapists, Speech Therapists, in a register jointly appointed by the KNGF and Zorgverzekeraars Oral Hygienists, Remedial Therapists, Orthoptists and Podiatrists Nederland. Decree and is entered in the Paramedics Quality Register. Geriatric physiotherapy EU country Care generally provided by geriatric physiotherapists. A country that is a member of the European Union: Austria, Belgium, Bulgaria, Croatia, the Czech Republic, Cyprus (Greek Specialist mental healthcare part), Denmark, Estonia, Finland, France (including Guadeloupe, Specialist medical mental healthcare. French Guyana, Martinique, Reunion, St. Martin), Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Healthcare psychologist Luxembourg, Malta, Norway, Poland, Portugal (including Madeira A healthcare psychologist registered as such in accordance with and the Azores), Romania, Slovenia, Slovakia, Spain (including the conditions defined in article 3 of the Wet BIG. Ceuta, Melilla and the Canaries), Sweden and the United Kingdom (including Gibraltar). GGZ Mental healthcare. Fraud To commit, to attempt to commit or to instruct others to commit HollandZorg forgery of documents, fraud, deceit, embezzlement or deliberate Eno Zorgverzekeraar N.V. In the event of references to prejudice to us, aimed at obtaining (a reimbursement of the supplementary insurance, 'HollandZorg' is taken to mean: Eno costs of) care to which no right exists, or to conclude, extend or Aanvullende Verzekeringen N.V. terminate an insurance contract or to obtain insurance cover under false pretences. Practitioner in charge The supplier who, in response to your request for care, diagnoses Physiotherapist you and is responsible for the treatment. The practitioner in A physiotherapist registered as such in accordance with the charge may provide the care him/herself. If the care is also conditions defined in article 3 of the Individual Health Care provided by others, the practitioner in charge retains ultimate Professions Act (Wet BIG). Physiotherapist is also given to mean responsibility for the treatment. a remedial gymnastics masseur as defined in article 108 of the Individual Health Care Professions Act (Wet BIG). Skin therapist A skin therapist who complies with the requirements of the Birth centre Skin therapist training requirements and area of expertise An institution for obstetric care. Here you can give birth and decree (Besluit opleidingseisen en deskundigheidsgebied possibly stay during the maternity period after delivery. huidtherapeut) and is affiliated with the Dutch Association of Skin Therapists (NVH).

42 General Practitioner (GP) Calendar year A doctor registered as a general practitioner in the register of The period from 1 January to 31 December inclusive. general practitioners, specialist geriatric doctors and doctors for the mentally disabled of KNMG's Board of Registration. Nuclear facility A nuclear facility in the sense of the Nuclear Accident Liability General practitioner services structure Act. An organisational association of general practitioners with a corporate personality. The association is set up to provide general Integrated care practitioner's care in the evening, at night and at the weekends Care that is financed under the policy rule for performance-related and charges a legally valid rate. financing of multidisciplinary care provision for chronic disorders, laid down pursuant to the Healthcare Market Regulation Act GP centre (Wet marktordening gezondheidszorg). Integrated care comprises An institution for the provision of general practitioner care. a care programme, set up for a particular disorder, that involves different care providers. There is only one rate for the entire care Institution programme. The objective is for care providers to work closely • an institution in the sense of the Healthcare Institutions together and to coordinate the patient's care properly. Eligibility Act (Wet toelating zorginstellingen); • a legal entity established outside the Netherlands that NIP-certified child and adolescent psychologist provides care in the country in question within the framework A care provider registered as a child and adolescent psychologist of the social security system of that country, or specialises in in the register of the Netherlands Institute of Psychologists (NIP). providing care to specific groups of public officials. Children's physiotherapist Institution for sensory disability care A physiotherapist who is entered as a children’s physiotherapist An institution for the provision of sensory disability care, which in a register jointly appointed by the KNGF and Zorgverzekeraars is a member of FENAC (Netherlands Federation of Audiological Nederland. Centres or NOG (Netherlands Ophthalmological Society). Children's physiotherapy Intensive childcare Care for minors generally provided by children's physiotherapists. Care because an insured person under the age of 18 suffers from a complex physical medical problem (complex somatic issue) or Children's remedial therapist physical disability, as part of which: A remedial therapist who is entered as a children’s remedial • there is a need for permanent monitoring; or therapist in a register jointly appointed by the Association of • round-the-clock care must be available close to the insured Cesar and Mensendiek Remedial Therapists and Zorgverzekeraars and that care at the same time includes nursing. Nederland.

IVF attempt (in-vitro fertilisation attempt) Clinical psychologist Care in accordance with the in-vitro fertilisation method, A healthcare psychologist registered as a clinical psychologist entailing: in accordance with the conditions defined in article 14 of the • stimulating the maturation of egg cells in the woman's body Individual Health Care Professions Act (Wet BIG). by means of hormone treatment; • the follicle puncture (obtaining mature egg cells); KNGF • fertilising egg cells and growing embryos in the laboratory; The Royal Dutch Society of Physiotherapists. • implanting one or two embryos, kept frozen or not, once or several times in the uterus to achieve a pregnancy. KNMG The Royal Dutch Medical Association. Youth doctor A doctor who: Maternity centre • is registered as a Public Health doctor in the Public Health A centre that provides maternity care and which qualifies as register of the Commission for the Registration of Social such, insofar as required, pursuant to the law. Medicine of the KNMG (Royal Netherlands Medical Society); or • is registered as a youth doctor in the youth healthcare profile Maternity carer register of the Commission for the Registration of Social A trained assistant who provides maternity care to the new Medicine of the KNMG (Royal Netherlands Medical Society); mother and her family after childbirth. A maternity carer and who provides youth healthcare as referred to in the Public ensures the wellbeing of mother and child, and reports to the Health (Preventive Measures) Act. obstetrician or doctor if necessary.

Dental surgeon Medical aids supplier A specialist in Oral Diseases, Dental and Facial Surgery who An organisation which provides (medical) aids and which is listed in the specialists register for Oral Diseases, Dental is registered in the General Care Providers Database (AGB and Facial Surgery by the Registration Committee for Dental database). This database records data on care providers in the Specialisms (RTS) of the Royal Dutch Dental Association (KNMT). Netherlands. This data is given a unique code, the AGB code.

43 This ensures a uniform registration of care provider data for the the care was provided and description of that care, name, date healthcare insurers. of birth and citizen's service number (BSN) or, failing that, the national insurance number of the insured party. Scar treatment Physiotherapy aimed at preventing or reducing pain and NVLF movement restrictions due to scars. Dutch Association of Speech Therapy and Phoniatry.

Speech therapist NVO educationalist-generalist A speech therapist who complies with the requirements of the An educationalist-generalist who is registered in the NVO Dieticians, Occupational Therapists, Speech Therapists, Oral Register (Educationalist-generalist of the Dutch Association of Hygienists, Remedial Therapists, Orthoptists and Podiatrists educationalists and teachers (NVO)). Decree and is entered in the Paramedics Quality Register. Oedema therapist Manual therapist A physiotherapist who is entered as an oedema therapist in a A physiotherapist who is entered as a manual therapist in a register jointly appointed by the KNGF and Zorgverzekeraars register jointly appointed by the KNGF and Zorgverzekeraars Nederland. Nederland. Oedema therapy and lymph drainage Manual therapy Care generally provided by oedema therapists. Manual therapy encompasses care that is generally provided by manual therapists. Remedial therapist A Cesar or Mensendiek remedial therapist who complies with the Competitive Dutch Rate requirements of the Dieticians, Occupational Therapists, Speech The costs of care minus the costs in excess of what can Therapists, Oral Hygienists, Remedial Therapists, Orthoptists reasonably be regarded as appropriate under Dutch market and Podiatrists Decree and is entered in the Paramedics Quality conditions. The competitive Dutch rate we apply is the maximum Register. rate that applies to the relevant care at that moment in time, as established pursuant to the Healthcare Market Regulation Act Cesar/Mensendieck remedial therapy (Wmg). If no maximum rate applies by virtue of the Wmg, the Care generally provided by Cesar/Mensendieck remedial competitive Dutch rate is the rate that we have agreed on in care therapists. agreements with care providers for that care. If we have agreed on different rates we apply the average of those rates. Eye clinic An independent treatment centre specialising in eye treatment. Medical adviser One of our employees who is entered in the registers in Public transport accordance with the conditions defined in article 3 of the Passenger transport open to all operated in accordance with a Individual Health Care Professions Act (Wet BIG). timetable by car, bus, train, underground train, tram or a vehicle propelled by a guidance system as defined in the Passenger Medical specialist Transport Act (Wet personenvervoer) 2000, and passenger A doctor who is entered as a specialist with a legally recognised transport open to all operated in accordance with a timetable in specialist title in a specialists register as referred to in article the form of a regular ferry service. 14, paragraph 1 of the The Individual Healthcare Professions Act (Wet op de beroepen in de individuele gezondheidszorg). Orthodontic care Care of an orthodontic nature as generally provided by dentists. Oral hygienist An oral hygienist who complies with the requirements of the Orthodontist Dieticians, Occupational Therapists, Speech Therapists, Oral A specialist dentist who is entered in the register for Hygienists, Remedial Therapists, Orthoptists and Podotherapists dentomaxillary orthopaedics of the Dutch Dental Association's Decree and is listed in the Paramedics Quality Register. (NMT) Board of Registration for Medical Specialists.

