Policy Conditions * VGZ supplementary covers

Transcription

1 For further information: Policy Conditions * VGZ supplementary covers *Disclaimer Our conditions of insurance have been translated into English for the benefit of our English-speaking customers. The insurance agreement, which has already been concluded or will be concluded, has been drawn up in the Dutch language. This means that only the conditions of insurance drawn up in the Dutch language have force of law. Alle aandacht voor goede zorg

2 2 POLICY CONDITIONS VGZ SUPPLEMENTARY COVERS 2009 Contents I. SUBJECT INDEX 5 II. GENERAL SECTIOn 10 Clause 1. Definitions 10 Clause 2. General provisions Basis Medical grounds Basis for the right to care Corresponding documents Fraud Right to care and other services as a result of terrorist acts Protection of personal data Notices Reimbursement of healthcare costs Membership of the Cooperative Society Reconsideration period Dutch law 16 Clause 3. Premium Premium payable Group health insurance contract Payment of premium, statutory contributions and costs Claim Death Overdue payments 17 Clause 4. Other obligations Obligation Expense claim period for invoices Interests 18 Clause 5. Changes in the premium and conditions Changes in the premium and conditions Right to give notice 18 Clause 6. Inception, term and termination Inception and term Changes in the insurance Termination by operation of law Notice by the policyholder Termination, dissolution or suspension by Zorgverzekeraar VGZ Health risk Notice procedure 19 Clause 7. Complaints and disputes 19 Clause 8. Care and waiting list mediation 20 Clause 9. Exclusions 20 III. JONG & ZEKER PAKKET, GEZIN & ZEKER PAKKET AND VITAAL & ZEKER PAKKET 21 Medical care 21 Clause 1. Obstetric care and maternity care Obstetric care Birth kit 21 Maternity care Personal contribution towards maternity care Maternity care on adoption Maternity care de luxe 21 Nursing Consultation with a lactation consultant Electrical breast pump 22 Clause 2. Specialist medical care Circumcision Auricle correction Eyelid correction Sterilisation 23 Clause 3. Alternative care 24 Psychological care 25 Clause 4. Primary psychological care 25 Clause 5. Sex therapy 26 Clause 6. Group rehabilitation and group therapy for cancer patients 26 Paramedic care 27 Clause 7. Dietary advice 27 Clause 8. Movement-related care (physiotherapy, Cesar/ Mensendieck remedial therapy, occupational therapy and alternative movement therapy) 27 Clause 9. Skin treatments Acne treatment Camouflage therapy Depilation Psoriasis treatment 29 Clause 10. Stammer therapy 29 Clause 11. Foot treatments 29 Pharmaceutical care 30 Clause 12. Special diets 30 Medical appliances 30 Clause 13. Eye glasses and contact lenses 30 Clause 14. Hearing aids 31 Clause 15. Mammary prosthesis 31 Clause 16. Wigs 31 Clause 17. Footwear 31 Clause 18. Arch supports 32 Clause 19. Home monitor 32 Clause 20. Alarm device/urination alarm 32 CONTENTS

3 3 Stay 33 Clause 21. Convalescent home 33 Clause 22. Lodging costs 33 Clause 23. Therapeutic holiday camp for insured persons under the age of Clause 24. Care hotel 34 Transport 34 Clause 25. Transport relating to organ transplants 34 Clause 26. Travel costs for patient visits 35 Family 35 Clause 27. Family assistance 35 Clause 28. Child care 35 Approvals 36 Clause 29. Driving licence medical approval 36 Prevention 36 Clause 30. Courses, information and training 36 Clause 31. Incontinence Care Service 37 Clause 32. Gezond Leven Test 37 Clause 33. Flu vaccination 37 Clause 34. Sports medicine 38 Clause 35. Giving up smoking 38 Clause 36. VGZ VrijZeker Prevention of STDs Condoms 38 Clause 37. Care provided by a menopause consultant 39 Travel 39 Clause 38. Urgent care during holiday and temporary stays 39 Clause 39. Repatriation 39 Clause 40. Vaccination 40 Abroad 40 Clause 41. Statutory contributions in an EU/EEA country or convention territory other than the Netherlands 40 Dental care 40 Clause 42. Dental care 40 Clause 43. Orthodontic care For insured persons under the age of For insured persons of 22 and over 41 Absenteeism 41 Clause 44. Household assistance 41 Clause 45. Transport by taxi 42 IV. BEPERKTE AANVULLENDE VERZEKERING, UITGEBREIDE AANVULLENDE VERZEKERING AND PLUS AANVULLENDE VERZEKERING 43 Medical care 43 Clause 1. Obstetric care and maternity care Obstetric care Birth kit 43 Maternity care Personal contribution towards maternity care Maternity care on adoption 43 Postnatal care Postnatal care for the mother Postnatal care for the newborn baby 44 Nursing Consultation with a lactation consultant Electrical breast pump 44 Clause 2. Specialist medical care Circumcision Auricle correction Laser eye treatments Eyelid correction Sterilisation 46 Clause 3. Alternative care 46 Psychological care 48 Clause 4. Primary psychological care 48 Clause 5. Sex therapy 48 Clause 6. Group rehabilitation and group therapy for cancer patients 49 Paramedic care 49 Clause 7. Dietary advice 49 Clause 8. Movement-related care (physiotherapy, Cesar/ Mensendieck remedial therapy, occupational therapy and alternative movement therapy) 49 Clause 9. Skin treatments Acne treatment Camouflage therapy Depilation Psoriasis treatment 51 Clause 10. Stammer therapy 51 Clause 11. Foot treatments 52 Pharmaceutical care 52 Clause 12. Special diets 52 Medical appliances 52 Clause 13. Eye glasses and contact lenses 52 Clause 14. Hearing aids 53 Clause 15. Mammary prosthesis 53 Clause 16. Wigs 53

4 4 POLICY CONDITIONS VGZ SUPPLEMENTARY COVERS 2009 Clause 17. Footwear 54 Clause 18. Arch supports 54 Clause 19. Home monitor 54 Clause 20. Alarm device/urination alarm 55 Stay 55 Clause 21. Convalescent home 55 Clause 22. Lodging costs 55 Clause 23. Therapeutic holiday camp for insured persons under the age of Clause 24. Payment upon hospitalisation 56 Transport 56 Clause 25. Transport relating to organ transplants 56 Prevention 57 Clause 26. Courses, information and training 57 Clause 27. Incontinence Care Service 58 Clause 28. Gezond Leven Test 58 Clause 29. Flu vaccination 58 Clause 30. Sports medicine 59 Clause 31. Giving up smoking 59 Clause 32. Care provided by a menopause consultant 59 Travel 59 Clause 33. Urgent care during holiday and temporary stays 59 Clause 34. Repatriation 60 Clause 35. Vaccination 60 Abroad 61 Clause 36. Statutory contributions in an EU/EEA country or convention territory other than the Netherlands 61 Absenteeism 61 Clause 37. Household assistance 61 Clause 38. Transport by taxi 62 V. BASIS TAND 63 Clause 1. Dental care 63 Clause 2. Orthodontic care For insured persons under the age of For insured persons of 22 and over 63 VI. LUXE TAND 64 Clause 1. Dental care 64 Clause 2. Orthodontic care For insured persons under the age of For insured persons of 22 and over 64 CONTENTS

