What is included in the basic Dutch health insurance package?

Some Dutch health insurance companies are restricting free choice of health care providers (doctors, physiotherapists, pharmacies, psychologists, hospitals and clinics). The implication is that when you go to a non-preferred provider, the insurance company will usually not reimburse the full cost. The reimbursement varies from 100% to 40%, depending on the company and particularly the health insurance polisvoorwaarden (policy).

You can choose between two types of health care policies:

• The natura polis (in-kind policy) will only allow you to go to providers that the company has contracted and they will pay your medical bills directly. If you decide to go to non-contracted providers, they will reimburse you for a much lower percentage and/or amount or you will not be reimbursed at all
• The restitutie polis (restitution policy) is more expensive because it honours the freedom of choice of provider. Therefore, you choose your own healthcare provider and pay the bill yourself. Later you will submit it to your insurance company for reimbursement. It will usually cover between 80% and 100% of what the health insurance companies consider a fair price. There is not any regulatory system that checks the health insurance companies on how they determine what the current rate is. These vary widely among the various insurance companies.

It is usual for all GPs to be contracted under the healthcare system (meaning that you can go to any huisarts (GP) and it will be covered by your insurance). That is not the case for all specialist care and paramedical services. The restitutie polis is more expensive than the natura polis, but it can be worth exploring further.

Dental care is covered in the basisverzekering (basic healthcare insurance) for children under the age of 18. If you are 18 years or older, dental care can be covered by taking out a tandarts aanvullende verzekering (additional insurance dental care). The premium and coverage vary per health insurance company. In most cases, orthodontics are not covered.

Children under the age of 18 are always covered under their parent’s premium for the basic package and dental care. Parents must register their child with an insurance company within four months of its birth.

If you are temporarily residing in the Netherlands (fewer than four months), you are not allowed to take out a Dutch health insurance. In that case, you should make sure to extend the international or travel insurance from your home country.

You need to have a Dutch health insurance within four months from the day you have a residence permit and are  registered with the gemeente (municipality). Please note that you will pay Dutch health insurance from the day you registered. Meaning, if you registered on 1 January but you take out the Dutch insurance on 1 March, you still have to pay for January and February. You can arrange reimbursement for health care costs incurred during that period.

If obtaining a verblijfsvergunning (residence permit) takes a while, it is possible to take out a voluntary and temporary health insurance. This is a health insurance for those who do not have a verblijfsvergunning yet.  An example of such an insurance can be found on the website of insurance company Oom https://www.oominsurance.com/to-the-netherlands/schengen-visitor-insurance/

If you take out a Dutch health insurance, you have to pay from the day you registered with the gemeente (municipality). Therefore, you may have to pay insurance premiums to the insurance company retrospectively. Please note that most insurance companies should allow you to pay the amount you owe in instalments.

If you don’t take out Dutch health insurance within four months after registering in the Netherlands, you will get a letter from the CAK, the Dutch Healthcare Institute, reminding you to take out health care insurance within three months. If you fail to do so, you will have to pay a penalty. Then you will get another three months to take out a health insurance. If you still haven’t done that after this time, you will have to pay a second penalty and the CAK will arrange a health insurance for you. The verzekeringspremie (insurance premium) will be higher than if you had taken out health insurance yourself. Please note that this premium will be automatically deducted from your income during 12 months.

The eigen risico (deductible) is the amount you have to pay yourself before you receive a reimbursement from your health insurance company. Everyone over 18 years of age is required to pay a deductible on the basic insurance coverage. The deductible is decided by the government and updated annually.

You can voluntarily raise your deductible; then you will receive a discount on the insurance premium. The higher your voluntary deductible, the lower the premium you will be charged. While this may be attractive for relatively healthy individuals, it may become a risk on the long run. For example, if you get ill or get involved in an accident, the insurance company is able to claim the total of the deductible in one payment.

If you are living illegally in the Netherlands, you can get urgent medical help without paying. The doctor decides which help is urgent in each individual case.

You can change your health insurance company only once a year and only on 1 February. There is one exception: you can change your health insurance company during the year if you switch from one collective employer’s agreement to another (i.e. if you switch jobs).

You have to cancel your health insurance before 31 December. Your new health insurance company may offer to cancel your old insurance on your behalf. If they don’t offer this, it is best to send an aangetekende brief (registered letter) well in advance.  A health insurance company is obliged to accept you for basic insurance, unless there are some payments overdue/outstanding at the current health insurance company. In such a case, the new company can refuse you basic health insurance.

The new health insurance company is allowed to refuse you for additional health insurance if you don’t meet its requirements. Therefore, it is suggested not to cancel your current additional health insurance until you have received an email or letter that the new company accepts you for additional insurance.