Vrije Keuze Basisverzekering

Transcription

Policy terms and conditions
Vrije Keuze Zorgplan 2014
ONVZ Zorgverzekeraar. Freedom of choice guaranteed.
Policy terms and conditions Vrije Keuze Zorgplan 2014
ONVZ Zorgverzekeraar
De Molen 66
Postbus 392
3990 GD Houten, Netherlands
+31 (0)30 639 62 22
www.onvz.nl
ONVZ
Zorgverzekeraar.
We ensure your
freedom of choice.
The risk bearer for the ONVZ Vrije Keuze Basisverzekering is ONVZ Ziektekostenverzekeraar N.V. (Utrecht: Trade Register no.
30135168, AFM [Netherlands Authority for the Financial Markets] no. 12000633); the risk of the supplementary health-care plans is
borne by ONVZ Aanvullende Verzekering N.V. (Utrecht: Trade Register no. 30209308, AFM no. 12001024), both located in Houten.
Postbus 392, 3990 GD Houten, Netherlands. Telephone: +31 (0)30 639 62 22. Fax: +31 (0)30 635 12 75. Internet: www.onvz.nl
ONVZ Vrije Keuze Zorgplan
Optimum freedom of choice, excellent service
and the best coverage
Dear Sir/Madam,
Thank you for your confidence in ONVZ. We believe that you have made an excellent choice, especially if you
value freedom of choice when it comes to health care. ONVZ gives you optimum freedom of choice in 2014
too. Whether you need to decide which hospital or which doctor to visit, your health is involved, so the choice
is yours. Besides optimum freedom of choice, ONVZ is synonymous with the best coverage and an excellent
service. In 2013 our policyholders rated our services an impressive 8.3 out of 10.
Terms and conditions
This booklet lists all policy terms and conditions of the 2014 ONVZ Vrije Keuze Zorgplan.
It describes what you are entitled to, the services provided by ONVZ and how you can use them. The terms
and conditions will apply as of 1 January 2014 and will be valid until any changes take effect.
The key paragraphs are highlighted in yellow. The logos indicate whether the highlight refers to optimum
freedom of choice, excellent service or best coverage:
- Excellent service
- Optimum freedom of choice
- Best coverage
Your policy documents list the terms and conditions that apply to you. You can also find your details online at
MijnONVZ.nl.
Any questions?
We want to make sure all of your questions are answered. Everything you need to know about our policy
terms & conditions is listed at www.onvz.nl. Of course, you can also get in touch with us by telephone. Our
Service Centre is ready to take your call between 8.30am and 9pm on working days, on +31 (0)30 639 62 22.
Alternatively, you can contact us through MijnONVZ.
The ONVZ Zorgteam is also ready to help you on Facebook and you can follow us on Twitter. We are here to
answer any questions you may have about your health-care plan, changes to health care and your health. We
would be happy to help you make the best decision.
Wishing you total freedom in 2014!
Yours faithfully,
Erno Kleijnenberg
Chairman of the Executive Board
www.facebook.com/onvz
www.twitter.com/onvz
Introduction
3
Reader's guide
The ONVZ Vrije Keuze Zorgplan is made up of the ONVZ Vrije Keuze Basisverzekering and a range of different
supplementary plans. This booklet lists the general provisions (Part A), the levels of coverage (Part B) and the
ONVZ health-care services (Part C).
The general provisions set out the agreements with regard to your rights (e.g. privacy) and obligations (e.g.
premium payment, notification of change of address). Part A-1 is applicable to all health-care plans, although
certain provisions do not apply to the supplementary health-care plans. Part A-2 applies to the supplementary
health-care plans only. Parts A-1 and A-2 both include a list of definitions.
Would you like to know at a glance what coverage is provided for a certain treatment? Take a look at the quick
search summary on page 6.
4
Reader's guide
Table of contents
Quick search summary
6
Contact details
8
General provisions
Part A-1 General terms and conditions
Part A-1 Definitions
Part A-2 General terms and conditions Part A-2 Definitions Primary health-care plan
ONVZ Vrije Keuze Basisverzekering
Part B Scope of coverage
Part C Health-care services
9
11
11
25
25
29
31
49
Supplementary health-care plans
ONVZ Vrije Keuze Startfit Part B Scope of coverage
51
53
55
ONVZ Vrije Keuze Extrafit Part B Scope of coverage
57
59
64
ONVZ Vrije Keuze Benfit
ONVZ Vrije Keuze Optifit
ONVZ Vrije Keuze Topfit
Part C Health-care services 67
69
76
79
82
91
93
96
105
ONVZ Vrije Keuze Superfit Part B Scope of coverage Part C Health-care services 107
110
124
ONVZ Tandfit Part B Scope of coverage 127
129
ONVZ Privé Zorgpakket Part B Scope of coverage 133
135
ONVZ Zó-fit ONVZ Zó-fit policy terms & conditions 137
139
Table of contents
5
Startfit
Extrafit
Benfit
Optifit
Topfit
Superfit
Acne treatment
-
-
60
72
86
100
114
Alternative/non-conventional medicine
-
-
60
71
84
98
112
40
-
-
-
-
-
-
Physical therapy
-
53
59
70
83
97
111
Lenses for glasses/contact lenses/laser eye
treatment
-
-
-
-
85
99
113
48
53
62
74
89
103
117
-
-
60
72
86
100
114
Dietetics
40
-
-
72
86
100
114
Dyslexia care
46
-
-
-
-
-
-
-
-
60
72
86
100
114
Testing for hereditary diseases
39
-
-
-
-
-
-
Occupational therapy
40
-
-
-
-
100
115
Pharmaceutical care
42
-
59
70
84
98
112
Physiotherapy/remedial therapy
40
53
59
70
83
97
111
Antenatal/post-natal care
36
-
59
69
82
96
110
Influenza vaccination
-
-
-
74
88
102
117
Recuperation home
-
-
-
-
-
102
116
General medical care
34
-
-
-
-
-
-
Domestic assistance
-
-
-
-
85
102
116
Medical appliances
44
-
60
71
85
99
113
In vitro fertilisation (IVF)
34
-
-
-
-
100
115
Childcare
-
-
-
-
-
102
116
Health resort
-
-
-
-
-
102
116
Speech therapy
40
-
-
-
-
-
-
Walking aids
44
-
60
71
85
99
113
Specialist medical care
34
-
-
-
-
-
102
Audiological health care
Abroad
Cosmetic skin camouflage treatment
Electrical epilation/laser treatment
6
Basisverzekering
Basisverzekering
Startfit
Extrafit
Benfit
Optifit
Dental health care excluding orthodontics
41
-
-
-
88
100
114
Kidney dialysis
38
-
-
-
-
-
-
Oedema therapy
40
-
61
72
86
101
115
Oncological conditions in children
39
-
-
-
-
-
-
Accident coverage
-
-
-
-
-
-
120
Organ transplants
38
-
-
-
-
-
-
Orthodontics
41
-
-
74
88
100
114
Menopause consultant
-
-
-
72
86
101
115
Pedicure for those with diabetes and
rheumatoid arthritis
-
-
-
72
86
101
115
34
-
-
-
87
101
115
-
-
61
73
87
101
115
32
53
61
74
88
102
116
-
-
61
73
87
101
115
Psychological care: basic mental health care
(GGZ)
46
-
-
-
83
97
112
Psychological care: specialist mental health
care (GGZ)
47
-
-
-
-
-
-
-
54
63
75
90
104
118
37
-
-
-
-
-
-
Sterilisation
-
-
-
73
87
101
115
Arch supports
-
-
60
72
86
99
113
Stuttering therapy
-
-
61
73
87
101
115
Vaccinations
-
53
60
71
85
98
113
Accommodation costs
-
-
61
73
87
101
115
Carer relief
-
-
-
71
85
102
116
Hospital admission
34
-
-
-
-
-
118
Medical transportation
45
-
61
73
88
99
113
Plastic surgery
Podiatry
Preventive care
Psoriasis day treatment
Repatriation
Rehabilitation
Topfit Superfit
7
Contact details
Postbus 392
Telephone: +31 (0)30 639 62 22
Fax: +31 (0)30 635 12 75
Internet: www.onvz.nl
ONVZ Service Centre
For general questions about your health-care plan.
Telephone: +31 (0)30 639 62 22
Available on working days between 8.30am and 9pm.
ONVZ ZorgConsulent
Information about methods of treatment, help
arranging health care and health-care mediation.
Telephone: 0800 022 14 50 (free of charge)
Available on working days between 8.30am
and 5.30pm.
Email: [email protected]
ONVZ Zorgassistance
Help with and advice on medical care in
emergency situations.
Telephone: +31 (0)88 668 97 67
Available 24 hours a day
ONVZ Zó-fit Assistent
Personal mediation for
insured persons with ONVZ Zó-fit
Telephone: +31 (0)30 639 62 25
Available on working days between 8.30am and 5.30pm.
ONVZ Verhaalszaken
Aid for claims against liable third parties for injury.
Telephone: +31 (0)30 639 62 64
Transportation by taxi
Telephone: 0900 333 33 30
ONVZ Kraamzorg Service
Information on and requests for maternity care.
Telephone: 088 668 97 05
Internet: www.onvz.nl/kraamzorg
8
Contact details
ONVZ
Zorgverzekeraar.
Freedom
of choice
ensured.
ONVZ
Health-care plan.
Freedom
of choice
ensured.
General provisions of
Table of contents
Part A – 1 General provisions
Definitions
Clause 1
11
Legal basis for the Basisverzekering Clause 2
16
Obligations of the insured person
Clause 3
17
Other provisions
Clause 4 Fraud 18
Clause 5 Ineligibility 18
Clause 6 Payment obligations 18
Clause 7 Notification of relevant events 19
Clause 8 Changes in premium or terms & conditions 19
Clause 9 Commencement and termination of the Basisverzekering
19
Clause 10
Disputes 20
Clause 11 Registration of personal details 21
Clause 12 Exclusions 22
Clause 13 Membership of Vereniging ONVZ 22
Clause 14 Our right to scrutinise the care you receive 22
Clause 15 Electronic communications 22
10
General provisions of ONVZ Zorgverzekeraar
Part A – 1
Definitions
Clause 1
Adjustment disorder
A general term for psychological disorders that involve disrupted behaviour, caused by emotional
and psychiatric stress that results from major life changes (e.g. the death of someone close, losing
your job, divorce or developments in society).
Algemene Wet Bijzondere Ziektekosten [Exceptional Medical Expenses Act] (AWBZ)
The social insurance that covers high medical costs not covered under the health-care plan.
Dispensing practice
A general practitioner's practice licensed to dispense medicines under the terms of the
Geneesmiddelenwet [Medicines Act].
Pharmacist
A pharmacist who is registered under the terms of the Geneesmiddelenwet [Medicines Act] in the
register of licensed pharmacists.
Doctor
A doctor registered under the terms of the Wet BIG [Dutch Individual Health-Care Professions Act].
Doctor for the mentally disabled
A doctor registered as a doctor for the mentally disabled in the register of recognised doctors
for the mentally disabled administered by the Royal Dutch Medical Association. This register was
established by the Huisarts, Verpleeghuisarts en arts voor verstandelijk gehandicapten Registratie
Commissie [Registration Commission for General Practitioners, Nursing Home Doctors and
Doctors for the Mentally Disabled] (HVRC).
Basisverzekering
The ONVZ Vrije Keuze Basisverzekering basic health-care plan.
Corporate doctor
A doctor registered as a corporate doctor in the register administered by the SociaalGeneeskundigen Registratie Commissie [Board of Registration of Doctors of Social Medicine]
(SGRC) of the Royal Dutch Medical Association. A corporate doctor intercedes on behalf of the
employer or the health and safety service with which the employer has a contract.
Pelvic therapist
A physiotherapist registered under the terms of the Wet BIG [Dutch Individual Health-Care
Professions Act] and listed in the specialist register for pelvic physiotherapists in the Central
Quality Register of the Royal Dutch Society for Physical Therapy.
Body Mass Index (BMI)
An index that compares a person’s weight and height. The BMI is calculated by dividing the
weight in kilos by the height in metres and then dividing the result again by the height in metres.
Bureau Jeugdzorg
An agency as defined in Article 4 of the Wet op de Jeugdzorg [Dutch Youth Care Act].
Dental hospital
A centre associated with a university - or recognised by ONVZ - dedicated to specialist dental
care, where dental care requires a team approach and/or specific expertise.
Centre for hereditary diseases
An establishment licensed to perform special medical tests and give advice on hereditary diseases
under the Wet bijzondere medische verrichtingen [Dutch Special Medical Procedures Act].
Complex multi-morbidity
The existence of various illnesses which, in combination, lead to disorders, limitations, handicaps
and loss of well-being. The causes of the problems are difficult to establish and the outcome of
treating the various illnesses may also differ from what was expected.
General provisions of ONVZ Zorgverzekeraar 98141
11
Day treatment
Admission for a period of less than 24 hours.
DBC
Diagnose Behandeling Combinatie [Diagnosis treatment combination]. A DBC code describes the
total combination of examination and treatment by health-care providers for a health problem.
DBC health-care product
The new name for a DBC for specialist medical care. A DBC health-care product code describes
the average of all tests and treatments provided for a specific health problem over a certain
period.
Out-of-hours surgery
An organisation which provides general medical care in the evenings, at night and at weekends,
and charges a legally valid rate.
Dietitian
A dietitian who meets the requirements of the Besluit diëtist, ergotherapeut, logopedist,
mondhygiënist, oefentherapeut, orthoptist en podotherapeut [Decree on the work of dietitians,
occupational therapists, speech therapists, dental hygienists, remedial therapists, orthoptists and
foot specialists].
DSM IV-TR
Diagnostic Statistical Manual of Mental Disorders: the international system of classification for
mental health care. The DSM specifies the criteria to be used as guidelines in establishing a
psychological disorder. IV-TR is the title of the text revision of the fourth version of the DSM.
Primary health care
The directly accessible health care to which everybody is entitled without referral. This is the first
point of contact for people requiring health care. Examples of primary health-care providers are
general practitioners, physiotherapists and dentists.
Occupational therapist
An occupational therapist who meets the requirements of the Besluit diëtist, ergotherapeut,
logopedist, mondhygiënist, oefentherapeut, orthoptist en podotherapeut [Decree on the work
of dietitians, occupational therapists, speech therapists, dental hygienists, remedial therapists,
orthoptists and foot specialists].
Serious dyslexia
A specific reading and spelling disorder caused by a genetic neurobiological disorder, which can
be distinguished from other reading and spelling problems.
EU/EEA member states
Together with the Netherlands, the following members states make up the European Union:
Austria, Belgium, Bulgaria, Croatia, Cyprus (Greek part), Czech Republic, Denmark, Estonia,
Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg,
Malta, Poland, Portugal, Romania, Slovenia, Slovakia, Spain, Sweden and the United Kingdom.
Switzerland is considered equal to the above. The EEA member states (signatories to the EEA
Agreement) are Iceland, Liechtenstein and Norway.
Physiotherapist
Professions Act] or a remedial gymnast masseur as referred to in Article 108 of the Wet BIG.
Birth centre
A primary health-care facility where childbirth is supervised by a primary midwife and the mother
can spend the post-delivery period.
Municipal public health service (GGD)
A regional organisation, affiliated with GGD Nederland, that works towards a healthier society
under the authority of a local council and works to monitor, protect and promote public health.
General basic mental health care (GGZ)
Complete health care for the treatment of a psychological disorder in accordance with the DSM
IV-TR, with low complexity in combination with average to low impairment. Chronic cases involve
crisis susceptibility or instability, or severe difficulties in remission. Health care may involve, for
example, diagnosis, individual or group therapy and eHealth.
12
Registered medicine
Medicine which is registered in one of the categories set out in the register of the Medicines
Evaluation Board.
Geriatrics physiotherapist
Professions Act] and listed in the specialist register for geriatrics physiotherapists in the Central
Quality Register of the Royal Dutch Society for Physical Therapy.
Specialist mental health care (GGZ)
Diagnosis and specialist treatment, in a multidisciplinary context, of a psychological disorder in
accordance with the DSM IV-TR, with moderate to severe complexity or high risk.
Health psychologist
A health psychologist registered under the terms of the Wet BIG [Dutch Individual Health-Care
Professions Act].
Primary practitioner
A health-care provider who, in response to the health needs of a patient, performs the diagnosis
and draws up the treatment plan. At least one face-to-face consultation with the patient is
required for this. The primary practitioner is responsible for the effective implementation of the
treatment plan by ensuring adequate communication and agreement between co-practitioners,
and reviews whether the treatment objectives are satisfied. The primary practitioner evaluates
progress with the patient and adjusts the treatment plan where necessary.
Skin therapist
A skin therapist registered as a full member of the Dutch Association of Skin Therapists and
authorised to use that title.
General practitioner
A doctor registered as a general practitioner in the register of recognised general practitioners
administered by the Royal Dutch Medical Association. This register was established by the
Huisarts, Verpleeghuisarts en arts voor verstandelijk gehandicapten Registratie Commissie
[Registration Commission for General Practitioners, Nursing Home Doctors and Doctors for the
Mentally Disabled] (HVRC).
School doctor
A doctor registered as a Doctor of Public Health under the terms of the Wet BIG [Dutch Individual
Health-Care Professions Act] and in the profile register for youth health care administered by the
Royal Dutch Medical Association. This register was established by the Sociaal-Geneeskundigen
Registratie Commissie [Board of Registration of Doctors of Social Medicine] (SGRC). The school
doctor for children aged 0 - 4 years used to be known as a "consultatiebureau-arts".
Dental surgeon
A dental specialist registered as a dental surgeon in the Specialistenregister voor mondziekten
en kaakchirurgie [Specialist register for dental health and surgery] with the Nederlandse
Maatschappij tot Bevordering der Tandheelkunde [Netherlands Dental Association].
Care chain
An integral package of targeted and structured, time-phased activities and/or measures aimed
at a specific patient category. This is an institutionalised, regional or local partnership, aimed at
facilitating collaboration at executive level with the objective of providing coordinated, integrated
care for specific patient categories.
Physiotherapist specialising in children
Professions Act] and listed in the specialist register for physiotherapists specialising in children in
the Central Quality Register of the Royal Dutch Society for Physical Therapy.
Paediatric psychologist
A paediatric psychologist registered as a full member in the appropriate register administered by
the Dutch professional association of psychologists (NIP).
Clinical psychologist
A health psychologist specialising in clinical psychology and registered under the terms of the
Wet BIG [Dutch Individual Health-Care Professions Act].
13
Maternity care
The care provided by a maternity nurse who cares for mother and baby and, where applicable,
takes care of the housework. The maternity nurse is either employed by the hospital, birth centre,
birth clinic or maternity-care agency, or is self-employed.
Vulnerability
A simultaneous decrease across several fronts in the body's ability to withstand physical duress
and threats presented by the environment, involving a loss of both physical and mental vitality.
Lifestyle consultant
An employee at a general practitioner’s practice who supports and coaches people with the aim
of influencing the factors that have a positive effect on healthy behaviour. This is done in close
cooperation with the general practitioner, medical assistant, physiotherapist, dietitian and local
organisers of sport and exercise activities.
Physical dysfunction
Serious physical dysfunction, which is assumed to have been caused by the physical abnormality
to be corrected and the correction of which can be expected to clear up the complaints suffered.
Physical complaints which are not directly related to physical abnormalities but are related to
psychological suffering resulting from such physical abnormalities do not constitute medical
grounds.
Speech therapist
A speech therapist who meets the requirements of the Besluit diëtist, ergotherapeut, logopedist,
foot specialists].
Manual therapist
Professions Act] and listed in the specialist register for manual therapists in the Central Quality
Register of the Royal Dutch Society for Physical Therapy.
Medical adviser
A doctor, dentist, pharmacist, nurse or allied health professional, who advises ONVZ on medical/
allied health matters.
Medical specialist
A doctor registered as a medical specialist in the specialist register administered by the Royal
Dutch Medical Association. This register was established by the Medisch Specialisten Registratie
Commissie [Registration Commission for Medical Specialists] (MSRC).
Specialist medical rehabilitation
Tests, consultation and treatment of a specialist medical, paramedical, behavioural and
rehabilitative nature. The care is provided by a multidisciplinary team of experts under the
supervision of a medical specialist. The team is affiliated with a legally authorised rehabilitation
centre.
Dental hygienist
A dental hygienist who meets the requirements of the Besluit diëtist, ergotherapeut, logopedist,
foot specialists].
Oedema therapist
Professions Act] and listed in the register for oedema therapists in the Central Quality Register of
the Royal Dutch Society for Physical Therapy.
Cesar/Mensendieck remedial therapist
A Cesar/Mensendieck remedial therapist who meets the requirements of the Besluit diëtist,
ergotherapeut, logopedist, mondhygiënist, oefentherapeut, orthoptist en podotherapeut [Decree
on the work of dietitians, occupational therapists, speech therapists, dental hygienists, remedial
therapists, orthoptists and foot specialists].
ONVZ
ONVZ Ziektekostenverzekeraar N.V., De Molen 66, Houten, Netherlands.
14
Admission
Admission to a hospital or rehabilitation centre if treatment by a medical specialist or dental
surgeon is required and, from a medical point of view, such care, examination and treatment can
only be provided in a hospital or rehabilitation centre.
Orthodontist
A dental specialist listed in the specialist register for odontomaxillary surgery (dentomaxillaire
orthopedie) of the Nederlandse Maatschappij tot bevordering der Tandheelkunde [Netherlands
Dental Association].
General remedial educationalist
A general remedial educationalist registered in the appropriate register of the Association of
Educationalists in the Netherlands (NVO).
Physician assistant
A nurse or an allied health professional registered under the terms of the Wet BIG [Dutch
Individual Health-Care Professions Act] with the specialism physician assistant. A physician
assistant works under the supervision of a medical specialist and carries out routine doctor's
duties independently, such as performing endoscopies, catheterisation, giving injections and
prescribing prescription medicines.
Basic mental health-care (GGZ) package
A basic mental health-care (GGZ) package comprises complete health care for a category of
patients in general basic mental health care (GGZ) that fits their patient profile. A basic mental
health-care (GGZ) package consists of various treatment modules that match the individual health
needs of the patient. This may involve health care being provided by different practitioners. The
modules are not paid for individually.
Psychiatrist
A doctor registered as a psychiatrist in the specialist register administered by the Royal Dutch
Medical Association. The register was established by the Medisch Specialisten Registratie
Commissie [Registration Commission for Medical Specialists] (MSRC).
Psychotherapist
A psychotherapist registered under the terms of the Wet BIG [Dutch Individual Health-Care
Professions Act].
Elderly medical care specialist (previously nursing home doctor)
A doctor registered as an elderly medical care specialist in the register of recognised elderly
medical care specialists administered by the Royal Dutch Medical Association. This register was
established by the Huisarts, Verpleeghuisarts en arts voor verstandelijk gehandicapten Registratie
Commissie [Registration Commission for General Practitioners, Nursing Home Doctors and
Doctors for the Mentally Disabled] (HVRC).
Dentist
A dentist registered under the terms of the Wet BIG [Dutch Individual Health-Care Professions Act].
Prosthodontist
A prosthodontist educated under the terms of the Besluit opleidingseisen en deskundigheid
tandprotheticus [Decree on the training requirements and area of expertise for prosthodontists]
and authorised to carry this title.
Home-care organisation
A framework providing patients with home care in accordance with legislation and regulations,
with the aim of providing such care and support that admission to a hospital, care home, nursing
home etc. will not be necessary. Besides general home care (district nursing, household help and
personal care, family care, loan of nursing equipment) a home-care organisation also often provides
maternity care, dietetics and, where applicable, such additional services as general social work.
You
The insured person(s) covered by the health-care plan.
Inpatient treatment
Admission for a period of more than 24 hours.
Treaty countries
Any state with which the Netherlands has concluded a social security treaty covering provision of
medical care. This is not to be interpreted as EU/EEA countries or Switzerland.
15
Midwife
A midwife registered under the terms of the Wet BIG [Dutch Individual Health-Care Professions Act].
Mutilation
A non-congenital seriously disfigured part of the body, which stands out immediately in everyday life and cannot be hidden by clothes, for example. Examples include burns, disfigurements
caused by paralysis of the facial nerve or amputation of arms or legs.
Nurse
A nurse registered under the terms of the Wet BIG [Dutch Individual Health-Care Professions Act].
Specialist nurse
A nurse registered under the terms of the Wet BIG [Dutch Individual Health-Care Professions Act]
as a specialist nurse in acute, chronic, preventive or intensive care of somatic conditions or mental
health care.
Addiction specialist
A doctor, registered in the Royal Dutch Medical Association's (KNMG) profile register of addiction
specialists, who works in a multidisciplinary team in an organisation for addiction health care or
mental health care, and who is responsible for investigating and assessing the psychological and
somatic impact of using addictive substances and the treatment thereof.
Insured person
A person specified on the policy documents as insured person.
Policyholder
The person who took out insurance with ONVZ.
Person liable for insurance
Person obliged to take out a health-care plan or have another party do this on his/her behalf
under Article 2 of the Zorgverzekeringswet [Health Insurance Act].
Prescription
Justified, written referral from a health-care provider for the provision of care, a medicine,
bandage or medical appliance, which you require given your condition.
Wet BIG
Wet op de beroepen in de individuele gezondheidszorg [Dutch Individual Health-Care
Professions Act].
Wet BOPZ
Wet bijzondere opnemingen psychiatrische ziekenhuizen [Psychiatric Hospitals (Compulsory
Admissions) Act]. This act governs the procedure for admissions and the legal status of people
who are admitted to a psychiatric facility against their will.
Over-the-counter medication
Medicine available without a prescription under the Geneesmiddelenwet [Medicines Act].
Hospital (including independent treatment centres)
An institution for specialist medical care (Instelling voor medisch-specialistische zorg, IMSZ),
registered under the Wet toelating zorginstellingen [Health-Care Institutions Act] (WTZi).
Legal basis for the Basisverzekering
Clause 2
Paragraph 1 The Basisverzekering basic health-care plan is based on the Zorgverzekeringswet [Health
Insurance Act], the Besluit zorgverzekering [Health Insurance Decree], the Regeling
zorgverzekering [Health-Care Regulations] (including the explanatory notes) and the completed
application form. The terms and conditions of the Basisverzekering are set out in the healthcare policy. Leaving aside anything else that might be determined in the terms and conditions,
this insurance policy is considered to meet the requirements set by or pursuant to the terms of
the Zorgverzekeringswet [Health Insurance Act]. The policyholder will be issued with proof of
Basisverzekering basic health-care plan coverage (the health-care policy document) and a medical
insurance card.
16
Paragraph 2The Basisverzekering can be taken out by or for people liable for insurance who live in the
Netherlands or abroad.
Paragraph 3 Claims for reimbursement of costs under the Basisverzekering basic health-care plan shall be
assessed in light of the form and extent of the treatment, as well as practical and theoretical
standards. If no such criteria exist, claims will be assessed according to what is held to be sound
and adequate health-care practice within the field of treatment in question. You shall only be
entitled to reimbursement of costs for health care which you reasonably need. This shall partly be
determined on the basis of effectiveness and quality. Care may not be unnecessarily expensive or
unnecessarily complicated.
Paragraph 4 In compliance with these policy terms and conditions, you are entitled to reimbursement of
health-care costs incurred within the term of the Basisverzekering basic health-care plan. The date
of treatment or delivery will be used in the assessment of entitlement, not the invoice date. If the
invoice relates to a DBC, DBC health-care product or basic mental health-care (GGZ) package,
costs will only be reimbursed if the start date is within the term of the Basisverzekering basic
health-care plan. If the care or service provided is spread over two consecutive calendar years
and invoiced in a single amount which is not broken down into its constituent parts, such as
with a DBC, DBC health-care product or basic mental health-care (GGZ) package, costs shall be
reimbursed only if the start date of the care or service is within the term of the Basisverzekering.
Paragraph 5 You can claim reimbursement of health-care costs from ONVZ. ONVZ shall reimburse the costs
that are covered under the Basisverzekering basic health-care plan, with the exception of the
applicable personal contributions and excesses. If an agreement exists between the health-care
provider and ONVZ, the health-care provider will claim reimbursement directly from ONVZ.
ONVZ may pay the health-care provider directly. In that case, ONVZ will have honoured its
payment obligations to you. If ONVZ pays the health-care provider directly, ONVZ shall advance
your excess, personal contributions and any costs not covered.
ONVZ may offset any such advanced amounts against subsequent reimbursements under your
Basisverzekering. If this is not possible, ONVZ will send you an invoice.
Paragraph 6 If ONVZ pays more than is covered under the Basisverzekering basic health-care plan, you will be
deemed to have authorised ONVZ to collect the excess amount paid to the health-care provider.
Obligations of the insured person
Clause 3
Paragraph 1 You are obliged to:
1. provide proof of identify when seeking health care from a hospital or outpatient clinic;
2. request that the doctor or medical specialist in attendance notify the medical adviser of the
reason for admission, if requested to do so, and with due regard for privacy/confidentiality
legislation;
3. grant ONVZ, its medical adviser or such party assigned to the case for verification purposes,
permission to access the information required, with due regard to privacy/confidentiality
legislation;
4. assist ONVZ, free of charge, in recovering costs from liable third parties and not to prejudice
ONVZ’ rights when settling your own (injury) claims.