5 5 I. Subject Index II GENERAL III TARGET GROUP PACKAGES IV REGULAR SUPPLEMENTARY PACKAGES V BASIS TAND VI LUXE TAND Clause Pg. Clause Pg. Clause Pg. Clause Pg. Clause Pg. A Abroad, statutory contributions Abroad, travel 38,39,40 39,40 33,34,35 37,38 Acne Acupuncture Adapted ready-made footwear Alarm device, urination alarm Alternative care, healing and medicines Ambulance, transport by Arch supports Auricle correction B Batteries for a hearing aid Birth kit BOMA, stammer therapy Breast prosthesis, items Breast pump, electric C Camouflage therapy Care hotel, stay in a Care mediation, care and waiting list mediation 8 20 Cesar/Mensendieck remedial therapy Changes in the premium and conditions 5 18 Child care Child psychologist and youth psychologist, care provided by Chiropractor Circumcision Complaints and disputes 7 19 Condoms Consultation with a lactation consultant Contact lenses, eye glasses Convalescent homes Cooperative Society 1, ,16

6 6 POLICY CONDITIONS VGZ SUPPLEMENTARY COVERS 2009 II GENERAL III TARGET GROUP PACKAGES IV REGULAR SUPPLEMENTARY PACKAGES V BASIS TAND VI LUXE TAND Clause Pg. Clause Pg. Clause Pg. Clause Pg. Clause Pg. D Definitions 1 10 Del Ferro, stammer therapy Delivery, obstetric care and maternity care Dental care Depilation Diabetes foot, treatment of Diagnose Behandeling Combinatie (DBC) [Diagnosis Treatment Combination] 1,2.3 10,14 Dietary advice Driving licence, medical approval E Electrical breast pump Exclusions 9 20 Eyelid correction F Family assistance Flu vaccination Foot treatments Footwear, adapted ready-made Footwear, semi-orthopaedic Fraud 1,2.5 10,15 G General provisions 2 14 Gezond Leven Test Giving up smoking 30,35 36,38 26,31 57,59 Group health insurance contract Group rehabilitation and group therapy for cancer patients H Hausdörfer, stammer therapy Hearing aid, batteries Herstel en Balans [recovery and balance] Holiday camps, therapeutic Home monitor Homeopathy Household assistance 27,44 35, SUBJECT INDEX

7 7 II GENERAL III TARGET GROUP PACKAGES IV REGULAR SUPPLEMENTARY PACKAGES V BASIS TAND VI LUXE TAND Clause Pg. Clause Pg. Clause Pg. Clause Pg. Clause Pg. I Implantology Inception, term and termination of the insurance contract 6 66 Incontinence Care Service Information, courses and training K Kiwanis House L Laser eye treatments Lodging costs M Mammary prosthesis, items Manual therapy Maternity care Maternity care de luxe McGuire, stammer therapy Mediation, care and waiting list mediation 8 20 Medicines, alternative Menopause consultant, care provided by Mensendieck, remedial therapy MiX Aanvullende Verzekering Movement-related care Movement programmes Movement therapy, alternative N O Obligations, miscellaneous 4 17 Obstetric care Oedema therapy Organ transplants, transport relating to Orthodontic care Orthopaedic footwear Osteopath Other obligations 4 17

8 8 POLICY CONDITIONS VGZ SUPPLEMENTARY COVERS 2009 II GENERAL III TARGET GROUP PACKAGES IV REGULAR SUPPLEMENTARY PACKAGES V BASIS TAND VI LUXE TAND Clause Pg. Clause Pg. Clause Pg. Clause Pg. Clause Pg. P Paediatric physiotherapy Payment upon hospitalisation Physical tests Physiotherapy and Cesar/Mensendieck remedial therapy Podotherapy Postnatal care, mother and newborn baby 1.5, Premium Prevention, courses and information Primary psychological care Prosthetic device Protruding ears, correction of Psoriasis treatment Psychological care, primary R Ready-made footwear, adapted Remgelden (personal contributions) Repatriation Ronald McDonald House S Sex therapy Skin treatments Special diets Eye glasses and contact lenses Sports medicine Stammer therapy Statutory contributions abroad STD combating and prevention Sterilisation Monitor, home monitor Swimming, therapeutic T Taxi, transport by Therapeutic holiday camps Transport relating to organ transplants Travel costs for patient visits SUBJECT INDEX

9 9 II GENERAL III TARGET GROUP PACKAGES IV REGULAR SUPPLEMENTARY PACKAGES V BASIS TAND VI LUXE TAND Clause Pg. Clause Pg. Clause Pg. Clause Pg. Clause Pg. U Urgent care during holiday and temporary stays Urination alarm V Vaccination, due to holidays abroad VGZ Kraamzorg [VGZ Maternity Care] VGZ VrijZeker VGZ-Hulpdienst [VGZ Emergency Service] 38, , 34 59, 60 W Waiting list mediation, care and waiting list mediation 8 27 Wigs

