IAK Unique Supplementary Health Care Insurances

Transcription

1 IAK Unique Supplementary Health Care Insurances Terms and conditions for 2015 Compact l Compleet l Extra Compleet

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3 Welcome to IAK This document tells you everything you need to know about your IAK Supplementary Health Care Insurance. The table of contents will help you find the precise information you need. Below is a list of important telephone numbers and addresses. You can also access the information about your IAK Supplementary Health Care Insurance online via Important telephone numbers and addresses Customer Service, Health Care and Income Insurances +31 (0) / info@iak.nl IAK Customer Service has specialised staff available to provide clear answers to your questions. You can contact them on workdays between 8.30 a.m. and 6 p.m. List of contracted care providers For details of those care providers with whom contracts have been signed, go to or call Customer Service. A different or lower reimbursement may apply to non-contracted care providers. See the list of reimbursements for non-contracted care providers on our website for the precise reimbursement levels. Patient transport You can download the application form for seated patient transport from the website or call Customer Service and ask for a form. Care advice and mediation For care advice or mediation, call our Health Care Advice department on +31 (0) SOS International alarm centre Call +31 (0) for emergency medical assistance abroad. IAK maternity care Call +31 (0) for general information. For specific information, go to and open your personal account. Applications for authorisation You can send your application for authorisation to undergo treatment to: IAK, Postbus 90165, 5600 RV Eindhoven. The cases in which you need to apply for authorization are clearly indicated in these terms and conditions. Submitting invoices If you have received an invoice, you can send the original invoice to: IAK, Postbus 90164, 5600 RT Eindhoven. Check that the following information is shown on the invoice: name, full address and date of birth of the insured person. Also, you should always note your insurance number (or client number) in the top right-hand corner of the invoice. Alternatively, you can submit your invoice online via your personal account on or via the IAK Health Care app on your mobile telephone. If the invoice you receive comes from outside the Netherlands, you should complete the Foreign medical expenses claim form. You can find the form on our website. IAK always makes payments to the policyholder, using the last known account number. Together for a perfectly insured future 3

4 Contents I General section 5 1 Definitions 5 2 General conditions 8 3 Premium 11 4 Other obligations 12 5 Amendments to premium and terms and conditions 13 6 Inception, term and cancellation 13 7 Exclusions 14 8 Complaints and disputes 14 9 Care mediation and waiting list mediation Final provision 15 II Compact 16 1 Alternative medicine and special remedies 16 2 Glasses/Lenses/Laser eye surgery (OptiekPlan) (if included under the insurance) 17 3 Abroad 17 4 Pharmaceutical care 17 5 Physiotherapy and remedial therapy 18 6 Skin therapy 18 7 Medical aids (individual contributions) 18 8 Preventive care 18 9 Arch supports Seated patient transport 19 III Compleet 20 1 Alternative medicine and special remedies 20 2 Glasses/Lenses/Laser eye surgery (OptiekPlan) (if included under the insurance) 21 3 Abroad 21 4 Pharmaceutical care 21 5 Physiotherapy and remedial therapy 22 6 Childbirth care (if included under the insurance) 22 7 Group therapy for rheumatism patients 23 8 Hand or finger splint for temporary use 23 9 Skin therapy Overnight stay facilities Specialist medical care/plastic surgery or reconstructive treatment Overnight stay following oncological treatment Preventive care Senior care (if included under the insurance) Arch supports Anti-stuttering therapy Dental care Seated patient transport 25 IV Extra Compleet 26 1 Alternative medicine and special remedies 26 2 Glasses/Lenses/Laser eye surgery (OptiekPlan) 27 3 Abroad 27 4 Pharmaceutical care 28 5 Physiotherapy and remedial therapy 28 6 Childbirth care 28 7 Group therapy 29 8 Skin therapy 29 9 Medical aids Membership of patient associations / patient interest groups Overnight stay facilities Informal care Specialist medical care / plastic surgery or reconstructive treatment Overnight stay following oncological treatment Menopause consultation Foot care for patients with rheumatism or diabetes Preventive care Arch supports Anti-stuttering therapy Dental care Therapeutic camps Seated patient transport 32 V Dental Care Supplementary Insurance 33 1 Cover 33 2 Exclusions 33 VI Ziekenhuis Ontzorg Pakket Supplementary Insurance 34 1 Cover 34 2 Obligations of the insured person 35 4

5 I General section 1 Definitions In the insurance terms and conditions below, the following words/terms will have the following meaning: 1.1 Alternative medicine and special remedies Medicine/remedies that differ from regular medicine/remedies in terms of both their nature and the treatment methods used. 1.2 Authorisation/permission Prior written permission granted to the insured person by IAK on behalf of the health care insurer for the acquisition of specific health care. 1.3 AWBZ Algemene Wet Bijzondere Ziektekosten (Exceptional Medical Expenses Act). 1.4 Beautician A beautician with an advanced diploma in beauty therapy or a specialist vocational diploma in camouflage therapy, acne or epilation techniques or electrical epilation. Said specialist diplomas must be registered with the branch organisation ANBOS. 1.5 Besluit Zorgverzekering Health Care Insurance Decree of 28 June 2005 providing for an Order in Council as referred to in articles 11, 20, 22, 32, 34 and 89 of the Zvw. 1.6 Care hotel An establishment contracted as such by the health care insurer that guarantees 24-hour care and service consisting at least of nursing and care in a hotel-like setting. 1.7 Cesar/Mensendieck remedial therapist A remedial therapist who meets the requirements laid down in the Decree for dieticians, occupational therapists, speech therapists, oral hygienists, remedial therapists, orthopaedists, and podotherapists, or a Cesar/Mensendieck remedial therapist or specialist remedial therapist listed in the Kwaliteitsregister Paramedici (Paramedics Quality Register), i.e. paediatric and psychosomatic remedial therapists. 1.8 Company doctor A physician listed as a company doctor in the Register van Erkende Sociaal Geneeskundigen (Register of Recognised Social Physicians) maintained by the Sociaal-Geneeskundige Registratie Commissie (Social-Medical Registration Committee) of the Koninklijke Nederlandsche Maatschappij tot bevordering der Geneeskunst (Royal Netherlands Society for the Promotion of Medicine). Said physician may be employed by the Arbodienst (Dutch Health and Safety Executive) or may have entered into a contract with the health care insurer. 1.9 Convention territory Countries that do not belong to the European Union and are not EEA member countries with which the Netherlands has entered into a social security agreement that includes an arrangement regarding the provision of medical care. The countries in question are Australia (temporary stay only), Bosnia-Herzegovina, Cape Verde, Croatia, Macedonia, Morocco, Serbia, Montenegro, Tunisia and Turkey Dental surgeon A dental specialist listed in the Specialistenregister voor mondziekten en kaakchirurgie (Register of Specialists in Oral Disease and Dental Surgery) maintained by the Nederlandse Maatschappij tot bevordering der Tandheelkunde (Netherlands Society for the Promotion of Dentistry) Dentist A person listed as such in the register referred to in section 3 of the Wet BIG Diagnose Behandeling Combinatie (DBC)(care product) A DBC details the completed and validated trajectory of medical specialist care and specialist second-line curative Geestelijke Gezondheidszorg (mental health care) by means of a DBC care trajectory code established by the Nederlandse Zorgautoriteit (Dutch Care Authority). This encompasses the request for care, the care type, the diagnosis and the treatment. With effect from 1 January 2012, all new care trajectories for medical specialist care are expressed in terms of DBC care products. The DBC care trajectory begins from the moment that the insured person submits his/her care request and ends when the treatment has been completed or after 365 days Doctor A person listed as such in the register referred to in article 3 of the Wet BIG. Together for a perfectly insured future 5