Paragraph 2 You must submit the original invoices to ONVZ in Dutch, German, English, French or Spanish
within 36 months. The date of treatment or delivery will be used in the assessment of entitlement,
not the invoice date. However, please submit the invoices as soon as possible after receiving
them, so that any excess amounts or personal contributions can be settled.
The invoice should be formulated in such a way that ONVZ can process it without any further
information being required. If the invoice is in a language other than those stated above, ONVZ
may request a translation - possibly by a sworn translator or translation agency - at your expense.
Paragraph 3 If ONVZ processes a claim on the basis of a copy of an invoice, for instance a scanned digital
invoice, a photo or a fax, you must keep the original invoice for a year. This term starts at the
point at which the claim is submitted. ONVZ may ask you to forward the original invoice until said
term expires.
Paragraph 4 Failure to fulfil any of the obligations listed above may result in costs not being reimbursed.
17
Clause 4
Other provisions
Fraud
Paragraph 1 There shall be no entitlement to reimbursement of costs if you or anyone else with an interest
in the reimbursement has misrepresented anything, or submitted misleading or falsified
documentation, provided a false statement in relation to a submitted claim or has omitted facts
that may have been required by ONVZ in assessing the claim. In such cases, there shall be no
entitlement to reimbursement whatsoever in relation to the entire claim, including those parts for
which nothing was falsified or misrepresented.
Paragraph 2 ONVZ may investigate any case of suspected fraud. ONVZ shall take steps to recover any
expenses incurred due to misrepresentation or submitting falsified or misleading documentation.
Any investigation costs incurred will also be charged to the insured person.
Paragraph 3 ONVZ reserves the right to terminate the Basisverzekering basic health-care plan as of the date
on which a fraudulent claim involving misrepresentation or deception is made.
In any such case, ONVZ may:
a. report the matter to the police, a court of law and/or the FIOD-ECD;
b. register your personal details, or those of the policyholder,
• in its internal warning system and
• with the Kenniscentrum Fraudebeheersing in de Zorg [Health-Care Fraud Management
Database], administered by the Zorgverzekeraars Nederland association, and
• in warning systems recognised by financial institutions.
Clause 5
Ineligibility
Paragraph 1 If, after taking out the Basisverzekering basic health-care plan, it emerges that you were not liable
for insurance, the Basisverzekering will be cancelled from the commencement date or the date on
which the liability for insurance no longer existed.
Paragraph 2 If the Basisverzekering basic health-care plan is terminated, ONVZ shall offset the premium from
the termination date against any reimbursements paid from the same date. ONVZ shall then pay
or charge the balance to the policyholder.
Clause 6
Payment obligations
Paragraph 1 The policyholder is obliged to pay a premium for the Basisverzekering basic health-care plan.
Paragraph 2 No premium will be payable for your Basisverzekering basic health-care plan until the first day of
the calendar month following the calendar month in which you reach 18 years of age.
Paragraph 3 The premium for the Basisverzekering basic health-care plan is equal to the cover base (gross
premium) less any discount on the premium.
Paragraph 4 The policyholder must pay the premium in advance in the agreed manner. If the policyholder fails
to make any quarterly, half-yearly or annual payments or fails to make such payments on time,
ONVZ may change the payment frequency to monthly.
In the event of any changes to the Basisverzekering basic health-care plan in the course of a
particular month, ONVZ will adjust the premium pro rata.
The policyholder is not entitled to offset the premium payable against any reimbursements to be
claimed from ONVZ.
Paragraph 5 If the policyholder fails to pay the premium, costs not covered, excesses or personal
contributions, or fails to pay on time, ONVZ may demand payment in writing after the first
(premium) due date. In the event of arrears of two monthly premiums, ONVZ shall offer the
policyholder an extension agreement. ONVZ shall point out that failure to accept said extension
agreement or failure to pay within the specified period, will lead to the termination of the
Basisverzekering basic health-care plan.
Should ONVZ take steps to collect its claim, all reasonable costs incurred in relation to said
collection, through the courts or otherwise, will be borne by the policyholder.
18
Paragraph 6 In the event of your death, ONVZ shall refund the premium from the day following the date of
your death.
Paragraph 7 The coverage of and obligation to pay premium for the Basisverzekering basic health-care plan
will be suspended during any custodial sentences. Coverage shall apply again upon your release,
and premiums must be paid again.
Clause 7
Notification of relevant events
Paragraph 1 You or the policyholder shall be obliged to notify ONVZ of any events of possible relevance to
the correct administration of the Basisverzekering basic health-care plan within 30 days. Examples
of such relevant events include change of address, divorce, birth, death, custodial sentence or the
end of a custodial sentence, the cessation of liability for insurance, or taking up military service.
ONVZ shall send any written communications to you or the policyholder at the address registered
in the municipal personal records database.
Paragraph 2 If, as an insured person, you would like to take out a voluntary excess from the age of 18, ONVZ
must receive notification of this before your 18th birthday. ONVZ will otherwise calculate the
premium based on the compulsory excess only.
Clause 8
Changes in premium or terms & conditions
Paragraph 1 ONVZ may change the terms and conditions and/or the premium for the Basisverzekering basic
health-care plan for all policyholders or for particular groups. Said change(s) shall be effective
from a date determined by ONVZ. ONVZ shall notify the policyholder in writing of any changes.
Any change in the insurance premium for the Basisverzekering shall not be introduced earlier than
six weeks after notification to the policyholder.
Paragraph 2 If the policyholder does not agree to the change, he/she may terminate the Basisverzekering
basic health-care plan. This shall only apply if said change does not stem directly from a statutory
provision. ONVZ must receive written notification of termination before the day on which the
change is to take effect or no later than one month after the policyholder has received notification
of the change. If ONVZ receives no such notification, the Basisverzekering shall continue subject
to the new terms and conditions and/or the new premium.
Paragraph 3 Collective discounts for the Basisverzekering basic health-care plan shall cease to apply if the
terms and conditions of the collective health-care plan agreement are no longer fulfilled. The
Basisverzekering will then continue subject to the individual terms and conditions. The agreement
referred to can be obtained from the contracting party (e.g. the employer).
Clause 9
Commencement and termination of the
Basisverzekering
Paragraph 1 The commencement date of the Basisverzekering basic health-care plan is the day on which
ONVZ receives the application for a Basisverzekering. If the person who is taking out the healthcare plan is already insured in respect of a health-care plan at the time ONVZ receives their
application, the policyholder may request a later commencement date. The commencement date
is specified in the policy document.
The policy is renewed from 1 January of the following year every year for the duration of one
calendar year, unless ONVZ has received written cancellation no later than 31 December.
Paragraph 2 If the Basisverzekering basic health-care plan is to commence within four months of the insured
person becoming liable for insurance, the commencement date will be the day on which this
liability commenced.
Paragraph 3 If the Basisverzekering basic health-care plan is to commence within one month of the
cancellation of a previous health-care plan as of 1 January, or further to a change in the premium
or terms and conditions, the commencement date will be the date on which the previous healthcare plan was terminated.
Paragraph 4 ONVZ is not entitled to terminate the Basisverzekering basic health-care plan except in the case
of fraud (Clause 4) or non-payment (Clause 6, Paragraph 5).
19
Paragraph 5The Basisverzekering basic health-care plan shall end on the day following the day of your death.
Paragraph 6The Basisverzekering basic health-care plan shall end on the day your liability for insurance ceases
to exist. This will be the case if you are no longer insured under the Algemene Wet Bijzondere
Ziektekosten [Exceptional Medical Expenses Act] (AWBZ) or if you take up military service.
Paragraph 7The Basisverzekering basic health-care plan shall end if ONVZ’s licence to work in the insurance
industry is revoked or changed and ONVZ therefore no longer provides or administers basic
health-care plans.
The Basisverzekering shall also end if a change in ONVZ’s area of operations means that you no
longer fall under the scope of ONVZ’s activities.
ONVZ will notify the policyholder of this at least two months prior to the termination of the
Basisverzekering, stating the reason and date on which it will end.
Paragraph 8 In the event of new employment, the policyholder may prematurely cancel the Basisverzekering
basic health-care plan if the termination is related to a switch from the collective health-care plan
of the previous employer to that of the new employer. The commencement date of the new
employment must be immediately subsequent to the end date of the previous employment.
The Basisverzekering can be cancelled up to 30 days after the commencement date of the new
employment. Neither the cancellation nor any subsequent registration can be made retroactively.
Both will be effective from the first day of the calendar month following the calendar month in
which they were made.
Paragraph 9 If the policyholder has insured someone other than themselves, they may cancel the
Basisverzekering basic health-care plan, provided the insured person has taken out a health-care
plan elsewhere. The cancellation will become effective:
• on the commencement date of the other health-care plan, if ONVZ received notice of
cancellation before said commencement date; or
• on the first day of the second calendar month following the cancellation if ONVZ receives the
cancellation on or after the commencement date.
Paragraph 10Upon commencement of the Basisverzekering basic health-care plan, the policyholder has a
'cooling-off period' of 14 days The policyholder may cancel the policy in writing within 14 days of
taking out the policy or, if that is later, within 14 days of receiving the policy terms & conditions.
Cancellation means, in effect, that the policy never existed. This also means that there is no
entitlement to coverage.
Paragraph 11If you are insured through Zorginstituut Nederland (formerly the Health-Care Insurance Board)
you may cancel the Basisverzekering basic health-care plan within 14 days. This term runs from
the date on which Zorginstituut Nederland notified you that it had taken out a health-care plan for
you. You must demonstrate the following to Zorginstituut Nederland and ONVZ. You had already
taken out a policy with another provider in the three months since Zorginstituut Nederland's
demand that you take out a health-care plan (or have one taken out on your behalf) and that said
health-care plan is still in force.
Paragraph 12If you are insured through Zorginstituut Nederland (formerly the Health-Care Insurance Board)
and it transpires that you were not, after all, liable for insurance, the Basisverzekering basic healthcare plan will be cancelled with effect from the commencement date due to misrepresentation.
Paragraph 13If Zorginstituut Nederland (formerly the Health-Care Insurance Board) has taken out a
Basisverzekering basic health-care plan on your behalf, the plan cannot be cancelled in the first
twelve months of its validity.
Clause 10
Disputes
Paragraph 1 This agreement is governed by Dutch Law.
Paragraph 2 If you do not agree with a decision made by ONVZ, you may ask ONVZ to reconsider. This also
applies to the policyholder. Please address your request to ONVZ’s customer service department.
Paragraph 3 If ONVZ states its reasons for upholding its original decision or does not respond to a request
to reconsider its decision, you or the policyholder may submit a complaint relating to the
Basisverzekering basic health-care plan to the Stichting Klachten en Geschillen Zorgverzekeringen
(SKGZ). The SKGZ's Ombudsman Zorgverzekeringen [Health-Care Insurance Ombudsman]
shall, in the first instance, try and resolve the complaint through mediation. If this proves
unsuccessful, you or the policyholder may submit the dispute to the SKGZ's Geschillencommissie
Zorgverzekeringen [Health-Care Insurance Disputes Committee]. It will make a binding
recommendation for both parties.
20
Stichting Klachten en Geschillen Zorgverzekeringen
Postbus 291, 3700 AG Zeist, Netherlands
Telephone: +31 (0)30 698 83 60
Internet: www.skgz.nl
You or the policyholder may also bring the matter before the competent civil court. If you or the
policyholder decide to do this, it will no longer be possible to submit the matter to the SKGZ.
Paragraph 4 If you have any complaints about the way in which ONVZ has treated you or the policyholder,
you or the policyholder may also contact the customer service department and, in the second
instance, the Stichting Klachten en Geschillen Zorgverzekeringen. The SKGZ's Ombudsman
Zorgverzekeringen [Health-Care Insurance Ombudsman] shall, in the first instance, try and resolve
the complaint through mediation. If this proves unsuccessful, you or the policyholder may submit
the dispute to the SKGZ's Geschillencommissie Zorgverzekeringen [Health-Care Insurance
Disputes Committee]. It will make a binding recommendation for both parties.
Paragraph 5 You or the policyholder may submit any complaints regarding ONVZ forms to the Nederlandse
Zorgautoriteit [Dutch Health-Care Authority] (NZa). Such complaints relate to forms you consider
superfluous or too complicated. The NZa’s judgements are binding.
Nederlandse Zorgautoriteit
T.a.v. de Informatielijn/het Meldpunt
Postbus 3017, 3502 GA Utrecht, Netherlands
Telephone: 0900 770 70 70
Internet: www.nza.nl Clause 11 Registration of personal details
Paragraph 1 For applications for health insurance or financial services, ONVZ requests personal and other
details and registers these in its personal details database. ONVZ uses this information for the
purposes of effecting and implementing your health insurance or financial service, managing
the ensuing relationships, activities aimed at increasing its customer base, statistical analysis, to
satisfy legal requirements and for security and integrity purposes within ONVZ and the financial
sector. In doing this, ONVZ shall of course observe the Wet bescherming persoonsgegevens
[Data Protection Act].
Paragraph 2 If you do not wish to receive information about products and/or services, or if you wish to
revoke permission for the use of your email address, you must notify us of this by writing to
ONVZ, Postbus 392, 3990 GD Houten, Netherlands, by calling us on +31 (0)30 639 62 22, or by
completing the contact form on our website at www.onvz.nl.
Paragraph 3 In relation to operating a responsible acceptance policy, ONVZ may check your details with
Stichting Centraal Informatie Systeem (CIS) in Zeist. Members of Stichting CIS may also share
information with each other in this respect. This is done with a view to managing risks and
tackling fraud. The Stichting CIS privacy regulations shall apply. More information can be found at
www.stichtingcis.nl. You can also call the ONVZ Service Centre on +31 (0)30 639 62 22 for further
information.
Paragraph 4 In administering the Basisverzekering basic health-care plan, ONVZ may request information
from, or provide information to, third parties (e.g. health-care providers, suppliers, etc.) in order
to fulfil its obligations. ONVZ uses the national internet portal VECOZO (Veilige Communicatie
in de Zorg [Secure Communications in Health Care]) for this purpose. Health-care providers and
suppliers need this information in order to claim back the costs of health care provided to you.
Information here includes your address and policy details. Please inform us in writing if there are
important reasons why your address details should not be disclosed to health-care providers or
suppliers.
Paragraph 5 ONVZ has an obligation to include the burgerservicenummer [personal identification number]
(BSN) in its records. Health-care providers and other service providers within the scope of the
Zorgverzekeringswet [Health Insurance Act] must use the BSN in all their communication. ONVZ
also uses the BSN in its contact with these parties.
21
Clause 12
Exclusions
Paragraph 1The Basisverzekering basic health-care plan does not provide coverage for the costs of:
1. personal contributions falling under the Algemene Wet Bijzondere Ziektekosten [Exceptional
Medical Expenses Act] (AWBZ) and in relation to population screening;
2. medical examinations for employment or other purposes (e.g. for a driving licence or pilot's
licence), certification or vaccinations, unless the Regeling zorgverzekering [Health-Care
Regulations] determines otherwise;
3. influenza vaccinations;
4. alternative/non-conventional medicine;
5. medication to prevent illness during travel;
6. fertility-related treatment for female insured persons over 43 years of age;
7. antenatal screening for congenital abnormalities, other than the care described in Part B,
Clause 7, Paragraph 1;
8. maternity package, surgical dressings and sterile hydrophilic gauze for obstetric care;
9. missed appointments;
10. collection - through the courts or otherwise - should you fail to pay a health-care provider’s
invoice (on time);
11. injury sustained as a result of armed conflict, civil war, insurrection, riot, rebellion or mutiny as
specified in Article 3:38 of the Wet op het financieel toezicht [Financial Services (Supervision)
Act].
Paragraph 2 Obligations for ONVZ to cover injury sustained as a result of acts of terrorism are limited. Any
reimbursement shall be no more than ONVZ would receive under reinsurance, which has been
placed with the Nederlandse Herverzekeringsmaatschappij voor Terrorismeschaden N.V. [Dutch
Reinsurance Company for Losses from Terrorist Acts] (NHT). If ONVZ has not reinsured this risk
with NHT, the obligation to pay out any reimbursement shall remain limited to that which would
be required of it, had this risk been reinsured. NHT reinsurance provides coverage for a maximum
of € 1 billion per calendar year. This amount may be adjusted annually and applies to all insurers
affiliated to NHT combined.
Terrorist acts include but are not limited to: violent acts, malicious contamination or preparations
to these ends, whereby it may be reasonably assumed that they are planned or carried out with
an intent to realise political, religious or ideological objectives. Preventive measures are included
herein.
Paragraph 3 Highly exceptional circumstances as defined in Article 33 of the Zorgverzekeringswet [Health
Insurance Act] or Article 3.23 of the Besluit zorgverzekering [Health Insurance Decree] may
lead to an additional contribution being made available to ONVZ. If this is the case, you will be
entitled to supplementary coverage in addition to the provisions of Paragraph 2. The level of such
coverage will be determined in accordance with Article 33 of the Zorgverzekeringswet
[Health Insurance Act] or Article 3.23 of the Besluit zorgverzekering [Health Insurance Decree].
Clause 13
Membership of Vereniging ONVZ
When taking out a Basisverzekering basic health-care plan, the policyholder becomes a member
of Vereniging ONVZ. If the Basisverzekering is part of a collective health-care plan, the relevant
contracting party becomes a member. A policyholder who holds more than one Basisverzekering
becomes a member once only. If the Basisverzekering is terminated, membership of the
Vereniging will also be terminated.
Clause 14 Our right to scrutinise the care you receive
ONVZ is entitled to verify whether the examination, test or treatment your health-care provider
charges for were actually carried out and whether this care was necessary given your condition.
Clause 15 Electronic communications
Paragraph 1 If you or the policyholder decide to contact ONVZ using electronic means, ONVZ shall also be
able to communicate with you electronically. Where the policy terms & conditions refer to ‘in
writing’, this shall also include ‘by email’. In this situation ‘address’ shall refer to ‘email address’.
22
Paragraph 2 If you or the policyholder has given us permission to communicate electronically, or to send the
policy by electronic means, such permission can be retracted at a later date. This can be done in
one of the following ways:
in writing:
• please send your written request to ONVZ Zorgverzekeraar, Verzekerdenadministratie,
Postbus 392, 3990 GD Houten, Netherlands;
• by completing the contact form on our website at www.onvz.nl.
23
Table of contents
Part A – 2 General provisions
ONVZ Aanvullende Verzekering
24
Applicability of general provisions for supplementary health-care plans
Clause 1
25
Definitions Clause 2
25
Other provisions
Clause 3 Legal basis for supplementary health-care plans
Clause 4 Commencement and termination of supplementary health-care plans Clause 5 Concealment Clause 6 Surcharges Clause 7 Exclusions 27
27
28
28
28
General provisions of ONVZ Aanvullende Verzekering
Part A – 2
General provisions of
ONVZ Aanvullende Verzekering
Applicability of general provisions for
supplementary health-care plans
Clause 1
The general provisions set out below apply to the supplementary health-care plan(s) only. The
general provisions of Part A - 1 also apply to the supplementary health-care plan(s) if the matter
would not be arranged without the provision concerned. However, the following provisions of
Part A - 1 are never applicable to the supplementary health-care plan(s):
• Clause 2, Paragraph 1 and Paragraph 2;
• Clause 6, Paragraph 2;
• Clause 7, Paragraph 2.
Definitions
Clause 2
Supplementary health-care plan
All health-care plans, apart from ONVZ Vrije Keuze Basisverzekering, ONVZ Zorgverzekering
Buitenland and ONVZ Basisfit Internationaal.
Acupuncturist
A doctor or practitioner based in the Netherlands with full membership to a professional
organisation for acupuncturists that is recognised by ONVZ. A list of these professional
organisations can be found at www.onvz.nl/polisvoorwaarden or requested from the ONVZ
Service Centre.
Treatments or diagnostic methods/tests not recognised by conventional medicine and aimed at
curing or treating an illness. According to conventional medicine, there is no scientific evidence of
the effectiveness.
Anthroposophic medicine (registered)
Medicine covered by the Geneesmiddelenwet [Medicines Act] for which the Medicines Evaluation
Board (CBG) has issued marketing authorisation and which is used in anthroposophic medicine.
Practitioner
A health-care provider with full membership of a professional organisation that is recognised
by ONVZ for the type of care provided. A list of these professional organisations can be found
at www.onvz.nl/polisvoorwaarden or requested from the ONVZ Service Centre. The health care
provided by the practitioner should be common practice within his/her profession. The official
rates or the prevailing rates within the profession determine the reimbursements to be paid.
A professional organisation’s standard rates shall prevail.
Abroad
Any country other than the country in which you are normally resident.
Chiropractor
A practitioner based in the Netherlands with full membership to a professional organisation for
chiropractors that is recognised by ONVZ. A list of these professional organisations can be found
at www.onvz.nl/polisvoorwaarden or requested from the ONVZ Service Centre.
Recuperation home
An institution for short-term individual 24-hour care. The care is intended for people who, due to
a physical condition or the necessary medical treatment of such a disorder, temporarily require
continuous care, supervision and nursing or are unable to stay at home independently while
awaiting such treatment.
Homeopathic medicine (registered)
Medicine covered by the Geneesmiddelenwet [Medicines Act] for which the Medicines
Evaluation Board (CBG) has issued marketing authorisation and which the CBG has designated a
homeopathic medicine.
25
Hospice
A home where terminally ill people in the last stages of their lives are cared for by professional
care staff and volunteers. The hospice must be AWBZ-accredited.
Breastfeeding specialists
breastfeeding specialists that is recognised by ONVZ. A list of these professional organisations
can be found at www.onvz.nl/polisvoorwaarden or requested from the ONVZ Service Centre.
Medical necessity
The need for tests, treatment or other nursing care which has been rigorously tested and found to
be sound, and which is necessary, effective and not specifically cosmetic.
Unlicensed medicine
Medicine that is not covered by the Geneesmiddelenwet [Medicines Act] and is classified as an
unlicensed medicine ('NG' product group) in the Z-index Taxe.
Accident
A sudden, external violent impact on the body of the insured person, outside his/her control,
causing medically demonstrable physical injury. However, accident coverage as provided for in
Clause 24 of the ONVZ Vrije Keuze Superfit plan shall be covered by the description given there.
Emergency treatment
Medically necessary treatment that could not have been reasonably foreseen upon departure and
that cannot be deferred since, from a medical perspective, immediate intervention is required.
ONVZ
ONVZ Aanvullende Verzekering N.V., De Molen 66, Houten, Netherlands.
Orthoptist
An orthoptist who meets the requirements of the Besluit diëtist, ergotherapeut, logopedist,
foot specialists].
Osteopath
osteopaths that is recognised by ONVZ. A list of these professional organisations can be found at
www.onvz.nl/polisvoorwaarden or requested from the ONVZ Service Centre.
Podiatrist/chiropodist
podiatrists/chiropodists that is recognised by ONVZ. A list of these professional organisations can
be found at www.onvz.nl/polisvoorwaarden or requested from the ONVZ Service Centre.
Foot specialist
A foot specialist who meets the requirements of the Besluit diëtist, ergotherapeut, logopedist,
foot specialists].
Preventive medical investigations
Preventive treatments or investigations by a medical specialist or general practitioner, with the
exception of investigations conducted under the Wet op het Bevolkingsonderzoek [Population
Screening Act].
Psychosomatic physiotherapist
Professions Act] and listed in the specialist register for psychosomatic physiotherapists in the
Central Quality Register of the Royal Dutch Society for Physical Therapy.
Beautician
beauticians that is recognised by ONVZ. A list of these professional organisations can be found at
www.onvz.nl/polisvoorwaarden or requested from the ONVZ Service Centre.
26
Sports doctor
A doctor based in the Netherlands, who is registered as a doctor of social medicine in the
appropriate register under the terms of the Wet BIG [Dutch Individual Health-Care Professions
Act]. The sports doctor studied social medicine and is a practising sports doctor.
Transportation which, for medical reasons, cannot occur using public transport. Such transport is
necessary for the purposes of medical investigation/tests or treatment.
Health-care plan
Insurance taken out by the policyholder with the insurer for the medical care of a person liable for
insurance under the terms of the Zorgverzekeringswet [Health Insurance Act].
Other provisions
Clause 3
Legal basis for supplementary health-care plans
Paragraph 1 The legal basis for the supplementary health-care plans is constituted by:
1. the application form;
2. any information provided separately by you or the policyholder and, if the policy is part of a
collective policy, the collective plan agreement in question.
Paragraph 2 You will be issued with proof of supplementary health-care plan coverage (policy document).
Paragraph 3 You will only be entitled to coverage in cases of medical necessity.
Clause 4
Commencement and termination of
supplementary health-care plans
Paragraph 1 If you move to a country other than the Netherlands, while remaining liable for insurance under
the Zorgverzekeringswet [Health Insurance Act], the following shall apply:
1. the supplementary health-care plan will be terminated;
2. ONVZ may offer you an alternative supplementary health-care plan;
3. you may apply for a supplementary health-care plan with a higher level of coverage than that
offered. This is subject to an acceptance procedure.
If you move to a country other than the Netherlands and are no longer liable for insurance under
the Zorgverzekeringswet [Health Insurance Act] or under a health-care plan in your country of
residence, ONVZ can offer you an international plan.
Paragraph 2 Collective discounts on the premium shall cease to apply if the collective health-care plan
agreement is no longer fulfilled.
Paragraph 3 If the supplementary health-care plan of the parent(s)/carer(s) is terminated, ONVZ shall terminate
the supplementary health-care plan of the children on the same date that the supplementary
health-care plan of the parent(s)/carer(s) is terminated.
If a health-care plan is taken out which provides less coverage than that of the terminated healthcare plan of the parent(s)/carer(s), the supplementary health-care plan of the children will be
terminated on the commencement date for the health-care plan in question. The policyholder is
able to choose a health-care plan offering the same level of coverage as that of the parent/carer.
The commencement date of the health-care plan for the children must be the same as that for the
parent(s)/carer(s) and any such decision must be made within one month of the commencement
date of the health-care plan for the parent(s)/carer(s).
Paragraph 4 In the event of fraud as described in Clause 4 of Part A-1, ONVZ shall also be entitled to
terminate any supplementary health-care plans taken out for the person who has committed
fraud, as of a date chosen by ONVZ.
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Clause 5
Concealment
Paragraph 1 If no health-care plan would have been provided had the actual situation been known, any right
to payment shall be revoked. This will also be the case if ONVZ was intentionally misled when the
health-care plan was taken out. If a health-care plan with a lower level of coverage would have
been offered had the actual situation been known, any claim will be assessed on the basis of that
lower level of coverage.
Paragraph 2 ONVZ may cancel the health-care plan if no health-care plan would have been provided had the
actual situation been known, or if ONVZ has been misled.
Clause 6
Surcharges
Paragraph 1 If you or the policyholder are required to pay certain taxes or duties in the country of residence,
ONVZ shall impose a surcharge on the premium to the value of the tax or duty as levied in the
country in question.
Paragraph 2 ONVZ will charge a premium surcharge, to be determined annually, for supplementary healthcare plans not taken out in combination with the Basisverzekering basic health-care plan. The
surcharge can be found in the premium table which constitutes part of the terms and conditions
of this health-care plan.
Clause 7
Exclusions
In addition to the exclusions specified in Clause 12, Paragraph 1, Sub-paragraphs 6, 7, 9, 10 and
11 and Paragraph 2 of Part A-1, no coverage shall be provided:
1. if, had this supplementary health-care plan not existed, you would have been able to
claim coverage under another policy agreement, effected earlier or otherwise, or a legal
provision. This supplementary health-care plan shall only apply over and above the coverage
provided under the agreement or scheme mentioned in the previous sentence, where the
supplementary health-care plan in question would not have existed;
2. for personal contributions or excesses payable by you or the policyholder in accordance
with (foreign) legislation, with the exception of personal contributions covered under the
supplementary health-care plan;
3. for costs not covered under a health-care plan offering coverage in kind (or a variant offering
in-kind coverage) where the health care could be reasonably provided in a timely fashion by a
health-care provider under contract with the health insurer in question, but where the insured
person opted nonetheless for a non-contracted health-care provider;
4. for the costs of consultations, treatments, medicines or medical appliances provided,
prescribed or issued by an insured person for himself/herself or, within a family, by a family
member for an insured person, except with the prior consent of ONVZ;
5. the costs of injury caused by terrorism if you are not a resident of the Netherlands.
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ONVZ Zorgverzekeraar. Freedom of choice ensured.
ONVZ
Vrije Keuze
Basisverzekering
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Table of contents
Clause 1 Basis for restitution Clause 2 Excess Clause 3 Preventive care Clause 4 General medical care Clause 5 Specialist medical care Clause 6 Nursing care
Clause 7 Antenatal/post-natal care Clause 8 Rehabilitation Clause 9 Organ transplants Clause 10 Dialysis care Clause 11 Mechanical respiration Clause 12 Oncological conditions in children Clause 13 Thrombosis service Clause 14 Testing for and advice on hereditary diseases
Clause 15 Audiological health care Clause 16 Allied health care Clause 17 Dental health care Clause 18 Pharmaceutical care Clause 19 Medical appliances Clause 20 Medical transportation by ambulance Clause 21 Other medical transportation Clause 22 Dyslexia care Clause 23 General basic mental health care (GGZ) Clause 24 Specialist mental health care (GGZ) Clause 25 Abroad Clause 26 General Part C Health-care services
ONVZ ZorgConsulent: from prevention to aftercare Health-care mediation Specialist medical treatment Health magazine, Lijf & Leden ONVZ Kraamzorg Service Transportation by taxi ONVZ Zorgassistance 30
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Clause 1
Basis for restitution
Paragraph 1The Basisverzekering basic health-care plan offers coverage for the costs of the care and other
services set out below. The provisions set out in part A-1 also apply. You are free to choose a
health-care provider within the limits of these descriptions.
Coverage for health care abroad is subject to Clause 25.
Paragraph 2 ONVZ shall cover the costs up to a maximum of:
1.the rate stipulated by the Wet marktordening gezondheidszorg (Wmg) [Organisation of
Health-Care Markets Act] at the time of the treatment; or
2. if no Wmg rate exists, the prevailing market rate in the Netherlands.
Paragraph 3 You are entitled to mediation on request. Please contact the ONVZ ZorgConsulent (see Part C) to
arrange this.
With regard to waiting lists, ONVZ takes medical factors into account, as well as social standards
of acceptability with respect to waiting lists, based on psychosocial, ethical and social factors.
Clause 2
Excess
Paragraph 1 A compulsory excess applies to the Basisverzekering basic health-care plan. This amounts
to € 360. In addition to this compulsory excess, you may also opt for a voluntary excess. The
voluntary excess amounts are specified in the premium table, which constitutes part of the terms
and conditions of the Basisverzekering.
Paragraph 2 ONVZ deducts the excess from coverage payable under the Basisverzekering basic health-care
plan. The compulsory excess is deducted before the voluntary excess.
The following costs are excluded from the compulsory and voluntary excesses:
1. cost of general medical care, including registration fees. The cost of tests relating to the
health care do fall under the excess if the tests are performed elsewhere and charged
separately;
2. cost of health care funded in accordance with the policy rule of the Nederlandse
Zorgautoriteit [Dutch Health-Care Authority] (NZa) for performance-related funding of
multidisciplinary health care in relation to chronic conditions. The policy rule relates to care
chains for diabetes mellitus type II for insured persons aged 18 and above and cardiovascular
risk management or COPD (chronic obstructive pulmonary disease);
3. costs of preventive care programmes designated by ONVZ. These programmes may relate to
the prevention of diabetes, depression, cardiovascular disease, chronic obstructive pulmonary
disease and obesity or quitting smoking. A list of designated preventive care programmes
can be obtained from the ONVZ Service Centre or by visiting www.onvz.nl/polisvoorwaarden;
4. costs of assessment of chronic use of prescription medication by a pharmacist designated by
ONVZ. A list of designated pharmacists can be found at www.onvz.nl/polisvoorwaarden or
requested from the ONVZ Service Centre;
5. costs of obstetric and maternity care. Costs of related care, such as medicines, laboratory
tests and ambulance transportation do fall under the excess;
6. costs of donor check-ups after the period defined in Clause 9, Paragraph 2 has elapsed;
7. costs of hiring medical appliances. Costs of the related consumables and usage costs do fall
under the excess.
Paragraph 3 ONVZ shall not deduct a compulsory excess from the cost of health care or other services, for
which the respective invoices are received on or after 31 December 2015 if you are not at fault for
the fact that said invoices were not received before 31 December 2015.
Paragraph 4 Costs not covered by the Basisverzekering basic health-care plan do not count as part of the
excess.
Paragraph 5 If the Basisverzekering basic health-care plan commences or ends during a calendar year, ONVZ
shall calculate the level of excess by multiplying the applicable level of excess by the number of
days the insurance was effective, divided by the number of days in the calendar year. If you turn
18, ONVZ shall calculate the level of excess by multiplying the applicable level of excess by the
number of days for which premium is due, divided by the number of days in the calendar year.
ONVZ Vrije Keuze Basisverzekering 100141
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Paragraph 6 If the excess changes during the calendar year and you had already taken out a Basisverzekering
basic health-care plan immediately prior to said change, ONVZ shall calculate the level of excess
as follows:
1. each separate level of excess that applied or will apply in the calendar year in question will be
multiplied by the number of days in that year to which the excess applied or will apply;
2. the amounts calculated in this way are then added together and divided by the number of
days in the calendar year concerned, and the result is rounded off to whole euros.
Paragraph 7 For the purposes of offsetting claims against the excess, any DBCs, DBC health-care products or
basic mental health-care (GGZ) packages will be allocated to the year in which they started.
Clause 3
Preventive care
Paragraph 1 ONVZ covers the costs of care defined in this health-care plan, also in cases of the following kinds
of prevention:
1. indicated prevention, aimed at preventing illness in people who belong to high-risk groups;
2. health-care related prevention, aimed at preventing complications with or worsening of an
illness.
ONVZ does not cover the costs of anonymous treatment over the internet.
Paragraph 2 For certain kinds of indicated preventive care as defined in Paragraph 1, additional terms &
conditions shall apply as set out below.
a. Support in quitting smoking
Cover includes reimbursement of the costs of participation in a programme aimed at quitting
smoking, at a maximum of once per calendar year. A programme aimed at quitting smoking
consists of medical care aimed at behavioural change, in combination with medication or
otherwise, with the aim of quitting smoking.
In addition to brief, supportive advice from a general practitioner, medical specialist or
midwife on quitting smoking, ONVZ also covers more intensive support in quitting smoking,
such as personal coaching, telephone coaching and group courses by a general practitioner,
nurse or health-care provider registered in the Stoppen met roken quality register of the Stop
met Roken partnership. The Stoppen met roken quality register can be viewed at
www.KwaliteitsregisterStopmetRoken.nl. You can also call the ONVZ Service Centre for further
information.
If the attending health-care provider considers it necessary, ONVZ will also cover support with
medication. This medication must be prescribed by the attending doctor, medical specialist,
midwife or specialist nurse and be a constituent part of the treatment programme.
b. Prevention of depression
Cover includes reimbursement of the costs of care for the prevention of depression, where this
involves subclinical depression, which means that someone has depressive complaints but not
yet to the extent that they can be referred to as depression.
ONVZ will reimburse the costs of care provided by or under the responsibility of the general
practitioner. The care may, therefore, also be provided by a medical assistant, psychologist or
other health-care provider. ONVZ will reimburse the costs under General medical care (Clause
4). The terms and conditions specified there also apply to this preventive care.
Care may comprise programmes based on the following types of therapy:
• cognitive behavioural therapy, including the programmes Beating the Blues and Kleur je
leven or the course In de put, uit de put;
• interpersonal therapy;
• problem-solving therapy.
Coverage does not extend to costs relating to exercise-related programmes.
c. Preventive care for obesity
In the case of a BMI of 25-30 kg/m2, reimbursement can also be claimed for the costs relating
to general lifestyle advice given by or under the responsibility of a general practitioner. This
advice may, therefore, also be provided by a medical assistant, lifestyle consultant, dietitian or
other health-care provider. ONVZ will reimburse this lifestyle, diet and behaviour advice under
General medical care (Clause 4). The terms and conditions specified there shall also apply to
this lifestyle consultation.
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Coverage includes partial reimbursement of the cost of a combined lifestyle intervention, as
described below. The combined lifestyle intervention must be under the referral of a general
practitioner, corporate doctor or medical specialist. The referral must state that there is:
1. a BMI of at least 30 kg/m2; or
2. a BMI of 25 - 30kg/m2 in combination with an increased risk of cardiovascular disease, an
increased risk of diabetes mellitus type II or evidence of a condition related to obesity.
The increased risk of or relation to an illness must have been established by the general
practitioner.
A combined lifestyle intervention is an integrated health-care programme aimed at adopting
and sustaining healthy behaviour. It has three components:
• advice and support on nutrition and eating habits: ONVZ will reimburse the costs under
Dietetics (Clause 16, Paragraph 6) or General medical care (Clause 4). The terms and
conditions specified in the relevant clauses shall also apply to this advice and support;
• exercise-related advice and support: If you are younger than 18, ONVZ will reimburse the
costs of exercise-related advice and support provided by a physiotherapist or remedial
therapist under Physiotherapy or Remedial therapy (Clause 16, Paragraph 3). The terms and
conditions specified there shall also apply to this advice and support. These costs are not
covered if you are aged 18 or above. If you have a supplementary health-care plan, ONVZ
recommends you check whether this provides relevant coverage. ONVZ will reimburse the
costs of exercise-related advice, provided by a lifestyle consultant under the responsibility
of a general practitioner (for insured persons of all ages) under General medical care
(Clause 4). The terms and conditions specified there shall also apply to this advice;
• support with behavioural change, provided by or under the responsibility of a general
practitioner. This support may, therefore, also be provided by a medical assistant, lifestyle
consultant, psychologist or other health-care provider at the general practitioner’s practice.
ONVZ will reimburse the costs under General medical care (Clause 4). The terms and
conditions specified there shall also apply to this support.
d. Prevention of problematic alcohol consumption
Cover includes reimbursement of the costs of care for the prevention of problematic alcohol
consumption, where there is a high risk of problematic alcohol consumption or alcohol
dependency.
Care may include short-term programmes based on the therapeutic principles of motivational
talks or cognitive behavioural therapy, for example the programmes Minder drinken and De
Drinktest, as offered by the Trimbos Instituut.
Coverage does not extend to costs relating to preventive care for children whose parents
are alcohol-dependent, if the child itself does not run a higher risk of problematic alcohol
consumption.
e. Prevention of panic disorder
Coverage includes reimbursement of the costs of care for the prevention of panic disorders,
where this involves a subclinical panic disorder. In such cases, the patient has panic-related
problems, without there actually being any evidence of 'full-blown' panic disorder.
Care may include short-term programmes based on cognitive behavioural therapy, for
example the Geen Paniek programme.
Clause 4 General medical care
Coverage includes reimbursement of the costs of medical care as provided by general
practitioners. The care is provided by a general practitioner or equivalent doctor/health-care
provider working under the responsibility of a general practitioner. General medical care
consequently also includes related (laboratory) tests.
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Clause 5
Specialist medical care
Paragraph 1 Coverage includes reimbursement of the costs of medical care as provided by medical specialists.
The care is provided by a medical specialist. With the exception of emergency treatment, claims
require a referral from a general practitioner, corporate doctor, doctor for the mentally disabled,
elderly care specialist or nursing home doctor, school doctor or 'consultatiebureau-arts'. If the
specialist medical care relates to pregnancy or delivery, the referral may also be given by a midwife.
Paragraph 2 a. Hospital admission
Coverage includes reimbursement of the costs of basic hospitalisation for a maximum period
of 365 days. An interval of a maximum of thirty days is not considered as an interval, but these
days do not form part of the 365 days. Intervals associated with weekend/holiday leave do
form part of the 365 days referred to above.
ONVZ will reimburse the costs of specialist medical treatment (as described below) and
hospital stay, whether or not associated with nursing and other care. ONVZ will also reimburse
the costs of allied health care, medicines, medical appliances and dressings related to the
treatment during the admission.
b. Non-clinical specialist medical care
Coverage includes reimbursement of the costs of specialist medical care provided in or by
a hospital, at a private practice operated by the medical specialist or elsewhere. ONVZ will
reimburse the costs of specialist medical treatment and the related nursing, allied health care,
medicines, medical appliances and dressings.
c. Plastic surgery
The costs of plastic surgery will only be covered if the treatment is to correct:
1. physical disfigurement associated with demonstrable physical dysfunctions;
2. mutilation as a result of an illness, accident or medical procedure;
3. paralysed or weak upper eye lids as a result of a congenital abnormality or chronic
condition present at birth;
4. the following congenital abnormalities: cleft lip, jaw or palate, deformations of the facial
skeleton, benign proliferation of blood vessels, lymph vessels or connective tissue, birth
marks or deformations of the urinary tract/genitalia;
5. primary features of genitals where sex reassignment surgery is required.
d. In vitro fertilisation (IVF)
Coverage for the reimbursement of the costs of IVF treatment will extend to the first, second
and third attempts for each potential pregnancy, providing you are not yet 43 years old upon
commencement of the attempt concerned.
If you are under 38 at the time of the first or second IVF attempt, ONVZ shall reimburse the
costs, provided that no more than one embryo is transferred.
An IVF attempt entails:
1. hormone treatment to stimulate the maturation of ova within your ovaries;
2. follicle aspiration;
3. laboratory phase;
4. single or multiple intrauterine transfer of one or two embryos to initiate pregnancy.
Note:
1. ONVZ shall not reimburse the costs of IVF if, in the event of a good prognosis based on a
risk score (Hunalt score), a conservative approach is not initially followed, as laid down in
the guidelines for “inexplicable subfertility” by the Nederlandse Vereniging voor Obstetrie
en Gynaecologie [Dutch Society for Obstetrics and Gynaecology] (NVOG).
2. ICSI (intracytoplasmic sperm injection) treatment with IVF treatment is considered an IVF
attempt, whether or not ovum donation is used. No coverage shall be provided for the
costs of the ovum donation.
3. An attempt always includes successful follicle aspiration. Only attempts that are abandoned
after follicle aspiration has taken place are counted in the number of attempts. The
transfer of (all of) the embryos created during an attempt (whether or not they have been
cryopreserved) is part of the attempt in which the embryos are created, as long as there is
no continuing pregnancy.
4. For natural pregnancies, a continuing pregnancy is defined as a living embryo from at
least twelve weeks’ pregnancy following the last menstruation. For IVF pregnancies,
this is defined as ten weeks after follicle aspiration. Fertilisation of the ovum takes place
immediately after aspiration. For embryos that have been cryopreserved, the count starts at
the time of transfer, not aspiration. This means that the defining period is four days shorter,
i.e. a total of nine weeks and three days.
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5. A new attempt following a continuing pregnancy – either a natural or IVF pregnancy – is
considered as a new first attempt.
e. Treatment of chronic non-specific back pain
There is also coverage until 1 January 2016 for the costs of treating chronic non-specific back
pain using anaesthesiological methods of pain relief, providing you participate in the research
being funded by the Netherlands Organisation for Health Research and Development
(ZonMw). For more information on this research, please contact the ONVZ Service Centre or
visit www.onvz.nl/polisvoorwaarden.
If you started receiving treatment before 1 January 2014 for chronic non-specific lower back
pain, using radio-frequency denervation, which was reimbursed under the Basisverzekering
basic health-care plan, ONVZ shall reimburse completion of such treatment until
1 January 2016.
f. Treatment of resistant hypertension
There is also coverage until 1 January 2017 for the costs of treating resistant hypertension
(high blood pressure), using percutaneous renal denervation, providing you participate
in the research being funded by the Netherlands Organisation for Health Research and
Development (ZonMw). For more information on this research, please contact the ONVZ
Service Centre or visit www.onvz.nl/polisvoorwaarden.
If you started receiving treatment before 1 January 2014 for resistant hypertension, using
percutaneous renal desensitisation, which was reimbursed under the Basisverzekering basic
health-care plan, ONVZ shall reimburse completion of such treatment until 1 January 2017.
g. Intra-arterial treatment for cerebral infarction
There is coverage until 1 January 2017 for intra-arterial thrombolysis (IAT) for insured persons
with a cerebral infarction, for which treatment using intravenous thrombolysis is not possible or
is advised against on medical grounds, providing you participate in the national study of IAT
in the Netherlands: Multicenter Randomized Clinical trial of Endovascular treatment for Acute
ischemic stroke in the Netherlands (MRCLEAN). For more information on this study, please
contact the ONVZ Service Centre or visit www.onvz.nl/polisvoorwaarden.
If you started receiving treatment before 1 January 2014 for cerebral infarction, using intraarterial thrombolysis, which was reimbursed under the Basisverzekering basic health-care plan,
ONVZ shall reimburse completion of such treatment until 1 January 2017.
h. Transluminal endoscopic step-up approach for patients with infected p
ancreatic necrosis
Abscesses occurring with infected pancreatic necrosis may be treated using endoscopy
instead of surgery (access through the oesophagus/abdomen). There is coverage until 1
January 2018 for the reimbursement of costs of transluminal endoscopic treatment, providing
you participate in the national study TENSION: Transluminal ENdoscopic versus SurgIcal
necrOsectomy in patients with infected pancreatic Necrosis, funded by the Netherlands
Organisation for Health Research and Development (ZonMw). For more information on this
study and a list of hospitals offering the treatment, please contact the ONVZ Service Centre or
visit www.onvz.nl/polisvoorwaarden.
i.Autologous stem cell transplantation in treatment-refractory patients suffering from
Crohn's Disease
There is coverage until 1 January 2018 for patients suffering from a severe form of Crohn's
Disease (chronic inflammation of the gastrointestinal tract), who do not respond adequately
to medication using, for example, TNF alpha blockers, for the reimbursement of the costs
of autologous stem cell transplantation, providing you participate in a national, prospective,
non-comparative study funded by the Netherlands Organisation for Health Research and
Development (ZonMw). For more information on this study and a list of hospitals offering the
treatment, please contact the ONVZ Service Centre or visit www.onvz.nl/polisvoorwaarden.
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Paragraph 3 Coverage does not extend to costs relating to:
1. treatment of paralysed or weak upper eye lids other than as a result of a congenital
abnormality or a chronic condition present at birth;
2. liposuction (the suction-assisted removal of fatty tissue) from the abdomen;
3. abdominoplasty (tummy tuck), unless the procedure is to correct physical disfigurement
associated with demonstrable physical dysfunction or other disfigurement as the result of an
illness, accident or operation;
4. surgical placement or replacement of a breast prosthesis, unless this becomes necessary after
a full or partial breast amputation;
5. surgical removal of a breast prosthesis without medical necessity;
6. uvuloplasty (reconstruction of the uvula) to combat snoring;
7. sterilisation (male or female);
8. reversal of sterilisation (male or female);
9. circumcision (male).
10. treatment of plagiocephaly (distorted skull) and brachycephaly (flat head syndrome) without
craniosynostosis (premature fusing of cranial sutures) using a corrective helmet.
Paragraph 4 This clause does not cover the costs of dental health care by a dental surgeon; they are covered
by Clause 17. This clause does not cover the costs of specialist mental health care (GGZ); they
are covered by Clause 24. If, however, mental health care is required as part of the integrated
treatment by a medical specialist, the costs will not be reimbursed separately under Clauses 23
and 24, rather they will come under the DBC health-care product for the specialist medical care.
Clause 6
Nursing care
Coverage includes reimbursement of the costs of care as provided by nurses. ONVZ will
reimburse the costs if the nursing care is necessary due to specialist medical care, without
hospitalisation. This health care is provided by a nurse or specialist nurse.
Coverage will only extend to the reimbursement of these costs with prior approval from ONVZ.
A treatment plan drafted by a medical specialist must be submitted with the application for such
approval to be given.
Coverage does not include the reimbursement of costs of nursing care relating to artificial
respiration at home or palliative terminal care. Coverage for these costs is provided under the
Algemene Wet Bijzondere Ziektekosten [Exceptional Medical Expenses Act] (AWBZ).
Clause 7
Paragraph 1 Female insured persons may claim the costs of obstetric care as provided by midwives. The care
is provided by a midwife, a medical specialist or a general practitioner, in combination with care
from a birth centre or otherwise. Female insured persons may also claim the costs of maternity
care as provided by maternity nurses.
This care includes antenatal screening, incorporating:
• information on antenatal screening (counselling);
• routine ultrasonography (SEO) during the second trimester of pregnancy (the 20-week
ultrasound scan);
• a combination test, consisting of a nuchal scan and a blood test for pregnant women aged
36 years and above. If you are under the age of 36, ONVZ shall only reimburse the costs of a
combination test upon referral by a general practitioner, midwife or medical specialist.
The SEO and combination test may only be performed by a health-care provider who is licensed
under the Wet op het Bevolkingsonderzoek [Population Screening Act] (WBO) or who has a
cooperation agreement with a licensed regional centre for antenatal screening, unless there is a
medical assessment.
Paragraph 2 A distinction is made between the following situations:
a. Birth and/or maternity care in a hospital as a medical necessity
If birth in a hospital is a medical necessity, ONVZ will cover the costs of specialist medical care
and hospitalisation for the mother and her child from the day of the birth, in accordance with
Clause 5.
b. Birth and/or maternity care in a hospital (not a medical necessity) or in a birth centre
If the birth and maternity care take place in a hospital without medical necessity or in a birth
centre, ONVZ will reimburse the costs of obstetric and maternity care for the mother and
her child from the day of the birth. This will be subject to a personal contribution for both
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the mother and her child of € 16.50 per person per day. This personal contribution will be
increased by the amount by which the rate charged by the hospital or birth centre exceeds
€ 116.50 per person per day. The number of days in hospital will be determined on the basis
of the report by the hospital or by the maternity-care agency providing the maternity care
after discharge from hospital.
c. Birth and maternity care at home
If the birth and maternity care take place at home, ONVZ will reimburse the costs of:
1. obstetric care (including antenatal and post-natal care) provided by the general
practitioner or midwife;
2. the registration, initial interview and childbirth assistance up to a maximum of three hours
after the birth;
3. at least 24 and a maximum of 80 hours of maternity care, during a maximum of ten days,
starting from the day of the birth. The actual number of hours of maternity care depends
on the needs of the mother and her child, and is calculated and allocated in consultation
with ONVZ. The starting point in this respect is what the birth centre or maternity-care
agency indicates on the basis of the Landelijk Indicatie Protocol Kraamzorg (an instrument
used in the Netherlands to calculate the extent of the required maternity care). This cover
is subject to a personal contribution of € 4.10 per hour.
If, following a birth in a hospital or birth centre, the maternity care is provided at home or
a birth clinic, ONVZ will cover the costs of maternity care as defined under 3. In this case,
ONVZ will deduct the number of days spent in the hospital or birth centre from the specified
maximum term of ten days.
Coverage shall not include any costs incurred at the birth clinic other than for maternity care.
d. ONVZ would be happy to arrange maternity care for you. The procedure for requesting this is
set out in Part C (Health-care services).
Clause 8
Rehabilitation
Paragraph 1 Specialist medical rehabilitation
Coverage includes reimbursement of the costs of specialist medical rehabilitation if:
1. this care is the most effective for you with regard to preventing, reducing or overcoming a
handicap. The handicap is the result of impairments or limitations of the musculoskeletal
system or of a condition of the central nervous system and leads to limitations in terms of
communication, cognition or behaviour; and
2. this care would enable you to achieve or maintain a level of independence which, given your
handicap, is reasonably possible.
Specialist medical rehabilitation may take place:
1. as part-time or day treatment;
2. during a stay in hospital or in a rehabilitation centre, if this is expected to lead to a better
result sooner than rehabilitation without admission.
Paragraph 2 Geriatric rehabilitation
Coverage includes reimbursement of the costs of geriatric rehabilitation as provided by elderly
care specialists, if
• it involves integrated and multidisciplinary rehabilitation care; and
• your case involves vulnerability, complex multimorbidity and diminished learning and training
ability; and
• the care is aimed at reducing your functional limitations such that you can return to your
home environment; and
• the care is initially associated with admission to a nursing home or other organisation that
is legally registered for the provision of geriatric rehabilitation. This organisation has a
department that specialises in the provision of geriatric rehabilitation care.
The care is associated with a hospital admission as referred to in Clause 5 Paragraph 2a while,
prior to that hospital admission, you were not being looked after under the Algemene Wet
Bijzondere Ziektekosten [Exceptional Medical Expenses Act] (AWBZ) and were being treated in a
nursing home or other organisation.
The medical assessment for geriatric rehabilitation care will be performed by the attending
medical specialist in consultation with the elderly medical care specialist, during the hospital
admission. The medical specialist and other health-care providers work systematically, and in
conjunction with the elderly medical care specialist, during the hospital admission, to establish
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clarity in relation to subsequent geriatric rehabilitation care.
The geriatric rehabilitation care is performed by a multidisciplinary team, led by an elderly care
specialist or nursing home doctor, in accordance with a treatment plan.
This treatment plan complies with the relevant guidelines set out by the CBO (Centraal
BegeleidingsOrgaan voor de intercollegiale toetsing [Central Guidance Body for intercollegiate
testing]) and the treatment frameworks of Verenso (the professional institution for elderly medical
care specialists and social geriatricians).
ONVZ will reimburse the costs of geriatric rehabilitation for a period of up to six months. In
exceptional cases, you can ask ONVZ's approval for a longer period.
Geriatric rehabilitation also includes ambulatory rehabilitation care following a return home.
The costs of geriatric rehabilitation care will be charged by means of a DBC health-care product.
Clause 9
Organ transplants
Paragraph 1 Coverage includes reimbursement for the costs of the transplantation of tissue and organs,
performed in a hospital, if the transplant is performed in:
1. an EU/EEA country, or
2. another country, if the donor lives there and said donor is your spouse, your registered
partner or one of your first, second or third-degree blood relatives.
ONVZ shall also reimburse the costs of specialist medical care in relation to donor selection and
the operative removal of the transplant material from the selected donor. ONVZ also covers
the costs of tests, preservation, removal and transportation of cadaveric organ(s)/tissue for the
transplant operation.
Paragraph 2 The donor may claim reimbursement of the costs of care as defined in this health-care plan up to
a maximum of 13 weeks after the date of discharge from the establishment to which the donor
was admitted for selection or removal of the organ(s)/tissue for the transplant operation. In the
event of a liver transplant, this period will be a maximum of six months. The coverage under this
paragraph shall extend only to the costs of care provided in relation to that admission.
The donor can also claim reimbursement of the costs of transportation within the Netherlands,
by the lowest class of public transport, for the selection, admission to and discharge from the
hospital and for the health care defined in this paragraph. This transportation may also be by car
if medically necessary.
If a donor lives abroad and a kidney, bone marrow or liver transplant is to take place in the
Netherlands, ONVZ will reimburse the costs of transportation of the donor to the Netherlands
and back. ONVZ shall also reimburse the other costs incurred by the donor in connection with the
transplant, insofar as these costs relate to the donor living abroad. The latter costs do not include
the cost of staying in the Netherlands and costs associated with loss of income.
Clause 10
Dialysis care
Coverage includes reimbursement of the costs of non-clinical haemodialysis and peritoneal
dialysis, and the related specialist medical care. The care is provided in a dialysis centre or at your
home and may involve tests, treatment, nursing, pharmaceutical care and psychosocial support of
yourself or the person(s) who help you perform dialysis at home.
Coverage for home dialysis also includes:
1. the costs of the training, by the dialysis centre, of those who perform or assist with the dialysis
at home;
2. the provision or loaning of dialysis equipment and accessories;
3. the costs of regular monitoring and maintenance (including replacement), and the costs of
chemicals and fluids required for dialysis;
4. any other items that need to be used for dialysis in the home (e.g. a dialysis chair), where this
necessity can be considered reasonable;
5. costs of necessary expert assistance provided by the dialysis centre.
These items apply to haemodialysis and the different types of peritoneal dialysis. The costs are
part of the DBC health-care product charged by the hospital or dialysis centre.
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In the case of home dialysis ONVZ will reimburse the following, in addition to the DBC healthcare product:
1. the reasonable costs of adjustments made to allow home dialysis for the insured person, and
the costs associated with returning the home to its original state, if other legal provisions do
not accommodate them;
2. other reasonable costs arising directly from home dialysis where they are not covered in other
- statutory - regulations.
Clause 11
Mechanical respiration
Coverage includes reimbursement of the costs of mechanical respiration in a respiratory centre,
and the specialist medical care associated with this.
Respiration may also be performed at your home under the responsibility of a respiratory centre.
In such cases, ONVZ will reimburse the costs of:
1. the provision by the respiratory centre of the required equipment in ready-to-use state;
2. the specialist medical and pharmaceutical care related to mechanical respiration, provided
under the responsibility of a respiratory centre.
Clause 12
Oncological conditions in children
Coverage includes reimbursement of the costs of central diagnostics (reference diagnostics),
coordination and registration of bodily samples received by the Stichting Kinderoncologie
Nederland (Skion).
Clause 13
Thrombosis service
Coverage includes reimbursement of the costs of care provided by the thrombosis service upon
referral from a doctor or medical specialist. ONVZ will reimburse the costs of:
1. taking regular blood samples;
2. conducting the necessary laboratory tests (under the responsibility of the thrombosis service)
to determine the blood coagulation time;
3. the provision of equipment and accessories to enable you to monitor your blood coagulation
time yourself;
4. teaching you to use this equipment and assistance in taking your readings;
5. advice on the use of coagulants or anti-coagulants.
Additional terms and conditions with regard to the coverage under 3 are defined in the [Medical
Appliance Regulations]. These regulations are available on request from the ONVZ Service Centre
or at www.onvz.nl/polisvoorwaarden.
Clause 14 Testing for and advice on hereditary diseases
Coverage includes reimbursement of the costs of central diagnostics (reference diagnostics),
coordination and registration of blood and bone marrow products submitted, performed by a
centre that tests for hereditary diseases, on referral from a general practitioner, corporate doctor
or medical specialist.