10 10 POLICY CONDITIONS VGZ SUPPLEMENTARY COVERS 2009 II. General Section CLAUSE 1. DEFINITIONS The terms used in these VGZ supplementary covers are defined as follows: 1 Authorization: a written consent for receiving certain care provided by or on behalf of Zorgverzekeraar VGZ to the insured person, prior to his/her receiving that particular care. 2 AWBZ: the Algemene Wet Bijzondere Ziektekosten [Exceptional Medical Expenses Act]. 3 Beautician: a beautician in possession of the Schoonheidsverzorging-B [Beauty specialist s] diploma, supplemented by the Camouflage diploma for camouflage therapy, the Elektrisch ontharen diploma for electrical depilation and the Acne diploma for acne treatment. 4 Besluit Zorgverzekering [Healthcare Insurance Decree]: Decree of 28 June 2005, including all amendments up to 1 January 2009, providing for an Order in Council as referred to in Sections 11, 20, 22, 32, 34 and 89, of the Zvw [Healthcare Insurance Act]. 5 BIG Act: the Wet op de beroepen in de individuele gezondheidszorg [Professions in Individual Healthcare Act]. 6 Breathing and relaxation therapist: a person who is certified to provide Breathing and Relaxation Therapy, Van Dixhoorn method, and is a member of the Van Dixhoorn Association for Breathing and Relaxation Therapy. 7 Care hotel: an establishment contracted as such by Zorgverzekeraar VGZ, in which, in a hotel-like setting, 24-hour care and services, at a minimum consisting of nursing and care, are guaranteed. 8 Cesar remedial therapist, Mensendieck remedial therapist: a person who, pursuant to Article 18 of the Besluit diëtist, ergotherapeut, logopedist, mondhygiënist, oefentherapeut, orthoptist en podotherapeut [Dieticians, Occupational Therapists, Speech Therapists, Oral Hygienists, Remedial Therapists, Orthoptists and Podotherapists Decree] is entitled to use the title of remedial therapist. 9 Cesar/Mensendieck paediatric remedial therapy: a remedial therapist who is registered as a paediatric remedial therapist in the Cesar/Mensendieck register for specialist remedial therapists. 10 Cesar/Mensendieck psychosomatic remedial therapist: a remedial therapist who is registered as a psychosomatic remedial therapist in the Cesar/Mensendieck register for specialist remedial therapists. 11 Child psychologist: a person who is registered as a child psychologist in the register of child psychologists maintained by the Nederlands Instituut van Psychologen (NIP) [Dutch Professional Association of Psychologists]. 12 Circumcision centre: a centre which specialises in performing circumcisions and is contracted to Zorgverzekeraar VGZ. 13 Company doctor: a physician who is registered as a company doctor in the register of recognised social physicians maintained by the Sociaal-Geneeskundige Registratie Commissie (SGRC) [Social-Medical Registration Committee] of the Koninklijke Nederlandsche Maatschappij tot Bevordering der Geneeskunst [Royal Dutch Medical Association] and is contracted by VGZ and may be employed by a certified working conditions service contracted by VGZ. 14 Convention territory: a country that does not belong to the European Union or EEA with which the Netherlands has entered into a social security convention including provisions for rendering medical care. These include the following countries: Australia (for holidays/temporary stay), Bosnia- Herzegovina, Cape Verde Islands, Croatia, Macedonia, Morocco, Serbia-Montenegro, Tunisia and Turkey. 15 Cooperative Society: the Cooperative Society with exclusion of liability Coöperatie VGZ-IZA-Trias-Groep U.A. is part of Univé-VGZ-IZA-Trias. 16 Craniosacral therapist: a person who is registered as such in the register of Craniosacraal Therapie Nederland (RCN) [Craniosacral Therapy Netherlands] or is a member of the Nederlandse Cranio-Sacraalvereniging (NCSV) [Dutch Association of Craniosacral Therapists]. 17 Dental surgeon: a dental specialist who is registered in the specialists register for oral diseases and dental surgery of the Nederlandse Maatschappij tot bevordering der Tandheelkunde [Dutch Dental Association]. 18 Dentist: a person who is registered as such in the register as referred to in Section 3 of the BIG Act (Wet op de beroepen in GENERAL SECTION

11 11 de individuele gezondheidszorg) [Professions in Individual Healthcare Act]. 19 Diagnose Behandeling Combinatie (DBC) [Diagnosis Treatment Combination]: by means of a DBC performance code, as determined by the NZa [Dutch Healthcare Authority], a DBC describes the closed and validated regimen of medical specialist care and specialist mental health care (second-line curative mental health care). This comprises the care need, care type, diagnosis and treatment. The DBC regimen starts as soon asthe insured person registers his/her care need, and ends at the end of the treatment or after 365 days. 20 Dietician: a person who pursuant to Article 2 of the Besluit diëtist, ergotherapeut, logopedist, mondhygiënist, oefentherapeut, orthoptist en podotherapeut [Dieticians, Occupational Therapists, Speech Therapists, Oral Hygienists, Remedial Therapists, Orthoptists and Podotherapists Decree] is entitled to use the title of dietician and is contracted to Zorg verzekeraar VGZ. 21 Dispensing general practitioner: a general practitioner who has been granted a permit to provide medicines, pursuant to Section 61, tenth or eleventh subsection, of the Wet op de geneesmiddelen [Medicines Act] to insured persons registered to his/her practice. 22 Employee: the employee as defined in the group health insurance contract. 23 Employer: the company or establishment as defined in the group health insurance contract. 24 Establishment: 1. an establishment in the sense referred to inthe Wet toelating zorginstellingen [Care Institutions (Eligibility) Act]; 2. a legal entity with its primary place of business abroad that provides care in the countryin questionin accordance with the local social security system or focuses on providing care to specific groups of public officials. 25 European Union and EEA Member State: includes the following countries other than the Netherlands within the European Union: Austria, Belgium, Bulgaria, Denmark, Estonia, Finland, France, Germany, Greece, Greek Cyprus, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, the Czech Republic, the United Kingdom. Under convention provisions, Switzerland is considered equivalent to these countries. EEA countries (Member States party to the Agreement on the European Economic Area) are also included: Iceland, Liechtenstein and Norway. 26 Fraud: the commission or attempted commission of forgery, deception, non-disclosure of facts that may be relevant to the performance of the insurance, actions detrimental to the rights of title holders and/or misappropriation by the parties and organizations party to a health insurance contract in the process of entering into and/or performing such a contract, and with the object of obtaining a benefit or performance to which the party is not entitled, or obtaining insurance coverage under false pretences. 27 General practitioner: a physician registered as a general practitioner in the register of the Huisarts, Verpleeghuisarts en arts voor verstandelijk gehandicapten Registratie Commissie (HVRC) [General Practitioners, Nursing Physicians and Doctors for the intellectually disabled Registration Committee] of the Koninklijke Nederlandsche Maatschappij tot bevordering der Geneeskunst [Royal Dutch Medical Association]. 28 Geriatric physiotherapist: a physiotherapist registered as a geriatric physiotherapist in the register for specialist physiotherapists of the Koninklijk Nederlands Genootschap voor Fysiotherapie [Royal Dutch Association for Physiotherapy]. 29 GGD: the Municipal Health Service. 30 GGZ: Geneeskundige Geestelijke gezondheidszorg [Mental Health Care]. 31 GGZ-establishment: an establishment providing medical care pertaining to a psychiatric condition, licensed as such under the Wet toelating zorginstellingen [Care Institutions (Eligibility) Act]. 32 Group health insurance contract: a contract concluded between Zorgverzekeraar VGZ and an employer or legal person with the object of offering participants the option to obtain a VGZ Zorgverzekering, VGZ Restitutieverzekering and any VGZ supplementary coverage under the conditions described in the contract. 33 Haptotherapist: a person registered as a member of the Association of Haptotherapists (VVH).

