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Health insurance in the Netherlands (part 1)

16.12.2020

Who should be insured by basic health insurance in the Netherlands

Basic medical insurance (basis zorgverzekering) is compulsory for all residents-residents of the Netherlands (i.e. both citizens and those with a residence permit). In this matter, residents are also equated with:

  • non-residents working abroad in Dutch government jurisdictions;
  • non-residents working in the Netherlands;
  • crews of ships and aircraft with a Dutch home port.

The nuance here is that a child under 18 fits into the insurance policy of one of the parents, and many areas of medical care in the Netherlands are free for him. But after the 18th birthday, everyone is required to have a personal insurance policy with a list of free and paid medical services corresponding to this policy.

In addition, there are three groups of exclusions that do not have insurance obligations. These are military personnel, conscientious objectors and detainees / serving sentences.

Other / additional compulsory health insurance requirements may apply to persons with Dutch income but living abroad or those living in the Netherlands with foreign income. But all these cases are usually considered individually.

 

Pay attention!If the insurance obligation is not fulfilled - that is, there is no medical insurance for various reasons, the uninsured person will have to pay a premium with a penalty of 130% of the nominal premium (the amount of this type of premium is determined by the VWS Ministry) for the entire uninsured period.

In addition, such a person may also be fined once or twice if it turns out that he has not been insured for a certain period of time.

This system works very well in the Netherlands.

If you do not have compulsory health insurance for 3 months, then you will receive a paper envelope with a letter of reminder. Such letters are sent CAK – Centraal Administratie Kantoor (Central Administrative Office). This organization implements health finance regulations and informs citizens on behalf of the VWS Ministry.

From the moment you receive such a letter from SAC, you are required to take out health insurance within 3 months. If for some reason you did not do this, then a fine is imposed on you, a new letter is sent, and you are again given another chance to take out insurance on your own.

If, after that, within the next 3 months you have not done this, then a second fine is imposed on you, another letter is sent, and again 3 months are given for self-registration of insurance.

If after that you remain uninsured, then SAC takes out insurance on your behalf (this is reported in a new letter), and the insurance premium is withheld from your income for 12 months. You must also pay the above two penalties if you haven't already.

Please note that this premium is higher than the premium you must pay if you are self-insured for Dutch health insurance. If you still managed to take advantage of the chances given to you to take out insurance on your own, you will still be obliged to pay for it for the entire period when you were not insured (as if "retroactively"), which sometimes translates into rather large sums. An overview of the whole situation is reviewed here. 

Newcomers to the Netherlands often face the above problems.

We recommend that you - always be interested in such things and, if necessary, ask for advice. For those who came on a partner visa or highly qualified migrants, issues with compulsory insurance should be decided by a partner or a potential employer. But even if for some reason this does not work out - do not let the situation take its course, throwing letters from CAK into the trash, and do not think that you are left alone with your problem, but immediately contact us... Our migration department is always ready to help you!

 

In general, only one conclusion suggests itself here - please, be attentive to this type of your obligations to the state, and always follow the changes that may occur in this context. And we will definitely help you with this!

Annual stages of review and approval of the main indicators of health insurance in the Netherlands

1 phase

Every year on Budget Day (this is the 3rd Tuesday of September) - Prince's Day or Budget Day - The Government of the Netherlands announces planned figures for the country's budget for the next year.

In 2020, it took place on September 15

Among other major economic indicators, on this day, and the most important changes in health insurancesuch as calculated /monthly premium (premie) and the limit the amount of the so-called "deductible" (eigen risico). We will dwell on these two indicators below.

Thereafter ministerie of Public health, Welfare en Sport -VWS (Ministry of Health, Welfare and Sport) is reviewing the contents of the basic package for the next year, namely, determining which compensation will be excluded from the basic package and which will be added to it. About standard content basic health insurance package in the Netherlands we will talk a little later.

