Reimbursement overview for The health insurer for university medical centres. like no other

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1 Reimbursement overview for 2013 The health insurer for university medical centres like no other

2 Health insurance for university medical centres Reimbursement overview for 2013 Reader s guide This overview provides an overview of reimbursements of the and the Aanvullende Verzekering. All items listed in the overview of reimbursements that are marked with a are covered by our policy. is a noncontracted care policy. You can find more information in the reader s guide. Reimbursements are specified per calendar year, unless stated otherwise. Where the abbreviation max. is used, we mean up to a maximum of. Policy conditions Additional conditions, such as authorisation requirements, necessary referrals and authorised care providers, are specified in the 2013 policy conditions. If you require care, we recommend that you first consult the policy conditions. These can be found at For more information, please call us on Non-contracted care policy You are free to choose which care provider you wish to visit, subject to the condition that the other requirements set out in these policy conditions have been met. The costs of care will be reimbursed 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 level equal to the current reasonable market prices in the Netherlands. If you obtain care from a contracted care provider, rates will have been agreed upon with the relevant care providers that are in accordance with reasonable current market prices in the Netherlands. Excess If you are aged 18 or over, a compulsory excess of 350 per calendar year applies to the. You can voluntarily increase your compulsory excess to 450, 550, 650, 750, or 850 and will then be eligible for a discount on the premium. The excess does not apply to expenses incurred for visits to a general practitioner, obstetric care, maternity care, preferred medications designated by us, care aids on loan, follow-up checks for kidney or liver donors and care programmes. Aanvullende Verzekering You are entitled to a reimbursement of the costs of care up to, as a maximum, the current statutory rates in the Netherlands. If no statutory rates apply to the relevant care, the costs will be reimbursed up to a level equal to the current reasonable market prices in the Netherlands. If you make use of care provided by a care provider contracted by us, the costs of care are reimbursed based on the rate agreed with the care provider concerned. Preferred, accredited or contracted care Please note! Preferred, accredited or contracted care may also be covered by your supplementary insurance package. If you make use of noncontracted, non-accredited or non-preferred care providers, you will not be reimbursed or will be reimbursed for a lower amount. You can find more information in the insurance conditions. Reimbursements are specified per calendar year, unless stated otherwise. Where the abbreviation max. is used, we mean up to a maximum of.

3 Reimbursement Overview for Budget Accent Plus Top Alternative care Alternative medicine and movement-related care (separate max. amounts apply to chiropractic and osteopathy) Chiropractic Homeopathic and anthroposophic medicine Osteopathy Contraceptives Audiological care for persons up to the age of 21 (a personal some contraceptives). This also applies to insured persons from the age of 21 using contraceptives to treat endometriosis or menorrhagia (for anaemia) The acupuncture specialist, classical homeopath, chiropractor and osteopath must be listed in the care guide (see in total for doctor, acupuncture specialist and classical homeopath combined The acupuncture specialist, classical homeopath, chiropractor and osteopath must be listed in the care guide (see in total for doctor, acupuncture specialist and classical homeopath combined The acupuncture specialist, classical homeopath, chiropractor and osteopath must be listed in the care guide (see in total for doctor, acupuncture specialist and classical homeopath combined Max. 260 Max. 260 Max. 260 Max % for persons from the age of 21 (a personal some contraceptives) 100% for persons from the age of 21 (a personal some contraceptives) 100% for persons from the age of 21 (a personal some contraceptives) The acupuncture specialist, classical homeopath, chiropractor and osteopath must be listed in the care guide (see up to max. 340 in total for doctor, acupuncture specialist and classical homeopath combined 100% for persons from the age of 21 (a personal some contraceptives) Delivery and maternity care Maternity package Maternity care at home by a maternity centre Maternity care by a private nurse or maternity care provider Maternity care not given by a maternity centre, hospital or private nurse Maternity care given by a hospital or contracted birth centre (without medical necessity) Maternity care in a hospital (with medical necessity) for max. 80 hours 10 days with a personal contribution of 4/hr for max. 80 hours 10 days with a personal contribution of 4/hr for max. 80 hours 10 days (a personal contribution of 16 per day for both mother and child applies) Care in kind through Kraamzorg 100% up to max. 100 per day for a max. of 10 days Care in kind through Kraamzorg 100% up to max. 100 per day for a max. of 10 days Care in kind through Kraamzorg 100% of the personal contribution up to max % up to max. 100 per day for a max. of 10 days Care in kind through Kraamzorg 100% of the personal contribution 100% up to max. 100 per day for a max. of 10 days 100% up to max % up to max % up to max % up to max. 296 Lactation consultation Max. 50 per delivery Max. 75 per delivery Max. 100 per delivery Home delivery Delivery in a hospital (with medical necessity) Delivery in a hospital or contracted birth centre (without medical necessity) Preconception care (this includes advice on a healthy diet, use of folic acid and other medicines) Extended maternity care/ newborn after-care Glasses and contact lenses From 0.25D, laser eye s and lens implants Care abroad Non-urgent care 197 per day (accommodation costs) based on NL rates or in accordance with statutory insurance amount applicable in the country of stay 100% for max. 12 hours 4 days 100% for max. 12 hours 4 days Max. 93 every 2 consecutive calendar 100% for max. 12 hours 4 days Max. 186 every 2 consecutive calendar 100% for max. 12 hours 4 days Max. 186 every 2 consecutive calendar 100%, based on NL rates 100%, based on NL rates 100%, based on NL rates 100%, based on NL rates

