2014 Group Health Insurance Reimbursement Overview for Basic, MiX and supplementary insurance. Manage everything online with.

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1 204 Group Health Insurance Reimbursement Overview for, MiX and supplementary insurance Manage everything online with My VGZ

2 Contents VGZ Group Health Insurance 3 insurance 3 Higher excess, lower premium 3 Supplementary insurance 4 MiX Aanvullende 4 Goed, Beter and Best 4 All-in-One s 4 Dental insurance: VGZ Tand Goed, Beter and Best 4 Finding your way around healthcare 5 Reader s Guide 6 Reimbursement Overview for supplementary insurance; MiX Aanvullend and Aanvullend 8 Reimbursement Overview for Dental Insurance 3 Reimbursement Overview for All-in-One s 4 Current news items Would you like to stay up to date about the latest developments in healthcare, health and your insurance? Subscribe to the VGZ newsletter. 2 VGZ Health Insurance 204

3 VGZ Group Health Insurance If you take out group insurance you will qualify for a discount on the premium and benefit automatically from our special supplementary insurance for this insurance category: MiX Aanvullende. In order to guarantee a good quality of care, we have concluded agreements with care providers about the price and quality of the care to be provided. After all, taking care of good care is something best done together. This Reimbursement Overview provides an overview of our basic and supplementary insurance policies. Follow the step-by-step instructions below to choose the package that suits your needs best to be assured of the best possible care in 204. insurance (required by law) Step : Voluntary excess MiX Aanvullende (mandatory) Step 2: Supplementary insurance and/or or Dental insurance All-in-One s insurance (required by law) Would you like to take out health insurance with VGZ? The first step is to choose a basic insurance policy. insurance covers the most common types of care provided. As the care covered by basic insurance has been set down by the government, the entitlements under this policy are the same for everyone. At VGZ you can choose from the following three types of basic insurance policies: VGZ Natura Selectief, VGZ Natura and VGZ Restitutie. VGZ Natura Selectief is a contracted care policy. Contracted care is provided by a care provider with which we have concluded an agreement. We have concluded agreements for maternity care at home, repeat prescriptions and a number of care and bandaging aids with a select group of care providers specifically for VGZ Natura Selectief. If you do not mind arranging more online (e.g. ordering medicines from an online pharmacy), VGZ Natura Selectief basic insurance may be exactly what you are looking for. This basic insurance policy also has a lower premium. VGZ Natura is also a contracted care policy, but offers a greater choice of contracted care providers than VGZ Natura Selectief. If you use the services of these care providers you can be assured of receiving good quality, easily accessible care. VGZ Restitutie offers the greatest freedom in choosing a care provider. If you do not engage one of our contracted care providers, you may receive the invoice yourself and have to claim your from VGZ. You can read more about basic insurance in the Reader s Guide on page 6. Step Higher excess, lower premium If you are aged 8 or older, a compulsory excess of 360 per calendar year applies to basic insurance. You can voluntarily increase your excess to 460, 560, 660, 760, or 860. This will entitle you to a discount on the premium of your basic insurance. A high discount on your premium and generous s Employees at a company can take out group health insurance if their employers conclude a special agreement with VGZ to that effect. With group insurance, you will benefit not only from an attractive group discount, but also from generous s! The benefits of group insurance - Attractive discount on your premium - Family members covered by this insurance also benefit from the discount - Generous s - MiX Aanvullende 3

4 Especially for members of group insurance schemes: Supplementary insurance As an employee you are automatically entitled to MiX Aanvullende. This will entitle you to generous s for treatments such as physiotherapy, and additionally medical check-ups, domestic support in the case of hospital admission and commuter transport by taxi on medical grounds (between your home and your place of work). Do you have, or would you like to arrange, any other supplementary insurance in addition to this? If so, your premium will be even lower because the care covered by MiX Aanvullende will no longer be included in your supplementary insurance. This way, you won t be paying double. Step 2 Goed, Beter and Best Dental insurance: VGZ Tand Goed, Beter and Best If you prefer the convenience of extensive health insurance at a highly attractive premium, Beter is a suitable supplement to your basic insurance package. The maximum amounts and budgets are higher than those offered by Goed. If you prefer an insurance package that offers maximum security, you should consider Best. All-in-One s Would you like insurance coverage that is tailored to your current stage of life? And would you prefer the convenience of a single package that already includes dental care? If you do, you should take out one of our four All-in-One s: Jong, Fit & Vrij, Gezin or Vitaal. VGZ Jong If you are between 8 and 27 years old and only want to pay for care that you really need, you should consider choosing the Jong, an ideal supplementary insurance alternative for young people. VGZ Fit & Vrij This unique package offers a care credit of,000 and allows its holders to determine the extent of their coverage individually. The All-in-One for persons younger than 50. VGZ Gezin The entitlements in this package are tailored specifically to the needs of a family, taking all your needs into consideration, from deluxe maternity care to orthodontics. VGZ Vitaal An excellent supplementary package for people aged 55 and over, the VGZ Vitaal provides insurance coverage for glasses and contact lenses, informal care and care aids. You can choose your own dental insurance to go with your Goed, Beter or Best, or take out one of our dental insurance packages separately. VGZ Tand Goed If you take out VGZ Tand Goed you won t have to worry about check-ups or fillings, with an allocated budget of up to 250 a year. VGZ Tand Beter With Tand Beter you will be allocated a budget of up to 500 a year, and insured children under the age of 8 will be entitled to a maximum of,500 per year to cover the costs of orthodontic treatment. VGZ Tand Best With Tand Best you will be allocated a budget of up to,000 a year, and insured children under the age of 8 will be entitled to a maximum of 2,500 per year to cover the costs of orthodontic treatment. Conditions for acceptance If you opt for the VGZ Tand Goed package, you will always be accepted. If you opt for the Tand Beter or Tand Best package, you will have to meet certain conditions. You can read more about these conditions at No premium owed for children No premium is owed for children under age 8. This applies to basic as well as supplementary insurance. If you have a VGZ supplementary insurance your children will benefit from the most extensive supplementary package taken out by yourself or your insured partner. 4 VGZ Health Insurance 204

