Univé healthcare insurance 2015

Transcription

1 Healthcare Insurance Reimbursement Overview Healthcare Insurance Reimbursement Overview Univé healthcare 2015 policies Univé Zorg Geregeld polis Univé Zorg Vrij polis Modular policies Univé polis Goed Univé polis Beter Univé polis Best Dental policies Univé Tand Goed Pakket Univé Tand Beter Pakket Univé Tand Best Pakket Total Care Packages Univé Jong Pakket Univé Fit & Vrij Pakket Univé Gezin Pakket Univé Vitaal Pakket

2 Reader s guide All items listed in the overview of s marked with a are covered by your policy. The level of the depends on the care provider you have chosen in combination with your policy. Please note that, in the conditions, the words per year refer to the calendar year. The s referred to are maximum amounts. Additional conditions Additional conditions, such as authorisation requirements, necessary referrals and authorised care providers, are specified in the 2015 If you require care, we recommend that you first consult the policy conditions, These can be found at or requested by telephone on (072) There are three types of basic healthcare to choose from: Univé Zorg Vrij policy The Univé Zorg Vrij policy is a non-contracted care policy. This policy gives you freedom of choice with respect to care providers. It does not matter whether the care provider you choose has agreements with Univé or not. The only requirement is that the care provider satisfies the requirements set out in our Univé Zorg Geregeld policy The Univé Zorg Geregeld policy offers complete freedom in your choice of contracted healthcare providers, making it easier to find one nearby. For a number of hospital treatments that can be scheduled in advance we have selected several healthcare providers. If you do not engage one of our contracted care providers, you may have to pay a portion of the costs yourself. Univé Zorg Select policy The Univé Zorg Select policy offers a more restricted choice of contracted care providers. Again, a number of hospital treatments that can be scheduled in advance we have selected several healthcare providers. You may have to travel somewhat further from your home to reach therm, but rarely further than 50 km. If you do not engage one of our contracted healthcare providers, you will have to be a larger portion of the costs yourself. This s overview concerns the Univé Zorg Vrij policy, Univé Zorg Geregeld policy and the associated supplementary policies. For more inmation about the Univé Zorg Select policy, consult the separate overview. Finding a good care provider easily The Univé website clearly illustrates the differences in the quality of care available to you and indicates the care providers with whom we have concluded a contract. A very handy tool! Because opting contracted care guarantees good-quality care at the best levels of. Find a good care provider easily via Excess and /maximum If you are aged 18 or older, a compulsory excess of 375 per calendar year applies to your basic. You can voluntarily increase your excess to 475, 575, 675, 775 or 875. If you do, you will be entitled to a discount on your premium. The excess does not apply to expenses incurred visits to, example, a general practitioner, obstetric care, maternity care, nursing and care, and preferred medications designated by us. If a particular type of care is subject to a and/or maximum, this will be indicated in the description. For more inmation, read the Supplementary policies We will reimburse the costs of care up to a maximum of the statutory rates current in the Netherlands. If no statutory rates apply, the costs will be reimbursed up to a maximum of the reasonable market price current in the Netherlands. If you are using the services of one of our contracted care providers, the costs of care are reimbursed based on the rate agreed with the care provider concerned. Your supplementary may refer to designated, accredited or contracted care. This is indicated in the overview. If you are using the services of non-contracted, non-accredited or non-designated care providers, note that you will have to pay a portion of the costs, or all of the costs, yourself. For more inmation, read the Budgets Univé has grouped the various treatments available to you, which allows you to see at a glance which care is reimbursed by Univé. There is a maximum each treatment group. We refer to this as a budget. You decide yourself which treatment you spend your budget on. This allows you to make the best possible use of your amount. Budgets are available (among other things) prevention, movementrelated care, foot treatments and care aids. You can find these budgets in the Reimbursement Overview and the Care credit the Univé Fit & Vrij Package An annual care credit of 1,000 applies to the Univé Fit & Vrij Package. This 1,000 care credit can be spent on care listed under the Fit & Vrij column. 2

3 A maximum amount within this 1,000 care credit is allocated to glasses/lenses (max. 150) and dental/oral care (max. 450). The maximum amount of 450 also applies to orthodontic care. Additionally, a maximum amount per day applies to a small number of s. These amounts are listed in the s overview. Submitting claims Submitting your claims online is easy using nl. Would you rather submit your claims by post? Complete a claim m and send it to us, together with the invoice. We will process your claim within ten working days. For more inmation, we refer to the policy conditions and our website. Explanation of icons used Univé aims to make it as easy as possible you to compare the available s. Icons have theree been placed next to all budgets and important s. The egoing is subject to changes in legislation. Step 1: Choose your basic (statutory obligation) Univé Zorg Geregeld policy Contracted healthcare lower premium Contracted care: full 1) Non-contracted care: 80%2) of the average contracted rates, specialist mental healthcare 75% 2) of the average contracted rates. Univé Zorg Vrij policy Non-contracted healthcare free choice of care provider Contracted care: full 1) Non-contracted care provider: statutory or (usual) Dutch market rates. 1) Note that the costs may come under your excess and that you may have to pay a or that a maximum may apply. 2) The maximum rates can be found in the List of Maximum Reimbursements Non-Contracted Care Providers on our website. Step 2: Choose your supplementary Option 1: Modular (not including dental ) Goed Beter Best Option 2: Supplementary dental (can be taken out separately or in combination with a modular supplementary policy) Goed Beter Best Option 3: Totaalpakket Zorg (including dental care) Jong Fit & Vrij Gezin Vitaal Coverage the costs of the most essential ms of care, including medical costs abroad, vaccinations and physiotherapy Larger budgets e.g. physiotherapy and prevention as well as coverage delivery, post-natal care Largest budgets plus coverage eye laser treatments and certain plastic surgery treatments such as eyelid corrections and abdominal wall surgery 80% up to 250 per year 80% up to 500 per year, orthodontic treatment once-only up to the age of 18 1,500 and from the age of % up to 1,000, orthodontic treatment once-only up to the age of 18 2,500 and from the age of 18 1,500 Only pay the care you really need. Complete freedom to choose how you spend your care credit. The best care your family. Enjoyment without a worry, sensibly insured. 3

4 Supplementary policies Modular Healthcare Insurance Reimbursement Overview polis Goed polis Beter polis Best Alternative care A budget to spend on the care types specified below: - treatments and consultations, psychosocial care from age 18 (by a preferred care provider) - homeopathic and/or anthroposophic medicines Contraceptives such as the contraceptive pill, birth control implant (Implanon rod), intrauterine contraceptive device (coil), ring or diaphragm up to age 21. This also applies to insured persons from age 21 using contraceptives to treat endometriosis or menorrhagia ( anaemia) such as the contraceptive pill, birth control implant (Implanon rod), intrauterine contraceptive device (coil), ring or diaphragm from age 21 Audiological care Examination of auditory function, hearing aid advice Circumcision Medically necessary circumcision (subject to prior permission1) Delivery and maternity care Delivery Home delivery the costs of a delivery without medical grounds inpatient care at one of our contracted birth centres delivery and/or maternity care without medical grounds in a hospital Delivery at a hospital or one of our contracted maternity centres with medical necessity Maternity care (a payable some contraceptives) 202 per day ( 235 minus 33 the maternity care) Maternity care at home or in a contracted birth centre up to 10 days (a of 4.15 per hour applies) Maternity care at a hospital after a delivery with medical necessity After-care of mother and newly born 300 per year. The treatments and consultations is capped at 45 a day full amount (a payable some contraceptives) Contracted care provider: full amount Non-contracted care provider: per year. The treatments and consultations is capped at 45 a day full amount (a payable some contraceptives) Contracted care provider: full amount Non-contracted care provider: 600 full amount 125 of the 6 hours divided over 2 days 800 per year. The treatments and consultations is capped at 45 a day full amount (a payable some contraceptives) Contracted care provider: full amount Non-contracted care provider: 600 full amount full of the 12 hours divided over 4 days Univé maternity full amount full amount Breast feeding Breast-feeding advice (lactation consultation) 50 per delivery 75 per delivery Rent of an electrical breast pump in the event of the admission of an ill baby 110 per delivery 110 per delivery All items listed in the overview of s marked with a are covered by your policy. The level of the depends on the care provider you have chosen in combination with your policy. You can find more inmation in the Reader s Guide. 4

5 Univé Modular policies Supplementary policies Modular Healthcare Insurance Reimbursement Overview polis Goed polis Beter polis Best Movement-related care (e.g. physiotherapy) A budget to spend on the care types specified below physiotherapy, oedema therapy and Cesar/Mensendieck remedial therapy chronic disorders, under age 18 (subject to prior permission1) chronic disorders, from age 18 as from the 21st treatment (subject to prior permission1) non-chronic disorders, under age treatment sessions per year non-chronic disorders, from age 18 pelvic physiotherapy to treat urine incontinence, from age 18 the first 9 treatment sessions occupational therapy 10 hours per year alternative movement-related therapy, such as chiropractic therapy and osteopathy (by a designated care provider) Glasses, contact lenses, laser eye treatments or lens implants Contact lenses and/or glasses lenses of the appropriate corrective strength with frames where applicable Laser eye treatment/lens implant Care abroad Urgent care while on holiday or during a temporary stay abroad Non-urgent care while abroad (subject to prior permission2) based on market rates in the Netherlands based on the market rates in the Netherlands 200 per year; non-contracted physiotherapists, remedial therapists and occupational therapists the maximum equals 80% of the average contracted rates. The maximum rate can be found in the 'List of Maximum Reimbursements Non-Contracted Care Providers. The alternative movement-related therapies is capped at 45 a day. 400 per year; non-contracted physiotherapists, remedial therapists and occupational therapists the maximum equals 80% of the average contracted rates. The maximum rate can be found in the 'List of Maximum Reimbursements Non-Contracted Care Providers. The alternative movement-related therapies is capped at 45 a day. 600 per year; non-contracted physiotherapists, remedial therapists and occupational therapists the maximum equals 80% of the average contracted rates. The maximum rate can be found in the 'List of Maximum Reimbursements Non-Contracted Care Providers. The alternative movement-related therapies is capped at 45 a day. 100 every 3 years 150 every 3 years 500 (once only during term of ) full amount full amount full amount Repatriation by Univé Alarmcentrale (Alarm Centre) full amount full amount full amount Dietary advice The provision of inmation about diet and eating habits a medical purpose 3 hours per year 250 per year; non-contracted care providers the maximum equals 80% of the average contracted rates. The maximum rate can be found in the 'List of Maximum Reimbursements Non- Contracted Care Providers. Genetic testing Tests to establish and determine the extent of genetic disorders Pharmaceutical care (medicines) Medicines listed in Appendix 1 to the Healthcare Insurance Regulations and the Pharmaceutical Care Regulations (subject to prior permission2) Diet preparations (subject to permission 1) (Pharmaceutical Care Regulations apply to liquid nutrients) (a payable some medicines) All items listed in the overview of s marked with a are covered by your policy. The level of the depends on the care provider you have chosen in combination with your policy. You can find more inmation in the Reader s Guide. 5

6 Supplementary policies Modular Healthcare Insurance Reimbursement Overview polis Goed polis Beter polis Best Skin treatments A budget to spend on the care types specified below (provided by designated care providers): - acne treatment - camouflage therapy - hair removal General practitioner care This also includes counselling in relation to stopping smoking and foot care in the case of diabetes mellitus (annual foot check and advice and diabetic foot treatments from care profile 2 and higher) Care aids Care and bandaging aids in accordance with the Healthcare Insurance Regulations and the Pharmaceutical Care Aids Regulations (subject to prior permission2) A budget to spend on statutory s/ payments or the care aids specified below (and associated extras): - audiological care aids - breast prosthesis, items used following mastectomy - wigs or head scarves - support pessary; - hand or finger splint temporary use (from a contracted care provider) In vitro fertilisation (IVF) and other fertility treatments In vitro fertilisation (IVF) women up to age 43. Additional conditions apply. Other fertility treatments(women up to 43 years of age) Multi-disciplinary care Multi-disciplinary care diabetes mellitus type 2, COPD and cardiovascular risk management ( care programmes ) Speech therapy Treatment or improvement of speech or ability to speak Inmal care Inmal care broker (after referral by Univé Care Advice and Mediation and provided by a contracted care provider) (a and/or a maximum apply to some care aids) first, second and third attempts 300 per year 500 per year 700 per year 250 per year a maximum of 2 hand or finger splints per year 500 per year a maximum of 2 hand or finger splints per year 250 per year 500 per year 750 per year Substitute inmal care (by a contracted care provider): 4 days a year 9 days a year 14 days a year Specialist medical care This also includes care provided by a thrombosis service, a second opinion and dialysis (subject to prior permission2) Plastic and/or reconstructive surgery On specific medical grounds (subject to prior permission 1) Abdominal wall surgery (subject to prior permission 1) specific 2,500 indications Eyelid corrections (subject to prior permission 1) specific indications 950 All items listed in the overview of s marked with a are covered by your policy. The level of the depends on the care provider you have chosen in combination with your policy. You can find more inmation in the Reader s Guide. 6

7 Univé Modular policies Supplementary policies Modular Healthcare Insurance Reimbursement Overview polis Goed polis Beter polis Best Prevention A budget to spend on the care types specified below: Healthy lifestyle - training courses (e.g. coping with illnesses or disorders) - first-aid course - reanimation course - lifestyle Check (by a contracted care provider) - weight consultant Advice and assistance - sports medical advice - menopause care Vaccinations - Preventative vaccinations and medicines in connection with a holiday Psychological care Mental healthcare from age 18 - General basic mental healthcare (GGZ) - Specialist mental healthcare (GGZ) Sexological care 200 per year 400 per year 500 per year 60 per session max. 4 sessions per year Mindfulness following symptoms of burnout 350 per year 350 per year 350 per year Rehabilitation This also includes a quick scan and oncological rehabilitation Geriatric rehabilitation (up to max. of 6 months) Herstel en Balans (Recovery and Balance) rehabilitation programme Redression helmet Redression helmet treatment children up to the age of 14 months specific indications Sterilisation 800 per diagnosis 800 per diagnosis 1,000 per diagnosis full amount full amount Sterilisation of a man Sterilisation of a woman 1,250 1,250 Stopping smoking Stop-smoking programme once a year Dental care/oral care Dental and orthodontic care in special cases Dental care (including implants and technician s costs, if applicable) and orthodontic care specific indications (subject to prior permission1) Dental care children under age 18 Dental care with the exception of crowns, bridges and orthodontic care Crowns, bridges and implants (including technician s costs) (subject to prior permission1) (a may apply) if to replace one or more permanent incisors or canines that have not developed or are missing due to an accident All items listed in the overview of s marked with a are covered by your policy. The level of the depends on the care provider you have chosen in combination with your policy. You can find more inmation in the Reader s Guide. 7

8 Supplementary policies Modular Healthcare Insurance Reimbursement Overview polis Goed polis Beter polis Best Dental care from age 18 Crowns (with implants, if medically necessary) and bridges required as the direct consequence of an accident (subject to prior permission1) Dental surgery from age 18 Dental surgery by a dental surgeon with the exclusion of fitting implants, treatment of gums and simple extractions Dental prostheses (dentures) from age 18 Removable full dentures (including technician s costs) (subject to prior permission 2) Removable dentures on implants (including technician s costs) seriously shrunken, toothless jaws (subject to prior permission1) Tissue and organ transplants If the transplant is carried out in an EU or EEA Member State Inpatient care Convalescent home/care hotel (at a contracted care provider) (a of 25% applies) (a of 125 per jaw applies) 100 per day, max. 1,000 per year full amount persons from age 18 to 22 full of the full of the 100 per day, max. 1,500 per year full amount persons from age 18 to 22 full of the full of the 100 per day, max. 2,000 per year Hospice (at an accredited care provider) 30 per day 30 per day 30 per day Hospital (psychiatric or otherwise), mental healthcare or rehabilitation facility (subject to prior permission 2) Ronald McDonald House/family house 300 per year 400 per year 600 per year Nursing and care Nursing and care without inpatient care (possibly in the m of a budget) Transport Ambulance transport Seated patient transport on specific medical grounds (subject to prior permission1), by: private car 0.31 per km (a of 97 per year applies) public transport or taxi transport (a of 97 applies) taxi (by contracted transport company) or private transport in connection with an organ transplant Foot treatments A budget to spend on the care types specified below: - foot care a rheumatoid and diabetic foot (with care profile 1) (also see general practitioner care and multi-disciplinary care) - podotherapy - arch supports Care persons with a sensory disability Care persons with a sensory disability taxi: full amount, private car: 0.31 per km taxi: full amount, private car: 0.31 per km taxi: full amount, private car: 0.31 per km 100 per year 300 per year 500 per year All items listed in the overview of s marked with a are covered by your policy. The level of the depends on the care provider you have chosen in combination with your policy. You can find more inmation in the Reader s Guide. 8

9 Univé Dental care Overview of dental s according to type of dental Supplementary policies Dental Tand Goed Tand Beter Tand Best Dental care from age 18 Dental care, with the exception of orthodontic care and general anaesthesia (including material costs and the cost of a dental technician) Orthodontic care Under age 18 80%, up to a maximum of 250 per year 80%, up to a maximum of 500 per year 80%, up to a maximum of 1,000 per year 1,500 the entire term of the 500 the entire term of the 2,500 the entire term of the 1,500 the entire term of the From age 18 Useful everyone Univé s extras At Univé, you enjoy the benefits of good health. We also offer many convenient extras, such as an online pharmacy. Univé Health Line If you have a question about your health or would like to obtain reliable medical advice, you can call the nurses of the Univé Gezondheidslijn (Univé Health Line). They can be contacted 24 hours a day on Univé Holiday Doctor If you become ill abroad, you can obtain medical advice from the Univé Vakantiedokter (Univé Holiday Doctor). We also help you to find a doctor or hospital close to your holiday address. De Univé Holiday Doctor is available night and day on Univé Emergency Service If you become ill abroad and require a stay of at least one night in a hospital, you are obliged to contact staff of the Univé Alarmcentrale (Univé Emergency Service). They will then inm you of what needs to be arranged and will also determine which expenses are or are not insured. De Univé Emergency Service is available night and day on Univé Apotheek (Pharmacy) The Internet Apotheek (Online Pharmacy) means you no longer need to go out to get your medicines, as you can simply order them from the comt of your home. If you would like to make use of our online pharmacy, go to Univé Maternity Care To apply maternity care and/or a maternity care, simply call the central number of Univé Maternity Care: (free). Finding your way around healthcare Healthcare is provided through a wide range of channels, including municipal agencies, your healthcare insurer and your health office. If you are uncertain about where to turn when you need care, Univé Care Advice and Mediation will be happy to help you, free of charge. They can be reached on Care adviser Where should I go exploratory surgery on my knee? And a second opinion? Where can I get a customised wheelchair? The Univé Care Adviser of the Care Advice and Mediation Department will be happy to answer these and many other questions relating to care. Care and waiting list mediation If you need to wait care a long time, our Care are Advice and Mediation Department will assist you in finding another care provider. We will also find you a new general practitioner or dentist if you move house. Inmal care broker Ordinary to you, special to us A society in which people support each other and are free to make their own choices that s what we at Univé believe in. And that s just why Univé considers inmal carers so important. These are the people who are unreservedly ready to lend a helping hand to those near and dear to them. There are over 4 million inmal carers in the Netherlands today, and this number is growing fast as a result of the ageing population and changes in government policy. New policies are being introduced to enable people to continue living in their own homes as long as possible. Univé s supplementary policies theree include a number of s specifically the inmal carers. Visit further inmation or call the Care Advice and Mediation Department to engage an inmal care broker. 9

10 Healthcare Insurance Reimbursement Overview Insurance Supplementary Insurance (Health and Dental) Total Care Packages Jong Fit & Vrij Gezin Vitaal Alternative care A budget to spend on the care types specified below: - treatments and consultations, psycho-social care from age 18 (provided by designated care provider) - homeopathic and/or anthroposophic medicines Contraceptives such as the contraceptive pill, birth control implant (Implanon rod), intrauterine contraceptive device (coil), ring or diaphragm up to age 21. This also applies to insured persons from age 21 using contraceptives to treat endometriosis or menorrhagia ( anaemia) such as the contraceptive pill, birth control implant (Implanon rod), intrauterine contraceptive device (coil), ring or diaphragm from age 21 Audiological care Examination of auditory function, hearing aid advice Circumcision Medically necessary circumcision (subject to prior permission1) Delivery and maternity care Delivery Home delivery the costs of a delivery without medical grounds inpatient care at one of our contracted birth centres delivery and maternity care without medical grounds in a hospital Delivery at a hospital or one of our contracted maternity centres with medical necessity Maternity care Maternity care at home or in a contracted birth centre Maternity care at a hospital after a delivery with medical necessity Deluxe maternity care Adoption (a payable some contraceptives) 202 per day ( 235 minus 33 the to maternity care) up to 10 days (a of 4.15 per hour applies) 200 per year. The treatments and consultations is capped at 45 a day full amount (a payable some contraceptives) Contracted care provider: full amount Non-contracted care provider: 600 The treatments and consultations is capped at 45 a day full amount (a payable some contraceptives) Contracted care provider: full amount Non-contracted care provider: per year. The treatments and consultations is capped at 45 a day full amount (a payable some contraceptives) Contracted care provider: full amount Non-contracted care provider: 600 full amount full of the 15 hours 300 per adopted child Univé maternity full amount Breast feeding Breast-feeding advice (lactation consultation) 100 per delivery Rent of an electrical breast pump in the event of 110 per delivery the admission of an ill baby 300 per year. The treatments and consultations is capped at 45 a day Contracted care provider: full amount Non-contracted care provider: 600 All items listed in the overview of s marked with a are covered by your policy. The level of the depends on the care provider you have chosen in combination with your policy. You can find more inmation in the Reader s Guide. 10

11 Univé Total Care Packages Supplementary Insurance (Health and Dental) Total Care Packages Healthcare Insurance Reimbursement Overview Insurance Jong Fit & Vrij Gezin Vitaal Movement-related care (e.g. physiotherapy) A budget to spend on the care types specified below: physiotherapy, oedema therapy and Cesar/ Mensendieck remedial therapy chronic disorders, under age 18 (subject to prior permission1) chronic disorders, from age 18 vas from the 21st treatment (subject to prior permission1) non-chronic disorders, under age treatment sessions per year non-chronic disorders, from age 18 pelvic physiotherapy to treat urine incontinence, from age 18 the first 9 treatment sessions occupational therapy 10 hours per year aalternative movement-related therapy, such as chiropractic therapy and osteopathy (by a designated care provider) Glasses, contact lenses, laser eye treatments or lens implants Contact lenses and/or glasses lenses of the appropriate corrective strength with frames where applicable Eye laser treatment / lens implant Care abroad Urgent care while on holiday or during a temporary stay abroad Non-urgent care while abroad (subject to prior permission2) based on market rates in the Netherlands based on market rates in the Netherlands 600 per year; non-contracted physiotherapists, remedial therapists and occupational therapists the maximum equals 80% of the average contracted rates. The maximum can be found in the List of Maximum Reimbursements Non-Contracted Care Providers. The alternative movementrelated therapies is capped at 45 a day. 150 every 3 years Part of the ; non-contacted physiotherapists, remedial therapists and occupational therapists the maximum equals 80% of the average contracted rates. The maximum can be found in the List of Maximum Reimbursements Non-Contracted Care Providers. The alternative movementrelated therapies is capped at 45 a day., maximum 150 every 3 years onderdeel pakket 600 per year; non-contracted physiotherapists, remedial therapists and occupational therapists the maximum equals 80% of the average contracted rates. The maximum can be found in the List of Maximum Reimbursements Non-Contracted Care Providers. The alternative movementrelated therapies is capped at 45 a day. 150 every three years ( 200 every three years children under age 18) 1,000 per year; noncontracted physiotherapists, remedial therapists and occupational therapists the maximum equals 80% of the average contracted rates. The maximum can be found in the List of Maximum Reimbursements Non-Contracted Care Providers. The alternative movementrelated therapies is capped at 45 a day. 150 every 3 years full amount full amount full amount full amount Repatriation by Univé Alarmcentrale (Alarm Centre) full amount full amount full amount full amount Dietary advice The provision of inmation about diet and eating habits a medical purpose Genetic testing Tests to establish and determine the extent of genetic disorders 3 hours per year 250 per year; non-contracted care providers the maximum equals 80% of the average contracted rates. The maximum can be found in the List of Maximum Reimbursements Non-Contracted Care Providers. All items listed in the overview of s marked with a are covered by your policy. The level of the depends on the care provider you have chosen in combination with your policy. You can find more inmation in the Reader s Guide. 11

12 Healthcare Insurance Reimbursement Overview Insurance Supplementary Insurance (Health and Dental) Total Care Packages Jong Fit & Vrij Gezin Vitaal Pharmaceutical care (medicines) Medicines listed in Appendix 1 to the Healthcare Insurance Regulations and the Pharmaceutical Care Regulations (subject to prior permission2) (a payable some medicines) Diet preparations (subject to permission1) (Pharmaceutical Care Regulations apply to liquid nutrients) Skin treatments A budget to spend on the care types specified below (provided by designated care providers): - acne treatment - camouflage therapy - hair removal General practitioner care This also includes counselling in relation to stopping smoking and foot care in the case of diabetes mellitus (annual foot check and advice and diabetic foot treatments from care profile 2 and higher) Domestic help Domestic help in the event of sickness, accidents or hospital admission (via Univé Care Advice and Mediation (Zorgadvies en bemiddeling) from a contracted care provider) Care aids Care and bandaging aids in accordance with the Healthcare Insurance Regulations and the Pharmaceutical Care Aids Regulations (subject to prior permission2) 300 per year 500 per year 500 per year 10 hours per year (a and/ or a maximum apply to some care aids) A budget to spend on statutory s/ payments or the care aids specified below (and associated extras): - audiological care aids - breast prosthesis, items used following mastectomy - wigs or head scarves - support pessary; - pad and buzzer children aged 6 to 18 (by contracted care provider) - hand or finger splint temporary use (from a contracted care provider) allocated budget a maximum of 2 hand or finger splints per year 250 per year a maximum of 2 hand or finger splints per year 350 per year a maximum of 2 hand or finger splints per yearr In vitro fertilisation (IVF) and other fertility treatments In vitro fertilisation (IVF) women up to age 43. Additional conditions apply. Other fertility treatments (women up to 43 years of age) Multi-disciplinary care Multi-disciplinary care diabetes mellitus type 2, COPD and cardiovascular risk management ( care programmes ) Child care For children up to and including age 12 (through Univé Care Advice and Mediation by a contracted care provider) Speech therapy Treatment or improvement of speech or ability to speak first, second and third attempts 24 hours per year All items listed in the overview of s marked with a are covered by your policy. The level of the depends on the care provider you have chosen in combination with your policy. You can find more inmation in the Reader s Guide. 12

13 Univé Total Care Packages Supplementary Insurance (Health and Dental) Total Care Packages Healthcare Insurance Reimbursement Overview Insurance Jong Fit & Vrij Gezin Vitaal Inmal care Inmal care broker (after referral by Univé Care Advice and Mediation and provided by a contracted care provider) Substitute inmal care (by a contracted care provider): Specialist medical care This also includes care provided by a thrombosis service, a second opinion and dialysis (subject to prior permission2) Plastic and/or reconstructive surgery For specific indications (subject to prior permission1) Abdominal wall surgery (subject to prior permission1) Eyelid corrections (subject to prior permission1) Protruding ear correction insured persons under age 18 Prevention A budget to spend on the care types specified below: - Healthy lifestyle - training courses (e.g. coping with illnesses or disorders) - first-aid course - reanimation course - lifestyle Check (by a contracted care provider) - weight consultant Advice and assistance - Sports medical advice - Menopause care Examination - Medical examination driving licences B or BE Vaccinations - Flu vaccination - Preventative vaccinations and medicines in connection with a holiday Psychological care Mental healthcare from age 18 - General basic mental healthcare (GGZ) - Specialist mental healthcare (GGZ) Sexological care specific indications specific indications 200 per year 60 per session max. 4 sessions per year 60 per session max. 4 sessions per year Mindfulness following symptoms of burnout 350 per year Rehabilitation This also includes a quick scan and oncological rehabilitation Geriatric rehabilitation ( a max. of 6 months) Herstel en Balans (Recovery and Balance) rehabilitation programme Redression helmet Redression helmet treatment children up to the age of 14 months specific indications 800 per diagnosis 500 per year 750 per year 9 days a year 9 days a year Contracted care provider: full amount Noncontracted care: 1, per year 60 per session max. 4 sessions per year per year 60 per session max. 4 sessions per year 350 per year 350 per year 800 per diagnosis 800 per diagnosis full amount All items listed in the overview of s marked with a are covered by your policy. The level of the depends on the care provider you have chosen in combination with your policy. You can find more inmation in the Reader s Guide. 13

