IAK Unique Health Care Insurance 2014

Transcription

1 IAK Unique Health Care Insurance 2014 Group insurance Maximum discount As a construction worker, I need lots of physiotherapy MIN MAX

2 Survey of reimbursements IAK Unique suits your needs 3 Put together your own IAK Unique Health Care Insurance 4 IAK: promoting digital innovation 5 IAK Zorg app 5 Mijn IAK 5 IAK Zorgvergelijker (Care Comparer) 5 Being aware of your health care costs 5 IAK Unique supplementary health care packages 6 IAK supplementary insurance packages 7 Reimbursements Medical care 8 Psychological care 10 Paramedical care 10 Oral care 10 Oral care / orthodontic treatment 10 Pharmaceutical care 12 Medical aids 12 Stay in an institution 12 Childbirth and maternity care 14 Patient transport 14 Care mediation 14 Abroad 16 Alternative care 16 Group therapy 16 Skin therapy 16 Health resorts etc. 16 Preventive care 18 Other 18 Dental care insurance 18 Hospital Plus 19 IAK Unique suits your needs You are unique. That s why your health care insurance should suit your unique needs. With IAK Unique, you can tailor your insurance to fit your phase of life, wishes and needs perfectly. Choose from the various packages available, select the level of certain reimbursements and make use of the many extras, such as the IAK Health Care app and Mijn IAK. Put together your own insurance package With IAK you can put together your own supplementary insurance package and opt for the reimbursements that best suit your particular needs. For example, you may wish to upgrade certain reimbursements to a maximum amount, and switch off others altogether. If you are planning an addition to your family or are approaching old age, you may be interested in switching on the Childbirth care or the Senior care topping. More information Go straight to to find out for yourself what IAK Unique can mean for you. I can decide for myself which reimbursements are included under my health care insurance. 2 The content of this brochure has been prepared with the greatest possible care and is provided for your information. However, no rights (including rights to reimbursement) may be derived from the content of this brochure. Always log on to (Dutch only) and consult the insurance terms and conditions for precise, up-to-date details of the reimbursements. Alternatively, contact Customer Service. 3

3 Put together your own IAK Unique Health Care Insurance. IAK: promoting digital innovation Of course you can also opt for one of the special packages created for specific target groups, such as Jong (for young people) or Comfort (for senior citizens). For more information, go to (Dutch only) and look under the header Aanvullende verzekeringen. OptiekPlan ON Alternatieve zorg 400,- 250,- 100,- Fysio 400,- 300,- 200,- Seniorzorg ON Geboortezorg ON Orthodontie <18 90% up to 2.000,- 90% up to 1.750,- 80% up to 1.250,- OptiekPlan ON OptiekPlan ON(required) Alternatieve zorg Alternatieve zorg 650,- 550,- 400,- 850,- 750,- 650,- Fysio 700,- 550,- 400,- Fysio 1.000,- 850,- 700,- 3 Then select your toppings Compact Compleet Extra Compleet Use the IAK Health Care app for convenience and speed Using the IAK Health Care app makes submitting your health care claims easy. As well as the time you save, there are many more advantages! For more information, go to (Dutch only). Mijn IAK Arrange all your health care insurance affairs online via your Mijn IAK personal account - from applying for your policy and amending it to submitting claims and keeping a precise record of all your important health care-related correspondence in your personal online file. For more information, go to (Dutch only). IAK Zorgvergelijker (Care Comparer) The updated IAK Zorgvergelijker provides an objective comparison between the terms and conditions and reimbursements offered by the various health care insurers. It makes it easy for you to pick out the health care insurance that best suits your particular needs. You can access the IAK Zorgvergelijker by logging on to (Dutch only). Being aware of your health care costs Health care costs in the Netherlands are soaring. You, as the insured person, need to be aware of what your medical treatment has actually cost. That s why IAK always informs you of the health care costs incurred by you and your family. Each insured person receives a digital overview of expenses twice per year. This overview lists all the claims submitted by you/on your behalf and paid out by IAK. For more information, go to (Dutch only). 2 And choose your supplementary health care package Health Care Insurance 1 Start with the basic insurance 4 This table simply shows which reimbursements are included under a supplementary health care package. We refer you to the policy terms and conditions for a more detailed overview that also states the precise reimbursement levels. 5

4 IAK Unique supplementary health care packages Compact for singles and couples Jong for young people and students aged < 27 Main reimbursements: individual contribution to costs of medicines max generous reimbursement of the costs of emergency care abroad Toppings: With IAK Unique, you set the level of the following reimbursements: Physiotherapy Alternative care OptiekPlan (optional) based on per year, for 3 years Main reimbursements: physiotherapy max alternative care and medicines max glasses and contact lenses max every 3 years vaccinations relating to foreign travel max optional:dental expenses max Compleet for families Comfort for people aged > 55 Main reimbursements: individual contribution to costs of medicines 100% generous reimbursement of the costs of maternity care Toppings: With IAK Unique, you set the level of the following reimbursements: Physiotherapy Alternative care OptiekPlan (optional) based on per year, for 3 years Orthodontic treatment for children < 18 80% up to 1, % up to 1, % up to 2, You can also opt for the toppings Seniorzorg (senior care) or Geboortezorg (childbirth care). Main reimbursements: physiotherapy max. 1, alternative care max individual contribution to costs of medicines 100% glasses and contact lenses max every 3 years convalescent homes and health resorts max. 1, every 3 years hearing aids max extra on top of basic insurance wigs max extra on top of basic insurance budget for preventive care Extra Compleet for families wanting extra security Main reimbursements: individual contribution to costs of medicines 100% generous reimbursement of the costs of maternity care orthodontic treatment for children up to age % orthodontic treatment from 18 years upwards 1, once only Toppings: With IAK Unique, you set the level of the following reimbursements: Physiotherapy , Alternative care OptiekPlan (mandatory) based on per year, for 3 years IAK supplementary insurance packages IAK Dental Care insurance If you opt for IAK Dental Care insurance, you qualify for 100% reimbursement of the costs of preventive treatments (including consultations, oral hygiene appointments and fillings). A reimbursement of 80% applies to all other treatments, up to an annual maximum of , or 1, IAK Home Help insurance If you opt for IAK Home Help insurance, you qualify for a reimbursement in relation to the costs of help such as a babysitter, a domestic assistant or transportation by taxi. The reimbursement varies between and per day spent in hospital. IAK Hospital Plus insurance IAK Hospital Plus insurance entitles you to extras like luxury meals and a private room during your stay in hospital. In addition, you will receive a reimbursement in relation to the costs of a stay in a convalescent home, and you and your family will have the costs of a maximum of 4 taxi rides reimbursed during your stay. 7

5 Medical care General practitioner care this also includes: health-related advice, assistance to stop smoking and preconception care Specialist medical care this also includes: care provided by thrombosis service, second opinion, haemodialysis at a dialysis centre, chronic intermittent artifical respiration and the necessary equipment, Stop smoking programme Rehabilitation this includes: oncological rehabilitation, quick scan and geriatric rehabilitation Heredity tests IVF and fertility-stimulating treatments Audiological care examination of hearing capacity, hearing aid advice Plastic / reconstructive surgery Transplantation of tissue / organs Second opinion Chain care (care programmes) for diabetes mellitus type 2, COPD and cardiovasculair risk management, subject to medical necessity. No reimbursement for treatments: - against snoring - aimed at sterilisation (man/woman) - sterilisation reversal (man/woman) - circumcision - 3 attempts up to age 43 (incl. ICSI and medicines) - other fertility treatments if medically indicated (incl. medicines) up to age 43 - sperm freezing - ovum/embryo freezing, particularly in relation to oncological treatment - correction of mutilations, congenital and other malformations, subject to specific medical indication - eyelid/abdominal wall corrections, subject to specific indication and following permission (see terms and conditions) - primary sexual characteristics, subject to medical indication. Not insured: - liposuction of the stomach - placement or replacement of breast prostheses, other than following full or partial breast amputation - upper eyelid correction without medical indication if within EU-EER member state (including donor s expenses) for care under basic insurance provided by medical specialist - anti-snoring treatment (uvuloplasty) if medically indicated - sterilisation (man/woman) - circumcision - correction of upper eyelids (if insured) - correction of protruding ears, subject to specific medical indications (see terms and conditions) - surgical placement/ replacement of breast prostheses, other than following full/partial breast amputation - anti-snoring treatment (uvuloplasty) if medically indicated - sterilisation (man/woman) - circumcision - correction of upper eyelids or protruding ears subject to specific medical indication (see terms and conditions) - surgical placement/ replacement of breast prostheses, other than following full/e9partial breast amputation 8 9

6 Psychological care General basic mental health care (first-line mental health care) Specialist mental health care (second-line mental health care) Psychiatric hospitalisation Neurofeedback treatment of children with ADHD/ADD Paramedical care Physiotherapy and remedial therapy physiotherapy for adults and children, oedema therapy, Cesar/Mensendieck remedial therapy and pelvic floor therapy Speech therapy Treatment of dyslexia Ergotherapy Dietary advice Oral care Dental care Dental care and orthodontic treatment in special cases Prothetic devices from age 18 Oral care / orthodontic treatment Orthodontic treatment (teeth alignment) up to age 18 Orthodontic treatment (teeth alignment) from age 18 (not insured: disorders relating to work, relationships or adaptation) up to age 18: if chronic 1, if acute 1-18 sessions per diagnosis. From age 18: reimbursement from 21st session in case of treatment of chronic disorders 2 ; first 9 sessions of pelvic floor therapy relating to urinary incontinence for treatment of severe dyslexia in children undergoing primary education who commence treatment whilst aged treatment hours each pp/year medically focused information on diet and eating habits: 3 hours per year up to age 18: for named treatments (limitative list, see terms and conditions²) for dental care (incl. any implants and technical costs) and orthodontic treatment in case of specific medical indication. In some cases an individual contribution will apply. - 75% of the cost of a full set of removable dentures (including technical costs) - fuly removable dental prosthesis on implants (incl. technical costs) in case of severely shrunken toothless jaw. A individual contribution of 125 per upper or lower jaw will apply. supplementary to Zvw max. 250 pp/year from age 18: max. 250 pp/year if insured - max. 400 per year - max. 300 per year - max. 200 per year - max. 700 per year - max. 550 per year - max. 400 per year up to age 18 supplementary to Zvw provision, bridges and crowns max. 500 pp/year - 90% up to max % up to max % up to max Max. amount applies for entire insurance term max per year by psychologist registered with the NIP - max per year - max. 850 per year - max. 700 per year up to age 18 supplementary to Zvw provision, bridge and crowns max. 750 pp/year in accordance with statutory rates per treatment max pp, in accordance with statutoryrates per treatment, once only supplementary to Zvw max pp/year 10 11

7 Pharmaceutical care Medicines Contraceptives such as contraceptive pill, contraceptive implant, diaphragm, ring or pessary Individual contribution to medicines (above Medical Reimbursement System amount) Dietary preparations Medical aids Medical aids Individual contribution to medical aids Special medical aids Glasses, including frames / contact lenses in accordance with Health Care Insurance Regulations and IAK Pharmaceutical Care Regulations (an individual contribution will apply to some medicines and in some cases permission is required) up to age 21 (an individual contribution applies to some pills/devices) from age 21 reimbursement only in case of anaemia in accordance with Dutch Health Care Insurance Regulations and IAK Pharmaceutical Care Regulations (in case of specific medical indication) in accordance with Health Care Insurance Regulations and IAK Medical Aids Regulations (an individual contribution and/or maximum reimbursement applies to some medical aids) from age 21 individual contribution under Zvw max. 150 pp/year from age 21 from age 21 from age 21 max. individual contribution under Zvw max. 150 pp/year max. 50 pp/3 years OptiekPlan (if insured) 100 pp/year for 3 years individual contribution in accordance with Dutch Health Care Insurance Regulations (Medical Aids Regulations) for: - hearing aid max wigs max. 100 pp/year see IAK Medical Aids Regulations (if insured) OptiekPlan (if insured) 100 pp/year for 3 years individual contribution in accordance with Dutch Health Care Insurance Regulations (Medical Aids Regulations) for: - hearing aid max wigs max. see IAK Medical Aids Regulations OptiekPlan 100 pp/year for 3 years Arch supports max. 50 pp/year max. 100 pp/year 1 pair pp/year Stay in an institution Hospital-based nursing Overnight stay following oncological treatment 35 pp/per night directly following treatment in an outpatients department 35 pp/per night directly following treatment in an outpatients department individual contribution in accordance with Dutch Health Care Insurance Regulations (Medical Aids Regulations) for: - hearing aid max wigs max. 300 pp/year see IAK Medical Aids Regulations BiPAP, CPM machines, Lympha presses and UVB home treatment devices max. 250 pp/3 years 35 pp/per night directly following treatment in an outpatients department 12 treatment sessions 12 13

8 Childbirth and maternity care Childbirth Prenatal screening Maternity care Maternity package via IAK Multiple births Lactation care Maternity care in case of adoption - at home or in maternity care hotel: full reimbursement - outpatient/short stay delivery without medical necessity: 200 per day, mother and child together ( 233 minus 33 individual contribution to maternity care in hospital) - outpatient/short stay delivery with medical necessity: counselling, examination, test - at home or in maternity care hotel: max. 10 days (individual contribution of 4.10 per hour applies) applications for maternity care at home via IAK Customer Service Health Care - in hospital (without medical indication): max. 10 days (individual contribution of 33 per day applies to both mother and child - in hospital (with medical indication): full reimbursement of individual contribution (if insured) of individual contribution (if insured) (if insured) 200 once only for 2nd and subsequent children (if insured) max. 115 pp/year (if insured) up to 12 hours spread over max. 4 days for insured mother (if insured) of individual contribution of individual contribution 200 once only for 2nd and subsequent children max. up to 12 hours spread over max. 4 days for insured mother Incubator-based aftercare up to 12 hours (if insured) up to 12 hours Patient transport Transport by ambulance Seated patient transport Care mediation Care and waiting list mediation for taxi and lowest class of public transport; private vehicle 0.31 per km: in case of indication relating to haemodialysis, oncological treatment, wheelchair use, limited vision or chronic condition: individual contribution of 96 pp/year; >200 km permission required mediation in case of unacceptably long waiting time via Health Care Advice department and help with looking for a new GP or dentist following a house move other indications + individual contribution other indications + individual contribution other indications + individual contribution + private vehicle 0.10 per km extra other indications + individual contribution + private vehicle 0.10 per km extra 14 15

9 Abroad Emergency assistance Non-urgent (predictable) care Assistance during stay abroad This includes: repatriation of the sick/injured from abroad Alternative care Alternative medicine and special remedies theses include the following: acupuncture and other traditional Eastern remedies, anthroposophy, homeopathy, natural remedies, psychosocial care and certain forms of alternative movementrelated therapy Homeopathic and anthroposophic remedies (counted together with reimbursement for alternative treatments) Group therapy Group therapy for rheumatism patients Group therapy for cancer patients Skin therapy Skin therapy, camouflage, facial epilation, peeling in case of serious acne, lymph drainage, oedema therapy Pedicure for rheumatism patients Health resorts etc. Health resorts and therapeutic camps based on Dutch or prevailing market rates (permission via SOS International required) based on Dutch rates (prior permission from/via IAK is required) max. 200% Dutch rate max. 200% Dutch rate max. 200% Dutch rate max. 200% Dutch rate max. 200% Dutch rate via SOS International alarm centre max., max. 75,- per day max., on doctor s prescription, supplied by pharmacy max. 150 pp/year, must be performed by skin therapist or beautician listed under Vergelijk en Kies via SOS International alarm centre - max. 400 per year - max. 250 per year - max. 100 per year max. 75 per day max. 125 pp/year, on doctor s prescription, supplied by pharmacy max. 150 pp/year, must be performed by skin therapist or beautician listed under Vergelijk en Kies via SOS International alarm centre - max. 650 per year - max. 550 per year - max. 400 per year max. 75 per day max. 250 pp/year, on doctor s prescription, supplied by pharmacy max. 150 pp/year for members of the rheumatism patients association max. 350 pp/year, must be performed by skin therapist or beautician listed under Vergelijk en Kies max. 200% Dutch rate via SOS International alarm centre - max. 850 per year - max. 750 per year - max. 650 per year max. 75 per day max. 500 pp/year, on doctor s prescription, supplied by pharmacy max. 150 pp/year for members of the rheumatism patients association max. 500 pp/year for group therapy for cancer patients max pp/year, must be performed by skin therapist or beautician included under Vergelijk en Kies max. 250 pp/year for insured person aged under 18 to visit therapeutic camp in the Netherlands for children with asthma or diabetes max. 200% Dutch rate via SOS International alarm centre max. 750 pp/year, max. 75 per day max. 500 pp/year on doctor s prescription, supplied by pharmacy (exceptional reimbursement) max. 180 pp/year for members of the rheumatism patients association max. 500 pp/year for group therapy for cancer patients max pp/year, must be performed by skin therapist or beautician included under Vergelijk en Kies - health resort: max. 70 per day, max. 1,250 pp/year - health resorts for psoriasis or rheumatism patients: max. 1,250 once pp/3 years. Call Customer Service Health Care to ask which resorts/convalescent homes qualify for reimbursement

10 Preventive care Preventive courses Vaccinations / medication in connection with foreign travel (not business-related) Sports medicine advice / sports medicine Stopping smoking programme Other via GP, medical specialist or clinical psychologist aimed at behavioural change and including support medication 100 pp/year 100 pp/year 100 pp/year 150 pp/year 150 pp/year 150 pp/year Replacement informal care max. 4 days per year max. 9 days per year Informal care broker max. 250 per year max. 500 per year Anti-stuttering therapy Patient association treatment at various anti-stuttering centres or by specialist speech therapist (see terms and conditions) max. 500 pp once only for Del Ferro, Hausdorfer, or BOMA method max. 75 pp/year in total for membership of patient associations (if insured) max. 750 pp once only for Del Ferro, Hausdorfer or BOMA method max. 75 pp/year in total for membership of patient associations max. 75 pp/year in total for membership of patient associations Menopause consultant Overnight stay facility In the column the care that is covered is named, but the level of the reimbursement may depend on the care provider and type of basic insurance you have selected cost of overnight stay for parents if child under age 18 is in hospital max. 160 pp, once only cost of overnight stay for parents if child under age 18 is in hospital Dental care insurance Hospital Plus Reimbursement of costs of dental care for insured persons aged 18 and upwards reimbursement up to max. 350 per year for: - C (consultations) / second opinion / M (oral hygiene) / V (fillings) / H (extractions) codes: 100% of statutory rate - other treatments: 80% of statutory rate reimbursement up to max. 950 per year for: - C (consultations) / second opinion / M (oral hygiene) / V (fillings) / H (extractions) codes: 100% of statutory rate - other treatments: 80% of statutory rate reimbursement up to max per year for: - C (consultations) / second opinion / M (oral hygiene) / V (fillings) / H (extractions) codes: 100% of statutory rate - other treatments: 80% of statutory rate Nursing care in a hospital Compensation if higher category is not present or not available Extra facilities, service and comfort Nursing/stay in convalescent home additional costs of nursing in a higher than standard category 70 per nursing day max. 200 per nursing day max. 100 per day up to max. 28 days Transportation to and from hospital by taxi max. 4 rides per stay 18 1 In accordance with Health Care Insurance Decree, chronic indications appendix In accordance with Health Care Regulations. These include preventive examinations, scaling, sealing, anaesthetics, repairs (fillings), prosthetics, surgical treatment, X-rays. No rights (including rights to reimbursement) may be derived from this survey of reimbursements. Always consult the insurance terms and conditions for precise, up-to-date details of the reimbursements, or contact Customer Service. 19

11 We re here to help you Go to to access detailed information and downloads. Call +31 (0) Our Customer Service staff will be pleased to assist you. Make an appointment with one of our advisors Our advisors arrange appointments regularly at a wide range of business locations. Visit one of our service desks At Beukenlaan 70 or at the High Tech Campus (The Strip) in Eindhoven. The content of this brochure has been compiled with the greatest possible care, and is provided for your information. Please be aware, however, that no rights (including rights to reimbursement) may be derived from the content of this brochure. For precise, up-to-date reimbursement details, always log on to (Dutch only) and consult the insurance terms and conditions, or contact Customer Service. IAK Verzekeringen B.V. IAK Volmacht B.V. Postbus 90165, 5600 RV Eindhoven Beukenlaan 70, Eindhoven T (040) , F (040) IAK Verzekeringen B.V. Chamber of Commerce: IAK Volmacht B.V. Chamber of Commerce: AFM licence number: ZV-VERG-UNIEK VGZ ENG ( )