2 phase

In parallel with this, health insurance companies are beginning to determine insurance premiums for the next year, and, as a rule, on November 12, they have to announce the amount of their insurance premiums - both the basic package and the additional ones, and these results are widely reported in the media. for example: 

And from now on, you can compare next year's health insurance on different sites, for example, herehere or here.

Why and why do we recommend you to do this? Because health insurance in the Netherlands is not cheap, the mandatory basic package covers a fairly limited list of services, and everyone wants to know in advance what to expect in case of unfavorable circumstances (pah-pah-pah, we wish you all only good health, but oh it’s better to have an idea in advance, don’t you agree?).

3-th stage

Therefore, after weighing all the pros and cons, until December 31 of the current year (inclusive) you have the right to switch to a new type of policy for the next year in the same insurance company or choose a new insurer.

If you do not change the insurance policy - that is, both the type of policy and the insurer company remain the same, then you do not need to do anything - your policy is automatically renewed for the next year.

Or, you can cancel your current health insurance policy within the same timeframe, taking a month's break to think, compare and finalize your budget.

4-th stage

If you independently canceled your old health insurance before January 1 of the next year (see Stage 3), and took "time to think", then only until January 31 of the next year you have the right to choose a new health insurance policy for this year. What can happen if you, for any reason, not done on time, or, independently canceling the insurance, forgot to do it at all, we have already briefly mentioned above.

Health insurance companies in the Netherlands

So, using our advice, you started choosing an insurer for the next year - and your eyes fled from the abundance of offers and options. Who is involved in the provision of health insurance services in the Netherlands?

The Dutch insurance system has come a long way, and the first so-called "health insurance funds", similar to modern health insurance funds, were established in the eighteenth century. Established in 1741 by the carpenters' guild in Nijmegen, "De Timmermansbus" became the predecessor of the existing insurance concern. VGZ

For a further overview of fascinating historical events you can find here.

Since the introduction of health insurance became mandatory and definitive rather than voluntary, many insurers have sold their health insurance portfolio.

In 2007, there were 15 health insurance companies operating in the Netherlands.

At the moment, insurance companies providing medical insurance services are united in an association Health insurers The Netherlands - ZN (Dutch health insurers).

And do not be afraid of the seeming abundance of insurance companies - as a rule, they represent the brand of an insurance concern / group (the largest of which in 2016, for example, there were nine), which in the past were bought / merged, and under whose auspices they worked at that time (Table 1).

 

List of major health insurers in 2016

Table 1

Concern / group Market share Insurer name
Achmea 30,4% Agis, Zilveren Kruis, FBTO, De Friesland, Avero, ZieZo, ProLife, Kiemer, OZF, Interpolis, Ik !, YouCare
VGZ 24,1% VGZ, IZA Cura, IZZ, Univé, Bewuzt, Besured, De Goudse, Promovendum, National Academic, ZEKUR, UMC
CZ 20,7% CZ, Just, Delta Lloyd, OHRA
Menzis 13,4% Menzis, Anderzorg, Azivo, HEMA, PMA
DSW 3,5% DSW, Stad Holland, in Twente
ONVZ 2,7% ONVZ, PNO zorg, VvAA
Care and security 2,6% Zorg en Zekerheid, MWVZ
ASR 2,0% De Amersfoortse, Ditzo
AND NO 0,7% Salland, Salland Zorgdirect

Source 
Thus, in 2016, almost 90% of the Dutch population was insured in one of the 4 large concerns/groups (Achmea, VGZ, CZ or Menzis), and only slightly more than 10% in the other 5 groups.

Introduced in Table 1 the list of medical insurers does not remain unchanged - companies develop, merge, merge, or, conversely, leave the market. Their list, included in ZN, and current at the current time, can be viewed here to register:

Legislative regulation of health insurance in the Netherlands

According to the Constitution, the Netherlands has chosen a system that should make health care affordable for all citizens from a financial point of view.

