Basis | Buitenland | Flex | Fysiotherapie | Tand
We are more than happy to assist if you have any questions or need to pass on information.
You will find all the information about your insurance by visiting our website anderzorg.nl. You can, for example, calculate your premium, claim online, find care providers and view and compare all reimbursements from A to Z
You can reach us by telephone, chat and Whatsapp, post or via social media. You can also pass on information or a change in your policy, wherever and whenever you want, via Mijn Anderzorg: anderzorg.nl/mijnanderzorg.
The most important telephone numbers are given below. Visit anderzorg.nl/contact for information on current opening times.
Customer service: 088 222 44 22
Anderzorg Emergency Centre: +31 317 455 555 Can be reached 24 hours a day
Anderzorg Transport Service Line: +31 317 492 051
Anderzorg
PO Box 1177
7500 BD Enschede
Do you have a complaint about Anderzorg? Information regarding complaints and disputes can be found on anderzorg.nl/klantenservice. Or see Article A17 of the General terms and conditions.
The Anderzorg App for iPhone and Android devices has many convenient features. The app contains detailed information about your insurance and offers the possibility to submit your claims online. Your Anderzorg care card is also visible in your app. That is convenient whenever you visit a care provider! Download the Anderzorg app from the App Store or Play Store now!
Below you will find a description of the care for which you are covered.
The Dutch text is binding should any disputes arise from the interpretation of the text.
The government defines the insured package of the Basic Insurance. The Dutch Healthcare Insurance Act, together with the Healthcare Insurance Decree and the Healthcare Insurance Regulations, is the foundation of these terms and conditions. We have described your coverage as clearly as possible in these insurance terms and conditions. In these terms and conditions, we sometimes refer to the Anderzorg Insurance Regulations. These Regulations are an integral part of the terms and conditions. In the unlikely event that something in these insurance terms and conditions should not concur with the Dutch Healthcare Insurance Act what has been defined in this Act will apply to you. If any other legal scheme can lead to the same care being paid, you will not be entitled to this care based on this Basic Insurance.
You can download the Anderzorg Insurance Regulations on anderzorg.nl/reglement (only available in Dutch). More information on the Dutch Healthcare Insurance Act, Decree or Regulations is available on wetten.overheid.nl.
You have chosen to take out the Anderzorg Basis. This is an insurance that is intended for everybody who lives in or outside of the Netherlands and who has to take out healthcare insurance. Anderzorg Basis is an insurance that is largely a contracted care policy. Contracted (or in-kind) means that you are entitled to the care itself. General practitioner care, medicines and dental care are insured on the basis of restitution. Restitution means that you are not entitled to the care itself, but rather to reimbursement of the costs of care and brokerage services to obtain that care. For these forms of care we reimburse the amount that is considered reasonable in the Dutch market conditions. All care for which you are insured is listed on the following pages.
In-kind benefits means that you are entitled to the care itself. Anderzorg, therefore, concludes contracts with care providers with regard to quality, price, accessibility and access times. Anderzorg has made arrangements that the bill of the care provider is sent directly to Anderzorg. You can check which type of care provider can deliver the care in the Articles below. A care provider is, for example, a hospital, medical specialist, speech therapist, physiotherapist, etc.
If you opt for a care provider that has not concluded a contract with Anderzorg, Anderzorg only reimburses part of the invoice from the care provider. What is more, the reimbursement is always lower than the amount Anderzorg contracted on average for that treatment. The amount of the reimbursement depends on the type of care:
Reimbursement | Type of care |
---|---|
60% reimbursement of the invoice from the care provider, subject to a maximum of 60% of the amount Anderzorg contracted on average for that treatment, in case of: | Plastic surgery Quitting smoking Occupational therapy Physical therapy Speech therapy Dietetics Dietary preparations IVF Maternity care Genetic examination Obstetric care District nursing Second opinion Thrombosis service Ambulance transport |
65% reimbursement of the invoice from the care provider, subject to a maximum of 65% of the amount Anderzorg contracted on average for that treatment, in case of: | Medical devices |
75% reimbursement of the invoice from the care provider, subject to a maximum of 75% of the amount Anderzorg contracted on average for that treatment, in case of: | Audio logical assistance First-line admission Medical Specialist Care Dialysis at home Rehabilitation Transplantation Admission Mental healthcare Sensory care for the disabled |
100% reimbursement of the invoice from the care provider, subject to a maximum of 100% of the amount Anderzorg contracted on average for that treatment, in case of: | Oncological care for children |
General practitioner care, medicines and dental care: for these forms of care we reimburse the amount that is considered reasonable in the Dutch market conditions.
More information about this can be found on our website anderzorg.nl/vergoedingen. You can also contact Anderzorg Customer Service. Any personal contributions that are owed and, subsequently, mandatory and voluntary excesses will be deducted from the amount to be reimbursed.
If you would prefer a care provider without a care agreement, but the lower reimbursement is preventing you from making this decision, you can indicate to us why this lower reimbursement is preventing you from making this decision and request that a higher percentage be reimbursed as yet. We will handle your request and will inform you within 4 weeks whether we are able to offer you a higher reimbursement (at most 75% of the bill of the care provider, up to a maximum of 75% of the amount that Anderzorg has contracted for this treatment on average). Thereafter, any personal contributions to be paid and the mandatory and voluntary excess will be deducted from the amount to be reimbursed.
Ask your care provider about his treatment rate and the treatment code in advance. The treatment code can be used to determine the maximum reimbursement. Please take into account unexpected circumstances, such as complications, follow-up treatments, a different treatment code or postponement of treatment. A different treatment code or postponement of treatment may affect the amount of the reimbursement. Complications or follow-up treatments may result in the non-contracted care provider charging additional costs. The amount you have to pay yourself may be higher if this is the case.
Anderzorg has made agreements with care providers close to your home about the quality, speed, service and price of the care provided. You can find out which care providers have a contract with Anderzorg by visiting ‘The Anderzorg Zorgvinder’ (The Anderzorg Care Finder) on anderzorg.nl/zorgvinder. If you have questions about the care, please ask the Anderzorg Care Advisor by contacting Customer Service.
Care provided by a care provider that does not meet the criteria as specified in the insurance terms and conditions will not be eligible at all for reimbursement.
If Anderzorg has a contract with a care provider, an agreement may have been made about the maximum volume (revenue ceiling). This may mean that the care provider no longer needs to accept you for treatment if his or her revenue ceiling has (nearly) been reached. The care provider or Anderzorg will help you find another care provider who can treat you when this is the case. If agreements have been made with a care provider about the volume (revenue ceilings), this will be indicated in the ZorgVinder (Care Finder). If you are already being treated when the care provider reaches his or her revenue ceiling, you will not be affected. You can complete the treatment with your care provider.
The content and scope of the care in these insurance terms and conditions are determined by what care providers ‘tend to offer’, the state-of-the-art and best practices. Many care types have not been described in detail in law. These care types have been indicated as care as a certain professional group tends to offer. This is how the care type is indicated. Whether a treatment falls under a covered care type, is in part determined by the state-of-the-art and best practices.
The aforementioned means that you are covered for the care that the involved professional group counts amongst the accepted range of medical examination and treatment methods. Other types of care are described in detail such as medication and medical aids. It also applies to this that these care types only belong to the covered care insofar as they meet the state-of-the-art and best practices. There is no ‘state of the art’ with regard to certain types of care, for example, in relation to non-emergency patient transport services. A slightly different rule applies in these cases: you are insured for the assistance that applies within the involved professional area as responsible and adequate care and services.
You will, of course only be examined or treated if this is required. There must be an indication to qualify for care. As the law prescribes, you must really be in need of this care. Which care is required for your case will be objectively determined. This care must, moreover, be effective. Care that is unnecessary or costs too much unnecessarily when compared to other types of care that is on an equal footing in view of the indication and your care need, will not be covered by the insurance.
You are entitled to care within a reasonable term and within a reasonable distance from your home address. What is deemed to be reasonable will depend on the type and urgency of the care. You are, in any case, entitled to care within the term that is deemed to be acceptable as a maximum in medical terms.
You will have to pay a mandatory excess of € 385 per calendar year when you are 18 or older. You can also pay a voluntary excess of € 100, € 200, € 300, € 400 or € 500 per calendar year in addition to your voluntary excess. Should you decide to accept a voluntary excess, you will receive a discount on the basis of the premium calculation. Per month with an excess of € 100 this discount amounts to € 4, with an excess of € 200 this discount amounts to € 8, with an excess of € 300 this discount amounts to € 12, with an excess of € 400 this discount amounts to € 16 and with an excess of € 500 this discount amounts to € 22.
Some forms of treatment are claimed with a treatment code, this is referred to formally as: a DBC care product (diagnosis treatment combination), such as the care you receive in a hospital. A DBC care product comprises all activities and procedures carried out by the hospital and the medical specialist for the purpose of diagnosis and treatment. The hospital claims a single amount for a DBC care product. In the event a DBC care product is provided in 2 consecutive years, the costs of the DBC care product count towards the excess of the year in which the DBC care product commenced (opening date). This means that if a DBC care product is opened in 2022and closed in 2023, the costs of the DBC care product count towards the excess for the year 2022. If a new, follow-up DBC care product is opened after a DBC care product has been closed, you will have to pay excess again for this new DBC care product.
The excess – mandatory and voluntary – does not apply to:
Medication and nicotine-replacing substances as part of a stop smoking programme, if you purchase them from a contracted care provider.
If you pay a personal contribution or payment, this will not be part of your excess. If the insurance does not start or end on 1 January of a year, the excess will be applied proportionally. First, the mandatory excess is applied and thereafter the voluntary excess. If Anderzorg pays your healthcare bill to the care provider directly, you or the policyholder (at the discretion of Anderzorg) must reimburse Anderzorg the excess and possibly the personal contribution (should this apply). You or the policyholder will receive a bill from Anderzorg in this case. The excess or personal contribution will also apply if you visit a contracted care provider.
Different types of personal payments may apply to the reimbursement of a bill. The order in which they are applied is:
Forensic care as referred to in Section 2 of the Forensic Care Interim Decree and youth mental healthcare as referred to in Section 10.2, first paragraph, of the Dutch Youth Care Act as referred to in Section 1.1 of the Dutch Youth Care Act is not insured in your Basic Insurance. We have made agreements with municipalities for integral care provision (Section 14a of the Dutch Healthcare Insurance Act). Insofar as they may be important for the insurance terms and conditions, they have been processed in these insurance terms and conditions in accordance with Section 14a, paragraph 1.
The rules of these insurance terms and conditions, EC Regulation 883/2004 and bilateral agreements apply to care abroad.
The terms and conditions as specified below for the different care types in the insurance terms and conditions apply to care abroad. You are entitled to care provided by a foreign care provider contracted by Anderzorg. If care is provided by a non-contracted care provider, you will be reimbursed for the costs of care that you would receive in the Netherlands from a non-contracted care provider. If you are residing or staying in another EU/EEA country or Treaty Country and not the Netherlands, you can choose from:
This choice will also be available to you if you reside in another EU/EEA country or Treaty Country and are staying in the Netherlands or another EU/EEA country or Treaty Country temporarily. If you reside or are staying in a country that is not an EU/EEA country or Treaty Country, you will be entitled to the reimbursement of the costs of care that you would be given in the Netherlands by a non-contracted care provider.
For hospital care abroad, that is to say medical care with admission in an institution of at least one night in another country than the country where you reside, you will require prior permission from Anderzorg. You can contact us for more information. Prior permission is not required when care is needed while you are abroad and the care involved cannot be deferred in all reasonableness until you return to the Netherlands.
If you are abroad and you require care there, you can call the Emergency Centre on +31 317 455 555. You will also find this telephone number on your Anderzorg Care Card. The Emergency Centre can be reached day and night. Call in the Emergency Centre direct to assist with regard to emergency care.
You can find additional information about care abroad on anderzorg.nl/buitenland.
Audiological assistance is a type of medical specialist care. Audiological assistance is preventing, tracing, examining and treating different types of hearing disorders.
You are entitled to :
You can visit an audiological centre for audiological assistance.
Anderzorg has contracts with audiological centres. You can select a centre from this list of centres. You will find an overview of care providers who have concluded a contract with Anderzorg on our website anderzorg.nl/zorgvinder by entering the “audiological assistance” search term. You can also contact Customer Service. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) specifies what will be reimbursed when you visit a non-contracted care provider.
You are only entitled to audiological assistance when you have a written referral from your general practitioner or medical specialist (paediatrician or throat, nose and ear specialist).
Would you like more information about hearing aids? Hearing aids are part of Medical aids. More information can be found in the Insurance Rules and Regulations and the Health Insurance Regulations. These rates can be found by visiting anderzorg.nl.
Dietetics is information provision about nutrition and eating habits with a medical objective. A dietician is the appointed expert that discovers, studies and, if required, adjusts eating patterns. The dietician can boost physical health by recommending a specific eating pattern (diet).
You are entitled to a maximum of 3 treatment hours for dietetics per calendar year with a medical objective about eating and eating habits. A treatment hour consists of the planned time that you are consulting the dietician and the average time that is required for the work related to the consultation (for example, finding information, setting down a dietary recommendation on paper or providing a report to the doctor).
You can visit a dietician who is earmarked as “Quality Registered” in the Paramedic Quality Register with regard to this care. You can find this register on kwaliteitsregisterparamedici.nl.
