My VGZ Healthcare Insurance Reimbursement overview for basic, supplementary and dental insurance policies and All-in-One packages

Transcription

1 2015 Healthcare Insurance Reimbursement overview for basic, supplementary and dental insurance policies and All-in-One packages Manage everything online with My VGZ

2 Contents VGZ healthcare insurance policies 3 Basic insurance policies 3 Higher excess, lower premium 3 Supplementary insurance policies 4 Goed, Beter en Best 4 All-in-One packages 4 Tandartsverzekeringen; VGZ Tand Goed, Beter en Best 4 Ensuring that you receive the best care 5 Reader s guide 6 Reimbursement overview of supplementary insurance policies 8 Reimbursement overview of dental insurance policies 13 Reimbursement overview for All-in-One packages 14 Current news items Would you like to stay up to date about the latest developments in healthcare, health and your insurance policy? Subscribe to the VGZ newsletter via Healthcare Insurance

3 VGZ Healthcare insurance policies To guarantee the best care, VGZ concludes agreements with care providers about the quality and price of the care to be provided. After all, taking care of good care is something best done together. This 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 Basic insurance (required by law) Step 1: Voluntary excess Step 2: Supplementary insurance policies and/or of Dental insurance policies All-in-One packages VGZ offers three basic insurance policies (required by law) VGZ Goede Keuze policy (contracted care policy) A choice for VGZ Goede Keuze is a conscious choice for good care. You have access to all care providers we have concluded contracts with. For a number treatments that can be scheduled in advance (including knee, hip and cataracts operations) and a number of oncological treatments and bariatric surgical procedures (for obesity), we have only contracted care providers that rank high according to our own standards. You may have to travel somewhat further from your home to reach therm, but rarely further than 50 km. This policy guarantees good care for a low premium. Step 1 Higher excess, lower premium If you are aged 18 or older, a compulsory excess of 375 per calendar year applies to your basic insurance. You can voluntarily increase your excess to 475, 575, 675, 775 or 875. If you do, you will be entitled to a discount. VGZ Ruime Keuze policy (contracted care policy) VGZ Ruime Keuze is similar to the VGZ Goede Keuze, except that you have a wider choice of contracted care providers, making it easier to find one nearby. VGZ Eigen Keuze policy ( care policy) The VGZ Eigen Keuze policy allows you to chose any care provider you wish. That freedom of choice comes at a higher premium. While we can guarantee good care if you opt for one of our contracted care providers, we are unable to make that same promise if you choose another care provider. However, if you decide to go to a care provider, we will reimburse the maximum prevailing market rate. Children are insured free of charge! No premium is owed for children up to age 18. This applies to basic as well as supplementary insurance. If you have a VGZ supplementary insurance package, your children will benefit from the highest supplementary package of either yourself or your insured partner. 3

4 Supplementary insurance policies You can expand the coverage of your basic insurance by taking out supplementary insurance. VGZ offers three supplementary insurance and three dental insurance packages to choose from, Alternatively, you can opt for one of our All-in-One packages. The s in these packages have been geared specifically to the different stages of life. Step 2 Goed, Beter en Best Dental insurance policies; VGZ Tand Goed, Beter and Best If you prefer the convenience of extensive health insurance against an attractive premium, Beter is a suitable supplement to your basic insurance package. The 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 packages Are you looking for a package that fits your current life phase? And would you prefer the convenience of a single package that includes dental care? If so, you should take out one of our four All-in-One packages: VGZ Jong, Fit & Vrij, Gezin or the Vitaal package. VGZ Jong Package If you are between 18 and 27 years old and only want to pay for care that you really need, you may consider the VGZ Jong Package, an ideal supplementary insurance alternative for young people. VGZ Fit & Vrij Package This unique package offers a care credit of 1,000, allowing you to decide which type of care to use. The All-in-One package for persons up to age 50. VGZ Gezin Package The entitlements in this package are tailored specifically to the needs of a family, with everything accounted for, from deluxe maternity care to orthodontics. VGZ Vitaal Package An excellent supplementary package for people aged 55 and over, the VGZ Vitaal Package provides extra insurance coverage for glasses and contact lenses, informal care, care aids, etc. You can choose your own dental insurance to go with your Goed, Beter, or Best insurance, You can also take out a dental care insurance policy on its own. 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 age 18 will be entitled to a of 1,500 to cover the costs of orthodontic treatment. VGZ Tand Best With Tand Best you will be allocated budget of up to 1,000 a year and insured children under age 18 will be entitled to a of 2,500 to cover the costs of orthodontic treatment. Conditions for acceptance If you opt for VGZ Tand Goed, you will always be accepted. If you opt for Tand Beter or Tand Best, you will have to meet certain conditions. You can find the conditions on MiX Aanvullende Verzekering If you are joining a VGZ group healthcare insurance policy via your employer, it will probably be the MiX Aanvullende Verzekering (supplementary insurance). The MiX Aanvullende Verzekering offers extra high s for physiotherapy, preventive care (such as vaccinations, courses and medical check-ups), domestic help in the event of hospital admission and taxi transport on medical grounds (between home and work), etc. If you already have or wish to take out a further supplementary insurance policy, you will receive an additional discount on the premium because the care provided under the MiX Aanvullende Verzekering will no longer need to be included in your supplementary insurance policies. This means you never have to pay for double insurance Healthcare Insurance If you would like to know whether the MiX Aanvullende insurance policy is included in your employer s group insurance scheme, go to vgz.nl/premieberekenen. Go to vgz.nl/premieberekenen.

5 Ensuring that you receive the best care We are already working on it If you ever need healthcare, you want to be sure that it is good-quality healthcare. Healthcare provision in the Netherlands is good, but some healthcare providers are better in certain treatments than others. This is why VGZ actively engages with specific healthcare providers with a view to raising quality. For a number of treatments to be provided in 2015, we have concluded contracts exclusively with healthcare providers that satisfy our standards. This collaboration helps us ensure that the quality of healthcare provision in the Netherlands remains high. How is quality measured? Measuring quality means carefully examining how you experience the healthcare provided as well as applying medical standards and drawing on scientific research and the knowledge available in patient organisations. For example, we look at how often specific care providers perform specific treatments since the more experienced the specialist, the more likely the treatment will be successful. Better quality for a lower premium By guaranteeing high-grade healthcare to our customers, we are helping to further raise quality levels. This translates into fewer complications, follow-up treatments, subsequent operations and, ultimately, a reduced need for healthcare. This all results in lower costs and that is reflected in your premium. What does this mean for you? You can always consult your own general practitioner. In the event of an emergency, you can always go to your own general practitioner, the after-hours clinic or the hospital. For a number treatments that can be scheduled in advance, we have concluded contracts exclusively with healthcare providers that satisfy our standards. If you go to one of our contracted care providers, you will be guaranteed good-quality care and we will fully reimburse the costs.* If you do not use the services of one of our contracted care providers, we may only be able to reimburse a portion of the costs. For further information, visit Submitting claims You submit your claims online simply via If you would rather submit your claims by post, you can complete a claim form and send it to us, together with the invoice. We will process your claim within ten working days. For more information, we refer to the insurance conditions and our website. Finding a good care provider easily Vergelijk en Kies clearly illustrates the differences in the quality of care available to you and indicates the care providers with whom we have concluded a contract. A very handy tool! Because opting for contracted care guarantees good-quality care at the best levels of. Find a good care provider easily via 1. Find a care provider In the search bar enter a treatment, condition or specialism and select one of the suggested options. Enter your postcode to find care providers in your area. 2. Compare care providers Select the care providers you wish to compare. * Some costs may come under your excess or you may have to pay a personal. See the conditions at 3.Select your care provider Select the care provider that best matches your needs. Declareren Uw declaraties dient u eenvoudig online in via Declareert u liever per post? U kunt dan een declaratieformulier invullen en samen met de nota naar ons opsturen. Uw declaratie handelen wij binnen tien werkdagen af. Voor meer informatie verwijzen wij u naar de verzekeringsvoorwaarden en onze website. 4. Evaluate your care provider r You can also evaluate your existing care provider on the Vergelijk en Kies platform. This way you let us know your experience and you help others in making their choice of care provider. 5

6 Reader s guide All items listed in the overview of s marked with a are covered by your policy. The level of the depends on the care provider you have chosen in combination with your insurance policy. Additional conditions Additional conditions, such as authorisation requirements, necessary referrals and authorised care providers, are specified in the 2015 insurance conditions. If you require care, we recommend that you first consult the policy conditions. These are available at The following basic healthcare insurance policies are available: VGZ Goede Keuze This is a contracted care policy. The contracted care you require is provided by one of our contracted care providers. For various types of healthcare, we have concluded contracts with a select number of care providers, indicated with a. VGZ Ruime Keuze VGZ Ruime Keuze is also a contracted care policy, but one that gives a wider choice of contracted care providers to provide the care you are looking for. VGZ Eigen Keuze VGZ Eigen Keuze is care policy. This policy gives you freedom of choice with respect to care providers, and it does not matter if the care provider you choose has agreements with VGZ or not. The only requirement is that the care provider satisfies the requirements set out in our policy conditions. The diagram below sets out the three basic healthcare insurance policies offered by VGZ. VGZ Goede Keuze VGZ Ruime Keuze VGZ Eigen Keuze Contracted care: full 1 ) Non-contracted care: 50% 2 ) of the average contracted rate.. Contracted care: full 1 ) Non-contracted care: 80% 2 ) of the average contracted rate. In the case of specialised mental health care, 75% 1) of the average contracted rate. Contracted care: full 1 ) Non-contracted care: (standard) Dutch market rates. 1) Note that the costs may come under your excess and you may have to pay a personal or that a may apply. 2) The rates can be found in the List of Maximum Reimbursements Providers on our website Healthcare Insurance

7 Excess and personal /maximum If you are aged 18 or older, a compulsory excess of 375 per calendar year applies to your basic insurance. You can voluntarily increase your excess to 475, 575, 675, 775 or 875. If you do, you will be entitled to a discount on your premium. The excess does not apply to, for example, expenses incurred for visits to a general practitioner, obstetric care, maternity care, nursing and care, preferred medications designated by us, care that is funded as part of a care programme and any applicable personal s and/ or private payments. We will indicate whenever a specific type of care is subject to a personal and/or. For more information, read the policy conditions. Supplementary insurance policies 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 may refer to designated, accredited or contracted care. This is indicated in the overview. If you are using the services of, non-accredited or non-designated service providers, note that you will probably have to pay a portion or all of the costs yourself. For more information, read the policy conditions. Please note that, in the conditions, the words per year refer to the calendar year. The s referred to are s. 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 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 prevention, movement-related care, foot treatments, care aids etc. You can find these budgets in the Reimbursements and the policy conditions. MyVGZ 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 2015 Healthcare Insurance Basis, MiX and Supplementary insurance cover Healthcare Insurance Reimbursement Basic insurance MiX Aanvullende Verzekering* Goed Beter Best Alternative care A budget to spend on the care types specified below: treatments and consultations, psycho-social care from age 18 (provided by designated care provider) Homoeopathic and/or anthroposophic medicines Contraceptives Such as the contraceptive pill, birth control implant (Implanon rod), intrauterine contraceptive device (coil), ring or diaphragm up to age 21. This also applies to insured persons from age 21 using contraceptives to treat endometriosis or menorrhagia (for anaemia) (a personal is payable for some contraceptives) 300 per year. The for treatments and consultations is capped at 45 a day 500 per year. The for treatments and consultations is capped at 45 a day 800 per year. The for treatments and consultations is capped at 45 a day For repeat prescriptions and the contraceptive pill, we have concluded contracts with a select number of care providers Such as the contraceptive pill, birth control implant (Implanon rod), intrauterine contraceptive device (coil), ring or diaphragm from age 21 Audiological care Examination of auditory function, hearing aid advice Circumcision Medically necessary circumcision (subject to prior permission 1 ) Delivery and maternity care Delivery home delivery the costs of a delivery without medical grounds for inpatient care at one of our contracted birth centres delivery and/or maternity care without medical grounds in a hospital the costs of a medically necessary delivery at a hospital or one of our contracted birth centres Maternity care maternity care at home or at a contracted birth centre 202 per day ( 235 minus 33 for the personal to maternity care) up to 10 days (a personal of 4.15 per hour applies) full amount (a personal is payable for some contraceptives) contracted care provider: full amount; care provider: 600 full amount (a personal is payable for some contraceptives) contracted care provider: full amount; care provider: 600 full amount (a personal is payable for some contraceptives) contracted care provider: full amount; care provider: 600 full amount full amount full amount 125 of the personal full of the personal For maternity care at home, we have concluded contracts with a select number of care providers maternity care at a hospital after a delivery with medical necessity after-care of mother and newly born 6 hours divided over 2 days 12 hours divided over 4 days VGZ s maternity package full amount full amount Breast feeding breast-feeding advice (lactation consultation) 50 per delivery 75 per delivery rent of an electrical breast pump in the event of the admission of an ill baby 110 per delivery 110 per delivery Healthcare Insurance

9 Healthcare Insurance Reimbursement Basic insurance MiX Aanvullende Verzekering* 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 chronische aandoeningen tot 18 jaar chronic disorders, under age 18 (subject to prior permission 1 ) chronic disorders, from age 18 as from the 21 st treatment (subject to prior permission1) non-chronic disorders, under age behandelingen per year niet-chronische aandoeningen vanaf 18 jaar pelvic physiotherapy to treat urine incontinence, from age 18 the first 9 treatment sessions occupational therapy 10 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 1,000 per year; for physiotherapists, remedial therapists and occupational therapists the equals 80% of the average contracted rate can be found in the List of Maximum Reimbursements Providers. The for alternative movement-related treatments therapies is capped at 45 a day. 200 per year 3 ; for physiotherapists, remedial therapists and occupational therapists the equals 80% of the average contracted rate can be found in the List of Maximum Reimbursements Providers. The for alternative movement-related treatments therapies is capped at 45 a day. 400 per year 3 ; for physiotherapists, remedial therapists and occupational therapists the equals 80% of the average contracted rate can be found in the List of Maximum Reimbursements Providers. The for alternative movement-related treatments therapies is capped at 45 a day. 600 per year 3 ; for physiotherapists, remedial therapists and occupational therapists the equals 80% of the average contracted rate can be found in the List of Maximum Reimbursements Providers. The for alternative movement-related treatments therapies is capped at 45 a day. 100 every 3 years 150 every 3 years 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 ) Repatriation arranged by VGZ Emergency Services (Alarmcentrale) Dietary advice The provision of information about diet and eating habits for a medical purpose Genetic testing Tests to establish and determine the extent of genetic disorders based on market rates in the Netherlands based on market rates in the Netherlands 3 hours per year 500 per year; for care providers the equals 80% of the average contracted rate can be found in the List of Maximum Reimbursements Providers. 500 (once only during term of insurance) full amount full amount full amount full amount full amount full amount 250 per year 3 ; for care providers the equals 80% of the average contracted rate can be found in the List of Maximum Reimbursements Providers. All items listed in the overview of s marked with a are covered by your policy. The level of the depends on the care provider you have chosen in combination with your insurance policy. Items marked with a are covered by your policy, but we have concluded contracts with a select number of care providers to deliver these care items. For more information, consult the Reader s Guide. 1 For this type of care you will need prior permission from VGZ. After receiving your application, we will send you our response within ten working days. See our policy conditions. 2 In a number of specific cases you will need prior permission from VGZ. After receiving your application, we will send you our response within ten working days. See our policy conditions. 3 Reimbursement of these costs does not apply if you are entitled to under MiX Aanvullende Verzekering. * will be automatically added to your healthcare insurance if this is a group scheme with your employer. VGZ Supplementary insurance cover 9

10 Healthcare Insurance Reimbursement Basic insurance MiX Aanvullende Verzekering* Goed Beter Best Pharmaceutical care (medicines) Medicines listed in Appendix 1 to the Healthcare Insurance Regulations and the Pharmaceutical Care Regulations (subject to prior permission 2 ) (a personal is payable for some medicines) For repeat prescriptions and the contraceptive pill, we have concluded contracts with a select number of care providers Diet preparations (subject to permission 1 ) (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 stopping smoking and foot care in the case of diabetes mellitus (annual foot check and advice and diabetic foot treatments from care profile 2 and higher) Domestic help Domestic help in the event of sickness, accidents or hospital admission (via Care Advice and Mediation (Zorgadvies en bemiddeling) from a contracted care provider) Care aids Care and bandaging aids in accordance with the Healthcare Insurance Regulations and the Pharmaceutical Care Aids Regulations (subject to prior permission 2 ) (a personal and/ or a maximum apply to some care aids) 30 hours per year 300 per year 500 per year 700 per year For stoma materials, bandaging aids, incontinence materials and diabetes materials, we have concluded contracts with a select number of care providers 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 or head scarves support pessary 250 per year 500 per year hand or finger splint for temporary use (from a contracted care provider) 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 broker (after referral by the VGZ Care Advisor and provided by a contracted care provider) Substitute informal care (by a contracted care provider): first, second and third attempts 2 hand or finger splints per year 2 hand or finger splints per year 250 per year 500 per year 750 per year 4 days a year 9 days a year 14 days a year Healthcare Insurance

11 Healthcare Insurance Reimbursement Basic insurance MiX Aanvullende Verzekering* Goed Beter Best Specialist medical care This also includes care provided by a thrombosis service, a second opinion and dialysis (subject to prior permission 2 ) For knee, hip and cataract operations, a number of oncological treatments and bariatric surgical procedures, we have concluded contracts with a select number of care providers Plastic and/or reconstructive surgery For specific indications (subject to prior permission 1 ) Abdominal wall surgery (subject to prior permission 1 ) for specific indications Eyelid corrections (subject to prior permission 1 ) for specific indications 950 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 Lifestyle Check (by contracted care provider) weight consultant Advice and assistance sports medical advice menopause care Vaccinations flu vaccination preventative vaccinations and medicines in connection with a holiday 750 per year 200 per year 3 not applicable 400 per year 3 not applicable 500 per year 3 not applicable Psychological care Mental healthcare from age 18 general basic mental healthcare (GGZ) specialist mental healthcare (GGZ) Sexological care 60 per session up to a max. of 4 sessions per year Mindfulness following symptoms of burnout 350 per year 350 per year per year per year 3 Rehabilitation This also includes a quick scan and oncological rehabilitation Geriatric rehabilitation (up to max. of 6 months) Herstel en Balans (Recovery and Balance) rehabilitation programme Redression helmet Redression helmet treatment for children up to the age of 14 months for certain indications Sterilisation 800 per diagnosis 800 per diagnosis per diagnosis full amount full amount Sterilisation of a man Sterilisation of a woman Stopping smoking Stop-smoking programme once a year All items listed in the overview of s marked with a are covered by your policy. The level of the depends on the care provider you have chosen in combination with your insurance policy. Items marked with a are covered by your policy, but we have concluded contracts with a select number of care providers to deliver these care items. For more information, consult the Reader s Guide. 1 For this type of care you will need prior permission from VGZ. After receiving your application, we will send you our response within ten working days. See our policy conditions. 2 In a number of specific cases you will need prior permission from VGZ. After receiving your application, we will send you our response within ten working days. See our policy conditions. 3 Reimbursement of these costs does not apply if you are entitled to under MiX Aanvullende Verzekering. * will be automatically added to your healthcare insurance if this is a group scheme with your employer. VGZ Supplementary insurance cover 11

12 Healthcare Insurance Reimbursement Basic insurance MiX Aanvullende Verzekering* Goed Beter Best Dental care/oral care Dental and orthodontic care in special cases Dental care (including implants and technician s costs, if applicable) and orthodontic care for specific indications (subject to prior permission 1 ) Dental care for children under age 18 Dental care with the exception of crowns, bridges and orthodontic care Crowns, bridges and implants (including technician s costs) (subject to prior permission 1 ) Dental care from age 18 Crowns (with implants, if medically necessary) and bridges required as the direct consequence of an accident (subject to prior permission 1 ) Dental surgery from age 18 Dental surgery by a dental surgeon with the exclusion of fitting implants, treatment of gums and simple extractions Dental prostheses (dentures) from age 18 Removable full dentures (including technician s costs) (subject to prior permission 2 ) Removable dentures on implants (including technician s costs) for seriously shrunken, toothless jaws (subject to prior permission 1 ) (a personal may apply) if to replace one or more permanent incisors or canines that have not developed or are missing due to an accident (a personal of 25% applies) (a personal of 125 per jaw applies) full amount for persons from age 18 to 22 full of the personal full of the personal full amount for persons from age 18 to 22 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) 100 per day, max per year 100 per day, max per year 100 per day, max 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 ) For knee, hip and cataract operations, a number of oncological treatments and bariatric surgical procedures, we have concluded contracts with a select number of care providers Ronald McDonald House/family house 300 per year 400 per year 600 per year Nursing and care Nursing and care without inpatient care (possibly in the form of a personal budget) Transport Ambulance transport Seated patient transport for specific indications (subject to prior permission 1 ), by: private car 0.31 per km (a personal of 97 per year applies) public transport or taxi transport (a personal of 97 applies) taxi transport (by a contracted transport provider) or private transport in connection with an organ transplant Taxi transport to and from work (by a contracted transport provider) 350 per year taxi: full amount, private car: 0.31 per km taxi: full amount, private car: 0.31 per km taxi: full amount, private car: 0.31 per km Healthcare Insurance

13 Healthcare Insurance Reimbursement Basic insurance MiX Aanvullende Verzekering* Goed Beter Best Foot treatments A budget to spend on the care types specified below: foot care for a rheumatoid and diabetic foot (with care profile 1) (also see general practitioner care and multi-disciplinary care) occupational therapy arch supports Care for persons with a sensory disability Multidisciplinary care in connection with a visual, auditive or communicative impairment 100 per year 300 per year 500 per year 2015 Healthcare Insurance, Basic and Dental insurance cover of dental insurance s according to type of dental insurance Dental care from age 18 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 18 from age 18 Basic 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 1,500 for the entire term of the insurance 500 for the entire term of the insurance 80%, up to a maximum of per year 2,500 for the entire term of the insurance for the entire term of the insurance All items listed in the overview of s marked with a are covered by your policy. The level of the depends on the care provider you have chosen in combination with your insurance policy. Items marked with a are covered by your policy, but we have concluded contracts with a select number of care providers to deliver these care items. For more information, consult the Reader s Guide. 1 For this type of care you will need prior permission from VGZ. After receiving your application, we will send you our response within ten working days. See our policy conditions. 2 In a number of specific cases you will need prior permission from VGZ. After receiving your application, we will send you our response within ten working days. See our policy conditions. 3 Reimbursement of these costs does not apply if you are entitled to under MiX Aanvullende Verzekering. * will be automatically added to your healthcare insurance if this is a group scheme with your employer. VGZ Dental insurance cover 13

