CZ Package Overview 2016

Transcription

1 CZ Package Overview 2016

2 Which policy is right for you? When you choose new health insurance, it is vital that you choose a policy that is right for your situation. This package overview is a summary of the. It enables you to see the reimbursements in this insurance at a glance. If you are in any doubt about which insurance is best for you, please call CZ Customer Services on (free). Our customer advisers would be pleased to help you decide. Under the, the entire bill will be reimbursed to you up to a reasonable market price, even if we did not contract your care provider. We must, however, have recognised the care provider or institution. If the care has a in this package overview, the care is insured. You can find a list of our contracted providers at (information in Dutch). Deductible Everyone over the age of 18 years pays a deductible for most of the care under the general insurance. The deductible for 2016 is 385. This has been set by the government. Once you ve paid the deductible, all further care is reimbursed according to the conditions of your general insurance. You will find more information about the deductible at (information in Dutch). Statutory personal For some care you have to pay a statutory personal. This has been set by the government. This amount is not reimbursed under the general insurance policy. The package comparer shows whether you have to pay a statutory personal. Important to note The amounts in this package comparer are maximum amounts per calendar year, unless specified otherwise. To receive reimbursement, CZ must recognise your care provider and/or institution. The conditions explain when we recognise a care provider and/or an institution, and when you are eligible for a reimbursement. For example, if you need a referral from a care provider, which indications are covered and whether you need prior permission from CZ. You will find the conditions at or contact CZ Customer Services: (free). Contents 4 Hospital care, healthcare in an institution or recognised ZBC 4 General Practitioner (GP care) 4 Medication and pharmacy 5 Nursing and personal care 5 Therapies (incl. physiotherapy) 5 Healthcare abroad 5 Childbirth and obstetric care 6 Transport 6 Hereditary disease investigation and advice 6 Audiological care 6 Mechanical respiration 6 Assistance with the treatment of children with cancer 6 Medical aids 6 Mental healthcare 6 Preventive care 6 Advice 7 Dentistry and orthodontics 2 3

3 Hospital care, healthcare in an institution or recognised ZBC Are you in doubt about the reimbursement of a hospital treatment, e.g. for non-contracted care, at an Independent Treatment Centre (ZBC) or a reimbursement from the additional insurance package? If so, you should first call the Ziekenhuislijn (013) Hospitalisation nursing and care yes specialist costs during hospitalisation 1 yes additional costs during hospitalisation, such as use of the operating room, medication and dressings, X-rays, laboratory tests and physiotherapy in hospital yes Outpatient consultant costs specialist costs 1 yes use of operating room yes X-rays, laboratory tests, radiation treatment, kidney dialysis, medicines and dressings yes Thrombosis service yes Second opinion by a doctor yes Rehabilitation yes Hospitalisation and/or treatment in connection with specified organ transplants heart, bone, kidney, liver, skin, cornea, bone marrow, lung, heart and lung, kidney and pancreas yes tissue typing yes costs of after-care for donor if you have received a donor organ (operation and nursing donor) 13 weeks yes 2 Travel costs if you are an organ transplant donor Healthcare for persons with sensory impairment yes General Practitioner (GP care) GP care Preventive foot care for diabetics possible 3 Medication and pharmacy Medication under the medicines Reimbursement System (GVS) yes possible Contraceptives up to 21 years of age under the medicines Reimbursement System (GVS) yes possible Dietary preparations (for certain disorders) yes Nursing and personal care Home nursing Therapies (incl. physiotherapy) Physiotherapy and exercise therapy from 18 years of age 21st and subsequent treatments, for indications included in the list of disorders 4 for physiotherapy and exercise therapy (Cesar/Mensendieck) (for certain indications a maximum yes of 3, 6 or 12 months) Physiotherapy and exercise therapy up to 18 years of age physiotherapy and exercise therapy (Cesar/Mensendieck) per indication 9 trt. and 9 trt. extra for indications on the list of disorders 4 for physiotherapy and exercise therapy (Cesar/Mensendieck) (for certain indications a maximum of 3, 6 or 12 months) Pelvic therapy for urinary incontinence 9 treatments yes Speech therapy yes UV B light equipment (for certain conditions, CZ permission required) yes Healthcare abroad Non-urgent medical care abroad 100% 5 yes Urgent medical care abroad (during a temporary stay) 100% 5 yes Childbirth and obstetric care Obstetric care in a hospital with medical necessity in maternity centre or hospital without medical necessity 16.50/day 6 at home 10 days 4.20 per hour Use of delivery room Obstetric care by midwife, general practitioner or obstetrician Maternity package yes Outpatient childbirth without medical indication yes Fertility treatments yes IVF/ICSI (at an institution appointed by the government) and corresponding hormone preparations for women up to 43 years of age attempts 1, 2 and 3 other fertility treatments yes Prenatal screening with medical indication yes 1 This does not apply to the following non-medical treatments: sterilisation, reversing sterilisation, circumcision, snoring remedies, corrections of the eyelids, ears and breasts (breast prosthesis) other than due to amputation. 2 You do not pay a deductible for the donor follow-up visit if you have received a kidney or liver. 3 You do not pay a deductible if the care falls under multidisciplinary care. 4 This list is determined by government. The list can be inspected at (information in Dutch). 5 According to the usual (market) rate applicable in the Netherlands. 6 The personal is per person. If your care provider claims an amount higher than 119 per person per day, you pay the higher amount per person as an additional. 4 5

4 Transport Ambulance transportation 200km one-way yes Seated patient transport (CZ permission required) 200km one-way 98 per year own car 0.30 per km yes taxi/public transport yes Seated patient transport is covered only in the following situations: - for kidney dialysis treatments, for radiotherapy or chemotherapy treatments - if you are blind, partially sighted or dependent on a wheelchair - for a long-term illness or disorder for which your doctor has provided a certificate indicating that you need long-term transport - for intensive childcare: the transport from and to a medical day nursery, with medical indication Hereditary disease investigation and advice Hereditary disease investigation and advice (by a recognised centre) yes Audiological care Audiological care (by a recognised audiological centre) yes Mechanical respiration Mechanical respiration yes Assistance with the treatment of children with cancer Assistance with the treatment of children with cancer (SKION) Medical aids The general insurance (partly) covers a number of medical aids, such as: breast prosthesis, hairpieces, hearing aids, bandage shoes, non-allergenic shoes, orthopaedic shoes, prostheses and ortheses, special visual aids, stoma care appliances, diabetes and incontinence and therapeutic elastic stockings. Mental healthcare Specialised mental healthcare from 18 years of age See Medical aids regulation 7 yes 8 possible 7 Psychiatric care (with our without hospitalisation) yes Psychotherapy (for certain disorders) yes Basic mental healthcare from 18 years of age yes Preventive care Stoppen-met-roken (stop smoking) course yes Problematic alcohol consumption programme yes Dealing with depression programme yes Advice Dietetics (prescribed by a doctor) 3 hours yes Total cover for dentistry Dentistry up to the age of 18 Check-up (on dentist indication, several a year possible) Fluoride treatment Other dentistry 9 Dentistry for all ages Dental prosthesis Reimbursement 1x per year 2x per year Deductible complete set of dentures (upper and/or lower) 75%, 1 x per 5 years yes 25% repair and rebasing of full set of dentures (upper and/or lower) yes Implants (for certain conditions, CZ consent required) fee for dentist or dental surgeon yes additional outpatient or clinical costs (hospital) yes superstructure yes upper or lower set of dentures on implant yes 125 upper and lower set of dentures on implant yes 250 Dentistry in special circumstances CZ consent required for some indications/handicap yes Orthodontics in special circumstances CZ consent required for some indications/handicap yes 7 The maximum reimbursement and the statutory personal are listed in the Medical Aids regulations at (information in Dutch). 9 Other dentistry includes regular treatments such as pulling teeth, fillings, nerve and root canal treatments and paradontology. 6 8 Except for medical aids on loan. The treatments are listed under the head Dentistry for all ages and dental whitening are not covered by other dentistry. 7

5 Everything for better healthcare No rights can be derived from this package comparer. See the general terms and conditions and the reimbursements overview for information on this subject