Anderzorg has contracted dieticians. You can select from these care providers. You will find an overview of dieticians on anderzorg.nl/zorgvinder who have concluded a contract with Anderzorg. You can also contact our Customer Service. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) specifies what will be reimbursed when you visit a non-contracted care provider.
No referral is required when you visit a contracted dietician who is immediately available for consultation. For this purpose can see whether a dietician can be accessed immediately in the Paramedic Quality Register.
In the following cases, a prior written referral from your general practitioner, medical specialist or youth healthcare doctor is always required, or from your company doctor when the complaints are related to your work:
A dietary preparation or prescription diet is a food type with another composition and another form than normal food. An example is drip-feeding.
You are entitled to polymer, oligomer, monomer and modular dietary preparations. You will only be entitled to dietary preparations when you cannot manage on an adjusted normal diet and/or other special diet products and if you:
For dietary preparations, you can visit a dispensing chemist’s, a general practitioner with dispensing facilities or a supplier of dietary preparations.
Anderzorg has contracted care providers. You can select from these care providers. You will find an overview of care providers on anderzorg.nl/zorgvinder who have concluded a contract with Anderzorg. You can also contact Customer Service. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) specifies what will be reimbursed when you visit a non-contracted care provider.
You require treatment advice from a general practitioner, a medical specialist or a dietician.
You are entitled to dietary preparations for at most a month for each prescription.
If you use a contracted care provider, you should hand over a medical certificate completed by your general practitioner, medical specialist or dietician together with the prescription. If the indication conditions have been met, you will immediately be given the dietary preparations. If you use a care provider who has not concluded a contract with Anderzorg you will require prior permission from Anderzorg. You can in this case use a Anderzorg request form for pharmaceutical care. With the form you must enclose a written well-founded explanation from the doctor who is treating you. You can find the request form by visiting anderzorg.nl.
Prior permission for infant formulae in case of cow's milk allergy:
It may be the case in specific situations that you have to deal with care requirements where your GP does not believe that it is medically responsible any more to stay at home, but where you do not have to be admitted to hospital. Your general practitioner can then determine in consultation with you that you be admitted in what is referred to as a primary care institution.
You are entitled to stay during the 24 hours that are required medically in relation to medical care as general practitioners usually offer. You are also entitled to the related required nursing, care and paramedical care. Your admittance is insured for an uninterrupted period of 1,095 days. An interruption of a maximum of 30 days is not considered to be an interruption but does not count for the calculation of the 1,095 days. An interruption due to weekend or holiday leave does, however, count.
Primary care institution takes place at an institution that is accredited under the Care Institutions (Accreditation) Act (WTZi) as an institution for nursing and care or is accredited as an institution for nursing, care and treatment.
Anderzorg has contracted care providers. You can select from these care providers. You will find an overview of care providers on anderzorg.nl/zorgvinder who have entered into a contract with Anderzorg by using the “staying in a primary care institution” search string. You can also contact our Customer Service. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) lists what will be reimbursed if you visit a non-contracted care provider.
You are only entitled to staying in a primary care institution if you have a prior written indication from your general practitioner, medical specialist (who can delegate this to a transfer nurse), geriatric specialist, doctor for the mentally challenged or social worker. If the stay is for a period that is longer than 6 months, you will require prior permission from Anderzorg. Your treating physician (GP, geriatric specialist or doctor for the mentally challenged) can request this permission on your behalf.
Genetic testing is a form of medical specialist care (also see that Article). Genetic testing is carried out to determine whether a complaint or a congenital defect is hereditary.
You are entitled to :
You can visit a centre for genetic testing for this type of testing. This is an institution holding a permit pursuant to the Dutch Special Medical Procedures Act for the application of clinical genetic research and advice on matters concerning hereditary diseases.
Anderzorg has contracts in place with centres for genetic testing. You can select a centre from this list of centres. You can find an overview of care providers who have concluded a contract with Anderzorg by visiting anderzorg.nl/zorgvinder and searching based on the “Genetic testing” search term. You can also contact our Customer Service. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) specifies what will be reimbursed when you visit a non- contracted care provider.
You are only entitled to genetic testing when you have a written referral from your general practitioner or medical specialist issued in advance.
Occupational therapy helps people who experience problems in carrying out daily activities due to physical, mental, sensory or emotional complaints. The occupational therapist (also known as an ergotherapist) provides practical solutions in the environment of the client so that daily activities are again possible. The occupational therapist can also provide advice about the use of aids and offer support with regard to the request/application procedure.
You are entitled to at most 10 treatment hours of occupational therapy per calendar year when the objective is stimulating and restoring your ability to care for yourself and your ability to live independently.
You can visit an occupational therapist who has the entry of “Quality Registered” in the Paramedic Quality Register. You can find this register on kwaliteitsregisterparamedici.nl.
Anderzorg has contracts in place with occupational therapists. You can select from these occupational therapists. You will find an overview of care providers on anderzorg.nl/zorgvinder who have concluded a contract with Anderzorg. You can also contact our Customer Service. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) specifies what will be reimbursed when you visit a non- contracted care provider.
You do not need a referral if you visit a contracted occupational therapist who is available immediately. You can find out whether an occupational therapist is available immediately in the Paramedic Quality Register.
In the following cases, a prior written referral from your general practitioner, medical specialist or youth healthcare doctor is always required, or from your company doctor when the complaints are related to your work:
The physiotherapist stabilises, reduces or restores a functional disorder or the results of this by applying physiotherapy, advice and/or supervision. The physiotherapist will try to improve the function of the posture and locomotory apparatus as well as other issues. Normal posture and movement will again be possible or you will learn how best to cope with your restrictions.
You are entitled to physiotherapy. What you are exactly entitled to, will depend on whether you are older or younger than 18. Working on the improvement or retention of your physical condition in the form of medical fitness (or a comparable activity such as physiotherapy fitness, Slender You and group swimming) and extracorporeal shockwave therapy are not classed as being physiotherapy. You are not entitled to those treatments. More information can be found on anderzorg.nl.
You are entitled to physiotherapy as from the 21st treatment when a complaint is involved that has been specified on the list defined by the Minister of the Dutch Ministry of Health, Welfare and Sport. You are entitled to physiotherapy for a maximum period in relation to a few conditions. You can find out whether this is the case from the list that the Minister of Public Health, Welfare and Sport has established. This is the list included in Annex 1 with Section 2.6 of the Decree on health insurance. You can find this list by visiting anderzorg.nl. You can also contact our Customer Service.
You are not entitled to the first 20 treatments for each disorder based on your Basic Insurance. A number of treatments is included in the additional Anderzorg insurances. Check your additional insurance for more information.
You are entitled to physiotherapy in the same cases as people who are 18 or older, but also from the first treatment. If you have a complaint that cannot be found on the list that the minister of Public Health, Welfare and Sport has established, you are entitled to 9 treatments at most for the each complaint per calendar year. If the first 9 treatments are not sufficient, you are entitled to another 9 treatments at most per year.
You can visit a general physiotherapist for most complaints. For some specific complaints, you are best visiting a therapist who specialises in the treatment of these complaints. Examples of this include the following:
We recommend asking your physiotherapist whether he or she specialises in the treatment of your complaints.
You can only visit a general physiotherapist, child physiotherapist, manual therapist, oedema physiotherapist, geriatric physiotherapist or a pelvic physiotherapist who is registered in the Centraal Kwaliteitsregister Fysiotherapie (CKR; Central Quality Register) or in the Keurmerk Fysiotherapie (Physiotherapy Quality Mark) register. You can also visit a skin therapist who is registered as “Quality Registered” in the Paramedic Quality Register for oedema therapy and scar therapy. For questions regarding specialized physiotherapy you can contact our Customer Service.
By visiting anderzorg.nl/zorgvinder you will find an overview of care providers who have concluded contracts with Anderzorg. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) specifies what will be reimbursed when you visit a non-contracted care provider.
In the following cases a prior written referral from your general practitioner, medical specialist, youth healthcare doctor or dentist or from your company doctor when the complaints are related to your work is required:
It is possible that Anderzorg may make more inquiries about the purpose and need for the treatment at the physiotherapist. For example, when you receive more than 50 treatment sessions per year. Anderzorg and the professional group of physiotherapists believe that effective care provision is important. This ensures we can offer the correct treatment and we can keep costs as low as possible for you.
Exercise therapy is aimed at improving posture and the way in which people with physical complaints move. The idea behind the therapy is that posture and movement are unconsciously modified based on the complaints and that these complaints continue due to this. The therapy consists of exercises to correct posture and movement.
You are entitled to exercise therapy. What you are exactly entitled to, will depend on whether you are older or younger than 18. Working on the improvement or retention of your physical condition in the form of medical fitness or a comparable activity such as Slender You and group swimming is not classed as exercise therapy. You are not entitled to those treatments. More information can be found on anderzorg.nl.
You are entitled to exercise therapy as from the 21st treatment when a complaint is involved that has been specified on the list defined by the Minister of the Dutch Ministry of Health, Welfare and Sport. You are entitled to exercise therapy for a maximum period in relation to a few conditions. You find out whether this is the case from the list that the Minister of Public Health, Welfare and Sport has established. The list is included in Annex 1 of Article 2.6 of the Dutch Health Insurance Decree. You can find this list by visiting anderzorg.nl. You can also contact Customer Service.
You are not entitled to the first 20 treatments. A number of treatments is included in the additional Anderzorg insurances. Check your additional insurance for more information.
You are entitled to exercise therapy in the same cases as people who are 18 or older, but also from the first treatment. If you have a complaint that cannot be found on the list, you are entitled to 9 treatments at most for each complaint per year. If the first 9 treatments are not sufficient, you are entitled to another 9 treatments at most per year.
You can visit an exercise therapist or a child exercise therapist who is registered as a “Quality registered” practitioner in the Paramedic Quality Register. Anderzorg has contracted exercise therapists. You can select an exercise therapist from this list. You will find an overview of care providers who concluded a contract with Anderzorg on anderzorg.nl/zorgvinder. You can contact our Customer Service for more information about exercise therapy. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) lists what will be reimbursed if you visit a non- contracted care provider.
In the following cases a prior written referral from your general practitioner or medical specialist or from your company doctor when the complaints are related to your work is required:
The pelvic physiotherapist will help you recognise and train all relevant muscles around the pelvic area. The pelvic floor is a sling of muscles at the bottom of the pelvis that supports the stomach organs, opens and closes the pelvic exit and contributes towards pelvic stability. The pelvic floor muscles work closely together with the stomach and back muscles and play an important role with regard to our daily movement and in preventing back and pelvic pain.
You are entitled to 9 pelvic physiotherapy treatments at most in relation to urine incontinency when you are 18 or older. This applies to the full insurance duration. Working on the improvement or retention of your physical condition in the form of medical fitness (or a comparable activity such as physiotherapy fitness, Slender You and group swimming) and extracorporeal shockwave therapy are not classed as being pelvic physiotherapy. You are not entitled to those treatments. More information can be found on anderzorg.nl.
You can visit a pelvic physiotherapist who is registered with the Centraal Kwaliteitsregister Fysiotherapie (CKF; Central Physiotherapy Quality Register) or is registered in the Kwaliteitskeurmerk Fysiotherapie (the Physiotherapy Quality Mark).
Anderzorg has contracted therapists. You can select from these therapists. You will find an overview of care providers on anderzorg.nl/zorgvinder who have entered into a contract with Anderzorg. You can also call Customer Service on 088 222 44 22. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) lists what will be reimbursed if you visit a non-contracted care provider.
You are only entitled to pelvic physiotherapy when you have a written referral from your general practitioner, medical specialist or obstetrician.
Not all treatments are reimbursed. Treatments that are not regarded as physiotherapy will not be reimbursed. Examples include: Working on the improvement or retention of your physical condition in the form of medical fitness (or a comparable activity such as physiotherapy fitness, Slender You and group swimming) and extracorporeal shockwave therapy are not classed as being physiotherapy. You are not entitled to those treatments. More information can be found on anderzorg.nl. This list is not a full overview.
Intermittent claudication is related to symptomatic peripheral arterial disease, a type of disability when walking. The arteries in your legs carry too little oxygen for the muscles that you use when walking within this context. This is because these arteries have narrowed. Narrowing occurs because of arteriosclerosis (Intermittent claudication condition).
If you are 18 or older, you will be entitled for at most 12 months to at most 37 exercise therapy sessions under supervision of a physiotherapist or exercise therapist if you suffer from intermittent claudication. Intermittent claudication is deemed to mean the following: peripheral arterial disease in stage 2 Fontaine.
You can visit a physiotherapist or exercise therapist who is a member of ClaudicatioNet.
Anderzorg has contracted therapists. You can select from these therapists. You will find an overview of care providers on anderzorg.nl/zorgvinder who have entered into a contract with Anderzorg. You can also call Customer Service on 088 222 44 22. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) lists what will be reimbursed if you visit a non-contracted care provider.
You are only entitled to being treated for intermittent claudication when you have a prior written referral from your general practitioner or medical specialist.
Arthrosis is wear of a joint. The cartilage becomes thinner and is damaged.
If you are 18 or older, you will be entitled for at most 12 months to at most 12 exercise therapy sessions under supervision of a physiotherapist or exercise therapist if you suffer from arthrosis of the hip or knee joint.
