VGZ Goede Keuze 2015 Policy conditions. Manage everything online with My VGZ

Transcription

1 VGZ Goede Keuze 2015 Policy conditions Manage everything online with My VGZ

2 Welcome to VGZ These are the insurance conditions that apply to your VGZ healthcare insurance policy. You can find further information about submitting claims or our healthcare insurance packages at Taking care of good car together My VGZ You can make changes to your insurance cover, view your claims and pay your premium contribution at My VGZ. Log in with your DigiD and discover the possibilities at Important information Contact: Go to for our contact information. Contracted care A list of our contracted care providers is available at Requesting permission Do you want to know for which types of care you will need prior permission from us? This information can be found in these policy conditions. To request permission, download the consent form at Print out the form, make sure it is completed and send it to: VGZ Postbus RS Eindhoven Simple online cost claiming Submitting your claims online is easy using Log in securely with DigiD. The amount that we reimburse will be transferred to your account within 10 working days. Would you rather submit your claims by post? In that case, send the original invoice, accompanied by a claim form, to: VGZ Postbus RS Eindhoven 2

3 Inhoud I. General section 5 Article 1. Insured care Content and extent of the insured care Medical indication Parties authorised to provide the care Reimbursement for care provided by a non-contracted care provider Submitting invoices Timely provision of care Direct payment Settlement of costs Referral, prescription or permission Derived right Exclusions Entitlement to care and other services as a result of acts of terrorism 7 Article 2. General provisions Basis of the insurance Operational area Accompanying documents Fraud Protection of your personal data Communications Membership of the Cooperative Reflection period Interpretation Priority provision Dutch law 10 Article 3. Premium Premium base and premium discounts Premium discount by virtue of a group contract Premium owed Payment of premium, statutory contributions, excess and costs Offsetting Overdue payment 11 Article 4. Other obligations 13 Article 5. Change in premium or basis of the premium and policy conditions Change in policy conditions Right of termination 13 Article 6. Commencement, duration and termination of the healthcare insurance Commencement and duration Termination by operation of law Times at which you may cancel your insurance Grounds on which we may cancel, terminate or suspend the insurance Statement of termination of the insurance Insurance of non-insured persons 15 Article 7. Compulsory excess Amount of the compulsory excess The types of care to which the compulsory excess applies Care providers and care arrangements to which the compulsory excess does not apply Calculation of the amount of the compulsory excess Calculation of the compulsory excess 16 Article 8. Voluntary excess Voluntary excess options The types of care to which the voluntary excess applies Calculation of the amount of the voluntary excess Changing the voluntary excess Calculation of the compulsory and voluntary excess 16 Policy conditions VGZ Goede Keuze

4 Article 9. Care abroad Residing or staying in an EU/EEA country or contracting country other than the Netherlands Residing or staying in a country that is not an EU/EEA country or contracting country Permission requirement for care abroad Referral and/or permission requirement 17 Article 10. Complaints and disputes Our complaints procedure. Submitting complaints to the Complaints Management Department Complaints about our forms 18 II. Care articles 19 Medical care 19 Article 11. General practitioner care 19 Article 12. Care programmes (multi-disciplinary care) 20 Article 13. Nursing and care 21 Article 14. Obstetric care and maternity care 22 Article 15. Specialist medical care 24 Article 16. Rehabilitation 26 Article 17. Genetic testing 27 Article 18. In vitro fertilisation (IVF) and other fertility treatments 28 Article 19. Audiological care 29 Article 20. Plastic and/or reconstructive surgery 30 Article 21. Tissue and organ transplants 30 Article 22. Care for persons with a sensory disability 31 Article 23. Stop-smoking programme 31 Mental Healthcare 32 Article 24. General basic mental healthcare (GGZ) from age Article 25. Specialist mental healthcare (GGZ) from age Paramedical care 34 Article 26. Physiotherapy and Cesar/Mensendieck remedial therapy 34 Article 27. Speech therapy 35 Article 28. Occupational therapy 36 Article 29. Dietary advice 36 Oral care 36 Article 30. Dental care and dental surgery 36 Article 31. Prosthetic devices for insured persons from age Pharmaceutical care 39 Article 32. Medicines 39 Article 33. Diet preparations 41 Care aid provision 42 Article 34. Care aids and bandaging materials 42 A stay in an institution 44 Article 35. Inpatient care 44 Patient Transport 45 Article 36. Ambulance and seated patient transport 45 Care mediation 46 Article 37. Care Advice and Mediation 46 III. Glossary 47 4 Contents / General section

5 I. General section Article 1. Insured care 1.1. Content and extent of the insured care The VGZ Goede Keuze is a VGZ contracted care policy, hereinafter referred to as the healthcare insurance. By virtue of this healthcare insurance, you are entitled to contracted care as described in these policy conditions. You are also entitled to care advice and care mediation. Care advice and mediation The Care Advice and Mediation Department (Zorgadvies en bemiddeling ) advises you with regard to the best institution or care provider to go to for your particular care need. You can also contact the Care Advice and Mediation Department in the event of unacceptably long waiting times, for example for a visit to an outpatients clinic or admission to a hospital. The Care Advice and Mediation Department can be contacted via the website 1.2. Medical indication You are entitled to care and the reimbursement of costs associated with that care as described in these policy conditions if you reasonably depend on the type of care in question in terms of its content and extent, and if the type of care provided is appropriate and effective. The content and extent of the type of care are partly determined by what the care providers concerned are in the habit of providing in terms of care. The content and extent of the type of care are also determined by the current state of science and professional practice. This is determined using the Evidence-Based Medicine (EBM) method. If information in this regard is lacking, the content and type of care are determined according to what is considered to be responsible and adequate care within the field of specialisation concerned Parties authorised to provide the care The contracted care is provided by a care provider with whom we have concluded an agreement for the relevant type of care, i.e. a contracted care provider. Several types of care require you to use the services of care providers specifically contracted for VGZ Goede Keuze healthcare insurance. These types of care are covered in Articles 14.2 (Maternity care), 32 (Medicines) and 34 (Care aids and bandaging materials). Our website features an overview of our contracted care providers and the care they are permitted to provide under the agreement. Your care provider must meet certain criteria. For many care providers these criteria are set out in law and titles for medical professions are protected. This applies, for instance, to general practitioners, medical specialists, health psychologists, psychotherapists, physiotherapists and dentists. See the relevant care article for the requirements that must be met by those care providers for whom these criteria are not set out in law or for whom we have imposed additional conditions. The care provider receives the reimbursement of the costs of the care directly from us, on the basis of the rate we have agreed with it. We conclude agreements with care providers about the quality, price and service level of the care to be provided. Your interests are our highest priority. If you opt for a contracted care provider, it will be less expensive for both you and us. If you nevertheless decide not to engage one of our contracted care providers, note that you will have to pay a portion of the costs yourself Reimbursement for care provided by a non-contracted care provider If you are not using the services of one of our contracted care providers, you may have to pay a portion of the costs yourself. This is because we reimburse the costs of care up to a maximum of 50% of the average rates as agreed for the types of care concerned with the care providers involved. If no rates have been agreed with the care provider in question and statutory Healthcare (Market Regulation) Act (WMG) rates apply, the costs will be reimbursed up to a maximum of 50% of the current WMG rate. The maximum reimbursement rates can be found in the List of Maximum Reimbursements for Non-Contracted Care Providers, which is available on our website. When determining a maximum reimbursement, an excess or personal contribution is not taken into account. These amounts are deducted from the maximum reimbursement. Policy conditions VGZ Goede Keuze

