Clear communication is essential in my job. I expect the same from my health insurance company.

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Good care is your choice

Reimbursement overview

2014

‘Clear communication is essential

in my job. I expect the same from

my health insurance company.’

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Reimbursement overview for 2014

Reader’s guide

This reimbursement overview provides an

overview of reimbursements of the UMC

Zorg-verzekering and the UMC Aanvullende Verzekering

supplementary insurances. All items listed in the

overview of reimbursements marked with a

• are covered by your UMC Zorgverzekering.

Reimbursements are specified per calendar year,

unless stated otherwise. When we use the abbre-

viation ‘max.’, we mean ‘up to a maximum of’.

Additional conditions

Additional conditions, such as authorisation

requirements, necessary referrals and authorised

care providers, are specified in the policy

con-ditions. If you require care, we recommend that

you first consult the policy conditions. You will

find these on www.umczorgverzekering.nl.

Non-contracted care

UMC Zorgverzekering is a non-contracted care

policy. If you are covered by this type of insurance,

you are entitled to reimbursement of the costs of

care and you are entirely free to choose your own

care provider. It does not matter whether the care

provider you choose has agreements with UMC

Zorgverzekering or not. The only requirement is

that the care provider satisfies the requirements

set out in our policy conditions. You are entitled

to reimbursement of the costs of care up to a

maximum of the statutory rates current in the

Netherlands. If statutory rates do not apply to the

relevant care, the costs will be reimbursed up to

a maximum of the reasonable market price

current in the Netherlands. If you obtain care from

a contracted care provider, rates will have been

agreed upon with the relevant care providers up

to a maximum of the reasonable market price

current in the Netherlands.

Compulsory and voluntary excess

If you are aged 18 or older, a compulsory excess

of € 360 per calendar year applies to the UMC

Zorgverzekering. You can voluntarily increase

your compulsory excess to € 460, € 560, € 660,

€ 760 or € 860. You are then eligible for a discount

on the premium. The excess does not apply to

expenses incurred for visits to a general

practitioner, obstetric care, maternity care,

preferred medications designated by us, care aids

on loan, follow-up checks for kidney or liver

donors and care programmes.

Reimbursements from supplementary

insurance

Your UMC supplementary insurance policy or

policies entitle you to reimbursement of the costs

of care up to a maximum of the statutory rates

currently applicable in the Netherlands. If

statu-tory rates do not apply to the relevant care, the

costs will be reimbursed up to a maximum of the

reasonable market price current in the

Nether-lands. If you choose to take out care provided by a

care provider contracted by us, the costs of care

are reimbursed based on the rate agreed with the

care provider concerned.

Preferred, accredited or contracted care

Please note! Preferred, accredited or contracted

care may also apply to your supplementary

insurance package. This is indicated in the

over-view. If you take out care from non-contracted,

non-accredited or non-preferred care providers

you may not be reimbursed for the full amount or

not receive reimbursement altogether. Further

information can be found in the policy conditions.

Budgets

If you choose to take out supplementary

insurance, UMC Zorgverzekering offers you

freedom and convenience in determining your

reimbursement. As UMC Zorgverzekering has

grouped the available treatments, you are able

to see at a glance which care is reimbursed.

A maximum reimbursement applies for each

group of treatments; we refer to this maximum

using the term ‘budget’. You decide which

treatment, within the given treatment group, you

use your budget for. This enables you to get the

most out of your reimbursement amount.

Budgets are available for e.g. movement related

care, care aids and dental care. You can find these

budgets in the reimbursements overview.

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UMC Zorgverzekering and UMC Extra Zorg

Alternative care

A budget to use for the care types specified below:

- Treatments and consultations (by a doctor or preferred care provider) included in the following categories: a. acupuncture and other

traditional Eastern therapies; b. anthroposophic alternative therapies; c. homeopathy; d. naturopathy; e. psychosocial care. - Homeopathic and/or anthroposophic medicines

Alternative Care Budget: max. € 300 per calendar year

Contraceptives

E.g.: the contraceptive pill, birth control implant, intrauterine contraceptive device (coil), ring or pessary

•

For persons under the age of 21 (personal con-tribution is payable for some contraceptives)

Full amount for persons from the age of 21 (perso-nal contribution is payable for some contraceptives)

Full amount for persons from the age of 21 (perso-nal contribution is payable for some contraceptives) Audiological care

Examination of auditory function, hearing aid advice

•

Delivery and maternity care

Maternity package Care in kind via UMC Kraamzorg

Care in kind via UMC Kraamzorg

Maternity care at home by a

maternity centre

•

10 days (a personal Up to a maximum of contribution of € 4.10 per hour applies)

Full amount of the

personal contribution Full amount of the personal contribution

Maternity care by a private nurse

or maternity care provider

•

(a personal contribu-Up to 10 days at most tion of € 4.10 per hour applies)