Since 2015, the health insurance system in the Netherlands at the legislative level consists of (Fig. 1):


Let's consider briefly the content of each of the mentioned Laws.

Zorgverzekeringswet - Zvw states that every resident of the Netherlands (and a person equivalent to him) must be insured with basic health insurance, which requires reimbursement of the costs of basic coverage, carried out on the basis of a health insurance contract with an insurer.

The main clarifications in the context of this Law can be viewed here to register::

In addition, a separate law, Wet op de zorgtoeslag (Law on Medical Benefits - 16.06.2005), regulates that the state determines and assigns benefits to reimburse basic insurance premiums for insured persons with low incomes.

Wet langdurige zorg - Wlz regulates the care of people who require intensive care or close observation throughout the day. For example, older people with dementia, people with mental, physical or sensory impairments. Clients can choose to stay in a special hospital / nursing home or in home care.

Wet Maatschappelijke Ondersteuning - Wmo determines that for unimpeded participation in the life of society, persons who need it are assigned compensation for disability. This can be psychological support, medical care, home help, shelter / special treatment, purchase / provision of vehicles, or special housing modifications. How such support will be organized is determined in each specific case by the municipality.

Youth Law provides prevention, educational support and mental health problems for children under 18 years of age. Each case is considered by the municipality separately.

The implementation of most of the points of these Laws occurs through the CAK, which we have already written about earlier. The main tasks of the CAK in the specified context are:

  • determination and collection of a personal contribution on the basis of the Wlz Act;
  • making payments to health care providers in accordance with the Wlz Act;
  • determination and collection of personal contributions for municipalities in accordance with the Wmo Law;
  • determination and collection of the parental contribution for municipalities on the basis of the Youth Act;
  • legalization of certificates for the export of medicines abroad (Schengen declarations), etc.

 

Basic health insurance - general requirements

When concluding a contract of any type of insurance, it is always important to know what exactly is included in the insurance coverage under this contract.

It is customary to call insurance coverage the entire group of risks from which the policyholder is protected by the contract with the insurer. In the event of an insured event, the policyholder will receive compensation only for those risks that are covered by the insurance coverage.

And this means that when concluding a contract, be sure to check what exactly the insurance coverage covers - especially for supplementary health insurance. If the items you need are missing, you will naturally not be able to get a refund for them.

Basic health coverage is governed by Chapter 1, Clause 2 Decree о health insurance (Besluit zorgverzekering).

There is stipulated the minimum established by law. The medical care offered under basic insurance is the same for all health insurers.

The actual amount of basic insurance set out by the insurer in the terms of the policy may differ slightly and be specified.

Basic insurance coverage provides eight directions / groups of services. More detailed transcripts are given below for each such group.

  1. Medical services, for example: assistance of a family doctor, midwife and medical specialists (the latter must be specified separately with the insurance company), as well as the first three IVF attempts;
  2. Oral care and dental care (there are some restrictions on types) for insured persons under 18 years of age;
  3. Pharmaceutical Assistance and Limited Medicines;
  4. Medical devices such as hearing aids and dentures (under certain conditions), guide dogs for the blind;
  5. Reception, treatment and care in a hospital / hospital for 365 days;
  6. Obstetric care / childbirth and follow-up care for the newborn and mother;
  7. Possibility to contact urgent medical help; the possibility of treatment in a sanatorium (there are restrictions);
  8. Transportation in accordance with the right to care on the basis of Zorgverzekeringswet – Zvw, transportation for medical reasons by taxi or private car.

An important addition to basic health insurance for 2021 is the inclusion of rehabilitative care / rehabilitation treatment for coronavirus patients. It is planned that these changes will be valid for at least one year.

As you can see, the list of basic services provided is not very extensive, and therefore in 2020, 83,2% of residents of the Netherlands also have additional insurance.