6 1.14 Establishment an establishment in the sense of the Wet toelating zorginstellingen (Health Care Institutions Accreditation Act); a legal entity established abroad that provides care in the country in question in the context of the local social security system or that provides health care to specific groups of public officials European Union and EEA member states In addition to the Netherlands, these include the following countries within the European Union: Austria, Belgium, Bulgaria, Cyprus (the Greek part), Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Poland, Portugal, Romania, Slovenia, Slovakia, Spain, Czech Republic, the United Kingdom and Sweden. Switzerland has also been accorded equal status under treaty provisions. Also included are the three EEA countries (member states that have signed the Agreement on the European Economic Area), namely Lichtenstein, Norway and Iceland Family A family is defined as two married or registered partners or long-term cohabiting persons and their unmarried biological children, stepchildren, adopted children or foster children up to the age of 18, or a single person with one or more children as described above. The term 'registered partner' is defined as the person with whom the insured person has entered into a registered partnership by means of a deed of registration drawn up by the civil registrar; the term 'long-term cohabiting person' refers to a person who has proof of cohabiting for at least one year with the insured person in a joint household or a person who has signed a cohabitation contract with the insured person, in which case the health care insurer will have the exclusive discretion to assess the durability of cohabitation Fraud The perpetration or attempted perpetration of forgery, deceit, suppression of facts that may be relevant to effecting the insurance, prejudicing the rights of claimants and/or fraudulent diversion by the persons and organisations party to a non-life insurance contract in the process of entering into and/or administering such a contract with the intention of obtaining a payment or treatment to which there is no entitlement or obtaining insurance cover under false pretences General practitioner A doctor listed as a general practitioner in the register of recognized general practitioners maintained by the HVRC (registration committee for general practitioners, nursing home doctors and doctors for the mentally handicapped) of the Koninklijke Nederlandsche Maatschappij tot bevordering der Geneeskunst (Royal Netherlands Society for the Promotion of Medicine) and who carries out the customary duties of a general practitioner Group health care insurance contracting party The legal entity or individual with whom the group health care insurance policy for health care costs and/or health care insurance has been entered into. A group health care policy is a policy entered into between the health care insurer and an employer or legal entity with the purpose of offering participants the opportunity to take out IAK Health Care Insurance (and, if desired, IAK Supplementary Insurances) under the conditions described in the policy Health care insurance/iak Health Care Insurance A non-life insurance contract between the health care insurer and the policyholder for the benefit of a person obliged to take out insurance. Said insurance must comply with the relevant provisions under or by virtue of the Zvw. The treatments provided thereunder must not extend beyond the provisions under or by virtue of the Zvw Health care insurer The health care insurer and its authorised agent named as such on the policy schedule Health care psychologist A person listed as such in the register referred to in section 3 of the Wet BIG and listed in the Register of Psychologists maintained by the NIP (Dutch Institute of Psychologists) Hospital An establishment for specialised medical care that carries out examinations and treatments and that is admitted as such under or pursuant to the statutory regulations IAK IAK Volmacht B.V. as authorised agent granted a mandate by the health care insurer as referred to in the Wet op het financieel toezicht (Act on financial supervision) in respect of health care insurances IAK Health Care Insurance A health care insurance policy concluded between the health care insurer and the policyholder in relation to the person obliged to take out insurance (also known as the main insurance) pursuant to the Zvw, offered and administered by IAK Volmacht B.V. in the name of and for the risk of the health care insurer in question as authorised agent. IAK Volmacht B.V. as authorised agent granted a mandate by the health care insurer as referred to in the Wet op het financieel toezicht (Act on financial supervision) in respect of health care insurances Independent treatment centre An establishment for specialised medical care that carries out examinations and treatments and that is licensed as such under or pursuant to the statutory regulations. 6

7 1.27 Insurance One or more of the health insurances described in these insurance terms and conditions, entered into as a supplement to the IAK Health Care Insurance Insured person The person on whose behalf this insurance policy has been entered into and who is named as such on the policy schedule or other proof of insurance issued by the health care insurer Main insurance The health care insurance policy entered into by the policyholder with the health care insurer pursuant to the Zvw Manual therapist A physiotherapist listed as a manual physiotherapist in the Register Verbijzonderde Fysiotherapeuten (Register of Specialist Physiotherapists) maintained by the Koninklijk Nederlands Genootschap voor Fysiotherapie (Royal Netherlands Society for Physiotherapy) or a person registered as an E.S. manual therapist with the Nederlandse Vereniging van Manueel Therapeuten (Dutch Society of Manual Therapists) Medical specialist A doctor listed as a medical specialist in one of the registers established by the Medisch Specialisten Registratie Commissie (Registration Committee for Medical Specialists) that falls under the Koninklijke Nederlandsche Maatschappij tot bevordering der Geneeskunst (Netherlands Society for the Promotion of Medicine) Medicines The medicines referred to in article 2.8 paragraph 1 (header and under a and b) of the Besluit Zorgverzekering Menopause consultant A nurse who has undergone specialist training with the organisation 'Care for Women' to become a menopause consultant or who is a member of the menopause practice 'Women s Life' Midwifery centre An establishment licensed as such under or pursuant to statutory regulations that has entered into a contract with the health care insurer or an establishment recognised as such by the health care insurer Nurse A person listed as such in the register referred to in article 3 of the Wet BIG NZa Nederlandse Zorgautoriteit (Dutch Care Authority) as referred to in the Wet marktordening gezondheidszorg (Health Care Market Regulation Act) Obstetrician A person listed as such in the register referred to in article 3 of the Wet BIG Oral hygienist An oral hygienist trained in accordance with the training requirements for oral hygienists laid down in the Decree for dieticians, occupational therapists, speech therapists, oral hygienists, remedial therapists, orthopaedists, and podotherapists and in the Decree on Functional Independence and/or with whom the health care insurer has entered into an agreement Orthodontist A dental specialist listed in the Specialistenregister voor dentomaxillaire orthopedie (Specialists Register for Dentomaxillary Orthopaedics) maintained by the Nederlandse Maatschappij tot bevordering der Tandheelkunde (Netherlands Society for the Promotion of Dentistry) Pharmacist/dispensing physician The dispensing general practitioner or a person listed in the register of pharmacists as referred to in article 61 paragraph 5 of the Geneesmiddelenwet (Dutch Medicines Act) Physiotherapist A physiotherapist or specialist physiotherapist listed in the Centraal Kwaliteitregister (Central Quality Register) of the Koninklijk Nederlands Genootschap voor Fysiotherapie (Royal Netherlands Society for Physical Therapy). The term physiotherapist also includes specialists in paediatric, pelvic floor and geriatric physiotherapy and manual therapists Podotherapist A person entitled to use the title of podotherapist under article 26 of the Decree for dieticians, occupational therapists, speech therapists, oral hygienists, remedial therapists, orthopaedists, and podotherapists Policyholder/you/your The person who has entered into the insurance policy with the health care insurer and who is named as the policyholder on the policy schedule. Together for a perfectly insured future 7