Non-contracted care provider Remedial educationalist A care provider with whom we have not concluded an An educationalist-generalist who is registered in the NVO agreement. Register (Educationalist-generalist of the Dutch Association of educationalists and teachers (NVO)). NIPT Non-invasive prenatal test. Chiropodist A chiropodist who is listed in the Chiropodist's Quality Register Invoice specialising as a diabetic foot chiropodist or medical chiropodist. Written proof of costs incurred by a care provider for care, A chiropodist who provides pedicure treatment within the containing at least the following information: name, address meaning of the supplementary insurance may also be listed in and profession of the care provider, invoice date, date on which the Chiropodists Quality Register specialising in foot care for

44 rheumatics. Prosthodontist Training Requirements and Area of Expertise Decree (Besluit opleidingseisen en deskundigheidsgebied Psychiatrist tandprotheticus). A doctor who is entered in the KNMG's Board of Registration's Medical Specialists register for psychiatrists. Temporary stay abroad A stay outside the Netherlands of no more than six consecutive Psychiatric hospital months. An institution which has been authorised as psychiatric hospital. Thrombosis service Psychotherapist A centre that provides thrombosis care and which qualifies as A psychotherapist registered in accordance with the conditions such, insofar as required, pursuant to the law. defined in article 3 of the Individual Health Care Professions Act (Wet BIG). You Whenever these insurance conditions refer to 'you', they refer Rational pharmacotherapy to the insured party. Whenever these insurance conditions Treatment with a medicine in a form that suits you. The refer to 'you (policyholder)', they refer to the policyholder. effectiveness of the medicine must be evidenced by scientific Whenever these insurance conditions refer to 'you (insured literature. Furthermore, treatment with that medicine must be party/policyholder)', they refer to both the insured party and the the most economical treatment. policyholder.

Prescription In-patient care Prescription for medicines. Admission with a duration of 24 hours or more.

Rehabilitation centre Treaty country An institution which provides rehabilitation care and that A country that is not an EU or EEA country with which the qualifies as an institution for rehabilitation, insofar as required, Netherlands has made agreements concerning the provision of pursuant to the law. A multidisciplinary team of experts, under medical care and the reimbursement of the costs of such care: the management of a medical specialist, is employed at the Australia (only for temporary stays of less than one year), Bosnia- centre. Herzegovina, Cape Verde, Macedonia, Montenegro, Morocco, Serbia, Switzerland, Tunisia and Turkey. In writing Transfer of information via hardcopy, e-mail or Internet web Obstetrician form. An obstetrician registered as such in accordance with the conditions defined in article 3 of the Individual Health Care SKGZ Professions Act (Wet BIG). Health Insurance Complaints and Disputes Committee Patient day Specialist mental healthcare A patient day as described in the policy document for specialist Specialist medical mental healthcare. medical care performance and rates defined by the Netherlands Care Authority. Geriatrics specialist A doctor entered as a geriatrics specialist (nursing home doctor) Nursing home in the KNMG's Board of Registration of general practitioners, A treatment and accommodation facility as defined by the specialist geriatric doctors and doctors for the mentally disabled. Exceptional Medical Expenses Act (AWBZ) for the treatment of somatic or psychogeriatric disorders. Sports doctor A doctor registered as a doctor of Society and Health in the Nurse KNMG's Board of Registration of Doctors of Social Medicine A nurse registered as such in accordance with the conditions register of Society and Health Doctors, designated as a sports defined in article 3 of the Individual Health Care Professions Act doctor. (Wet BIG).