Max. € 100 per day for a

max. of 10 days Max. € 100 per day for a max. of 10 days Max. € 100 per day for a max. of 10 days Max. € 100 per day for a max. of 10 days

Maternity care not given by a maternity centre, hospital or private nurse

Max. € 296 Max. € 296 Max. € 296 Max. € 296

Maternity care given by a hospital or contracted birth centre (without medical necessity)

•

Up to 10 days at most (a personal contribu-tion of € 33 per day for both mother and child applies)

Maternity care in a hospital (with medical necessity)

•

Lactation consultation Max. € 50 per delivery Max. € 100 per delivery 100% per delivery

Home delivery

•

Delivery in a hospital

(with medical necessity)

•

Delivery in a hospital or contrac-ted birth centre (without medical necessity)

€ 200 per day (accommodation costs)

Preconception care (this includes advice on a healthy diet, use of folic acid and other medicines)

•

Extended maternity care Max. 12 hrs distributed

across max. 4 days Max. 12 hrs distributed across max. 4 days Max. 12 hrs distributed across max. 4 days Max. 12 hrs distributed across max. 4 days

TENS device Max. € 80 for the entire

term of the insurance

Max. € 150 for the entire term of the insurance

Electrical breast pump Max. € 110 per delivery Max. € 150 per delivery

Movement-related care

A budget to spend on the care types specified below:

Movement-related care budget: max. € 250 per calendar year

Movement-related care budget: max. € 500 per calendar year

Movement-related care budget: max. € 1.000 per calendar year

Movement-related care budget: max. € 1.500 per calendar year

Up to the age of 18: physiotherapy, Cesar/Mensendieck remedial therapy, oedema therapy and manual therapy

•

Max. 18 sessions per complaint, per calendar year. Additional sessions only for complaints listed in Appendix 1 of the Health Insurance Decree (Besluit ZV) (chronic complaints)

UMC Zorgverzekering

UMC Extra Zorg 1

UMC Extra Zorg 2

UMC Extra Zorg 3

UMC Extra Zorg 4

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From the age of 18: physiotherapy, Cesar/Mensendieck remedial therapy, oedema therapy and manual therapy

•

Only for complaints listed in Appendix 1 of the Health Insurance Decree (Besluit ZV), except for the first 20 sessions

Occupational therapy Max. 10 hours

Alternative movement-related the-rapy (by a preferred care provider)

Glasses and contact lenses

A budget to spend on the care types specified below: - glasses and contact lenses - eye laser treatment or lens

implants

Max. € 100 every 3 calendar years

Care abroad

Non-urgent care

•

Based on NL rates Full amount, based on NL rates

Full amount, based on NL rates

Urgent care while on holiday or a

temporary stay abroad

•

Based on NL rates

Full amount for urgent care via the UMC Alarm Centre

Repatriation (patient transport and transport of mortal remains from abroad)

Full amount via the

UMC Alarm Centre Full amount via the UMC Alarm Centre Full amount via the UMC Alarm Centre Full amount via the UMC Alarm Centre Care for dyslexics

Care related to severely dyslexic children aged 7 or older who are attending primary

education

•

Genetic testing

Examination to identify and investi-gate possible hereditary defects

•

Mental healthcare

Cogmed for children up to the age of 18 with developmental and learning disorders

Max. € 400

per calendar year Max. € 400 per calendar year

General mental healthcare

treatment (basic)

•

Group therapy for children up to the age of 18 with parents with a mental condition or addiction

Max. € 400

per calendar year Max. € 400 per calendar year Max. € 400 per calendar year

Neurofeedback (for ADHD and ADD up to the age of 18)

Max. € 1.000 per calendar year

Psychosocial care for oncology patients

Max. € 445 per calendar year

Sexological care Max. € 60 per session.

Max. 4 sessions per calendar year

Max. € 60 per session. Max. 4 sessions per calendar year

Specialised medical mental

healthcare

•

may apply to insured A personal contribution persons aged 18 and older

Medical care

Medically necessary circumcision (with prior permission1₎

Max. € 600 Max. € 600 Max. € 600 Max. € 600

In vitro fertilisation (IVF) up to 43 years of age Additional conditions apply

•

First, second and third attempt

Fourth attempt Fourth and fifth attempt

Other fertility treatments

(women up to the age of 43)

•

Reconstructive and cosmetic or

aesthetic surgery

•

medical groundsOn a number of

Full amount on a number of medical grounds not accepted by the health insurer and 50% for cos-metic or aesthetic surgery due to specific medical circumstances

Redression helmet: treatment for children up to the age of 14 months on specific medical grounds (by a contracted care provider)

Full amount Full amount

Sterilisation and reversal (male or female)

