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Health insurance
abroad 2013
Medical care during a temporary stay in the Netherlands
Temporary stay
in the Netherlands
International insurance form
One of the conditions is that you have the relevant international insurance form with you. Please do not forget to request this form from your health insurance fund before you leave for the Netherlands. We recommend that you make several copies of this form. Your health care supplier needs this copy to declare the costs for medical care to us. The insurance form must be valid on the date on which you request medical care.
Registered health care supplier
Another condition is that the medical care that you use is covered by the Agis Basispolis or the AWBZ (the Exceptional Medical Expenses Act). In addition, the health care supplier that you seek medical care from must be registered. This brochure contains brief informa-tion about the medical care to which you are entitled, and the type of internainforma-tional insurance form you will need.
Which
countries?
The information included in this brochure is intended for anyone insured against medical expenses in one of the following countries:
Member states of the European Union (EU) and the European
Economic Area (EEA):
• Switzerland
• Countries participating in the Convention for the Navigation of the Rhine
Countries bordering the Rhine (Germany, France, Switzerland), Belgium and Luxembourg
• Other treaty countries
Australia, Bosnia-Herzegovina, Cape Verde, Croatia, Macedonia, Montenegro, Serbia, Tunisia and Turkey.
Which form?
Please find below an overview listing the forms you will need for reimbursement of the costs of your medical care.
EU-, EER-countries and Switzerland
European Health Insurance Card (EHIC)
For medical care required for the duration of the insured party’s stay in the Netherlands. The EHIC will be issued by your health insurance fund. The expiry date is stated on the card.
Provisional health insurance certificate
For emergency situations, for example in case of theft or loss of the EHIC. You can request this provisional (paper) health insurance certificate from your health insurance fund.
Form E 112/S2
If you call on medical assistance, for which you specifically need to travel to the Nether-lands. In certain situations you may prefer to receive certain medical care in the
Netherlands rather than in your country of residence. It is important that you contact your health insurance fund well before your departure for the Netherlands. If your health insurance fund agrees, it will issue you with Form E 112/S2.
Form E 123/DA1
If you require medical care due to an accident (at work) or an occupational disease.
Form E 112/S2
Do you come to the Netherlands especially to undergo medical treatment? Make sure you get approval from your own country’s national health service first.
Rhine-bordering countries
Form R 110
If you are employed on a vessel navigating the Rhine. You must fill in two original Forms R 110, both of which must be signed by your employer. Give these forms to the health care supplier.
Form R 123
If you require medical care due to an accident (at work) or an occupational disease.
Other Treaty countries
If you are insured in one of the other treaty countries, you are only entitled to (a reim-bursement of costs resulting from) emergency medical care. You will require one of the following forms:
Form HR/NL 111
If you are insured against medical expenses in Croatia.
Form K/N 111
If you are insured against medical expenses in Cape Verde.
Form RM/NL 111
If you are insured against medical expenses in Macedonia.
Form TUN/N 111
If you are insured against medical expenses in Tunisia.
Form TUR/N 111
If you are insured against medical expenses in Turkey.
Form YN 111
Agis Basispolis
The Agis Basispolis is legally determined and is comparable to the Dutch Zorgverzekerings-wet. Please find below an overview listing a number of common forms of medical care covered by the Agis Basispolis.
General practitioner
Care provided by a general practitioner includes:
• a visit to the GP during surgery hours (a consultation)
• a GP’s visit to your home, if you are unable to visit the GP during surgery hours (a home visit)
• a telephone consultation
The costs for an influenza vaccination or a medical examination for a job are not covered.
Pharmaceutical care
This concerns medical, bandaging and diet products. Only products prescribed by a doctor are covered. For some medicines a personal contribution will be applicable. For instance, this is the case for products that can be replaced by cheaper alternatives with the same effect. There are also medicines that are not covered by the Dutch Health Insurance Act. Your pharmacist can tell you more about this.
You are only entitled to
reimbursement of products tha
t
you need during your stay
Specialist care
Amongst other things, specialist care includes medical care provided by a specialist in his/ her surgery, or at a hospital’s outpatients’ department. Such care requires a written referral from a general practitioner, dentist, midwife or other specialist. Specialist care also includes medical care provided by a specialist during a hospital stay.
Hospital admission
If it is necessary for you to be admitted to hospital during your stay in the Netherlands, the costs involved are covered. The amount of the reimbursement depends on the price arrangement agreed on with the hospital. Admission for plastic surgery is only possible after the specialist has submitted an application and approval from us.