SVB Nursing specialist Social Insurance Bank (Sociale Verzekeringsbank). A nurse registered as a specialist nurse in accordance with the conditions defined in section 14 of the Dutch Individual Health Dentist Care Professions Act (Wet BIG). A dentist registered as such in accordance with the conditions defined in article 3 of the Individual Health Care Professions Act (Wet BIG).

Prosthodontist A prosthodontist who complies with the requirements of the

45 Specialist mental healthcare nurse District nurse A nurse registered as a specialist mental healthcare nurse in A nurse who has been trained to Bachelor degree. accordance with the conditions defined in article 14 of the Dutch Individual Health Care Professions Act (Wet BIG). Wlz Long-term Care Act. Compulsory excess The sum of costs for care that remains payable by you. Independent treatment centre An institution for medical specialist care. Referral The written advice and explanations you receive from a care Medication for self-care provider who provides you with care, about the care provider • Over-the-counter medication (referred to as AV-category who can provide you with further care and which you need on medicine in the Medicine Act); and medical grounds. The care provider giving the referral is the • Over-the-counter medication sold at a chemist's or elsewhere referrer. A referrer cannot refer you to himself. under the supervision of a chemist, and which cannot only be sold at a chemist's without a prescription (referred to as UAD- Insurance category medicine in the Medicine Act). Public healthcare insurance, supplementary insurance, dental insurance. Neurologist A doctor who is entered as neurologist in the KNMG's Board of Policyholder Registration's Medical Specialists register. The person who has taken out insurance with us. If this person takes out the insurance for him/herself, he/she is also the Hospital insured party. A specialist medical care facility for the examination, treatment, and nursing of the sick. Insured party The party whose risk of requiring care is covered by the insurance Care and who is listed on the policy as the insured party. The care and other services as referred to in the Healthcare Insurance Act with regard to public healthcare insurance. The Insurance conditions care and services in the articles on cover and reimbursement The rights and obligations as they apply to you (insured party/ in the chapter on specific provisions for the supplementary policyholder) and us, and which form the insurance. insurances as regards the supplementary insurances.

Prescription Care provider The written direction and explanations you receive from a care A natural person or legal person that provides care professionally provider for care to be provided to you, which you need on or commercially. medical grounds. This may be for a certain medicine or aid. The care provider issuing the prescription is the prescribing party. Care group A care provider who provides integrated care as a principal Voluntary excess contractor. The care provider can provide the care with or without An amount of costs for care, agreed by you (policyholder) and the help of other care providers who, at the instructions of the HollandZorg as part of the public healthcare insurance, which is principal contractor, provide coherent and collaborative integrated payable by the insured party. care. In principle, the care is invoiced by the principal contractor.

Wet BIG Care institute The Individual Healthcare Professions Act. National Health Care Institute.

Statutory personal contribution Care plan The share of the costs of care covered by the public healthcare A dynamic set of agreements between you and your care insurance that remains payable by you. The minister has provider(s) regarding district nursing and your personal determined which costs this relates to. The statutory personal contribution to the care (self-management). These agreements contribution exists in addition to the compulsory and, if are based on individual targets, needs and situations. They are applicable, voluntary excess. formulated as part of a joint decision-making process. The care plan must at least state the type, scope and intended duration We of the required district nursing and the performances. You or Whenever these insurance conditions refer to 'we' or 'us', this your legal representative must have signed the care plan. The refers to 'Eno Zorgverzekeraar N.V.'. In the event of references to obligation to sign also applies when adjustments are made to supplementary insurance, these terms refer to 'Eno Aanvullende the care plan. Verzekeringen N.V.' Health insurance Health insurance as defined in the Healthcare Insurance Act (Zorgverzekeringswet).

46 47 Munsterstraat 7 7418 EV Deventer Telephone: +31 (0)570 687 123 Fax: +31 (0)570 687 300 www.hollandzorg.nl