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Basic Healthcare Insurance Uitzendpolis 2016

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Basic Healthcare Insurance Uitzendpolis 2016 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
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