2014 Coverage overview

Transcription

1 2014 Coverage overview Basic Health Insurance Choice Care Plan (Keuze Zorg Plan) and supplementary insurance Aon s Global Health Supplement The compensations of our healthcare insurance Our health insurance policies offer the right healthcare when you need it, without any subsequent financial surprises. However, even when you are healthy, you want to be able to rely on us too. This brochure provides an overview of the coverage of basic health insurance and our supplementary insurance for healthcare outside the Netherlands. What is necessary, is covered Choice Care Plan is our basic health insurance plan. We will cover everything that you need. In some cases, you are required by law to pay a mandatory personal contribution, for example for maternity care, hospital transfers and medical aids. The treatments covered under the Choice Care Plan are insured based on the Dutch treatment rates. Supplementary insurance Aon s Global Health Supplement We offer you a supplementary insurance for treatments abroad that are not or not fully covered by the basic health insurance plan. Additionally, we offer supplementary dental plans and the Comfort Class insurance. The costs covered by these plans are listed in this brochure. How to use the coverage overview In the left column, please find the different treatments in alphabetical order. The adjacent column shows if these treatments are covered by the Choice Care Plan. If not, please check the column to the right. This will show if the treatment is covered by the supplementary insurance Aon s Global Health Supplement. You can also check if the legally required personal contributions are reimbursed. The numbers and amounts listed apply per insured per calendar year, unless indicated otherwise. Quick reference - that s all This brochure serves to quickly and conveniently check your insurance coverage. However, this coverage overview is not a replacement of the policy conditions that form the actual and full basis of your insurance. For this reason, no rights may be derived from this brochure. More information? Please visit to read the terms and conditions in full detail. Alternatively, contact us via ipm@aonhewitt.com or call + 31 (0) during Dutch office hours. 1

2 Healthcare activity (alphabetical) Adoption/maternity care for children under 12 months or medical screening in the case of an adoption Alternative (homeopathic and anthroposophical) medicine (registered and supplied by a pharmacy) Alternative medicine and therapies Contraceptives Asthma Centre Davos Basic health insurance Choice Care Plan Up to age 21: (in accordance with Achmea Regl. Pharm. Healthcare legally required personal contribution (upper limit GV) is not reimbursed. NL rate Aon s Global Health Supplement (AGHS) Max 3 days up to 3 hours per day, or maximum 300 per adopted child Named medical consultants ** 75 Named non-medical consultants*** 40 Combined maximum 20 consults per year. Up to age 21: supplemented up to From age 21: Audiological centre NL rate Obstetric care, giving birth Giving birth at home, in a clinic and policlinic with medical indication Policlinic giving birth (without medical indication) NL rate Compensation for use of delivery room 200, remaining amount is legally required personal contribution In NL: delivery room: coverage Obstetric care NL rate Monitoring equipment to prevent cot death Monitoring equipment (hire) Sensor mat Nanny Care (purchase) Exercises in extra heated water for rheumatism patients maximum 12 months, after approval of the company. coverage* together with other costs up to 500 per cy. 2

3 Glass for prescription glasses and contact lenses Laser eye surgery Glasses or contact lenses with a minimum strength of plus or minus 4 dioptres up to 1 pair per 3 cy and up to 250 per pair. Contact lenses of minimum plus or minus 4 dioptres, specifically made for short-term use, such as daily, weekly, monthly, 6-monthly and annual lenses, replacing the above-mentioned reimbursement*: 65 per cy. Discount plan for Visionclinics, Eyescan and Oogkliniek Heuvelrug. Maximum 500 coverage* for the duration of the insurance plan. Abroad Emergency care Max NL rate Non-emergency care Max NL rate see policy conditions. Special conditions apply for the USA and Canada Repatriation and evacuation of transport remains Vaccinations and medication when travelling abroad Circumcision on religious grounds Dyslexia care, diagnosis and treatment serious dyslexia for children age 7 to 12 Generalistic Basic GGZ (mental healthcare) due to non-complex psychological condition Non-clinical specialist GGZ due to complex psychological condition (second-line GGZ) Max NL rate Max NL rate Maximum NL rate Max 75% up to 150 per insured per cy. (see policy terms and conditions for medication and vaccinations) Maximum 6 supplementary sessions including reimbursement of personal contribution, maximum 2,000 per cy. Psychiatric ward hospitalisation (in GGZ institution) Maximum NL rate Pharmaceutical care, coverage in accordance with Pharmaceutical Care Rules (upper limit GVS is personal contribution) Supplemented to coverage of personal contribution 3