You can visit a physiotherapist or exercise therapist. Anderzorg has contracted therapists. You can select from these therapists. You will find an overview of care providers on anderzorg.nl/zorgvinder who have entered into a contract with Anderzorg. You can also call our Customer Service desk on 088 222 44 22. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) lists what will be reimbursed if you visit a non-contracted care provider.
COPD is a pulmonary disease that has damaged your lungs. Breathing is more difficult and you have less energy. The abbreviation COPD stands for Chronic Obstructive Pulmonary Disease. Exacerbation applies in case the illness becomes more active after having shown no or little activity for a prolonged period of time.
If you are aged 18 or over you are entitled to exercise therapy under the supervision of a physiotherapist or exercise therapist in case of stage II or higher of the GOLD Classification for spirometry. This must be established by a doctor. You are entitled to at most:
Class A | |
---|---|
The maximum number of treatments during the 1st 12 months (the 1st year of treatment) |
5 |
The maximum number of treatments per 12 months for the maintenance phase (the years after the 1st year of treatment) |
0 |
Class B1 | |
The maximum number of treatments during the 1st 12 months (the 1st year of treatment) |
27 |
The maximum number of treatments per 12 months for the maintenance phase (the years after the 1st year of treatment) |
3 |
Class B2, C | |
The maximum number of treatments during the 1st 12 months (the 1st year of treatment) |
70 |
The maximum number of treatments per 12 months for the maintenance phase (the years after the 1st year of treatment) |
52 |
Class D | |
The maximum number of treatments during the 1st 12 months (the 1st year of treatment) |
70 |
You can visit a physiotherapist or exercise therapist.
Anderzorg has contracted therapists. You can select from these therapists. You will find an overview of care providers on anderzorg.nl/zorgvinder who have entered into a contract with Anderzorg. You can also call our Customer Service desk on 088 222 44 22. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) lists what will be reimbursed if you visit a non-contracted care provider.
Mental Healthcare provides diagnostics and treatment for people with psychological disorders. The objective is to restore or improve mental health and to improve the quality of life. Mental Healthcare is subdivided into psychological care provided by the general practitioner, general basic mental healthcare (GBGGZ) and specialist mental healthcare. Specialist mental healthcare (SGGZ), in turn, is subdivided into outpatient specialist mental healthcare (without admission) and clinical specialist mental healthcare (with admission). Youth mental healthcare as referred to in Section 10.2, first paragraph, of the Dutch Youth Care Act as referred to in Section 1.1 of the Dutch Youth Care Act is not insured.
You are entitled to general basic mental care if you have a recognised psychological DSM (Diagnostic and Statistical Manual or Mental Disorders) mental disorder. Treatment takes place based on a Short, Medium, Intensive or Chronic care product. A care product lasts a maximum of 365 days. The care product is determined through a treatment plan that the care provider and you draw up together. The scope of the care is limited by what clinical psychologist and psychiatrists usually offer.
You can visit an independent:
You can go to a mental healthcare institution where one of the following practitioners is a managing practitioner:
Other practitioners involved in your treatment at that institution must formally act under the responsibility and supervision of this managing practitioner. The managing practitioner is the practitioner who is ultimately responsible for the entire treatment process. He is also the primary contactperson for everyone involved, including yourself and those close to you.
Every care provider is required to have a quality charter that satisfies the requirements from the GGZ National Quality Charter (LKS). This quality charter must be registered with the National Health Care Institute (Zorginstituut Nederland). This quality charter will specify what the healthcare provider has arranged for you about quality and justification. If the healthcare provider whom you visit does not have a registered quality charter, the given care will not be eligible for reimbursement.
Anderzorg has contracted care providers. You can select from these care providers. All care providers contracted by Anderzorg will have a quality charter. You will find an overview of care providers on anderzorg.nl/zorgvinder who have entered into a contract with Anderzorg. You can also contact our Customer Service and ask for our Care Advisor. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) lists what will be reimbursed if you visit a non-contracted care provider.
If you go to a non-contracted care provider, check whether this care provider has a registered quality charter prior to the treatment. You can ask the Care Advisor by contacting our Customer Service. You can also contact the relevant care provider, visit the website of the care provider or visit zorginzicht.nl. If the healthcare provider whom you visit does not have a registered quality charter, the given care will not be eligible for reimbursement.
You are only entitled to general basic mental healthcare if you have a prior written referral from your general practitioner, medical specialist, emergency care physician (first aid), your community health doctor or your managing practitioner issued in advance. This means that the referral letter must be dated before the date of your first visit to the general basic mental health care provider. The referral letter must specify the DSM (Diagnostic and Statistical Manual of Mental Disorders) mental disorder your referrer thinks you suffer from.
You will receive care on a specialist level with regard to specialist mental healthcare. Outpatient specialist mental healthcare means that you visit the care provider regularly for your treatment but that you stay at home where you also sleep. Most psychological disorders can be treated as an outpatient.
You are entitled to diagnostics and treatment of complex and/or multiple mental disorders where a multidisciplinary approach is often required. The scope of specialist mental healthcare (SGGZ) is limited by what clinical psychologists and psychiatrists usually offer.
For specialist mental healthcare without admission you can go to an independently established:
You can go to a mental healthcare institution or the outpatients’ department of a psychiatric department of a hospital where one of the following practitioners is a managing practitioner:
Other practitioners involved in your treatment at that institution must formally act under the responsibility and supervision of this managing practitioner. A psychiatrist or clinical psychologist is always a part of the multidisciplinary team that treats you. The managing practitioner is the practitioner who is ultimately responsible for the entire treatment process. He is also the primary contactperson for everyone involved, including yourself and those close to you.
Every care provider is required to have a quality charter that satisfies the requirements from the GGZ National Quality Charter (LKS). This quality charter must be registered with the National Health Care Institute (Zorginstituut Nederland). This quality charter will specify what the healthcare provider has arranged for you about quality and justification. If the healthcare provider whom you visit does not have a registered quality charter, the given care will not be eligible for reimbursement.
Anderzorg has contracted care providers. You can select from these care providers. All care providers contracted by Anderzorg will have a quality charter. You will find an overview of care providers on anderzorg.nl/zorgvinder who have entered into a contract with Anderzorg. You can also contact our Customer Service and ask for our Care Advisor. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) lists what will be reimbursed if you visit a non-contracted care provider.
If you go to a non-contracted care provider, check whether this care provider has a registered quality charter prior to the treatment. You can contact the Care Advisor by contacting our Customer Service. You can also contact the relevant care provider, visit the website of the care provider or visit zorginzicht.nl. If the healthcare provider whom you visit does not have a registered quality charter, the given care will not be eligible for reimbursement.
You are only entitled to specialist mental healthcare without admission if you have a prior written referral from your general practitioner, medical specialist your community health doctor or your managing practitioner issued in advance. This referral letter must be dated before the date of your visit to the SGGZ, must at least specify the (Diagnostic and Statistical Manual of Mental Disorders) mental disorder your referrer thinks you suffer from and the reason for the referral. If emergency care is required for which no referral was reasonably possible, you do not require a written referral.
Some mental issues are of such a serious nature that outpatient treatment is not sufficient. Admission at a psychiatric clinic or the psychiatric ward of a general hospital is then the best solution. This means that you will be given your treatment in the clinic or hospital and this also means that you will be living and sleeping in the clinic or the hospital for the duration of the treatment. The decision may also be taken to admit the patient in the case of a crisis situation.
You are entitled to :
You can go to a mental healthcare institution or the psychiatric department of a hospital where one of the following practitioners is a managing practitioner:
Other practitioners involved in your treatment at that institution must formally act under the responsibility and supervision of this managing practitioner. It can be agreed in consultation with the psychiatrist or clinical psychologist that the managing practitioner whom you had when your received specialised mental healthcare without being admitted will also be your managing practitioner when you are admitted. The managing practitioner is the practitioner who is ultimately responsible for the entire treatment process. He is also the primary contactperson for everyone involved, including yourself and those close to you.
Every care provider is required to have a quality charter that satisfies the requirements from the GGZ National Quality Charter (LKS). This quality charter must be registered with the National Health Care Institute (Zorginstituut Nederland). This quality charter will specify what the healthcare provider has arranged for you about quality and justification. If the healthcare provider whom you visit does not have a registered quality charter, the given care will not be eligible for reimbursement.
Anderzorg has contracted care providers. You can select from these care providers. All care providers contracted by Anderzorg will have a quality charter. You will find an overview of care providers on anderzorg.nl/zorgvinder who have entered into a contract with Anderzorg. You can also contact our Customer Service and ask for our Care Advisor. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) lists what will be reimbursed if you visit a non-contracted care provider.
If you go to a non-contracted care provider, check whether this care provider has a registered quality charter prior to the treatment. You can contact the Care Advisor by contacting our Customer Service. You can also contact the relevant care provider, visit the website of the care provider or visit zorginzicht.nl. If the healthcare provider whom you visit does not have a registered quality charter, the given care will not be eligible for reimbursement.
You are only entitled to specialised mental health care without admission when you have a written referral from your general practitioner, medical specialist, your community health doctor or your managing practitioner issued in advance. This referral letter must be dated before the date of your visit to the SGGZ, must specifically refer to the SGGZ and must at least specify the (Diagnostic and Statistical Manual of Mental Disorders) mental disorder your referrer thinks you suffer from and the reason for the referral. If emergency care is required for which no referral was reasonably possible, you do not require a written referral.
If you would like to use the esketamine, including Spravato, you will need Anderzorg's prior, written approval. You can contact Customer Service in order to request this approval.
If you do not wish the diagnosis code to be specified on the bill but want to claim the costs, a doctor’s declaration is required in advance or with the first bill at the latest. You must sign a doctor’s declaration together with your practitioner and send it to Anderzorg. This doctor’s declaration pro forma can be found by visiting anderzorg.nl/vergoedingen. The bill must contain all information that is required by legislation and regulations (with the exception, therefore, of the diagnosis code). Visit Anderzorg.nl for information on these requirements.
A medication (or drug) is a substance that has a specific, desired effect on the body. Medication is available in all different forms such as in tablet, injection liquid, suppository or plaster form. There are thousands of medications available on the market. Producers require a marketing authorisation in order to launch a medication on to the market. This authorisation is only granted if the (branded or non-branded) medication meets strict quality criteria.
With the exception of the excluded products referred to under the header ‘Preference policy’, you are entitled to all medication that the Minister of the Dutch Ministry of Health, Welfare and Sport has included in the insurance package. Which medication has been included can be found in Annex 1 of the Healthcare Insurance Rules and Regulations. You can consult the Health Insurance Regulations and annexes by visiting overheid.nl. If you want to find out whether a specific medication is on the list, you can also contact our Customer Service.
You are entitled to medication that is prepared in the dispensing chemist’s itself. You are also entitled to medication that your doctor orders for you for use if this medication is prepared by a manufacturer in the Netherlands as referred to in Article 1, paragraph 1, mm of the Dutch Medicines Act. If an order of medication is involved that is not available on the Dutch market but is available in another country, this is only allowed if you are suffering from an illness that does not occur more than 1 time in every 150,000 residents in the Netherlands. In all cases this must involve a rational pharmacotherapy. That is to say, the treatment is taking place with a medication form that is suitable for the patient regarding which the effectiveness and efficacy has been demonstrated based on scientific literature and which also is the most economical for the healthcare insurance.
The advice and the support by the person who has made the medication available are included in this care.
Restrictions apply with regard to: preference policy, indication, location where administered and maximum period.
All medication has an active ingredient. You are entitled to all active ingredients that are present in the medication listed in annex 1 of the Health Insurance Regulations. Often, different medications with the same active ingredient are available on the market. You will only be entitled to some medicines with the same active substance and the same form of administration to those medicines that are indicated by Anderzorg. These are the preferred medications. The Insurance Rules and Regulations list and on anderzorg.nl/preferentiebeleid for which active ingredients preferred medication has been indicated and which medication this involves. It may be the case in exceptional cases that treatment with a preferred medication is not medically safe. In such cases you are entitled to receive a different medication from Annex 1 of the Health Insurance Regulations. You can consult the Health Insurance Regulations and the annexes by visiting overheid.nl.
If treatment with a preferred medication is not justifiable medically and, therefore, you wish to use another, non-preferred medication, you require prior permission from Anderzorg. If you visit a dispensing chemist’s with which Anderzorg has a contract in place, the pharmacist will give you the medication when you submit a prescription signed by a doctor on which the doctor has written “Medisch noodzakelijk” (Medically Required) or “MN” (MR). The same applies when you submit a declaration completed by your Municipal Health Service, dentist, medical expert, obstetrician or a Municipal Health Service doctor together with the prescription. If you visit a dispensing chemist’s with which Anderzorg has not concluded a contract in place, use the Pharmaceutical Care Request Form to ask permission from Anderzorg. Enclose the motivated explanation of your doctor with this form.
If medication is involved that you are using for the very first time, you will also be entitled to the medication for the first 15 days without Anderzorg’ permission. You must, however, submit your request for permission at Anderzorg within those 15 days. If you do not submit the request on time you will no longer be entitled to be reimbursed for the non-preferred medication after the 15th day has elapsed.
You will only be entitled to reimbursement of the costs of certain medication when you have an indication that is described in the legal regulations. You can find information about these medications and indications in Annex 2 related to the Health Insurance Regulations. You can consult the Health Insurance Regulations and annexes by visiting overheid.nl. Other conditions also apply to some medicines that are specified in Annex 2. These conditions are specified in the Insurance Rules and Regulations. You can find the Insurance Rules and Regulations on anderzorg.nl or you can request them from Anderzorg Customer Service.
Some drugs may only be administered and/or given in a hospital when the relevant medication needs to be taken except when Anderzorg has given permission for the drugs to be administered or given elsewhere. These drugs are listed in table 2 of the Insurance Rules and Regulations. The drugs that are listed in table 3 of the Insurance Rules and Regulations may only be administered and/or given in a hospital when required. Administration or giving outside the hospital is not insured. The Insurance Rules and Regulations also define what is understood by a hospital.
The doctor’s prescription and the prescribed quantity of medicine is guiding for the quantity of medicine supplied by your pharmacy, unless this exceeds the abovementioned quantities. Another reason may be that the shelf life of a medicine means that you are only supplied with part of the medicine. The pharmacist will always discuss this with you.
You may have to pay a personal contribution. All medicines that you are entitled can be found in Annex 1 of the Health Insurance Regulations. This Annex has a section A and a section B. All medicines for which a reimbursement limit has been set can be found in section A. If you use medication that costs more than the reimbursement limit, you need to pay the part that is higher than the limit. This also applies when the medication that you use is prepared from a medication that costs more than the reimbursement limit. If the medication can be found in section B, there is no reimbursement limit.
You are not entitled to medication:
that are equivalent or almost equivalent to any non-designated, registered medicine, unless it concerns a pharmacy preparation of a medicine included in Appendix 3, part A, of the Healthcare Insurance Regulations, or it concerns a pharmacy preparation of a medicine in respect of which the Minister has not yet made a decision regarding inclusion in the insured package, as apparent from appendices 1 and 3 of the Healthcare Insurance Regulations,
which are included in Appendix 3, part B, of the Healthcare Insurance Regulations,
You can visit a dispensing chemist’s or a general practitioner with dispensing facilities for medication.
Anderzorg has contracts in place with pharmacists and GPs who have a pharmacy. You can select from these care providers. You will find an overview of care providers on anderzorg.nl/zorgvinder who have concluded a contract with Anderzorg. You can also call Customer Service on 088 222 44 22. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) specifies what will be reimbursed when you visit a non-contracted care provider.
You require a prescription from a general practitioner, dentist, medical specialist, obstetrician, company doctor or Municipal Health Service doctor. Or from a geriatric specialist if you are staying in a first-line care facility (ELV).
For some medication you will require prior permission from Anderzorg. The specific medication that is involved has been specified in the Insurance Rules and Regulations in table 1. Your doctor can complete a doctor’s declaration related to this medication. There are special forms for this. They can be found by visiting znformulieren.nl. If you visit a dispensing chemist’s with which Anderzorg has a contract with this doctor’s declaration, the chemist will assess whether you are entitled to this medication. You do not have to first ask Anderzorg’ permission. If you decide to use a dispensing chemist’s for the medication with which Anderzorg has not concluded a contract in place, you must ask prior permission from Anderzorg.
The general practitioner is the first point of contact if you have questions or problems regarding your health and illness. General medical care (as provided by, for example, a general practitioner) is freely accessible and person focused. You can be assisted in the evening, night and at weekends from a GP out-of-hours surgery.
You are entitled to :
Medical Care for Specific Patient Groups (GZSP) provided by a Geriatric Specialist or a Doctor for the Mentally Handicapped.
You should consult a general practitioner for general medical care. General practitioner care can also be provided by a care provider who works under the responsibility of a GP such as, for example, a doctor’s assistant, nurse practitioner, somebody who supports the practice or a care provider with whom Anderzorg has made agreements about the general practitioner care. You can visit the GP out-of hours surgery or the general practitioner who is on call in the evenings, nights or during the weekend for GP care related to critical emergency issues. Ask your GP about which GP is on duty or to which GP station you can go. You will also find information on vereniginghuisartsenposten.nl.
For laboratory, representational diagnostics and function tests requested by a general practitioner you can go to a first-line diagnostics centre, a production group practice, a hospital or an independent treatment centre.
To have an IUD placed (to prevent pregnancy) you can also visit a obstetrician.
For the purpose of the Combined Lifestyle Intervention (GLI), you can apply to:
If you have any questions concerning the GLI, please call the Anderzorg Care Advisor at 088 222 44 22 .
You can visit a podiatrist for preventive foot care outside the care pathway for diabetes mellitus.
If you require GZSP you can visit a Geriatric Specialist or a Doctor for the Mentally Handicapped.
You are only entitled to foot care when you have a written referral from your general practitioner or medical specialist issued in advance.
If you visit a pedicure directly for preventive foot care in relation to diabetes, you will not be reimbursed for the incurred costs. The costs of a pedicure will only be reimbursed as part of the care pathway or if the podiatrist refers you to the pedicure.
You are only entitled to combined lifestyle intervention if you have obtained a written referral from your general practitioner, occupational physician or medical specialist in advance.
You are only entitled to Medical Care for Specific Patient Groups if you have obtained a written referral from your general practitioner or medical specialist in advance.
Anderzorg has contracted care providers. You can select one of these care providers. You can find an overview of care providers with whom Anderzorg has concluded a contract for the relevant care by entering the search term General Practitioner Care, GZSP or First-line Diagnostics via anderzorg.nl/zorgvinder. You can also call Customer Service on 088 222 44 22. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) specifies what will be reimbursed when you visit a non-contracted care provider.
A medical aid is, for example, a hearing aid or a leg prosthesis but also incontinence, dressing and diabetes test material.
You are entitled to functional aids that the Dutch Minister of Health, Welfare and Sport has included in the insurance package. Which aids these are can be found in the Health Insurance Regulations. Some groups of medical aids are described specifically in the Health Insurance Regulations while others are described based on their function. In the last case, this means that you are entitled to a medical aid that fits in with a described function restriction. Anderzorg has included an overview of medical aids in its Insurance Rules and Regulations that fall under the Health Insurance Regulations. Anderzorg has also set further conditions in the Insurance Rules and Regulations with regard to obtaining these medical aids.
“External medical aids to be used when checking and regulating disorders in the blood sugar level”. Diabetes testing material, for example.
Do you require a medical aid that belongs to function-based aids but this medical aid is not included in the Insurance Rules and Regulations? In this case, submit a request with Anderzorg. Anderzorg will assess your request. The assessment criteria are also included in the Health Insurance Regulations that you must meet to be entitled to the medical aid. You can find the Health Insurance Regulations and the Insurance Rules and Regulations by visiting anderzorg.nl. If you want to know whether a specific medical aid is on the list, you can also contact our Customer Service.
A (percentage) statutory personal contribution or a maximum reimbursement applies to certain medical aids. You can find out from the Health Insurance Regulations whether this is the case and how much the personal contribution or maximum reimbursement will be. You pay the personal contribution to the supplier. The statutory personal contributions and maximum reimbursements can also be found in the Insurance Rules and Regulations.
You can approach a supplier of medical aids in order to receive these. Anderzorg has contracts in place with suppliers for the different medical aids. You can select suppliers from this list of contracted suppliers. You will find an overview of care providers on anderzorg.nl/zorgvinder who have concluded a contract with Anderzorg. You can contact our Customer Service.
If you decide to visit a care provider who does not have a contract with Anderzorg, the costs will be reimbursed up to a maximum amount per treatment. Consult the Insurance Rules and Regulations to find out what is paid/reimbursed. If you use a supplier who has not concluded a contract with Anderzorg for a medical aid, this supplier must sometimes meet specific quality and expertise criteria. You can find out what they are in the Insurance Rules and Regulations where they are specified for each medical aid.
Whether permission from Anderzorg is required is specified in the Insurance Rules and Regulations for each medical aid. This may involve the first issue but also replacements, corrections or repairs to the medical aid. You do not require permission from Anderzorg for most medical aids that are supplied by a contracted supplier. The supplier will assess your application. If the supplier is unsure whether Anderzorg will issue or reimburse the medical aid, the supplier will pass on the application to Anderzorg for permission.
If you expressly damage the medical aid or if it is damaged because the medical aid has not been cared for properly due to you, you will not be entitled to a replacement, correction or repair of the medical aid before the use duration as specified in the Insurance Rules and Regulations has elapsed. If you have the medical aid on loan and you have expressly damaged it or if it is damaged because the medical aid has not been cared for properly by you, Anderzorg is entitled to recover the costs from you.
IVF and ICSI are fertility treatments. In vitro fertilisation (IVF) means ‘in glass fertilisation’ and is also referred to as test tube fertilisation. ICSI stands for intracytoplasmic sperm injection. Fertilisation of the female egg cell by a male sperm cell takes place artificially within the context of these treatments. IVF treatment has its own place within the context of stepped care. The choice of treatment takes ac count of the effectiveness, the intensity of this treatment for couples, the risks and the costs.
Your age will determine what you are entitled to exactly. Ask your care provider to inform you well before you start the treatment or ask the Care Advisor by contacting our Customer Service.
You are entitled to the 1st, 2nd and 3rd IVF attempt per pregnancy to be realised. You are only entitled to the reimbursement of costs of the 1st and 2nd IVF attempt per pregnancy to be realised when a maximum of 1 embryo is placed back in the uterus. With the 3rd attempt a maximum of 2 embryos may be placed back in the uterus.
You are entitled to the 1st, 2nd and 3rd IVF attempt per pregnancy to be realised. With each attempt a maximum of 2 embryos may be placed back in the uterus per attempt.
You can visit an IVF centre for IVF treatment that has the authorisations that are required by law for this purpose.
Anderzorg has contracted IVF centres. You can select a centre from this list of centres. You can find an overview of centres that have concluded a contract with Anderzorg by visiting anderzorg.nl/zorgvinder and searching based on the “IVF” search term. You can also contact our Care Advisor by contacting our Customer Service. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) specifies what will be reimbursed when you visit a non-contracted care provider.
You will only be entitled to IVF if you have a prior written referral from your medical specialist and you require permission from Anderzorg before receiving IVF treatment. If you wish to use a care provider who has not concluded a contract with Anderzorg, please contact our Customer Service.
A full IVF attempt consists of the following 4 phases:
An attempt will only be deemed an attempt when a successful follicular puncture has taken place. Only an attempt that has ended between the moment that a follicular puncture was successful and the moment that a continued pregnancy is involved counts with regard to the number of attempts. A continued pregnancy is a pregnancy of at least 10 weeks as from the moment of the follicular puncture. A continued pregnancy is a pregnancy of at least 9 weeks and 3 days as from the implant when cryopreserved (frozen) embryos are transferred. The transfer of all embryos obtained during the attempt (either interim cryopreserved or not) is a part of the attempt with which the embryos are obtained. A pregnancy of at least 12 weeks after the first day of the last menstruation that has occurred without medical intervention is also deemed to be a continued pregnancy.
Medical specialist care as referred to in that article includes the following with regard to other fertilisation-stimulating treatments: gynaecology treatments that stimulate fertility (for example ovulation induction (OI) and intrauterine insemination (IUI).
Women who are 43 or older are not entitled to this care.
You can visit a gynaecologist or urologist for this care.
Anderzorg has contracted these care providers. You can select from these care providers. You will find an overview of care providers on anderzorg.nl/zorgvinder who have entered into a contract with Anderzorg. You can also contact our Care Advisor by contacting our Customer Service. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) lists what will be reimbursed if you visit a non-contracted care provider.
You are only entitled to fertilisation-stimulating treatments when you have a prior written referral from your general practitioner or medical specialist.
There are a number of clinics that work in partnerships with hospitals in Germany and Belgium for IVF/ICSI treatments. Please note that you are not entitled to reimbursement of costs when the treatment abroad does not meet the conditions included in this and the previous article. Ask your care provider to inform you well before you start the treatment or ask the Care Advisor by contacting our Customer Service.
The maternity care provider assists the obstetrician/midwife or doctor during childbirth and makes arrangements with regard to issues such as linen in the first hours after having given birth. Next, the maternity care provider usually assists during a week in taking care of the mother and baby. The maternity care provider will provide information and checks the mother and baby during the first days after the birth.
You are entitled to maternity care for up to 10 days at most as from the date on which you gave birth.
The number of hours of maternity care is determined based on the National Recommended Protocol for Maternity Care (Landelijk Indicatieprotocol Kraamzorg). You can find the protocol on anderzorg.nl.
You can use Babybalance. This is e-health in the form of videos about the care for your new-born baby. Babybalance can only by purchased in combination with maternity care at your home. The use of Babybalance is considered to form part of the maternity care hours within the National Recommended Protocol for Maternity Care. Babybalance costs 4 hours of maternity care; no personal contribution applies.
A statutory personal contribution of € 4.70 per hour applies to maternity care at home. If you are having your baby in a hospital or a birth centre without a medical indication, you will pay a statutory personal contribution of € 38 per day that you are admitted (€ 19 for the mother and € 19 for the baby). If the hospital charges an amount that is higher than € 268 per day (€ 134 for the mother and € 134 for the baby), you must, in addition to the € 38, also pay the amount that is higher than € 268 per day.
Maternity care is granted by a qualified maternity care provider that is related to a maternity care institution.
Anderzorg has contracts with maternity care providers. You can select providers from the list of maternity care providers. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) specifies what will be reimbursed when you visit a non-contracted care provider.
Please contact Customer Service for advice on maternity care. You can then apply for the maternity pack too. You can also do this through anderzorg.nl/zelf-regelen/kraamzorg-en-kraampakket.
A speech therapist provides assistance with regard to breathing, voice, speech, language and hearing disorders. This assistance can consist of treating the disorder but also doing a test, providing advice and information and supervision of the family (carer) of the patient.
You are entitled to speech therapy if:
You are not entitled to speech therapy with regard to:
You can visit a general speech therapist for most complaints. Some speech therapist have an entry for specific complaints. Examples of this include the following:
We recommend asking your speech therapist whether he or she specialises in the treatment of your complaints.
You can consult a speech therapist for this care who is registered in the Paramedic Quality Register. You can find this register on kwaliteitsregisterparamedici.nl. The speech therapists who have a specific entry can be found in the relevant subregister of the NVLF (Nederlandse Vereneging voor Logopedie en Foniatrie). They can be found on nvlf.nl.
Anderzorg has contracts in place with speech therapists. You can select a speech therapist from the list of speech therapists. You will find an overview of care providers on anderzorg.nl/zorgvinder who have concluded a contract with Anderzorg. You can also contact our Customer Service. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) lists what will be reimbursed if you visit a non-contracted care provider.
No referral is required when you visit a contracted speech therapist who is immediately available for consultation. You can find out whether a speech therapist is immediately available in the Paramedic Quality Register.
In the following cases a prior written referral from your general practitioner, dentist or medical specialist is always required:
You are only entitled to speech therapy at a school or day nursery with prior written permission from Anderzorg. Your speech therapist can apply for this permission from Anderzorg on your behalf.
A medical specialist is a doctor who has specialised after completing his or her basic training and is registered as a medical specialist. There are approximately 30 different specialisations in the Netherlands. Most medical specialisations are linked to a hospital.
You are entitled to :
an allowance towards the electricity costs in case of mechanical respiration at home.
You are not entitled to treatments when it concerns:
Some forms of (medical specialist) care are described separately in these insurance terms and conditions. Refer to the relevant Article for details. They are:
You can visit a hospital and consult the medical specialist who is linked to this hospital or you can consult a medical specialist who has his or her own practice for medical specialist care. You can also visit an independent treatment centre (in Dutch: ZBC) that offers care by a medical specialist.
Anderzorg has contracted care providers. You can select from these care providers. You will find an overview of care providers on anderzorg.nl/zorgvinder who have concluded a contract with Anderzorg. You can also contact our Customer Service. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) specifies what will be reimbursed when you visit a non-contracted care provider.
Emergency care in the Netherlands will always be fully reimbursed in accordance to the rates that apply in the Netherlands for this.
You are only entitled to medical specialist care when you have a prior written referral from your GP, medical specialist, nurse specialist, physicians assistant obstetrician, specialist geriatric care provider (nursing home doctor), a doctor who works in youth health care or a doctor for the mentally challenged.
You do not need a written referral for emergencies.
You require prior permission for a number of treatments:
You can find these treatments listed in the Limitative List of Medical Specialist Healthcare (in Dutch: Limitatieve Lijst Medische Specialistische Zorg) of the Association of Dutch Health Insurers (ZN). Which treatments does this refer to?
The list may change during the year. Visit zn.nl to obtain the most recent version.
You are only entitled to these treatments when you have obtained permission from Anderzorg in advance:
We recommend that you request permission for the treatment should you have any doubts. Your medical specialist must inform you that you must pay the care expenses if you do not have prior permission.
The entitlement to plastic surgery treatment types is arranged in the plastic and/or reconstructive surgery policy article. If you are looking for a medical specialist with a special area of expertise or for highly complex care, contact our Care Advisor by contacting our Customer Service for more information.
Non-clinical dialysis includes haemodialysis and peritoneal dialysis. Haemodialysis is a therapy that replaces the kidney function where use is made of filters; the so-called artificial kidneys. Specially formulated dialysis fluid is introduced in the abdomen to purify the blood with regard to peritoneal dialysis. This is why this is sometimes referred to as a renal replacement therapy. Dialysis can be provided in a dialysis centre, an independent treatment center or in a hospital, but home dialysis is also possible.
You are entitled to haemodialysis and peritoneal dialysis, the related medical specialist care, examinations, treatment, nursing, medication and psychosocial supervision. Psychosocial supervision is also provided to people who assist in carrying out dialysis at home. You will also be entitled to the following with regard to home dialysis:
The Insurance Regulations includes further conditions for the reimbursement of costs related to home modifications that are reasonably required in relation to home dialysis and the reimbursement of costs that are related directly to home dialysis.
You can visit a dialysis centre, an independent treatment center or a hospital for this care.
Anderzorg has contracted various care providers you can choose from. You can find an overview of care providers who have concluded a contract with Anderzorg by visiting anderzorg.nl/zorgvinder and searching based on the “dialyse” (dialysis) search term. You can also contact Customer Service. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) specifies what will be reimbursed when you visit a non-contracted care provider.
You are only entitled to non-clinical dialysis when you have a prior written referral from your general practitioner or medical specialist.
The reimbursement of costs of any adaptations to your home and reasonable costs directly related to home dialysis fall under medical aid care. Refer to the Insurance Rules and Regulations for more information.
Investigation into the spread of the disease and the further typing of the tumour is required for effective treatment as well as having the correct diagnosis. The SKION has a central laboratory for children with blood and lymph node cancer (hematologic malignancies) where blood, bone marrow and cerebrospinal fluid of all Dutch children with these diseases are investigated.
You are entitled to register and be examined and compared with the material present to ensure you have the best possible treatment plan.
The care is provided by the Stichting Kinderoncologie Nederland (SKION).
You are only entitled to oncology assistance for children if you have a prior written referral from a general practitioner or a medical specialist.
Plastic surgery is a surgical specialisation in which the focus is on the modification of your appearance from a functional (and sometimes aesthetic) perspective, for example, the restoration of congenital or suffered mutilation. Plastic surgery has been included in a very limited fashion in the Basic Insurance.
You are entitled to the treatment of a plastic surgical nature when it involves the correction of the following:
You are not entitled to treatment of a plastic surgical nature if the following is involved:
You can visit a hospital and a medical specialist that is linked to this hospital for plastic surgery. You can also visit an independent treatment centre (in Dutch ZBC) if a medical specialist is linked to this centre.
Anderzorg has contracted care providers. You can select from these care providers. You will find an overview of care providers on anderzorg.nl/zorgvinder who have concluded a contract with Anderzorg. You can also contact Customer Service. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) specifies what will be reimbursed when you visit a non- contracted care provider.
You are only entitled to plastic surgery when you have a prior written referral from your general practitioner, medical specialist or specialist geriatric care provider (nursing home doctor).
For reimbursement of treatments on the ‘Limitatieve Lijst Medisch Specialistische Zorg’ of ‘Zorgverzekeraars Nederland’ (ZN) you require permission from Anderzorg prior to the treatment. If we give you permission, it is valid for 1 year, starting on the date on which you received our written permission. If the permission is valid for a shorter or longer period of time, we will mention this explicitly when giving the permission.
Rehabilitation is a form of medical specialist care under the responsibility of a rehabilitation doctor. Medical specialist rehabilitation focuses on the recovery of people with a temporary or chronic disorder as a result of an accident, medical intervention or serious illness. If full recovery is not being expected in the short term, the rehabilitation doctor will try to help you to prevent permanent limitations by using the assistance of care providers from different disciplines. If this does not have the desired effect either, the rehabilitation doctor and his or her team will work with you to manage your limitation as best as possible within your life and environment and society in general.
You are entitled to medical specialist rehabilitation if this care is the most effective for your case to prevent, reduce or overcome a handicap/disability. You will be able to attain or keep a certain degree of independence that is considered to be possible in all reasonableness that takes your disability into account after rehabilitation. This must refer to a disability that is due to one of the following:
You are entitled to medical specialist rehabilitation as part-time or outpatients’ treatment. You will only be admitted (to an institution) for rehabilitation if better results can be expected quickly when compared to part-time or outpatients’ treatment rehabilitation.
You will be treated by a multidisciplinary team of experts led by a medical specialist or a rehabilitation doctor. This team must be linked to a rehabilitation institution or hospital.
You can find an overview of care providers who have concluded a contract with Anderzorg by visiting anderzorg.nl/zorgvinder and searching based on the “revalidatie” (rehabilitation) search term. You can also contact Customer Service. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) specifies what will be reimbursed when you visit a non-contracted care provider.
You are only entitled to medical specialistic rehabilitation when you have a prior written referral from your GP, medical specialist, mental health doctor, geriatric specialist (nursing home doctor) or company doctor when the complaints are linked to your work.
Will you be visiting a care provider who does not have a contract with Anderzorg for rehabilitation care? You are only entitled to medical specialist rehabilitation if you have prior consent from Anderzorg. Please enclose a well- founded explanation and a treatment plan from the care provider with your request.
Reintegration in the workplace is not part of the care that is insured.
Geriatric rehabilitation focuses on vulnerable elderly people who have received medical specialist treatment in a hospital, for example, because of a stroke or a bone fracture. These people require rehabilitation treatment that combines multiple types of care such as nursing, physiotherapy, occupational therapy, speech therapy, psychotherapy, dietary advice and care provided by a social and geriatric healthcare provider specialist. The above is all offered under the responsibility of a geriatric healthcare provider specialist. The care is adjusted to the individual recovery options and the training pace of elderly people and takes into account other existing conditions and disorders. The aim is to assist these elderly patients to return to their homes.
You are entitled to geriatric rehabilitation in relation to vulnerability, complex multimorbidity and reduced learning capacity and trainability. Geriatric rehabilitation is integral and multidisciplinary rehabilitation care and must focus on the reduction of functional restrictions in such a way that to return to the home is made possible.
You are entitled to geriatric rehabilitation if you are hospitalised at the start of the geriatric rehabilitation and
You can go to an institution that provides geriatric rehabilitation care in accordance with the Geriatric Rehabilitation Treatment Frameworks for geriatric rehabilitation. The Geriatric Rehabilitation Treatment Frameworks have been drawn up by the Dutch Association of Elderly Care Physicians and Social Geriatricians, Verenso. The institution has been authorised as an institution for specialist care (independent treatment centre, hospital or rehabilitation centre) or has been authorised as an institution for providing treatment and sleeping arrangements (nursing home) based on the Dutch Care Institutions (Accreditation) Act (WTZi).
Anderzorg has contracted care providers. You can select from these care providers. You can find an overview of care providers who have concluded a contract with Anderzorg by visiting anderzorg.nl/zorgvinder and searching based on the “Geriatrische revalidatie” (Geriatric rehabilitation) search term. You can also call the Anderzorg Care Advisor on 088 222 44 22 . The “To a non-contracted care provider” article at the start of this section (Basic Insurance) specifies what will be reimbursed when you visit a non-contracted care provider.
You are only entitled to geriatric rehabilitation if you have a prior written referral from a medical specialist of the hospital where you were admitted and the indication for geriatric rehabilitation has been determined under the supervision of a geriatric specialist.
The indication for geriatric rehabilitation should always be made under the responsibility of a geriatric specialist, clinical geriatrician or a geriatric internist.
Will you be visiting a care provider who does not have a contract with Anderzorg for geriatric rehabilitation? You are only entitled to geriatric rehabilitation if you have prior consent from Anderzorg. Please enclose a well-founded explanation and a treatment plan from the care provider with your request.
A second opinion is requesting an assessment of a diagnosis or proposed treatment provided by a doctor from a second, independent doctor who works in the same specialisation field as the first consulted doctor.
You will be entitled to a second opinion when:
You can visit a GP, medical specialist, midwife, physiotherapist, clinical psychologist, mental healthcare institution or an (out-patients’ department of a) psychiatric department of a hospital.
Anderzorg has contracted care providers. You can select from these care providers. You will find an overview of care providers on anderzorg.nl/zorgvinder who have concluded a contract with Anderzorg. You can also ask our Care Advisor by contacting our Customer Service. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) specifies what will be reimbursed when you visit a non-contracted care provider.
You are fully entitled to a second opinion when you have a prior written referral from the person who is treating you.
A programme to quit smoking consists of a combination of interventions to change behaviour (in a group or individually) sometimes with the support of medication. The behaviour-based support forms the basis with regard to this integral programme. This means that a form of recognised behaviour- based support is always deployed that may be supplemented with medication that has been proven to be effective but that medication can never be deployed without behaviour-based support.
You are entitled to a programme to quit smoking once per calendar year:
For behaviour support when quitting smoking you can visit a care provider contracted by Anderzorg. You can also visit your general practitioner for behaviour-based support. For nicotine products and medication you can go to a supplier of nicotine products and medication contracted by Anderzorg. The medication must have been prescribed through the medication application form used when quitting smoking or with a prescription of the general practitioner.
You will find an overview of care providers who have concluded a contract with Anderzorg for behaviour support and the supply of nicotine products and medication on anderzorg.nl/zorgvinder when you enter the search term “Stoppen met roken” (Quitting smoking). You can also contact our Customer Service. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) specifies what will be reimbursed when you visit a non-contracted care provider.
The excess applies to the quitting smoking programme even when the general practitioner provides the behaviour-based support.
Special dentistry work is meant for people for whom regular dentistry work is not sufficient with regard to a special complaint. Examples are a cleft palate or a very severe overbite.
You are entitled to special dentistry work that is essential if you:
You can visit a dentist, a Centre for Special Dentistry Work, a dental surgeon or an orthodontist. You can visit an orthodontist for the orthodontic part of the treatment.
You require prior permission from Anderzorg for special dentistry work. Please enclose a written well- founded explanation and a treatment plan from the care provider with your request.
You are entitled to dentistry. What you are exactly entitled to, will depend on whether you are older or younger than 18.
You are entitled to :
You are entitled to dental replacement treatment with non-plastic materials and inserting implants if they are replacing one or more permanently missing incisors or laniaries that were not initially present, or because the absence of that tooth or those teeth is the direct consequence of an accident. You are only entitled to this care if the need has been established before you became 18.
Should you visit the dentist outside normal surgery hours, you will only be entitled to dentistry work if the visit cannot be postponed to another day.
You are entitled to :
Are you 18 years old or older? You pay a personal contribution of 25% of the total costs of full dentures. You pay a personal contribution of 10% of the total costs of full dentures on implants and related mesostructure for the bottom jaw and 8% of the total costs of full dentures on implants and related mesostructure for the top jaw. The excess for repairs and filling (rebasing) of a detachable full prosthetic facility is 10% of the costs of this repair or filling. You can also find more information in the Insurance Rules and Regulations. Consult the scheme on anderzorg.nl or request this information from Customer Service.
You can visit a dentist, oral surgeon or dental prosthesis specialist. If you are younger than 18, you can also visit an independent oral hygienist. For implants related to the placing of full dental prosthesis in the top jaw you can visit a care provider contracted for this purpose or to a dentist/implantologist that is recognised by the Nederlandse Vereniging voor Orale Implantologie (NVOI; Dutch Association for Oral Implantology). You can find out who they are by visiting nvoi.nl/erkende-implantologen.
For full dentures and implants, Anderzorg has contracted care providers. You can select from these care providers. You will find an overview of care providers on anderzorg.nl/zorgvinder who have concluded a contract with Anderzorg. You can also contact our Customer Service. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) specifies what you will be reimbursed if you visit a non-contracted care provider.
Will you visit an oral surgeon in an Independent Treatment Centre who does not have a contract with MAnderzorg? The “To a non-contracted care provider” article at the start of this section (Basic Insurance) specifies what will be reimbursed when you visit a non-contracted care provider.
You are only entitled to a treatment by a dental surgeon, if you have a prior written referral from a dentist or a general practitioner.
You will require prior permission from Anderzorg:
Please enclose a written well-founded explanation and a treatment plan from the care provider with your request.
Transplantation is a form of medical specialist care. Transplantation is the replacement of an organ or tissue that no longer functions or only functions poorly of a patient by the organ of a donor. Organs/ tissues that can be transplanted are, for example, the heart, skin, lungs, kidneys, the pancreas, the liver, bones and bone marrow. Sections of organs can also be transplanted.
You are entitled to a transplant of tissues or organs if the transplant takes place:
You are also entitled to be reimbursed for the costs related to:
Other costs incurred due to the transplant and the donor living abroad are also reimbursed except the costs linked to staying in the Netherlands and lost income.
The costs for the transport under hyphens 8 and 9 in relation to “Which Care” are to be paid by the healthcare insurer of the donor. If the donor has not taken out healthcare insurance, the costs will be paid from your Basic Insurance.
For a transplant, you can visit a medical specialist in a hospital that is licensed to perform transplants.
Anderzorg has contracted care providers. You can select from these care providers. You will find an overview of care providers on anderzorg.nl/zorgvinder who have concluded a contract with Anderzorg. You can also contact our Customer Service. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) specifies what will be reimbursed when you visit a non- contracted care provider.
You are only entitled to a transplant when you have a prior written referral from your general practitioner or medical specialist.
Thrombosis is a clot in a blood vessel or artery. This can occur in, for example, the leg vessels, coronary arteries, capillaries of the lung and brain vessels. The intensive care department for thrombotic patients is responsible for setting up, checking and supervising out-patients who use specific oral anticoagulants.
You are entitled to :
The Insurance Regulations includes further conditions for the reimbursement of costs related to blood coagulation self-measurement equipment.
You can visit an intensive care department for thrombotic patients.
Anderzorg has contracted care providers. You can select from these care providers. You will find an overview of care providers on anderzorg.nl/zorgvinder who have concluded a contract with Anderzorg. You can also contact our Customer Service. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) specifies what will be reimbursed when you visit a non-contracted care provider.
You will only be entitled to care offered by an intensive care department for thrombotic patients if you have a prior written referral from your general practitioner or medical specialist.
Patients can be admitted for examination, intervention or observation after consulting a medical specialist. If a patient must be admitted for several days, the patient is deemed to have been ‘clinically’ admitted. The stay in a hospital or institution may be long term. In this case, 1,095 days will be covered by the Basic Insurance. Dutch Long-term Care Act (in Dutch: Wet langdurige zorg (Wlz)) insures any admissions that occur after the first 1,095 days. If you have questions about the care, please ask our Care Advisor by contacting Customer Service.
You are entitled to stay during the 24 hours that are required medically in relation to obstetrician care, oral surgeon dentistry care of a specialist nature, medical specialist care and geriatric rehabilitation. You are also entitled to the related required nursing, care, paramedical care and medication. You are also entitled to the related required nursing, care, paramedical care and medication. You admittance is insured for an uninterrupted period of 1,095 days. An interruption of a maximum of 30 days is not considered to be an interruption but does not count for the calculation of the 1,095 days. An interruption due to weekend or holiday leave does, however, count.
Admittance with regard to mental healthcare is not described here. You can find this information under “Mental healthcare”. Primary care institution is not described here, but in the “Primary care institution” article.
Anderzorg has contracted institutions. You can select one of these institutions. You can find an overview of care providers who have concluded a contract with Anderzorg. You can also ask our Care Advisor by contacting our Customer Service. The “To a non- contracted care provider” article at the start of this section (Basic Insurance) specifies what will be reimbursed when you visit a non-contracted care provider.
The reimbursement for hospitalisation other than the hospital after CAR-T cell therapy is a maximum of € 77.50 per day.
You are only entitled to rehabilitation if you have prior permission from Anderzorg with regard to:
Most obstetric care given to pregnant women is provided by midwifes. They will supervise and check women during their pregnancies and when the baby is delivered.
You are entitled to obstetric care and prenatal screening.
The prenatal screening consists of:
For obstetric care you can visit a general practitioner who is registered in the Obstetrician Register of the College voor huisartsen met bijzondere bekwaamheden (CHBB; Board of General Practitioners with Special Competences) or an obstetrician. If there is a medical requirement, obstetric care is given in a hospital under the supervision of a medical specialist. See the article about medical specialist care. For laboratory. representational diagnostics and function tests requested by a general practitioner or obstetrician you can go to a first-line diagnostics centre, a production group practice, a hospital or an independent treatment centre.
Anderzorg has contracted care providers. You can select from these care providers. You will find an overview of care providers on anderzorg.nl/zorgvinder who have concluded a contract with Anderzorg. You can also contact Customer Service. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) specifies what will be reimbursed when you visit a non- contracted care provider.
The structural echoscopic examination and the combination test may only be performed by a care provider who has been granted a permit based on the Dutch Population Screening Act or has a cooperation agreement with a Regional Centre that has been granted a permit based on the Dutch Population Screening Act permit. WBO is Dutch for Wet op het bevolkingsonderzoek (Population Screening Act). No WBO permit is required with a medical indication for the examination.
A statutory personal contribution of € 4.70 per hour applies to maternity care at home. If you deliver your baby in a hospital or a birth centre without a medical indication, you must pay a statutory personal contribution of € 38 per admittance day (€ 19 for the mother and € 19 for the baby). If the hospital charges an amount that is higher than € 268 per day (€ 134 for the mother and € 134 for the baby) you must, in addition to the € 38, also pay the amount that is higher than € 268 per day.
There are 2 types of ambulance transport: emergency transport (usually reported by dialling 112) and booked transport. The ambulance care is provided by nurses and drivers who have been especially trained for this (paramedic staff).
You are entitled to :
You are entitled to transport with another means of transport than an ambulance (for example, a helicopter) when ambulance transport is not possible.
Ambulance transport is provided by a permit holder designated by the Ministry of VWS.
You are only entitled to plastic surgery when you have a prior written referral from your general practitioner, medical specialist or specialist geriatric care provider (nursing home doctor). You are only entitled to transport by helicopter when you have a prior written referral from the Ambulance Central Control Room (Meldkamer Ambulance Zorg) or a centre for neonatal and child surgery intensive care unit. You do not require a referral for emergency transport.
The transport must have been indexed by the doctor in charge of treatment.
Nursing and care focuses on physical healthcare, self-sufficiency, metal well-being and your own living environment.
You are entitled to nursing and care. Nursing and care mean the following: care as offered by nurses that
You are also entitled to specialized pediatric daycare and care at a pediatric care facility if you are less than 18 years old and need care because of complex somatic issues or a physical disability where continuous supervision is required, or there must be care 24 hours a day in the vicinity and this care is linked to one or more specific nursing action.
Supervision is not an insured care. An exception to this is when your treating doctor has determined that the palliative terminal phase has arrived. If it is medically necessary for nursing supervision to be present, this supervision may be eligible for reimbursement. Even in the palliative terminal phase, attendance resulting from the lack of a family care network is not insured care.
You are only entitled to nursing and care when you have an indication. This indication must meet the standards for indexing and organising of nursing and care in your own environment as established by the professional association of community nurses, Verpleegkundigen & Verzorgenden Nederland (V&VN). To be eligible for reimbursement you must have a nursing indication with a care plan that describes the care that you need with regard to its nature, scope and duration including the set goals. This indication and care plan must be drawn up by a HBO-community nurse or nurse specialist and must be signed by you and the care provider.
You are not entitled to nursing and care if these forms of care can be financed for you on the basis of the Long-Term Care Act (Wlz) or the Social Support Act (Wmo). If there are indications that your care can be financed on the basis of one of these acts, Anderzorg may ask you to invoke these acts by requesting a decision on the care required from the Care Needs Assessment Centre (CIZ) or the municipality of your place of residence. You are no longer entitled to nursing and care if you do not cooperate in this or if the CIZ or your municipality actually decides that you have the right to rely on the Wlz or the Wmo.
A person-linked budget (PGB) is an amount that you can use to purchase nursing and care services yourself. If you are entitled to nursing and care, you may also possible apply for the reimbursement of this care in the form of a person-linked budget. The Insurance Regulations provide information when you are eligible for this, what your responsibilities are with regard to this and how the PGB is paid. You can find the Insurance Regulations on our website. You can also request these regulations from Anderzorg Customer Service.
You can go to a (homecare) institution for nursing and care with a Healthcare and Care Providers (Accreditation) Act permit (in Dutch: Wet toelating zorginstellingen; WTZi) with a higher professional education (HBO) (paediatric) nurse or a nursing specialist who is permanently employed. The HBO (paediatric) nurse or nursing specialist determines the care required and remains involved in the performance and evaluation of the care plan. The care is provided by a HBO/senior secondary vocational education (MBO) nurse, nursing specialist or care worker level 3 or higher.
You can also go to an independently working HBO (pediatric) nurse or nursing specialist for determinating the indication and care (zzp'er). The care can also be provided by an MBO nurse or a carer with education level 3 or higher who is in possession of the KIWA quality mark for self-employed persons in care or the HKZ-NEN quality mark for self-employed persons (zzp'er) in 'Zorg & Welzijn'. This is only allowed if this healthcare provider works together with the HBO (pediatric) nurse or the nurse specialist who has determined the indication. The care provider who has determined the indication remains involved in the implementation and evaluation of the care plan
Anderzorg has contracted care providers. You can select from these care providers. You will find an overview of care providers on anderzorg.nl/zorgvinder who have concluded a contract with Anderzorg. You can also ask our Care Advisor by contacting Customer Service. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) specifies what will be reimbursed when you visit a non- contracted care provider.
The costs incurred are not fully reimbursed if you opt for treatment by a care provider that has not concluded a contract with Anderzorg. You also require Anderzorg’ prior approval. You can ask our Care Advisor by contacting Customer Service in order to request this approval.
A permission is valid for a maximum of 365 days, unless expressly stated otherwise. A permission is no longer valid if applicable laws or regulations change.
Do you have any questions about nursing and care? Please contact our Care Advisor for more information on the options.
Some forms of care have been included in the Basic Insurance conditionally. This concerns care regarding which there are doubts about the effectiveness or regarding which the effectiveness has not or has not fully been proven yet. It may concern new treatment methods but also care that is already included in the Basic Insurance but regarding which there are doubts or doubts have arisen.
You will find the care options that are permitted conditionally in the Insurance Terms and Conditions and on anderzorg.nl.
Sensory care for the disabled is a treatment for people with a sensory impairment. A sensory impairment is a visual, hearing or communication impairment as a result of a language development disorder or a combination of these impairments. Multiple specialists are involved in the treatment (multidisciplinary care).
This care consists of:
In addition to the treatment of the person who has the sensory impairment, it also concerns (indirect) system-focused co-treatment of parents or carers, children and adults around the person with the sensory impairment who will learn skills in the interest of the person with the sensory impairment.