4 4 Health insurance for university medical centres Budget Accent Plus Top Urgent care while on holiday or a temporary stay abroad Patient transport from abroad (repatriation) Transport of mortal remains from abroad Circumcision (medical necessity) Care for dyslexics (care in connection with severely dyslexic children attending primary school to whom initial care is given in 2013 at the age of 7, 8, 9, 10, 11 or 12) Genetic testing based on NL rates in accordance with the market or in accordance with statutory insurance amount applicable in the country of stay from the Dutch border if a medical necessity 100% for urgent care through the Alarm Centre Alarm Centre Alarm Centre 100% for urgent care through the Alarm Centre Alarm Centre Alarm Centre 100% for urgent care through the Alarm Centre Alarm Centre Alarm Centre 100% for urgent care through the Alarm Centre Alarm Centre Alarm Centre Max. 600 Max. 600 Max. 600 Max. 600 Pharmaceutical care Diet preparations (on specific ) Medicines listed in Appendix 1 of the Healthcare Insurance Regulations and the Pharmaceutical Care Regulations Vitamins to treat a serious vitamin deficiency Skin s Acne Camouflage therapy up to the maximum statutory reimbursement amount (GVS) (a personal some medicines) Max. 200 per calendar year for personal contribution 100% 100% 100% 100% Max. 26 per for a max. of 15 sessions in total Max. 165 every 3 calendar Max. 26 per for a max. of 15 sessions in total Max. 165 every 3 calendar Max. 26 per for a max. of 15 sessions in total Max. 165 every 3 calendar Epilation (hair removal) Max. 445 Max. 445 Max. 445 Max. 445 General Practitioner Care aids Hearing aids Care and bandaging aids in accordance with the Healthcare Insurance Regulations and the Pharmaceutical Care Aids Regulations (a personal contribution of 25% applies) for some aids are on loan (a personal contribution and/or partial reimbursement amount applies to some aids) Urinary buzzer 100% 100% 100% Wig Max. 393 Support pessary 100% 100% 100% Max. 300 per calendar year for personal contribution Max. 26 per for a max. of 15 sessions in total Max. 165 every 3 calendar Purchase price minus health insurance reimbursement up to max. 200 per hearing aid Arch supports and therapeutic soles Max. 190 Max. 190 Max. 190 Support hose 100% for max. 4 pairs 100% for max. 4 pairs 100% for max. 4 pairs IVF In vitro fertilisation (IVF) up to 43 of age Other fertility s (women up to 43 of age) Multi-disciplinary care for diabetes, COPD and cardiovascular risk management Speech therapy First, second and third attempt on NV Zorgverzekeraar