4 Physiotherapy and exercise therapy age 18 and older 1 condition included in the list issued by the Ministry of VWS (Public Healthcare, Wellbeing and Sports). Your doctor/physiotherapist determines the condition. Manual lymph drainage during serious lymph oedema may also be performed by a skin therapist instead of a physiotherapist or exercise therapist Non-chronic condition diagnosed by a doctor or physiotherapist Pelvic physiotherapy in connection with urine incontinence Treatments 1 through 20 are a personal contribution Treatments 1 through 20 are a personal contribution. Treatments 21 and onwards are covered Treatments 1 through 9 Max 20 treatments per cy. Max 30 Maximum of 12 treatments up to 30 per session. Extension possible of maximum 12 treatments after permission of the company Physiotherapy and exercise therapy age 18 and younger Condition included in the list issued by the Ministry of VWS (Public Healthcare, Wellbeing and Sports). Your doctor/physiotherapist diagnoses the condition. Condition not included in the list issued by the Ministry of VWS (Public Healthcare, Wellbeing and Sports). Your doctor/physiotherapist diagnoses the condition. Manual lymph drainage during serious lymph oedema may also be performed by a skin therapist instead of a physiotherapist or exercise therapist Hospital Accommodation costs for polyclinic treatment in a hospital 18 treatments per diagnosis, NL rate Maximum of 12 treatments up to 30 per session. Extension possible of maximum 12 treatments after permission of the company Maximum 35 per day together with other costs* up to 500 per cy. Birth TENS (for giving birth) lease 4

5 Recovery & Balance, cancer rehabilitation programme Recovery centres Max 1,000 Max 50 per day up to 28 days pp per cy. Skin care Acne treatment, camouflage Max 600 therapy, hair removal treatment for significant aesthetic blemish due to facial hair in women Healthcare provided by GPs NL rate Medical aids, reimbursed in NL rate accordance with Medical Aids Prior permission is required for rules certain medical aids. A maximum coverage or legally required personal contribution may apply IVF (in vitro fertilisation) First 3 attempts for each pregnancy to be realised. Reimbursement of medication first 3 attempts in accordance with GVS, after permission of the company Maternity pack Max legally required personal contribution for other medical aids Maximum 7,000 per pregnancy to be realised, including the reimbursement from the main insurance policy Maternity care At home The number of hours is determined based on the National Protocol Maternity Care Postponed maternity care with medical indication NL rate, legally required personal contribution 4.10 per hour. coverage of legally required personal contributions Medically required maternity care, maximum of 15 hours In hospital, birth centre or maternity centre without medical indication 10 days. You pay the legally required personal contribution of 33 per day plus any amount in excess of 233 charged by the hospital, birth centre or maternity centre coverage of legally required personal contributions Lactation care 75% up to 115 Life-style training 1 training up to 200 Speech therapy NL rate excepting dyslexia and language development conditions Replacement for informal care of relatives Max 21 days per insured up to 1,000 per cy. Mechanical breathing aid NL rate. Melatonin (for certain conditions) Maximum 150 after permission granted by the company 5

6 Kidney dialysis NL rate. Obesity treatment level 3 Maximum 1,000 for the entire duration of the insurance Organ transplant, after permission issued by the company After permission issued by the company, supplemented to cost Donor nursing Max 3 months. For liver transplants maximum 6 months Orthodontic treatment For insured up to age 18: maximum 2,000 for the entire duration of this supplementary insurance. For insured above age 18: after approval 70% up to 1,000 for the entire duration of this supplementary insurance if IOTN indication is higher than 2 Orthopedic healthcare, coverage together with other costs* up to 500 per cy. Menopause consultant 75% of the consultation rate up to 115 Membership of patient associations Pedicure care for insured with rheumatism or diabetes Adhesive strips breast prosthesis Maximum 25 per membership* together with other costs up to 500 per cy., with reference together with other costs* up to 500 per cy. Plastic surgery with medical indication. For example breast prosthesis after mastectomy (no breast enlargement, surgically removing breast prostheses without medical necessity, tummy liposuction, eye lid and ear position correction) Bedwetting alarm Foot therapy/podology Prevention courses Course overview see policy conditions Preventative healthcare NL rate after permission issued by the company Correction of upper eye lids/ear position after permission issued by the company coverage* together with other costs up to 500 per cy. With reference, coverage* together with other costs up to 500 per cy. 75% up to 115 per course per insured per cy* together with other costs up to 500 per cy., vaccinations in accordance with national vaccination programme, tetanus vaccination and flu vaccination 6

7 Preventative examinations Cervical cancer, breast cancer, cardiovascular conditions, prostate cancer Periodic general examination (check-up) by GP or specialist Psoriasis Treatment in psoriasis day treatment centre Recovery (medical specialist or geriatric recovery) Second opinion for basic health insurance healthcare Sports consultant (Sports Medical Institution) Sterilisation in hospital or independent treatment centre Support pessarium (for prolapsed cervix) Support insoles (excluding podotherapeutic/podological support insoles) Stutter therapy With logopedist excluding population survey Max 75 (1 x per 2 yr) up to 1,000 pp per cy. NL rate. NL rate. 2 times per cy costs of injury and/or follow-up consultation. Personal contribution 10 excluding reversal operation Max 1 x time per cy* together with other costs up to 500 per cy. NL rate Maximum 1,000 coverage per insured per cy; see for the duration of the supplementary insurance Dental care age 18 and older Dentures (prosthesis) Purchase of fully removable dentures (false teeth) prepared by dentist or dental prosthetist (immediate, replacement or implant retained denture) Repairing or refitting (rebasing) fully removable dentures (false teeth) prepared by dentist or dental prosthetist (immediate or implant retained denture) 75% NL rate 75% NL rate Legally required personal contribution 25%. You will require our prior permission if: Costs exceed 575 for an upper prosthesis Costs exceed 600 for a lower prosthesis. Costs exceed 1,230 for a full prosthesis Upon replacement within 5 years NL rate. 7

8 Implants for removable prosthesis for serious development or growth disorder. Dentures prepared by dentist, oral surgeon or centre for specialist dental treatment Fully removable prosthesis on implants for serious development or growth disorder. Dentures prepared by dentist, dental prosthetist or centre for specialist dental treatment NL rate after permission Abroad: after permission issued by the company, supplemented to cost. NL rate after permission. 125 legally required personal contribution per lower or upper jaw. Prior permission required Abroad: after permission issued by the company, supplemented to cost Oral surgery No periodontal surgery, dental implants and non-complicated extractions Dental care age 18 and younger All treatments by a dentist, oral hygienist, oral surgeon and dental prosthetist (excluding moulded fillings, caps, bridges, inlays and implants) Oral surgery No periodontal surgery, dental implants and non-complicated extractions Dental care for disabled persons Dental care for special cases Due to an accident Dental costs due to accident from age 18 NL rate NL rate NL rate NL rate after permission and if the insured is not entitled to coverage pursuant to AWBZ Prior permission data required NL rate after permission In some cases, a legally required personal contribution applies after permission and if the insured is not entitled to coverage pursuant to AWBZ excluding legally required personal contribution 75% up to 200 per element up to 2,500 per accident 75% up to 200 per element up to 2,500 per accident Therapeutic camps For disabled persons After permission issued by the company, up to 23 per day per insured per cy* together with other costs up to 500 per cy. 8

9 For asthmatic persons up to age 18 TRANS therapy for incontinence, rental neuromodulator (BioStim) and bio-feedback equipment (FemiScan) With reference by treating doctor up to per day up to 42 days per cy* together with other costs up to 500 per cy. after permission issued by the company Thrombosis service NL rate. Lodging costs For patient Maximum 100 per day up to 1,000 per event of illness if the patient incurs costs due to medical treatment outside his/her residential area in a hospital For parents of a co-insured child Maximum of 100 per day for both parents together up to a limit of 1,000 per event of illness. Excluding costs incurred in NL or in the country of citizenship Nursing (extramural) Fertilisation enhancement treatments other than IVF Hospitalisation, maximum 365 days (excluding home breathing equipment and palliative care), after permission issued by the company after permission issued by the company, excluding GGZ, for plastic surgery and oral surgery after permission issued by us.. * For these healthcare activities, the total payment per insured per calendar year is capped at 500. ** The alternative medical consultants are: doctor and acupuncturist, homeopathic doctor, doctor for natural healing methods, anthroposophical doctor, doctor and enzyme therapist, Sickesz doctor, manual therapy doctor or Moerman doctor. *** The alternative non-medical consultants are: acupuncturist, physiotherapist and acupuncturist, classic homoeopathist, manual therapist, chiropractor, hapto-therapist, natural healing therapist. The payments under the basic health insurance Choice Care Plan are based on the Dutch rates. The supplementary insurance policy Aon s Global Health Supplement offers a supplement up to cost abroad, unless indicated otherwise in the policy terms and conditions. 9

10 Coverage overview Supplementary insurance Comfort Class Supplementary compensation covering the difference between staying in a standard hospital room designed for 1 or 2 persons and a standard hospital room designed for more than 2 persons in the institution where the patient is hospitalised. Coverage overview Supplementary insurance Dental Care insurance T start : C (consultation) codes, M (oral hygiene) codes, V (filling) codes and H codes or treatments that are the equivalent of these codes: coverage Other codes: 75% Maximum payment per year 250 T extra: C (consultation) codes, M (oral hygiene) codes, V (filling) codes and H codes or treatments that are the equivalent of these codes: coverage Other codes: 75% Maximum payment per year 500 T royal: C (consultation) codes, M (oral hygiene) codes, V (filling) codes and H codes or treatments that are the equivalent of these codes: coverage Other codes: 75% Maximum payment per year