Support with being able to perform socially and the complex, log-term and life-wide support to adults who are deaf and blind and adults who are pre-lingual deaf does not fall under sensory care for the disabled.
You are entitled to multidisciplinary care (care where different specialists are involved). You need this care because you have a:
The care focuses on learning to cope, removing or compensating with/for the impairment to ensure that you can perform as independently as possible.
You can visit an institution that has been accredited in accordance with the Dutch Care Institutions Accreditation Act for giving sensory care to the disabled and which mainly focuses on providing out- patient treatment for the sensory impaired.
Anderzorg has contracted care providers. You can select from these care providers. You will find an overview of care providers on anderzorg.nl/zorgvinder who have concluded a contract with Anderzorg. You can also ask our Care Advisor by contacting Customer Service. The “To a non-contracted care provider” article at the start of this section (Basic Insurance) specifies what will be reimbursed when you visit a non- contracted care provider.
You are only entitled to sensory care for the disabled if you have a referral in advance. If it concerns the treatment of a visual impairment, you need a referral from a medical specialist who has established rehabilitation and a referral based on the evidence-based NOG (Nederlands Oogheelkundig Gezelschap; Dutch Ophthalmic Society) guideline Visual Disorders that a visual impairment is involved.
If it concerns the treatment of an auditive and/or communication impairment, you need a referral from a clinical physicist-audiologist from the audiology centre or a doctor who has established based on the applicable FENAC (Federatie van Nederlandse Audiologische Centra; Federation of Dutch Hearing Centres) guidelines that an auditive and/or communication impairment is or are involved.
You will require prior permission from Anderzorg for sensory care for the disabled from a care provider who does not have a contract with Anderzorg. Please enclose a written well-founded explanation and a treatment plan from the care provider with your request.
You can make an appeal on this insurance for the transport or the costs of this transport with regard to certain indications. There are 3 types of non-emergency patient transport services. You can be conveyed using your own transport, public transport or using a different means of transport, for example, a boat.
You are entitled to public transport of the lowest class or the reimbursement of the costs of using a vehicle. When a private car is used, you are entitled to be reimbursed € 0.32 per kilometre. You are entitled to transport using a different means of transport, when you cannot be conveyed by public transport or by using your own transport. If supervision is required or when a child younger than 16 is involved who needs to be supervised, the costs of public transport and personal transport or transport using a different means of transport of the attendant/ carer will also be paid/reimbursed. In special cases, Anderzorg will allow the reimbursement of the costs of public transport and personal transport or the transport using a different means of transport for 2 attendants/carers.
You are entitled to transport if it involves the transport from and to persons, institutions and the private addresses as referred to in the Article about ambulance transport, and:
If you are entitled to reimbursement of travel expenses and you require such transport on three or more consecutive days, you may opt for reimbursement of the costs of overnight stay. The reimbursement of the costs of overnight stay is at most €77,50 per night and partially replaces the reimbursement of the travel expenses.
If you are entitled to transport or reimbursement of costs, you may also obtain reimbursement of the costs of transport incurred by a possible assistant if you require assistance. Children below the age of 16 are always entitled to reimbursement of the travel expenses of assistants. Anderzorg may reimburse the costs of 2 assistants in special cases.
You pay a personal contribution of € 111 per calendar year. The personal contribution does not apply to the reimbursement of overnight stay.
You do not pay a personal contribution for transport:
The transport will be provided by a transport company or a private person (for example, a member of your family or an acquaintance). Anderzorg has contracts in place with transport companies. When permission is granted, the transport companies that can be used will be specified. If you decide to use a transport company that has not concluded a contract with Anderzorg, you will receive a maximum of € 0.85 per kilometre. You will receive € 0.32 per kilometre when the transport is provided by a private person.
You must request prior permission from Anderzorg. Call the Transport Service Line on +31 317 492 051 or send the request form “non-emergency patient transport”. The request form can be downloaded by visiting anderzorg.nl. Anderzorg will determine whether you will be given permission and for which type of transport (public transport, personal transport or transport with a different vehicle) you will be given permission.
Other costs such as parking or ferry costs will not be reimbursed.
Anderzorg offers different additional insurances. Below we list all the care types that are included in the additional insurances. Every care type includes a table. We specify in this table for each additional insurance whether the care is covered and/or what any possible reimbursement will be. Your healthcare policy will specify which additional insurance you have.
The Dutch text is binding should any disputes arise from the interpretation of the text.
Your additional insurance is a supplement to your Basic Insurance. The additional insurance is not a replacement of the Basic Insurance. That which is insured through the Basic Insurance is not reimbursed through your additional insurance. This also applies to your excess and personal contribution of the Basic Insurance unless it is included in the additional insurance as an additional reimbursement.
Anderzorg makes agreements with care providers. Hospitals, doctors and physiotherapists are, for example, care providers. These agreements are related to the payment of bills but also to the quality of the provided care. Anderzorg can also approve care providers. This approval will depend on, for example, good training. Some types of care are not insured except when you visit a contracted care provider or an approved care provider. If this is the case, this type of care will be specified. You can find contracted and approved care providers by visiting anderzorg.nl/zorgvinder.
Anderzorg has a contract with many care providers. This care provider can submit the bill directly to Anderzorg. You will not have to do anything. You can, however, always check all bills in Mijn Anderzorg. Have you received a bill from a care provider? You can claim your bill online through anderzorg.nl/mijnanderzorg. You can also use the free Anderzorg claiming app. This makes submitting your bills very easy, fast and secure.
Only the costs for care supplied in the Netherlands by a care provider or supplier established in the Netherlands will be reimbursed. The exception to the above is emergency care abroad (see the Article Abroad).
You will only be examined or treated if this is required. There must be a medical indication to qualify for the reimbursement of care. Which care is required for your case will be objectively determined. This care must also be effective (must have a purpose). Care that is unnecessary or costs too much unnecessarily when compared to other types of care that is on an equal footing in view of the indication and your care need, will not be covered by the insurance.
When staying abroad, you may require immediate medical care or medication. You will receive service and support from the Anderzorg Emergency Centre with regard to emergency care during a stay abroad. The Emergency Centre will, for example, take responsibility for the contact with the treating doctors and repatriation and will act as a guarantor. Additional information can be found by visiting anderzorg.nl/buitenland.
Dentistry work is classed as requiring emergency treatment if there are pain complaints as is the case with regard to the inflammation of a nerve or gums that means that the dentistry work cannot be deferred until you return to the Netherlands and it had not been foreseen that this dentistry work would be required.
Dentistry work will be reimbursed up to a maximum amount. This maximum amount is per calendar year:
Fysiotherapie |
---|
No |
Buitenland & Tandongeval |
€ 250 |
Flex |
€ 250 |
Fysiotherapie | Buitenland & Tandongeval | Flex |
---|---|---|
No |
€ 250 |
€ 250 |
You will only be reimbursed the costs if:
Care is an emergency when a situation is involved in which medical assistance is needed as soon as possible that makes returning to the Netherlands no longer an option. It had not been foreseen that this medical assistance would be required.
You will receive a supplement to the reimbursement that you receive based on the Basic Insurance.
The supplement is the difference between the reimbursement that you receive from the Basic Insurance and the charged costs.
Fysiotherapie |
---|
No |
Buitenland & Tandongeval |
Yes |
Flex |
Yes |
Fysiotherapie | Buitenland & Tandongeval | Flex |
---|---|---|
No |
Yes |
Yes |
You will only be reimbursed the costs if:
You break a leg in the United States. You are given a bill for an amount of € 3,000 for the treatment. This would have cost € 2,000 in the Netherlands. You will receive this amount based on the Basic Insurance. The additional insurance will then reimburse the remaining € 1,000.
Rescue costs are costs incurred with regard to tracking, rescue and salvage. If you want to be reimbursed for rescue costs, take out travel insurance. For more information visit anderzorg.nl/reisverzekering.
You may become sick or suffer an accident when abroad and that you need to return to the Netherlands for further treatment.
You will be reimbursed for transport from the location abroad to an institution in the Netherlands.
Fysiotherapie |
---|
No |
Buitenland & Tandongeval |
Yes |
Flex |
Yes |
Fysiotherapie | Buitenland & Tandongeval | Flex |
---|---|---|
No |
Yes |
Yes |
You will be entitled to this reimbursement when the medical need has been determined by Anderzorg’ Emergency Centre and they also make the arrangements for travel.
People with disorders related to the posture and locomotory apparatus are given support through exercises or different therapies and are assisted to improve their movement capacity and to reduce pain. When you have complaints related to your posture and locomotory apparatus, you can visit a physiotherapist or exercise therapist. This therapist will try to improve the function of your posture and locomotory apparatus by applying different techniques and exercise. A normal posture and movement will again be possible or you will be taught how to cope with your limitations in the best possible manner.
You will be reimbursed for physiotherapy treatments and exercise therapy up to a maximum number of treatment sessions. This maximum number of treatments per calendar year is:
Fysiotherapie |
---|
4 |
Buitenland & Tandongeval |
0 |
Flex |
0 |
Fysiotherapie | Buitenland & Tandongeval | Flex |
---|---|---|
4 |
0 |
0 |
You are entitled to be reimbursed when your therapist has a contract with Anderzorg. Visit anderzorg.nl/zorgvinder to find out who these therapists are.
We recommend asking your physiotherapist whether he or she specialises in the treatment of your complaints.
Ask your therapist, visit anderzorg.nl/fysiotherapie for even more examples or contact our Customer Service if you have any doubts.
FysioZelfCheck is an app developed by and of physiotherapists. FysioZelfCheck offers exercises, information and suggestions in an easily accessible way with which people can actively work on solving their complaints themselves. The app is for people with mild musculoskeletal complaints, such as sore shoulders, low back pain or complaints during/after exercise.
You get full access to FysioZelfCheck:
You can download FysioZelfCheck via the app-store (IOS and Android). For more information, please visit www.fysiozelfcheck.nl.
Fysiotherapie |
---|
yes |
Buitenland & Tandongeval |
no |
Flex |
yes |
Fysiotherapie | Buitenland & Tandongeval | Flex |
---|---|---|
yes |
no |
yes |
Common, mild musculoskeletal complaints often diminish or disappear within a few weeks with rest and simple exercises. FysioZelfCheck can help in these situations. Users of FysioZelfCheck start by completing a questionnaire. These are questionnaires that meet the current guidelines of the profession. On this basis, the user is presented with information, suggestions and a series of exercises. With various instruction videos and vlogs from, mostly specialist physiotherapists, the user can get started with the exercises. If the questionnaire shows that additional care is required, a recommendation will be made to make an appointment with a (specialist) physiotherapist or GP.
You will receive compensation for care you need after an accident. An accident is a sudden, unexpected, external force on the body, directly resulting in medically detectable physical injury. Events in which it can be foreseen in advance that physical injury to the body may occur are not covered by this definition.
You will be reimbursed for physiotherapy or remedial therapy treatments following an accident. The maximum amount per accident is:
Fysiotherapie |
---|
16 |
Buitenland & Tandongeval |
0 |
Flex |
16 |
Fysiotherapie | Buitenland & Tandongeval | Flex |
---|---|---|
16 |
0 |
16 |
You will be reimbursed for physiotherapy and/or remedial therapy following an accident, provided that:
Please note: any costs of the excess and personal contributions (Basic health Insurance) will not be reimbursed unless stated otherwise.
You are not entitled to compensation if the complaint has arisen:
The following are examples of situations in which you are not entitled to reimbursement:
You will be entitled to this reimbursement if your therapist has a contract with Anderzorg. The relevant therapists can be found at The Anderzorg Zorgvinder.
You will need permission from Anderzorg before you can claim compensation. In doing so, you must fill in a statement with information about the accident. You can apply for permission at anderzorg.nl.
On the basis of your statement, we will assess whether the treatment qualifies for reimbursement. We will then check whether there has been an accident that has caused the damage, whether the exclusions do not apply and whether you meet the other conditions. We may ask you to provide additional information. If you meet all the above conditions, you will receive a statement of consent for treatment. Is there third-party involvement? Report this to Anderzorg. Then we will recover the damage.
The physiotherapist will invoice the treatments for which permission has been given for accident cover directly to Anderzorg. You will not receive an invoice for this. If you do receive an invoice, please contact your physiotherapist.
You are entitled to physiotherapy under the Basic health Insurance for a number of disorders or complaints, for example in the event of recovery from a broken leg or as part of the treatment of a muscle disease. It concerns diseases and complaints included on a list drawn up by the Minister of Health, Welfare and Sport. This is the list included in Appendix 1 to Article 2.6 of the Healthcare Insurance Decree. This list can be found at anderzorg.nl
Under the Basic health Insurance, you are entitled to physiotherapy as from the 21st treatment, per disorder or complaint. The first 20 treatments for each initial diagnosis will not be reimbursed under the Basic health Insurance.
If you meet the conditions of the Basic health Insurance, the first 20 treatments will be reimbursed under the supplementary insurance.
This maximum number of treatments per 12 months is: 20 treatments after the first diagnosis, per disorder or complaint. This maximum number applies to combined physiotherapy and/or remedial therapy treatments.
Fysiotherapie |
---|
yes |
Buitenland & Tandongeval |
no |
Flex |
no |
Fysiotherapie | Buitenland & Tandongeval | Flex |
---|---|---|
yes |
no |
no |
Excluded are disorders that are reimbursed as from the first treatment under the Basic health Insurance; osteoarthritis of the hip and knee joints, intermittent claudication, COPD and pelvic physiotherapy in the event of urinary incontinence.