8 1.44 Policy year The year in which the insurance is entered into according to the date on the policy schedule, up to 1 January of the subsequent year Preferred supplier/preferred provider A supplier/care provider with which/whom the health care insurer has entered into a contract and with which/whom specific arrangements have been made Prosthodontist A person entitled to use the title prosthodontist pursuant to article 2 of the Besluit opleidingseisen en deskundigheidsgebied tandprotheticus (Decree Governing the Educational Requirements and Discipline of Prosthodontists) and/or with whom the health care insurer has entered into an agreement Psychiatrist/neurologist A doctor listed as a psychiatrist/neurologist in the Specialistenregister (Register of Specialists) established by the Medisch Specialisten Registratie Commissie (Registration Committee for Medical Specialists) that falls under the Koninklijke Nederlandsche Maatschappij tot bevordering der Geneeskunst (Royal Netherlands Society for the Promotion of Medicine) Regeling Zorgverzekering Health Care Insurance Regulations issued by the Minister of Health, Welfare and Sport dated 1 September 2005, number Z/VV , containing rules on the implementation of the Zvw as published in the Staatscourant (Government Gazette) 2005, no Skin therapist/oedema therapist A person entitled to use the title of 'skin therapist' or oedema therapist pursuant to article 2 of the Decree on the training requirements and area of expertise of the skin therapist. The skin therapist must be listed in the Paramedics Quality Register. The oedema therapist must be listed in the Centraal Kwaliteitregister (Central Quality Register) of the Koninklijk Nederlands Genootschap voor Fysiotherapie (Royal Netherlands Society for Physical Therapy) Sports medicine establishment An establishment affiliated to the Federatie van Sportmedische Instellingen (Federation of Sports Medicine Associations) Stay A stay of 24 hours or longer Wet BIG Wet op de beroepen in de individuele gezondheidszorg (Individual Health Care Professions Act) Wmg rates Rates as set or approved by the NZa pursuant to the Wet marktordening gezondheidszorg (Health Care Market Regulation Act (Wmg)) Zvw Zorgverzekeringswet (Health Care Insurance Act). 2 General conditions 2.1 Basis This insurance contract is entered into on the basis of the information provided by the policyholder, whether or not in his/her own hand, on the application form or supplied to the health care insurer in some other written form (e.g. per ). The health care insurer will provide the policyholder and - if this person is not the insured person - the insured person with an insurance policy as soon as possible after the health insurance contract is entered into, and subsequently prior to the start of every calendar/policy year. The insured person(s) and the insurance policy/policies effected for said insured persons will be named on the policy schedule. These insurance terms and conditions form an integral part of the health care policy and are applicable to the following supplementary insurances: Compact: section II; Compleet: section III; Extra Compleet: section IV; Dental Care Supplementary Insurance: section V; Ziekenhuis Ontzorg Pakket Supplementary Insurance: section VI. The supplementary insurances can be entered into by or on behalf of an insured person living in the Netherlands, unless the health care insurer specifies otherwise. The health care insurer can set special conditions to be applied to supplementary insurance. The supplementary insurances Dental Care and Ziekenhuis Ontzorg Pakket can only be entered into if and insofar as the health care 8

9 insurer specifically grants permission based on a dental inspection report or health certificate or the state of health of the prospective insured person. Unless otherwise specified, section I and the Definitions will apply to all supplementary insurances. 2.2 Group health insurance contract The provisions of the group health insurance contract entered into with the group contracting party will prevail if and insofar as they deviate from the provisions laid out in these insurance terms and conditions. If the provisions in the group health insurance contract entered into with the employer are no longer applicable, the provisions of the IAK Supplementary insurances as they apply to individually insured persons will once more become valid. It is not possible to be insured under more than one group insurance contract at one and the same time. The supplementary insurance will be terminated as soon as the criteria for participating in the group health insurance contract are no longer met, for example upon termination of the employment contract. The health care insurer can then offer the insured person an individual insurance policy. 2.3 Medical necessity Entitlement to care or to the reimbursement of the costs of care as defined in these insurance terms and conditions will only exist if and insofar as the insured person can reasonably be deemed to need the type of care in question (in terms of both the form and extensiveness of the care) and provided that the type of care is both appropriate and effective. Appropriate form and extensiveness will be defined in part on the basis of the latest scientific advances and current practice as identified via the Evidence-Based Medicine (EBM) method. In the absence of such information, the appropriate form and extensiveness of care will be determined on the basis of what constitutes responsible and adequate care within the relevant discipline. 2.4 Who may provide care The care provider has to meet certain requirements. For many care providers (including general practitioners, medical specialists, dentists, physiotherapists and health care psychologists), these requirements are prescribed by law and the medical title is protected. For those care providers in respect of whom the requirements are not prescribed by law or to whom additional requirements apply, the exact requirements the care provider must meet are laid out in the relevant article of this document. For certain types of care, specific care providers have been contracted, designated or recognised by the health care insurer. Where a care provider is used that has not been not contracted, designated or recognised by the health care insurer, the insured person may receive a lower reimbursement or no reimbursement at all. In that case, this will be stated in the relevant article in this document. For other types of care, the insured person is free to select a care provider, provided that the other requirements laid down in these insurance terms and conditions are met. For a list of care providers that have been contracted and designated by the health care insurer, visit or call the number given at the start of this document. The recognised care providers are named in the relevant article in this document. Specific agreements have been reached with certain suppliers, referred to as preferred suppliers. Where preferred suppliers have been designated, this is noted in the relevant article in this document. 2.5 Reimbursement of care costs Reimbursement of the costs of care will take place exclusively on the basis of a maximum of the Wmg rates that apply in the Netherlands. If no Wmg rates apply, the costs will be reimbursed up to a maximum of the reasonable market prices applicable in the Netherlands or on the basis of the rate that the health care insurer has set or agreed in consultation with the care provider in question. If a rate applies that is lower than the statutory maximum, then the amount set by or on behalf of the health care insurer will determine the level of the reimbursement. For certain types of care, specific care providers have been contracted, designated or recognised by the health care insurer. Where a care provider is used that has not been not contracted, designated or recognised by the health care insurer, the insured person may receive a lower reimbursement or no reimbursement at all. In that case, this will be stated in the relevant article in this document. For other types of care, the insured person is free to select a care provider, provided that the other requirements laid down in these insurance terms and conditions are met. For a list of care providers that have been contracted and designated by the health care insurer, visit or call the number given at the start of this document. The recognised care providers are named in the relevant article in this document. If you go to a non-contracted care provider, you may have to pay for the care (or part of the care ) yourself. We refer you to our website for the maximum reimbursements applicable to non-contracted care providers. 2.6 Basis for entitlement Entitlement to care or to the reimbursement of the costs of care will only exist if and insofar as rights can be derived from the insurance policy, the determining factor being the date on which or the period within which the relevant form of care was provided. Where these insurance terms and conditions refer to a calendar/policy year, the actual date of treatment or date on which the services/goods were supplied as stated by the health care provider will determine to which calendar/policy year the claimed costs should be allocated. In cases involving a Diagnose Behandeling Combinatie (DBC), the costs will be allocated to the calendar year in which the DBC was opened. In cases where Together for a perfectly insured future 9