There is limited cover for plastic
surgery. In all cases, the specialist
Dental Care
Dental care for insured under 18 years of age
All dental care is covered with the exception of crowns, bridges, implants and orthodontic care.
Dental care for insured from 18 years of age
Reimbursement is only possible for prosthetic services and special dentistry (only with our prior approval).
For prosthetic services please taking into account that:
• Only the costs for complete upper and lower dentures will be reimbursed. • You do need to pay a minimum of 25% towards the cost.
You will also be reimbursed for the repair or relining of existing complete dentures.
Midwife and maternity care
Any costs associated with giving birth in a hospital are completely covered if the birth is a result of a medical indication. This also applies to a “home birth” at a Dutch address. If you choose to give birth in a hospital without having a medical reason for doing so, then you would need to pay a contribution of € 312,87. The hospital would provide you with an invoice in such cases. You need to settle this invoice direct with the hospital, after which it can beforwarded onto us. You will then be reimbursed for part of these costs.
Paramedical care
Paramedical care includes physiotherapy, remedial therapy, speech therapy, occupational therapy and dietary advice.
Physiotherapy and remedial therapy
With the reimbursement of physiotherapy and remedial therapy a distinctionis made between a chronic and a non-chronic condition and between two age groups. The govern-ment has decided in which cases reimbursegovern-ment is possible.
Hip physiology
For insurance holders aged 18 years and above, a maximum of nine sessions for the treatment of urine incontinence are reimbursed.
Up to 18 years old 18 years or above
Chronic condition All medically required treatments
are reimbursed.
Reimbursement for medically required treatments from the twentyfirst treatment applies. The first twenty treatments are at your own expense.
Non-chronic condition
A reimbursement applies for a maximum of nine treatments per condition per year. An inadequate result means you have the option of an additional maximum nine treatments.
All treatment are at your own expense.
Speech therapy
All necessary treatments will be reimbursed, except treatments related to language development disorders in connection with a dialect or because a person speaks a different language.
Occupational therapy
A maximum of 10 hours per calendar year applies.
Dietary advice
A maximum of 3 hours per calendar year applies.
Patient transport
Ambulance
Transport by ambulance is completely paid for by us. You do not need to contribute to this.
Transport by car (own transport or taxi) and public transport Here, a reimbursement will only apply to:
• insured parties who need to undergo kidney dialysis treatment
• insured parties who need to undergo oncological treatment with chemotherapy or radiotherapy
• insured parties who are completely restricted to a wheelchair
• visually handicapped people, who cannot travel without the assistance of others as a result of their disability
Transport from the Netherlands to another country and/or vice versa will not be reimbursed by us (this also applies for transport to and from a bordercrossing or an airport).
You need to request prior permission from us regarding any transport needs. The request needs to be accompanied by a declaration from the relevant GP, from which it should be apparent he is part of one of the aforementioned groups.
For transport by car and public transport you will need to pay a contribution of € 95,- per calendar year.
GGZ (Mental Health Care)
First line psychological care
This includes visits to healthcare suppliers like a first line psychologist, mental health psychologist, but also the orthopediatric, youth psychologist and sexological assistance. The first 5 sessions are covered. You will pay a personal contribution of € 20,- per full session. It may be that you have to pay a higher amount yourself. This depends on the rate that the health care supplier will charge. The healthcare provider must charge for expenses on the basis of performance codes.
There is no reimbursement possible for care bearing no relation to mental disorders. Examples of the latter are remedial teaching, homework support and career counselling.
Second line mental health care (non-clinical and clinical mental health care)
The AWBZ is an insurance covering exceptional medical expenses.
Currently, the AWBZ covers expenses for:
• nursing care in a hospital or sanatorium, if your stay extends beyond a year • care provided by a homecare organisation • nursing care in a nursing home • nursing care in a retirement home • nursing care in an institution for the physically disabled • nursing care in an institution for the mentally disabled • placement in a daycentre for the disabled • placement in a surrogate family unit • home care
If you would like to know whether you are entitled to any of the abovementioned care, and whether or not you yourself will have to pay part of the costs involved, please contact our colleagues of Groep AWBZ on telephone number +31 (0)33 445 68 71.
Important additional information
Working for a Dutch employer
If you are going to work for a Dutch employer during your stay, you have to pay income tax. You also come under the Dutch Zorgverzekeringswet (Health Care Insurance Act), which means that you must be insured in the Netherlands.
The Zorgverzekeringswet prevail over your foreign health insurance. As soon as you are employed by a Dutch employer, it is very important that you notify us and your foreign health insurance fund of this.
Reimbursement of medical costs
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