5 Reimbursement Overview for Budget Accent Plus Top Medical specialist care (This includes care by a thrombosis service, a second opinion, kidney dialysis, necessary at home and assistance in stopping smoking) Orthodontics Orthodontic for children under the age of 18 Orthodontia from the age of 18 Paramedical care Pelvic physiotherapy to prevent urine incontinence for adults aged 18 and over on a limited number of (a personal contribution may apply) on specific medical grounds (a personal contribution may apply) The first 9 sessions ; cosmetic dental 80% up to max. 1,380 ; cosmetic dental 80% up to max. 2, % on a limited number of ; cosmetic dental 100% up to max. 2, % on a limited number of ; other orthodontic onceonly up to max. 300 Dietary advice Max. 3 hours 4 hours of 4 hours of 4 hours of 4 hours of Occupational therapy Physiotherapy, remedial therapy, Cesar/Mensendieck, oedema therapy and manual therapy for children under 18 Physiotherapy, remedial therapy, Cesar/Mensendieck, oedema therapy and manual therapy for adults aged 18 and over Group swimming lessons for patients with rheumatism Menopause consultant for women entering menopause Podotherapy or specialised pedicure for patients with diabetes or rheumatism Plastic and/or reconstructive surgery Prevention Medical check-up Preventative courses (incl. pregnancy, coping with illnesses or disorders) Treatment for sports-related injuries Vaccinations for travel abroad Max. 10 hours max. 18 sessions per complaint, per calendar year; additional sessions only for complaints listed in Appendix 1 of the Health Insurance Decree (Besluit ZV), (chronic complaints) only for complaints listed in Appendix 1 of the Health Insurance Decree (Besluit ZV), except for the first 20 sessions on a number of medical grounds Partial reimbursement, the amount depends on the type of for max. 20 sessions for complaints listed in Appendix 1 of the Health Insurance Decree (Besluit ZV), and 9 sessions for other complaints 100% for serious types of rheumatoid arthritis Max. 50 per for max. 4 sessions Partial reimbursement, the amount depends on the type of for max. 20 sessions for complaints listed in Appendix 1 of the Health Insurance Decree (Besluit ZV), and 18 sessions for other complaints 100% for serious types of rheumatoid arthritis Max. 50 per for max. 4 sessions Partial reimbursement, the amount depends on the type of for max. 20 sessions for complaints listed in Appendix 1 of the Health Insurance Decree (Besluit ZV), and 18 sessions for other complaints 100% for serious types of rheumatoid arthritis Max. 50 per for max. 4 sessions Max. 115 Max. 115 Max % on a number of not accepted by the health insurer and 50% for cosmetic or aesthetic surgery due to specific medical circumstances 100% on a number of not accepted by the health insurer and 50% for cosmetic or aesthetic surgery due to specific medical circumstances Max. 55 Max. 55 Max. 55 Max. 75 Substitute informal care 4 days 4 days 9 days 14 days Psychological care Partial reimbursement, the amount depends on the type of for max. 20 sessions for complaints listed in Appendix 1 of the Health Insurance Decree (Besluit ZV), and 24 sessions for other complaints 100% for serious types of rheumatoid arthritis Max. 50 per for max. 4 sessions 100% on a number of not accepted by the health insurer and 50% for cosmetic or aesthetic surgery due to specific medical circumstances Max. 55 every 2 consecutive calendar Max % to max. 175 Primary psychological care Neurofeedback (for children up to the age of 18) max. 5 sessions minus the personal contribution (2013: 20 per session and 50 for online therapy) Max. 1,000 Max. 1,000