10 treatment is spread across two calendar years and the care provider is entitled to charge a single amount (DBC), the costs will be reimbursed provided that treatment commenced within the term of the supplementary insurance. 2.7 Entitlement to care and other services where the need arises as the result of an act of terrorism If the need for care or another service is the result of one or more acts of terrorism and the total amount in damages claimed in relation to such acts in any calendar year from non-life, life or funeral services (benefits in kind for funerals) insurers to which the Wft (Act on Financial Supervision) applies, will - according to the expectations of the NHT (Dutch Reinsurance Company for Damages Resulting from Acts of Terrorism) - be higher than the maximum amount reinsured by that company per calendar year, the insured person will only be entitled to compensation of the costs of care and other services up to a maximum to be determined by the NHT, which for all insurances will be equal to the percentage of the costs or value of the care or other services. The precise definitions and provisions applicable to the above entitlement are detailed in the NHT Terrorism Cover Clauses Sheet. Said Clauses Sheet forms part of these insurance terms and conditions and is available on request. See also Protection of personal data The personal data provided when applying for or amending an insurance and any supplementary personal or administrative data to be submitted will be processed in IAK s personal data file. Such data will be used for the following purposes: to enter into and administer insurance agreements or financial services; to manage the customer relationships arising from the above; for activities aimed at increasing the customer base; for research among insured persons to establish whether the care has actually been delivered; for research into what insured persons think of the quality of the care delivered; for statistical analysis; to comply with statutory obligations; in the context of the security and integrity of the financial sector and the prevention and combating of fraud. The processing of personal data is governed by the Gedragscode Verwerking Persoonsgegevens Zorgverzekeraar (Code of Conduct on the processing of personal data by health care insurers). The code of conduct is available on or on request. From the inception date of the supplementary insurance, the health care insurer may: contact third parties (e.g. health care providers and suppliers) to request or provide any information it considers necessary in order to fulfil its obligations under the supplementary insurance(s); enter the BSN (social insurance and tax number) in the records. Care providers are required by law to quote the BSN in all communications. The health care insurer will quote the BSN in all communications with the care providers, and will comply with privacy legislation in all such correspondence. 2.9 Notifications Notifications sent to the last postal address or address known to the health care insurer will be deemed to have reached the policyholder or the insured person. If the policyholder opts to contact the insurer electronically, then the insurer will also send electronic notifications to the policyholder. Where the term in writing is used in these insurance terms and conditions in this context, the term will also be taken to mean by . Similarly, in this context address will also be taken to mean address Fraud Substantive tests and fraud investigations will be carried out in compliance with the provisions pertaining to health care insurance laid down in the Zvw. If IAK or the health care insurer detects fraud, this will result in any entitlement to care or reimbursement of the cost of care under this insurance being forfeited, including in relation to claims where no fraud has actually been detected. Detected fraud can also result in the health care insurer (or IAK on behalf of the health care insurer): recording in the incident register of the health care insurer the personal data of the person committing fraud and the person considered to be an accessory or participant. This incident register is registered with the CBP (Data Protection Authority) and maintained by IAK and/or the health care insurer s Security department; informing the CBV (Centre for Combating Insurance Fraud) that forms part of the Verbond van Verzekeraars (Association of Insurers); terminating the insurance(s) and refusing to enter into new insurance policies for a period of 8 years; terminating running non-life and other insurance(s); recording the incident in the internal and external warning systems recognized by financial institutions, i.e. the IVR (Internal Referral Register) and the EVR (External Referral Register); claiming back/recovering from policyholder and/or the insured person reimbursements already paid out; submitting a statement to the police, the judiciary and/or the FIOD-ECD (Fiscal Intelligence and Investigation Service & Economic Investigation Service); claiming/recovering the necessarily incurred costs relating to investigations etc. from the policyholder and/or the insured person Reflection period Having entered into the insurance contract, the policyholder may cancel the policy in writing or by within 14 days from the date on which the insurance agreement was entered into, or - if this is later - 14 days from the date of receipt of the insurance terms and conditions, without being required to give reasons. The insurance contract will then be deemed not to have been concluded. 10

11 2.12 Applicable law The insurance is governed by Dutch law. 3 Premium 3.1 Premium payable The policyholder is required to pay premiums. Insured persons are not required to pay premiums under the Compact, Compleet and Extra Compleet supplementary health care insurances until the first day of the calendar month following the calendar month in which they reach the age of 18. Group contract The premiums and conditions as agreed in the group contract apply from the day on which the insured person is covered under the contract and continue to apply until the day on which the insured person no longer meets the criteria for participation in this group contract. The policyholder/insured person can only participate in one group health insurance contract. The insurance terms and conditions (including the premium and premium payments) as applicable under the individual policy, will apply from the date following the day on which the insured person no longer meets the criteria for participation in the group health insurance contract in question. 3.2 Payment of premium, statutory contributions and costs The policyholder is obliged to pay the premium as well as Dutch (and, where applicable, foreign) statutory contributions monthly in advance for all insured persons, unless specifically agreed otherwise. If the premium is paid annually in advance, a premium discount will be awarded. The amount of the discount will be shown on the policy schedule. The premium must be paid according to the method agreed with the health care insurer. Payment options with no extra charge attached The policyholder can authorise the health care insurer to collect the amounts owed by direct debit, or the policyholder can pay the premium via Accept . There is no extra charge attached to these payment methods. Charge for payment via paper payment slip If the policyholder chooses not to make use of the payment options for which no charge is made, the policyholder will be sent a paper payment slip, in which case a charge will apply per payment slip. The policyholder will also be sent a paper payment slip if a direct debit cannot be executed. In that case, a charge per paper payment slip will also apply Direct debit authorisation applies to the payment of premiums, excess, individual contributions and other expenses. The direct debit of excess, individual contributions and other expenses due is subject to a maximum of Prior to the collection date, the health care insurer will inform the policyholder of the amount to be debited and the date on which collection will take place. The policyholder will be sent a payment slip or Accept in respect of any amounts over and above There will be no charge to the policyholder in cases where the decision to send a payment slip lies with the health care insurer. 3.3 Setoff The policyholder is not permitted to set off amounts he owes against amounts owed to him by the health care insurer. 3.4 Death Should the insured person die, the premium already paid will be refunded from the day after the date on which he or she died. 3.5 Overdue premium payments, statutory contributions and costs If the policyholder fails to meet the obligation to pay the premium, statutory contributions, excess and costs on time, the healthcare insurer will send a reminder. If payment is not made within the period named in the reminder (which period must be at least 14 days), the health care insurer may suspend coverage In the event of suspension of coverage, entitlement to care and/or reimbursement of care costs, as described in these insurance terms and conditions, will cease from the last premium due date before the reminder or a later date (to be stipulated). The policyholder will continue to owe the premium for the period of the suspension. Cover will resume from the day following the date on which the health care insurer receives the full amount due plus the costs as referred to in clause In the event of termination of the insurance contract, a new application for insurance can be submitted following payment of the amount due and any costs. The insurance will then take effect on 1 January of the subsequent calendar year The health care insurer is entitled to charge the policyholder administration costs, collection charges (both statutory and non-statutory) and statutory interest. Together for a perfectly insured future 11

12 3.5.4 If the policyholder has already been sent a reminder regarding failure to pay the premium, statutory contributions, excess, individual contributions or costs on time and the policyholder then fails to pay a subsequent invoice on time, the health care insurer will not be required to send the policyholder another separate written reminder The health care insurer may set off overdue premium and costs as referred to in paragraph against claims that the insured person has submitted and/or any other amounts the health care insurer owes to the insured person If the insurance policy is terminated because of a failure to pay the premium on time, the health care insurer can refuse to conclude a new insurance contract with the policyholder for a period of 5 years. 4 Other obligations 4.1 Obligations The policyholder and the insured person are obliged: to ask the attending practitioner to disclose the reasons for hospitalization to the health care insurer s medical advisor; to cooperate with the health care insurer, its medical advisor or those responsible for inspection so that the information can be acquired that is needed for the proper administration of the insurance; to submit a referral from the attending general practitioner, company doctor or medical specialist, stating that the care and/or transport being provided is medically necessary, in cases where authorisation is required under the insurance terms and conditions; to inform the health care insurer about any facts that might mean that expenses may be recovered from liable (or potentially liable) third parties, and to provide the health care insurer with the necessary information in this regard. In this context, the insured person will not make any arrangements with any third parties without the prior written approval of the health care insurer. The insured person will refrain from any actions that may prejudice the interests of the health care insurer; to inform the health care insurer as soon as possible (but no later than two months after the change has taken place) of all facts and circumstances that might be relevant to the proper administration of the insurance. Such changes include birth, adoption, death or a different bank or giro account number. The health care insurer bears no risk whatsoever where the policyholder/insured person fails to inform it of the above changes. If the above obligations are not fulfilled and as a result the interests of the health care insurer are harmed, the health care insurer may suspend entitlement to care and/or the reimbursement of health care costs. 4.2 Submitting invoices and the deadline for submitting claims Most care providers send the invoices directly to us. If you have received an invoice, you can complete a claim form and send it to us together with the original invoice. Please do not send us a copy or a reminder. We can only process original invoices. It is important that the following information is shown on the invoice: the name and date of birth of the insured person, the treatment received, the date of said treatment, the invoice amount and the initials of the care provider. Also, you should always not your insurance number (or client number) in the top right-hand corner of the invoice. Invoices must be itemised in such a way that we can readily deduce which reimbursement we are required to pay without needing to make further enquiries. We will deduct excess and any statutory individual contribution from the reimbursement. When converting foreign invoices to Euros we use the historical rates quoted on XE.com, taking as our basis the exchange rate on the date on which the treatment took place. You can submit invoices up to a maximum of 3 years after the date on which treatment commenced. If the invoice you receive comes from outside the Netherlands, you should complete the Foreign medical expenses claim form. You can find the form on our website. IAK always makes payments to the policyholder, and transfers the money to the last known account number. 4.3 Submitting claims online The policyholder/insured person can use the online claims service or the IAK health care app on his/her mobile telephone. Information about this service can be found on our website Once the claim has been submitted, the original invoice should be retained for one year, as the health care insurer may want to see the invoices as part of their monitoring procedure. If the policyholder/insured person is unable to produce an invoice for inspection, the amount that has already been reimbursed in relation to that invoice may be reclaimed or set off against amounts owed to the insured person. 4.4 Direct payment We have the right to pay the costs of care directly to the care provider. Upon such payment, your entitlement to reimbursement shall expire. 4.5 Settlement of costs When we pay the care provider directly, we do not take into account with any excess or individual contribution that may be due. We charge any such amounts to you, the policyholder, later. You are obliged to pay said amounts. We can, if necessary, set these amounts off against amounts we owe you. 4.6 Referral, prescription or permission/authorisation For some forms of care, a referral, prescription and/or prior written permission is required, as proof that the insured person actually needs the care. Where this is the case, it is indicated clearly in the relevant article of this document. 12

13 In cases where prior written permission (also referred to as authorization) is required, if the insured person fails to acquire said authorisation, he/she will not be entitled to care/reimbursement of the costs of care. If the insured person goes to a care provider with whom the health care provider has entered into a contract, he/she does not need to apply for authorization. In that case, the care provider will judge whether the insured person meets the conditions and/or will approach the health care provider for authorisation. If the insured person goes to a care provider with whom the health care insurer has not entered into a contract, the insured person must apply to the health care insurer for authorisation. 4.7 Interests If the interests of the health care insurer are prejudiced as a result of failure to perform the obligations named in 4.1 above, the health care insurer may suspend entitlement to care or reimbursement of the costs of care as outlined in these insurance terms and conditions. 5 Amendments to premium and terms and conditions 5.1 Amendments to premium and terms and conditions The health care insurer is entitled to amend these insurance terms and conditions and the premium for the health care insurances to which they refer at any time. The health care insurer will notify the policyholder of any intended amendments. Such amendments will take effect for each insurance on a date to be specified by the health care insurer. In the case of group insurance contracts, the terms under which terms and conditions and/or premiums may be reviewed may be laid down in greater detail in the group contract. 5.2 Right to give notice of termination If the health care insurer increases the premiums and/or changes the insurance terms and conditions to the disadvantage of the policyholder or insured person, the policyholder will be entitled to give notice of termination of the contract from the day on which the increase or change becomes effective, and in any event at any time during a period of one month after the policyholder has been notified of the change. However, the right to give notice of termination will not apply in cases where the change to the insurance terms and conditions is a direct consequence of statutory measures, legislation or provisions, or where the increase in the premium is a direct result of the insured person to whose age the premium is linked having reached a certain age. 6 Inception, term and cancellation 6.1 Inception and term The insurance will commence on the date stated on the policy schedule or on 1 January of a calendar year and will apply throughout the calendar year in which the policy inception date falls. After this period has expired, the policy will be renewed tacitly for one calendar year at a time. From the date on which the insurance takes effect, the health care insurer may supply information to and gather information from third parties (health care providers, suppliers and the like) as far as deemed necessary in order to fulfil the obligations of the insurance All insured persons aged 18 and older who are included on the policy have the option of taking out a supplementary insurance policy of their choice. Children under 18 years of age are covered under the same supplementary insurance as the adult included on the policy with the highest level of cover. 6.2 Switching to a different insurance The policyholder has the right to change to a different insurance policy with effect from 1 January of any year. In that case, the policyholder must inform the health care insurer of the change by 31 December at the latest. The health care insurer may set special conditions to be applied to the granting of supplementary insurance, such as the requirement to submit a completed and signed health certificate. 6.3 Cancellation by operation of law The health care insurances described in these insurance terms and conditions will be cancelled by operation of law with effect from the day following the date on which: the health care insurer is no longer allowed to offer health care insurances, due to changes in or a revocation of its licence to operate a non-life insurance company; the insured person dies; the insured person s obligation under the Zvw to take out insurance comes to an end; the insured person takes up permanent residence abroad, unless the health care insurer stipulates otherwise; the health care insurer ceases to offer and administer these insurances. The policyholder will inform the health care insurer immediately of all facts and circumstances about the insured person that have led or might lead to the cancellation of the insurance. If on the basis of the information referred to above the health care insurer comes to the conclusion that the insurance must be cancelled or has already been cancelled, it will notify the policyholder to that effect immediately, stating the reason and the date on which the insurance was cancelled or is to be cancelled. Together for a perfectly insured future 13

14 If the insurance is to be cancelled on the basis of above, the health care insurer undertakes to inform the policyholder at least 3 months beforehand of said cancellation. 6.4 Cancellation by the policyholder The policyholder may submit notice of cancellation of the insurance in writing or by no later than 31 December of any year, to take effect from 1 January of the subsequent calendar year; simultaneously with the cancellation of the statutory IAK Health Care Insurance; in any of the situations described in article Cancellation dissolution or suspension by the health care insurer The health care insurer may cancel, dissolve or suspend the insurance: because of failure to pay the premium on time as outlined in article 3.5; in cases of fraud as outlined in article 2.10; in the event that the policyholder and/or insured person deliberately fails to supply the health care insurer with complete and correct information or documents relevant to the administration of the insurance that may/will disadvantage the health care insurer; if the policyholder and/or the insured person has deliberately acted with the intention of misleading the health care insurer or if the health care insurer would not have entered into a health care insurance if it had been aware of the true state of affairs. In such cases, the health care insurer can cancel the insurance within two months of discovery and with immediate effect. The health care insurer will not, then, be required to make any payments, or may opt to reduce the payment amount. The health care insurer may set off the debt owed as a result of the above deception against other payments/benefits. 6.6 Health risk The health care insurer may not cancel or amend the insurance in response to an increase in health risk, insofar as said risk relates to the insured person as an individual. 7 Exclusions There will be no entitlement to care or the reimbursement of the costs of care: relating to illnesses or disorders that already existed before or at the time when the insurance was entered into and of which the insured person was aware or could have been aware or in relation to which he was already experiencing symptoms but of which the health care insurer was not informed in writing. This exclusion will not apply in cases where the insurance was effected without prior medical or dental selection; relating to written statements, mediation fees that are not accompanied by a written agreement from the health care insurer, administration charges, costs of missed appointments or costs incurred as a result of failure to pay the invoices submitted by health care providers on time; where these are incurred as a result of gross negligence or intention; arising from individual contributions or excess payable under a different insurance, unless otherwise specified in these insurance terms and conditions; relating to which a claim could be submitted under the AWBZ, where the insured person was insured under this act; relating to which a claim could be submitted under a different insurance (possibly dated earlier) or under a different act or provision if the insurance with the health care insurer had not existed. In such cases, all the alternative options listed above will apply before this insurance applies, and even then payment under these insurance terms and conditions will remain restricted to any amount exceeding the amount that the insured person would be able to claim elsewhere; where a claim can or could be made under a health care policy based on the Zvw or an equivalent health care or medical insurance; the health care insurer operates in accordance with the Convenant samenloop zorgverzekering/ reisverzekering (Agreement on the concurrence of health care/travel insurance policies). See also caused by or resulting from armed conflict, civil war, uprising, civil disorder, riots or mutiny, as defined in article 3.38 of the Wft; resulting from damage that is indirectly caused by actions taken by or negligence on the part of the health care insurer; in cases where the costs are charged by a partner, child, parent or other family member living in the same house who is treating himself/herself, unless the health care insurer has granted prior authorization. 8 Complaints and disputes 8.1 Complaints and disputes relating to the administration of the insurance 14

15 8.1.1 Complaints and disputes relating to the administration of the insurance should be addressed to the management of the health care insurer s Health Care Complaints department or sent per to zorgklachten@iak.nl. Complaints can also be submitted via our website The Health Care Complaints department acts on behalf of the management A 'dispute' is defined as a difference of opinion with regard to a decision relating to the administration of the insurance taken by the health care insurer and upheld following reconsideration, as a result of which the interests of the policyholder or insured person are affected. All other cases are referred to as 'complaints' The health care insurer will decide on its final position or reconsider its original decision within a period of 30 days. If the policyholder or the insured person does not agree with the opinion of the health care insurer or if the health care insurer has not responded within a period of 30 days, the policyholder or the insured person can submit his/her complaint or dispute to the SKGZ (Health Insurance Complaints and Disputes Commission), Postbus 291, 3700 AG Zeist, or via Alternatively, the policyholder or the insured person may, in such cases, submit his/her complaint or dispute to the competent court. 8.2 Complaints about forms used by the health care insurer Complaints about forms used by the health care insurer should be submitted to the health care insurer's Health Care Complaints department. It is also possible to download a complaints form via Once the health care insurer has been informed of a complaint and the health care insurer has made its definitive position known or has not responded within a period of 30 days following submission of the complaint, a complaint as detailed under paragraph can be submitted by the policyholder or the insured person to the NZa (Dutch Care Authority), Information Line/Complaints Office, Postbus 3017, 3502 GA Utrecht, informatielijn@nza.nl. The above complaints relate to forms that, in the opinion of the policyholder or insured person, are redundant or unnecessarily complicated. The decision of the NZa will be binding on the policyholder, insured person, health care provider and health care insurer. 9 Care mediation and waiting list mediation The insured person will be entitled to care mediation in cases where there the waiting time is unacceptably long for medical specialist care, dental surgery, psychological care or any other form of care to which waiting time applies and which care can be provided by a health care provider under the terms of this policy. If there is an unacceptably long waiting time, the insured person can request care mediation by calling the health care insurer s Health Care Advice department on +31 (0) The insured person can also call this department to ask general questions about care, for instance when looking for a care provider with a certain type of expertise or needing advice on how to go about finding the right care. The health care insurer will examine all the options together with the insured person. 10 Final provision The health care insurer will decide on all matters not covered by these insurance terms and conditions. Together for a perfectly insured future 15

16 II Compact Cover Extent of the cover Reimbursement will be provided for the following costs of care or services insofar as there is no entitlement (or no longer any entitlement) to such reimbursement under the IAK Health Care Insurance based on the Zvw or pursuant to one or more of the supplementary insurances described in these insurance terms and conditions that have been entered into supplementary to the IAK Health Care Insurance (main insurance). 1 Alternative medicine and special remedies 1.1 Reimbursement of the cost of alternative treatments, consultations and alternative movement-related therapies: a. acupuncture and other traditional Eastern medicines; b. anthroposophy; c. homeopathy; d. natural remedies; e. psychosocial care from age 18; f. podotherapy (with the exception of aids made for the treatment, including arch supports); g. haptotherapy; h. craniosacral therapy; i. chiropractic treatment; j. osteopathy; k. manual therapy (eggshell method); l. manual/orthomanual medicine; m. Van Dixhoorn relaxation and breathing therapy. The care named under a. to m. above must be provided by a care provider designated by the health care provider. You can find a list of designated care providers on our website. Alternatively, you can call us and ask for a list. For more information, see articles 2.4 and 2.5 of the General conditions section of these insurance terms and conditions. If you go to a care provider we have not designated, we will not reimburse the costs of care. 1.2 Reimbursement of the costs of medicines and aids registered under the Geneesmiddelenwet (Dutch Medicines Act) and homeopathic and/or anthroposophical medicines that have an HA or HM registration in the Taxe Homeopathic Z index list. The above medicines/remedies must be prescribed by a physician with a BIG registration, a general practitioner, a medical specialist, a dental surgeon or an obstetrician and must be supplied by a pharmacist or dispensing general practitioner. 1.3 Reimbursement of the costs of the treatments and consultations and/or medicines and aids named in 1.1 and 1.2 above is subject to the total maximum reimbursement amount per selected Topping stated on your policy schedule. A maximum of per insured person per day will be reimbursed for the costs of consultations and/or treatments provided by the above-named physicians and/or therapists, subject to said consultations and/or treatments being standard within this occupational group. The selected maximum reimbursement amount applicable to the Topping includes the following maximum reimbursement amount for medicines and aids: Alternative care 0 topping: Alternative care 100 topping: Alternative care 250 topping: Alternative care 400 topping: no coverage a total maximum of for treatments/consultations, medicines and aids a total maximum of , of which a maximum of will be reimbursed for medicines and aids a total maximum of , of which a maximum of will be reimbursed for medicines and aids 1.4 Points to note Alternative medicine does not include consultations and group or individual treatments in the following areas: prevention, wellbeing and/or self-fulfilment; community/public service delivery; problems relating to work, parenting and/or school; beauty enhancement; advice on diet and/or exercise in relation to weight problems. 16

17 2 Glasses/Lenses/Laser eye surgery (OptiekPlan) (if included under the insurance) Reimbursement according to the OptiekPlan options module for the costs of: prescription spectacle lenses (may include frames), up to a maximum of 1 pair of glasses per year or; prescription contact lenses up to a maximum of 365 sets of 1-day lenses, 12 sets of monthly lenses, 2 sets of sixmonthly lenses or 4 sets of quarterly lenses or 1 sets of lenses with a long lifespan up to a maximum of the savings amount accrued; laser eye surgery (refractive surgery) by a designated care provider. The maximum accruable savings amount is per insured person per policy year up to a total amount of If after three calendar years no claim has been submitted and no payment has been made, the accrued savings amount will be reserved until such time as a claim is submitted and reimbursement takes place. If reimbursement of costs takes place in a given policy year, any remainder of the savings amount for that policy year will expire and the savings amount in the policy year following the year in which the claim was submitted will once again be set at The spectacle lenses (including frames where applicable) or the contact lenses must be supplied by an optician or optical retailer. There are special benefits for you as a customer of IAK. See our website for the latest member benefits. Reimbursement of the costs of sunglasses and tinted spectacles/contact lenses is not included. N.B. Please submit your claims no later than 1 month following the end of the policy year in which you purchased spectacle lenses (with or without frames) or contact lenses so that we can notify you in good time about your savings amount for the new policy year. 3 Abroad 3.1 Urgent care during a holiday or temporary stay Reimbursement of the costs of essential emergency medical care due to an unforeseen illness that has arisen during the first 12 months of a stay in a foreign country on holiday, on a work-related trip or for study, up to a maximum of 200% of the costs that would have been reimbursed for equivalent treatment in the Netherlands. Entitlement to reimbursement exists exclusively subject to the maximum reimbursement payable under the policy and provided that there is an entitlement to care under the IAK Health Care Insurance. In such cases, the reimbursement granted will be of a supplementary nature. 3.2 Assistance/Alarm centre In the event of acute hospitalisation abroad, immediate contact must be made with the health care insurer or with the alarm centre of the Dutch emergency organisation SOS International. SOS International can be contacted day and night, also at weekends, on +31 (0) Repatriation Reimbursement of the costs of repatriation of sick or injured persons by ambulance and/or airplane, including the costs charged for accompaniment in cases where this is medically necessary. Intended repatriation must be reported in advance to the health care insurer or the SOS International alarm centre so that the medical necessity can be assessed. 4 Pharmaceutical care 4.1 Contraceptives Reimbursement of the costs of contraceptives for insured persons aged 21 and above that may be provided under the Regeling Zorgverzekering, such as the contraceptive pill, a contraceptive implant, IUD, ring or pessary, prescribed by a general practitioner or medical specialist and supplied by a pharmacy or dispensing general practitioner to insured persons aged 21 and above, for the first prescription for a new contraceptive pill/device, up to a maximum of the amount laid down in the Regeling Zorgverzekering and the GVS (Medicines Reimbursement System). The cost of the placement and removal of a contraceptive device such as an IUD will be reimbursed under the health care insurance irrespective of your age. If you are under 21 years of age, you are entitled under the health care insurance to the reimbursement of contraceptives such as the contraceptive pill, a contraceptive implant, IUD, ring or pessary. 4.2 Individual contribution Reimbursement of the individual contribution owed pursuant to the GVS set up by the government, subject to a maximum of per insured person per policy year. The GVS falls under the Regeling Zorgverzekering. Together for a perfectly insured future 17

18 5 Physiotherapy and remedial therapy Reimbursement of the costs of care such as is usually provided by physiotherapists and remedial therapists from a child physiotherapist, manual therapist or Cesar/Mensendieck remedial therapist, oedema therapist, psychosomatic therapist or pelvic floor physiotherapist, exclusively if and insofar as there is no entitlement (or no longer any entitlement) to such reimbursement under the IAK Health Care Insurance or one or more of the supplementary insurances described in these insurance terms and conditions. Reimbursement is subject to the maximum reimbursement amount per selected Topping as stated on your policy schedule. In the case of treatment of chronic conditions as defined in Appendix 1 of the Besluit Zorgverzekering, the invoice must be accompanied by a certificate from the attending practitioner showing the indication. It must be evident from the wording on the certificate that the treatment is medically indicated. You can find a list of care providers contracted by the health care insurer on our website. Alternatively, you can call us and ask for a list. For more information, see articles 2.4 and 2.5 of the General Conditions section of these terms and conditions. The costs of the following will not be reimbursed: antenatal exercises and maternity exercises, sports massage, occupational therapy and individual or group treatment or types of fitness training intended to improve the level of fitness. 6 Skin therapy Reimbursement of the costs of the following, up to a maximum of per insured person per policy year: camouflage lessons and the cost of purchasing the aids needed for these lessons; facial epilation by laser or other means for female insured persons; peeling in the case of severe acne; lymph drainage. Entitlement to reimbursement of these costs is subject to the care being provided by a skin therapist or beauty specialist on prescription by a general practitioner or medical specialist. 7 Medical aids (individual contributions) Reimbursement of the individual contributions that the insured person owes over and above the maximum reimbursement payable under the applicable Regeling Zorgverzekering named in the IAK Health Care Insurance, subject to a maximum of per insured person per policy year. A maximum may apply to the reimbursement of the individual contributions. Said maximum will be set at the discretion of the health care insurer. The health care insurer may make the reimbursement of the costs of purchasing or renting medical aids subject to its prior consent, at the discretion of the health care insurer and/or in conformity with the relevant provisions laid down in the Reglement Hulpmiddelen (Medical Aids Regulation). See 'IAK Vergoedingsregeling hulpmiddelen' for the reimbursement rates. 8 Preventive care A budget that you can spend on the following forms of preventive care: 8.1 Courses courses during pregnancy to prepare for delivery, organised by a home-care organisation, a midwifery centre, an obstetrician or a yoga teacher who is a member of the VYN (Netherlands Association of Yoga Teachers); courses designed to help participants cope with an illness and/or condition such as asthma, COPD, diabetes, joint disorders, cancer and cardio-vascular disease, subject to such courses being organised by a patient society that is a member of or is affiliated to the NPCF (Dutch Patient Consumer Federation) or a home-care organisation; courses on coping with dementia organised by a home-care organisation, the GGD (Municipal Health Service) or a GGZ (mental health care) institution; first aid courses run by a recognised society/organisation; reanimation courses given by an instructor or organisation certified by the NRR (Dutch Reanimation Council). For a list of patient societies, go to Under the heading NPCF you will find a link onze leden. 8.2 Sports Medicine Advice Treatment sessions, consultations and physical examinations provided by a sports medicine doctor working for a sports medicine organisation affiliated to the FSMI (Federation of Sports Medicine Organisations). 18

19 8.3 Vaccinations in connection with foreign travel Reimbursement of essential vaccinations, consultations and/or preventive medication in connection with travel to foreign countries, against: hepatitis A/B, DTP, yellow fever, typhoid, cholera, meningococcal or other meningitis, rabies, malaria, tuberculosis, Japanese encephalitis or tick-borne encephalitis subject to these being provided/administered by a general practitioner or a physician recognised by the LCR (National Coordination Centre for Advice to Travellers) and qualified to vaccinate against yellow fever. See for a list of addresses. Vaccinations and/or medication in connection with business trips or business-related visits to other countries do not qualify for reimbursement. Reimbursement The preventive care named in this article is subject to a total maximum reimbursement of per insured person per policy year. 9 Arch supports Reimbursement, up to a maximum of per insured person per policy year, of the costs of arch supports or insoles that support the joints, ligaments and joint capsules of the foot, on prescription from the general practitioner, medical specialist or podotherapist. These must be supplied by an orthopaedic shoemaker or shoemaking business or a podotherapist. 10 Seated patient transport Reimbursement of: the costs of seated patient transport (taxi, private vehicle or lowest class of public transport) if and insofar as there is no entitlement (or there is no longer entitlement) on the basis of the medical indications as mentioned in the IAK Health Care Insurance and the Decree and the Regeling Zorgverzekering that form part thereof, all at the discretion of the health care insurer and subject to the prior written permission of the health care insurer (in the event of transport by private vehicle, a certain amount will be reimbursed per kilometre, as laid down in the Regeling Zorgverzekering); the statutory individual contribution as mentioned in the Regeling Zorgverzekering that forms part of the IAK Health Care Insurance, per insured person per calendar year for seated patient transport (taxi or private vehicle). Reimbursement applies to medically necessary patient transport within the Netherlands, to and from a hospital or the address of the medical specialist's practice or to and from facilities that fall fully or partially under the AWBZ (Exceptional Medical Expenses Act). Transport to and from an AWBZ establishment for a care session lasting part of a day qualifies for reimbursement under the AWBZ. Together for a perfectly insured future 19

20 III Compleet Cover Extent of the cover Reimbursement will be provided for the following costs of care or services insofar as there is no entitlement (or no longer any entitlement) to such reimbursement under the IAK Health Care Insurance based on the Zvw or pursuant to one or more of the supplementary insurances described in these insurance terms and conditions that have been entered into supplementary to the IAK Health Care Insurance (main insurance). 1 Alternative medicine and special remedies 1.1 Reimbursement of the cost of alternative treatments, consultations and alternative movement-related therapies: a. acupuncture and other traditional Eastern medicines; b. anthroposophy; c. homeopathy; d. natural remedies; e. psychosocial care from age 18; f. podotherapy (with the exception of aids made for the treatment, including arch supports); g. haptotherapy; h. craniosacral therapy; i. chiropractic treatment; j. osteopathy; k. manual therapy (eggshell method); l. manual/orthomanual medicine; m. Van Dixhoorn relaxation and breathing therapy. The care named under a. to m. above must be provided by a care provider designated by the health care provider. You can find a list of designated care providers on our website. Alternatively, you can call us and ask for a list. For more information, see articles 2.4 and 2.5 of the General conditions section of these insurance terms and conditions. If you go to a care provider we have not designated, we will not reimburse the costs of care. 1.2 Reimbursement of the costs of medicines and aids registered under the Geneesmiddelenwet (Dutch Medicines Act) and homeopathic and/or anthroposophical medicines that have an HA or HM registration in the Taxe Homeopathic Z index list. The above medicines/remedies must be prescribed by a physician with a BIG registration, a general practitioner, a medical specialist, a dental surgeon or an obstetrician and must be supplied by a pharmacist or dispensing general practitioner. 1.3 Reimbursement of the costs of the treatments and consultations and/or medicines and aids named in 1.1 and 1.2 above is subject to the total maximum reimbursement amount per selected Topping stated on your policy schedule. A maximum of per insured person per day will be reimbursed for the costs of consultations and/or treatments provided by the above-named physicians and/or therapists, subject to said consultations and/or treatments being standard within this occupational group. The selected maximum reimbursement amount applicable to the Topping includes the following maximum reimbursement amount for medicines and aids: Alternative care 0 topping: Alternative care 400 topping: Alternative care 550 topping: Alternative care 650 topping: no coverage a total maximum of , of which a maximum of will be reimbursed for medicines and aids a total maximum of , of which a maximum of will be reimbursed for medicines and aids a total maximum of , of which a maximum of will be reimbursed for medicines and aids 1.4 Points to note Alternative medicine does not include consultations and group or individual treatments in the following areas: prevention, wellbeing and/or self-fulfilment; community/public service delivery; problems relating to work, parenting and/or school; beauty enhancement; advice on diet and/or exercise in relation to weight problems. 20