6 If acute care is provided by a non-contracted care provider, you are entitled to a reimbursement of the costs up to a maximum of the WMG rates current in the Netherlands. If WMG rates do not apply, we will reimburse the costs up to a maximum of the reasonable market price current in the Netherlands. You must inform us as soon as possible about such care Submitting invoices Most care providers send their invoices directly to us. If you have personally received an invoice, you can complete a claim form and send it to us, together with the original invoice. Please do not send us any copies or payment demands. We only process original invoices. You can submit invoices up to a maximum of three years after the start of the treatment in question. It is important that the invoice specifies the name and birth date of the insured person, the treatment, the date of treatment, the invoice amount and the name and initials of the care provider. Invoices must be itemised in such a way as to preclude the need for further queries to determine the reimbursement we are obliged to pay. We will deduct any applicable excess and statutory personal contribution from the reimbursement. For the conversion of the amounts indicated on foreign invoices into euros, we use the historical rates provided at based on the exchange rates that applied on the day the treatment took place. Invoices must be made out in Dutch, German, English, French or Spanish. If necessary, we may require a sworn translation of the invoice. The costs of translation are not eligible for reimbursement. Submitting claims online You can submit your claims simply and fast online. To do this, go to mijn.vgz.nl. You are obliged to keep the original invoices for one year after having submitted the claim. We may ask you to provide the original invoice for inspection purposes. If you are unable to produce the invoice, we may reclaim the amounts paid out to you or settle these against any amounts owed to you Timely provision of care If a contracted care provider is expected to be unable to provide the required care or is unable to do so in time, you are entitled to care mediation. We may grant you permission to go to a non-contracted care provider for this care. In that case, we will reimburse the costs up to the maximum statutory WMG rates. If WMG rates do not apply, the costs will be reimbursed up to a maximum of the reasonable market price current in the Netherlands. To determine the timeliness of the care, we will consider the following: - medical factors; - general, socially acceptable waiting periods based on psychosocial, ethical and societal factors Direct payment We are authorised to pay the costs of care directly to the care provider. In such a case, your entitlement to reimbursement will lapse Settlement of costs If we pay the care provider directly, we will not take into account an excess or personal contribution. We will charge these amounts to you, the policyholder, at a later stage. You are obliged to pay these amounts. We are authorised to offset these amounts against any amounts owed to you Referral, prescription or permission For certain types of care you require a referral, prescription and/or prior written permission to prove that you depend on that care. This is specified in the relevant care article. A referral, prescription and/or prior permission are not required for acute care, i.e. care that cannot reasonably be delayed. Referral or prescription If the care article specifies that you need a referral or prescription, you can ask for this from the care provider listed in that article. In many cases, this care provider is the general practitioner. Permission Some types of treatment require our written prior permission. This permission is also referred to as an authorisation. If you failed to obtain prior written permission, you will not be entitled to this care or to reimbursement of the costs. If you are using the services of one of our contracted care providers, you will not need to apply to us for prior permission. Your care provider will, in this case, determine whether you satisfy the conditions and/or will apply for 6 General section

7 permission from us on your behalf. You may, for reasons of privacy, prefer to apply directly to us for prior written permission. In such cases you can send your application to us directly. You will find our address in these policy conditions. If you are not using the services of one of our contracted care providers, you will need to apply to us directly for permission Derived right You are entitled to care and the reimbursement of the associated costs if the treatment or delivery of the care occurs during the term of your healthcare insurance. If a given treatment occurs during two calendar years and the care provider is entitled to charge a single amount for it (Diagnosis Treatment Combination), we will reimburse the costs in question if the treatment is started within the term of the healthcare insurance cover. Where these policy conditions refer to a year or calendar year, the actual treatment date or supply date specified by the care provider is decisive for determining the year or calendar year to which the costs claimed must be allocated Exclusions You are not entitled to: - forms of care or services that are financed by virtue of a statutory regulation such as the Long-Term Care Act (Wlz), the Youth Act or the Social Support Act (Wmo) 2015; - reimbursement of a personal contribution or excess owed pursuant to the healthcare insurance, unless determined otherwise in these policy conditions; - reimbursement of costs incurred because you failed to attend an appointment with a care provider; - reimbursement of costs of written statements, mediation costs charged by third parties without our prior written agreement, administrative costs or costs incurred due to a failure to pay invoices of care providers on time; - reimbursement for damage that is an indirect consequence of acts or omissions on our part; - care and the reimbursement of associated costs made necessary by armed conflict, civil war, insurrection, internal civil commotion, riots and mutiny taking place in the Netherlands as provided in Section 3.38 of the Financial Supervision Act (Wft) Entitlement to care and other services as a result of acts of terrorism Should you need care as a result of one or more acts of terrorism, the following rule applies. If the total damages to be claimed in a year from non-life, life or funeral with in-kind benefits insurers (including healthcare insurers) according to the Dutch Terrorism Risk Reinsurance Company (Nederlandse Herverzekeringsmaatschappij voor Terrorismeschaden N.V., NHT) exceeds the maximum amount reinsured per year by this company, you will only be entitled to a specific percentage of the costs or value of the care. The NHT determines this percentage. This applies to life, non-life and funeral insurers (including healthcare insurers) that fall within the scope of the Financial Supervision Act (Wft). The exact definitions and provisions for the entitlement referred to above are set out in the NHT s Terrorism Cover Clauses Sheet (Clausuleblad terrorismedekking). If, following an act of terrorism, we receive an additional contribution pursuant to Section 33 of the Healthcare Insurance Act (Zorgverzekeringswet, Zvw) or Section 2.3 of the Healthcare Insurance Decree, you will, in addition to this percentage, be entitled to an additional settlement as referred to in Section 33 of the Zvw or Section 2.3 of the Healthcare Insurance Decree. Guaranteed payment in the event of claims due to terrorism To be able to guarantee that you will receive a payment in the event of a claim due to terrorism, almost all insurance companies in the Netherlands came together to set up the Nederlandse Herverzekeringsmaatschappij Terrorismeschaden N.V. (NHT). We are also affiliated with them. The NHT has set up a scheme to ensure that you will always receive at least part of your claim. The NHT has imposed a maximum on the total amount to be paid out in the event of an act of terrorism. The maximum, which is one billion euros per year, applies to all insured persons as a group. If the total damages exceed this amount, each insured person who has suffered damages will receive the same percentage of the maximum amount. The NHT has set out the rules for the proper settlement of damage claims for compensation in the Claims Settlement Protocol (Protocol Afwikkelen schadeclaims). In practice, this can therefore mean that you will receive less than the actual value of the damages. However, it also means that you are always guaranteed to receive at least part of your claim. Policy conditions VGZ Goede Keuze

8 Article 2. General provisions 2.1. Basis of the insurance The insurance contract is concluded on the basis of the details you provided on the application form or forwarded to us in writing. After the healthcare insurance has been effected, you will receive a healthcare insurance policy from us as soon as possible and will subsequently receive a new healthcare insurance policy before the start of each calendar year. These policy conditions form part of the healthcare insurance policy. The insured persons and healthcare insurance or insurances effected for them are specified on the policy schedule Operational area The healthcare insurance is available to all persons obliged to take out insurance who reside in the Netherlands or abroad. VGZ is a nationally operating insurer. You may keep this insurance as long as you remain obliged to take out healthcare insurance. Persons who are obliged to take out insurance and who reside abroad are also entitled to this insurance Accompanying documents These policy conditions make reference to the following documents, which are part of the policy conditions : - Appendix 1 to the Healthcare Insurance Decree; - Healthcare Insurance Regulations; - Terrorism Cover Clauses Sheet; - schedule of premiums; - List of Maximum Reimbursements for Non-Contracted Care Providers; - National Indication Protocol for Maternity Care (Landelijk Indicatie Protocol Kraamzorg); - overview of contracted care providers; - Excess Exemption Overview (Overzicht vrijstelling eigen risico); - Prevention of Diabetic Foot Ulcer Care Module; - Diabetes mellitus, COPD and VRM Care Standards; - Dutch Healthcare Authority Policy Regulations Comprehensive funding of multidisciplinary care for chronic conditions (DM type 2, VRM, COPD) ; - Netherlands Health Insurers Limitative List of Diagnosis Treatment Combinations (DCBs) Requiring Prior Permission (Limitatieve lijst van vooraf aan te vragen Diagnose Behandeling Combinaties (DBC s) van Zorgverzekeraars Nederland) - Pharmaceutical Care Regulations; - Care Aids Regulations; - Personal Budget for Nursing and Care (Reglement persoonsgebonden budget verpleging en verzorging); - Guide for the assessment of treatments involving plastic surgery (Werkwijzer beoordeling behandelingen van plastischchirurgische aard); - dynamic overview of psychological and other interventions within the mental healthcare of the Netherlands Health Insurers. You will find these documents on our website. You may also request these documents from our Client Service Fraud The commitment of fraud, either full or partial, will result in no payments being made and the recovery of any payments already made. If you commit fraud, your entitlement to care and the reimbursement of associated costs will lapse, We will reclaim any reimbursements paid to you. You will also be obliged to pay any costs incurred by us that arise from the fraud investigation. Upon detection of fraud, we will enter your personal data and the personal data of the accessory or co-perpetrator in our Incidents Register. This Incidents Register is registered with the Dutch Data Protection Authority (CBP) and is administered by our Security Affairs Department. Your personal data and the personal data of the accessory or co-perpetrator can also be registered: - at the Centre for Combating Insurance Fraud of the Dutch Association of Insurers; - in the external reference register of the Stichting CIS (Netherlands Central Information System Foundation). In addition, we may report the fraud to the police and investigative authorities. 8 General section

9 Upon detection of fraud, we will terminate your healthcare insurance policy or policies and will be authorised to refuse to conclude a new insurance contract with you for a period of five years. Your supplementary healthcare and other insurance policy or policies may also be terminated and you will not be permitted to take out supplementary insurance policies with any company that is a member of the Coöperatie VGZ U.A. (the VGZ U.A. Cooperative) for a period of eight years Protection of your personal data Your privacy is a serious matter to us. We need to collect and process your personal data in order to enter into and perform your healthcare and other insurance policies, including supplementary policies. We will enter your personal data in our insured persons administration. Processing personal data We process your personal data for the following purposes: - to enter into and perform your insurance policy or financial service; - to conduct surveys amongst insured persons to ascertain whether the care was indeed provided; - to conduct surveys amongst insured persons to establish the quality of the care provided; - for the purpose of statistical analysis; - for compliance with statutory obligations; - within the framework of safety and integrity of the financial sector (to prevent and combat fraud); - if you participate in a group contract: for information exchange with the contracting party of the group agreement for the purpose of assessing your right to premium discount; - advertising for this insurance and advertising for the insurer s own and similar services and products and the associated marketing activities (up to one year following the termination of the agreement). The processing of your personal data is subject to privacy legislation, including the Personal Data Protection Act, the ZN (Netherlands Health Insurers) Code of Conduct for the Processing of Personal Data by Health Insurers, the Citizen Service Number (General Provisions) Act, the Use of BSN in the Healthcare Sector Act, and the Privacy Statement of the Coöperatie VGZ U.A. The Code of Conduct and Privacy Statement are available on our website. We are obliged to keep your Citizen Service Number (BSN) in our records and to use it when communicating with care providers (as part of data exchange). The BSN is also used as part of the claims process. Both uses of your BSN have a legal basis. We may need to consult your personal details at the Stichting CIS (Netherlands Central Information System Foundation) in Zeist in the interests of the safety and integrity of the financial sector. Would you like more information, view your personal data, correct it or lodge an objection? Please contact our privacy manager via the address you will find under the heading Privacy. Use of personal data by care providers If we receive your invoices directly from your care providers and pay the amounts owed directly to them, your healthcare insurance will run more rapidly and simply. To that end, it may be necessary for a care provider to know how you are insured. For this reason, care providers can inspect your address and policy details as well as your Citizen Service Number in a secure manner. They may only do so if they are actually treating you. If there is an urgent reason to prevent care providers from inspecting your address details, please let us know and we will ensure that these details remain inaccessible Communications Communications sent to your last address known to us are deemed to have reached you. If you prefer to contact us by , we will also contact you by in the future. Wherever reference is made in these policy conditions to communication in writing, this will extend to communication by . In such a situation the term address will be taken to mean address. Policy conditions VGZ Goede Keuze

10 2.7. Membership of the Cooperative By taking out this insurance, you will also become a member of the Coöperatie VGZ U.A. (VGZ U.A. Cooperative) as a policyholder, unless you indicate in writing that you do not wish to become a member. The Cooperative represents the interests of its members in the area of healthcare and other insurances. Membership can be terminated at any time with due observance of a notice period of one month. Membership will in any case end at the moment at which the insurance contract ends Reflection period When entering into a healthcare contract, you will have a reflection period of 14 days as a policyholder. You will be authorised to cancel the insurance in writing within 14 days of having concluded the contract or, if this occurs later, within 14 days of having received the policy conditions. The insurance contract will then be deemed not to have been concluded Interpretation The Healthcare Insurance Act, Healthcare Insurance Decree and Healthcare Insurance Regulations serve as guides with respect to the contents of these policy conditions. In the event of differences in interpretation, legislative and regulatory texts, including legislative history, will be decisive Priority provision Insofar as provisions laid down by or in accordance with Title 7.17 of the Dutch Civil Code or the Healthcare Insurance Act influence or should influence the healthcare insurance, they are hereby included in these policy conditions. In the event of conflict between the provisions laid down by or in accordance with Title 7.17 of the Dutch Civil Code or the Healthcare Insurance Act and the provisions of this contract, the provisions laid down by or in accordance with Title 7.17 of the Dutch Civil Code or the Healthcare Insurance Act will prevail Dutch law The insurance is governed by Dutch law. Article 3. Premium 3.1. Premium base and premium discounts The premium base is the premium without premium discount for a voluntary excess and/or a group discount agreed in a group contract. The premium base and premium discounts for voluntary excess are specified on the annually adjusted schedule of premiums. You will find this schedule on our website. The premium base and premium discounts applicable to you are specified on your policy schedule Premium discount by virtue of a group contract If you participate in a group contract, you will receive a discount on the premium base From the date that you are no longer able to participate in the group contract, the premium discount and terms and conditions as agreed in the group contract will lapse. The healthcare insurance will be continued on an individual basis from that date You can only participate in one group contract at a time Premium owed The policyholder is required to pay a premium. No premium is owed for an insured person younger than 18 until the first day of the month following his or her 18th birthday. With respect to death, premium is owed up to and including the date of death. In the event of a change in the insurance we will recalculate the premium owed from the inception date of the change. Example: A person who turns 18 on 1 July will owe premium from 1 August Payment of premium, statutory contributions, excess and costs You are obliged to pay the premium and national or foreign statutory contributions owed for all insured persons on a monthly basis in advance, unless agreed otherwise. If you pay the premium on an annual basis in advance, you will receive a discount on the premium owed. The amount of the discount is stated on the policy schedule. 10 General section

11 You are obliged to pay the premium, the excess and contributions and to pay back any erroneous reimbursements using the payment method agreed with us when you took out the policy. Payment methods that are free of charge a. You can authorise us to deduct the amounts owed by direct debit. b. You can also download an invoice via My VGZ. Please remember that if you do so, you are responsible for timely payment of the amounts owed. If you wish you can pay us directly using ideal. c. Your employer deducts the premium from your salary and pays it directly to us. This method can only be used for the payment of premium contributions. These payment methods are free of charge. Costs associated with paper giro collection forms If you prefer not to use the payment methods that are free of charge, you will receive a paper giro collection form. An administrative fee of 1.50 applies to each payment with a giro collection form in order to cover the costs of maintaining, drawing up, sending and processing these forms. You will also be sent a paper giro collection form if we are unable to collect your premium payment through direct debit. In this case you will also be charged the applicable fee of Your direct debit authorisation applies to the payment of premiums, excess, personal contributions and erroneous reimbursements. A direct debit authorisation will also grant your bank a standing authorisation to deduct a specific amount in accordance with our instructions. The authorisation will be valid for the term of the insurance agreement and may continue to apply after its termination, if necessary. We will inform you at least three days before the amount will be debited, stating the amount and the date on which it will be debited. If you are not in agreement with a direct debit collection, you can request to have the entry reversed. Please note that you must contact your bank about this within eight weeks of the debit date. The amount to be deducted by direct debit for excess, personal contributions and erroneous reimbursements is capped at 220 per month. We will send a giro collection form for amounts above 220. If we choose to send you a giro collection form we will not charge you for administrative costs arising from this Offsetting You are not permitted to offset the amount you owe against an amount that you expect from us Overdue payment If you fail to pay the premium, statutory contributions, excess and personal contributions on time and to pay back erroneous reimbursements, we will send you a demand for payment. If you do not pay within the term of at least 14 days specified in the demand for payment, we will be authorised to suspend the insurance cover. In that case, there will be no entitlement to care and reimbursement of the associated costs from the last premium due date prior to the demand for payment. You will remain obliged to pay the premium even in the event of suspension of the insurance cover. Entitlement to care and reimbursement of the associated costs will resume on the date subsequent to the one on which we have received the amount due and any costs owed. We are entitled to terminate the healthcare insurance if you fail to pay on time. The insurance will in that case not be terminated with retroactive effect We are authorised to charge collection costs and statutory interest to you If a demand for payment has already been sent to you for overdue payment of premiums, statutory contributions, excess, personal contributions, the return of erroneous reimbursements or costs, we will not be required to send you a separate, written demand for payment in the event of a failure to pay a subsequent invoice on time We are authorised to offset overdue premiums, costs and statutory interest against costs of care claimed by you or other amounts to be received from us If we terminate the insurance due to a failure to effect timely payment of premiums owed, we will be authorised to refuse to conclude any insurance contract with you for a period of five years If you are in arrears of payment equalling two monthly premiums we will offer you, as a policy holder, a payment arrangement not later than ten days after we have discovered the arrears in payment. That payment arrangement will include at least: a. - your authorisation for payment through direct debit for the new premium owed, or; - your instructions to your employer, pension fund, benefits agency or another third party from which you receive regular payment to pay us the new premium owed directly on your behalf; b. agreements about the method to be used to effect payment of your debts to us, including interest and collection costs and the associated payment terms; Policy conditions VGZ Goede Keuze

12 c. our pledge to refrain from terminating, suspending or postponing your healthcare insurance as long as you have not revoked your authorisation or payment instructions as included under a. and comply with the agreements included in the payment arrangement. You will be given four weeks to accept our offer for a payment arrangement. We will also inform you of the consequences should you refuse our offer and the arrears equal six or more monthly premiums. See Article for more information. If you have insured another person again healthcare costs with us, we will include in our payment arrangement offer a statement of willingness to terminate this insurance policy commencing on the day on which the payment arrangement is to come into effect, on condition that: - the insured person has taken out another insurance policy that commences no later than on this same date; - and that the insured person has issued a payment authorisation or order as defined under a. if we are the insurer of the new policy. We will send this insured person a copy of all the documents specified in this article at the same time these documents are sent to you as the policyholder a. If you, as a policyholder, have incurred arrears in payment equalling four monthly premiums, we will inform you that we will register you with the Dutch Health Care Institute (Zorginstituut Nederland), pursuant to the provisions of Article If the healthcare insurance has been concluded for another person, we will inform this insured person. b. You or the insured person may submit an appeal to us within four weeks should you contest the debt in its entirety or the level of the amount owed. If we have received your appeal in due time we will conduct an investigation into the matter. If we notify you that we uphold our position, you can submit the dispute within four weeks to the Health Insurances Complaints and Disputes Foundation (Stichting Klachten en Geschillen Zorgverzekeringen, SKGZ) or a competent civil court. c. If the payment arrangement as defined in Article commences after your payment arrears have reached four monthly premiums, we will not send you a notification as defined under a. as long as we receive payment of your new premium in due time We will notify the Dutch Health Care Institute once your arrears equal six or more monthly premiums. Upon receipt of confirmation of your registration with the Dutch Health Care Institute you will be obliged to pay the Dutch Health Care Institute a premium under administrative law of 130% of the average market premium. The Dutch Health Care Institute will collect this premium until you have paid all amounts owed, including interest and collection charges. We will not register you with the Dutch Health Care Institute if: a. you have contested the payment arrears in due time and we have not yet notified you of our standpoint on the matter; b. you have submitted the dispute to the SKGZ or a competent civil court within four weeks after we have informed you of our standpoint and our intention to register your debt with the Dutch Health Care Institute and as long as no irrevocable decision has been made in respect of the dispute; c. you have registered with an accredited debt assistance organisation and are able to show us a written agreement concluded with this organisation for the stabilisation of your debts. Registration with the Dutch Health Care Institute includes a statement from us that we have complied with Section 18b and Section 18c(2) of the Healthcare Insurance Act We will instantly inform you and the Dutch Health Care Institute of the date on which: a. \the debt arising from the arrears in payment for healthcare insurance premiums was paid in full or cancelled; b. \a court of law has declared the debt rescheduling regulation for natural persons as referred to in the Bankruptcy Act to be applicable to your situation; c. you will be participating in an amicable settlement for a debt rescheduling arrangement, arranged through an accredited debt assistance organisation, in which we also participate. The payment obligation towards the Dutch Health Care Institute of a premium under administrative law will be cancelled as from the first day of the month following the dates as stated above. From that moment on, your payment obligation towards us will be reinstated with respect to the premium owed You will not owe us a premium for the period referred to in Section 18d(1) or 18e of the Healthcare Insurance Act. 12 General section

13 Article 4. Other obligations You are obliged: - to ask the care provider to make the reason for admission known to our medical adviser; - to cooperate with our medical adviser or employees tasked with obtaining all information needed for verifying the execution of the care; - to inform us about facts that enable or could enable costs to be recovered from liable or potentially liable third parties, and to provide all necessary information to us in that regard. You may not enter into any arrangement whatsoever with a third party without our prior written agreement. You must furthermore refrain from acts that may harm our interests; - to inform us as soon as possible about facts and circumstances pertinent to the proper execution of the insurance. Among other things, these facts and circumstances include the obligation to take out insurance, the start and end date of a period of detention, separation or divorce, a birth, an adoption or a change in bank or giro account number. We will bear no risk whatsoever for a failure to comply with the foregoing provisions. If you fail to meet your obligations and our interests are harmed as a result, we will be authorised to suspend your entitlement to the insured care. Article 5. Change in premium or basis of the premium and policy conditions 5.1. Change in policy conditions We are at all times authorised to change the conditions and premium of the healthcare insurance. We will inform you, the policyholder, accordingly in writing. A change in the premium base will not come into effect until six weeks following the date on which it was made known to you Right of termination If we change the conditions and/or basis of the premium calculation of the healthcare insurance to your detriment, you will be authorised as a policyholder to terminate the insurance contract from the date on which the change enters into force. You will be able to terminate the contract within a period of one month after the change has been reported to you. This right of termination will not apply if a change in the insured care is a direct result of an amendment to the regulations laid down by or pursuant to Sections 11 up to and including 14 of the Healthcare Insurance Act. Article 6. Commencement, duration and termination of the healthcare insurance 6.1. Commencement and duration The insurance comes into effect on the date on which we have received your application (or application form). You will receive a confirmation of receipt stating the date on which the application was received. By applying to us for healthcare insurance, you give us permission to cancel your old policy with a Dutch healthcare insurer. Are you obliged to take out insurance but you do not yet have a BSN? We can still register you as an insured person We may not be able to deduce from the application whether we are obliged to provide healthcare insurance for the person to be insured. In that case, we will ask you to submit information confirming that we are obliged to provide healthcare insurance. The healthcare insurance will only come into effect on the date on which we received such additional information. You will receive a confirmation of receipt stating the date on which the additional information was received If you already have different healthcare insurance on the date referred to in Article or 6.1.2, the healthcare insurance will come into effect on a later date indicated by you If the previous insurance is terminated with effect from 1 January of a calendar year or due to a change in the policy conditions, the insurance with the new insurer will come into effect on the termination date of the old insurance. You must then register with the new healthcare insurer within a month of termination of the previous insurance If the insurance contract comes into effect within four months after the obligation to take out insurance has arisen, the healthcare insurance will come into effect on the date on which the obligation to take out insurance arose. Example: You are obliged to insure your child within four months of his or her birth so that he or she is insured from the date of birth. Policy conditions VGZ Goede Keuze

14 The Healthcare Insurance Act provides for an obligation to take out insurance. We are not under any obligation to provide healthcare insurance for or to a person who is obliged to take out healthcare insurance and is already insured under the Healthcare Insurance Act Termination by operation of law The healthcare insurance will end by operation of law on the date subsequent to the one on which: - due to a change in or the withdrawal of its licence to act as a non-life insurer, VGZ is no longer authorised to offer or effect healthcare insurances. We will inform you of this no later than two months before this date; - the insured person dies; - the insured person s obligation to take out insurance ceases to apply. As a policyholder, you are obliged to inform us as soon as possible about the death of an insured person or the end of an insured person s obligation to take out insurance. If you fail to report the end of an obligation to take out insurance in time and we pay the costs of care to a care provider as a result, we will reclaim these costs from you. If we establish that the healthcare insurance has ended, we will send you a document proving that the insurance has ended as soon as possible Times at which you may cancel your insurance Annually As a policyholder, you may cancel the healthcare insurance in writing as from 1 January of each year, provided that we have received your cancellation no later than 31 December of the previous year. You will then have until 1 February to find another insurer that will insure you with retroactive effect from 1 January In the interim period As a policyholder, you may cancel the healthcare insurance in the interim period in writing: - of another insured person if this insured person has taken out different healthcare insurance. If you cancel your healthcare insurance prior to the inception date of the other healthcare insurance, cancellation will take effect on the inception date of the new healthcare insurance. If the cancellation is received at a later time, cancellation will take effect on the first day of the second calendar month after we have received the cancellation; - in the event of a change in the premium and/or policy conditions as stated in Article 5.2; - if you are a participant in a group contract with us taken out by your former employer and may participate in a group contract of your new employer. You may cancel the healthcare insurance up to 30 days after commencement of the new employment. In that case, both the cancellation and registration will take effect on the first day of employment with your new employer if that is the first day of the calendar month, or, if it is not, on the first day of the calendar month following the commencement date of employment Cancellation service You can also make use of the Dutch healthcare insurers cancellation service to cancel the insurance as referred to in Articles and This means that you give the new insurer offering the new healthcare insurance permission to cancel the old healthcare insurance Times at which you may cancel your insurance If we have sent you a demand for payment in connection with a premium arrears, you will not be able to cancel your healthcare insurance in the period that the premium owed, interest and collection charges are still due. You may cancel the healthcare insurance if we have suspended the insurance cover or have confirmed your cancellation within two weeks Grounds on which we may cancel, terminate or suspend the insurance We will be authorised to cancel, terminate or suspend the healthcare insurance in writing: - in the case of overdue payments as stated in Article 3.6; - in the case of fraud (see Article 2.4); - if you have deliberately withheld information or documents from us, or provided incomplete or inaccurate information or documents to us, as a result of which we are or could be adversely affected; - if you have acted with the deliberate intention of misleading us or if we would not have provided healthcare insurance had we been aware of the true state of affairs. In those case, we will be authorised to cancel the healthcare insurance with immediate effect within two months following discovery. We will in those cases not owe any payment or may reduce any payment due. In addition, we may offset claims that have arisen against other payments Statement of termination of the insurance If and when the healthcare insurance ends, you will receive a document proving the end of insurance. This document will contain the following information: - the name, address, place of residence and the Citizen Service Number (BSN) of the insured person - the name, address and place of residence of the policyholder 14 General section

15 - the date on which the healthcare insurance ended; - whether an excess applied to you before that date and, if so, the amount of the excess If the insurance obligation has also ended, this too will be specified on the statement of termination Insurance of non-insured persons If the National Health Care Institute has concluded this insurance policy on your behalf pursuant to Section 9d(1) of the Healthcare Insurance Act, the following applies: a. You can cancel this insurance policy if you are able to demonstrate to us and the National Health Care Institute within two weeks that you have already taken out another policy. The term of two weeks commences on the date on which the National Health Care Institute has informed you that it has taken out this insurance policy on your behalf. b. We can also cancel this policy on grounds of a judicial error should it become clear that you are not obliged to take out insurance. c. You are not entitled to cancel this policy for the first 12 months of its duration. Once this 12-month period has elapsed the usual cancellation provisions as stated in Article 6.3 will apply. Article 7. Compulsory excess 7.1. Amount of the compulsory excess If you are aged 18 or older, a compulsory excess of 375 per calendar year applies. The costs of care will be payable by you up to this amount. If you turn 18 in the course of a calendar year, the compulsory excess will apply from the first day of the calendar month following your 18th birthday. The amount of the compulsory excess will in that case be calculated according to the method stated in Article The types of care to which the compulsory excess applies The compulsory excess applies to all the types of care referred to in these policy conditions, with the following exceptions: - general practitioner care. Please be aware that medicines prescribed by a general practitioner are not covered by general practitioner care. The same applies to laboratory tests in connection with general practitioner care. Such laboratory tests are carried out at the request of a general practitioner by another care provider and invoiced accordingly. As such, this care falls within your compulsory excess. - care that is financed through application of the Dutch Healthcare Authority Policy Regulations Comprehensive funding of multidisciplinary care for chronic conditions (DM type 2, VRM, COPD). See Article 12, Care programmes (multi-disciplinary care); - nursing and care as described in Article obstetric care and maternity care. Please be aware that the costs relating to these types of care are not among those to which exceptions apply. This means that medicines, blood tests, prenatal diagnostics or patient transport all fall within the compulsory excess. - the medicines specified by us as preferred medicines, as listed in the Reglement farmaceutische zorg (Pharmaceutical Care Regulations). Please note that the pharmacy services, such as the cost of dispensing medicine, the counselling interview in the case of a new medicine or inhalation instructions are not exempt from this excess. - the care providers contracted by us to dispense liquid nutrients (dietary preparations), insofar as they dispense the nutrients designated by us as preferred products as stated in the Pharmaceutical Care Regulations (Reglement farmaceutische zorg); - care aids on loan. - follow-up checks for kidney or liver donors after the period specified in Article 21; Tissue and organ transplants as defined in section d, has expired; - transportation of a donor as referred to Article 21, Tissue and organ transplants; - any personal contributions and/or personal payments Care providers and care arrangements to which the compulsory excess does not apply If you make use of care providers or care arrangements designated by us, you will not owe the excess or only part of the excess. The same applies to specific programmes or care programmes that promote health or are aimed at prevention. This information is included in the Overview of Excess Exemptions. You will find this overview on our website. Policy conditions VGZ Goede Keuze

16 7.4. Calculation of the amount of the compulsory excess If the healthcare insurance cover does not end or commence on 1 January, the excess is calculated as follows: Excess x number of days that the healthcare insurance is in effect. number of days in the calendar year concerned. The amount calculated is rounded to whole euros. Example: The healthcare insurance cover is in effect from 1 January - 30 January, inclusive. This amounts to 30 days in total. The calendar year comprises 365 days. The excess is therefore: 375 x 30 divided by 365 = 30.82, which is rounded to Calculation of the compulsory excess To calculate the compulsory excess, the costs of care or of another service are allocated to the calendar year in which the care was received. If a treatment is spread across two calendar years and the care provider may issue a single invoice for the costs of this treatment (Diagnosis Treatment Combination), these costs will be deducted from the excess of the calendar year in which the treatment started. Article 8. Voluntary excess 8.1. Voluntary excess options If you are aged 18 or older, you may opt for a healthcare insurance cover with a voluntary excess of 0, 100, 200, 300, 400 or 500 per calendar year. The costs of care will be payable by you up to this amount. Depending on the voluntary excess chosen, you will receive a discount on the premium base. The voluntary excess selected and any applicable discount are specified on the policy schedule The types of care to which the voluntary excess applies The voluntary excess applies to the types of care specified in Article Calculation of the amount of the voluntary excess If the healthcare insurance cover does not end or commence on 1 January, the voluntary excess is calculated as follows: number of days that the healthcare insurance is in effect. Excess x number of days in the calendar year concerned. The amount calculated is rounded to whole euros. Example: You have chosen a voluntary excess of 100. The healthcare insurance cover is in effect from 1 January - 30 January, inclusive. This amounts to 30 days in total. The calendar year comprises 365 days. The voluntary excess is therefore: 100 x 30 divided by 365 = 8.22, which is rounded to 8. The compulsory excess is 375 x 30 divided by 365 = 30.82, which is rounded to 31. The total excess amounts to 39 ( 31 compulsory excess and 8 voluntary excess) If the insurance cover does not come into effect on 1 January and you had a different voluntary excess under an insurance policy with us immediately before, the total voluntary excess is calculated as follows: a. Every amount of voluntary excess x the number of days that the voluntary excess applies. b. The sum of the amounts specified under a. divided by the number of days in the relevant calendar year. c. The result is rounded to whole euros Changing the voluntary excess You may change the voluntary excess each year, with effect from 1 January. The change will come into effect on 1 January and must be made known to us in writing or via My VGZ by 31 December of the previous calendar year at the latest Calculation of the compulsory and voluntary excess If a voluntary excess applies, the costs of care will first be deducted from the compulsory excess and subsequently from the voluntary excess. The same provision as referred to in Article 7.5 applies for the calculation of the voluntary excess in the event of treatment over two calendar years. 16 General section

17 Article 9. Care abroad 9.1. Residing or staying in an EU/EEA country or contracting country other than the Netherlands If you reside or are temporarily staying in an EU/EEA country or contracting country other than the Netherlands, you are entitled to the following in terms of care: - care according to the statutory insurance package in an EU/EEA country or contracting country if this applies to you. This entitlement to care is provided for in the EU social security regulation or a social security treaty; - care by a contracted care provider or care institution; - reimbursement of the costs of care provided by a non-contracted care provider. We will reimburse the costs up to a maximum of the amount that you would receive in the Netherlands if you opted for a non-contracted care provider. See Article 1, paragraphs 4 and 6 of these policy conditions. Please note If acute care is provided by a non-contracted care provider, you are entitled to reimbursement up to a maximum of the Healthcare (Market Regulation) Act rates (WMG rates) current in the Netherlands or the reasonable market price current in the Netherlands. For foreseeable care that a care provider will probably not be able to provide or will not be able to provide in time, we may top up reimbursement for the costs of care provided by a non-contracted care provider to a maximum of the WMG rates current in the Netherlands or the reasonable market price current in the Netherlands. European Healthcare Insurance Card (EHIC) A European Healthcare Insurance Card (EHIC) is printed on the reverse of your healthcare insurance card. Presentation of this card will entitle you to necessary medical care when you are on holiday in an EU/EEA country or Switzerland. The EHIC is also valid in Australia. In Australia, the card will entitle you to emergency medical care. This card can only be used if you are insured with us. If you use the EHIC abroad and you know or could have known that it is no longer valid, you will be required to pay for the cost of care yourself Residing or staying in a country that is not an EU/EEA country or contracting country If you reside or are temporarily staying in a country that is not an EU/EEA country or contracting country, you can opt for the following in terms of care in your country of residence or the one in which you are temporarily staying: - care by a contracted care provider or care institution; - reimbursement of the costs of care provided by a non-contracted care provider. We will reimburse the costs up to a maximum of the amount that you would receive in the Netherlands if you opted for a non-contracted care provider. See Article 1, paragraphs 4 and 6 of these policy conditions. Please note Care abroad can be more expensive than treatment in the Netherlands. We will reimburse the costs up to a maximum of the amount that you would receive in the Netherlands. Please note that you may have to pay a considerable portion of the cost of treatment abroad yourself Permission requirement for care abroad Would you like to receive treatment abroad? If your treatment abroad requires you to stay for one or more nights at a hospital or other institution you will need to obtain permission from us first. You do not need prior permission if you are admitted to a hospital unexpectedly and the treatment cannot reasonably be postponed until you have returned to your country of residence. If you are to be admitted to a hospital for one or more nights, our Emergency Service (Alarmcentrale) must be notified. You can find the telephone number on your healthcare insurance card and on our website Referral and/or permission requirement A specific referral, prescription and/or authorisation may be required in addition to permission for using care facilities (Article 9.3). Information in this regard can be found in the relevant care article (see also Article 9.1). Policy conditions VGZ Goede Keuze

18 Article 10. Complaints and disputes Our complaints procedure. Submitting complaints to the Complaints Management Department We make every effort to ensure that all matters pertaining to your insurance are properly arranged. Nevertheless, it is possible that you are not entirely satisfied about all aspects. We are open to your complaints and suggestions. You can submit a complaint online via our website. You can also send a letter to the Complaints Management Department at the following address: Afdeling Klachtenmanagement Postbus 1256, 5602 BG Eindhoven. The Complaints Management Department acts on behalf of management. Tips when submitting a complaint: - Provide a description of what happened that is as accurate as possible and specify the source of your dissatisfaction as well as what, in your view, would be the best solution. - Send copies of all relevant documents together with your complaint. Do not send original documents with your complaint, as you may need these yourself at some point in the future. - If you are unwilling or unable to submit your complaint yourself, someone else may do so on your behalf. To protect your privacy, however, we need your written permission before we can address your complaint You will receive a response to your complaint from us within 30 days. If you are unsatisfied with the decision or have not received a response within 30 days, you can submit your complaint or dispute to the Health Insurances Complaints and Disputes Foundation (Stichting Klachten en Geschillen Zorgverzekeringen, SKGZ), Postbus 291, 3700 AG Zeist, You can also submit a dispute to a competent court Complaints about our forms If you consider a form to be superfluous or unnecessarily complicated, You can submit a complaint online via our website. You can also send a letter to the Complaints Management Department at the following address: Afdeling Klachtenmanagement Postbus 1256, 5602 BG Eindhoven You will receive a response to your complaint about our forms within 30 days. If you are unsatisfied with the reply or have not received a response within 30 days, you can submit your complaint to the Dutch Healthcare Authority (Nederlandse Zorgautoriteit) for the attention of the Informatielijn/het Meldpunt, Postbus 3017, 3502 GA Utrecht, informatielijn@nza.nl. For instructions on how to submit a complaint about forms, consult the website of the Dutch Healthcare Authority at 18 General section / Care articles

19 II. Care articles MEDICAL CARE Article 11. General practitioner care You are entitled to the following: 1. Medical care as provided by general practitioners and to laboratory testing associated with such care. This also includes health advice, counselling in relation to a stop-smoking programme, preconception care (fertility consultation) and foot care if you have diabetes mellitus type 1 or 2. Counselling in relation to a stop-smoking programme includes: - short treatments such as non-recurring, brief advisory sessions on stopping; - intensive forms of treatment aimed at effecting a change in behaviour in a group or individual. Preconception care (fertility consultation) includes: - advice about a healthy diet; - advice on the use of folic acid; - advice about vitamin D intake; - advice about stopping smoking, alcohol and drug use, possibly combined with active assistance to achieve objectives in this regard; - advice about the use of medicines; - advice about the treatment of existing diseases and previous pregnancy complications; - advice about infectious diseases and vaccinations; - the identification of risks based on your medical history and genetic counselling if you are not (or not yet) pregnant. Foot care for persons with diabetes mellitus includes: - annual check-ups of the feet consisting of a review of your case history, a risk inventory and the establishment of the Simm s classification; - from care profile 1: advice on adequate shoes, on caring for the feet and on dealing with foot loading; - from care profile 2: more frequent targeted examination, including diagnosis and treatment of skin and nail problems and deviations in the shape and stance of the feet or other risk factors. This foot care does not include care such as removing callouses for purely cosmetic or conditioning purposes and general nail care such as cutting nails. The Simm s classification and care profiles are described in the Prevention of Diabetic Foot Ulcer Care Module. Care profiles provide an insight into the requisite foot care based on a risk classification of patients with diabetes mellitus. The Care Module is available on our website. Your general practitioner can inform you of your care profile. Foot care as part of a care programme If you suffer from diabetes mellitus type 2 and are receiving care via a care programme as specified in Article 12, you are not entitled to foot care as described in this article. 2 Specialist medical care that borders on the general practitioner medical domain and about which we and a general practitioner have concluded agreements. Examples include: - minor surgical treatment; - ECG diagnosis (heart film); - lung function tests (respiratory flow volumes and rates); - Doppler ultrasound tests (to evaluate blood flow through the vessels, arteries and veins); - MRSA screening (screening for Meticilline Resistant Staphylococcus Aureus); - audiometry (hearing tests); - placement and removal of a contraceptive device. Are you 21 years of age or older? If so, you are not entitled to reimbursement for contraceptives; - injection of varicose veins (sclerotherapy); - therapeutic injections. Policy conditions VGZ Goede Keuze

20 Parties authorised to provide the care A general practitioner or medically competent third parties. Under the medical responsibility of a general practitioner, this care may also be provided by a doctor s assistant, nurse, social worker, nurse practitioner (NP), physician assistant (PA) or medical practice assistant (mental healthcare, GGZ). For the foot care referred to in this article, you may consult a podotherapist who is affiliated with the Dutch Association of Podotherapists (Nederlandse Vereniging van Podotherapeuten, NVvP) and listed in the Paramedics Quality Register (Kwaliteitsregister paramedici, KP). Is the podotherapist not the person providing (all of) the foot care? In that case the foot care may be performed by a medical pedicure or a pedicure holding an additional qualification foot care for diabetics (DV) who is listed in the ProCert Chiropodists Quality Register (KwaliteitsRegister voor Pedicures, KRP) if this pedicure works together with the podotherapist. You will find a list of our contracted care providers on our website. You will also find a list of group practices of podotherapists and pedicures on our website. If you are not using the services of one of our contracted care providers, note that you will probably have to pay a portion of the costs yourself. For more information, see Article 1, paragraphs 4 and 6 of these policy conditions. Treatment locations for foot care The foot care may be provided at the treatment location of your care provider or in a hospital, nursing home or care home. If your attending care provider considers this medically necessary, this care can also be provided at home. Please note For entitlement to: 1. foot care as part of the diabetes mellitus type 2 care programme, see Article 12, Care programmes; 2. specialist medical care, see Article 15, Specialist medical care. VGZ Gezondheidslijn If you have a question about your health you can, of course, consult your general practitioner, but you can also call the VGZ Gezondheidslijn. The VGZ Gezondheidslijn is a telephone service where you can speak with an experienced nurse for medical advice. Based on a number of targeted questions, the nurse will determine the seriousness of your complaint and then provide medical advice. The nurse may consult a general practitioner during the conversation if necessary. The advice can vary from self-help ( take two aspirins and lie down ) to see your general practitioner immediately. The VGZ Gezondheidslijn is available 24 hours a day, 7 days a week for health advice. See our website for the telephone number. Your health is our concern. Our website offers a wealth of clear and medically reliable information, tailored to the health and lifestyle of our clients. Article 12. Care programmes (multi-disciplinary care) You are entitled to the following care programmes (multi-disciplinary care): 1. diabetes mellitus type 2 (DM type 2); 2. vascular risk management (VRM; this is the management of cardiovascular diseases and the risks of developing them); 3. COPD (Chronic Obstructive Pulmonary Disease; this is an umbrella term for the lung disorders chronic bronchitis and lung emphysema). All care components of the care programme must meet the diabetes mellitus, COPD or VRM care standards. You will find the care standards on our website. The care programmes are financed in accordance with the Dutch Healthcare Authority Policy Regulations Comprehensive funding of multidisciplinary care for chronic conditions (DM type 2, VRM, COPD). Care programmes (multi-disciplinary care) Our care programmes have been specially developed to better organise region-based care for the chronically ill or disabled in terms of quality and efficiency. The care providers collaborate closely in a care group to ensure that the care you require is better coordinated. The care programme is subject to a comprehensive fee that covers all care provided in the programme. This is why you may only access care offered in the care programme through care providers that are affiliated by a care group contracted by us. 20 Care articles