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Health insurance in the Netherlands (part 2)

17.12.2020

Basic health insurance cost / monthly premium (premie) for 2021

It has already been mentioned that on November 12 of each year, insurance companies must announce the amount of their insurance premiums for medical care for the next year - both the basic package and the additional ones. What awaits us in 2021?

Unfortunately, as already stated, health insurance premiums have increased, which is associated with both the general trend of recent years and the coronavirus. In accordance with the forecast calculation of the average monthly personal insurance premium per person, it increases from 60 euros per year or from 5 euros per month.

In the coming year, the difference in monthly premiums (premie) between insurers of the “big four”, whose composition in recent years is: Zilveren Kruis, VGZ, CZ and Menzis, will decrease.

Thus, Zilveren Kruis is increasing its premie by 3 euros (2,39%) per month to 128,45 euros. As a result, he is no longer the most expensive of the four, and this dubious honor now goes to Menzis. His premie rises by 7 euros (5,69%), resulting in a monthly amount of 130 euros.

VGZ and CZ remain the most profitable of the four. At VGZ, with an increase of 4,50 euros (3,75%), the increase in premie was even slightly below the government's expectations. CZ remains the cheapest of the four, but the gap between the other three is narrowing significantly thanks to an increase in its premie of 8,15 euros (7,09%).

Now, after the general overview data, let's compare the cheapest, average and most expensive basic insurance in the Netherlands for 2021 using one of the sites.

Among the 69 insurance policies presented here, we will single out the cheapest (1) from ZEKUR, the average (35) from IZZ (VGZ) and the most expensive (69) from De Amersfoortse insurance.

What do all the mentioned policies have in common?

  1. These are basic insurances.
  2. They cover almost all necessary services, among which are highlighted:
  • family doctor;
  • hospital care;
  • medications;
  • psychological help.
  1. All of these insurances have direct acceptance - i.e. you get it right away and you do not need to answer questions about your health or teeth (which is quite logical for basic insurance).
  2. The deductible for all these insurances is 385 euros.
  3. There is no waiting period for all these health insurance plans - i.e. from the start date, you are immediately eligible for coverage, which is part of the policy (there are certain clarifications related to the franchise - see below about it).

What are the differences between the selected insurance (Table 2)?

Comparison of three basic medical insurance for 2021 (by different parameters)

Table 2

Insurer name ZEKUR IZZ (VGZ) De Amersfoortse
Number in the list 1 35 69
Cost / monthly

contribution (premie)

105,95 124,45 147,95
Policy name Just ZEKUR Basic insurance Variant Natura Your own choice
Number of reviews /

average mark

258/7,4 382/7,9 75/6,8
Choice of care 1/5 limited 3,5 / 5, spacious 5/5, free
Main characteristics You have a limited choice of services. The insurance company ZEKUR has contracts with a limited number of hospitals. In hospitals without a contract, you will receive less compensation for treatment You have a wide range of services. (Almost) all hospitals have a contract with this insurance company.

In hospitals without a contract, you will receive less compensation for treatment

You have free choice of health care. It doesn't matter which hospital you go to. You choose your health care provider.

Reimbursement for non-contractual medical care is 100% of the market or statutory rate

Nursing - hospitals You can contact 130 out of 277 hospitals.

You can go to any hospital for emergency care and the bill will be paid.

You can contact 277 out of 277 hospitals.

Limited choice of healthcare providers for certain types of treatment, for example:
– knee or hip replacement;
– treatment of cataracts;
– a number of cardiac procedures;
– a range of oncological treatment methods

You can contact 277 from 277 hospitals for any type of treatment
Care - pharmacies You can contact great number of pharmacies in the Netherlands. You can contact great number of pharmacies in the Netherlands You can contact all pharmacies in the Netherlands.
Nursing - other health care providers Your medical expenses fully reimbursed by all health care providers who have entered into a contract with this insurance company.

Up to 80% of health care costs are reimbursed to health care providers who have not entered into a contract with this insurance company.

Your medical expenses fully reimbursed by all health care providers who have entered into a contract with this insurance company.

Up to 80% of health care costs are reimbursed to health care providers who have not entered into a contract with this insurance company.

Your medical expenses fully reimbursed by all health care providers who have entered into a contract with this insurance company.

Health care providers who do not have a contract with this insurance company are reimbursed for service costs up to 100%.

In general, health insurance in 2021 does not differ in many ways from insurance in 2020. Much has remained the same (we do not cover here all the nuances associated with collective insurance, family, personal contribution (this is not a deductible), payment monthly or once a year, percentages of additional insurance coverage, etc.).

In 2021, the amount of premiums (premie) increased, as has been said many times.

And one of the important points is that the “franchise” has remained the same.

 

"Franchise" (eigen risico) and its limit in 2021

Eigen risico (own risk) or “franchise”, as it is commonly called when translated into Russian, is a kind of “cherry on the cake” of health insurance in the Netherlands.