Full amount Full amount Full amount

UMC Extra Zorg 2

UMC Extra Zorg 1

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Medicines and vitamins

Medicines listed in Appendix 1 of the Healthcare Insurance Regulations and the VGZ Pharmaceutical Care Regulations (with prior permission1₎

•

Up to the maximum statutory reimburse-ment amount (GVS) (a personal contribution is payable for some medicines)

Max. € 300 per year for

personal contribution Max. € 500 per year for personal contribution

Diet preparations (by specific sup-pliers and with prior permission1₎

•

Vitamins to treat a serious vitamin deficiency

Full amount Full amount Full amount Full amount

Skin treatments

Acne treatment (a list of our prefer-red providers can be found in the care guide on our website)

Max. € 26 per treatment for a max. of 15 treat-ments per calendar year

Camouflage therapy (a list of our preferred providers can be found in the care guide on our website)

Max. € 165 every 3 calendar years Max. € 165 every 3 calendar years Max. € 165 every 3 calendar years Max. € 165 every 3 calendar years

Epilation (a list of our preferred providers can be found in the care guide on our website)

Max. € 445

per calendar year Max. € 445 per calendar year Max. € 445 per calendar year Max. € 445 per calendar year General practitioner care

General practitioner care. This includes assistance to help you quit smoking and foot care for diabetes mellitus type 1 and 2 patients.

•

Care aids

Care and bandaging aids in accordance with the Healthcare Insurance Regulations and the UMC Pharmaceutical Care Aids Regulations (with prior permission1₎

•

For some aids on loan (a personal contribution and/or partial reimbur-sement amount applies to some aids)

A budget for care aids that you can spend on:

1. a reimbursement of the statutory personal contributions/personal payments for the care aids specified below; or 2. the purchase of the care aids

specified below (or of associated extras) that are not listed in the Healthcare Insurance Regulations - Arch supports and therapeutic

soles - Support pessary

- Support/compression hose, pressure class 1

- Alarm device/pad and buzzer - Hearing aids - Wigs - Breast prosthesis - Crutches

•

Hearing aids (a personal contribution of 25% applies)

•

Wig: max. € 409

Care aids budget: max. € 250 per calendar year

Multi-disciplinary care

Multi-disciplinary care for diabetes mellitus type 2, COPD and cardiovascular risk management (‘care programmes’)

•

Speech therapy

Treatment or improvement of

speech or ability to speak

•

On medical grounds

Specialist medical care

This also includes: care provided by a thrombosis service, a second opi-nion, kidney dialysis, necessary tre-atment at home. Consult the policy conditions for a comprehensive list of the conditions.

•

Oral care/Dental care

Dental care for children up to the age of 18

Special dental care

•

On a limited number of grounds (a personal contribution may apply in some cases)

UMC Zorgverzekering

UMC Extra Zorg 1

UMC Extra Zorg 2

UMC Extra Zorg 3

UMC Extra Zorg 4

1_{For this type of care you will need prior permission from UMC Zorgverzekering. Consult our policy conditions.}

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UMC Extra Zorg 2

UMC Extra Zorg 1

UMC Zorgverzekering

UMC Extra Zorg 3

UMC Extra Zorg 4

Consultation, examination and

prevention

•

Gnathology G Codes*

•

Implants in a non toothless jaw

•

On 2 specific grounds

Implants in a toothless jaw by a

dentist

•

groundsOn a limited number of

Crowns and bridges R Codes*

•

For crowns replacing canines or molars on 2 grounds

Dentures P Codes*

•

Dental care for insured persons from the age of 18

Crowns (with implants, if medically necessary) and bridges required as the direct consequence of an accident for insured persons between the ages of 18 and 27 (with prior permssion1₎

Special dental care

•

On a limited number of grounds (a personal contribution may apply in some cases)

Implants in a non toothless jaw

•

On 2 specific grounds

Implants in a toothless jaw by a dentist, for persons with a seriously shrunken jaw

•

A personal contribution applies of € 125 per denture for dentures on implants

Dentures (full) P Codes*

•

(A personal contributi-on of 25% applies) Orthodontics

Orthodontic treatment for children

up to the age of 18

•

of specific medical On a limited number grounds (a personal contribution may apply)

80% on a limited number of grounds 80% on a limited number of grounds; cosmetic dental treatment 80% up to max. € 1250 80% on a limited number of grounds; cosmetic dental treatment 80% up to max. € 2500 Full amount

Orthodontic treatment from the

age of 18

•

specific medical On a limited number of grounds (a personal contribution may apply)

80% on a limited number of grounds 80% on a limited number of grounds 80% on a limited number of grounds

Full amount on a limited number of grounds; other orthodontic treatment once only up to max. € 300 Paramedical care

Pelvic physiotherapy related to urine incontinence for adults aged 18 and up

•

The first 9 treatment sessions

Group swimming for rheumatic patients (for patients with serious cases)