14 2015 Basic healthcare insurance, MiX supplementary insurance (aanvullende verzekering) and All-in-One packages Healthcare Insurance Reimbursement Basic insurance MiX* Aanvullende Verzekering VGZ Jong VGZ Fit & Vrij VGZ Gezin VGZ Vitaal Alternative care A budget to spend on the care types specified below: treatments and consultations, psycho-social care from age 18 (provided by designated care provider) Homoeopathic and/or anthroposophic medicines 200 per year. The for treatments and consultations is capped at 45 a day package The for treatments and consultations is capped at 45 a day 300 per year. The for treatments and consultations is capped at 45 a day 300 per year. The for treatments and consultations is capped at 45 a day Contraceptives Such as the contraceptive pill, birth control implant (Implanon rod), intrauterine contraceptive device (coil), ring or diaphragm up to age 21. This also applies to insured persons from age 21 using contraceptives to treat endometriosis or menorrhagia (for anaemia) (a personal is payable for some contraceptives) For repeat prescriptions and the contraceptive pill, we have concluded contracts with a select number of care providers Such as the contraceptive pill, birth control implant (Implanon rod), intrauterine contraceptive device (coil), ring or diaphragm from age 21 Audiological care Examination of auditory function, hearing aid advice Circumcision Medically necessary circumcision (subject to prior permission 1 ) Delivery and maternity care Delivery home delivery the costs of a delivery without medical grounds for inpatient care at one of our contracted birth centres delivery and/or maternity care without medical grounds in a hospital 202 per day ( 235 minus 33 for the personal to maternity care in a hospital) full amount (a personal is payable for some contraceptives) contracted care provider: full amount; care provider: 600 full amount (a personal is payable for some contraceptives) contracted care provider: full amount; care provider: 600 full amount (a personal is payable for some contraceptives) contracted care provider: full amount; care provider: 600 full amount contracted care provider: full amount; care provider: 600 the costs of a medically necessary delivery at a hospital or one of our contracted birth centres Maternity care maternity care at home or at a contracted birth centre have concluded contracts with a select number of care providers maternity care at a hospital after a delivery with medical necessity up to 10 days (a personal of 4.15 per hour applies) full of the personal deluxe maternity care 15 hours adoption 300 per adopted child VGZ s maternity package full amount Breast feeding breast-feeding advice (lactation consultation) 100 per delivery rent of an electrical breast pump in the event of the admission of an ill baby 110 per delivery Healthcare Insurance

15 Healthcare Insurance Reimbursement Movement-related care (e.g. physiotherapy) A budget to spend on the care types specified below: physiotherapy, oedema therapy and Cesar/ Mensendieck remedial therapy: Basic insurance chronic disorders, under age 18 (subject to prior permission 1 ) chronic disorders, from age 18 from the 21st treatment session (subject to prior permission 1 ) non-chronic disorders, under age treatment sessions per year non-chronic disorders, from age 18 pelvic physiotherapy to treat urine incontinence, from age 18 the first 9 treatment sessions occupational therapy 10 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 based on market rates in the Netherlands MiX* Aanvullende Verzekering 1,000 per year; for physiotherapists, remedial therapists and occupational therapists the maximum equals 80% of the average contracted rate can be found in the List of Maximum Reimbursements Providers. The for alternative movement-related treatments therapies is capped at 45 a day. VGZ Jong 600 per year3; for physiotherapists, remedial therapists and occupational therapists the maximum equals 80% of the average contracted rate can be found in the List of Maximum Reimbursements Providers. The for alternative movement-related treatments therapies is capped at 45 a day. 150 every 3 years VGZ Fit & Vrij Part of the package3; for non-contacted physiotherapists, remedial therapists and occupational therapists the maximum equals 80% of the average contracted rate can be found in the List of Maximum Reimbursements Providers. The for alternative movement-related treatments therapies is capped at 45 a day. package, maximum 150 every 3 years package VGZ Gezin 600 per year 3 ; for physiotherapists, remedial therapists and occupational therapists the maximum equals 80% of the average contracted rate can be found in the List of Maximum Reimbursements Providers. The for alternative movement-related treatments therapies is capped at 45 a day. 150 every three years ( 200 every three years for children up to age 18) VGZ Vitaal 1,000 per year 3 ; for physiotherapists, remedial therapists and occupational therapists the maximum equals 80% of the average contracted rate can be found in the List of Maximum Reimbursements Providers. The for alternative movement-related treatment therapies is capped at 45 a day. 150 every 3 years full amount full amount full amount full amount Non-urgent care while abroad (subject to prior permission 2 ) based on 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 Genetic testing Tests to establish and determine the extent of genetic disorders 3 hours per year 500 per year; for care providers the equals 80% of the average contracted maximum rate can be found in the List of Maximum Reimbursements Contracted Care Providers. 250 per year 3 ; for care providers the maximum equals 80% of the average contracted rate can be found in the List of Maximum Reimbursements Providers. All items listed in the overview of s marked with a are covered by your policy. The level of the depends on the care provider you have chosen in combination with your insurance policy. Items marked with a are covered by your policy, but we have concluded contracts with a select number of care providers to deliver these care items. For more information, consult the Reader s Guide. 1 For this type of care you will need prior permission from VGZ. After receiving your application, we will send you our response within ten working days. See our policy conditions. 2 In a number of specific cases you will need prior permission from VGZ. After receiving your application, we will send you our response within ten working days. See our policy conditions. 3 Reimbursement of these costs does not apply if you are entitled to under MiX Aanvullende Verzekering. * will be automatically added to your healthcare insurance if this is a group scheme with your employer. VGZ All-in-One packages 15

