Coverage overview 2014 Choice Care Plan and supplementary insurance: Aon s Global Health Supplement (AGHS)

Transcription

1 Coverage overview 2014 Choice Care Plan and supplementary insurance: Aon s Global Health Supplement (AGHS) The reimbursements of our health insurances Our health insurance offers you the right care when you are ill, without financial surprises later. But even when you are healthy you want to be able to trust that you are in good hands. In this brochure you will find an overview of the coverage offered by the basic health insurance and our supplementary insurance for abroad. What is necessary is reimbursed Choice Care Plan is our basic health insurance. We reimburse you for everything that is necessary, but in certain cases you must pay a statutory contribution, for example for maternity care, transport in connection with illness, and health aids. The insured treatments in the Choice Care Plan are insured on the basis of treatment rates in the Netherlands. Supplementary insurance Aon s Global Health Supplement We offer you a global supplementary insurance for the costs of treatments that are not, or not fully, reimbursed by the basic health insurance. In addition we offer supplementary dental insurance and Comfort Class insurance. This brochure also informs you of which costs are reimbursed by these insurances. How do you use the coverage overview In the left-hand column you find the various treatments. The middle column indicates whether these treatments are covered by the Choice Care Plan. If no reimbursement is listed, look to the right-hand column. There you can see whether the treatment is covered by the supplementary insurance Aon s Global Health Supplement. You can also find whether statutory contributions are reimbursed. The numbers and amounts we cite apply per insured per calendar year, unless otherwise indicated. Quick reference, but no more than that This brochure allows you to easily and quickly look up what coverage you have. This coverage overview does not, however, replace the policy terms and conditions document, which constitutes the actual and comprehensive basis of your insurance. You cannot derive any rights from this brochure therefore. Want to know more? You can contact us by ipm@aonhewitt.com or phone Aon at + 31 (0) Care activity Basic Insurance Aon s Global Health Supplement Adoption/maternity care for children younger than 12 months or medical screening for adoption Alternative (homeopathic and anthroposophist) medicines (registered and dispensed by pharmacy) Max. 3 days to max. 3 hours per day or max. EUR 300 per adoptive child. Alternative treatments and therapies Specifically the doctors mentioned** EUR 75 Specifically the non-doctors mentioned*** EUR 40 total of max. 20 consultations per cal. yr. Contraception Under 21: (according to the Achmea Pharm..Care Reg. the statutory personal contribution (in excess of GVS price limit) is not reimbursed Under 21: supplement to 21 and above: supplement to Asthma Centre Davos Hearing centre Abroad: supplement to cost price Delivery and obstetric care Home birth, clinic birth and polyclinic birth on Abroad: supplement to cost price medical indication Polyclinic birth (without medical indication) Reimbursement use of delivery room EUR 192 exclusive personal contribution Abroad: supplement to cost price In NL: delivery room: reimbursement Obstetric care Abroad: supplement to cost price Monitoring equipment for prevention of crib death Monitoring equipment (rental) Sensormat from Nanny Care (purchase) Exercise in heated water for insureds with rheumatism for max. 12 months, after permission from the company. reimbursement* together with other costs to max. EUR 500 per cal.yr. 1 AON (V)-01

2 Glasses and contact lenses Glasses or contact lenses with a minimum strength of plus or minus 4 dioptre to max. 1 pair per 3 cal. yr and to max. EUR 250 per pair. Contact lenses of at least plus or minus 4 dioptre, specially made for short-term use, such as daily, weekly, monthly, half-yearly and yearly lenses, instead of the reimbursement mentioned above: max. EUR 65 per cal. yr reimbursed. Laser eye surgery At Visionclinics max. EUR per 3 cal. yrs. At other clinics EUR 45 per 3 cal. yrs. Abroad Emergency care Max. Abroad: supplement to cost price Non-emergency care Max., see policy conditions Abroad: supplement to cost price. Special conditions apply for USA and Canada Repatriation and evacuation Transport of physical remains Vaccinations and medicines in connection with travel abroad Max. 75% subject to a maximum of EUR 150 per insured per cal.yr. (see policy conditions for the medicines and vaccinations) Circumcision on religious grounds Dyslexia care, diagnosis and treatment of Max. Abroad: supplement to cost price several dyslexia in children aged 7 to 10 Primary psychological care Pharmaceutical care According to the company s Pharmaceutical care regulation Physical therapy and exercise therapy for those aged 18 and older Chronic disorder diagnosed by GP or Manual lymphatic drainage in the event of severe lymphoedema may also be carried out y a skin therapist instead of a or exercise therapist Non-chronic disorder diagnosed by GP of Pelvic physiotherapy, if supplied by contracted pharmacist (GVS upper limit price) Session 1 through 9 NL rate Physical therapy and exercise therapy for those ages 18 and younger Chronic disorder diagnosed by GP or Non-chronic disorder diagnosed by GP or. Manual lymphatic drainage in the event of severe lymphoedema may also be carried out by a skin therapist instead of a pshysiotherapist or exercise therapist Guesthouse accommodation Accommodation costs in the case of outpatient treatment at a hospital reimbursement of personal contribution (GVS upper limit price) Sessions 1 through 20 are payable by you The first 20 sessions to a maximum of EUR 30 per session From session 21: 18 sessions per diagnosis, NL rate Maximum 12 sessions per indication per cal.yr. subject to a maximum of EUR 30 per session Max. EUR 35 per day together with other costs to max. EUR 500 per cal.yr. TENS unit for labour/birth (rental) Recovery and Balance, after-care former Max. EUR cancer patients Sanatorium Max. EUR 50,- per day to max. 28 days p.p. per cal.yr. Skincare Acne treatment, camouflage therapy, hair Max. EUR 600 removal treatment for women with seriously disfiguring facial hair Physician care Abroad: supplement to cost price Health aids EUR 250 statutory personal contribution other health aids IVF (in vitro fertilization) Before the age of 43,first 3 attempts per prospective pregnancy. Reimbursement of medicines for first 3 attempts in line with GVS, Max. EUR 7,000 per prospective pregnancy including reimbursement from the primary insurance after permission from the company. Maternity package Max. EUR 50 2

3 Maternity care Home or in a birth centre Ma. 10 days, statutory contribution EUR 3.90 reimbursement of statutory personal per hour contribution. Postponed maternity care on medical Medically required maternity care, max. 15 hrs. indication Lactation consultant care 75% to max. 115 Lifestyle training courses 1 training course to max. EUR 200 Speech therapy except for dyslexia and language Abroad: supplement to cost price development disorders. Informal home care backup Max. 21 days per insured subject to a maximum of EUR 1,000 per insured per cal.yr. Mechanical respiration Abroad: supplement to cost price. Melatonin (for certain disorders) Max. EUR 150 after permission from the company. Kidney dialysis Abroad: supplement to cost price. Obesity treatment for grad 3 Max. EUR 1,000 for entire duration of the insurance. Organ transplants, after permission from the company. After permission from the company, supplement to cost price. Donor nursing Max. 3 months. In case of liver transplant max. 6 months. Orthodontie For insureds aged up to 18: max. EUR 2,000 for the entire duration of this supplementary insurance. For insureds ages 18 and above: after approval 70% subject to a maximum of EUR 1,000 for the entire durations of this supplementary insurance if there is an IOTN diagnosis of more than 2. Orthopedic medicine together with other costs to max. EUR 500 per cal.yr. Menopause consultant 75% of consultation rate to max. EUR 115 Patient associations Max. EUR 25 per membership * together with other costs to max. EUR 500 per cal.yr. Foot care for insureds with rheumatism or diabetes on referral together with other costs to max. EUR 500 per cal.yr. Adhesive strips for affixing prosthetic breasts Plastic surgery / Cosmetic surgery Plastic surgery on medical indication. (except breast enlargement and switch of breast prosthesis when not following Correction of eyelids/ ear positioning after permission from company. breast amputation, liposuction of the stomach, procedures on eyelids and ear positioning), after our permission. Pad and buzzer reimbursement* together with other costs to maximum EUR 500 per cal.yr. Podotherapy/ podology On referral reimbursement* together with other costs tot maximum EUR 500 per cal.yr. Preventive courses See terms and conditions for course overview Preventive medicine 75% to maximum EUR 115 per course per insured per cal.yr.* together with other costs to maximum EUR 500 per cal.yr. 5, Immunisation in accordance with Dutch government vaccination programme, tetanus vaccine, and influenza vaccine. 3

4 Preventive examinations Cervical cancer, breast cancer, cardiovascular diseases, prostate cancer. Periodic general examination (check-up) by a GP or specialist Psoriasis Treatment at Psoriasis Day treatment centre Rehabilitation in hospital or rehabilitation centre except in context of population screening. Max. EUR 75 (once per 2 yrs) to max. EUR 1,000 p.p. per cal.yr. Abroad: supplement to cost price. Second opinion (medical specialist) Abroad: supplement to cost price. Sports doctor (Sports Medicine Facility) Twice per cal.yr. the costs of an injury and/ or repeat consultation. Personal contribution EUR 10 Sterilisation in hospital or independent except for reversal procedure. treatment centre Supportive pessary (in case of prolapsus of uterus) Supportive arches (except podotherapeutic/ podologic support soles) Stutter therapy At various centres for stutter treatment Dental care Age 18 and older Prostheses Purchase of full removable prostheses made by a dentist or dental prosthetician Repairing of refitting (rebasing) full removable prostheses by dentist of dental prosthetician Implants to removable prostheses in the event of severe development or growth disorders made by dentist, oral surgeon or centre for special dental care Prostheses Full removable prostheses in the event of severe development or growth disorders made by dentist, dental prosthetician or centre for special dental care Dental care 18 years and younger All treatments by dentist, oral hygienist, oral surgeon and dental prosthetician (except cast fillings, crowns, bridges, inlays and implants) Special dental care For the disabled For special cases Dental costs resulting from accident Age 18 years and older Therapeutic camps For the disabled Max. once per cal.yr.* together with other costs to max. EUR 500 per cal.yr. Max. EUR 1,000 per insured per cal.yr. for the duration of the supplementary insurance. 75% NL rate Statutory personal contribution 25%. Costs in excess of EUR 600 per jaw after permission. Replacement within 5 years after permission Abroad: supplement to cost price. after permission Abroad: supplement to cost price after permission of the company. 6 after permission. Statutory personal contribution EUR 125 per upper or lower jaw. Abroad: supplement to cost price after permission of the company. Abroad: supplement to cost price, if no claim can be made on AWBZ, after permission from the company. In some cases a statutory personal contribution applies Abroad: supplement to cost price after permission from the company and if no claim can be made on AWBZ. Abroad: supplement to cost price exclusive personal contribution. 75% to max. EUR 200 per element to max EUR 2,500 per accident. After permission from the company, max. EUR 23 per day per insured per cal.yr* together with other costs to max. EUR 500 per cal.yr. For asthmatic youth to the age of 18 On referral from treating doctor, max per day subject to a maximum of 42 days per cal.yr.* together with other costs to max. EUR 500 per cal.yr. Trans-therapy by rented neuromodulator after permission from the company. (BioStim) and biofeedback equipmen (femiscan) for treatment of incontinence Care for thrombosis patients Abroad: supplement to cost price. 4

5 Accommodation cost Accommodation costs patient Max. EUR 100 per day to max. EUR 1,000,- per case of illness if the patient incurs costs in connection with medical treatment in a hospital outside his or her town/city Accommodation costs parents Co-insured child Max. EUR 100 per day for both parents subject to a maximum of EUR 1,000 per case of illness. Costs incurred in NL or in the country of nationality excluded. Nursing (outpatient) (except for home respiration and Abroad: supplement to cost price. palliative care), after permission from the company. Fertility treatments other than IVF after permission from the company. Abroad: supplement to cost price. Hospital admission, max. 365 days except for GGZ, our permission required in case of plastic surgery and dental surgery. Abroad: supplement to cost price. * For these care activities, a total maximum of EUR 500 is reimbursed per insured per calendar year. ** The alternative doctors are: doctor-acupuncturists, homeopathic doctors, doctors of natural medicine, anthroposophist doctors, doctors of enzyme therapy, Sickesz doctors, manual doctors and Moerman doctors. *** The alternative non-doctors are: acupuncturists, -acupuncturists, traditional homeopaths, manual therapists, chiropractors, haptotherapists and natural medicine therapists. The reimbursements in the basic insurance Choice Care Plan are based on the rates in the Netherlands. The supplementary insurance Aon s Global Health Supplement offers a supplement abroad to cover the cost price, unless stated otherwise in the policy terms and conditions. Although this Cover Overview has been composed with due care, no rights can be derived from it. 5 For a full description of cover please refer to the Policy Conditions.