14 Healthcare Insurance Reimbursement Overview Insurance Supplementary Insurance (Health and Dental) Total Care Packages Jong Fit & Vrij Gezin Vitaal Sterilisation Sterilisation of a man 800 Sterilisation of a man 1,250 Stopping smoking Stop-smoking programme Dental care/oral care Dental and orthodontic care in special cases Dental care (including implants and technician s costs, if applicable) and orthodontic care specific indications (subject to prior permission1) Dental care children under age 18 Dental care with the exception of crowns, bridges and orthodontic care Crowns, bridges and implants (including technician s costs) (subject to prior permission1) once a year (a may apply) if to replace one or more permanent incisors or canines that have not developed or are missing due to an accident Dental care from age 18 Dental care, with the exception of orthodontic care and general anaesthesia (including material costs and the cost of a dental technician) 80%, up to a maximum of 450 per year, maximum 80% up to a maximum of 450 per year, part of the maximum Dental Care and/ or Oral Care 80%, up to a maximum of 450 per year 80%, up to a maximum of 450 per year Crowns (with implants, if medically necessary) and bridges required as the direct consequence of an accident (subject to prior permission1) Dental surgery from age 18 Dental surgery by a dental surgeon with the exclusion of fitting implants, treatment of gums and simple extractions Dental prostheses (dentures) from age 18 Removable full dentures (including technician s costs) (subject to prior permission2) full amount full amount persons from age 18 to 22 (a of 25% applies) Reimbursement of the, part of the maximum dental care insured persons from age 18 Reimbursement of the, part of the maximum dental care insured persons from age 18 full of the full of the uitneembaar kunstgebit op implantaten, inclusief techniekkosten bij een zeer ernstig geslonken tandeloze kaak (na toestemming1) (a of 125 per jaw applies) full of the full of the All items listed in the overview of s marked with a are covered by your policy. The level of the depends on the care provider you have chosen in combination with your policy. You can find more inmation in the Reader s Guide. 14

15 Univé Total Care Packages Supplementary Insurance (Health and Dental) Total Care Packages Healthcare Insurance Reimbursement Overview Insurance Jong Fit & Vrij Gezin Vitaal Orthodontic care Under age 18 From age 18 Tissue and organ transplants If the transplant is carried out in an EU or EEA Member State Univé VrijZeker Prevention of sexually transmitted diseases (at contracted care provider) Condoms (to be ordered via Inpatient care Convalescent home/care hotel (at a contracted care provider) 350 the entire term of the once a year 20 per year maximum dental care, max. of 100 per day 80%, up to a maximum of 2,500 the entire term of the 350 the entire term of the 100 per day, max. 1,000 per year 100 per day, max. 1,000 per year Hospice (at an accredited care provider) 30 per day 30 per day 30 per day, max. of 30 per day Hospital (psychiatric or otherwise), mental healthcare or rehabilitation facility (subject to prior permission2) Ronald McDonald House/family house 400 per year 400 per year Nursing and care Nursing and care without inpatient care (possibly in the m of a budget) Transport Ambulance transport Seated patient transport specific indications (subject to prior permission 1), by: private car 0.31 per km (a of 97 per year applies) public transport or taxi (a of 97 applies)) taxi (by contracted transport company) or private transport in connection with an organ transplant Foot treatments A budget to spend on the care types specified below: - foot care a rheumatoid and diabetic foot (with care profile 1) (also see general practitioner care and multi-disciplinary care) - podotherapy - arch supports Care persons with a sensory disability Care persons with a sensory disability taxi: full amount, private car: 0.31 per km, taxi: up to a maximum of the budget, private car: 0.31 per km taxi: full amount, private car: 0.31 per km taxi: full amount, private car: 0.31 per km 300 per year 300 per year All items listed in the overview of s marked with a are covered by your policy. The level of the depends on the care provider you have chosen in combination with your policy. You can find more inmation in the Reader s Guide. 15

16 Healthcare Insurance Reimbursement Overview For further inmation Our website Our telephone number Customer Service: (free) Available: Mondays to Fridays from 08:00 till 20:00 Saturdays from 09:00 till 13:00 hours Our office If you prefer to speak to us in person, you are welcome to visit us at the Univé office near you. For an overview of Univé offices, check Our postal address Univé Postbus AK Eindhoven The Netherlands Our complaints procedure Do you have any complaints regarding your healthcare? Please visit where you will find an explanation of our complaints procedure. D N.V. Univé Zorg (Univé), with registered offices in Arnhem, CoC number: , DNB licence number: