I amsterdam - Health Insurance

Before 2006, there were two types of health insurances: compulsory and voluntarily. Employees, people entitled to a social benefit and self-employed people with incomes to a certain level were compulsorily insured under the Social Health Insurance Act (Ziekenfondswet). People on a higher income could choose to either take out a private health insurance or to go through life uninsured.

Private insurance, social conditions

The new system is a private health insurance with social conditions. The system is operated by private health insurance companies; the insurers are obliged to accept every resident in their area of activity. A system of risk equalisation enables the acceptance obligation and prevents direct or indirect risk selection.

The insured pay a nominal premium to the health insurer. Everyone with the same policy will pay the same insurance premium. The Health Insurance Act also provides for an income-related contribution to be paid by the insured. Employers contribute by making a compulsory payment towards the income-related insurance contribution of their employees.

Essential healthcare

The new health insurance comprises a standard package of essential healthcare. The package provides essential curative care tested against the criteria of demonstrable efficacy, cost effectiveness and the need for collective financing:

• Medical care: doctor, hospital, medical specialists
• Hospital stay
• Dental care
• Prescribed medicines
• Baby care
• Ambulance 
   

Additional insurance

It is possible to insure yourself for health care that is not included in the standard package. There is one insurance company that offers information in English. For more information see www.oomverzekeringen.nl

Optional

You are free to choose your insurance company. Your level of income will not be taken into account. You are free to change from your insurance company once a year. Due to the differences in quality and service this could be a useful option.

Insurance companies are not permitted at this stage to refuse you on the basis of your current medical history.

Insurance premium

Everyone from the age of 18 will be paying a nominal premium to the insurance company. No fee has to be paid for children under the age of 18.

Every insurance company offers different fees and packages. Currently the monthly cost for the standard package varies from EUR 82.50 to EUR 89. There is very little difference between the "basic" packages on offer, the cost differences are minimal. The real differences are in the "extras" (aanvullende) packages - look at the number of treatments available. There is a comparison website, www.kiesbeter.nl (in Dutch).

Everyone who has an income has to pay a contribution premium. A 6.25 percent premium is paid by the employer and individuals have to pay the premiums charged by the insurer they choose to go with. People who run their own business will receive a bill from the tax authorities (belastingdienst).

People on low incomes receive an application form from the Belastingdienst to apply for an extra benefit payment to help cover the cost of the premium.

There are two basic sorts of insurance available, either the insurance company asks you to use care suppliers they have a contract with and therefore pay the care supplier directly (in general less expensive), or you choose where you wish to have your care, pay for it in advance and are then reimbursed.- the level of reimbursement is geared to the insurance company’s definition of "reasonable cost", therefore when possible, always ask beforehand what will be covered.

No claim

The premium of EUR 1,100 includes a no-claim amount of EUR 255. If you do not claim any medical costs during the year, you will get a rebate from your insurance company. If you claim less than EUR 255 the difference will be paid back to you.

Own risk

Insurance companies may offer you a package with or without an own risk excess. You are free to choose whether you want your health care package with or without.

There are different own risk amounts - EUR 100, EUR 200, EUR 300, EUR 400, EUR 500. If you decide to include an own-risk excess in your package you will have to pay the first EUR 100-500 (depending on your own risk amount) of medical costs yourself.

Your insurance company will charge a lower insurance premium if you include an own risk excess in your package.

More Information

This information was provided by ACCESS,  a not-for-profit organisation established in 1986 to bridge the gap between the international community and English-speaking services available in The Netherlands. They supply free information from an extensive database, offer publications, courses, events, a professional counselling referral service and run a free helpline. They also provide several fact sheets covering subjects such as these, and 'The ACCESS Guide to Health Care in The Netherlands) .

Tel: +31 (0)20 423 3217
email:info@access-nl.org
Website: www.access-nl.org

Last updated: 14 June 2006