5 Finding your way around healthcare Healthcare is provided through a wide range of channels, including municipal agencies, your health insurer or your health office. If you are uncertain about where to turn when you need care, VCZ Care Advice and Mediation will be happy to help you, free of charge. Care Advice and Mediation Where can I go to have an arthroscopy done on my knee? Who can give me a second opinion? Where can I get a wheelchair tailored to my size? The Care Advice and Mediation Department will be happy to answer these and many other questions relating to care. Are you on a waiting list? If so, contact Care Advice and Mediation and we will try to find you a faster alternative at a hospital or treatment centre that provides care of a comparable standard of quality. Go to for the current contact details of our Care Advice and Mediation Department. Tell us what you think! Would you like to tell us what you think about your dentist, general practitioner or hospital? Share your opinion on the Vergelijk en Kies consumer platform at vergelijkenkies.. Find a care provider Select a care type. Narrow down your search by selecting a specialism or condition. Finish by entering your post code or city. The VGZ Care Adviser will: provide information about treatment and the best place to get it; arrange domestic and other support after surgery or if you need long-term care; provide waiting list mediation services so that you will be treated sooner; advise you about substitute informal care and informal care brokers; help you find a new general practitioner or dentist; advise you about getting a second opinion. Advice in selecting your insurance If you are unsure about which insurance you should choose, fill out the Keuzehulp form on for advice about taking out supplementary insurance. You can also compare all the alternatives using the Pakketvergelijker (package comparing tool) at 2. Compare care providers Next, compare the selection of care providers in your area. 3. Choose your care provider Choose the care provider that suits your needs best. 4. Evaluate your care provider You can also evaluate your care provider on the Vergelijk en Kies platform. This way, we will know your opinion of the care provided and you will help others make a good choice. Informal Care Broker The Care Advice and Mediation Department also employs care advisers who are specialised in informal care: our VGZ informal care brokers. They enable us to help our customers even better with all their care-related questions. We are now able to give customers seeking informal care all the answers they need. Take Mr Janssen, for example, who recently contacted us: Ms Janssen suffers from rheumatoid arthritis. He asked: I ve been taking care of my wife for many years and do all the housework. This means that I ve been her informal caregiver all these years. Am I entitled to a? Informal Care Bonus I was able to inform Mr Janssen about the informal care bonus for which Ms Janssen could apply on his behalf through the Social Insurance Bank (Sociale sbank, SVB). The informal care bonus is for informal carers who provide long-term, intensive care to a relative, spouse, friend or acquaintance and amounts to 200. We were very happy to be of help to Mr Janssen! 5