ONVZ reimburses the costs of: the investigation of hereditary diseases by means of family tree
research, chromosome analysis, biochemical diagnostics, ultrasound and DNA tests, advice on
hereditary diseases, and the psychosocial support associated with this form of care. ONVZ will
also reimburse the costs of testing people other than yourself, if such tests are necessary in order
to give you advice. The other people tested may then also receive advice.
Clause 15 Audiological health care
Coverage includes reimbursement of the costs of care provided by an audiological centre upon
referral from a general practitioner, corporate doctor, paediatrician or ENT doctor.
ONVZ will reimburse the costs of:
1. hearing test;
2. advice on hearing aids or other equipment as appropriate;
3. information on the use of the aforementioned equipment;
4. psychosocial care required in relation to the problems of impaired auditory function;
5. help in diagnosing speech and language disorders in children up to the age of seven.
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Clause 16 Allied health care
Paragraph 1 Coverage includes reimbursement of the costs of care as provided by physiotherapists, remedial
therapists, occupational therapists, speech therapists and dietitians.
ONVZ will reimburse the costs of treatment at different surgeries, such as schools for mainstream
or special education, (medical) day nurseries or [Youth and Family Centres], providing ONVZ has
granted prior permission for treatment at these locations. ONVZ will only grant permission if there
is a medical assessment for treatment at the intended locations, and the treatment is incidental.
ONVZ will not reimburse additional costs relating to treatment outside regular working hours.
Paragraph 2 Physiotherapy and remedial therapy
Coverage includes reimbursement of the costs of treatment by a physiotherapist, physiotherapist
specialising in children, manual therapist, Cesar/Mensendieck remedial therapist, pelvic therapist,
geriatrics physiotherapist or oedema therapist. Oedema therapy may also be provided by a skin
therapist.
This requires a medical assessment and diagnosis of a condition listed in Appendix 1 of
the [Health Insurance Decree]. The duration of treatment specified in the decree may not be
exceeded. If you are aged 18 or above, the costs of the first 20 treatments for the condition
concerned will not be reimbursed.
Contrary to these provisions, if you are aged 18 or above, ONVZ will reimburse the costs of up
to nine sessions of pelvic physiotherapy in relation to urinary incontinence. In this case therefore,
coverage shall apply from the first treatment.
Appendix 1 of the [Health Insurance Decree] is available on request from the ONVZ Service
Centre and can also be found at www.onvz.nl/polisvoorwaarden.
Paragraph 3 For physiotherapy and remedial therapy for children under 18, coverage shall also include, in
addition to the coverage provided in Paragraph 2, reimbursement of the costs of a maximum of
nine sessions with a physiotherapist, physiotherapist specialising in children, manual therapist,
pelvic therapist or Cesar/Mensendieck remedial therapist per diagnosis per calendar year.
Upon referral from a general practitioner or medical specialist, ONVZ shall reimburse the costs
to these insured persons for a maximum of nine additional treatments by the aforementioned
health-care providers per diagnosis per calendar year if insufficient results have been achieved
after nine treatments.
Paragraph 4 Occupational therapy
Coverage includes reimbursement of the costs of advice, instruction, training or treatment by an
occupational therapist with the aim of improving or restoring the insured person’s ability to look
after himself/herself. ONVZ will reimburse a maximum of ten hours' treatment per calendar year.
The occupational therapist may provide the care at their practice or at your home.
Paragraph 5 Speech therapy
Coverage includes reimbursement of the costs of treatment performed by a speech therapist.
ONVZ will reimburse the costs of speech therapy where there is a medical aim and treatment is
expected to restore or improve speech. ONVZ shall not reimburse the cost of treatment aimed at
supporting education. This includes the treatment of language development problems involving
a dialect or foreign language.
Paragraph 6 Dietetics
Coverage includes reimbursement of the costs of information and advice on nutrition and eating
habits provided with a medical purpose by a dietitian. ONVZ will reimburse a maximum of three
hours' treatment per calendar year.
Clause 17 Dental health care
Paragraph 1 Coverage includes reimbursement of the costs of health care as provided by dentists. This care
may be provided by a dentist, dental surgeon, orthodontist, prosthodontist or dental hygienist.
ONVZ shall reimburse only the costs of specialist dental care, i.e. dental care required:
1. if you have such a serious developmental or growth disorder, or an acquired abnormality
of the framework of the mouth that you cannot maintain or acquire proper dental function
without such health care. Proper dental function means equivalent to that which you would
have had without the disorder/abnormality; or
2. if you have a physical or mental condition unrelated to dental health and you cannot maintain
or acquire proper dental function without such health care. Proper dental function means
equivalent to that which you would have had without the condition; or
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3. if a medical treatment would have a demonstrably worse result without such health care and
you would not be able to maintain or acquire proper dental function without such health
care. Proper dental function means equivalent to that which you would have had without the
condition.
Paragraph 2 ONVZ will also reimburse the costs of placing a dental implant and fitting the fixed part of the
suprastructure if the jaw is severely shrunk and toothless. The implant should serve to anchor a
removable prosthesis. The suprastructure is the part of the implant above the gum.
Paragraph 3 ONVZ will reimburse the costs of orthodontic care if you have a very serious developmental or
growth disorder in relation to the framework of the mouth. This requires a necessity for additional
diagnostics and co-treatment in other disciplines besides dental health care.
Paragraph 4 If you are younger than 18, coverage shall include reimbursement of the costs of:
1. regular preventive dental check-ups once per year, unless you need such dental health care
more than once a year;
2. incidental dental consultations;
3. periodontal scaling;
4. fluoride application where at least one element of the second teeth has emerged, up to twice
a year, unless you require this kind of dental treatment more often;
5. sealing (application of a protective coating);
6. periodontics (for gums);
7.anaesthesia;
8. root-canal work (for the tooth pulp);
9. restoration of teeth with plastic materials;
10. gnathological care (for the jaws and masseters);
11. removable dental prostheses;
12. tooth replacement using non-plastic materials and the placing of dental implants, with prior
approval from ONVZ. The care provided must involve the replacement of one or more
missing, permanent incisors or canine teeth (front teeth) which have not developed or are
missing as the direct result of an accident;
13. dental surgery, except for the cost of placing dental implants;
14. X-rays, except the cost of X-rays for orthodontic care.
The cost of such care provided outside regular surgery times will only be reimbursed if treatment
cannot in all reasonableness be postponed.
Paragraph 5 If you are aged 18 or above, coverage shall include reimbursement of the costs of:
1. specialist dental surgery and any X-rays involved, with the exception of periodontal surgery,
the placing of dental implants and uncomplicated extractions. This care must be under the
referral of a general practitioner, corporate doctor or medical specialist;
2. removable dental prostheses for the upper and/or lower jaw.
Paragraph 6 In relation to the manufacture and placing of removable upper or lower full dental prostheses,
ONVZ will reimburse 75% of the costs of a full immediate prosthesis or full replacement
prosthesis (removable or otherwise).
ONVZ will reimburse 100% of the costs of repair and rebasing of an existing full prosthesis
(removable or otherwise). Rebasing involves filling the space between the jaw and the prosthesis
to create a better fit on a shrunken jaw.
Prior approval from ONVZ is required if the total costs of the full prosthesis (including technical
costs) exceed:
• € 650 each for the upper and lower jaw, if performed by a dentist; or
• € 500 each for the upper and lower jaw, if performed by a prosthodontist.
Paragraph 7 Coverage of the costs in relation to dental care defined in Paragraphs 1 - 3 inclusive always
requires prior approval from ONVZ. If the dental health care defined in Paragraphs 4 and 5 is
performed in a dental hospital, this will also require prior approval from ONVZ.
Claims require a supporting letter from the dentist including a treatment plan. Permission may
be revoked if the dental health care is no longer necessary, if you do not follow the health-care
provider’s instructions or if you seriously neglect your dental hygiene.
Paragraph 8 Coverage includes reimbursement of the costs of hospitalisation in relation to specialist surgical
dental care for a continuous period of no more than 365 days. An interval of a maximum of thirty
days is not considered as an interval, but these days do not form part of the 365 days referred to
above. Intervals associated with weekend/holiday leave do form part of the 365 days referred to
above.
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ONVZ shall reimburse the costs of specialist dental surgery and hospital stay, whether or not
associated with nursing and other care. ONVZ will also reimburse the costs of allied health care,
medicines, medical appliances and dressings related to the treatment during the admission.
Paragraph 9 The reimbursement of the costs of care provided by a dental specialist for dental health care and
surgery in relation to periodontal care, extraction under anaesthetic, osteotomy or the placing of
a dental implant require prior approval from ONVZ.
Paragraph 10Reimbursement of the costs of dental health care performed where the insured person is staying
(i.e. not at the health-care provider’s practice) requires an opinion (in writing) from the patient's
general practitioner or the medical specialist.
Paragraph 11A personal contribution may apply for health care as defined in Paragraph 1 for an insured person
aged 18 and above.
This personal contribution applies to treatments that are not directly related to the medical
assessment for specialist dental care.
The personal contribution is equivalent to the amount that would have been charged for the
standard treatment, i.e. if the treatment had not been provided as specialist dental care.
Paragraph 12A full prosthesis, whether or not in combination with implants, provided as part of the care as
defined in Paragraph 1, will require a personal contribution of € 125 each for the upper and lower
jaw.
Clause 18 Pharmaceutical care
Paragraph 1 Coverage includes the reimbursement of the costs of dispensing:
1. registered medicines listed in Appendix 1 of the [Health-Care Regulations] designated by
ONVZ. Designation by ONVZ is such that of all the active ingredients listed in the [HealthCare Regulations List of Designated Medicines], at least one medicine is available to you. A
further description of this provision can be found in the [Pharmaceutical Care Regulations].
These regulations are available on request from the ONVZ Service Centre or can be found at
www.onvz.nl/polisvoorwaarden;
2. medicines – as long as rational pharmacotherapy is applied – referred to in:
a. Article 40, Paragraph 3, Sub-paragraph a, of the [Medicines Act]. This Article deals with
pharmacy or magistral preparations. The costs of pharmacy preparations equivalent or
practically equivalent to a registered medicine that is not listed in Appendix 1 of the
[Health-Care Regulations] are excluded from coverage;
b. Article 40, Paragraph 3, Sub-paragraph c of the [Medicines Act], which, at the request of
a doctor as defined in that article, are prepared in the Netherlands by a manufacturer as
defined in Article 1, Paragraph 1, Sub-paragraph mn of that Act;
c. Article 40, Paragraph 3, Sub-paragraph c of the Geneesmiddelenwet [Medicines Act],
which are available commercially in another country and, at the request of a doctor as
defined in that article, are brought into the Netherlands, and are intended for one of the
doctor’s patients who is suffering from an illness which does not commonly occur in the
Netherlands (less than one case per 150,000 heads of the population);
3. polymeric, oligomeric, monomeric and modular dietary preparations.
Rational pharmacotherapy is interpreted as treatment or diagnosis with a form of medicine that is
suitable for the patient, the effectiveness of which has been demonstrated in scientific literature
and which is the most economical.
Coverage also includes reimbursement of the costs of advice and support as provided by
pharmacists in relation to selection of the right medicine and the responsible use of the
aforementioned medicines. This advice and support is provided by health-care providers
registered under the terms of the Wet BIG [Dutch Individual Health-Care Professions Act.
Advice and support includes:
a. initial dispensation consultation;
b. explanation of the use of medicine-related medical appliances prescribed for the patient;
c. assessment of chronic use of prescription medication;
d. pharmaceutical support where hospital admission or a visit to an outpatient clinic is concerned;
e. pharmaceutical support upon discharge from hospital.
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Coverage shall only extend to reimbursement of the costs of a medicine listed in Appendix 2
of the Regeling zorgverzekering [Health-Care Regulations] if there is a medical assessment in
accordance with the provisions defined in this Appendix.
Appendices 1 and 2 of the Regeling zorgverzekering [Health-Care Regulations] may be amended
during the course of the year. For an up-to-date list, please visit www.wetten.nl. Please get in
touch with the ONVZ Service Centre if you have any questions about this.
Paragraph 2 The substances listed in Paragraph 1 must be prescribed by the attending doctor, medical
specialist, dentist, dental specialist, midwife, specialist nurse or physician assistant. Such
medicines must be dispensed by a licensed pharmacist or dispensing practice.
Paragraph 3 ONVZ will only reimburse the costs of dietary preparations if adjustments in normal nutrition and
nutritional supplements alone will not suffice and you:
1. suffer from a metabolic disorder; or
2. suffer from a food allergy; or
3. suffer from a resorption disorder; or
4. suffer from illness-related malnutrition or a risk to that effect and this has been determined
using a validated screening instrument; or
5. rely on dietary preparations as per the guidelines used by the relevant professional groups in
the Netherlands.
Paragraph 4 With regard to over-the-counter medication for chronic use listed in the Regeling zorgverzekering
[Health-Care Regulations], ONVZ will not reimburse the costs of use during the first 15 days. This
includes laxatives, calcium tablets, anti-allergy products, products to stop diarrhoea, products to
prevent dry eyes and emetics, as well as other medicines with an equivalent active substance and
the same dosage form.
Also, with regard to proton-pump inhibitors for chronic use (including combination preparations
that contain proton-pump inhibitors) listed in the Regeling zorgverzekering [Health-Care
Regulations], ONVZ will not reimburse the costs of use during the first 15 days.
Paragraph 5 The medicines listed in the Regeling zorgverzekering [Health-Care Regulations] have been
classified, as far as possible, into groups of equivalent medicines. The government sets a
maximum reimbursement amount for each group. If the purchase price for a particular medicine
is higher than the maximum reimbursement amount, the difference will be charged as a personal
contribution. A personal contribution will also apply for a medicine prepared from a medicine
subject to a personal contribution.
Paragraph 6The Reglement Farmaceutische zorg [Pharmaceutical Care Regulations] imposes stricter
conditions relating to the effectiveness of pharmaceutical care. This includes the requirement
to acquire prior permission, dispensing quantities, advice and support. These regulations
are available on request from the ONVZ Service Centre or can be found at www.onvz.nl/
polisvoorwaarden.
• pharmaceutical care in the cases defined in the Regeling zorgverzekering [Health-Care
Regulations];
• medicines registered in the Netherlands not listed in Appendix 1 of the Regeling
zorgverzekering [Health-Care Regulations];
• a personal contribution in accordance with Paragraph 5;
• over-the-counter medication other than those listed in the Regeling zorgverzekering [HealthCare Regulations];
• medicines relating to a health risk when travelling;
• medicines for tests as defined in Article 40, Paragraph 3, Sub-paragraph b of the
Geneesmiddelenwet [Medicines Act];
• medicines that are equivalent or practically equivalent to a registered medicine that is not
listed in Appendix 1 of the Regeling zorgverzekering [Health-Care Regulations];
• medicines as defined in Article 40, Paragraph 3, Sub-paragraph f of the Geneesmiddelenwet
[Medicines Act]. These are medicines for which either an application for marketing
authorisation has been submitted to the European Medicines Agency or for which clinical
tests are still ongoing.
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Clause 19 Medical appliances
Paragraph 1 Coverage includes reimbursement of costs relating to functioning medical appliances and
dressings as listed in ONVZ’s Reglement zorgverzekering [Health-Care Regulations] and
Reglement Hulpmiddelen [Medical Appliance Regulations.] As an exception to the coverage
for the reimbursement of costs, ONVZ lends out certain medical appliances. The conditions for
reimbursement, loan of medical appliances and the specific requirements for each appliance can
be found in ONVZ’s Reglement Hulpmiddelen [Medical Appliance Regulations]. A copy of these
regulations is available on request from the ONVZ Service Centre and they can also be found at
www.onvz.nl/polisvoorwaarden.
Paragraph 2 If the Reglement Hulpmiddelen [Medical Appliance Regulations] specifies as such, prior
permission from ONVZ will be required for the provision, replacement, correction or restoration
of a medical appliance. ONVZ may also impose stricter conditions.
Paragraph 3 The costs of normal use will not be reimbursed unless the Reglement Hulpmiddelen [Medical
Appliance Regulations] specifies otherwise. Such costs include the cost of energy consumption
and batteries.
Paragraph 4 ONVZ will only reimburse the costs of, or lend out medical appliances if the appliances in
question are necessary, effective and not unnecessarily expensive or complicated. In principle,
coverage will not extend to the reimbursement of the costs or loan if the medical appliance
is only to be used at the place of work or education. Personal medical appliances for hearing
disorders used to modify the workplace for someone who is hard-of-hearing may be an exception
to this rule. The terms and conditions for this are specified in the Reglement Hulpmiddelen
[Medical Appliance Regulations].
Paragraph 5 ONVZ will only reimburse the costs of dressings in the event of a serious condition requiring longterm medical treatment with such materials.
Paragraph 6 In some cases, specialist medical care shall include the costs of medical appliances and dressings
used at home under the responsibility of a medical specialist. Such items will be reimbursed
through a DBC health-care product, not under this provision. The CVZ report Afbakening
hulpmiddelenzorg en geneeskundige zorg zoals medisch-specialisten die plegen te bieden
[Specification of medical appliances and medical care as provided by medical specialists] 2
provides guidance on this. This report is available on request from the ONVZ Service Centre or at
The costs of prescribed medical appliances and dressings will also not come under this coverage
if you stay and receive treatment in an AWBZ institution. This is covered by the Algemene Wet
Bijzondere Ziektekosten [Exceptional Medical Expenses Act] (AWBZ).
Clause 20
Medical transportation by ambulance
Paragraph 1 Coverage includes reimbursement of the costs of medical transportation by ambulance provided
by a paramedic/ambulance driver if other means of transport (public transport, taxi or private car)
would be irresponsible on medical grounds. ONVZ will reimburse the transportation costs for a
maximum distance of 200 kilometres, unless ONVZ has given prior permission for transportation
across a greater distance.
Paragraph 2 ONVZ will reimburse the costs of transportation:
• to a health-care provider or an institution where you will receive care, the costs of which are
covered fully or partially by the Basisverzekering basic health-care plan;
• to an institution where you are to be admitted, the costs of which will be covered by the
Algemene Wet Bijzondere Ziektekosten [Exceptional Medical Expenses Act] (AWBZ);
• from an institution where you have been admitted to a health-care provider or institution
where you are to undergo an examination, tests or treatment, covered under the Algemene
Wet Bijzondere Ziektekosten [Exceptional Medical Expenses Act] (AWBZ);
• from an institution where you have been admitted to a health-care provider or institution to
be measured for or fitted with a prosthesis, if the prosthesis is fully or partially covered under
the Algemene Wet Bijzondere Ziektekosten [Exceptional Medical Expenses Act] (AWBZ);
• from the health-care providers or institutions listed in this paragraph to your own home, or to
someone else’s home if you cannot reasonably receive the necessary care in your own home.
Paragraph 3 Coverage does not include the cost of medical transportation provided for a single morning or
afternoon at an AWBZ institution.
Paragraph 4 If medical transportation by ambulance is not possible, you may request prior permission from
ONVZ to use another form of transportation.
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Other medical transportation
Clause 21
Paragraph 1 Coverage includes reimbursement of the costs of transportation by the lowest class of public
transport, by taxi or by private car up to a maximum of 200 kilometres per single journey. This
limit of 200 kilometres shall not apply if ONVZ gives permission for the health care to be provided
at a specific person’s practice or a specific institution.
Paragraph 2 ONVZ will only reimburse the costs of other medical transportation where it has granted
permission in advance. When granting such permission, ONVZ may impose conditions relating to
the manner of transportation.
Paragraph 3 For transportation by private car, ONVZ will reimburse € 0.31 per kilometre. In calculating the
amount to be reimbursed, ONVZ assumes the optimum route by car is taken; this is ascertained
using the Routenet route planner.
Paragraph 4 Coverage includes reimbursement of the costs of transportation to and from a person, institution
or home as referred to in Clause 20, Paragraph 2 if:
• you have to undergo kidney dialysis;
• you have to undergo oncological treatment involving chemotherapy or radiotherapy;
• you can only move about using a wheelchair;
• your sight is so impaired that you cannot move about unaccompanied.
Paragraph 5 In all cases other than those mentioned in Paragraph 4, coverage shall include reimbursement of
the costs of other medical transportation if you rely on other medical transportation for treatment
of a long-term disease or condition and non-reimbursement of these costs to you would result in
a particularly unfair situation for you.
Paragraph 6 Coverage does not include the cost of medical transportation provided for a single morning or
afternoon at an AWBZ institution.
Paragraph 7 The coverage for other medical transportation is subject to a personal contribution of € 96 per
calendar year.
This personal contribution does not apply for transportation:
• from an institution where you have been admitted to another institution where you are
to be admitted in order to undergo a specialist examination/tests or specialist treatment
that cannot be performed in the first institution. The costs of both admissions must be
covered under the Basisverzekering basic health-care plan or the Algemene Wet Bijzondere
Ziektekosten [Exceptional Medical Expenses Act] (AWBZ);
• from, and back to, an institution where you have been admitted to a person or institution
in order to undergo a specialist examination/tests or specialist treatment that cannot be
performed in the first institution. The examination/tests or treatment must be covered under
the Basisverzekering basic health-care plan or the Algemene Wet Bijzondere Ziektekosten
[Exceptional Medical Expenses Act] (AWBZ);
• from, and back to, an institution where you have been admitted, to a person or institution
to undergo dental treatment that cannot be performed in the first institution. Both the
treatment and the admission are covered under the Algemene Wet Bijzondere Ziektekosten
[Exceptional Medical Expenses Act] (AWBZ).
Paragraph 8 ONVZ will also cover the transportation of a companion if necessary or if the patient is a child
under the age of 16. In exceptional cases, you can request prior permission from ONVZ for
transportation with two companions.
Paragraph 9 ONVZ would be happy to arrange taxi transportation for you. The procedure for requesting this is
set out in Part C (Health-care services).
Paragraph 10 If medical transportation by public transport, taxi or private car is not possible, you may also
apply to ONVZ for prior permission for medical transportation by another means of transport.
Clause 22
Dyslexia care Paragraph 1 Coverage includes reimbursement of the costs of care relating to serious dyslexia. Entitlement
only applies:
1. to children aged 7 or older who are in primary education;
2. if the provision of care commences at the age of 7, 8, 9, 10, 11 or 12; and
3. if the care is provided by the Regionaal Instituut voor Dyslexie [Regional Institute for
Dyslexia] (RID) or a health psychologist or general remedial educationalist registered as
such in the quality register for qualified practitioners of the Dutch professional association of
psychologists (NIP) or the Association of Educationalists in the Netherlands (NVO); and
45
4. if the diagnostics and/or treatment are in line with the criteria of the Protocol dyslexie
diagnostiek en behandeling [Protocol for diagnostics and treatment of dyslexia] from 2006.
The Protocol dyslexie diagnostiek en behandeling serves as a guide for the diagnosis, medical
assessment and treatment of people with dyslexia. The objective is to set out the best possible
care for people with dyslexia, based on current scientific, professional and social insights.
The protocol is available on request from the ONVZ Service Centre or at www.onvz.nl/
polisvoorwaarden.
Paragraph 2 Coverage for the costs of dyslexia care requires a referral from the school doctor or a competent
official with the appropriate expertise who is associated with the school. This referral must contain
a motivation showing that the insured person’s school or learning progress is showing stagnation,
and additional support at school has yielded insufficient improvement.
Paragraph 3 The costs of dyslexia care will be charged by means of a DBC.
Clause 23
Paragraph 1 Coverage includes reimbursement of the costs of general basic mental health care (GGZ) as
provided by clinical psychologists.
The primary practitioner is:
• a health psychologist registered under the terms of the Wet BIG [Dutch Individual HealthCare Professions Act];
• a clinical psychologist registered under the terms of the Wet BIG [Dutch Individual HealthCare Professions Act];
• a paediatric psychologist registered with the Dutch Association of Psychologists (NIP);
• a general remedial educationalist registered with the Association of Educationalists in the
Netherlands (NVO);
• a psychotherapist registered under the terms of the Wet BIG [Dutch Individual Health-Care
Professions Act];
• an addiction specialist registered under the terms of the Wet BIG [Dutch Individual HealthCare Professions Act] and registered in the Royal Dutch Medical Association's profile register
of addiction specialists; or
• a psychiatrist registered under the terms of the Wet BIG [Dutch Individual Health-Care
Professions Act] and registered in the Royal Dutch Medical Association's register of
specialists;
• in chronic cases, the primary practitioner may be a specialist mental health-care nurse.
During health care, other health-care providers may provide care under the responsibility of the
primary practitioner. This may also include an internet programme.
Paragraph 2 1. General basic mental health care (GGZ) requires a referral from a general practitioner,
corporate doctor or school doctor. This requirement will be waived in acute cases.
2. For children referred to in the Wet op de Jeugdzorg [Dutch Youth Care Act], such health
care will be provided on the basis of diagnosis from the Bureau Jeugdzorg or a referral from
a doctor or other practitioner as referred to in Article 10 of the Uitvoeringsbesluit Wet op
de Jeugdzorg [Dutch Youth Care Act Implementation Decree], if the health care in question
is that as defined in Article 9b, Paragraph 5 of the Algemene Wet Bijzondere Ziektekosten
• treatment of psychological conditions without an underlying psychological disorder, in
accordance with the DSM IV-TR;
• treatment of adjustment disorders;
• assistance in the event of work-related and relationship problems.
This Clause does not cover the reimbursement of costs of treatment of psychological conditions
resulting from or related to a primary somatic (physical) ailment; they are covered by Clause 5
‘Specialist medical care’.
Paragraph 4 The costs of general basic mental health care (GGZ) will be charged by means of integrated basic
mental health-care (GGZ) packages.
Paragraph 5 If you started a course of primary psychological health care before 1 January 2014, which has not
been completed by that date, the following situations may arise.
• You had a maximum of two sessions of primary psychological health care in 2013 and the
treatment continues into 2014. In that case, ONVZ will reimburse the costs of health care
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in 2013 in accordance with the terms and conditions that applied to 31 December 2013
inclusive. For the health care in 2014, ONVZ will reimburse the shortest integrated basic
mental health-care (GGZ) package (the "Prestatie Basis GGZ Kort [Short basic mental healthcare (GGZ) package]) in accordance with the terms and conditions of this Clause. If, upon
completion of the treatment, more psychological health care is required in 2014, you will
need a new referral from your general practitioner. The general practitioner may stipulate
whether continuation of the treatment would be best within general medical care, general
basic mental health care (GGZ) or specialist mental health care (GGZ).
• You commenced a course of primary psychological health care in 2013, and require a
maximum of two further sessions in 2014. In that case, ONVZ will reimburse the costs of
health care in 2013 in accordance with the terms and conditions that applied to 31 December
2013 inclusive. For the health care in 2014, ONVZ will reimburse the designated basic mental
health-care (GGZ) package (the "Transitieprestatie Generalistische Basis GGZ [General basic
mental health-care (GGZ) transition package]).
Clause 24
Specialist mental health care (GGZ)
Paragraph 1 Admission to a psychiatric hospital
Coverage includes reimbursement of the costs of admission to a psychiatric hospital, or the
psychiatric wing of a hospital for no longer than 365 days. An interval of a maximum of thirty days
is not considered as an interval, but these days do not form part of the 365 days referred to above.
Intervals associated with weekend/holiday leave do form part of the 365 days referred to above.
ONVZ will reimburse the costs of specialist mental health care (GGZ) (as described below) and
hospital stay, whether or not associated with nursing and other care. ONVZ will also reimburse the
costs of allied health care, medicines, medical appliances and dressings related to the treatment
during the admission.
Paragraph 2 Specialist mental health care (GGZ)
Coverage extends to the costs of specialist mental health care (GGZ).
The primary practitioner is:
• a clinical psychologist registered under the terms of the Wet BIG [Dutch Individual HealthCare Professions Act];
• a psychotherapist registered under the terms of the Wet BIG [Dutch Individual Health-Care
Professions Act];
• an addiction specialist registered under the terms of the Wet BIG [Dutch Individual HealthCare Professions Act] and registered in the Royal Dutch Medical Association's profile register
of addiction specialists; or
• a psychiatrist registered under the terms of the Wet BIG [Dutch Individual Health-Care
Professions Act] and registered in the Royal Dutch Medical Association's register of
specialists;
The primary practitioner works in a multidisciplinary context, within which at least a psychiatrist,
clinical psychologist, clinical neuropsychologist, psychotherapist, elderly medical care specialist,
addiction specialist, clinical geriatric specialist or specialist mental health-care nurse works.
ONVZ will reimburse the costs of the treatment and also the related nursing, medicines, medical
appliances and dressings.
Paragraph 3 The extent of coverage is limited to care such as psychiatrists and clinical psychologists typically
offer.
Paragraph 4 1. Specialist mental health care (GGZ) (either with or without admission) requires a targeted
referral from a general practitioner. This requirement will be waived in acute cases.
2. For children referred to in the Wet op de Jeugdzorg [Dutch Youth Care Act], such health
care will be provided on the basis of diagnosis from the Bureau Jeugdzorg or a referral from
a doctor or other practitioner as referred to in Article 10 of the Uitvoeringsbesluit Wet op
de Jeugdzorg [Dutch Youth Care Act Implementation Decree], if the health care in question
is that as defined in Article 9b, Paragraph 5 of the Algemene Wet Bijzondere Ziektekosten
• treatment of simple or low-complexity psychological disorders that can be treated under
general basic mental health care (GGZ);
• treatment of adjustment disorders;
• assistance in the event of work-related and relationship problems;
• psychoanalysis.
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Paragraph 6 If you commenced specialist mental health care (GGZ) before 1 January 2014, and this has not
been completed by that date, ONVZ will reimburse completion of this treatment in accordance
with the terms and conditions that applied to 31 December 2013 inclusive. If you qualify for
follow-up treatment in relation to the same health needs, you will need a new referral from your
general practitioner. The general practitioner may stipulate whether continuation of the treatment
would be best within general medical care, general basic mental health care (GGZ) or specialist
mental health care (GGZ).
Clause 25
Abroad
If you spend time outside the Netherlands, or if you wish to undergo treatment outside the
Netherlands, ONVZ recommends that you check before travel that you have the correct medical
insurance card with you and whether you need to apply for any documentation in advance. For
more information, please contact the ONVZ Service Centre or visit
www.onvz.nl/buitenland.
Paragraph 1 Coverage will include reimbursement of the costs of the aforementioned health care provided by
a health-care provider or institution outside the Netherlands. ONVZ will reimburse the costs up to
the maximum amounts referred to in Clause 1, Paragraph 2.
Not all health care available outside the Netherlands meets the requirements of Clause 2,
Paragraph 3 of the General provisions (part A-1) of the Basisverzekeing basic health-care plan. For
more information, please contact the ONVZ Service Centre or visit www.onvz.nl/polisvoorwaarden
for the explanatory notes in De grens van zorg in het buitenland [The limits of health care
abroad].
Paragraph 2 If you live or are staying in another EU/EEA member state or a treaty country, you have the choice
of:
1. the right to reimbursement of the costs of health care under the statutory provisions of that
country under the EU Social Security Regulations or the appropriate treaty; or
2. the right to reimbursement of the costs of health care under this health-care plan. ONVZ will
reimburse the costs up to the maximum amounts referred to in Clause 1, Paragraph 2.
This shall also apply if you live in another EU/EEA member state or a treaty country and are
temporarily staying in the Netherlands, another EU/EEA member state, or a treaty country.
Paragraph 3 If you live or are staying in a country that is not an EU/EEA member state or a treaty country, you
shall be entitled to reimbursement of the costs of health care under this health-care plan. ONVZ
will reimburse the costs up to the maximum amounts referred to in Clause 1, Paragraph 2.
Paragraph 4 In the event of hospitalisation as a result of an acute illness or accident, you can contact ONVZ
Zorgassistance to arrange health care covered by the Basisverzekering basic health-care plan. The
procedure for doing this is set out in Part C (Health-care services).
Paragraph 5 ONVZ will reimburse invoices from foreign health-care providers in euros. This reimbursement
will be based on the average exchange rate that applied in the month before the claim was
processed.
Clause 26
General
Where necessary, you can claim reimbursement of the cost of types of health care other than
those specified in this health-care plan if it has been established that:
• it is generally accepted that this type of health care will lead to a similar result; and
• ONVZ has granted prior permission; and
• this type of health care has not been excluded by law.
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ONVZ ZorgConsulent: from prevention to aftercare
The ONVZ ZorgConsulent gives you personal assistance with information on health, prevention,
illness and health care. You can also get in touch with the ZorgConsulent for a range of health-care
matters and (waiting list) mediation. The ZorgConsulent is available on workdays from 8.30am
- 5.30pm on the following number: 0800 022 14 50 (free of charge within the Netherlands), or
through [email protected].
The ONVZ ZorgConsulent provides you with the following services:
• general information by telephone from a doctor or dietitian about illnesses, ailments and nutrition;
• information on subjects relating to health care, a healthy lifestyle, exercise and nutrition.
Health-care mediation
If you need medical assistance but it cannot be provided quickly (enough), you can request healthcare mediation from the ONVZ ZorgConsulent, who will endeavour to shorten the waiting time.
The ONVZ ZorgConsulent will also try to help if you request health-care mediation for any other reason.
Specialist medical treatment
The ONVZ ZorgConsulent gives you information about treatments in a hospital, and arranges
aspects related to such treatment:
• ONVZ collaborates with a network of selected medical specialists. At your request, the
ONVZ ZorgConsulent can provide information on treatment methods, treatment locations or
attending medical specialists. You will receive this information in writing so that you can discuss
it with your general practitioner/doctor or attending medical specialist;
• at your request, the ONVZ ZorgConsulent will help to arrange treatment in a hospital (as an
outpatient if necessary) or in a zorghotel. The ZorgConsulent can also help to arrange home
care or childcare. However, the costs of the latter are not covered by the Basisverzekering basic
health-care plan.
ONVZ provides information and mediation with the utmost care. However, ONVZ is not a healthcare provider, and therefore does not make diagnoses or perform medical treatments. Neither
does ONVZ offer medical advice and it cannot guarantee the correctness and effectiveness of the
treatment by a health-care provider. The health-care provider in question remains responsible for
his/her own actions. ONVZ, therefore, does not assume liability for those actions.
Health magazine, Lijf & Leden
Our health magazine, Lijf & Leden, gives you information on subjects relating to health, vitality and
developments in the health-care sector. As a member of ONVZ, you will receive this magazine free
of charge four times per year.
ONVZ Kraamzorg Service
Maternity care is part of the coverage for antenatal/post-natal care as defined in Clause 7 in Part B
of the Basisverzekering basic health-care plan. For information on maternity care, or if you would
like ONVZ to arrange your maternity care, please call ONVZ Kraamzorg Service. You can also
request maternity care by visiting www.onvz.nl/kraamzorg.
ONVZ Kraamzorg Service will arrange maternity care through a recognised maternity-care
organisation. You should request maternity care at least four months before the expected date of
birth. ONVZ Kraamzorg Service is ready to take your call between 8am and 5.30pm on working
days, on +31 (0)88 668 97 05.
Transportation by taxi is part of the coverage for other medical transportation as defined in Clause
21 in Part B of the Basisverzekering basic health-care plan. To ensure the best service for its
members, ONVZ has contracted a taxi company to arrange taxi transportation for insured persons.
To make use of this service, please call the taxi company on 0900 333 33 30, between 8.30am and
5pm on working days.
ONVZ Zorgassistance
If you are unexpectedly admitted to a hospital abroad, you can contact (or have someone else
contact) ONVZ Zorgassistance. You will be asked to provide your customer number and the name
of the insured person. You can also contact ONVZ Zorgassistance in emergency situations for
advice on medical assistance.
ONVZ Zorgassistance is available 24 hours per day, 7 days per week on the following telephone
number: +31 (0)88 668 97 67.
ONVZ Vrije Keuze Basisverzekering 124141
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ONVZ
Vrije Keuze Startfit
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Table of contents
ONVZ Vrije Keuze Startfit
Clause 1 Physical therapy 53
Physiotherapy and remedial therapy 53
Clause 2 Vaccinations 53
Clause 3 Preventive care 53
Health check-up 53
Clause 4 Abroad 53
Paragraph 1 Emergency treatment 54
Paragraph 2 Exchange rate 54
Paragraph 3 ONVZ Zorgassistance 54
Paragraph 4 Repatriation 54
Paragraph 5 Medical details 54
ONVZ ZorgConsulent: from prevention to aftercare A helping hand from the ZorgConsulent eHealth Health magazine, Lijf & Leden ONVZ Zorgassistance Aid for third-party claims for injury sustained as the result of an accident 52
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If coverage is offered under the Basisverzekering basic health-care plan or another health-care
plan and ONVZ Vrije Keuze Startfit offers supplementary coverage, you must act in accordance
with the terms and conditions of the Basisverzekering or the other health-care plan.
ONVZ reimburses the costs of the health care and other services set out below, on the basis
of statutory rates and performance or the prevailing market conditions. Coverage shall only
be provided in the event of medical necessity. If more than one person is covered by the same
health-care plan, the (maximum) levels of coverage shall apply for each insured person, unless
otherwise specified.
Clause 1
Physical therapy
Physiotherapy and remedial therapy
ONVZ will reimburse the costs of up to nine sessions per calendar year with a physiotherapist,
physiotherapist specialising in children, manual therapist, Cesar/Mensendieck remedial therapist,
pelvic therapist, oedema therapist, geriatrics physiotherapist or psychosomatic physiotherapist.
or special education, (medical) day nurseries or Centra voor Jeugd en Gezin [Youth and Family
Centres], providing ONVZ has granted prior permission for treatment at these locations. ONVZ
will only grant permission if there is a medical assessment for treatment at the intended locations,
and the treatment is incidental.
Clause 2
Vaccinations
ONVZ will reimburse the costs of vaccinations against hepatitis A and B, DTP, yellow fever,
typhoid, cholera, meningococci and rabies and the costs of malaria prophylactics in connection
with travel abroad, up to a maximum of € 75 per calendar year.
Clause 3
Preventive care
Health check-up
Following mediation by the ONVZ ZorgConsulent, ONVZ will reimburse the costs of an annual
health check-up. This comprises a medical questionnaire, BMI calculation, body fat percentage
calculation, waist circumference measurement, pulmonary function test, blood pressure
measurement, fitness test, fitness and health profile and examination of posture and the
musculoskeletal system. As an alternative to this annual medical check-up, you may opt for a
sport/exercise examination. This examination comprises a medical questionnaire, BMI calculation,
body fat percentage calculation, exertion test and individual exercise plans.
To request a health check-up or sport/exercise examination, please contact the ONVZ
ZorgConsulent (see Part C).
Clause 4
Abroad
ONVZ will reimburse the costs of the following medical care abroad. Not all health care available
outside the Netherlands meets the requirements of Clause 2, Paragraph 3 of the General
provisions (part A-1). For more information, please contact the ONVZ Service Centre or visit
www.onvz.nl/polisvoorwaarden for the explanatory notes in De grens van zorg in het buitenland
[The limits of health care abroad].
ONVZ Vrije Keuze Startfit 109141
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Paragraph 1 Emergency treatment
In cases of acute illness or accidents during time spent in an EU/EEA member state or a treaty
country, ONVZ will reimburse the costs of:
• care which is not otherwise covered by the Basisverzekering basic health-care plan or other
health-care plan, but only where it exceeds the amount that would have been reimbursed
had the care been provided in the Netherlands. The reimbursement shall be limited to the
statutory rate or prevailing market rate in the country concerned. The reimbursement under
the Basisverzekering or other health-care plan will constitute part of this;
• care which, under this supplementary health-care plan is covered up to a maximum of the
statutory or prevailing market rate in the country concerned.
In cases of acute illness or accidents during time spent outside an EU/EEA member state or a
treaty country, ONVZ will reimburse the costs of:
had the care been provided in the Netherlands. The reimbursement shall be limited to twice
the statutory rate or prevailing market rate in the Netherlands. The reimbursement under the
Basisverzekering or other health-care plan will constitute part of this;
• care which, under this supplementary health-care plan is covered up to a maximum of twice
the statutory or prevailing market rate in the Netherlands.
Paragraph 2 Exchange rate
ONVZ will reimburse invoices from foreign health-care providers in euros. This reimbursement
processed.
Paragraph 3 ONVZ Zorgassistance
If you are admitted to hospital due to an acute illness or accident during a temporary stay
abroad, you are obliged to contact (or have someone else contact) ONVZ Zorgassistance. You
will be asked to provide your customer number and the name of the insured person. You can also
contact ONVZ Zorgassistance for advice on medical assistance in emergency situations.
ONVZ Zorgassistance is available 24 hours per day, 7 days per week (see Part C).
Paragraph 4 Repatriation
In the event of serious illness or severe injury during a temporary stay abroad, coverage shall be
provided for medically necessary repatriation to the Netherlands with the prescribed medical
accompaniment. ONVZ Zorgassistance will arrange the repatriation.
In the event of essential repatriation, you are obliged to request help immediately (or have
someone else request help) from ONVZ Zorgassistance. You will be asked to provide your
customer number and the name of the insured person.
Paragraph 5 Medical details
You shall grant ONVZ Zorgassistance's medical adviser permission to pass on all relevant details
to ONVZ’s medical adviser where necessary. This includes information about the cause and
background of hospitalisation and/or repatriation.
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illness and health care. You can also get in touch with the ZorgConsulent for a range of
health-care matters and (waiting list) mediation. The ZorgConsulent is available on workdays
from 8.30am - 5.30pm on the following number: 0800 022 14 50 (free of charge within the
Netherlands), or through [email protected].
A helping hand from the ZorgConsulent
Our ZorgConsulent will provide support for you in the form of the following services.
Information and/or advice on:
• health care, healthy lifestyle, nutrition and exercise;
• preventive health check;
• preventive health-related courses;
• health-care provider(s), including general practitioner, dentist or psychologist;
• possible treatments for ailments.
Arranging:
• health check-up or exercise advice, see Part B, Clause 3;
• general information by telephone from a doctor or dietitian about illnesses, ailments and
nutrition.
Mediation:
• to reduce the waiting time for an initial consultation, treatment or admission;
• for a second opinion.
The ONVZ ZorgConsulent works with the utmost care. However, the ZorgConsulent is not a healthcare provider, cannot make a diagnosis and does not perform medical duties. Neither does the
ZorgConsulent offer medical advice and he/she cannot guarantee the correctness and effectiveness
of the treatment by a health-care provider. The health-care provider in question remains responsible
for his/her own actions. ONVZ, therefore, does not assume liability for those actions.
eHealth
ONVZ believes that it is important that you have as much personal control over your health and
treatment as possible. eHealth can help you in this respect. eHealth uses information and
communication technology (ICT) to support or improve your health. In many cases, it offers
alternative ways of providing health care, which are covered in your health-care plan. For example,
telemonitoring in the event of heart failure (remote control of the heart using a computer) is
covered by the Basisverzekering basic health-care plan, and online physiotherapy through
HelloFysio is covered by the supplementary health-care plan. eHealth also offers different kinds
of mental health care, which are covered by the Basisverzekering basic health-care plan or
supplementary health-care plan. For further information about the options and reimbursement of
eHealth, please contact our ZorgConsulent.
Our health magazine, Lijf en Leden, gives you information on subjects relating to health,
vitality and developments in the health-care sector. As a member of ONVZ, you will receive this
magazine free of charge four times per year.
ONVZ Zorgassistance
If you are unexpectedly admitted to a hospital abroad, you must contact (or have someone else
contact) ONVZ Zorgassistance. This also applies in the event of essential repatriation. You will
be asked to provide your customer number and the name of the insured person. You can also
ONVZ Zorgassistance is available 24 hours a day, 7 days a week on the following telephone number:
+ 31 (0)88 668 97 67.
ONVZ Vrije Keuze Startfit 134141
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Aid for third-party claims for injury sustained as the result of an accident
Under certain circumstances, you can receive aid from a lawyer or claims management service
engaged by ONVZ when making third-party claims for injury sustained as the result of an
accident. Third-party claims for injuries sustained can cover such health-care costs as those not
reimbursed by ONVZ under the coverage of the health-care plan, as well as compensation and
loss of income.
ONVZ will reimburse the costs of assistance up to a maximum of € 12,500, including any court
costs. The Reglement verhaalsbijstand [Rules for aid for third-party claims], also containing the
terms and conditions, can be obtained from ONVZ Verhaalszaken, or by visiting www.onvz.nl/
polisvoorwaarden. For more information, or to request and arrange aid, please contact ONVZ
Verhaalszaken.
ONVZ Verhaalszaken can be contacted during office hours on telephone number
+31 (0)30 639 62 64.
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ONVZ
Vrije Keuze Extrafit
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Table of contents
ONVZ Vrije Keuze Extrafit
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Clause 1 Antenatal/post-natal care Maternity package Clause 2 Physical therapy Paragraph 1 Physiotherapy and remedial therapy Paragraph 2 Sports doctor Clause 3 Pharmaceutical care Clause 4 Alternative/non-conventional medicine Clause 5 Vaccinations Clause 6 Other medical appliances Paragraph 1 Elbow crutches Paragraph 2 Bed-wetting alarm Paragraph 3 Supporting pessary Paragraph 4 Arch supports Clause 7 Other treatments and therapies Paragraph 1 Acne treatment Paragraph 2 Cosmetic skin camouflage treatment Paragraph 3 Electrical epilation or laser treatment Paragraph 4 MammaPrint Paragraph 5 Oedema therapy Paragraph 6 Podiatry
Paragraph 7 Psoriasis day treatment Paragraph 8 Stuttering therapy Clause 8 Accommodation costs Paragraph 1 Stay in a guest house Paragraph 2 Therapeutic camp for asthmatic children Clause 9 Medical transportation Clause 10 Preventive care Paragraph 1 Health check-up Paragraph 2 Preventive health-related courses Clause 11 Abroad Paragraph 1 Emergency treatment Paragraph 2 Planned treatment Paragraph 3 Exchange rate Paragraph 4 ONVZ Zorgassistance Paragraph 5 Repatriation Paragraph 6 Medical details 59
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ONVZ ZorgConsulent: from prevention to aftercare A helping hand from the ZorgConsulent eHealth Health magazine, Lijf & Leden Maternity care Transportation by taxi ONVZ Zorgassistance Aid for third-party claims for injury sustained as the result of an accident 64
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plan and ONVZ Vrije Keuze Extrafit offers supplementary coverage, you must act in accordance
Clause 1
Maternity package
The expectant mother is entitled to a maternity package, provided by the ONVZ Kraamzorg
Service. The procedure for requesting this is set out in Part C (Health-care services).
Clause 2
Physical therapy
ONVZ will reimburse the costs of up to nine sessions per calendar year with a physiotherapist,
Paragraph 2 Sports doctor
ONVZ will reimburse the costs of treatment by a sports doctor up to a maximum of € 100 per
calendar year.
Clause 3
Pharmaceutical care
Paragraph 1ONVZ will reimburse a maximum of € 100 per calendar year of the costs of:
• dispensing registered medicines which are not covered under the Basisverzekering basic
health-care plan or another health-care plan;
• the personal contributions for medicines under the Basisverzekering or another health-care
plan;
• dressings used to cover or dress skin conditions or wounds under the responsibility of the
attending doctor which are not covered under the Basisverzekering or another health-care
plan.
The medicines and dressings must be prescribed by the attending doctor, medical specialist,
dentist, dental specialist, midwife, specialist nurse or physician assistant. The medicines must
have been provided by a licensed pharmacist, dispensing practice or a chemist.
Paragraph 2 ONVZ will not reimburse the costs of:
• pharmaceutical health-care services other than dispensing medicines;
• substances classified as unlicensed medicine;
• homeopathic or anthroposophic medicines;
• vaccinations and preventive remedies other than those described in Clause 5;
• over-the-counter medication not covered by the Basisverzekering basic health-care plan or
another health-care plan;
• contraceptives, except in cases of medical necessity;
• medication for fertility treatment.
ONVZ Vrije Keuze Extrafit 117141
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Paragraph 3 ONVZ may stipulate that, where equivalent registered medicines are concerned, coverage
will extend to medicines designated by ONVZ only. However, if treatment with the designated
medicine is not medically responsible, ONVZ will reimburse the cost of another medicine with the
same active substance.
Clause 4
Paragraph 1 ONVZ will reimburse the costs of consultation or treatment provided by a doctor who practices
alternative/non-conventional medicine. Coverage shall be limited to a maximum of € 27
per consultation/treatment up to a maximum of one consultation/treatment per day, and 20
consultations/treatments per calendar year.
Paragraph 2 ONVZ will not reimburse the cost of treatment relating to (laboratory) tests prescribed by the
doctor referred to in Paragraph 1.
Clause 5
Vaccinations
Clause 6
Other medical appliances
Clause 3 Paragraph 1 applies to reimbursement for dressings.
Paragraph 1 Elbow crutches
ONVZ will reimburse the costs of the hire of elbow crutches prescribed by the attending doctor.
The maximum reimbursement is € 50 per calendar year.
Paragraph 2 Bed-wetting alarm
ONVZ will reimburse the costs of the hire of a bed-wetting alarm (incl. pads) for a period of no
longer than three months, or for the purchase of a bed-wetting alarm up to a maximum of € 85
for the whole duration of the health-care plan.
Paragraph 3 Supporting pessary
ONVZ will reimburse the costs of a supporting pessary in the case of treatment by a general
practitioner.
Paragraph 4 Arch supports
ONVZ will reimburse the costs of arch supports on prescription from the attending doctor. An
orthopaedic technician supplies the arch supports.
Clause 7
Other treatments and therapies
Paragraph 1 Acne treatment
If you are younger than 21 years of age, ONVZ will reimburse the costs of acne treatment
performed by a skin therapist or beautician. The treatment must be prescribed by the attending
dermatologist.
Paragraph 2 Cosmetic skin camouflage treatment
In the case of serious neck or facial skin disfigurements, ONVZ will reimburse the cost of
instruction relating to cosmetic skin camouflage treatment and the use of associated cosmetic
products.
Paragraph 3 Electrical epilation or laser treatment
ONVZ will reimburse female insured persons with excessive facial hair growth for the costs
of electrical epilation or laser treatment performed by a medical specialist, skin therapist or
beautician. The treatment must be prescribed by the attending dermatologist. The coverage shall
be limited to € 1,000 for the whole duration of the health-care plan.
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Paragraph 4 MammaPrint
ONVZ will reimburse the costs of MammaPrint, prescribed by the attending
medical specialist associated with a hospital. MammaPrint is a diagnostic test for breast-cancer
patients, which enables a better assessment of the risk of metastasis.
The attending medical specialist can use the result to make a better decision as to which
treatment would be most effective after the operation.
Paragraph 5 Oedema therapy
ONVZ will reimburse the costs of treatment of serious lymphoedema by a skin therapist.
Paragraph 6 Podiatry
ONVZ will reimburse the costs of care provided by a foot specialist or podiatrist/chiropodist.
ONVZ will also reimburse the costs of manufactured podiatric soles and ortheses.
Paragraph 7 Psoriasis day treatment
ONVZ will reimburse the costs of treatment in a psoriasis day treatment centre up to a maximum
of € 500 per calendar year. Treatment must be prescribed by the attending doctor.
Paragraph 8 Stuttering therapy
ONVZ will reimburse the costs of stuttering therapy and the meal and accommodation costs in
the institution concerned if this constitutes part of the treatment. The coverage shall be limited to
€ 350 for the whole duration of the health-care plan.
Clause 8 Accommodation costs
Paragraph 1 Stay in a guest house
• If you are younger than 18 and are being treated in a hospital, ONVZ will reimburse the
personal contribution for your co-insured parent(s) to stay in a Ronald McDonald House or
in a guest house associated with the hospital. The cover is limited to € 12.50 per day with a
maximum of € 260 per calendar year.
• If you are aged 18 or above and have been admitted to hospital, ONVZ will reimburse the
costs for a co-insured family member to stay in a guest house associated with the hospital
during your admission. The maximum reimbursement is € 25 per day.
Paragraph 2 Therapeutic camp for asthmatic children
ONVZ will reimburse the personal contribution up to a maximum of € 6 per day for a maximum of
42 days per calendar year.
Clause 9
If you are covered for medical transportation under the Basisverzekering basic health-care plan or
another health-care plan, ONVZ will reimburse the personal contribution.
Clause 10
Preventive care
Paragraph 1 Health check-up
Paragraph 2 Preventive health-related courses
ONVZ shall reimburse the costs of the following preventive health-related courses recognised by
ONVZ up to a maximum of € 75 per calendar year. A list of recognised preventive health-related
courses can be found at www.onvz.nl/polisvoorwaarden or requested from the ONVZ Service
Centre.
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Clause 11
Abroad
If you spend time outside the Netherlands, or if you wish to undergo treatment outside
the Netherlands, ONVZ recommends that you check before travel that you have
the correct medical insurance card with you and whether you need to apply for any
documentation in advance. For more information, please contact the ONVZ Service
Centre or visit www.onvz.nl/buitenland.
ONVZ will reimburse the costs of the following medical care abroad. Not all health care
available outside the Netherlands meets the requirements of Clause 2, Paragraph 3
of the General provisions (Part A-1). For more information, please contact the ONVZ
Service Centre or visit www.onvz.nl/polisvoorwaarden for the explanatory notes in De
grens van zorg in het buitenland [The limits of health care abroad].
In cases of acute illness or accidents during time spent in an EU/EEA member state or a
• care which is not otherwise covered by the Basisverzekering basic health-care
plan or other health-care plan, but only where it exceeds the amount that would
have been reimbursed had the care been provided in the Netherlands. The
reimbursement shall be limited to the statutory rate or prevailing market rate in the
country concerned. The reimbursement under the Basisverzekering or other healthcare plan will constitute part of this;
• care which, under this supplementary health-care plan is covered up to a maximum
of the statutory or prevailing market rate in the country concerned;
• medicines that are not registered in the Netherlands, and medicines that are
classified in the Netherlands as unlicensed medicine (Niet geneesmiddel) up to a
In cases of acute illness or accidents during time spent outside an EU/EEA member
state or a treaty country, ONVZ will reimburse the costs of:
• care which is not otherwise covered by the Basisverzekering basic health-care
plan or other health-care plan, but only where it exceeds the amount that would
have been reimbursed had the care been provided in the Netherlands. The
reimbursement shall be limited to twice the statutory rate or prevailing market rate
in the Netherlands. The reimbursement under the Basisverzekering or other healthcare plan will constitute part of this;
• care which, under this supplementary health-care plan is covered up to a maximum
of twice the statutory or prevailing market rate in the Netherlands;
• medicines that are not registered in the Netherlands, and medicines that are
classified in the Netherlands as unlicensed medicine (Niet geneesmiddel) up to a
Paragraph 2 Planned treatment
ONVZ will reimburse the costs:
• of specialist medical care (other than alternative/non-conventional care), as referred
to in Clause 5 of Part B of the Basisverzekering basic health-care plan, if the care
is provided in a hospital recognised by ONVZ within 60 kilometres of the Dutch
border. The reimbursement under the Basisverzekering or other health-care plan
will constitute part of this. The list of hospitals recognised by ONVZ is subject to
change. The current list is available on request from the ONVZ Service Centre or
can be found at www.onvz.nl/polisvoorwaarden;
• which are covered under this supplementary health-care plan. The reimbursement
shall be limited to the statutory rate or prevailing market rate in the Netherlands.
ONVZ will reimburse invoices from foreign health-care providers in euros. This
reimbursement will be based on the average exchange rate that applied in the month
before the claim was processed.
If you are admitted to hospital due to an acute illness or accident during a temporary
stay abroad, you are obliged to contact (or have someone else contact) ONVZ
Zorgassistance. You will be asked to provide your customer number and the name of
the insured person. You can also contact ONVZ Zorgassistance for advice on medical
assistance in emergency situations.
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accompaniment. ONVZ Zorgassistance will arrange the repatriation.
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Arranging:
• health check-up or exercise advice, see Part B, Clause 10, Paragraph 1;
• general information by telephone from a doctor or dietitian about illnesses, ailments and nutrition.
Mediation:
eHealth
ONVZ believes that it is important that you have as much personal control over your health
and treatment as possible. eHealth can help you in this respect. eHealth uses information
and communication technology (ICT) to support or improve your health. In many cases, it
offers alternative ways of providing health care, which are covered in your health-care plan.
For example, telemonitoring in the event of heart failure (remote control of the heart using a
computer) is covered by the Basisverzekering basic health-care plan, and online physiotherapy
through HelloFysio is covered by the supplementary health-care plan. eHealth also offers different
kinds of mental health care, which are covered by the Basisverzekering basic health-care plan or
Maternity care
If you have any questions about maternity care or would like to request the maternity package,
please contact the ONVZ Kraamzorg Service. The ONVZ Kraamzorg Service is ready to take your
call between 8am and 5.30pm on working days, on +31 (0)88 668 97 05. You can also request
maternity care by visiting www.onvz.nl/kraamzorg. Details of the maternity package can be found
at www.onvz.nl/polisvoorwaarden.
Transportation by taxi is part of the coverage for other medical transportation as defined in
Clause 9 of Part B. To ensure the best service for its members, ONVZ has contracted a taxi
company to arrange taxi transportation for insured persons. To make use of this service, please
call the taxi company on 0900 333 33 30, between 8.30am and 5pm on working days.
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ONVZ Vrije Keuze Extrafit 132141
ONVZ Zorgassistance
+ 31 (0)88 668 97 67.
loss of income.
ONVZ will reimburse the full costs of assistance up to a maximum of € 12,500, including any
court costs. The Reglement verhaalsbijstand [Rules for aid for third-party claims], also containing
the terms and conditions, can be obtained from ONVZ Verhaalszaken, or by visiting www.onvz.
nl/polisvoorwaarden. For more information, or to request and arrange aid, please contact ONVZ
Verhaalszaken.
+31 (0)30 639 62 64.
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Table of contents
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Clause 1 Antenatal/post-natal care Paragraph 1 Birth and maternity care Paragraph 2 Maternity package Paragraph 3 Breastfeeding specialist Paragraph 4 Health care upon adoption Clause 2 Physical therapy Paragraph 1 Physiotherapy and remedial therapy Paragraph 2 Other therapies for posture and movement Paragraph 3 Exercise programmes Clause 3 Pharmaceutical care Clause 4 Alternative/non-conventional medicine Clause 5 Vaccinations Clause 6 Carer relief Clause 7 Personal contribution for medical appliances Clause 8 Other medical appliances Paragraph 1 Elbow crutches Paragraph 2 Contraceptive devices Paragraph 3 Bed-wetting alarm Paragraph 4 Supporting pessary Paragraph 5 Arch supports Clause 9 Other treatments and therapies Paragraph 1 Acne treatment Paragraph 2 Cosmetic skin camouflage treatment Paragraph 3 Dietitian Paragraph 4 Electrical epilation or laser treatment Paragraph 5 MammaPrint Paragraph 6 Oedema therapy Paragraph 7 Orthoptics Paragraph 8 Menopause consultant Paragraph 9 Pedicure Paragraph 10 Podiatry Paragraph 11 Psoriasis day treatment Paragraph 12 Sterilisation Paragraph 13 Stuttering therapy Clause 10 Accommodation costs
Paragraph 1 Stay in a guest house Paragraph 2 Therapeutic camp for young people Clause 11 Medical transportation Clause 12 Travel costs for visiting ill people Clause 13 Orthodontics Clause 14 Preventive care Paragraph 1 Health check-up Paragraph 2 Influenza vaccination Paragraph 3 Preventive health-related courses Clause 15 Abroad
Paragraph 1 Emergency treatment Paragraph 2 Planned treatment Paragraph 3 Exchange rate Paragraph 4 ONVZ Zorgassistance Paragraph 5 Repatriation Paragraph 6 Medical details Paragraph 7 Telephone costs 69
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plan and ONVZ Vrije Keuze Benfit offers supplementary coverage, you must act in accordance
Clause 1
Paragraph 1 Birth and maternity care
Following a birth, the mother can claim reimbursement of the following costs, up to a combined
maximum of € 250:
• the personal contribution for a birth in an outpatient clinic without medical necessity under
the Basisverzekering or another health-care plan;
• the personal contribution for maternity care under the Basisverzekering basic health-care
plan or another health-care plan;
• the costs of incubator care following the arrival home of a newborn baby who spent at least
five days in the incubation department, or who spent time in the incubation department
during a hospital admission of at least eight days. The care involves providing essential
support, advice and guidance on caring for, and looking after, the child;
• the costs of deferred or additional maternity care.
Maternity care that starts ten days or more after the birth is referred to as deferred maternity
care. This kind of maternity care always involves fewer care days and hours than normal
maternity care.
Maternity care that, for medical reasons, involves the provision of more care than is covered
by the Basisverzekering basic health-care plan or other health-care plan, is referred to as
additional maternity care.
ONVZ would be happy to arrange maternity care for you. The procedure for requesting this is set
out in Part C (Health-care services).
Paragraph 2 Maternity package
Paragraph 3 Breastfeeding specialist
ONVZ will reimburse the costs of a maximum of two consultations with a breastfeeding specialist.
Paragraph 4 Health care upon adoption
In case of adoption of a child under twelve months, ONVZ shall pay a contribution of a maximum
of € 250 to go towards covering the following costs:
• the costs of maternity care;
• the personal contribution for maternity care under the Basisverzekering basic health-care plan
or another health-care plan;
• the costs of medical screening by a paediatrician.
If both parents are insured with ONVZ, only a single claim can be made for reimbursement under
these provisions.
ONVZ Vrije Keuze Benfit 111141
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Clause 2
Physical therapy
ONVZ will reimburse the costs of up to twelve sessions per calendar year by a physiotherapist,
Paragraph 2 Other therapies for posture and movement
ONVZ will reimburse the costs of the following treatments up to a combined maximum of € 500
per calendar year:
• chiropractic therapy by a chiropractor;
• “Eggshell method” E.S.® manual therapy by a therapist who is a member of the Vereniging
van Manueel Therapeuten [Manual Therapists’ Association] (VMT);
• osteopathy by an osteopath;
• treatment by a sports doctor.
Paragraph 3 Exercise programmes
ONVZ will reimburse the costs of the following exercise programmes up to a combined maximum
of € 250 per calendar year:
• an exercise programme that meets the standards set by the Royal Dutch Society for Physical
Therapy for exercise interventions and is prescribed by the attending doctor. The exercise
programme must be aimed at healing and recovery, preventing further complaints or, in cases
of chronic illness, promoting good health;
• the Herstel & Balans [Recovery & Balance] rehabilitation programme, aimed at helping
cancer patients learn to deal with (residual) symptoms and reducing these symptoms. The
programme must be prescribed by the attending doctor and given by an institution with a
licence from the Herstel & Balans Foundation;
• an exercise programme under the referral of a general practitioner, corporate doctor or
medical specialist. The referral must state that there is:
1. a BMI of at least 30kg/m2 (obese); or
2. a BMI of 25 - 30kg/m2 (overweight) in combination with an increased risk of cardiovascular
disease, an increased risk of diabetes mellitus type II, or evidence of a condition related
to obesity.
The exercise programme must be provided by a physiotherapist, Cesar/Mensendieck
remedial therapist, or a home-care organisation. The exercise programme must be aimed
at influencing the patient’s level of exercise and developing an active and healthy lifestyle,
such that after three to four months the patient can progress to a regular sports programme.
The exercise programme can constitute part of a combined lifestyle intervention, of which
the other components, for example dietetics and behavioural change, are partially or fully
covered under the Basisverzekering basic health-care plan or another health-care plan. For
further information, please contact the ONVZ ZorgConsulent (see Part C).
Clause 3
Pharmaceutical care
Paragraph 1 ONVZ will reimburse a maximum of € 200 per calendar year of the costs of:
plan;
attending doctor which are not covered under the Basisverzekering or another health-care plan.
ONVZ will reimburse in full the costs of registered medicines for contraceptive purposes (to
prevent pregnancy), if you are aged 21 or older.
have been provided by a licensed pharmacist, dispensing practice or a chemist.
Vaccinations and preventive remedies for travel abroad are covered under Clause 5.
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• substances classified as unlicensed medicine;
• homeopathic or anthroposophic medicines;
• over-the-counter medication not covered by the Basisverzekering basic health-care plan or
another health-care plan;
• medication for fertility treatment.
Clause 4
Paragraph 1 ONVZ shall reimburse the costs of consultation or treatment provided by a doctor who practices
alternative/non-conventional medicine or an acupuncturist. The coverage shall be limited to a
maximum of € 27 per consultation/treatment, with a maximum of one consultation/treatment per
day, and a maximum of 20 consultations/treatments per calendar year.
The acupuncturist must have full membership of a professional organisation that is recognised by
ONVZ. A list of these professional organisations can be found at www.onvz.nl/polisvoorwaarden
or requested from the ONVZ Service Centre.
Paragraph 2 ONVZ will not reimburse the cost of treatment relating to (laboratory) tests prescribed by the
doctor or acupuncturist referred to in Paragraph 1.
Clause 5
Vaccinations
Clause 6
Carer relief
If you are chronically ill or handicapped and your own carers are ill or on holiday, ONVZ shall
arrange and reimburse the costs of carer relief for a maximum of eight days per calendar year.
The Stichting Mantelzorgvervanging Nederland “Handen-in-Huis” association shall provide the
care. You can request carer relief from the ONVZ ZorgConsulent (see Part C).
Clause 7
Personal contribution for medical appliances
ONVZ will reimburse the personal contributions payable as stated in the Reglement
Hulpmiddelen [Medical Appliance Regulations] up to a combined maximum of € 250 per
calendar year. The Reglement Hulpmiddelen [Medical Appliance Regulations] constitutes part of
the Basisverzekering basic health-care plan A copy of these regulations is available on request
from the ONVZ Service Centre and they can also be found at www.onvz.nl/polisvoorwaarden.
Clause 8
Paragraph 1 Elbow crutches
ONVZ will reimburse the costs of the hire of elbow crutches prescribed by the attending doctor.
The maximum reimbursement is € 50 per calendar year.
Paragraph 2 Contraceptive devices
If you are aged 21 or older, ONVZ will reimburse the costs of pessaries and copper IUDs for
contraceptive purposes.
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practitioner.
Clause 9
dermatologist.
products.
Paragraph 3 Dietitian
ONVZ will reimburse the costs of information and advice on nutrition and eating habits with a
medical purpose provided by a dietitian up to a maximum of € 120 per calendar year.
ONVZ will not reimburse the costs of:
• dietary preparations and food;
• treatment for obesity in insured persons who are 18 years or older, where the patient's BMI
is 25 - 30kg/m2, except where there is comorbidity or other risk factors, familial or otherwise.
ONVZ will reimburse the costs of this type of health care under Preventive health-related
courses (Clause 14, Paragraph 3).
ONVZ will reimburse the costs of MammaPrint, prescribed by the attending medical specialist
associated with a hospital. MammaPrint is a diagnostic test for breast-cancer patients, which
enables a better assessment of the risk of metastasis. The attending medical specialist can use
the result to make a better decision as to which treatment would be most effective after the
operation.
Paragraph 7 Orthoptics
ONVZ will reimburse the costs of orthoptic care by an orthoptist up to a maximum of € 500 per
calendar year. The care must be prescribed by the attending general practitioner or medical
specialist.
Paragraph 8 Menopause consultant
ONVZ will reimburse the costs of information, advice and care provided by a menopause
consultant during the menopause up to a maximum of € 120 per calendar year. The
menopause consultant must be affiliated with Care for Women or Vereniging Verpleegkundig
OvergangsConsulenten [Medical Menopause Consultants’ Association] (VVOC).
Paragraph 9 Pedicure
ONVZ will reimburse the costs of foot care provided by a pedicurist in cases of diabetes mellitus
or rheumatoid arthritis, up to a maximum of € 100 per calendar year.
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Paragraph 10Podiatry
Paragraph 11Psoriasis day treatment
Paragraph 12Sterilisation
ONVZ will reimburse the costs of sterilisation. No coverage shall be provided for the reversal of
sterilisation.
Paragraph 13Stuttering therapy
Clause 10 Accommodation costs
personal contribution for your co-insured parent(s) to stay in a Ronald McDonald House or in
a guest house associated with the hospital. The coverage is limited to € 12.50 per day with a
Paragraph 2 Therapeutic camp for young people
ONVZ will reimburse the personal contribution towards the costs of a therapeutic camp for young
people who are overweight or who have asthma, diabetes mellitus, constitutional eczema, or an
oncological condition. The maximum reimbursement is € 250 for a maximum of one camp per
calendar year.
Clause 11
ONVZ will reimburse the costs of medical transportation in the Netherlands, where the
transportation is for treatment covered by the Basisverzekering basic health-care plan or another
health-care plan and, for medical reasons, public transport cannot be used.
ONVZ will reimburse:
1. the personal contribution under the Basisverzekering or another health-care plan;
2. € 0.27 per kilometre, where transportation is by private car. The amount reimbursed will be
ascertained with reference to the optimum route by car according to the Routenet route
planner;
3. transportation by taxi.
Costs associated with transportation, for example parking charges, will not be reimbursed.
If you would like transportation by taxi, ONVZ can arrange this for you. For more information,
please see Part C (Health-care services).
Clause 12 Travel costs for visiting ill people
If a member of your family has been admitted to a hospital in the Netherlands or to a hospital
within 60 kilometres of the Dutch border, ONVZ will reimburse the travel costs for visiting him/her,
from the eighth day of admission onwards. The period of admission must be continuous. ONVZ
will reimburse € 0.27 per kilometre from your home address in the Netherlands to the hospital.
The amount reimbursed will be ascertained with reference to the optimum route by car according
to the Routenet route planner. The maximum reimbursement is € 150 per calendar year. Both you
and the hospitalised family member must be insured with ONVZ.
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Clause 13 Orthodontics
ONVZ will reimburse the costs of orthodontic treatment (such as a brace) provided by a dentist
or orthodontist. Treatment must be performed before the patient reaches the age of 18. The
coverage shall be limited to € 1,365 for the whole duration of the health-care plan.
ONVZ will not reimburse the costs of making and fitting a Mandibular Repositioning Appliance (MRA).
This is a brace which forces both jaws into a particular position, whilst keeping the airway clear.
Clause 14
Preventive care
Paragraph 2 Influenza vaccination
ONVZ shall reimburse the costs of an annual influenza vaccination if you do not belong to one
of the risk groups eligible under the Nationaal Programma Grieppreventie [National Influenza
Prevention Programme].
ONVZ will reimburse the costs of the following preventive health-related courses recognised by
ONVZ up to a combined maximum of a€ 150 per calendar year. A list of recognised preventive
health-related courses can be found at www.onvz.nl/polisvoorwaarden or requested from the
ONVZ Service Centre.
Clause 15
Abroad
In cases of acute illness or accidents during time spent in an EU/EEA member state or a treaty
country, ONVZ will reimburse the costs of:
• medicines that are not registered in the Netherlands, and medicines that are classified in
the Netherlands as unlicensed medicine (Niet geneesmiddel) up to a maximum of € 75 per
calendar year.
In cases of acute illness or accidents during time spent outside an EU/EEA member state or a
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• care which, under this supplementary health-care plan is covered up to a maximum of twice
the statutory or prevailing market rate in the Netherlands;
calendar year.
• of specialist medical care (other than alternative/non-conventional care), as referred to in
Clause 5 of Part B of the Basisverzekering basic health-care plan, if the care is provided in a
hospital recognised by ONVZ within 60 kilometres of the Dutch border. The reimbursement
under the Basisverzekering or other health-care plan will constitute part of this. The list of
hospitals recognised by ONVZ is subject to change. The latest list is available on request
from the ONVZ Service Centre or can be found at www.onvz.nl/polisvoorwaarden;
• of medical transportation if the transportation is for a treatment covered under the
Basisverzekering basic health-care plan or another health-care plan. Treatment must
take place in a hospital within 60km of the Dutch border. ONVZ will reimburse the cost
of transportation from your home address in the Netherlands to the hospital. ONVZ will
reimburse the cost of transportation by taxi, or € 0.27 per kilometre, where transportation
is by private car. The amount reimbursed will be ascertained with reference to the optimum
route by car according to the Routenet route planner. If you would like transportation by
taxi, ONVZ can arrange this for you. For more information, please see Part C (Health-care
services). Costs associated with transportation, for example parking charges, will not be
reimbursed;
• which are covered under this supplementary health-care plan. The reimbursement shall be
limited to the statutory rate or prevailing market rate in the Netherlands.
processed.
accompaniment. In the event of death, ONVZ will reimburse the costs of repatriation of the
physical remains to the Netherlands. ONVZ Zorgassistance will arrange the repatriation.
Paragraph 7 Telephone costs
ONVZ will reimburse telephone costs incurred when calling ONVZ Zorgassistance from abroad.
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Arranging:
• carer relief, see Part B, Clause 6;
• health check-up or exercise advice, see Part B, Clause 10, Paragraph 1;
nutrition.
Mediation:
The ONVZ ZorgConsulent works with the utmost care. However, the ZorgConsulent is not a
health-care provider, cannot make a diagnosis and does not perform medical duties. Neither
does the ZorgConsulent offer medical advice and he/she cannot guarantee the correctness and
effectiveness of the treatment by a health-care provider. The health-care provider in question
remains responsible for his/her own actions. ONVZ, therefore, does not assume liability for those
actions.
eHealth
Maternity care
please contact the ONVZ Kraamzorg Service. The ONVZ Kraamzorg Service is ready to take your
call between 8am and 5.30pm on working days, on +31 (0)88 668 97 05. You can also request
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ONVZ Zorgassistance
+ 31 (0)88 668 97 67.
loss of income.
Verhaalszaken.
+31 (0)30 639 62 64.
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Vrije Keuze Optifit
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Table of contents
Clause 1 Antenatal/post-natal care Paragraph 1 Birth and maternity care Paragraph 2 Maternity package Paragraph 3 Breastfeeding specialist Paragraph 4 TENS device Paragraph 5 Health care upon adoption
Clause 2 Physical therapy Paragraph 1 Physiotherapy and remedial therapy Paragraph 2 Other therapies for posture and movement Paragraph 3 Exercise programmes Clause 3 General basic mental health care (GGZ) Clause 4 Pharmaceutical care Clause 5 Alternative/non-conventional medicine Clause 6 Vaccinations Clause 7 Domestic assistance Clause 8 Carer relief Clause 9 Personal contribution for medical appliances Clause 10 Other medical appliances Paragraph 1 Lenses for glasses, (contact) lenses, or laser eye treatment Paragraph 2 Contraceptive devices Paragraph 3 Walking aids Paragraph 4 Bed-wetting alarm Paragraph 5 Supporting pessary Paragraph 6 Arch supports Clause 11 Other treatments and therapies Paragraph 1 Acne treatment Paragraph 2 Cosmetic skin camouflage treatment
Paragraph 3 Dietitian Paragraph 4 Electrical epilation or laser treatment
Paragraph 5 MammaPrint Paragraph 6 Oedema therapy
Paragraph 7 Orthoptics Paragraph 8 Menopause consultant Paragraph 9 Pedicure Paragraph 10 Plastic surgery Paragraph 11 Podiatry Paragraph 12 Psoriasis day treatment
Paragraph 13 Sterilisation Paragraph 14 Stuttering therapy Clause 12 Accommodation costs Paragraph 1 Stay in a guest house Paragraph 2 Stay in a hospice Paragraph 3 Therapeutic camp for young people Clause 13 Medical transportation Clause 14 Travel costs for visiting ill people Clause 15 Dental health care Clause 16 Preventive care Paragraph 1 Health check-up Paragraph 2 Influenza vaccination
Paragraph 3 Patients' association membership
Paragraph 5 Preventive medical investigations Paragraph 6 Programmes for quitting smoking Clause 17 Abroad Paragraph 1 Emergency treatment Paragraph 2 Planned treatment Paragraph 3 Exchange rate Paragraph 4 ONVZ Zorgassistance Paragraph 5 Repatriation Paragraph 6 Medical details Paragraph 7 Telephone costs 80
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plan and ONVZ Vrije Keuze Optifit offers supplementary coverage, you must act in accordance
Clause 1
maximum of € 400:
maternity care.
ONVZ will reimburse the costs of a maximum of four consultations with a breastfeeding specialist.
Paragraph 4 TENS device
ONVZ will reimburse the costs of hiring a TENS device for a maximum period of six weeks. TENS
is a device used for pain relief during childbirth. You can request a TENS device from the ONVZ
these provisions.
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ONVZ Vrije Keuze Optifit 112141
Clause 2
Physical therapy
ONVZ will reimburse the costs of up to 35 treatments per calendar year by a physiotherapist,
ONVZ will reimburse the costs of the following treatments up to a combined maximum of € 750
per calendar year:
ONVZ will reimburse the costs of the following exercise programmes up to a combined maximum
of € 500 per calendar year:
programme must be aimed at healing and recovery, preventing further complaints or, in
cases of chronic illness, promoting good health;
• an exercise programme based on the CytoFys, OncoMove or Sportplan Tegenkracht
method, during chemotherapy treatment. The exercise programme must be prescribed by
the attending doctor and provided by a physiotherapist or sports medical advice centre
(Sportmedisch Adviescentrum);
2. a BMI of 25-30 kg/m2 (overweight) in combination with an increased risk of
cardiovascular disease, an increased risk of diabetes mellitus type II or evidence of a
condition related to obesity.
further information, please contact the ONVZ ZorgConsulent (see Part C).
Clause 3
ONVZ will reimburse the costs of general basic mental health care (GGZ) for the treatment of
adjustment disorders or care in the event of work-related or relationship problems, up to a
maximum of € 500 per calendar year. The primary practitioner is a health psychologist registered
under the terms of the Wet BIG [Dutch Individual Health-Care Professions Act], a clinical
psychologist registered under the terms of the Wet BIG [Dutch Individual Health-Care Professions
Act], a paediatric psychologist registered with the Dutch Association of Psychologists (NIP),
or a general remedial educationalist registered with the Association of Educationalists in the
Netherlands (NVO).
General basic mental health care (GGZ) requires a referral from a general practitioner, corporate
doctor or school doctor.
ONVZ will not cover accommodation expenses.
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Clause 4
Pharmaceutical care
Paragraph 1 ONVZ will reimburse a maximum of € 4,540 per calendar year of the costs of:
• registered over-the-counter medication which is not covered under the Basisverzekering basic
health-care plan or any other health-care plan;
plan;
• melatonin that can only be obtained from the pharmacist with a doctor's prescription.
ONVZ will not reimburse the costs of freely available melatonin (i.e. without a prescription).
Melatonin can be obtained through the ONVZ delivery service. For more information, please
see Part C (Health-care services);
plan.
have been provided by a licensed pharmacist, dispensing practice or a chemist. Melatonin must,
however, be supplied by a pharmacist or dispensing practice.
For coverage for:
• registered homeopathic and anthroposophic medicines, Clause 5 Paragraph 3 applies;
• vaccinations and preventive remedies for travel abroad, Clause 6 applies.
• substances classified as unlicensed medicine (Niet geneesmiddel).
Clause 5
alternative/non-conventional medicine, including doctors who practice acupuncture. The
coverage shall be limited to a maximum of € 85 per consultation/treatment, with a maximum of
one consultation/treatment per day. ONVZ will reimburse up to a maximum of € 750 per calendar
year for all consultations and treatments combined.
Paragraph 2 ONVZ will reimburse the costs of consultation or treatment provided by practitioners of
alternative/non-conventional medicine, including acupuncturists. The coverage shall be limited
to a maximum of € 65 per consultation/treatment, with a maximum of one consultation/treatment
per day. ONVZ will reimburse up to a maximum of € 250 per calendar year for all consultations
and treatments combined.
The practitioner must have full membership of a professional organisation that is recognised by
Paragraph 3 ONVZ will reimburse a maximum of € 250 per calendar year of the costs of:
• registered homeopathic or anthroposophic medicines. The homeopathic or anthroposophic
medicines must have been prescribed by the attending doctor or practitioner and supplied
by a licensed pharmacist or dispensing practice;
• treatment relating to (laboratory) tests prescribed by the doctor or practitioner referred to in
Paragraphs 1 and 2.
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Clause 6
Vaccinations
Clause 7
Domestic assistance
Domestic assistance is covered by the Wet maatschappelijke ondersteuning [Social Support Act]
(WMO). If you are not eligible for this Wmo provision, you can claim under the coverage offered
by this clause. The coverage does not extend to the reimbursement of personal contributions
payable under the Wmo.
ONVZ will reimburse the costs of domestic assistance up to a maximum of nine hours if:
• you are aged 18 or above;
• the assistance immediately follows hospitalisation of at least five days;
• the assistance was requested through the ONVZ ZorgConsulent (see Part C) as soon as
possible, but no later than the day you were discharged; and
• the ONVZ ZorgConsulent arranges the domestic assistance.
Clause 8
Carer relief
arrange and reimburse the costs of carer relief for a maximum of eight days per calendar year.
The Stichting Mantelzorgvervanging Nederland “Handen-in-Huis” association shall provide the
care. You can request carer relief from the ONVZ ZorgConsulent (see Part C).
Clause 9
Hulpmiddelen [Medical Appliance Regulations] up to a combined maximum of € 500 per
Clause 10
Paragraph 1 Lenses for glasses, (contact) lenses, or laser eye treatment
ONVZ will reimburse the costs of prescription/corrective lenses for glasses (including the frame),
prescription/corrective contact lenses or intraocular lenses to correct defective vision, and laser
eye treatment, up to a combined maximum of € 150 per calendar year.
Paragraph 3 Walking aids
ONVZ will reimburse the cost of purchase or hire of:
• elbow crutches;
• walking aids with three or four legs;
• walking frames;
• rollators;
• serving trolleys.
The aids must be prescribed by the attending general practitioner or medical specialist.
The maximum reimbursement is € 100 per calendar year for all aids combined.
85
practitioner.
Clause 11
dermatologist.
products.
medical purpose provided by a dietitian up to a maximum of €200 per calendar year.
enables a better assessment of the risk of metastasis. The attending medical specialist can use
the result to make a better decision as to which treatment would be most effective after the
operation.
ONVZ will reimburse the costs of orthoptic care by an orthoptist up to a maximum of € 750 per
calendar year. The care must be prescribed by the attending general practitioner or medical
specialist.
consultant during the menopause up to a maximum of € 250 per calendar year. The
menopause consultant must be affiliated with Care for Women or Vereniging Verpleegkundig
OvergangsConsulenten [Medical Menopause Consultants’ Association] (VVOC).
Paragraph 9 Pedicure
or rheumatoid arthritis, up to a maximum of € 200 per calendar year.
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Paragraph 10Plastic surgery
• surgery to correct the position of the ears (sticky-out ears) in children up to 18 years of age;
• the following treatments for a demonstrable physical dysfunction:
1. upper eyelid correction (blepharoplasty);
2. abdominal correction (abdominoplasty);
3. replacement of breast prostheses.
The regulations for reimbursement are available on request from the ONVZ Service Centre or at
Paragraph 13Sterilisation
ONVZ will reimburse the costs of sterilisation. No coverage shall be provided for the reversal of
sterilisation.
Clause 12
Accommodation costs
a guest house associated with the hospital. The coverage is limited to € 12.50 per day with a
Paragraph 2 Stay in a hospice
ONVZ will reimburse the personal contribution for a stay in a hospice or other palliative care
facility for a maximum three months, provided an indication has been issued for the stay by the
Centrum Indicatiestelling Zorg [Care Needs Assessment Centre] (CIZ), the general practitioner or
the attending medical specialist. The maximum reimbursement is € 25 per day.
oncological condition. The maximum reimbursement is € 300 per calendar year.
87
Clause 13
ascertained with reference to the optimum route by car according to the Routenet route planner;
If you would like transportation by taxi, ONVZ can arrange this for you.
For more information, please see Part C (Health-care services).
Clause 14 Travel costs for visiting ill people
to the Routenet route planner. The maximum reimbursement is € 250 per calendar year. Both you
and the hospitalised family member must be insured with ONVZ.
Clause 15
Dental health care
Paragraph 1 ONVZ will reimburse the costs of orthodontic treatment (such as a brace) provided by a dentist or
orthodontist. Treatment must be performed before the patient reaches the age of 18.
Paragraph 2 If you are younger than 18, ONVZ will reimburse the costs of general dental health care (including
technical costs). The care must be provided by a dentist or, where dental prostheses are involved,
a prosthodontist. The maximum reimbursement is € 500 per calendar year.
• teeth whitening;
• making and fitting an MRA (Mandibular Repositioning Appliance). This is a brace which forces
both jaws into a particular position, whilst keeping the airway clear.
Clause 16
Preventive care
ONVZ will reimburse the minimum contribution for membership of a patients' association affiliated
with the Nederlandse Patiënten en Consumenten Federatie [Federation of Patients and Consumer
Organisations in the Netherlands] (NPCF), the Chronisch zieken en Gehandicapten Raad [Dutch
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Council of the Chronically Ill and Disabled] or the Landelijk Platform GGz [National Mental HealthCare Platform] (LPGGz), up to a maximum of € 25 per calendar year. ONVZ will reimburse the
contribution upon presentation of a copy of proof of registration and payment.
ONVZ shall reimburse the costs of the following preventive health-related courses recognised by
ONVZ up to a maximum of € 250 per calendar year. A list of recognised preventive health-related
courses can be found at www.onvz.nl/polisvoorwaarden or requested from the ONVZ Service Centre.
Paragraph 5 Preventive medical investigations
ONVZ will reimburse 50% of the costs of preventive medical investigations up to a maximum
of € 250 per calendar year. The costs of tests carried out within a context other than medical
necessity (e.g. on behalf of an employer) are excluded from coverage. For further information,
please contact the ONVZ ZorgConsulent (see Part C).
Paragraph 6 Programmes for quitting smoking
ONVZ will reimburse the costs of the following programmes for quitting smoking:
• laser therapy;
• Allen Carr training;
• “De Opluchting” training.
Clause 17 Abroad
In cases of acute illness or accidents during time spent abroad, ONVZ will reimburse the cost of:
calendar year.
hospitals recognised by ONVZ is subject to change. The latest list is available on request from
the ONVZ Service Centre or can be found at www.onvz.nl/polisvoorwaarden;
Basisverzekering basic health-care plan or another health-care plan. Treatment must take place
in a hospital within 60km of the Dutch border. ONVZ will reimburse the cost of transportation
from your home address in the Netherlands to the hospital. ONVZ will reimburse the cost
of transportation by taxi, or € 0.27 per kilometre, where transportation is by private car. The
amount reimbursed will be ascertained with reference to the optimum route by car according
to the Routenet route planner. If you would like transportation by taxi, ONVZ can arrange this
for you. For more information, please see Part C (Health-care services). Costs associated with
transportation, for example parking charges, will not be reimbursed;
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processed.
accompaniment. In the event of death, ONVZ will reimburse the costs of repatriation of the
physical remains to the Netherlands. ONVZ Zorgassistance will arrange the repatriation.
Paragraph 7 Telephone costs
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Arranging:
• a TENS device, see Part B, Clause 1, Paragraph 4;
• domestic assistance, see Part B, Clause 7;
• health check-up, see Part B, Clause 16, Paragraph 1;
• preventive medical investigations, see Part B, Clause 16, Paragraph 5;
nutrition.
Mediation:
eHealth
Maternity care
please contact the ONVZ Kraamzorg Service. ONVZ Kraamzorg Service is ready to take your call
between 8am and 5.30pm on working days, on +31 (0)88 668 97 05. You can also request normal
ONVZ Vrije Keuze Optifit 126141
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Melatonin
ONVZ will reimburse the costs of melatonin as described in Clause 4, Paragraph 1 of Part B. You
can claim reimbursement of the costs of melatonin from ONVZ. However, you can also choose
to use the delivery service provided by pharmacists affiliated with ONVZ. In such cases the
pharmacist delivers the melatonin to your home and claims reimbursement of the costs directly
from ONVZ. To make use this service, please contact the ONVZ ZorgConsulent.
ONVZ Zorgassistance
+ 31 (0)88 668 97 67.
loss of income.
ONVZ will reimburse the full costs of assistance up to a maximum of € 12,500, including any
court costs. The Reglement verhaalsbijstand [Rules for aid for third-party claims], also containing
the terms and conditions, can be obtained from ONVZ Verhaalszaken, or by visiting www.onvz.
nl/polisvoorwaarden. For more information, or to request and arrange aid, please contact ONVZ
Verhaalszaken.
+31 (0)30 639 62 64.
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ONVZ
Vrije Keuze Topfit
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Table of contents
Clause 1 Antenatal/post-natal care Paragraph 1 Birth and maternity care
Paragraph 2 Maternity package Paragraph 3 Breastfeeding specialist Paragraph 4 TENS device Paragraph 5 Health care upon adoption Clause 2 Physical therapy Paragraph 1 Physiotherapy and remedial therapy Paragraph 2 Other therapies for posture and movement Paragraph 3 Exercise programmes Clause 3 General basic mental health care (GGZ) Clause 4 Pharmaceutical care Clause 5 Alternative/non-conventional medicine Clause 6 Vaccinations Clause 7 Personal contribution for medical appliances Clause 8 Other medical appliances Paragraph 1 Lenses for glasses, (contact) lenses or laser eye treatment Paragraph 2 Contraceptive devices Paragraph 3 Walking aids
Clause 9 Medical transportation Clause 10 Travel costs for visiting ill people Clause 11 Dental health care Clause 12 Other treatments and therapies Paragraph 1 Acne treatment Paragraph 2 Cosmetic skin camouflage treatment Paragraph 3 Dietitian
Paragraph 5 Occupational therapy Paragraph 6 In vitro fertilisation (IVF)
Paragraph 11 Pedicure Paragraph 12 Plastic surgery Paragraph 13 Podiatry
Paragraph 14 Psoriasis day treatment
Paragraph 15 Sterilisation and reversal operation
Paragraph 16 Stuttering therapy
Clause 13 Accommodation costs Paragraph 1 Stay in a guest house Paragraph 2 Stay in a hospice
Paragraph 4 Recuperation home
Paragraph 5 Health resort
Clause 14 Domestic assistance Clause 15 Carer relief Clause 16 Childcare Clause 17 Preventive care Paragraph 1 Health check-up Paragraph 2 Influenza vaccination Paragraph 3 Patients' association membership Paragraph 4 Preventive health-related courses Paragraph 5 Preventive medical investigations
Paragraph 6 Programmes for quitting smoking Clause 18 Abroad Paragraph 1 Emergency treatment Paragraph 2 Planned treatment
Paragraph 3 Exchange rate Clause 19 ONVZ Zorgassistance 94
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102
102
102
102
102
102
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104
ONVZ ZorgConsulent: from prevention to aftercare 105
A helping hand from the ZorgConsulent 105
eHealth105
Health magazine, Lijf & Leden105
Maternity care 105
Melatonin 106
Transportation by taxi 106
ONVZ Zorgassistance 106
Aid for third-party claims for injury sustained as the result of an accident 106
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plan and ONVZ Vrije Keuze Topfit offers supplementary coverage, you must act in accordance
Clause 1 Antenatal/post-natal care
maximum of € 550:
maternity care.
ONVZ will reimburse the costs of health care provided by a breastfeeding specialist.
these provisions.
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ONVZ Vrije Keuze Topfit 113141
Clause 2
Physical therapy
ONVZ will reimburse the costs of treatment by a physiotherapist, physiotherapist specialising
in children, manual therapist, Cesar/Mensendieck remedial therapist, pelvic therapist, oedema
therapist, geriatrics physiotherapist or psychosomatic physiotherapist.
ONVZ will reimburse the costs of the following treatments up to a combined maximum of € 1,000
per calendar year:
ONVZ will reimburse the costs of the following exercise programmes:
programme must be aimed at healing and recovery, preventing further complaints or, in
cases of chronic illness, promoting good health;
medical specialist.
The referral must state that there is:
2. a BMI of 25 - 30kg/m2 (overweight) in combination with an increased risk of
cardiovascular disease, an increased risk of diabetes mellitus type II, or evidence of a
condition related to obesity.
further information, please contact the ONVZ ZorgConsulent (see Part C);
• swimming programmes aimed at keeping senior citizens or those aged 50 or above fit. ONVZ
will reimburse a maximum of € 50 per calendar year. The training is aimed at senior citizens and
intended to support their health and fitness, suppleness, muscle strength and coordination.
Clause 3
adjustment disorders or care in the event of work-related or relationship problems, up to a maximum
of €1,000 per calendar year. The primary practitioner is a health psychologist registered under
the terms of the Wet BIG [Dutch Individual Health-Care Professions Act], a clinical psychologist
registered under the terms of the Wet BIG [Dutch Individual Health-Care Professions Act], a paediatric
psychologist registered with the Dutch Association of Psychologists (NIP), or a general remedial
educationalist registered with the Association of Educationalists in the Netherlands (NVO).
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Clause 4
Pharmaceutical care
Paragraph 1 ONVZ will reimburse a maximum of €4,540 per calendar year of the costs of:
plan;
see Part C (Health-care services);
plan.
dental specialist, midwife, specialist nurse or physician assistant. The medicines must have been
provided by a licensed pharmacist, dispensing practice or a chemist. Melatonin must, however,
be supplied by a pharmacist or dispensing practice.
For coverage for:
Clause 5
alternative/non-conventional medicine, including doctors who practice acupuncture. The
coverage shall be limited to a maximum of € 85 per consultation/treatment, with a maximum
of one consultation/treatment per day. ONVZ will reimburse up to a maximum of € 1,000 per
calendar year for all consultations and treatments combined.
Paragraph 3 ONVZ will reimburse a maximum of €500 per calendar year of the costs of:
Paragraphs 1 and 2.
Clause 6 Vaccinations
ONVZ will reimburse the costs of vaccinations for the prevention of serious infectious diseases
and malaria prophylactics in connection with travel abroad.
98
Clause 7
Hulpmiddelen [Medical Appliance Regulations] up to a combined maximum of € 1,000 per
Clause 8 Other medical appliances
eye treatment, up to a combined maximum of €300 per calendar year.
• elbow crutches;
• walking frames;
• rollators;
ONVZ will reimburse the costs of hiring or purchasing a bed-wetting alarm (including pads).
practitioner.
Clause 9
planner;
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Clause 10
Travel costs for visiting ill people
to the Routenet route planner. Both you and the hospitalised family member must be insured
with ONVZ.
Clause 11
Dental health care
orthodontist. Treatment must be performed before the patient reaches the age of 18. If you are
aged 18 or above, ONVZ will reimburse the costs of orthodontics up to a maximum of € 500 per
calendar year.
a prosthodontist.
Clause 12
dermatologist.
ONVZ will reimburse the cost of instruction relating to cosmetic skin camouflage treatment and
the use of associated cosmetic products.
medical purpose provided by a dietitian.
ONVZ will reimburse the costs of advice, instruction, training or treatment by an occupational
therapist.
Paragraph 6 In vitro fertilisation (IVF)
ONVZ shall reimburse the costs of IVF treatments in a hospital, providing you are not yet 43 years old.
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ONVZ will reimburse the costs of MammaPrint, prescribed by the attending
medical specialist associated with a hospital. MammaPrint is a diagnostic test for breast-cancer
patients, which enables a better assessment of the risk of metastasis. The attending medical
specialist can use the result to make a better decision as to which treatment would be most
effective after the operation.
ONVZ will reimburse the costs of orthoptic care by an orthoptist up to a maximum of € 1,000
per calendar year. The care must be prescribed by the attending general practitioner or medical
specialist.
Paragraph 10Menopause consultant
consultant during the menopause. The menopause consultant must be affiliated with Care for
Women or Vereniging Verpleegkundig OvergangsConsulenten [Medical Menopause Consultants’
Association] (VVOC).
Paragraph 11Pedicure
or rheumatoid arthritis.
• plastic and reconstructive surgery in cases of demonstrable physical dysfunction.
ONVZ will reimburse the costs of treatment in a psoriasis day treatment centre.
Paragraph 15Sterilisation and reversal operation
ONVZ will reimburse the costs of sterilisation and the reversal of a sterilisation operation.
the institution concerned if this constitutes part of the treatment.
Clause 13
Accommodation costs
a guest house associated with the hospital.
during your admission.
• If you need to stay in a guest house associated with the hospital immediately following a
transplant or oncological treatment, ONVZ will reimburse the cost of accommodation for you
and a companion.
ONVZ will reimburse the personal contribution for a stay in a hospice or other palliative care
facility for a maximum three months, provided an indication has been issued for the stay by the
Centrum Indicatiestelling Zorg [Care Needs Assessment Centre] (CIZ), the general practitioner or
the attending medical specialist. The maximum reimbursement is € 25 per day.
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oncological condition.
ONVZ will reimburse the costs of a stay in a recuperation home recognised by ONVZ. The stay is
intended for recuperation following a physical illness or associated medical treatment. The stay
will take place under the referral of the attending doctor and with the prior permission of ONVZ.
A list of recognised recuperation homes can be found at www.onvz.nl/polisvoorwaarden or
requested from the ONVZ Service Centre.
ONVZ will reimburse the costs of a stay at a health resort, if you suffer from rheumatoid arthritis or
psoriasis, up to a maximum of € 500 per calendar year.
Clause 14
Domestic assistance
ONVZ will reimburse the costs of domestic assistance up to a maximum of 18 hours if:
Clause 15
Carer relief
arrange and reimburse the costs of carer relief for a maximum of 16 days per calendar year. The
Stichting Mantelzorgvervanging Nederland "Handen-in-Huis" association shall provide the care.
You can request carer relief from the ONVZ ZorgConsulent (see Part C).
Clause 16
Child care
If you are a parent and have to be admitted to hospital, ONVZ shall reimburse the costs of
childcare from the fourth day of admission onwards. The period of admission must be continuous.
Coverage shall be limited to a maximum of € 25 per child up to the age of 12 years who is also
insured, per workday for a maximum of 60 workdays. The childcare must be provided by an
organisation recognised by the authorised body. For further information, please contact the
ONVZ ZorgConsulent (see Part C).
Clause 17
Preventive care
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ONVZ will reimburse the minimum contribution for membership of a patients' association
affiliated with the Nederlandse Patiënten en Consumenten Federatie [Federation of Patients and
Consumer Organisations in the Netherlands] (NPCF), the Chronisch zieken en Gehandicapten
Raad [Dutch Council of the Chronically Ill and Disabled] or the Landelijk Platform GGz [National
Mental Health-Care Platform] (LPGGz). ONVZ will reimburse the contribution upon presentation
of a copy of proof of registration and payment.
ONVZ will reimburse the costs of the following preventive health-related courses recognised by ONVZ
up to a combined maximum of € 325 per calendar year. A list of recognised preventive health-related
courses can be found at www.onvz.nl/polisvoorwaarden or requested from the ONVZ Service Centre.
ONVZ will reimburse the costs of preventive medical investigations up to a maximum of € 500
per calendar year. The costs of tests carried out within a context other than medical necessity
(e.g. on behalf of an employer) are excluded from coverage. For further information, please
contact the ONVZ ZorgConsulent (see Part C).
• laser therapy;
Clause 18
Abroad
more information, please contact the ONVZ Service Centre or visit www.onvz.nl/buitenland.
calendar year.
hospitals recognised by ONVZ is subject to change. The latest list is available on request from
the ONVZ Service Centre or can be found at www.onvz.nl/polisvoorwaarden;
Basisverzekering basic health-care plan or another health-care plan. Treatment must take place
in a hospital within 60km of the Dutch border. ONVZ will reimburse the cost of transportation
from your home address in the Netherlands to the hospital. ONVZ will reimburse the cost
of transportation by taxi, or € 0.27 per kilometre, where transportation is by private car. The
amount reimbursed will be ascertained with reference to the optimum route by car according
to the Routenet route planner. If you would like transportation by taxi, ONVZ can arrange this
for you. For more information, please see Part C (Health-care services). Costs associated with
transportation, for example parking charges, will not be reimbursed;
103
processed.
Clause 19 ONVZ Zorgassistance
Paragraph 1 If you are admitted to hospital due to an acute illness or accident during a temporary stay
Paragraph 2 If you have a permanent address in the Netherlands, but are temporarily staying outside the
Netherlands, ONVZ shall offer additional services provided by or through ONVZ Zorgassistance:
a. In the event of acute illness or an accident ONVZ will reimburse:
• the provision of a guarantee of direct payment to the health-care institution concerned of
the health-care costs incurred;
• essential advance payments;
• shipping of essential medicines, if these are not available at the location in question;
• the costs of essential medical repatriation to the Netherlands, including the prescribed
medical accompaniment, in the event of a serious illness or severe injury;
• the essential additional costs of accommodation if repatriation is not possible for medical
reasons;
• the travel expenses for one visit by a member of your family if repatriation is not possible
for medical reasons.
b. In the event of death, ONVZ will reimburse the costs of:
• transportation of the physical remains to the Netherlands, or
• burial or cremation abroad, and the travel of family members up to a maximum of the
amount that could be claimed if the physical remains were repatriated to the Netherlands.
c. If you find yourself in an emergency situation, involving essential search or rescue, ONVZ shall
reimburse the search and rescue costs up to a maximum of € 11,345.
Paragraph 3 You shall grant ONVZ Zorgassistance's medical adviser permission to pass on all relevant details
104
• possible treatments for ailments;
• patients' associations.
Arranging:
• childcare, see Part B, Clause 16;
Mediation:
actions.
eHealth
Maternity care
ONVZ Vrije Keuze Topfit 127141
105
Melatonin
ONVZ Zorgassistance
Additional services that ONVZ Zorgassistance can offer you are defined in Part B, Clause 19.
ONVZ Zorgassistance is available 24 hours a day, 7 days a week on the following telephone
number: + 31 (0)88 668 97 67.
loss of income.
Verhaalszaken.
+31 (0)30 639 62 64.
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ONVZ
Vrije Keuze Superfit
107
Table of contents
ONVZ Vrije Keuze Superfit
Clause 1 Antenatal/post-natal care Paragraph 1 Birth and maternity care Paragraph 2 Maternity package Paragraph 3 Breastfeeding specialist Paragraph 4 TENS device Paragraph 5 Health care upon adoption Clause 2 Physical therapy Paragraph 1 Physiotherapy and remedial therapy Paragraph 2 Other therapies for posture and movement Paragraph 3 Exercise programmes Clause 3 General basic mental health care (GGZ) Clause 4 Pharmaceutical care Clause 5 Alternative/non-conventional medicine Clause 6 Vaccinations Clause 7 Personal contribution for medical appliances Clause 8 Other medical appliances Paragraph 1 Lenses for glasses, (contact) lenses, or laser eye treatment Paragraph 2 Contraceptive devices Paragraph 3 Walking aids Paragraph 4 Bed-wetting alarm Paragraph 5 Supporting pessary Paragraph 6 Arch supports Paragraph 7 Dressings Clause 9 Medical transportation Clause 10 Travel costs for visiting ill people Clause 11 Dental health care Clause 12 Other treatments and therapies Paragraph 1 Acne treatment Paragraph 2 Cosmetic skin camouflage treatment Paragraph 3 Dietitian Paragraph 4 Electrical epilation or laser treatment Paragraph 5 Occupational therapy Paragraph 6 In vitro fertilisation (IVF) Paragraph 7 MammaPrint Paragraph 8 Oedema therapy Paragraph 9 Orthoptics Paragraph 10 Menopause consultant
Paragraph 11 Pedicure Paragraph 12 Plastic surgery Paragraph 13 Podiatry Paragraph 14 Psoriasis day treatment Paragraph 15 Sterilisation and reversal operation Paragraph 16 Stuttering therapy Clause 13 Accommodation costs Paragraph 1 Stay in a guest house Paragraph 2 Stay in a hospice Paragraph 3 Therapeutic camp for young people Paragraph 4 Recuperation home Paragraph 5 Health resort
Clause 14 Domestic assistance Clause 15 Carer relief Clause 16 Childcare Clause 17 Preventive care Paragraph 1 Health check-up Paragraph 2 Influenza vaccination Paragraph 3 Patients' association membership Paragraph 4 Preventive health-related courses Paragraph 5 Preventive medical investigations Paragraph 6 Programmes for quitting smoking Clause 18 Abroad Paragraph 1 Emergency treatment Paragraph 2 Planned treatment Paragraph 3 Exchange rate 108
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111
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112
112
112
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Clause 19 Clause 20 Clause 21 Clause 22 Clause 23 Clause 24 ONVZ Zorgassistance Privé Kamer Zorg Luxe Zorg Assistent Private room abroad Accident coverage Paragraph 1 Definitions Paragraph 2 What is covered? Paragraph 3 Further exclusions Paragraph 4 Level of payment Paragraph 5 Establishing the percentage to be paid Paragraph 6 Existing condition(s) Paragraph 7 Medical appraisal Paragraph 8 What to do in the event of an accident Part C Health-care services
ONVZ ZorgConsulent: from prevention to aftercare A helping hand from the ZorgConsulent eHealth Health magazine, Lijf & Leden Maternity care Melatonin Transportation by taxi ONVZ Zorgassistance Aid for third-party claims for injury sustained as the result of an accident ONVZ Vrije Keuze Superfit
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109
plan and ONVZ Vrije Keuze Superfit offers supplementary coverage, you must act in accordance
Clause 1 Antenatal/post-natal care
maximum of € 550:
maternity care.
ONVZ will reimburse the costs of health care provided by a breastfeeding specialist.
these provisions.
110
ONVZ Vrije Keuze Superfit 152141
Clause 2
Physical therapy
ONVZ will reimburse the costs of treatment by a physiotherapist, physiotherapist specialising
in children, manual therapist, Cesar/Mensendieck remedial therapist, pelvic therapist, oedema
therapist, geriatrics physiotherapist or psychosomatic physiotherapist.
ONVZ will reimburse the costs of the following treatments up to a combined maximum of € 1,500
per calendar year:
ONVZ will reimburse the costs of the following exercise programmes:
programme must be aimed at healing and recovery, preventing further complaints or, in cases
of chronic illness, promoting good health;
2. a BMI of 25 - 30kg/m2 (overweight) in combination with an increased risk of cardiovascular
disease, an increased risk of diabetes mellitus type II, or evidence of a condition related
to obesity.
further information, please contact the ONVZ ZorgConsulent (see Part C);
• swimming programmes aimed at keeping senior citizens or those aged 50 or above fit.
ONVZ will reimburse a maximum of € 50 per calendar year. The training is aimed at senior
citizens and intended to support their health and fitness, suppleness, muscle strength and
coordination.
111
Clause 3
adjustment disorders or care in the event of work-related or relationship problems, up to a maximum
of € 1,500 per calendar year. The primary practitioner is a health psychologist registered under
the terms of the Wet BIG [Dutch Individual Health-Care Professions Act], a clinical psychologist
registered under the terms of the Wet BIG [Dutch Individual Health-Care Professions Act], a paediatric
psychologist registered with the Dutch Association of Psychologists (NIP), or a general remedial
educationalist registered with the Association of Educationalists in the Netherlands (NVO).
Clause 4
Pharmaceutical care
Paragraph 1 ONVZ will reimburse the costs of:
• the personal contributions for medicines under the Basisverzekering or another health-care plan;
see Part C (Health-care services).
The medicines must be prescribed by the attending doctor, medical specialist, dentist, dental
specialist, midwife, specialist nurse or physician assistant. The medicines must have been
provided by a licensed pharmacist, dispensing practice or a chemist. Melatonin must, however,
be supplied by a pharmacist or dispensing practice.
For coverage for:
Clause 5
alternative/non-conventional medicine, including doctors who practice acupuncture. Cover shall
be limited to € 85 per consultation/treatment for a maximum of one consultation/treatment per
day. ONVZ will reimburse up to a maximum of € 1,250 per calendar year for all consultations and
treatments combined.
Paragraph 3 ONVZ will reimburse a maximum of €750 per calendar year of the costs of:
Paragraphs 1 and 2.
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Clause 6 Vaccinations
ONVZ will reimburse the costs of vaccinations for the prevention of serious infectious diseases
and malaria prophylactics in connection with travel abroad.
Clause 7
Hulpmiddelen [Medical Appliance Regulations] that forms part of the Basisverzekering basic
health-care plan. A copy of these regulations is available on request from the ONVZ Service
Centre and they can also be found at www.onvz.nl/polisvoorwaarden.
Clause 8 Other medical appliances
eye treatment, up to a combined maximum of €450 per calendar year.
• elbow crutches;
• walking frames;
• rollators;
ONVZ will reimburse the costs of hiring or purchasing a bed-wetting alarm (including pads).
practitioner.
ONVZ will reimburse the costs of arch supports supplied by an orthopaedic technician.
Paragraph 7 Dressings
ONVZ will reimburse the costs of dressings used to cover or dress skin conditions or wounds
under the responsibility of the attending doctor. The dressings must have been prescribed by a
doctor and provided by a licensed pharmacist, dispensing practice or a chemist.
Clause 9
planner;
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Clause 10
Travel costs for visiting ill people
to the Routenet route planner. Both you and the hospitalised family member must be insured with
ONVZ.
Clause 11
Dental health care
orthodontist.
a prosthodontist.
Paragraph 3 If you are aged 18 or above, ONVZ will reimburse the costs of general dental health care
(including technical costs) up to a maximum of € 1,600 per calendar year. The care must be
provided by a dentist or, where dental prostheses are involved, a prosthodontist.
Paragraph 4 ONVZ will reimburse the costs of dental treatment that is required due to an accident no more
than once per calendar year up to a maximum of € 5,000 (including technical costs and the costs
of any prostheses required).
ONVZ will only provide this coverage if:
• the accident occurs within the duration of this health-care plan;
• the treatment was performed within one year of the accident;
• ONVZ had granted prior permission. This requirement will be waived in acute cases.
Clause 12
ONVZ will reimburse the costs of acne treatment performed by a skin therapist or beautician. The
treatment must be prescribed by the attending dermatologist.
ONVZ will reimburse the cost of instruction relating to cosmetic skin camouflage treatment and
the use of associated cosmetic products.
medical purpose provided by a dietitian.
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ONVZ will reimburse the costs of advice, instruction, training or treatment by an occupational
therapist.
Paragraph 6 In vitro fertilisation (IVF)
ONVZ shall reimburse the costs of IVF treatments in a hospital, providing you are not yet 43 years
of age.
enables a better assessment of the risk of metastasis. The attending medical specialist can use the
result to make a better decision as to which treatment would be most effective after the operation.
ONVZ will reimburse the costs of orthoptic care by an orthoptist up to a maximum of € 1,500 per
calendar year. The care must be prescribed by the attending general practitioner or medical specialist.
Paragraph 10Menopause consultant
consultant during the menopause. The menopause consultant must be affiliated with Care for
Women or Vereniging Verpleegkundig OvergangsConsulenten [Medical Menopause Consultants’
Association] (VVOC).
Paragraph 11Pedicure
or rheumatoid arthritis.
• plastic and reconstructive surgery in cases of demonstrable physical dysfunction.
ONVZ will reimburse the costs of treatment in a psoriasis day treatment centre.
Paragraph 15Sterilisation and reversal operation
ONVZ will reimburse the costs of sterilisation and the reversal of a sterilisation operation.
the institution concerned if this constitutes part of the treatment.
Clause 13
Accommodation costs
a guest house associated with the hospital.
during your admission.
•
If you need to stay in a guest house associated with the hospital immediately following a
transplant or oncological treatment, ONVZ will reimburse the cost of accommodation for you
and a companion.
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ONVZ will reimburse the personal contribution for a stay in a hospice or other palliative care facility,
provided an indication has been issued for the stay by the Centrum Indicatiestelling Zorg [Care
Needs Assessment Centre] (CIZ), the general practitioner or the attending medical specialist.
oncological condition.
ONVZ will reimburse the costs of a stay in a recuperation home recognised by ONVZ. The stay is
intended for recuperation following a physical illness or associated medical treatment. The stay
will take place under the referral of the attending doctor and with the prior permission of ONVZ.
A list of recognised recuperation homes can be found at www.onvz.nl/polisvoorwaarden or
requested from the ONVZ Service Centre.
ONVZ will reimburse the costs of a stay at a health resort, if you suffer from rheumatoid arthritis or
psoriasis, up to a maximum of € 500 per calendar year.
Clause 14
Domestic assistance
ONVZ will reimburse the costs of domestic assistance up to a maximum of 30 hours if:
Clause 15
Carer relief
arrange and reimburse the costs of carer relief for a maximum of 24 days per calendar year. The
Stichting Mantelzorgvervanging Nederland "Handen-in-Huis" association shall provide the care.
You can request carer relief from the ONVZ ZorgConsulent (see Part C).
Clause 16
Child care
If you are a parent and have to be admitted to hospital, ONVZ shall reimburse the costs of
childcare from the fourth day of admission onwards. The period of admission must be continuous.
Coverage shall be limited to a maximum of € 25 per child up to the age of 12 years who is also
insured, per workday for a maximum of 60 workdays. The childcare must be provided by an
organisation recognised by the authorised body. For further information, please contact the
Clause 17
Preventive care
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ONVZ will reimburse the minimum contribution for membership of a patients' association
affiliated with the Nederlandse Patiënten en Consumenten Federatie [Federation of Patients and
Consumer Organisations in the Netherlands] (NPCF), the Chronisch zieken en Gehandicapten
Raad [Dutch Council of the Chronically Ill and Disabled] or the Landelijk Platform GGz [National
Mental Health-Care Platform] (LPGGz). ONVZ will reimburse the contribution upon presentation
of a copy of proof of registration and payment.
ONVZ will reimburse the costs of the following preventive health-related courses recognised by ONVZ
up to a maximum of € 500 per calendar year. A list of recognised preventive health-related courses
can be found at www.onvz.nl/polisvoorwaarden or requested from the ONVZ Service Centre.
ONVZ will reimburse the costs of preventive medical investigations up to a maximum of € 750 per
calendar year. The costs of tests carried out within a context other than medical necessity (e.g. on
behalf of an employer) are excluded from coverage. For further information, please contact the
• laser therapy;
Clause 18
Abroad
more information, please contact the ONVZ Service Centre or visit www.onvz.nl/buitenland.
calendar year.
In an EU/EEA member state or treaty country, ONVZ will reimburse the costs:
hospitals recognised by ONVZ is subject to change. The current list is available on request
from the ONVZ Service Centre or can be found at www.onvz.nl/polisvoorwaarden;
Basisverzekering basic health-care plan or another health-care plan. Treatment must
take place in a hospital within 60km of the Dutch border. ONVZ will reimburse the cost
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of transportation from your home address in the Netherlands to the hospital. ONVZ will
reimburse the cost of transportation by taxi, or € 0.27 per kilometre, where transportation is
by private car. The amount reimbursed will be ascertained with
reference to the optimum route by car according to the Routenet route planner. If you would
like transportation by taxi, ONVZ can arrange this for you. For more information, please
see Part C (Health-care services). Costs associated with transportation, for example parking
charges, will not be reimbursed;
• which are not otherwise covered by the Basisverzekering basic health-care plan or other
health-care plan, but only where they exceed the amount that would have been reimbursed
limited to twice the statutory rate or prevailing market rate in the Netherlands.
Outside of EU/EEA member states or treaty countries, ONVZ will reimburse the costs of health
care covered under this supplementary health-care plan, up to a maximum equivalent to the
statutory or prevailing rate in the Netherlands.
processed.
ONVZ Zorgassistance
Clause 19
Paragraph 1 If you are admitted to hospital due to an acute illness or accident during a temporary stay
Paragraph 2 If you have a permanent address in the Netherlands, but are temporarily staying outside the
Netherlands, ONVZ shall offer additional services provided by or through ONVZ Zorgassistance:
a. In the event of acute illness or an accident ONVZ will reimburse:
• the provision of a guarantee of direct payment to the health-care institution concerned
of the health-care costs incurred;
• essential advance payments;
• shipping of essential medicines, if these are not available at the location in question;
• the costs of essential medical repatriation to the Netherlands, including the prescribed
medical accompaniment, in the event of a serious illness or severe injury;
• the essential additional costs of accommodation if repatriation is not possible for medical
reasons;
• the travel expenses for one visit by a member of your family if repatriation is not possible
for medical reasons.
b. In the event of death, ONVZ will reimburse the costs of:
• transportation of the physical remains to the Netherlands, or
• burial or cremation abroad, and the travel of family members up to a maximum of the
amount that could be claimed if the physical remains were repatriated to the Netherlands.
c. If you find yourself in an emergency situation, involving essential search or rescue, ONVZ shall
reimburse the search and rescue costs up to a maximum of € 11,345.
Paragraph 3 You shall grant ONVZ Zorgassistance's medical adviser permission to pass on all relevant details
Clause 20
Privé Kamer
Paragraph 1 If you are admitted to a hospital in the Netherlands, ONVZ will reimburse the costs of a single
room if:
• the hospital has a guarantee agreement with ONVZ;
• the admission is a medical necessity for specialist tests or treatment.
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For more information, to arrange a single room, or for a list of the hospitals with which ONVZ
has a guarantee agreement, please contact the ONVZ ZorgConsulent (see Part C). The list of
hospitals with a guarantee agreement can also be found at www.onvz.nl/polisvoorwaarden.
Hospitals with a guarantee agreement can offer a single room for the patient in any event if
admission is scheduled for more than one day, in the case of the following specialisms: surgery,
gynaecology, ENT, dental surgery, orthopaedics, ophthalmology, urology or plastic surgery. For
other specialist fields, the availability of a single room will depend on the hospital occupancy.
Where possible and medically responsible, you will be offered a single room.
Paragraph 2 If you have been admitted to a hospital in the Netherlands that does not have a guarantee
agreement with ONVZ, ONVZ will reimburse the costs of staying in a single room in the specialist
field for which you have been admitted. The admission must be a medical necessity for specialist
tests or treatment.
Paragraph 3 ONVZ will reimburse the extra costs of specific arrangements to be taken care of by ONVZ.
For more information and to request these specific arrangements, please contact the ONVZ
ZorgConsulent (see Part C). The list of arrangements can also be found at www.onvz.nl/
polisvoorwaarden.
Paragraph 4 If a hospital in the Netherlands does have single rooms, but you cannot stay in one during your
planned admission lasting more than one day, you will be entitled to a reimbursement of € 75 per
day spent in hospital. This does not apply, therefore, if you are admitted to hospital unexpectedly.
Some hospitals have single rooms intended exclusively for patients who have to stay in one for
medical reasons. If that is the case, you will not be entitled to the compensation of € 75 per day.
Clause 21
Zorg Luxe
Paragraph 1 If you are admitted to a hospital in the Netherlands, ONVZ will reimburse the costs of a luxury
package offered by the hospital. The benefits provided by this package depend on the facilities
available in the hospital in question and may include the following:
a. telephone calls within the Netherlands, provided that the room has its own telephone;
b. a refrigerator filled with a range of drinks;
c. newspaper or magazine;
d. coffee and tea for visitors;
e. gourmet meals or extra snacks;
f. television and internet connection.
Paragraph 2 If a hospital in the Netherlands does offer luxury packages, but does not have one available
during your admission, you shall be entitled to compensation of € 5 per day spent in hospital.
Clause 22 Zorg Assistent
Paragraph 1 If you know in advance that you will be admitted to a hospital in the Netherlands, you will be
entitled to assistance from the ONVZ Zorg Assistent. The ONVZ Zorg Assistent:
a. will contact you for an initial interview prior to hospitalisation;
b. will arrange transportation to the hospital if required;
c. will be at the hospital when you are admitted and will help you to become familiarised with
the hospital;
d. will answer your care-related questions;
e. can, if required, stay in contact with you by telephone, enter into discussion with the (medical)
staff, visit you and arrange home care, childcare or medical appliances. The costs of home
care, childcare and/or medical appliances are not covered;
f. will assist you when you are discharged;
g. will, if required, arrange transportation when you are discharged.
Paragraph 2 If you are admitted to a hospital in the Netherlands unexpectedly, you will be entitled to
assistance from the ONVZ Zorg Assistent as defined in Paragraph 1 (d - g).
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Paragraph 3 ONVZ will reimburse the costs of transportation to and from a hospital in the Netherlands:
• at a rate of € 0.27 per kilometre, for transportation by car. The amount reimbursed will be
planner;
• in full, where transportation is by taxi, if the taxi firm used is one with which ONVZ has a
contract (see Part C).
Such transportation is provided for admissions covered under Clause 20 (Privé Kamer). If the costs
of transportation will be (partially) reimbursed under another (supplementary) (health-care) plan,
ONVZ shall only reimburse the amount that exceeds such reimbursement, up to the maximum
coverage defined in this clause. Costs associated with transportation, for example parking
charges, will not be reimbursed.
For more information and to arrange the services of the ONVZ Zorg Assistent, please contact the
Clause 23
Private room abroad
Paragraph 1 If you live in the Netherlands, but choose to be admitted to a hospital in Belgium, Germany or
France, the coverage defined in Clause 18, Paragraph 2 shall include the extra costs for a stay
in a single or double room, if such a room is available for the specialist field for which you are
admitted. The admission must be a medical necessity for specialist tests or treatment. To claim
reimbursement, you will be required to provide ONVZ with an itemised invoice of the extra costs
incurred for staying in a single or double room.
Paragraph 2 If you live abroad, the coverage defined in Clause 18 Paragraph 2 shall include the extra costs
for a stay in a single or double room in a hospital in any country, if such a room exists for the
specialist field for which you are admitted. The admission must be a medical necessity for
specialist tests or treatment. To claim reimbursement, you will be required to provide ONVZ with
an itemised invoice of the extra costs incurred for staying in a single or double room.
Clause 24
Accident coverage
Paragraph 1 Definitions
Beneficial entitlement
You are the beneficiary for all payments. In the event of your death, payment will be made
directly to your estate.
Injury
Physical injury that can be established medically and objectively, where the injury in question is
the direct result of an accident.
Accident
A sudden, external violent impact to the body, outside your control, causing injury or death.
Accident includes:
a. acute poisoning, unless this is caused by abuse of medicines, stimulants, intoxicants, narcotics
or other drugs;
b. infection by pathogens;
c. involuntary intake of substances or objects affecting the digestive tract, the airways, the eyes
or the ears;
d. infected wounds, blood poisoning or tetanus occasioned by an accident;
e. suffocation, drowning, sun stroke, thermoplegia, frostbite, burning (except as the result of
radiation), cauterisation or electric discharge;
f. exhaustion, starvation, dehydration or sun stroke as the result of a natural disaster;
g. sprains, dislocations and tears of the muscles and ligaments, where the injury occurs
suddenly;
h. complications or aggravation of injuries as the direct result of first aid or urgent medical
treatment provided by a qualified health professional;
i. injury occasioned by reasonable self-defence within the bounds of the law;
j. murder, manslaughter, assault, or attempts at any of these, hostage-taking or acts of
terrorism;
k. injury occasioned during amateur sport, including preparations for and participation in
competitive events, except:
• as defined in Paragraph 3, Sub-paragraph 1j;
• for the sports listed in Paragraph 3, Sub-paragraph 1k.
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The following are not regarded as an accident or the result of an accident: abdominal hernia or
prolapsed intervertebral disc (spinal disc herniation).
Paragraph 2 What is covered?
Insured sums
For each accident, ONVZ shall pay the insured sum in the event of death or shall pay a maximum
of the insured sum in the event of permanent loss (or loss of function) of one or more limbs or
other parts of the body or sensory functions.
Payment in the event of death
In the event of death, the insured amount is € 5,000. ONVZ shall pay out this amount in the event
of death resulting from an accident.
Payment in the event of permanent loss (or loss of function)
a. Entitlement to payment:
In the event of permanent loss (or loss of function) or permanent impairment of limbs or other
parts of the body or sensory functions, ONVZ will pay a maximum of € 20,000 if this is the
result of an accident. If the insured person dies before invalidity can be established, ONVZ
will not pay a sum in respect of permanent invalidity.
b. Existing impairment/infirmity:
If any loss (or loss of function) or impairment of limbs/parts of the body or sensory functions
already existed before the accident, ONVZ shall only pay if the loss (or loss of function) or
impairment as a result of the accident exceeds the loss (or loss of function) or permanent
impairment of limbs/parts of the body or sensory functions that existed before the accident.
Paragraph 3 Further exclusions
1. No coverage is provided if the accident was the result of, or could be partly attributed to:
a. poor health or a mental or physical defect;
b. poor health due to infection with pathogens, with the exception of the provisions of
Paragraph 1 in the definition of accident;
c. allergic reactions, other than those occasioned by an event as referred to in Paragraph 1
in the definition of an accident;
d. suicide or attempted suicide;
e. committing or being accomplice to a crime;
f. recklessness, except where injury is incurred as a result of an attempt to rescue a person
or animal, or to divert impending danger;
g. being under the influence of alcohol, intoxicants, stimulants or other such substances to
such an extent that it is impossible to care for oneself as well as usual;
h. a fight, except reasonable self-defence within the bounds of the law;
i. being in an aircraft, unless you were a passenger on an aircraft designed for passengers
and flown by a qualified pilot and at the time of the accident this aircraft was being used
by:
• a company authorised to run an airline;
• a private company;
j. sport for which payment is received;
k. 'dangerous' sports, such as boxing, wrestling, ice hockey, rugby, mountaineering,
bobsleighing, parasailing, hang-gliding, parachuting, ice sailing, ski jumping, ‘extreme’
ski jumping and freestyle skiing;
l. preparation for and participation in races or record attempts involving motor vehicles, gokarts, horses, bicycles or motorboats;
m. professional work with industrial timber-processing equipment;
n. ignoring official warnings not to travel to specific countries.
o. nuclear reactions.
2. Psychological trauma
No payment will be made for loss of mental or cognitive function.
a. This exclusion is not classed as loss in accordance with generally-accepted neurological
understanding, if it is caused by a demonstrably serious organic impairment of the central
nervous system.
b. Neither will payment be made for whole or partial loss of function, or whole or partial
impairment of limbs/parts of the body or sensory functions if such loss of function or
impairment is the result of a psychological trauma.
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Paragraph 4 Level of payment
1.Death
In the event of death, ONVZ shall pay the insured amount. ONVZ shall deduct from this sum
any earlier payment for permanent loss (or loss of function), or permanent disability or loss of
sensory functions. ONVZ shall not demand repayment of any earlier payments.
2. Permanent loss (or loss of function)
In the event of permanent loss (or loss of function), ONVZ shall pay the following percentages
of the insured sum, up to a maximum of the insured sum.
• For permanent loss (or loss of function) or permanent full impairment of the following limbs/
parts of the body or sensory functions:
an arm: up to the shoulder joint 75%
an arm: up to the elbow joint 65%
an arm: between the elbow and shoulder joint 65%
an arm: between the wrist and elbow joint 60%
a hand: up to the wrist 60%
a leg: up to the hip joint 70%
a leg: up to the knee joint 60%
a leg: between the knee and hip joint 60%
a leg: between the ankle and knee joint 50%
a foot: up to the ankle 50%
a thumb 25%
an index finger 15%
a middle finger 15%
a ring finger or little finger 15%
For permanent full loss (or loss of function) or permanent full impairment of more than one
finger of a hand, ONVZ will pay a maximum of 60% of the insured amount.
a big toe 10%
a toe other than the big toe 5%
sight in one eye 30%
sight in both eyes 100%
hearing in one ear 20%
hearing in both ears 50%
sense of smell/taste 20%
loss of sexual potency, unless the terms of Paragraph 3, under 2 apply 25%
• For one of the injuries listed below (or combination thereof):
total loss of mental functions, unless the terms of Paragraph 3, under 2 apply 100%
loss of both arms or hands 100%
loss of both legs or feet 100%
loss of one arm or hand, together with one leg or foot 100%
• In the event of partial loss (or loss of function) or partial impairment of limbs/parts of the body
or sensory functions as described above, ONVZ shall pay a portion of the aforementioned
payment percentages in proportion to the level of loss (or loss of function). This partial loss
(or loss of function) or partial impairment must be established in accordance with generallyaccepted medical standards. Partial loss of smell or taste is not considered to be a handicap.
• In the event of permanent loss of function or permanent impairment of limbs/parts of the
body or sensory functions as a result of an injury or combination of injuries not specifically
described above, the following shall apply. The percentage to be paid shall equal the
percentage of permanent loss (or loss of function) as established in accordance with
generally-accepted medical standards. Your profession or occupation shall not be taken into
consideration.
Paragraph 5 Establishing the percentage to be paid
1. ONVZ shall establish the percentage to be paid on the basis of the 'recognised situation',
where possible within two years of the accident.
2. If, after medical treatment has been terminated, no ‘recognised situation’ has yet been
established, ONVZ shall pay statutory interest on the payment from the day on which the
medical treatment is terminated until the day on which payment is made. If a medical
examination establishes that no ‘recognised situation’ yet exists, a new medical examination
shall be conducted by order of ONVZ within five years of the date of the accident. Any
invalidity established at that point shall form the basis for establishing the level of payment.
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Paragraph 6 Existing condition(s)
1. If the consequences of an accident are increased by poor health or mental or physical defects
that already existed before the accident, ONVZ shall pay out no more than would be paid to
a person without that condition who suffered a similar accident.
2. The terms set out under 1 do not apply if the circumstances in question are solely and directly
the result of an earlier accident suffered by you during the term of this health-care plan.
Paragraph 7 Medical appraisal
If ONVZ deems medical appraisal necessary in order to establish the percentage to be paid,
you shall be obliged to cooperate. In such cases, you shall be required to undergo a medical
examination conducted by a doctor appointed by ONVZ in an institution or establishment
appointed by ONVZ. The medical appraisal shall take place in the Netherlands. ONVZ will
reimburse the costs.
Paragraph 8 What to do in the event of an accident
1. Notification
An accident that may lead to payment must be reported to ONVZ as soon as possible, but
at least within thirty days. This should include an accurate description of the accident and,
where possible, the cause and consequences of the accident.
2. Obligations after an accident
a. You are obliged to seek medical attention as soon as possible after an accident, and to
give full cooperation to enhance your recovery.
b. You are obliged to provide all information, to the best of your knowledge, to ONVZ or to
a doctor appointed by ONVZ.
c. The beneficiary/beneficiaries will not receive payment unless they cooperate with all
measures ONVZ deems necessary in establishing the cause of death (e.g. permission for
a post mortem).
3. ONVZ is entitled to refuse payment if these obligations are not observed. If notification
is given later than specified under 1, you shall retain entitlement to a payment if you can
demonstrate that:
• the loss (or loss of function) of limbs/parts of the body or sensory function is the sole
result of an accident;
• the consequences of an accident have not been aggravated by illness, infirmity or
abnormal constitution or state of mind;
• you have complied with instructions given by the attending doctor;
• notification was delayed as the result of extraordinary circumstances.
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• possible treatments for ailments;
• patients' associations.
Arranging:
• childcare, see Part B, Clause 16;
• single room, see Part B, Clause 20, Paragraph 1;
• specific arrangements, see Part B, Clause 20, Paragraph 3;
• the ONVZ Zorg Assistent, see Part B, Clause 22;
Mediation:
actions.
eHealth
Maternity care
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Melatonin
Transportation by taxi is part of the coverage for other medical transportation as defined in Clauses
9 and 22, Paragraph 3 of Part B. To ensure the best service for its members, ONVZ has contracted a
taxi company to arrange taxi transportation for insured persons. To make use of this service, please
ONVZ Zorgassistance
Additional services that ONVZ Zorgassistance can offer you are defined in Part B, Clause 19.
ONVZ Zorgassistance is available 24 hours a day, 7 days a week on the following telephone
number: + 31 (0)88 668 97 67.
loss of income.
Verhaalszaken.
+31 (0)30 639 62 64.
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126
127
ONVZ Tandfit
ONVZ
Tandfit
Table of contents
ONVZ Tandfit
Tandfit A 129
Tandfit B 129
Tandfit C 130
Tandfit D 130
Costs of dental treatment outside country of residence
131
128
ONVZ Tandfit
ONVZ Tandfit
Coverage shall include reimbursement of the costs of dental health care as defined below. The
policy document specifies the applicable coverage.
plan and ONVZ Tandfit offers supplementary coverage, you must act in accordance with the
terms and conditions of the Basisverzekering or the other health-care plan.
ONVZ will reimburse the costs of treatment by a dentist, prosthodontist or dental hygienist,
on the basis of statutory performance or the prevailing market conditions. Coverage shall only
Coverage shall not extend to costs relating to:
• orthodontics;
Clause 1
Tandfit A
General dental health care
ONVZ will reimburse 75% of the costs of general dental health care (including technical costs) up
to a maximum of € 250 per calendar year.
Clause 2
Dental health care after an accident
ONVZ will reimburse the costs of dental treatment that is required due to an accident no more
Tandfit B
Clause 1
Paragraph 1 ONVZ will reimburse 100% of the costs of the following treatments:
• C11 Regular check-ups;
• M01 Preventive information and/or instruction;
• M02 Consultation for assessment of preventive information and/or instruction;
• M03 Dental cleaning;
• M10 Fluoride application (Method I);
• M20 Fluoride application (Method II);
• X10 X-ray (not for orthodontic treatment);
• V30 Sealing of first element;
• V35 Sealing of the next element during the same session.
Paragraph 2 ONVZ will reimburse 75% of the costs of other general dental health care (including technical
costs).
Paragraph 3 The maximum reimbursement of the costs referred to in Paragraphs 1 and 2 together is € 750 per
calendar year.
ONVZ Tandfit 114141
129
Clause 2
Tandfit C
Clause 1
Paragraph 1 ONVZ will reimburse 100% of the costs of the following treatments:
• C11 Regular check-ups;
• M01 Preventive information and/or instruction;
• M02 Consultation for assessment of preventive information and/or instruction;
• M03 Dental cleaning;
• M10 Fluoride application (Method I);
• M20 Fluoride application (Method II);
• X10 X-ray (not for orthodontic treatment);
• V30 Sealing of first element;
• V35 Sealing of the next element during the same session.
Paragraph 2 ONVZ will reimburse 75% of the costs of other general dental health care (including technical
costs).
Paragraph 3 The maximum reimbursement of the costs referred to in Paragraphs 1 and 2 together is € 1,500
per calendar year.
Clause 2
Clause 1
Tandfit D
ONVZ will reimburse 100% of the costs of general dental health care (including technical costs)
up to a maximum of € 1,500 per calendar year.
Clause 2
130
ONVZ Tandfit
Costs of dental treatment outside country of
residence
Clause 1
If you incurred the costs of dental health care outside your country of residence, ONVZ will
reimburse the costs incurred up to a maximum of the statutory or prevailing market rates in the
Netherlands for a similar treatment in the Netherlands, up to the coverage of Tandfit A, B, C or D.
Clause 2
processed.
131
132
ONVZ
Privé Zorgpakket
133
Table of contents
ONVZ Privé Zorgpakket
Clause 1 Privé Kamer 135
Clause 2 Zorg Luxe135
Clause 3 Zorg Assistent 136
Clause 4 Zorg Totaal 136
Clause 5 Private room abroad 136
Clause 6 Services
136
134
Coverage includes reimbursement of the costs as defined below for the various components
insured under the ONVZ Privé Zorgpakket. The components included are specified on the policy
document.
ONVZ will reimburse the costs of health care:
1. up to a maximum of the rate agreed between ONVZ and the hospital;
2. if no such rate has been agreed:
• in the Netherlands up to a maximum of the statutory or prevailing market rate in the
Netherlands;
• abroad up to a maximum of twice the statutory or prevailing market rate in the
Netherlands.
Clause 1
Privé Kamer
Paragraph 1 If you are admitted to a hospital in the Netherlands, ONVZ will reimburse the costs of a single
room if:
• the hospital has a guarantee agreement with ONVZ;
• the admission is a medical necessity for specialist tests or treatment.
For more information or for a list of the hospitals with which ONVZ has a guarantee agreement,
please contact the ONVZ ZorgConsulent (see Clause 6). The list of hospitals with a guarantee
agreement can also be found at www.onvz.nl/polisvoorwaarden.
Hospitals with a guarantee agreement can offer a single room for the patient in any event if
admission is scheduled for more than one day, in the case of the following specialisms: surgery,
gynaecology, ENT, dental surgery, orthopaedics, ophthalmology, urology or plastic surgery. For
other specialist fields, the availability of a single room will depend on the hospital occupancy.
Where possible and medically responsible, you will be offered a single room.
Paragraph 2 If you have been admitted to a hospital in the Netherlands that does not have a guarantee
agreement with ONVZ, ONVZ will reimburse the costs of staying in a single room in the specialist
field for which you have been admitted. The admission must be a medical necessity for specialist
tests or treatment.
Paragraph 3 ONVZ will reimburse the extra costs of specific arrangements to be taken care of by ONVZ.
For more information and to request these specific arrangements, please contact the ONVZ
ZorgConsulent (see Clause 6). The list of arrangements can also be found at www.onvz.nl/
polisvoorwaarden.
Paragraph 4 If a hospital in the Netherlands does have single rooms, but you cannot stay in one during your
planned admission lasting more than one day, you will be entitled to compensation of € 75 per
day spent in hospital. This does not apply, therefore, if you are admitted to hospital unexpectedly.
Some hospitals have single rooms intended exclusively for patients who have to stay in one for
medical reasons. If that is the case, you will not be entitled to the compensation of € 75 per day.
Clause 2
Zorg Luxe
Zorg Luxe offers the same level of cover as Privé Kamer (Clause 1) plus extra services at a hospital
in the Netherlands.
Paragraph 1 If you are admitted to a hospital in the Netherlands, ONVZ will reimburse the costs of a luxury
package offered by the hospital. The benefits provided by this package depend on the facilities
available in the hospital in question and may include the following:
• telephone calls within the Netherlands, provided that the room has its own telephone;
• a refrigerator filled with a range of drinks;
• newspaper or magazine;
• coffee and tea for visitors;
• ‘gourmet’ meals or extra snacks;
• television and internet connection.
ONVZ Privé Zorgpakket 149141
135
Paragraph 2 If a hospital in the Netherlands does offer luxury packages, but does not have one available
during your admission, you shall be entitled to compensation of € 5 per day spent in hospital.
Clause 3
Zorg Assistent
Zorg Assistent offers the same level of cover as Privé Kamer (Clause 1), plus the services of the
ONVZ Zorg Assistent and reimbursement of the costs of transportation.
Paragraph 1 If you know in advance that you will be admitted to a hospital in the Netherlands, you will be
entitled to assistance from the ONVZ Zorg Assistent. The ONVZ Zorg Assistent:
a. will contact you for an initial interview prior to hospitalisation;
b. will arrange transportation to the hospital if required;
c. will be at the hospital when you are admitted and will help you to become familiarised with
the hospital;
d. will answer your care-related questions;
e. can, if required, stay in contact with you by telephone, enter into discussion with the (medical)
staff, visit you and arrange home care, childcare or medical appliances. The costs of home
care, childcare and/or medical appliances are not covered;
f. will assist you when you are discharged;
g. will, if required, arrange transportation when you are discharged.
Paragraph 2 If you are admitted to a hospital in the Netherlands unexpectedly, you will be entitled to
assistance from the ONVZ Zorg Assistent as defined in Paragraph 1 (d - g).
Paragraph 3 ONVZ will reimburse the costs of transportation to and from a hospital in the Netherlands:
• at a rate of € 0.27 per kilometre, for transportation by car. The amount reimbursed will be
ascertained with reference to the optimum route by car according to the Routenet route planner;
• in full, where transportation is by taxi, if the taxi firm used is one with which ONVZ has a
contract (see Clause 6).
Such transportation is provided for admissions covered under Clause 1 (Privé Kamer). If the costs
of transportation will be (partially) reimbursed under another (supplementary) (health-care) plan,
ONVZ shall only reimburse the amount that exceeds such reimbursement, up to the maximum
coverage defined in this clause. Costs associated with transportation, for example parking
charges, will not be reimbursed.
Clause 4
Zorg Totaal
Zorg Totaal offers the combined coverage as described in Clauses 1 - 3.
Clause 5
Private room abroad
Paragraph 1 If you live in the Netherlands, but choose to be admitted to a hospital in Belgium, Germany or
France, coverage shall include the extra costs for a stay in a single or double room, if such a room
is available for the specialist field for which you are admitted. The admission must be a medical
necessity for specialist tests or treatment. To claim reimbursement, you will be required to provide
ONVZ with an itemised invoice of the extra costs incurred for staying in a single or double room.
Paragraph 2 If you live abroad, coverage shall include the extra costs for a stay in a single or double room
in a hospital in any country, if such a room exists for the specialist field for which you are
admitted. The admission must be a medical necessity for specialist tests or treatment. To claim
reimbursement, you will be required to provide ONVZ with an itemised invoice of the extra costs
incurred for staying in a single or double room.
Clause 6
Services
If you have any further questions about the Privé Kamer or Zorg Assistent options, or if you wish
to take out one of these packages, please contact the ONVZ ZorgConsulent.
The ONVZ ZorgConsulent is available during office hours on the following number: 0800 022 14
50 (free of charge in the Netherlands).
To arrange taxi transportation, where this has not already been arranged by the ONVZ Zorg Assistent,
please contact the taxi firm that has a contract with ONVZ on 0900 333 33 30.
136
ONVZ
Zó-fit
137
Table of contents
ONVZ Zó-fit
General provisions
Clause 1 Applicability of general provisions ONVZ Zó-fit Scope of coverage
Clause 2 Mediation Clause 3 Method Clause 4 Influenza vaccination Clause 5 Liability
138
ONVZ Zó-fit
139
139
139
140
140
ONVZ Zó-fit
Clause 1
General provisions
Applicability of general provisions
Paragraph 1 The ONVZ Aanvullende Verzekering general provisions apply to ONVZ Zó-fit. These general
provisions are attached.
Paragraph 2 Should any provision(s) of the of ONVZ Zó-fit policy terms and conditions be in conflict with the
ONVZ Aanvullende Verzekering general provisions, the provision(s) of ONVZ Zó-fit will prevail.
Paragraph 3 The commencement date is the day on which ONVZ receives the application for an ONVZ Zó-fit
supplementary health-care plan. At the request of the policyholder this may also be a later date,
but never an earlier date.
Paragraph 4 In Clause 12 (Exclusions) of Part A-1 of the general provisions, “coverage for the costs of” should
be interpreted as: “entitlement to payment (in kind)”.
Clause 2
ONVZ Zó-fit Scope of coverage
Mediation
Paragraph 1 If you are partially or fully unable to continue to work as a result of an illness or accident, you or
the policyholder should notify ONVZ accordingly. ONVZ offers the guarantee that the process
of diagnosis (including appropriate tests) or treatment will commence within five days of ONVZ
receiving notification. The diagnosis and treatment will focus on enabling a return to work.
Once the diagnosis has been made, it is guaranteed that treatment shall start within five
workdays. The guarantee relates to common conditions (as part of a waiting list, for example).
If necessary, ONVZ shall contact a health-care provider abroad (in EU/EEA member states) for
diagnosis and treatment.
Paragraph 2 The specified period of five workdays shall apply provided the situation relating to the diagnosis
or treatment is not so complex that this requirement cannot reasonably be met. ONVZ shall
nevertheless make every effort. The guarantee does not apply for transplants and similar
treatments.
Paragraph 3 ONVZ can also mediate for childcare, domestic assistance and transportation by taxi, if provided
by organisations that have contracts with ONVZ.
Coverage shall include mediation for childcare in the event of illness or an accident suffered by
you, your partner or your child aged 12 or younger. Childcare at home can be combined with
domestic assistance, if required.
Paragraph 4 Costs for diagnoses or treatment itself are not reimbursed. The costs of childcare, domestic
assistance or transportation by taxi are also excluded from coverage. These costs may be covered
under a (supplementary) health-care plan. ONVZ advises you to gain prior information from your
(health-care) insurer about the level of coverage.
Clause 3
Method
Paragraph 1 Mediation takes place at your request. ONVZ shall inform you of the various possibilities and
arrange an appointment as you require.
Paragraph 2 The ONVZ Zó-fit Assistent is your point of contact. The ONVZ Zó-fit Assistent is available on
working days from 8.30am – 5.30pm on +31 (0)30 639 62 25, or by emailing [email protected].
Paragraph 3 Mediation requires a referral from the general practitioner, the corporate doctor or a medical
specialist. You will be required to provide this referral if so requested by ONVZ.
ONVZ Zó-fit 160141
139
Clause 4
Influenza vaccination
Clause 5
Liability
ONVZ provides the mediation defined above with the utmost care. However, ONVZ is not a
health-care provider, and therefore does not make diagnoses or perform medical treatments.
Neither does ONVZ offer medical advice and it cannot guarantee the correctness and
actions.
140
ONVZ Zó-fit
The risk bearer for the ONVZ Vrije Keuze Basisverzekering is ONVZ Ziektekostenverzekeraar N.V. (Utrecht: Trade Register no.
30135168, AFM [Netherlands Authority for the Financial Markets] no. 12000633); the risk of the supplementary health-care plans is
borne by ONVZ Aanvullende Verzekering N.V. (Utrecht: Trade Register no. 30209308, AFM no. 12001024), both located in Houten.
Postbus 392, 3990 GD Houten, Netherlands. Telephone: +31 (0)30 639 62 22. Fax: +31 (0)30 635 12 75. Internet: www.onvz.nl
Vrije Keuze Zorgplan 2014
ONVZ Zorgverzekeraar. Freedom of choice guaranteed.
Policy terms and conditions Vrije Keuze Zorgplan 2014
De Molen 66
Postbus 392
+31 (0)30 639 62 22
www.onvz.nl
ONVZ
Zorgverzekeraar.
We ensure your
freedom of choice.

Vrije Keuze Basisverzekering

Transcription

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