You need proof of diagnosis. Proof of the diagnosis can be provided digitally or on paper clearly mentioning the names of the patient and the diagnostician. The diagnosis is specific enough to determine whether it concerns a disorder listed in Appendix 1 Article 2.6 of the Healthcare Insurance Decree.
Working on your mental and physical health with premium health apps such as Headspace, Sworkit, Fabulous and the FysioZelfCheck. Such as: practising mediation, reducing stress, developing healthier routines and behaviour, working on your stamina and strength and the reduction of physical complaints.
You will have access to premium health apps Headspace, Fabulous, Sworkit and the FysioZelfCheck:
Fysiotherapie |
---|
No |
Buitenland & Tandongeval |
No |
Flex |
Yes |
Fysiotherapie | Buitenland & Tandongeval | Flex |
---|---|---|
No |
No |
Yes |
You will require an activation code in order to gain access to the apps. You will receive your activation code in MyAnderzorg. You can find more information about this at anderzorg.nl/flex.
The activation code can only be used by one insured person aged 18 or over who has taken out Flex. Children below the age of 18 who are co-insured on the basis of their parents’ health insurance policy cannot use an (own) premium account using the same activation code.
An accident can lead to high dental expenses. An accident is a sudden, unexpected act of violence that comes from outside in relation to the insured person that has led to direct physical injury that can be established medically. Events regarding which you can foresee in advance that damage to the dentures will occur do not fall under this definition. Examples of this are opening a bottle with your teeth, biting on something that is hard such as nuts, not using dental protection with regard to relevant sports and damage to teeth as a result of an illness.
If you are 17 or younger, dental expenses after an accident are insured in the Basic Insurance. The dental insurance covers dental expenses after an accident if you are 18 or older. You will receive a reimbursement for dental expenses after an accident up to a maximum amount of € 10,000 for each accident in the following packages:
Buitenland & Tandongeval |
---|
Yes |
Tand 75% € 250 |
Yes |
Tand 75% € 500 |
Yes |
Flex |
Yes |
Buitenland & Tandongeval | Tand 75% € 250 | Tand 75% € 500 | Flex |
---|---|---|---|
Yes |
Yes |
Yes |
Yes |
Dental expenses are fully reimbursed up to at most € 10,000 for each accident provided that:
Any expenses related to the excess and personal contribution (Basic Insurance) will not be reimbursed.
You are not entitled to a payment in case of dental damage that is due to:
You need a statement of approval from Anderzorg before you start treatment. Your dentist or orthodontist can apply for this from us by drawing up a treatment plan and sending it to Anderzorg. If required, Anderzorg may request photos to make an assessment.
You must also complete a statement with information about the accident. You can find the statement on anderzorg.nl/tandongeval. The following applies in this connection:
We will assess whether the treatment is eligible for reimbursement based on the treatment plan of your dentist or orthodontist and your statement. We will then determine whether an accident has been involved that caused the damage, whether the exclusions are applicable and whether you meet the other conditions. We will also assess whether the proposed treatment will be effective. Care that is unnecessary or costs too much unnecessarily when compared to other types of care that is on an equal footing in view of the indication and your care need, will not be covered by the insurance.
If you meet all specified conditions, you will receive a statement of approval for the treatment At most, the amount of the treatment plan of your dentist or orthodontist will be reimbursed. Are third parties involved? Report this to Anderzorg. We will then recover the losses.
Dentistry care covers all care that a dentist, oral hygienist and/or dental prosthesis specialist offers.
Dental care will be reimbursed up to a maximum amount per calendar year:
Tand 75% € 250 |
---|
75% to € 250 |
Tand 75% € 500 |
75% to € 500 |
Tand 75% € 250 | Tand 75% € 500 |
---|---|
75% to € 250 |
75% to € 500 |
The following are not reimbursed: external bleaching (E97), the jaw overview photo (X21) below the age of 18, general anaesthesia (A20).
If your dental care provider gives you a bill for dental care, you can claim online by visiting anderzorg.nl/mijnanderzorg. Visit anderzorg.nl/declareren for more information about claiming bills. Some care providers claim directly from Anderzorg. You will, in this case, receive a bill from your care provider for the costs that you must pay.
Below you will find the general terms and conditions. You will find the rules that apply to your Basic Insurance, additional insurance and dental insurance in the general terms and conditions (1). For example, about cancelling your insurance, premium payment and how you can submit a complaint. You will also find (additional) terms and conditions that do not apply to the Basic Insurance but do apply to the additional and dental insurances in the general terms and conditions (2).
The Dutch text is binding should any disputes arise from the interpretation of the text.
Anderzorg is the one that carries the risk of your insurance. Anderzorg refers to the following: Anderzorg N.V. when it involves the Basic Insurance and Menzis N.V. when it involves the additional insurance or the dental insurance. Coöperatie Menzis U.A. is the only shareholder of Anderzorg N.V. and Menzis N.V. By taking out the insurance you will become a member of Coöperatie Menzis U.A. as a Anderzorg insured party. This Cooperation focuses on promoting the interests of its members. Coöperatie Menzis U.A., Anderzorg N.V. and Menzis N.V. are non-profit organisations.
Anderzorg Basis is a Basic Insurance that is meant for everybody who lives in or outside the Netherlands and who must take out a Basic Insurance.
The insurance will become effective on the date that is shown on your healthcare policy. Your insurance will run up to 1 January of the next calendar year. The insurance will be tacitly extended by a year on 1 January for as long as the insurance is not cancelled.
The “duration of the insurance” is not the same as a “calendar year”. The insurance term may consist of many calendar years.
If you are the policyholder, you can change your insurance as from 1 January of any year. You can change your voluntary excess or select another additional insurance or dental insurance. Anderzorg must have received your request no later than on 31 December. You can implement these changes online at Mijn Anderzorg (MyAnderzorg). You can also call Customer Service on 088 222 44 22, send an email or complete a change form.
Only the policyholder can cancel an insurance policy through a letter.
If you are the policyholder, you can:
Anderzorg can terminate the insurance if:
Your Basic Insurance will terminate automatically on the day after:
Your Basic Insurance will end by operation of law on the 1st day of the 2nd month that follows on the day on which you start to live outside the working region of Anderzorg because of your move. If Anderzorg changes the working area or is no longer permitted to offer Basic Insurances, MAnderzorg will inform you about this no later than 2 months before your Basic Insurance terminates.
If you have taken out insurance with Anderzorg, you can cancel the insurance up to 14 days after receiving your healthcare policy. You do not have to specify a reason when cancelling within this period. This means that you do not have to pay premiums or costs. You will not be reimbursed for costs either. You can cancel the insurance using the same method as specified in Article A6.
If you authorise Anderzorg to collect the insurance premium through a direct debit authorisation, this autorisation also applies to all other amounts that you must pay Anderzorg. For example, payments for excess and personal contributions. You will be informed about direct debits of excess payments or personal contributions ahead of time. This will happen at least 5 days before the direct debit takes place. The healthcare policy is the announcement for taking the premium through direct debit from your account for the whole of the calendar year.
Should you not pay the premium even when sent a reminder, Anderzorg can report your Basic Insurance to the Centraal Administratiekantoor (CAK; Central Accounting Office) based on the Dutch Healthcare Insurance Act for deduction at source. An administrative premium of at least 110% and at most 130% of the average market premium will be imposed. This premium shall be deducted from, for example, your salary or benefits. You can read when we report you to the CAK. The rules related to this can be found in articles 18a up to and including 18g of the Dutch Healthcare Insurance Act. Which rules apply when the CAK starts to collect the administrative premium are also described in these articles.
Anderzorg is entitled to change the terms and conditions, the premium and discounts at any given time. If Anderzorg changes the basis of the premium of the Basic Insurance, this change will not come into effect until 7 weeks have elapsed after the day on which you were informed about the change.
Anderzorg often pays care providers directly. Sometimes, however, you may receive a bill. You can submit a bill online:
You can submit a bill by standard mail:
Act when you receive a bill. Do not save your bills for later. The best option is to submit a bill immediately.
A bill must meet the following requirements:
The following applies to all insurances (Basic Insurances, additional insurances and dental insurances):
If you are unsatisfied about the services Anderzorg provides, please let Anderzorg know at your earliest convenience. How should you deal with this situation and to whom should you be submitting it?
Also refer to Section A13.2 for complaints about premium arrears.
If you do not exactly know to whom you should be sending your complaint/objection, the Klachtenmanagement department can provide assistance.
You are not entitled to care or a reimbursement for costs if they are a result of an armed conflict, revolts, civil war, national riots, insurrection and/or mutiny. These 6 specified forms of damage as well as the definitions of this can be found in the text that has been filed under number 136/1981 by the Verbond van Verzekeraars (Dutch Association of Insurers) in the Netherlands on 2 November 1981 with the registry of the district court in The Hague.
If you need care due to an act of terrorism, the following applies regarding the Basic Insurance:
If the Nederlandse Herverzekeringsmaatschappij voor Terrorismeschaden N.V.(NHT) expects the total loss that will be claimed due to such acts in any calendar year from non-life, life or funeral services (benefits in kind for funerals) insurers to which the Dutch Financial Supervision Act applies, will be higher than the maximum amount reinsured by this company per calendar year, you will only be entitled to care or the reimbursement thereof up to a percentage of the costs or value of the care or other services to be determined by the NHT which is equal for all insurances. It is possible that after a terrorist act an additional amount is provided to Anderzorg based on Article 33 of the Dutch Care Insurance Act or Article 3.16 of the Healthcare Insurance Decree. If this is the case, you will be entitled to the provisions with regard to which the scope is established in the scheme as referred to in Article 33 of the Dutch Care Insurance Act or Article 3.16 of the Healthcare Insurance Decree as well as the provisions as referred to in the first sentence of this article.
Anderzorg cannot be held liable for damages that you suffer as the result of any action or omission of a care provider whose care you have used. Any liability on Anderzorg’ part for damages as a result of Anderzorg’ own shortcomings is limited to the amount of the costs that would have been charged to Anderzorg should the insurance have been executed correctly.
You are not entitled to the reimbursement of costs that you are charged if you have missed an appointment with your care provider.
If you or the policyholder deliberately mislead Anderzorg, you are no longer entitled to reimbursement. Anderzorg will then also have the right to terminate all your insurances. The amounts that Anderzorg may already have paid either to yourself or directly to the care provideras a direct result of the deception, must be paid back. You must also pay Anderzorg for the incurred investigation costs. Anderzorg will report you and your data will be registered. This will be done in the registers in accordance with the Insurance and Criminality Protocol (Protocol Verzekeraars en Criminaliteit) of the Dutch Association of Insurers.
The general terms and conditions (2) only apply to the additional insurance and the dental insurance. The Dutch text is binding should any disputes arise from the interpretation of the text.
If you are the policy holder and you cancel the Basic Insurance, you can have your Anderzorg additional insurance and dental insurance continued or cancelled as from the same date.
Anderzorg can cancel the additional and dental insurance when:
If you are a policyholder and you change your additional or dental insurances successively for another Anderzorg additional or dental insurance, this will not interrupt the insurance period. Not even when this change is because you or other insured listed on the healthcare policy sheet will be participating in a group insurance or the participation in such insurance ends. Nor after suspension of cover due to non- payment. An existing term for reimbursement will then not restart. The insurance period will, however, be interrupted if you end the additional and dental insurances and you do not successively take out a Anderzorg additional or dental insurance.
Anderzorg will accept you without medical selection for the additional insurances and dental insurances. Additional insurance with more extensive cover than for one of the insured specified on the healthcare policy who is 18 or older cannot be requested for children younger than 18. An adult premium will then be charged for the child.
The additional insurance and dental insurance do not offer cover for costs for losses that are already being reimbursed based on another insurance that may or may not be of a later date or an Act, a treaty, an agreement or some other provision.
The additional insurance and dental insurance do not offer cover for costs for losses that would already have been reimbursed based on another insurance that may or may not be of a later date or an Act, a treaty, an agreement or some other provision if you had not taken out the additional insurance or dental insurance.
If you rely on the additional or dental insurance while you could rely on another insurance or provision, for example, travel insurance, you must inform Anderzorg about this other insurance or provision.
When terrorist acts are involved, the following will apply to the additional insurance and dental insurance. You are not entitled to care or reimbursement of costs if these are the result of terrorism, malicious infection or preventive measures to avert the danger of terrorism or malicious infection. This will be different if these costs are reinsured with the Dutch Terrorism Risk Reinsurance Company. The Clauses Sheet Terrorism Cover is a part of the insurance and can be consulted through anderzorg.nl or terrorismeverzekerd.nl and will be sent to you upon request.
Care or the reimbursement of the costs related to care as a result of a nuclear reaction is not covered by the additional and dental insurances. A nuclear reaction is deemed any nuclear reaction where energy is released such as nuclear fusion, nuclear fission and artificial or natural radioactivity.
Anderzorg may reject the application to conclude an additional or dental insurance if (this is not an exhaustive list):
Anderzorg publishes it's Anderzorg healthcare insurance terms and conditions 2022
in an accessible online document.
This means that it provides equal access and equal opportunity to all people. This is important to us at Anderzorg.