Health Care Insurance; Additional Issues
Elsewhere in this online issue of The XPat Journal, in Dutch Public Health Insurance and How it Works we go into health care insurance and how it is arranged in the Netherlands. Here, we will touch on a number of additional issues and/or provide some additional information.
How Much Does It Cost?
To pay for health care insurance, everyone pays a fixed contribution of approximately € 1,450 and an income-dependent contribution. This income-dependent contribution is compensated by your employer, who pays it directly to the tax authorities. If you are unemployed or self-employed, you receive no such compensation, but the percentage is also lower.
You receive an annual preliminary assessment for the amount you owe, which is based on what the tax authorities estimate you will be earning that year (in the case of self-employment). If you end up paying too much, you will be reimbursed after the final tax assessment over the year in question. Also if you are receiving a benefit or old age pension, you pay an income-dependent contribution – whether this is compensated, depends on your social security institution or pension plan.
Selecting an Insurance Company
As mentioned in our article, Enjoy the Best Health Care in Europe, you can change insurance companies at the start of every year (you arrange this in November/December); visit www.independer.nl, www.zorgkiezer.nl or zorgwijzer.nl to compare insurance companies and coverage. English-language information can be found on www.zorgwijzer.nl/zorgvergelijker/english and general information on health care insurance on https://www.zorgverzekering.org/eng/#kz.
Issues that are of interest to look at when doing comparative shopping are: the amount of the deductible (eigen risico, or ‘own risk’), what the coverage is if you are abroad and fall ill or otherwise require medical care, level of dental care offered, alternative therapies, etc. Another very important issue is described in the next paragraph.
'Children are covered free of charge, including dental care, by the insurer of one of the parents'
Insurance in Kind or Restitution
When you are arranging your insurance, you will run into the terms ‘natura polis’ or ‘restitutie polis’. If you take out a natura policy, your insurance will pay your medical bills directly. However, they will only pay out these bills to medical service providers they have entered into a contract with (you are free to select your own huisarts, or GP), which means that you must verify that such a contract exists between the medical care provider you wish to select and your insurance company before you make use of his or her services – or else run the risk of paying the bill yourself.
The restitutie policy is slightly more expensive, but does give you freedom of choice as to whom you wish to turn to for medical assistance. With the restitution policy, you may be requested to pay the bill yourself and then submit it with your insurance company, for restitution.
Some insurance companies offer a combination of the two types of insurances, and with many insurance companies you will find they are not excessively strict about the existence of an actual contract between them and the care provider, provided he/she is recognized by a professional organization.
Exceptional Medical Expenses
The WLZ (Wet Langdurige Ziektekosten), which is also mentioned in our article Dutch Public Health Insurance and How it Works, is a national insurance scheme that insures persons (also self-employed persons) against risks that cannot be covered by individual insurance. Everyone who legally resides and works in the Netherlands has a right to coverage by this insurance. Its premise is that everyone should be able to stay living at home with the support of their social network or the assistance of the municipality, though it also covers care in an institution. It is meant to cover steep medical expenses that are not covered by a regular health insurance and that are simply not affordable. The same health care insurance company with which you have placed your ‘regular’ health insurance also takes on your personal coverage by this insurance. You owe a social security contribution to pay for the WLZ, which is calculated over – and withheld from – your salary / income from self-employment.
A special aspect of exceptional medical expenses is the PGB (persoonsgebonden budget, or personal budget): you are granted a certain amount of money, which you can use to ‘purchase’ personal care, care by a nurse or other personal assistance. PGB-WMO helps cover assistance if you want to stay living at home but cannot live fully independently, PGB-WLZ is for long-term care, PGB-jeugdwet is for children (it is used to cover psychological care, for instance), and PGB-ZVW is for medical care at home. A combination of multiple PGB-budgets is possible.
In your policy you are likely to find something along the lines of “we only cover GVS medication”. This has to do with the ‘clustering’ of types of medication, after which a maximum price has been determined for this cluster. If you are prescribed medication, then the cluster-specific maximum price is covered by the insurance. If your medication is more expensive than that, you will have to pay the difference. Homeopathic medicine is not covered by the ‘GVS’-system.
Check with your insurance company whether you can take out an additional policy to cover these extra costs as well as the cost of homeopathic / alternative medication.
'The WLZ covers steep medical expenses that are not covered by a regular health insurance and that are simply not affordable'
Pregnancy and Childbirth
Visits to your midwife is covered by your insurance. At least two ultrasounds, if they are medically required, are also covered. If your child is born at home, with the help of a midwife (only about 13% of the deliveries take place at home); this is covered by your insurance. The costs of a hospital delivery are fully covered if your midwife, GP or specialist has determined that, for health and safety reasons, the baby should be delivered in the hospital. If you voluntarily choose to have your baby in the hospital, you will have to contribute towards the costs of your hospital delivery – though some insurance companies also cover these costs. Kraamzorg (Maternity Home Care) is also covered by the basic insurance package, though you have to pay a contribution towards the costs.
If you can no longer work due to illness or an accident, then – during the first two years – your employer continues to pay your salary. During this period, you and your employer will look into reintegration options. If, after two years, you remain (partially) disabled for work, you will receive a so-called WIA-benefit – with a particular additional acronym, depending on your degree of disability and your age. All these benefits pay out a capped maximum percentage of your last-earned wage, which means that you could fall well below your customary income level. For this reason, many employers (sometimes based on a collective labor agreement) offer additional insurance to cover this gap. If they don’t, you can arrange one yourself.
Disability for Self-Employed Persons
Self-employed persons are not covered by the employee insurance schemes for the consequences of disability, and have to arrange private insurance to cover these consequences. When selecting this type of insurance, you can take the following issues into account: when you wish the payments to cease (for instance, when your pension starts to pay out), your job level (the amount of premium you owe depends on your job level), as of which percentage of disability you want the insurance to start paying out, the degree of disability it is meant to cover (for instance, inability to do the same work, similar work, or any type of work), and whether or not you want the payments indexed over time. Some insurance companies offer a lower premium to beginning entrepreneurs.