Podotherapy or pedicure for rheumatic patients (for foot care for diabetes patients, see General practitioner care and Multi-disciplinary care)

Max. € 115 Max. € 115 Max. € 115

Dietary advice (the provision of information about diet and eating habits for a medical purpose)

•

Max. 3 hours of treatment

Max. 4 hours of treatment Max. 4 hours of treatment Max. 4 hours of treatment Max. 4 hours of treatment

Preventive care

Menopause care Max. € 50 per consultation. Max. 4 consultations per calendar year

Max. € 50 per consultation. Max. 4 consultations per calendar year

Full amount per calendar year

Substitute informal care Max. 4 days per calendar

year Max. 8 days per calendar year Max. 12 days per calendar year Max. 24 days per calendar year

Sports medicine Max. € 55 per calendar year

Medical check-up (with the exception of preventive scans)

Max. € 75 every 2 consecu-tive calendar years

Full amount for 2 consecu-tive calendar years

Training courses (incl. pregnancy, coping with illnesses or disorders and reanimation)

Vaccinations required in connection with a holiday abroad

80% up to max. € 125 per calendar year

80% up to max. € 175 per calendar year

Full amount per calendar year

Rehabilitation

Rehabilitation (this also includes a quick scan and geriatric rehabilitation)

•

Geriatric rehabilitation

•

(For max. 6 months) Stopping smoking

Stop smoking programme (medical care and support medications aimed at effecting a change in behaviour)

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Home care

Housekeeping help (housekeeping help on specific grounds)

Max. 10 hours per calendar year

Max. 20 hours per calendar year

Child care (on specific grounds) Max. 24 hours

per calendar year

Max. 50 hours per calendar year Tissue and organ transplants

Transplantation carried out in an EU or EEA member state (incl. donor costs)

•

Lodging

Treatment at a health resort

(in accordance with our list) Max. € 855 Max. € 855 Max. € 855 Max. € 855 A stay at a convalescent home or

care hotel or holiday (for more than one night) (by contracted care provider)

50% for max. 6 weeks 50% for max. 6 weeks 50% for max. 6 weeks 50% for max. 6 weeks

Accommodation expenses Max. € 18 per day Max. € 18 per day Max. € 18 per day Max. € 18 per day

Hospice (by accredited care provider)

Max. € 130 per day Max. € 130 per day Max. € 130 per day Max. € 130 per day

A stay at a therapeutic holiday camp for children aged up to 16 on specific grounds

Max. 1 month per calendar year

A stay in a psychiatric or other hospital (medical specialist care and accommodation), mental health institution or rehabilitation centre (with prior permission1₎

•

A personal contribution may apply to insured persons aged 18 and older

Transport

Ambulance transport

•

Seated patient transport with own

car on specific medical grounds

•

Max. € 0,31 per km on _{a limited number of}

grounds with personal contribution of € 96 per year

Seated patient transport by public transport or a taxi on specific medical grounds

•

On a limited number of grounds with personal contribution of € 96 per year

Hospital care

Outpatient care

(with prior permission1₎

•

Admission to hospital (specialist medical care and accommodations) (with prior permission1₎

•

With the exception of a number of grounds (a personal contribution may apply to a stay by insured persons aged 18 and older)

Care and waiting list mediation

_•

* A number of treatments are precluded from reimbursement in all packages, such as the costs for missed appointments, examinations and study models for a treatment plan, physical examination reports and statements of good health, bleaching of teeth, sealing and polishing, indirect pulp caps, mouth protectors, general anaesthesia, a number of gnathologic treatments and restoration treatments such as composite inlays. A comprehensive overview is included in the insurance terms and conditions (see www.umczorgverzekering.nl).

UMC Extra Tand

UMC Extra Tand 1

UMC Extra Tand 2

UMC Extra Tand 3

Dental care for insured persons from the age of 18

Dental care, with the exception of orthodontic care and general anaesthesia (including material costs and the costs of a dental technician)

Full amount for consultations (Code C), preventive oral care (Code M), specific gum treatments by an oral hygienist (T22, T52, T54 and T56) and 80% for other treatments up to max. € 250 per calendar year

UMC Zorgverzekering

UMC Extra Zorg 1

UMC Extra Zorg 2

UMC Extra Zorg 3

UMC Extra Zorg 4

1_{For this type of care you will need prior permission from UMC Zorgverzekering. Consult our policy conditions.}

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No rights may be derived from this brochure. The original version of this brochure was drawn up in the Dutch language. If, as a result of translation of the original text into the English language, there is a difference in content or interpretation in respect to the Dutch version, then only the text and content of the Dutch language version, which is in the possession of NV Zorgverzekeraar UMC, will be binding. N.V. Zorgverzekeraar UMC (Zorgverzekeraar UMC), located in Arnhem, CoC number: 09154428, DNB number: 12001037.