12 12 POLICY CONDITIONS VGZ SUPPLEMENTARY COVERS Healthcare Insurance: a non-life insurance taken out by the policyholder with a healthcare insurer for a person obliged to take out insurance: this insurance should comply with the relevant provisions in or pursuant to the Zvw, and the performances it covers should not exceedexceed the provisions laid down in or pursuant to this Act. 35 Healthcare psychologist: a person registered as such in the register referred to in Section 3 of the BIG Act (Wet op de beroepen in de individuele gezondheidszorg) [Professions in Individual Healthcare Act]. 36 Healthcare Regulations: the Regulations instated by the minister of Health, Welfare and Sports on 1 September 2005, number Z/VV , outliningrules for the implementation of the Zvw. 37 Hospital: an establishment for specialized medical care that is duly licensed under the Wet toelating zorginstellingen (WTZi) [Care Institutions (Eligibility) Act]. Hospital stays of 24 hours or longer are covered. 38 Independent treatment centre: an establishment for specialised medical care that is duly licensed under the Wet toelating zorginstellingen (WTZi) [Care Institutions (Eligibility) Act]. A stay of 24 hours or more for any treatment of which the DBC in question has been classified in the A-segment is not covered. 39 Insurance: one or more insurance contracts described in these Policy Conditions. 40 Insured person: a person for whose benefit this insurance contract has been taken out and who is referred to in the policy schedule or on another certificate of insurance issued by Zorgverzekeraar VGZ. 41 Lactation consultant: a lactation consultant in possession of the international diploma International Board Certified Lactation Consultant (IBCLC) who is registered with the Dutch Association of Lactation Consultants (NVL). 421 Manual therapist: a physiotherapist who is registered as a manual therapist in the register for specialist physiotherapists of the Koninklijk Nederlands Genootschap voor Fysiotherapie [Royal Dutch Association for Physiotherapy], or is a member of the Association of Manual Therapists (VMT) in the capacity of manual therapist E.S.. 43 Maternity assistant: a qualified maternity assistant or a nurse working in that capacity. 44 Maternity centre: an establishment licensed as such according to or pursuant to the provisions laid down by law as well as the establishment recognised as such by Zorgverzekeraar VGZ and contracted to Zorgverzekeraar VGZ. 45 Medical specialist: a physician who is registered as medical specialist in one of the registers established by the Medisch Specialisten Registratie Commissie (MSRC) [Specialists Registration Committee] of the Koninklijke Nederlandsche Maatschappij tot bevordering der Geneeskunst [Royal Dutch Medical Association]. 46 Medicines: the medicines referred to in Article 2.8, first paragraph, opening sentence and under a and b of the Besluit zorgverzekering [Healthcare Insurance Decree]. 47 Menopause consultant: a nurse who has completed the specialist course for menopause consultants at the Care for Women organization or who has joined the Women s Life menopause practice. 48 Midwife: a person registered as such in the register referred to in Section 3 of the BIG Act (Wet op de beroepen in de individuele gezondheidszorg) [Professions in Individual Healthcare Act]. 49 Nurse: a person registered as such in the register referred to in Section 3 of the BIG Act (Wet op de beroepen in de individuele gezondheidszorg) [Professions in Individual Healthcare Act]. 50 NZa: the Nederlandse Zorgautoriteit [Dutch Healthcare Authority], as defined in the Wet marktordening gezondheidszorg [Healthcare Market Organization Act]. 51 Occupational therapist: a person entitled to use the title of occupational therapist pursuant to Article 6 of the Besluit diëtist, ergotherapeut, logopedist, mondhygiënist, oefentherapeut, orthoptist en podotherapeut [Dieticians, Occupational Therapists, Speech Therapists, Oral Hygienists, Remedial Therapists, Orthoptists and Podotherapists Decree]. 52 Oedema therapist: a physiotherapist registered as an oedema therapist in the register for specialist physiotherapists of the Koninklijk Nederlands Genootschap voor Fysiotherapie [Royal Dutch Association for Physiotherapy]. GENERAL SECTION

13 13 53 Oral hygienist: a person entitled to use the title of oral hygienist pursuant to Article 14 of the Besluit diëtist, ergotherapeut, logopedist, mondhygiënist, oefentherapeut, orthoptist en podotherapeut [Dieticians, Occupational Therapists, Speech Therapists, Oral Hygienists, Remedial Therapists, Orthoptists and Podotherapists Decree]. 54 Orthodontist: a dental specialist registered in the specialists register for dento-maxillary orthopaedics of the Nederlandse Maatschappij tot bevordering der Tandheelkunde [Dutch Dental Association]. 55 Orthomanual practitioner: a physician who is a member of the Nederlandse Vereniging van artsen voor OrthoManuele Geneeskunde (NVOMG) [Dutch Society of OrthoManual Medicine] or is listed in the Register OrthoManuele Geneeskunde (ROMG) [Register of OrthoManual Medicine]. 56 Paediatric physiotherapist: a physiotherapist registered as a paediatric physiotherapist in the register for specialist physiotherapists of the Koninklijk Nederlands Genootschap voor Fysiotherapie [Royal Dutch Association for Physiotherapy]. 57 Pedicure with diabetes foot certification: a pedicure in possession of valid Chiropody for Diabetics certification from the Kennis- en Ontwikkelingscentrum Uiterlijke Verzorging (KOC) [Knowledge and Development Centre for Surface Treatments] or Diabetes Foot certification from the Nederlandse Organisatie Huid en Voetverzorging (NOHV) [Dutch Skin and Foot Care Organization]/Landelijke Organisatie Pedicure in de Zorg (NOHV/LOPZ) [national organisation for pedicure in the healthcare sector]. 58 Pelvic floor therapist: a physiotherapist registered as a pelvic floor therapist in the register for specialist physiotherapists of the Koninklijk Nederlands Genootschap voor Fysiotherapie [Royal Dutch Association for Physiotherapy]. 59 Pharmacist: a person who is registered in the register of established pharmacists referred to in Section 61, fifth subsection, of the Wet op de geneesmiddelen [Medicines Act]. 60 Physician: a person registered as such in the register referred to in Section 3 of the BIG Act (Wet op de beroepen in de individuele gezondheidszorg) [Professions in Individual Healthcare Act]. 61 Physiotherapist: a person registered as such in the register referred to in Section 3 of the BIG Act (Wet op de beroepen in de individuele gezondheidszorg) [Professions in Individual Healthcare Act]. The term physiotherapist also denotes a remedial gymnast/masseur according to Section 108 of the BIG Act. 62 Podotherapist: a person who, pursuant to Article 26 of the Besluit diëtist, ergotherapeut, logopedist, mondhygiënist, oefentherapeut, orthoptist en podotherapeut [Dieticians, Occupational Therapists, Speech Therapists, Oral Hygienists, Remedial Therapists, Orthoptists and Podotherapists Decree], is entitled to use the title of podotherapist. 63 Policyholder: a person who has taken out a healthcare insurancewith Zorgverzekeraar VGZ. 64 Preferred supplier/preferred provider: a supplier/care provider contracted to Zorgverzekeraar VGZ with whom specific arrangements have been made. 65 Primary care psychologist: a healthcare psychologist who is registered as a primary care psychologist in the register of primary care psychologists of the Nederlands Instituut van Psychologen (NIP) [Dutch Professional Association of Psychologists]. 66 Prosthodontist: a person who pursuant to Article 2 of the Besluit opleidingseisen en deskundigheidsgebied tandprotheticus [Prosthodontist (Professional Training Requirements and Area of Expertise) Decree] is entitled to use the title of prosthodontist and is contracted to Zorgverzekeraar VGZ. 67 Psychosomatic physiotherapist: a physiotherapist registered as a psychosomatic physiotherapist in the register for specialist physiotherapists of the Koninklijk Nederlands Genootschap voor Fysiotherapie [Royal Dutch Association for Physiotherapy]. 68 Remedial educationalist-generalist: a person registered as such in the register of the Nederlandse Vereniging van pedagogen en onderwijskundigen (NVO) [Netherlands Association of Educationalists]. 69 RIAGG: Regionale Instelling voor Ambulante Geestelijke Gezondheidszorg [Regional Institute for Outpatient Mental Health Care].

14 14 POLICY CONDITIONS VGZ SUPPLEMENTARY COVERS Sexologist: a person registered as such in the register of the Nederlandse Vereniging voor Seksuologie (NVVS) [Netherlands Association for Sexology]. 71 Skin therapist: a person who pursuant to Article 2 of the Besluit opleidingseisen en deskundigheidsgebied huidtherapeut [Skin Therapists (Professional Training Requirements and Area of Expertise) Decree] is entitled to use the title of skin therapist. 72 Sports medical centre: an institution associated with the Federatie van Sportmedische Instellingen (FSMI) [Sports medical centres federation]. 73 Stay: a stay of 24 hours or longer. 74 Transport by ambulance: the transport by ambulance of sick and injured persons as referred to in Section 1, first subsection, of the Wet ambulancevervoer [Ambulance Transport Act]. 75 Travel Health Clinic: a clinic attached to a hospital that specialises in providing health advice, vaccinations and products necessary for a healthy stay in the subtropics or tropics. 76 VGZ Zorgverzekering/VGZ Restitutieverzekering: a healthcare insurance taken out with Zorgverzekeraar VGZ by the policyholder for a person obliged to take out insurance. 77 Wmg rates: rates as established by or pursuant to the Wet marktordening gezondheidszorg (Wmg) [Healthcare Market Organization Act]. 78 Youth psychologist: a person registered as a youth psychologist in the register of youth psychologists with the Nederlands Instituut van Psychologen (NIP) [Dutch Professional Association of Psychologists]. 79 Zorgverzekeraar VGZ: the VGZ Zorgverzekeraar NV, having its registered offices in Nijmegen, offering or implementing these policies. VGZ Zorgverzekeraar NV is part of the Cooperative Society with exclusion of liability Coöperatie VGZ-IZA- Trias-Groep U.A. 80 Zvw: the Zorgverzekeringswet [Healthcare Insurance Act]. CLAUSE 2. General PROVISIONS 2.1. Basis The contract of insurance is entered into on the basis of the information provided by the policyholder, in his/her own hand or that of a third party, on the application form or supplied to Zorgverzekeraar VGZ in some other written form. Zorgverzekeraar VGZ provides the policyholder and, if this is not the insured person, the insured person with an insurance policy as soon as possible after the insurance is entered into, and subsequently prior to each calendar year. The policy schedule will state the persons insured and the insurance(s) taken out for them. These Policy Conditions form part of the contract of insurance and apply to the following insurance packages: Jong & Zeker Pakket: Chapter III; Gezin & Zeker Pakket: Chapter III; Vitaal & Zeker Pakket: Chapter III; Beperkte Aanvullende Verzekering: Chapter IV; Uitgebreide Aanvullende Verzekering: Chapter IV; Plus Aanvullende Verzekering: Chapter IV; MiX Aanvullende Verzekering: Chapters III and IV; Basis Tand: Chapter V; Luxe Tand: Chapter VI. The MiX Aanvullende Verzekering applies if and for as long as this has been laid down in the group health insurance contract agreed between the employer and Zorgverzekeraar VGZ. The Basis Tand and Luxe Tand can only be taken out in combination with the Beperkte Aanvullende Verzekering, the Uitgebreide Aanvullende Verzekering or the Plus Aanvullende Verzekering. Unless stipulated otherwise in any provision, Chapter II will apply to all insurance packages Medical grounds Insured persons are only entitled to care or reimbursement of costs of care as mentioned in these Policy Conditions if and insofar as they reasonably requirethe content and extent of this type of care. The content and extent of the types of care are also determined by the current state of scientific developments and the professional practice and, should such a criterion be absent, by what is regarded in the relevant discipline as responsible and adequate care Basis for the right to care The insured person only has a right to care or reimbursement of the costs if and insofar as rights can be derived from the insurance contract, the determining factor being the date on which or the period GENERAL SECTION

15 15 within which the relevant form of care was provided. Should these Policy Conditions refer to a year or calendar year, the actual date of treatment or date on which services/goods were supplied stated by the care provider will determine the year or calendar year to which the costs in question should be attributed. For Diagnose Behandeling Combinatie [Diagnosis Treatment Combination] packages, the costs are apportioned to the calendar year in which the DBC commenced Corresponding documents If and insofar as reference is made in these Policy Conditions to the following documents, they will be deemed to form part of the Conditions: Appendix 1 to the Besluit zorgverzekering [Healthcare Insurance Decree] Healthcare Regulations the Clausuleblad terrorismedekking [Clauses Sheet Terrorism Coverage] the overview of contracted care providers the Verwijzingsprotocol naar de lactatiekundige NVL [Referral protocol to the lactation consultant NVL] This information is available via and can also be requested by phone on or if you are covered by your employer s group insurance Fraud If Zorgverzekeraar VGZ detects fraud, this will have the effect of negating all claims for care or reimbursement of the cost of care arising from this insurance, including claims in regard to which no fraud has been detected(so-called partial fraud). In the event that fraud is detected, Zorgverzekeraar VGZ will also: - include the personal data of those persons who commit fraud, as well as those who can be considered to be an accessory or coperpetrator in its Incident Register. This Incident Register is reported to the College bescherming persoonsgegevens (CBP) [Dutch Data Protection Authority] and is managed by the Security Affairs Department of Univé-VGZ-IZA-Trias; - notifythe Centrum Bestrijding Verzekeringsfraude (CBV) [Centre for combating social fraud] of the Verbond van Verzekeraars (VvV) [Dutch Association of Insurers]; - terminate the health insurance contract or contracts and possibly refuse to enter into new health insurance contracts for a period of five years. This term is eight years for supplementary insurance contracts, and non-life insurance contracts carried within Univé. - possibly terminate the current supplementary health insurance policy or policies, and current non-life or other insurance policies within the Univé organisation; - arrange for registration in the internal and external warning systems recognised by financial organisations, the internal reference register (IVR) and the external reference register (EVR); - reclaim and/or recover previously paid out compensation from the policyholder and/or the insured person; - file a report with the police, the judicial authorities and/or the Fiscale inlichtingen- en opsporingsdienst en Economische controledienst (FIOD-ECD) [Fiscal Information and Investigation Service and Economic Investigation Service]; - claim and/or recover all costs (including costs of investigation) from the policyholder and/or the insured. The amount of the costs of investigation to be charged will always be set at 25% of the amount to be reclaimed due to the fraudulent act, with a minimum of Right to care and other services as a result of terrorist acts If the need for care or other services is the result of one or more terrorist acts and the total damages claimed in any calendar year due to such acts from non-life, life or funeral services (benefits in kind for funerals) insurers to which the Wet op het financieel toezicht [Financial Supervision Act] applies, will, according to the expectations of the Nederlandse Herverzekeringsmaatschappij voor Terrorismeschaden N.V. (NHT) [Dutch Terrorism Risk Reinsurance Company], be higher than the maximum amount reinsured by this company per calendar year, the insured person will only be entitled to compensation of the costs of performance up to a percentage of the costs or value of the care or other services to be determined by the NHT, this percentage being equal for all insurance policies. The exact definitions and provisions regarding the above right are featured in the Clausuleblad terrorismedekking van het NHT [Clauses Sheet Terrorism Cover by the NHT] Protection of personal data The personal data issued upon the application for or amendment to insurance products and any further personal and/or implementation data to be submitted will be entered in the personal data registration system maintained by Zorgverzekeraar VGZ. This data is processed for the purpose of entering into and implementing insurance contracts and managing the ensuing relationships, including the prevention and combating of fraud. The Code of Conduct for healthcare insurers processing personal data applies to the registration. This Code of Conduct is available at and on request Notices Notices sent to the most recent address known to Zorgverzekeraar VGZ are deemed to have reached the policyholder or the insured person.

16 16 POLICY CONDITIONS VGZ SUPPLEMENTARY COVERS Reimbursement of healthcare costs Healthcare costs will only be reimbursed on the basis of either statutory rates or (for rates not subject to regulation by law) on the basis of the (fixed) rate agreed by Zorgverzekeraar VGZ with the care provider in question. If a rate lower than the statutory maximum applies, the amount specified by or on behalf of Zorgverzekeraar VGZ will determine the reimbursement. Zorgverzekeraar VGZ is entitled to pay the costs of care, the reimbursement of which the insured person is entitled to claim from Zorgverzekeraar VGZ pursuant to an insurance, directly to the care provider who provided the care. This nullifies the insured person s right to reimbursement. If Zorgverzekeraar VGZ pays more to the care provider than it is obliged to with regard to the insured person, or if the costs of care are otherwise to be borne by the policyholder under these Policy Conditions, the insured person will owe the costs to Zorgverzekeraar VGZ. Zorgverzekeraar VGZ will charge these costs to the policyholder, who must then undertake to pay these amounts. By entering into the contract of insurance, the policyholder grants Zorgverzekeraar VGZ authority to do so. Without prejudice to Zorgverzekeraar VGZ s general right to offset claims, it may offset said costs against amounts due to the policyholder or insured person Membership of the Cooperative Society By taking out this insurance the policyholder will also become a member of the Cooperative Society with exclusion of liability Coöperatie VGZ-IZA Groep U.A., unless the policyholder has given written notice of his/her wish not to do so. This Cooperative Society represents the interests of its members as regards healthcare or other insurance. The membership can be terminated at any time by the policyholder by giving notice with due observance of a notice period of one month. The membership will be regarded as being terminated at the time that the insurance agreement lapses Reconsideration period Upon entering into the insurance contract, the policyholder may, within 14 days after entering into the contract or, if this is later, 14 days after receipt of the Policy Conditions, terminate the insurance contract in writing. In that event, the policyholder will not be deemed to have entered into the insurance contract Dutch law The insurance contract is governed by Dutch law. CLAUSE 3. PREMIUM 3.1. Premium payable The policyholder is obliged to pay premiums. No premium will be due for an insured person up to the first day of the calendar month following the calendar month in which he/she reached the age of 18. An insured person with a Jong & Zeker Pakket or Basis Tand pays a lower premium until reaching the age of 22. The higher premium commences on the first day of the calendar month following the calendar month in which he/she reaches the age of Group health insurance contract The premiums and conditions as agreed in the group health insurance contract apply from the date on which the insured person is covered under the contract and continue to apply until the date on which the insured person no longer meets the criteria for participation in this group health insurance contract The policyholder and/or insured person may only participate in one group health insurance contract at any given time The Policy Conditions, including the premium/premium payment as applicable under the individual contract, commence on the date following the day upon which the insured person no longer meets the criteria for participation in the group health insurance contract in question Payment of premium, statutory contributions and costs The policyholder is obliged to pay the monthly premium in advance as well as the contributions ensuing from foreign or domestic statutory regulations or provisions, unless agreed otherwise. If premium is paid annually in advance, an instalment discount of 3% will apply to the required premium amount Zorgverzekeraar VGZ charges 6 annually for payment via giro collection slip Authorisation issued by the policyholder for direct debit is applicable to the payment of premium, statutory contributions, excess and other costs. Under certain conditions, Zorgverzekeraar VGZ may opt to send a giro collection slip to the policyholder without any associated extra costs for the policyholder Claim The policyholder is not allowed to offset the outstanding amounts against an amount to be received from Zorgverzekeraar VGZ. GENERAL SECTION

17 Death Should the insured person die, any previously paid premiums will be refunded from the day after the date of death Overdue payments If the policyholder does not fulfil his/her obligation towards paying premiums, statutory contributions, excess or costs on time, and continues to neglect his/her obligations after a written demand for payment with with a notice period of at least 14 days, Zorgverzekeraar VGZ can suspend the coverage and/or terminate the insurance policy. In the event of suspension of the coverage, the policy holder has no right to insured performances beginning from the latest premium payment deadline prior to the demand for payment or, if a later moment is specified, that later moment. The policyholder is obliged to pay the premium in the event of suspension. The coverage will resume on the day following the day on which the amount due plus any costs have been received by Zorgverzekeraar VGZ. In the event the insurance contract is terminated, it may be reapplied for after payment of the amount owed and any outstanding costs. The insurance contract will commence per 1 January of the next calendar year Zorgverzekeraar VGZ may charge administration costs, collection costs (both judicial and extra-judicial) and statutory interest to the policyholder If the policyholder has already received a demand for the payment of premiums, statutory contributions, excess or costs after failing to pay on time, Zorgverzekeraar VGZ will not have to make a separate written demand of the policyholder if a subsequent invoice is not paid on time Zorgverzekeraar VGZ may offset premiums in arrears and costs as referred to in clause against claims for compensation submitted to Zorgverzekeraar VGZ by the insured, or against other amounts to be received from Zorgverzekeraar VGZ Zorgverzekeraar VGZ is entitled to refuse to enter into an insurance contract with the policyholder for a period of 5 years if the insurance contract is terminated due to failure to pay the premium owed in a timely manner. CLAUSE 4. OTHER OBLIGATIONS 4.1. Obligation The policyholder and insured person are obliged: - to furnish proof of identity by way of a driving licence, passport or Dutch identity card if care is called in; - to ask the treating professional to disclose the reason for hospitalisation to the medical advisor of Zorgverzekeraar VGZ; - to cooperate with Zorgverzekeraar VGZ, its medical advisor or those entrusted with inspection in order to obtain the information necessary for implementation of the VGZ Zorgverzekering; - to report to Zorgverzekeraar VGZ within a reasonable period of time that the insured person has been detained in connection with the statutory provision regarding suspension of coverage and liability to pay contributions during the period of detention; - if care is needed that requires authorisation under these Policy Conditions, to submit a referral note from the treating general practitioner, doctor for the intellectually disabled, nurse practitioner, midwife, medical specialist, psychiatrist/neurologist or dental surgeon, from which it is evident that the care and/or the seated transport provided to the patient is required on medical grounds; - to inform Zorgverzekeraar VGZ about any facts which signify (or could signify) that expenses may be recovered from liable third parties (or potentially liable third parties), and to provide Zorgverzekeraar VGZ with all necessary information in this regard. In connection with this provision, the insured person shall not come to any arrangement with a third party without the prior written consent of Zorgverzekeraar VGZ. The insured person shall refrain from any actions that might be prejudicial to Zorgverzekeraar VGZ s interests; - to inform Zorgverzekeraar VGZ as quickly as possible, but no later than within two months of the time the change was made, of all facts and circumstances which may be relevant to the proper implementation of the insurance policy. Changes include marriage, co-habitation, separation or divorce, birth, adoption or a change in bank or giro account number. Zorgverzekeraar VGZ will bear no risk whatsoever for negligence vis-à-vis the above provisions Expense claim period for invoices The policyholder and the insured person may, in the event reimbursement of the costs of care is requested, submit the original invoices within three years of the invoice date. These invoices have to be specified in such a way that the reimbursements Zorgverzekeraar VGZ is obliged to make can be deduced from them without any further queries. Computer-generated invoices must be duly initialled by the care provider. Any submitted invoices that are reimbursed will not be returned to the insured person.

18 18 POLICY CONDITIONS VGZ SUPPLEMENTARY COVERS Interests When the interests of Zorgverzekeraar VGZ are prejudiced by failure to fulfil the obligations set out in clause 4.1, Zorgverzekeraar VGZ may suspend the right to care or reimbursement of healthcare costs as described in these Policy Conditions. CLAUSE 5. CHANGES IN THE PREMIUM AND CONDITIONS 5.1. Changes in the premium and conditions Zorgverzekeraar VGZ is entitled to amend these Policy Conditions and the premium for the types of insurance provided in these Conditions. Zorgverzekeraar VGZ will then notify the policyholder of the intended change. For any insurance such a change will be effective on a date to be determined by Zorgverzekeraar VGZ Right to give notice If Zorgverzekeraar VGZ increases the premium and/or changes the conditions of the insurance to the disadvantage of the policyholder or the insured person, the policyholder will be entitled to give notice of termination of the contract from the day on which the change becomes effective and in any event for a period of one month after the policyholder has been notified of the change. However, the policyholder does not have this right if: - a change in the Policy Conditions results directly from statutory measures, regulations or provisions; - an increase in the premium is a direct consequence of the insured person reaching the age of 22 in cases where he/she pays an agebased premium. CLAUSE 6. INCEPTION, TERM AND TERMINATION 6.1. Inception and term The insurance commences on the date on which the VGZ Zorgverzekering/VGZ Restitutieverzekering starts or on 1 January of a calendar year. From the moment that the insurance contract commences, Zorgverzekeraar VGZ may request information from third parties (care providers, suppliers and the like) and provide them with such information insofar as it deems this necessary in order to fulfil obligations ensuing from the insurance. The insurance is entered into for the calendar year in which the insurance commences. After this period has expired, the insurance will be tacitly extended by periods of one calendar year. If Zorgverzekeraar VGZ receives your bills directly from care providers and pays them, your insurance policy will be implemented more quickly and easily. In order to ensure that this is the case, it may be necessary for the care provider treating you to know how you are insured. For that reason, the care providers may inspect your address and policy data in a safe manner. They may do so only if they are in fact treating you. If it is necessary for urgent reasons that care providers be prohibited from inspecting your address details, you may notify us accordingly. In that case Zorgverzekeraar VGZ will arrange for your address details to be protected Changes in the insurance Any changes to an insurance by the policyholder will take effect from 1 January. Zorgverzekeraar VGZ must be notified of any such changes by31 December at the latest. The situation described in clause is excepted from this rule. Instalments for the reimbursements referred to in the clauses will continue as normal Termination by operation of law The insurance terminates by operation of law from the day following the date on which: Zorgverzekeraar VGZ is no longer allowed to offer insurance policies due to a change in or revocation of its licence to operate a non-life insurance business; The insurance contracts described in these Policy Conditions end by operation of law with effect from the day following the date on which Zorgverzekeraar VGZ stops offering and implementing these insurance contracts; the insured person dies; The MiX Aanvullende Verzekering terminates when participation in the group health insurance contract is no longer possible; The Basis Tand and the Luxe Tand terminate by operation of law when the insured person is no longer insured under the Beperkte Aanvullende Verzekering, the Uitgebreide Aanvullende Verzekering or the Plus Aanvullende Verzekering; The Jong & Zeker Pakket ends by operation of law on the first day of the month following the month in which the insured person reaches the age of 27. The Jong & Zeker Pakket is then tacitly converted into a with Basis Tand. The insured person has the option to choose a different insurance. The policyholder must inform Zorgverzekeraar VGZ of his/her wish do so in writing within 30 days after being notified of the change. GENERAL SECTION

19 19 The policyholder will inform Zorgverzekeraar VGZ immediately of all facts and circumstances regarding the insured person which have led or can lead to termination of the VGZ Zorgverzekering under the provisions set out in clauses and If, based onthe information referred to above, Zorgverzekeraar VGZ comes to the conclusion that the VGZ Zorgverzekering will terminate or is effectively terminated, it will immediately notify the policyholder thereof, stating the reason and the date on which the insurance has terminated or will terminate. If the insurance contract ends pursuant to the provisions of 6.3.2, Zorgverzekeraar VGZ will undertake to notify the policyholder of this termination of the insurance contract no later than three months prior to termination Notice by the policyholder The policyholder may give notice of termination of the insurance: - no later than 31 December of any year with effect from 1 January of the next calendar year; - on the date of termination of the VGZ Zorgverzekering or the VGZ Restitutieverzekering; - in the situations referred to in clause Termination, dissolution or suspension by Zorgverzekeraar VGZ Zorgverzekeraar VGZ may cancel, dissolve or suspend the insurance contract: - in the event of overdue payment of the premium due as stated in clause 3.6; - in cases of deliberately failing to provide, or deliberately providing incomplete or false information or documents relevant to implementation of the insurance to Zorgverzekeraar VGZ which would or could disadvantage Zorgverzekeraar VGZ; - iif the policyholder and/or insured person has acted with the intent to mislead Zorgverzekeraar VGZ or if Zorgverzekeraar VGZ would not have entered into a healthcare insurance if it had known the true state of affairs. In this case, Zorgverzekeraar VGZ may cancel the VGZ Zorgverzekering with immediate effect within two months after having discovered this information. In such cases, Zorgverzekeraar VGZ will not be obliged to make payments or has the right to reduce payments. Zorgverzekeraar VGZ is entitled to offsetset the claims which have originated on this basis against other payments Health risk Zorgverzekeraar VGZ may not terminate or change the insurance on the basis of an increased health risk, insofar as this is due to the insured person Notice procedure Both the policyholder and Zorgverzekeraar VGZ must give written notice of termination of the insurance. CLAUSE 7. COMPLAINTS AND DISPUTES 7.1. Complaints and disputes on the implementation of the insurance Complaints and disputes regarding the implementation of the insurance can be submitted to Zorgverzekeraar VGZ, to the attention of the Department of Complaint Management, Antwoordnummer 9292, 5600 VM, Eindhoven. A complaint can also be submitted via our website The Complaint Management Department acts on the behalf of the board A dispute is defined as a difference of opinion resulting from a decision made and following reconsideration -maintained by Zorgverzekeraar VGZ, regarding the implementation of the insurance contract, whereby this decision affects the policyholder s or insured person s interests. All other cases are deemed to be a complaint Zorgverzekeraar VGZ will determine its definitive position or reconsider its original decision within a term of 30 days. If the result is unsatisfactory to the policyholder or the insured person, or if Zorgverzekeraar VGZ does not respond within a period of 30 days, the policyholder or insured person may submit the complaint or dispute to the Stichting Klachten en Geschillen Zorgverzekeringen (SKGZ) [Healthcare Insurance Complaints and Disputes Foundation], PO Box 291, 3700 AG, ZEIST, In such cases the policyholder or the insured person may also submit the complaint or the dispute to the competent court Complaints concerning forms used by Zorgverzekeraar VGZ Complaints regarding the forms used by Zorgverzekeraar VGZ can be submitted to Zorgverzekeraar VGZ, to the attention of the Department of Complaint Management, Antwoordnummer 9292, 5600 VM, Eindhoven. A complaint form can also be downloaded from If a complaint as defined under clause has been submitted to Zorgverzekeraar VGZ and Zorgverzekeraar VGZ has communicated its final position or has not responded within a term of 30 days after the complaint was submitted, the policyholder or insured person may submit the complaint to the NZa, to the attention of the Information line/reporting point, PO Box 3017, 3502 GA, Utrecht, informatielijn@ nza.nl.

20 20 POLICY CONDITIONS VGZ SUPPLEMENTARY COVERS 2009 This type of complaint relates to forms that are, in the opinion of the policyholder or insured person, redundant or overly complicated. The decision of the NZa will qualify as a thirdparty opinion that is binding forthe policyholder, insured person, care provider and health insurer. The procedure for submitting a complaint concerning forms is described on the website of the NZa ( CLAUSE 8. CARE AND WAITING LIST MEDIATION The insured person has a right to mediation for care if there is an unacceptably long waiting time for the specialist medical treatment, dental surgery, psychological care or any other form of care due to waiting lists at a care provider permitted to provide this care under the insurance. If the waiting time is unacceptably long, the insured person may appeal to Zorgverzekeraar VGZ s Care Advisory and Mediation Department. The insured person can also appeal to this department with general questions on care, such as questions with regard to finding a care provider with a specific area of expertise or help in navigating through the care sector. Zorgverzekeraar VGZ will help the insured person in considering the available options. CLAUSE 9. EXCLUSIONS There is no right to care or reimbursement of the costs: 9.1. of care related to diseases or deficiencies that already existed before or at the time the insurance came into effect and of which the insured person was or could have been aware, or in relation to which the insured person was already suffering from symptoms at that time, and of which Zorgverzekeraar VGZ was not informed in writing. This exclusion does not apply if the insurance came into effect without any prior medical or dental screening; 9.2. for written statements, mediation fees charged by third parties without the prior written consent of Zorgverzekeraar VGZ, administrative charges or costs incurred as a result of failure to pay the invoices of care providers in a timely manner; 9.3. incurred as a result of gross negligence or intentional actions; 9.4. consisting of personal contributions or excesses payable under the terms of any other insurance, unless there are provisions to the contrary in these Policy Conditions; 9.5. of care claimable under the AWBZ, if the insured person was covered under this Act; 9.6. which could have been claimed under any other insurance, whether or not of a previous date or under any act or other provision if the insurance with Zorgverzekeraar VGZ had not been entered into. In that case this insurance will only be valid in the last resort. Under these Policy Conditions, the only losses eligible for reimbursement would then be those exceeding the amount that could be claimed elsewhere by the insured person. Zorgverzekeraar VGZ adheres to the covenant on overlap of travel insurance policies and supplementary health insurance. See of care which can or could possibly be claimed under a healthcare insurance according to the Zvw or corresponding healthcare insurance; 9.8. of care caused by or resulting from armed conflict, civil war, uprising, civil disorder, riots or mutiny, as defined in Section 3.38 of the Wet op het financieel toezicht [Financial Supervision Act]; 9.9. for losses indirectly resulting from the acts or omissions of Zorgverzekeraar VGZ. GENERAL SECTION