The deductible in this case is the threshold amount that insured persons over the age of 18 must pay as soon as they bear the health care costs covered by basic insurance.

The government determines the amount of the deductible required by the law annually. It was installed in the modern context since 2011 in the amount of 170 euros, and from 2016 to 2021 inclusive, its growth stopped at around 385 euros per insured (Fig. 2):


Source

In the long term, while the current Cabinet of Ministers is working, the franchise should remain at 385 euros.

 

What treatment is covered by the deductible?

The deductible applies to most medical expenses covered by basic insurance, including:

  • hospital services: stay / stay, care in a hospital or specialized medical clinic;
  • specialized care: consultations, examinations, procedures and treatments performed by a specialist such as a cardiologist or an ENT specialist;
  • medicines: medicines prescribed by a family doctor or specialist;
  • laboratory tests (with a prescription), such as a blood test;
  • ambulance transport: urgent transportation of patients by ambulance or trauma helicopter;
  • psychological assistance, such as interviews with a psychologist or treatment at a GGZ facility;
  • paramedical services from basic insurance (if included) such as physiotherapy, occupational therapy, diet advice and speech therapist;
  • some assistive devices: hearing aids, dentures or crutches.

 

What treatment is not covered by the deductible?

In other words, you are NOT paying a deductible for:

  • consultation and treatment by a family doctor or general nurse;
  • family doctor visit;
  • home care (community nurse);
  • obstetric care and childbirth (there are nuances for childbirth and childbirth in a hospital without medical need)
  • care that is reimbursed in accordance with the Wlz Act or the Wmo Act;
  • caring for children under 18 years old - this applies to both basic and additional insurance;
  • care that is covered by any additional insurance.

Some national screening and vaccination programs are also excluded from the franchise.

 

How does a franchise work?

You pay for your deductible as soon as you receive the medical care from the basic package, unless there is no deductible - i.e. treatments that it does not cover (for example, visiting your family doctor).

For example, in May of this year, your deductible in the base amount of 385 euros has already been spent - i.e. covered by your funds. Then, for the entire further period until the end of the year, you no longer bear medical costs for basic insurance and do not pay a deductible.

Please note that the so-called "deductible counter" is restarted every year, and from next year you will have to pay the deductible again in the event of certain expenses for basic insurance, and only then, by the end of this year, basic insurance services will become you are free.

The current deductible amount of 385 euros is the minimum legal amount that every insured person in the Netherlands has to face. However, you can voluntarily increase your deductible in €100 increments up to €500 (i.e. a maximum of €885). If you choose this, you will receive a discount on the monthly insurance premium (premie), the amount of which depends on the insurer, and can be somewhere between 25 -35 euros per month or about 300 or more euros per year.

The disadvantage in this case is that if you need treatment, you will have to pay much more out of your own pocket before you are eligible for compensation covered by basic insurance. Therefore, the voluntary increase in the franchise is especially popular among young people and healthy people who, as a rule, need little medical attention or are limited to visiting only a family doctor.

Why is there a so-called “deductible” in health insurance in the Netherlands, and for what purpose was it introduced? According to the information available on the Internet, this was done in order to “make the population more aware of the care / medical service, understand its value and seek treatment immediately after every minor incident”. We will not comment on this statement, but take the existence of the franchise for granted.
Let's sum up.

While living or working in the Netherlands, you are required to be covered by basic health insurance. If such insurance is not available for a specified period, you may be subject to fines and obligations to pay all premiums for the uninsured period at an increased rate in addition to current premiums.

Health insurance in the Netherlands is expensive - the cheapest and fairly limited compulsory insurance policy for 2021 is 105,95 euros per month (premie). In addition, there is a threshold of 385 euros, called a deductible (eigen risico), only after paying out of your own pocket, you are entitled to further coverage of services with basic insurance until the end of the calendar year.

The types of medical care provided under basic insurance can be expanded with additional policies, which entails an increase in the monthly insurance premium. Often, additional services are reimbursable not 100%, but in the amount of 75-80%, depending on the chosen coverage and the type of policy.

And it may happen that in some month your “medical expenses” per one adult member of your family will exceed 500-600 euros, which is very significant for many.
What to do?

After all, we already wrote earlier that according to the Constitution, the Netherlands chose a system that should make health care affordable for all citizens from a financial point of view. And the state keeps its promises - the Wet op de zorgtoeslag Act regulates the determination and assignment of subsidies / benefits to reimburse basic insurance premiums for insured persons with low incomes.

Basic information about healthcare allowance posted on the Belastingdienst website

In our articles, we have also repeatedly covered issues such as subsidies / benefits in general, and directly the requirements for the request subsidies / benefits for health insurance.

After all, the amount of this subsidy, which varies depending on insured person's income and other criteria can significantly ease the burden of your health care costs.
Finally.

It was in December that the most convenient time to request-change-stop any subsidies (toeslagen), including the subsidy for health insurance, came.

And the Nalog.nl team is always happy to help you with this! Contact us!

The information posted in the article is current at the time of its publication.

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