Deciphering the Dutch health insurance system - Part 2
Medical insurance is one of those matters that the Dutch have devoted particular thought to - meaning that the outcome is characteristically complex. It is a topic that requires some discipline to decipher, yet it is also a very important one, with considerable consequences if you fail to deal with it correctly.
Trying to read up about it requires becoming familiar with terms that even the average Dutch person will have a hard time grasping, let alone explaining to you.
In these articles (see also Part 1), we cover the most important rules and terminology in order to help you figure out what your options and your obligations are.
Deductible - "Own Risk"
For 2012, there is a fixed minimum deductible of 220 euros. It does not apply to children until the age of 18, visits to the general practitioner (GP), visits to the midwife, maternity care, or dental care for children / persons until the age of 21. You can also opt for a voluntary deductible of up to 500 euros a year.
By increasing the amount of the deductible, you can decrease the income-independent part of your contribution.
Exceptional medical expenses
The AWBZ is a national insurance scheme that insures persons against risks that cannot be covered by individual insurance - its name translates into "Exceptional Medical Expenses Act." Everyone who legally resides and works in the Netherlands has a right to coverage by this insurance.
It is meant to cover steep medical expenses that are not covered by a regular health insurance and that are simply not affordable, such as long-term home care, or admittance to a nursing home or a home for disabled persons.
The same health care insurance company with which you have placed your "regular" health insurance also takes on your personal coverage by this insurance. You owe a social security contribution to pay for the AWBZ, which is calculated over - and withheld from - your salary and some types of benefits. You also owe a contribution for this insurance over income from self-employment.
Dental care is not included in any basic package (with the exception of dental care for children up to the age of 18 and "specialist" dental care, including dentures). You must take out an additional dental policy to cover standard dental care.
In your policy you are likely to find something along the lines of "we only cover GVS medication." This refers to an arrangement whereby types of medication have been "clustered," after which a maximum price has been determined for this cluster. If you are prescribed medication, then the cluster-specific maximum price is covered by the insurance. If your medication is more expensive than that, you will have to pay the difference.
Homeopathic medicine is not covered by the GVS-system, so that you will have to pay for it yourself. Check with your insurance company whether you can take out an additional policy to cover more expensive medicine as well as the cost of homeopathic / alternative medication.
On the website Mijnmedicijnvergoeding.nl you can check whether your medication is covered by your insurance company:
› Click on "Worden mijn medicijnen vergoed?" (is my medication covered?)
› On the next page you type in the name of the medication, the amount you take a day and a year, followed by the name of your insurance company
The site will tell you which of the company’s insurance packages cover the medication and how much you will have to contribute yourself.
Pregnancy & Childbirth
During pregnancy, you visit a midwife with increasing frequency up to and including delivery; this is covered by your insurance. At least two ultrasounds, if they are medically required, are also covered.
In principle, in the Netherlands, a home delivery is fully covered by your insurance. The costs of a hospital delivery are fully covered if your midwife, GP or specialist has determined that, for health and safety reasons, the baby should be delivered in the hospital. This is called a "bevalling op medische indicatie."
If you voluntarily choose to have your baby in the hospital (called a "poliklinische bevalling"), you will have to pay a contribution in the costs, though some insurance companies offer the option of additional voluntary insurance to cover these expenses.
Students will often find that their host institution has made sure that they are insured. Be sure to verify this. Special packages for students are available.
This is the second part of the "Deciphering the Dutch health insurance system - Bringing it back to simpler terms " article written by Stephanie Dijkstra, editor-in-chief of The XPat Journal - have a look at the current issue of the journal or subscribe here. This article has been based on a contribution to The Holland Handbook. For more information visit XPat Media.
Previous in the series
› Deciphering the Dutch health insurance system - Part 1
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