6 Reader s Guide This Reimbursement Overview lists the s that apply to the basic and supplementary insurance policies offered by VGZ. All items in the overview of s marked with a are covered by your policy. The amount depends on your choice of care provider in combination with your chosen policy. Additional conditions Additional conditions, such as permission requirements, necessary referrals and authorised care providers, are specified in the 204 policy conditions. If you require care, we therefore recommend that you first consult the policy conditions, available at at Please note that, in the conditions, the words per year refer to the calendar year. The amounts stated here are maximum amounts. You can choose from the following basic insurance policies: VGZ Natura Selectief VGZ Natura Selectief is a contracted care policy. The contracted care is provided by a care provider with which VGZ has concluded an agreement. We have concluded agreements for maternity care at home, repeat prescriptions and a number of care and bandaging aids with a select group of care providers specifically for VGZ Natura Selectief. You will find a list of these and other care providers at vergelijkenkies. If you do not engage one of our contracted care providers, note that you will probably have to pay a portion of the costs yourself. Costs are reimbursed up to, as a maximum, the rates specified in the List of Maximum Reimbursements for Non-Contracted Care Providers under the 204 VGZ Natura policy (Lijst maximale VGZ Natura 204). The maximum amounts have been calculated based on 75% of the average contracted rates as agreed with the relevant care providers. You will find this list on our website. For more information, read the policy conditions. VGZ Natura VGZ Natura is also a contracted care policy; one difference with VGZ Natura Selectief is that you have more freedom to choose from VGZ s contracted care providers. The contracted care is provided by a care provider with which we have concluded an agreement. You will find a list of these care providers at If you do not engage one of our contracted care providers, note that you will probably have to pay a portion of the costs yourself. Costs are reimbursed up to, as a maximum, the rates specified in the List of Maximum Reimbursements for Non-Contracted Care Providers under the 204 VGZ Natura policy (Lijst maximale VGZ Natura 204). The maximum amounts have been calculated based on 80% of the average contracted rates as agreed with the relevant care providers. A maximum of 75% of the average contracted rates applies to specialist mental healthcare and the associated medically necessary inpatient accommodation. You will find this list on our website. For more information, read the policy conditions. VGZ Restitutie VGZ Restitutie is a non-contracted care policy. This policy gives you complete freedom of choice with respect to care providers, regardless of whether or not the care provider you choose has agreements with VGZ. The only requirement is that the care provider satisfies the requirements set out in our policy conditions. You are entitled to of the costs of care up to a maximum of the statutory rates current in the Netherlands. You will find the statutory rates listed on the website of de Dutch Healthcare Authority (Nederlandse Zorgautoriteit, NZa). If no statutory rates apply to the relevant care, the costs will be reimbursed up to a maximum of the reasonable market price current in the Netherlands. A summary of our three basic insurance policies: VGZ Natura Selectief Contracted care provider: full based on the Non-contracted care provider: 75% of the average VGZ Natura VGZ Restitutie Contracted care provider: full based on the Non-contracted care provider: 80% of the average Specialist mental healthcare and medically necessary inpatient accommodation: 75% of the average Contracted care provider: full based on the Non-contracted care provider: statutory or (usual) Dutch market rates. 6 VGZ Health Insurance 204

7 Excess If you are aged 8 or older, a compulsory excess of 360 per calendar year applies to basic insurance. You can voluntarily increase your excess to 460, 560, 660, 760, or 860. If you do, you will be entitled to a discount. The excess does not apply to expenses incurred for visits to a general practitioner, obstetric care, maternity care, care that is financed as part of a care programme, preferred medications or liquid nutrients designated by us, care aids on loan, follow-up checks for kidney or liver donors after a specified period of time has elapsed and personal s and/or payments, if applicable. Budgets VGZ has grouped the various treatments available to you, allowing you to see at a glance which types of care are reimbursed by VGZ. There is a maximum for each treatment group. We refer to this as a budget. You decide yourself which treatment you spend your budget on. This allows you to make the best possible use of your amount. Budgets are available for (among other things) prevention, movement-related care, foot treatments and care aids. You can find these budgets in the Reimbursements Overview and the policy conditions. Supplementary insurance We will reimburse the costs of care up to a maximum of the statutory rates current in the Netherlands. If no statutory rates apply to the relevant care, the costs will be reimbursed up to a maximum of the reasonable market price current in the Netherlands. If you are using the services of one of our contracted care providers, the costs of care are reimbursed based on the rate agreed with the care provider concerned. Your supplementary insurance package may refer to designated, accredited or contracted care. This is indicated in the overview. If you are using the services of non-contracted, non-accredited or non-designated care providers, note that you may have to pay the costs (or a portion of the costs) yourself. With regard to types of care to which a lower amount applies if you engage non-contracted care providers, please consult the maximum amounts specified in the List of Maximum Reimbursements for Non-Contracted Care Providers under the 204 VGZ Natura policy (Lijst maximale VGZ Natura 204). For more information, read the policy conditions. My VGZ If you would like to submit your claims or make any changes to your insurance conveniently online, go to to take care of this directly. 7

8 204 Health Insurance, and MiX Aanvullende cover Health Insurance Reimbursement Overview Insurance MiX Aanvullende Goed Beter Best Alternative care A budget to spend on the care types specified below: Treatments and consultations (by a doctor or designated care provider) Homeopathic and/or anthroposophic medicines Contraceptives e.g. the contraceptive pill, birth control implant (Implanon rod), intrauterine contraceptive device (coil), ring or diaphragm under age 2. This also applies to insured persons from age 2 using contraceptives to treat endometriosis or menorrhagia (for anaemia) e.g. the contraceptive pill, birth control implant (Implanon rod), intrauterine contraceptive device (coil), ring or diaphragm from age 2 Audiological care examination of auditory function, hearing aid advice Circumcision medically necessary circumcision (subject to prior permission ) Delivery and maternity care fertility consultation (preconception care): Delivery home delivery delivery at a hospital or one of our contracted maternity centres (without medical necessity) delivery at a hospital or one of our contracted birth centres (medically necessary) Maternity care is payable for some contraceptives) 200 per day ( 233 minus 33 for the personal to maternity care in a hospital) maternity care at home up to 0 days of 4.0 per hour applies) maternity care at a hospital or one of our contracted maternity centres (without medical necessity) up to 0 days of 33 per day for both mother and child applies) 300 per year; the amount for treatments and consultations is capped at 45 a day full amount is payable for some contraceptives) 500 per year; the amount for treatments and consultations is capped at 45 a day full amount is payable for some contraceptives) per year; the amount for treatments and consultations is capped at 45 a day full amount is payable for some contraceptives) full amount full amount full amount 25 of the personal 25 of the personal maternity care at a hospital or one of our contracted birth centres (medically necessary) after-care of mother and newly born 6 hours divided over 2 days full of the personal full of the personal 2 hours divided over 4 days VGZ s maternity package full amount full amount Breast feeding breast-feeding advice (lactation consultation) 50 per delivery 50 per delivery rent of an electrical breast pump in the event of the admission of an ill baby 0 per delivery 0 per delivery All items in the overview of s marked with a are covered by your policy. The amount depends on your choice of care provider in combination with your chosen policy. You can find more information in the Reader s Guide. 8 VGZ Health Insurance 204

9 Health Insurance Reimbursement Overview Insurance MiX Aanvullende Goed Beter Best Movement-related care (e.g. physiotherapy) A budget to spend on the care types specified below: physiotherapy, oedema therapy and Cesar/ Mensendieck remedial therapy: chronic disorders, under age 8 (subject to prior permission ) chronic disorders, from age 8 as from the 2 st treatment session (subject to prior permission ) non-chronic disorders, under age 8 8 treatment sessions per year non-chronic disorders, from age 8 pelvic physiotherapy to treat urine incontinence, insured persons from age 8 the first 9 treatment sessions occupational therapy 0 hours per year alternative movement-related therapy, such as chiropractic therapy and osteopathy (by a designated care provider) Glasses, contact lenses, laser eye treatments or lens implants contact lenses and/or glasses lenses of the appropriate corrective strength with frames where applicable laser eye treatment/lens implant Care abroad urgent care while on holiday or during a temporary stay abroad non-urgent care while abroad (subject to prior permission 2 ) based on the market rates in the Netherlands based on the market rates in the Netherlands,000 per year; physiotherapists, remedial therapists and occupational therapists the maximum equals 80% of the average The maximum rates can be found in the Lijst maximale VGZ Natura 204. A maximum amount of 45 per day applies to alternative movementrelated therapy 200 per year 3 ; physiotherapists, remedial therapists and occupational therapists the maximum equals 80% of the average The maximum rates can be found in the Lijst maximale VGZ Natura 204. A maximum amount of 45 per day applies to alternative movementrelated therapy 400 per year 3 ; physiotherapists, remedial therapists and occupational therapists the maximum equals 80% of the average The maximum rates can be found in the Lijst maximale VGZ Natura 204. A maximum amount of 45 per day applies to alternative movementrelated therapy 00 every 3 years 600 per year 3 ; physiotherapists, remedial therapists and occupational therapists the maximum equals 80% of the average The maximum rates can be found in the Lijst maximale VGZ Natura 204. A maximum amount of 45 per day applies to alternative movementrelated therapy 50 every 3 years 500, once-only full amount full amount full amount repatriation arranged by VGZ Emergency Services full amount full amount full amount Dietary advice the provision of information about diet and eating habits for a medical purpose Care for dyslexics care in connection with severely dyslexic children aged 7 and up who are attending primary education Genetic testing tests to establish and determine the extent of genetic disorders Pharmaceutical care (medicines) medicines listed in Appendix of the Healthcare Insurance Regulations and the VGZ Pharmaceutical Care Regulations (subject to prior permission 2 ) 3 hours per year 500 per year; care providers the maximum equals 80% of the average contracted rates. The maximum rates can be found in the Lijst maximale nietgecontracteerde VGZ Natura 204. is payable for some medicines) 250 per year 3 ; care providers the maximum equals 80% of the average contracted rates. The maximum rates can be found in the Lijst maximale nietgecontracteerde VGZ Natura 204 All items in the overview of s marked with a are covered by your policy. The amount depends on your choice of care provider in combination with your chosen policy. You can find more information in the Reader s Guide. 2 in specific cases you may need prior permission from VGZ. See our policy conditions. 3 of these costs does not apply if you are entitled to under MiX Aanvullende. VGZ Supplementary insurance 9

10 Health Insurance Reimbursement Overview Insurance MiX Aanvullende Goed Beter Best diet preparations (subject to prior permission ) (the VGZ Pharmaceutical Care Regulations apply to liquid nutrients) Skin treatments A budget to spend on the care types specified below (provided by designated care providers): acne treatment camouflage therapy hair removal General practitioner care this also includes counselling in relation to a stop-smoking programme and foot care if you have diabetes mellitus type or 2 Care aids care and bandaging aids in accordance with the Healthcare Insurance Regulations and the VGZ Pharmaceutical Care Aids Regulations (subject to prior permission 2 ) A budget to spend on statutory s/ personal payments or the care aids specified below (and associated extras): audiological care aids breast prosthesis, items used following mastectomy wigs and Mutssja head covers support pessary In vitro fertilisation (IVF) and other fertility treatments in vitro fertilisation (IVF) for women younger than 43. Additional conditions apply other fertility treatments (women younger than 43) Multi-disciplinary care multi-disciplinary care for diabetes mellitus type 2, COPD and cardiovascular risk management ( care programmes ) Speech therapy treatment or improvement of speech or ability to speak Informal care informal care (with a referral from the VGZ Care Advisor and provided by a contracted care provider) and/ or a maximum amount apply to some care aids) st, 2 nd and 3 rd attempts 300 per year 500 per year 700 per year 250 per year 500 per year 250 per year 500 per year 750 per year substitute informal care (by a contracted care provider) 4 days a year 9 days a year 4 days a year Specialist medical care this also includes care provided by a thrombosis service, a second opinion, dialysis and the necessary nursing care provided at home (subject to prior permission 2 ) Plastic and/or reconstructive surgery on specific medical grounds (subject to prior permission ) abdominal wall surgery (subject to prior permission ) eyelid corrections (subject to prior permission ) on specific medical grounds on specific medical grounds 2, All items in the overview of s marked with a are covered by your policy. The amount depends on your choice of care provider in combination with your chosen policy. You can find more information in the Reader s Guide. 2 in specific cases you may need prior permission from VGZ. See our policy conditions. 0 VGZ Health Insurance 204

11 Health Insurance Reimbursement Overview Insurance MiX Aanvullende Goed Beter Best Prevention A budget to spend on the care types specified below: Healthy lifestyle training courses (e.g. coping with illnesses or disorders) first-aid course reanimation course health test weight consultant Advice and assistance sports medical advice menopause care Vaccinations flu vaccination preventative vaccinations and medicines in connection with a holiday Psychological care cogmed for insured persons under 8 with developmental and learning disorders generalist basic mental healthcare (GGZ) group therapy for children up to age 8 whose parents suffer from a psychological disorder or addiction neurofeedback (for ADHD and ADD) under age 8 sexological care specialist mental healthcare (GGZ) Rehabilitation this also includes a Quick scan and rehabilitation associated with oncology geriatric rehabilitation Herstel en Balans (Recovery and Balance) rehabilitation programme Redression helmet redression helmet treatment for children up to the age of 4 months on specific medical grounds (by a contracted care provider) Sterilisation (max. 6 months) 750 per year 200 per year per year per year per diagnosis 800 per diagnosis full amount 400 per year 400 per year,000 per year 60 per session up to a maximum of 4 sessions per year,000 per diagnosis full amount sterilisation of a man sterilisation of a woman,250,250 Stopping smoking stop-smoking programme once a year Dental care/oral care Dental and orthodontic care in special cases dental care (including implants and technician s costs, if applicable) and orthodontic care on specific medical grounds (subject to prior permission ) Dental care under age 8 dental care with the exception of crowns, bridges and orthodontic care crowns, bridges and implants (including technician s costs) (subject to prior permission ) Dental care from age 8 crowns (with implants, if medically necessary) and bridges required as the direct consequence of an accident (subject to prior permission ) may apply) if to replace one or more permanent incisors or canines that have not developed or are missing due to an accident full amount for persons from age 8 to 22 full amount for persons from age 8 to 22 All items in the overview of s marked with a are covered by your policy. The amount depends on your choice of care provider in combination with your chosen policy. You can find more information in the Reader s Guide. 2 in specific cases you may need prior permission from VGZ. See our policy conditions. 3 of these costs does not apply if you are entitled to under MiX Aanvullende. VGZ Supplementary insurance

12 Health Insurance Reimbursement Overview Insurance MiX Aanvullende Goed Beter Best Dental surgery from age 8 dental surgery by a dental surgeon with the exclusion of fitting implants, treatment of gums and simple extractions Dental prostheses (dentures) from age 8 removable full dentures, including technician s costs (subject to prior permission 2 ) of 25% applies) full of the personal full of the personal Removable dentures on implants, including technician s costs, for seriously shrunken, toothless jaws (subject to prior permission ) of 25 per jaw applies) full of the personal full of the personal Tissue and organ transplants if the transplant is carried out in an EU or EEA Member State Inpatient care convalescent home/care hotel (at a contracted care provider) 00 per day, max.,000 per year 00 per day, max.,500 per year 00 per day, max. 2,000 per year hospice (at an accredited care provider) 30 per day 30 per day 30 per day hospital (psychiatric or otherwise), mental health or rehabilitation facility (subject to prior permission 2 ) Ronald McDonald House/family house 300 per year 400 per year 600 per year Transport ambulance transport seated patient transport on specific medical grounds (subject to prior permission ), by: private car 0.3 per km of 96 per year applies) public transport or taxi of 96 per year applies) taxi (by a contracted transport provider) or private transport in connection with an organ transplant taxi: full amount, private car: 0.3 per km taxi: full amount, private car: 0.3 per km taxi: full amount, private car: 0.3 per km taxi transport to and from work (by a contracted transport company) 350 per year Foot treatments A budget to spend on the care types specified below: rheumatic foot treatment podotherapy arch supports 00 per year 300 per year 500 per year All items in the overview of s marked with a are covered by your policy. The amount depends on your choice of care provider in combination with your chosen policy. You can find more information in the Reader s Guide. 2 in specific cases you may need prior permission from VGZ. See our policy conditions. 2 VGZ Health Insurance 204

13 204 Health Insurance, and Dental insurance cover Reimbursement Overview for Dental Care Dental care from age 8 dental care, with the exception of orthodontic care and general anaesthesia (including material costs and the cost of a dental technician) Orthodontic care under age 8 from age 8 Insurance VGZ Tand Goed VGZ Tand Beter VGZ Tand Best 80% up to a maximum of 250 per year 80% up to a maximum of 500 per year,500 for the entire term of the insurance 500 for the entire term of the insurance 80% up to a maximum of,000 per year 2,500 for the entire term of the insurance,500 for the entire term of the insurance VGZ Dental insurance 3

14 204 Health Insurance, insurance, MiX Aanvullende and All-in-One s Health Insurance Reimbursement Overview insurance MiX Aanvullende VGZ Jong VGZ Fit & Vrij VGZ Gezin VGZ Vitaal Alternative care A budget to spend on the care types specified below: treatments and consultations (by a doctor or designated care provider) homeopathic and/or anthroposophic medicines 200 per year; the amount for treatments and consultations is capped at 45 a day part of the package; the amount for treatments and consultations is capped at 45 a day 300 per year; the amount for treatments and consultations is capped at 45 a day 300 per year; the amount for treatments and consultations is capped at 45 a day Contraceptives e.g. the contraceptive pill, birth control implant (Implanon rod), intrauterine contraceptive device (coil), ring or diaphragm under 2. This also applies to insured persons from age 2 using contraceptives to treat endometriosis or menorrhagia (for anaemia) is payable for some contraceptives) e.g. the contraceptive pill, birth control implant (Implanon rod), intrauterine contraceptive device (coil), ring or diaphragm from age 2 full amount is payable for some contraceptives) part of the package is payable for some contraceptives) full amount is payable for some contraceptives) Audiological care examination of auditory function, hearing aid advice Circumcision medically necessary circumcision (subject to prior permission ) Delivery and maternity care fertility consultation (preconception care) Delivery home delivery delivery at a hospital or one of our contracted maternity centres (without medical necessity) delivery at a hospital or one of our contracted birth centres (medically necessary) Maternity care 200 per day ( 233 minus 33 for the personal to maternity care in a hospital) full amount maternity care at home up to 0 days of 4.0 per hour applies) full of the personal maternity care at a hospital or one of our contracted maternity centres (without medical necessity) maternity care at a hospital or one of our contracted birth centres (medically necessary) up to 0 days of 33 per day for both mother and child applies) full of the personal deluxe maternity care 5 hours VGZ s maternity package full amount adoption 300 per adopted child Breast feeding breast-feeding advice (lactation consultation) 00 per delivery rent of an electrical breast pump in the event of the admission of an ill baby 0 per delivery All items in the overview of s marked with a are covered by your policy. The amount depends on your choice of care provider in combination with your chosen policy. You can find more information in the Reader s Guide. 4 VGZ Health Insurance 204

15 Health Insurance Reimbursement Overview Movement-related care (e.g. physiotherapy) A budget to spend on the care types specified below: physiotherapy, oedema therapy and Cesar/ Mensendieck remedial therapy: insurance chronic disorders, under age 8 (subject to prior permission ) chronic disorders, from age 8 as from the 2 st treatment session (subject to prior permission ) non-chronic disorders, under age 8 8 treatment sessions per year non-chronic disorders, from age 8 pelvic physiotherapy to treat urine incontinence, insured persons from age 8 the first 9 treatment sessions occupational therapy 0 hours per year alternative movement-related therapy, such as chiropractic therapy and osteopathy (by a designated care provider) Glasses and contact lenses contact lenses and/or glasses lenses of the appropriate corrective strength with frames where applicable laser eye treatment/lens implant Care abroad urgent care while on holiday or during a temporary stay abroad based on the market rates in the Netherlands MiX Aanvullende,000 per year; physiotherapists, remedial therapists and occupational therapists the maximum equals 80% of the average contracted rates. The maximum rates can be found in the Lijst maximale VGZ Natura 204. A maximum amount of 45 per day applies to alternative movementrelated therapy VGZ Jong 600 per year 3 ; physiotherapists, remedial therapists and occupational therapists the maximum equals 80% of the average contracted rates. The maximum rates can be found in the Lijst maximale VGZ Natura 204. A maximum amount of 45 per day applies to alternative movementrelated therapy 50 every 3 years VGZ Fit & Vrij part of the package 3 ; physiotherapists, remedial therapists and occupational therapists the maximum equals 80% of the average The maximum rates can be found in the Lijst maximale VGZ Natura 204. A maximum amount of 45 per day applies to alternative movementrelated therapy part of the package, max. 50 every 3 years part of the package VGZ Gezin 600 per year 3 ; physiotherapists, remedial therapists and occupational therapists the maximum equals 80% of the average contracted rates. The maximum rates can be found in the Lijst maximale VGZ Natura 204. A maximum amount of 45 per day applies to alternative movementrelated therapy 50 every three years ( 200 every two years for children up to the age of 8) VGZ Vitaal,000 per year 3 ; physiotherapists, remedial therapists and occupational therapists the maximum equals 80% of the average contracted rates. The maximum rates can be found in the Lijst maximale VGZ Natura 204. A maximum amount of 45 per day applies to alternative movementrelated therapy 50 every 3 years full amount full amount full amount full amount non-urgent care while abroad (subject to prior permission 2 ) based on the market rates in the Netherlands repatriation arranged by VGZ Emergency Services full amount full amount full amount full amount Dietary advice the provision of information about diet and eating habits for a medical purpose Care for dyslexics care in connection with severely dyslexic children aged 7 and up who are attending primary education Genetic testing tests to establish and determine the extent of genetic disorders 3 hours per year 500 per year; for non-contracted care providers the maximum equals 80% of the average The maximum rates can be found in the Lijst maximale VGZ Natura per year 3 ; care providers the maximum equals 80% of the average The maximum rates can be found in the Lijst maximale VGZ Natura 204 All items in the overview of s marked with a are covered by your policy. The amount depends on your choice of care provider in combination with your chosen policy. You can find more information in the Reader s Guide. 2 in specific cases you may need prior permission from VGZ. See our policy conditions. 3 of these costs does not apply if you are entitled to under MiX Aanvullende. VGZ All-in-One s 5

16 Health Insurance Reimbursement Overview insurance MiX Aanvullende VGZ Jong VGZ Fit & Vrij VGZ Gezin VGZ Vitaal Pharmaceutical care (medicines) medicines listed in Appendix of the Healthcare Insurance Regulations and the VGZ Pharmaceutical Care Regulations (subject to prior permission 2 ) is payable for some medicines) Diet preparations (subject to prior permission ) (the VGZ Pharmaceutical Care Regulations apply to liquid nutrients) Skin treatments A budget to spend on the care types specified below (provided by designated care providers): acne treatment camouflage therapy hair removal General practitioner care 300 per year part of the package 500 per year 500 per year This also includes counselling in relation to a stop-smoking programme and foot care if you have diabetes mellitus type or 2 Domestic support domestic help in the event of sickness, accidents or hospital admission (by a contracted care provider) 30 hours per year 0 hours per year Care aids care and bandaging aids in accordance with the Healthcare Insurance Regulations and the VGZ Pharmaceutical Care Aids Regulations (subject to prior permission 2 ) and/or a maximum amount applies to some care aids) A budget to spend on statutory s/ personal payments or on the care aids specified below (and associated extras): audiological care aids breast prosthesis, items used following mastectomy wigs and mutssja head covers part of the allocated budget 250 per year 350 per year support pessary not applicable pad and buzzer for children aged 6 to 8 not applicable not applicable In vitro fertilisation (IVF) and other fertility treatments in vitro fertilisation (IVF) for women younger than 43. Additional conditions apply other fertility treatments (women younger than 43) Multi-disciplinary care multi-disciplinary care for diabetes mellitus type 2, COPD and cardiovascular risk management ( care programmes ) Child care for children up to age 2 (through Care Advice and Mediation) Speech therapy treatment or improvement of speech or ability to speak Informal care informal care (with a referral from the VGZ Care Advisor and provided by a contracted care provider) st, 2 nd and 3 rd attempts 24 hours per year part of the package 500 per year 750 per year substitute informal care (by a contracted care provider) part of the package 9 days a year 9 days a year All items in the overview of s marked with a are covered by your policy. The amount depends on your choice of care provider in combination with your chosen policy. You can find more information in the Reader s Guide. 2 in specific cases you may need prior permission from VGZ. See our policy conditions. 6 VGZ Health Insurance 204

17 Health Insurance Reimbursement Overview Specialist medical care this also includes care provided by a thrombosis service, a second opinion, dialysis and the necessary nursing care provided at home (subject to prior permission 2 ) Plastic and/or reconstructive surgery on specific medical grounds (subject to prior permission ) abdominal wall surgery (subject to prior permission ) eyelid corrections (subject to prior permission ) protruding ear correction for insured persons under age 8 insurance on specific medical grounds on specific medical grounds MiX Aanvullende VGZ Jong VGZ Fit & Vrij part of the package VGZ Gezin VGZ Vitaal part of the package 950 contracted care provider: full amount; non-contracted care provider:,500 Prevention A budget to spend on the care types specified below: 750 per year 200 per year 3 part of the package per year per year 33 Healthy lifestyle training courses (e.g. coping with illnesses or disorders) first-aid course reanimation course health test weight consultant Advice and assistance sports medical advice menopause care not applicable not applicable Examination medical examination for driving licences B or BE not applicable not applicable not applicable Vaccinations flu vaccination not applicable not applicable preventative vaccinations and medicines in connection with a holiday Psychological care cogmed for insured persons under age 8 with developmental and learning disorders generalist basic mental healthcare (GGZ) 400 per year group therapy for children up to age 8 whose parents suffer from a psychological disorder or addiction 400 per year neurofeedback (for ADHD and ADD) under age 8,000 per year sexological care 60 per session up to a maximum of 4 sessions per year part of the package. 60 per session up to a maximum of 4 sessions per year 60 per session up to a maximum of 4 sessions per year 60 per session up to a maximum of 4 sessions per year specialist mental healthcare (GGZ) Rehabilitation this also includes a Quick scan and rehabilitation associated with oncology geriatric rehabilitation (max. 6 months) Herstel en Balans (Recovery and Balance) rehabilitation programme 800 per diagnosis part of the package 800 per diagnosis 800 per diagnosis Redression helmet redression helmet treatment for children up to the age of 4 months on specific medical grounds (by a contracted care provider) full amount All items in the overview of s marked with a are covered by your policy. The amount depends on your choice of care provider in combination with your chosen policy. You can find more information in the Reader s Guide. 2 in specific cases you may need prior permission from VGZ. See our policy conditions. 3 of these costs does not apply if you are entitled to under MiX Aanvullende. VGZ All-in-One s 7

18 Health Insurance Reimbursement Overview insurance MiX Aanvullende VGZ Jong VGZ Fit & Vrij VGZ Gezin VGZ Vitaal Sterilisation sterilisation of a man part of the package 800 sterilisation of a woman part of the package,250 Stopping smoking stop-smoking programme Dental care/oral care Dental and orthodontic care in special cases dental care (including implants and technician s costs, if applicable) and orthodontic care on specific medical grounds (subject to prior permission ) once a year may apply) Dental care under age 8 dental care with the exception of crowns, bridges and orthodontic care crowns, bridges and implants (including technician costs) (subject to prior permission ) if to replace one or more permanent incisors or canines that have not developed or are missing due to an accident Dental care from age 8 dental care, with the exception of orthodontic care and general anaesthesia (including material costs and the cost of a dental technician) 80% up to a maximum of 450 per year part of the package, maximum 80% up to a maximum of 450 per year, part of the maximum amount for Dental Care and/ or Oral Care 80% up to a maximum of 450 per year 80% up to a maximum of 450 per year crowns (with implants, if medically necessary) and bridges required as the direct consequence of an accident (subject to prior permission ) full amount full amount for persons from age 8 to 22 Dental surgery from age 8 dental surgery by a dental surgeon with the exclusion of fitting implants, treatment of gums and simple extractions Dental prostheses (dentures) from age 8 removable full dentures, including technician s costs (subject to prior permission 2 ) of 25% applies) of the personal, part of the maximum for Dental Care and/or Oral Care full of the personal full of the personal removable dentures on implants, including technician s costs, for seriously shrunken, toothless jaws (subject to prior permission ) of 25 per jaw applies) of the personal, part of the maximum for Dental Care and/or Oral Care full of the personal full of the personal All items in the overview of s marked with a are covered by your policy. The amount depends on your choice of care provider in combination with your chosen policy. You can find more information in the Reader s Guide. 2 in specific cases you may need prior permission from VGZ. See our policy conditions. 8 VGZ Health Insurance 204

19 Health Insurance Reimbursement Overview insurance MiX Aanvullende VGZ Jong VGZ Fit & Vrij VGZ Gezin VGZ Vitaal Orthodontic care under age for the entire term of the insurance part of the maximum for Dental Care and/or Oral Care 80% up to a maximum of 2,500 for the entire term of the insurance from age for the entire term of the insurance Tissue and donor transplants if the transplant is carried out in an EU or EEA Member State (including donor costs) VGZ Vrij Zeker prevention of sexually transmitted diseases (by contracted care provider) once a year condoms (order via 20 per year Inpatient care convalescent home/care hotel (at a contracted care provider) part of the package, max. of 00 per day 00 per day, max.,000 per year 00 per day, max.,000 per year hospice (at an accredited care provider) 30 per day part of the package, max. of 30 per day 30 per day 30 per day hospital (psychiatric or otherwise), mental health or rehabilitation facility (subject to prior permission 2 ) Ronald McDonald House/family house 400 per year 400 per year therapeutic holiday camp under age 8 Transport ambulance transport seated patient transport on specific medical grounds (subject to prior permission ), by: 300 per year private car 0.3 per km of 96 per year applies) public transport or taxi transport of 96 per year applies) taxi transport or private transport (by a contracted transport provider) in connection with an organ transplant taxi: full amount, private car: 0.3 per km part of the package, taxi: up to a maximum of the budget, private car: 0.3 per km taxi: full amount, private car: 0.3 per km taxi: full amount, private car: 0.3 per km taxi transport to and from work (by contracted transport company) 350 per year Foot treatments A budget to spend on the care types specified below: rheumatic foot treatment podotherapy arch supports part of the package 300 per year 300 per year All items in the overview of s marked with a are covered by your policy. The amount depends on your choice of care provider in combination with your chosen policy. You can find more information in the Reader s Guide. 2 in een aantal gevallen hebt u voorafgaande toestemming van VGZ nodig. Raadpleeg de verzekeringsvoorwaarden. VGZ All-in-One s 9

20 for further information and contact details This translation of the VGZ Natura 204 policy conditions is intended as a service for persons insured with us who do not have a command of the Dutch language. Rights may only be derived from the Dutch version. D VGZ Zorgverzekeraar N.V. (VGZ), registered office in Nijmegen, Chamber of Commerce No , DNB licence number:

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