6 6 Health insurance for university medical centres Budget Accent Plus Top Psychosocial care for oncology patients Specialised medical mental healthcare Rehabilitation (this also includes a quick scan and geriatric rehabilitation) Sterilisation (male or female) and vasectomy reversal Stop Smoking Programme (medical care and support medications aimed at effecting a change in behaviour) Dental care for children up to the age of 18* Special dental care Consultation, examination and prevention Gnathology G-Codes* once a year limited number of medical grounds minus a personal contribution, if applicable Max. 445 Max. 445 Max. 445 Max % 100% 100% Implants in a non-toothless jaw Implants in a toothless jaw by a dentist Crowns and bridges R-Codes* Dentures P-Codes* Restoration using non-plastic materials R-Codes* on 2 specific grounds on a limited number of for crowns replacing canines or molars on 2 grounds 90% to max. 850 every 80% up to a max. reimbursement per sort for max. 6 elements for every 80% up to a max. reimbursement amount depending on the Dental care for adults from the age of 18 and up* Anaesthesia A-Codes* 80% 80% 80% 100% Special dental care limited number of medical grounds minus a personal contribution, if applicable Surgical H-Codes* 100% 100% 100% 100% 100% to max. 1,075 every 100% up to a max. reimbursement per sort for max. 6 elements for every 100% up to a max. reimbursement amount depending on the Dental Consultations C-Codes* Gnathology G-Codes* Implants in a non-toothless jaw Implants in a toothless jaw by a dentist, for persons with a seriously shrunken jaw Crowns and bridges R-Codes* Periodontology and oral hygiene by an independent oral hygienist* Periodontology by a dentist T-Codes* on 2 specific grounds a personal contribution applies of 125 per denture for dentures on implants 100% for a periodical consultation and 80% for any other consultation 100% for a periodical consultation and 80% for any other consultation 100% for a periodical consultation and 80% for any other consultation 90% up to max. 850 every 80% up to a max. reimbursement per type of inlay, crown or bridge for max. 6 elements for every 100% 90% up to max. 1,075 every 3 consecutive calendar 100% up to a max reimbursement per type of inlay, crown or bridge (higher than Plus) for max. 6 elements for every 80% up to max % up to max % up to max % up to max % up to max % up to max % up to max % up to max. 150 * A number of s are precluded from reimbursement in all packages, such as the costs for appointments missed, examinations and study models for a plan, physical examination reports and statements of good health, bleaching of teeth, sealing and polishing, indirect pulp caps, mouth protectors, general anaesthesia, a number of gnathologic s and restoration s such as composite inlays. A comprehensive overview is included in the insurance terms and conditions (see NV Zorgverzekeraar

7 Reimbursement Overview for Prevention/oral hygiene M-Codes* Dentures (partial) P-Codes* Dentures (full) P-Codes* 80% up to a maximum. The max. amount depends on the (a personal contribution of 25% applies) Budget Accent Plus Top 100% up to max % up to max % up to max % up to max % up to a maximum. The max. amount depends on the 80% up to a maximum. The max. amount depends on the Pulp cap and root canal 100% 100% 100% 100% s E-Codes* Restoration with plastic 80% 80% 80% 100% materials V-Codes* X-Ray diagnosis X-Codes* 100% 100% 100% 100% Treatment using non-plastic materials R-Codes* Organ and tissue transplants (transplantation performed in a EU or EEA member state) A stay (including costs of the donor) 100% up to a maximum. The max. amount depends on the Convalescent homes and 50% for max. 6 weeks 50% for max. 6 weeks 50% for max. 6 weeks 50% for max. 6 weeks care hotels (listed in our care guide) Hospice Max. 130 per day Max. 130 per day Max. 130 per day Max. 130 per day Health resort (listed in our Max. 885 Max. 885 Max. 885 Max. 885 care guide) Therapeutic holiday camps for children under the age of 16 on specific grounds 100% for max. 1 month 100% for max. 1 month 100% for max. 1 month 100% for max. 1 month A stay in a guesthouse Max. 18 per day Max. 18 per day Max. 18 per day Max. 18 per day A stay in a hospital, psychiatric hospital or rehabilitation centre Transport Ambulance transport Seated patient transport on specific with own car Seated patient transport on specific by public transport or a taxi Hospital care Outpatient care Hospital admittance (medical specialist care and a stay) Care and waiting list mediation Max per km on a limited number of medical grounds with a personal contribution (2013: 95) on a limited number of with a personal contribution (2013: 95) with the exception of a number of a personal contribution may apply to a stay by insured persons aged 18 and over, with the exception of a number of * A number of s are precluded from reimbursement in all packages, such as the costs for appointments missed, examinations and study models for a plan, physical examination reports and statements of good health, bleaching of teeth, sealing and polishing, indirect pulp caps, mouth protectors, general anaesthesia, a number of gnathologic s and restoration s such as composite inlays. A comprehensive overview is included in the insurance terms and conditions (see

8 Health insurance for university medical centres More information If you have any questions after reading this brochure or if you would like additional information, please visit or contact us. You can reach by telephone at on working days from 8 a.m. to 8 p.m. or by sending an to vraagumc@vgziza.nl. Like no other Health insurance by and for employees of university medical centres:. Like no other, is able to respond to your specific needs as a member of a specialised group of professionals, and as an individual or family member. With you can count on a competitive price/quality ratio, extensive freedom of choice and superior service. D N.V. Zorgverzekeraar, established in Arnhem, Chamber of Commerce number: , DNB number: