Right to health care during a temporary stay

We reimburse:

• A visit during consulting hours (a consultation)
• A visit from the general practitioner to a Dutch address, if you can’t make it to the consulting hours
• A consultation by phone

We do not reimburse:

• Flu shot
• A medical assessment
• The costs of a prescription refill

Some medical devices are reimbursed. Do you need a medical device, then please contact us. We will tell you if a reimbursement is possible and the conditions that apply.

A frequently used medical device is a hearing aid

Do you need a hearing aid? A reimbursement is possible if you:

• have a hearing loss of at least 35 dB and can prove this with an audiogram and
• you go to a StAr certified hearing care specialist. (Find a list of certified hearing care specialists at www.audicienregister.nl)

The reimbursement amount depends on your hearing profile. This profile is determined by the hearing care specialist. You will be categorised based on your hearing profile.

Your statutory contribution is always 25% of the price of the hearing aid. You pay the difference out-of-pocket if the hearing aid is more expensive than maximum reimbursement. Would you like to know more about the maximum reimbursement in your situation then don’t hesitate to contact us.

We only reimburse medication such as pills and ointments, and only if you need them in the Netherlands and prescribed by a doctor. Sometimes you will have to pay an extra financial contribution. For example, if another brand of medicine is cheaper and has the same effect. Ask your pharmacist for advice about the reimbursement.

Specialist medical care is care by a specialist in his or her office, or at the hospital clinic. For planned specialist medical care you need a referral from your general practitioner, dentist, midwife or other medical specialist. Urgent medical care is also specialist medical care. You don’t need a referral if you require urgent medical care. We will reimburse the costs if you are hospitalized.

We almost never reimburse plastic surgery. Your plastic surgeon therefore has to request your treatment with us in advance. We will let your plastic surgeon know if we grant permission for the treatment.

We do not reimburse non-medical circumcision or sterilization.

Are there medical grounds for a hospital delivery, then we will reimburse medical care before, during and after the delivery. This also applies to a home birth at a Dutch address. Are there no medical grounds for a hospital delivery, then you will have to pay the hospital bill. Send us the bill and we will reimburse € 208.

Are you under 18?

We will reimburse dental care, except for crowns, bridges, implants and orthodontic care.

Are you 18 or over?

• We reimburse special dentistry, for example when there is a serious dental abnormality. Your dentist will ask an hourly rate, which has to be requested in advance.
• We will reimburse upper, lower or complete dentures. You will pay a personal contribution of at least 25%.
• We will reimburse the reparation of your dentures or refitting of full dentures.
• We will sometimes reimburse the cost of implants, which support your dentures. This only applies if you have full dentures. You will then pay a personal contribution. The own contribution for upper dentures is 8%. The own contribution for lower dentures is 10%. Do you need this treatment? Your dentist will ask us for permission in advance.
• Other treatments, such as check-ups or fillings, are not reimbursed.

Physiotherapy and remedial therapy

There is a difference between chronic and non-chronic indication for the reimbursement of physiotherapy and remedial therapy. There is also a difference between 2 age groups. The government determines in which cases reimbursement is possible.

• Chronic indications for insured persons under 18: we will reimburse all medically necessary treatments.
• Non-chronic indications for insured persons under 18: we will reimburse a maximum of 9 treatments per condition per calendar year. If the effect of the treatment is not sufficient, then we will reimburse up to a further 9 treatments.
• Chronic indication for insured persons of 18 years and older: we will reimburse all medically necessary treatments from the 21st treatment and onwards. The first 20 treatments are out-of-pocket.
• Non-chronic indication for insured persons of 18 years and older: we do not reimburse any of the treatments. You will have to pay all the treatments.

Are you under 18?

Unfortunately, we do not reimburse the costs of psychological care.

Are you 18 or over?

Do you have psychological problems? The first step is to visit your general practitioner (GP). He or she will determine what type of care you need. There are two options: or you will receive treatment at the GP’s office, or your GP will refer you to basic mental health care or specialized mental health care (second line).

Basic mental health care treats mild and moderate disorders

You will receive care from a psychologist, psychotherapist or psychiatrist. He will determine which course of treatment you will get. All treatments are fully reimbursed. As long as your care provider lists the course of treatment and the treatment code on the bill.

Specialist mental health care treats severe disorders

You will receive care from a mental health institution, psychiatrist, psychotherapist or clinical psychologist. All treatments are fully reimbursed.

We do not reimburse transportation to and from another country.

We only reimburse transportation within the Netherlands to a care provider in the Netherlands. Your transportation to and from a border crossing or airport is not reimbursed.

Transporation by ambulance within the Netherlands is fully reimbursed

Your personal contribution doesn’t apply

Transport by car, taxi or public transport is reimbursed in 4 situations

• You require kidney dialysis
• You require chemotherapy or radiotherapy
• You are wheelchair-dependent
• You are blind or visually impaired, and you cannot travel unaccompanied

You ask the transport for your treatment in advance, extramural. You need the ‘request form seated medical transportation’, which you can request by e-mail: gbr@zilverenkruis.nl or phone: 033 445 68 70.

Along with this, submit a medical statement from your doctor.With this medical statement we can assess whether 1 of the above options apply to you and if the costs will be reimbursed. Please note that you will pay a personal contribution of € 100 per calendar year.

We will reimburse all treatments. We do not reimburse the costs of treatments due to a dialect or a language deficiency.

We will reimburse a maximum of 10 hours per calendar year.

We will reimburse a maximum of 3 hours per calendar year.

The Long-term Care Act (Wlz) regulates long-term care in the Netherlands. Do you need intensive care and all day supervision? Ask for an indication at the Centrum Indicatiestelling (CIZ) through the CIZ application form. Send the form to:

CIZ
Team Indicatiestelling Buitenland
Postbus 84
3970 AB DRIEBERGEN

The CIZ examines if you are entitled to care from the Wlz. If so, you will receive an indication. This indication says to what kind of medical care you are entitled, and for how many hours. You will need a valid international proof of insurance.

Do you have a question for the CIZ?

Please call + 31 88 789 10 00. The CIZ can also be reached via e-mail: indicatiestelling.buitenland@ciz.nl.

District nursing includes nursing and personal care. Do you need district nursing care at your Dutch residence address? Then please contact a district nurse. The district nurse determines if you need district nursing. If care is determined necessary the disctric nurs will draw up a care plan.

W do no reimburse:

• District nursing at your home address.