Additional health insurance - general requirements

In addition to basic health insurance in the Netherlands, you can choose additional insurance. This type of insurance is not compulsory, and many are asking the question - how much is this insurance necessary? And if so, what should I choose and for what amount? However, in this case, only you yourself know your personal situation, and therefore you can only independently answer the questions asked above.

For example, the cost of visiting a dentist in the Netherlands for those over 18 years of age is not reimbursed by basic insurance. This also applies to X-rays, brushing your teeth, and other similar expenses. In other words, these services are not reimbursed at all, and you may be thinking about additional insurance. But if you go to the dentist once or twice a year and you have good teeth, then there is no need for dental insurance. As a rule, it is cheaper to pay for a visit to the dentist on your own.

Or the opposite situation may occur - you decide to apply for dental insurance with a high reimbursement/reimbursement. In this case, the insurer may request a medical report or a certificate from a dentist, consisting of a list of questions about your teeth and/or expected dental expenses. The insurer then evaluates the data and decides whether it wants to insure you.

And it may happen that the insurer will refuse you. Unlike compulsory basic insurance, he is entitled to this. After all, dental insurance is an additional insurance, and it is denied in cases, for example, if the costs are expected to be too high. In other words, the risk of insuring you is probably too high. You can ask the insurance company why you were denied. Alternatively, you can choose slightly less coverage to get accepted, or you can try purchasing that coverage from a different insurance company. In the Netherlands it is not prohibited to have basic and additional health insurance from different insurers, but sometimes it ends up being a little more expensive overall.

But, in any case, our advice is to always be honest when answering the insurer’s questions. If you do not do this, it may be considered fraud in the future, as a result of which the insurer will not pay you compensation.

So, for what types of medical services in the Netherlands is it possible to take additional health insurance?

General supplementary insurance policies include:

  • dental care (for people over 18 years old);
  • physiotherapy (except for a limited list of chronic diseases, the compensation for which occurs under basic insurance after the 21st treatment session);
  • alternative treatment (eg acupuncture, homeopathy, psychotherapy, etc.);
  • emergency assistance abroad (in the Eurozone or around the world);
  • the cost of glasses or contact lenses.

In addition, you can take out additional health insurance for pregnancy. But, as we said, most of it is already covered by basic insurance. Nevertheless, many women choose additional pregnancy insurance, which covers, for example, hospital births without medical necessity (after all, many Dutch women traditionally give birth at home, and this is what is considered the norm!), Courses for pregnant women, such as special yoga, the cost of additional care for pregnant women, etc.

Among the special policies of supplementary health insurance are:

  • "Luxury" - hospital care (for example, staying in a private ward with TV, Internet, etc.);
  • preventive screening (usually when you have no health problems or complaints at the time of this screening. The screening may consist of various medical examinations such as biometrics and blood tests. In addition, you can check your mental health, motivation and balance between work and personal life, etc.).

These types of insurance are not provided by all companies, so it is better to clarify in advance whether your insurer provides such services.

In general, we can say that the content of supplementary insurance in recent years has become increasingly limited. In addition, according to studies already carried out, supplementary insurance policies for 2021 are concluded less frequently than in the past.

Both basic and supplementary health insurance are selected for the entire year, from January 1st to December 31st. Therefore, it is usually not possible to make intermediate changes. But a number of insurers have exceptions to this rule, therefore, in the event of force majeure, it is best to contact your insurer.

You can cancel additional insurance at the end of the calendar year. The health insurance period is one year – until January 1. If you refuse it, then from January 1 you will no longer be additionally insured. You can take out a new additional insurance policy in a different location or for a different type of service, or you can keep only the basic insurance.

About the cost of basic health insurance / monthly premium (premie) for 2021, about the concept of “deductible” (eigen risico) and its maximum amount in 2021, and what to do if in any of the months your expenses are “on medicine” for one an adult member of your family will exceed 500-600 euros, which is very significant for many - read the continuation of this article tomorrow, December 17, 2020.

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

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