16 Healthcare Insurance Reimbursement Basic insurance MiX* Aanvullende Verzekering VGZ Jong VGZ Fit & Vrij VGZ Gezin VGZ Vitaal Pharmaceutical care (medicines) geneesmiddelen opgenomen in bijlage 1 van de Medicines listed in Appendix 1 to the Healthcare Insurance Regulations and the Pharmaceutical Care Regulations (subject to prior permission 2 ) (a personal is payable for some medicines) For repeat prescriptions and the contraceptive pill, we have concluded contracts with a select number of care providers Diet preparations (subject to permission 1 ) (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 300 per year package 500 per year 500 per year General practitioner care This also includes counselling in relation to stopping smoking and foot care in the case of diabetes mellitus (annual foot check and advice and diabetic foot treatments from care profile 2 and higher) Domestic help Domestic help in the event of sickness, accidents or hospital admission (via VGZ Care Advice and Mediation (Zorgadvies en bemiddeling) from a contracted care provider) Care aids Care and bandaging aids in accordance with the Healthcare Insurance Regulations and the Pharmaceutical Care Aids Regulations (subject to prior permission 2 ) For stoma materials, bandaging aids, incontinence materials and diabetes materials, we have concluded contracts with a select number of care providers (a personal and/or a apply to some care aids) 30 hours per year 10 hours per year 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 or head scarves allocated budget 250 per year 350 per year support pessary not applicable pad and buzzer for children aged 6 to 18 (by contracted care provider) not applicable not applicable hand or finger splint for temporary use (from a contracted care provider) 2 hand or finger splints per year 2 hand or finger splints per year 2 hand or finger splints per year In vitro fertilisation (IVF) and other fertility treatments In vitro fertilisation (IVF) for women younger than 43. Additional conditions apply. first, second and third 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 and including age 12 (through VGZ Care Advice and Mediation by a contracted care provider) 24 hours per year Speech therapy Treatment or improvement of speech or ability to speak Healthcare Insurance

17 Healthcare Insurance Reimbursement Informal care Informal care broker (after referral by the VGZ Care Advisor and provided by a contracted care provider) Substitute informal care (by a contracted care provider) Specialist medical care This also includes care provided by a thrombosis service, a second opinion and dialysis (subject to prior permission 2 ) For knee, hip and cataract operations, a number of oncological treatments and bariatric surgical procedures, we have concluded contracts with a select number of care providers Plastic and/or reconstructive surgery For specific indications (subject to prior permission 1 ) Abdominal wall surgery (subject to prior permission 1 ) Eyelid corrections (subject to prior permission 1 ) Protruding ear correction for insured persons under age 18 Basic insurance for specific indications for specific indications MiX* Aanvullende Verzekering VGZ Jong VGZ Fit & Vrij package package package package VGZ Gezin VGZ Vitaal 500 per year 750 per year 9 days a year 9 days a year provider: full amount; noncontracted care provider: 1,500 Prevention A budget to spend on the care types specified 750 per year 200 per year 3 below:: package 3 Healthy lifestyle training courses (e.g. coping with illnesses or disorders) first-aid course reanimation course Lifestyle Check (by a contracted care provider) 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 Mental healthcare from age 18 general basic mental healthcare (GGZ) specialist mental healthcare (GGZ) Sexological care 60 per session up to a max. of 4 sessions per year package 60 per session Up to a max. of 4 sessions per year 60 per session up to a max. of 4 sessions per year per session up to a max. of 4 sessions per year Mindfulness following symptoms of burnout 350 per year 350 per jaar per jaar per jaar per jaar 3 Rehabilitation This also includes a quick scan and oncological rehabilitation Geriatric rehabilitation (max. 6 months) Herstel en Balans (Recovery and Balance) rehabilitation programme 800 per diagnosis package 800 per diagnosis 800 per diagnosis All items listed in the overview of s marked with a are covered by your policy. The level of the depends on the care provider you have chosen in combination with your insurance policy. Items marked with a are covered by your policy, but we have concluded contracts with a select number of care providers to deliver these care items. For more information, consult the Reader s Guide. 1 For this type of care you will need prior permission from VGZ. After receiving your application, we will send you our response within ten working days. See our policy conditions. 2 In a number of specific cases you will need prior permission from VGZ. After receiving your application, we will send you our response within ten working days. See our policy conditions. 3 Reimbursement of these costs does not apply if you are entitled to under MiX Aanvullende Verzekering. * will be automatically added to your healthcare insurance if this is a group scheme with your employer. VGZ All-in-One packages 17

18 Healthcare Insurance Reimbursement Basic insurance MiX* Aanvullende Verzekering VGZ Jong VGZ Fit & Vrij VGZ Gezin VGZ Vitaal Redression helmet Redression helmet treatment for children up to the age of 14 months for specific indications full amount Sterilisation Sterilisation of a man package 800 Sterilisation of a woman package 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) and orthodontic care for specific indications (subject to prior permission 1 ) (a personal may apply) Dental care for children under age 18 Dental care with the exception of crowns, bridges and orthodontic care Crowns, bridges and implants (including technician s costs) (subject to prior permission 1 ) 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 18 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 package, maximum 80% up to a maximum of 450 per year, 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 1 ) full amount full amount for persons from age 18 to 22 Dental surgery from age 18 Dental surgery by a dental surgeon with the exclusion of fitting implants, treatment of gums and simple extractions Dental prostheses (dentures) from age 18 Removable full dentures (including technician s costs) (subject to prior permission 2 ) (a personal of 25% applies) of the personal, part of the maximum for dental care from age 18 ull of the personal ull of the personal Removable dentures on implants (including technician s costs) for seriously shrunken, toothless jaws (subject to prior permission 1 ) (a personal of 125 per jaw applies) of the personal, part of the maximum for dental care from age 18 ull of the personal ull of the personal Orthodontic care under age 18 maximum for dental 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 350 for the entire term of the insurance Healthcare Insurance

19 Healthcare Insurance Reimbursement Tissue and organ transplants If the transplant is carried out in an EU or EEA Member State VGZ Vrij Zeker Prevention of sexually transmitted diseases (at contracted care provider) Condoms (to be ordered via Inpatient care Convalescent home/care hotel (at a contracted care provider) Basic insurance MiX* Aanvullende Verzekering VGZ Jong once a year 20 per year VGZ Fit & Vrij package, max. of 100 per day 100 per day, max. 1,000 per year Hospice (at an accredited care provider) 30 per day package, max. of 30 per day Hospital (psychiatric or otherwise), mental health or rehabilitation facility (subject to prior permission 2 ) VGZ Gezin 100 per day, max per year VGZ Vitaal 100 per day, max per year 30 per day 30 per day For knee, hip and cataract operations, a number of oncological treatments and bariatric surgical procedures, we have concluded contracts with a select number of care providers Ronald McDonald House/family house 400 per year 400 per year Nursing and care Nursing and care without inpatient care (possibly in the form of a personal budget) Transport Ambulance transport Seated patient transport for specific indications (subject to prior permission 1 ), by: private car 0.31 per km (a personal of 97 per year applies) public transport or taxi transport (a personal of 97 applies) taxi transport (by a contracted transport provider) or private transport in connection with an organ transplant Taxi transport to and from work (by a contracted transport provider) Foot treatments A budget to spend on the care types specified below: foot care for a rheumatoid and diabetic foot (with care profile 1) (also see general practitioner care and multi-disciplinary care) occupational therapy arch supports Care for persons with a sensory disability Multidisciplinary care in connection with a visual, auditive or communicative impairment 350 per year taxi: full amount, private car: 0.31 per km package, taxi: up to a maximum of the budget, private car: 0.31 per km package taxi: full amount, private car: 0.31 per km taxi: full amount, private car: 0.31 per km 300 per year 300 per year All items listed in the overview of s marked with a are covered by your policy. The level of the depends on the care provider you have chosen in combination with your insurance policy. Items marked with a are covered by your policy, but we have concluded contracts with a select number of care providers to deliver these care items. For more information, consult the Reader s Guide. 1 For this type of care you will need prior permission from VGZ. After receiving your application, we will send you our response within ten working days. See our policy conditions. 2 In a number of specific cases you will need prior permission from VGZ. After receiving your application, we will send you our response within ten working days. See our policy conditions. 3 Reimbursement of these costs does not apply if you are entitled to under MiX Aanvullende Verzekering. * will be automatically added to your healthcare insurance if this is a group scheme with your employer. VGZ All-in-One packages 19