Important information! Your health care insurance in 2016

Transcription

1 Important information! Your health care insurance in 2016

2 Index IAK health care insurance 3 An overview of your health care insurance options 4 Supplementary insurance packages 5 Statutory and other changes to the basic insurance package 6 Changes to the supplementary health care packages for Changes to the supplementary All-in-1 health care packages for New: video clips 9 New: 2-in-1 health insurance card 10 Digital convenience 11 Use this table of contents to go straight to the information you need. Click on one of the titles to navigate to the correct page. 2

3 IAK Health Care Insurance Our IAK Health Care Insurance options offer you major discounts combined with extensive reimbursements. This brochure contains information about the new health care packages for The existing packages have undergone some changes: some dictated by the government and others initiated by IAK. Read this brochure to find out more about these changes and our service. Rest assured: next year you will once again be perfectly insured with IAK! Find your care provider Do you need a care provider? Evidently you want only the best possible care and preferably nearby. But how do you find the right care provider? Take a look at iak.nl/zorgverleners (Dutch only) to quickly find a care provider close to you. Mijn IAK more closely tailored to your wishes We regularly ask you for input on how to improve our services. The responses show that you prefer to receive personalised information and more details about your health care costs. To accommodate these preferences, the brochure is now available together with your survey of reimbursements in Mijn IAK. We provide details of your health care costs, your reimbursements and the amount of the excess that has been deducted as well. This allows you to see your exact status whenever you want. Discover this new environment in Mijn IAK, under the tab labelled Mijn Zorgkosten. 3

4 An overview of your health care insurance options 1. Select one of the 3 basic insurance packages: IAK Goede Keuze (Selective contracted care) Choice of preselected care providers. For non-contracted care, you will receive a maximum of 75% of the average contracted rate. IAK Ruime Keuze (Contracted care) Extensive choice of care providers. For non-contracted care, you will receive a maximum of 80% of the average contracted rate. IAK Eigen Keuze (Non-contracted care) Free choice of any care provider. Maximum of 100% of prevailing market rates. For a complete overview, including the accompanying reimbursements, we refer you to the policy terms and conditions. Go to iak.nl/zorgdownloads and log in. 2. Optional: Select a supplementary package Aanvullend Goed Aanvullend Beter Aanvullend Best Aanvullend Aanvullend Aanvullend Supplementary Goed Beter Best health care packages Jong Fit & Vrij Gezin Vitaal Pakket Pakket Pakket Pakket Dental Dental Dental Dental care care care care Jong Fit & Vrij Gezin Vitaal included included included included Pakket Pakket Pakket Pakket Dental Supplementary Dental Dental Dental care All-in-1 health care care packages care care included included included included Supplementary health care packages Supplementary All-in-1 health care packages 3. Optional: Select your dental care insurance Tand Goed Tand Beter Tand Best Tand Dental care Tand insurance Tand Goed Beter Best Dental care insurance 4

5 Supplementary insurance packages You can extend your health care insurance by adding a supplementary insurance package. There are three modular supplementary packages: Aanvullend Goed, Aanvullend Beter and Aanvullend Best, with the option to add dental care Insurance. Alternatively, you can select one of the following All-in-1 packages (including dental care insurance): Jong, Fit & Vrij, Gezin or Vitaal. The reimbursements under these packages are carefully tailored to suit your family situation and lifestyle. Jong Pakket Are you aged between 18 and 27 and looking for affordable health care insurance whereby you only pay for the care you actually need? The Jong Pakket is the ideal health care insurance for young people and students. Reimbursements for dental care are included. Aanvullend Goed If you want to insure yourself for extra care at an attractive premium rate, Aanvullend Goed is a good supplement to the basic insurance. Coverage includes a reimbursement for alternative care and a budget for movement-related therapy. Fit & Vrij Pakket The Fit & Vrij Pakket is a unique supplementary health care package. You receive a health care budget of 1,000.00, and you decide which health care you want reimbursed. A straightforward total package for people aged under 50, combining good care with optimal freedom of choice. Aanvullend Beter Aanvullend Beter insurance offers you extensive health care insurance at an attractive premium rate. The maximum reimbursements and budgets are higher than those under the Aanvullend Goed package. Coverage includes a reimbursement for glasses and contact lenses and a maternity package if you are pregnant. Gezin Pakket The Gezin Pakket is especially designed for families. All the reimbursements have been selected with the family in mind, covering everything from extra maternity care to orthodontic care. Therefore this is the ideal supplement to the basic insurance for families. Aanvullend Best For maximum health care insurance security, choose the Aanvullend Best package. The reimbursements are higher than those under the Aanvullend Beter package, and include an extra budget for movement-related therapy, skin therapy and a reimbursement for laser eye surgery. Vitaal Pakket As you get older, there are certain types of care you no longer need. Why should you pay for maternity care or orthodontic treatment? The Vitaal Pakket is an excellent supplementary health care insurance for you if you are 55 plus, a senior or elderly. 5

6 Statutory and other changes to the basic insurance package Changes to excess/individual contributions/maximum reimbursements Mandatory excess per year (was in 2015) Indexed rates for individual contributions and maximum reimbursements Every year, the government indexes the statutory individual contributions and the maximum reimbursements in basic insurance packages. For the indexed rates for 2016, visit iak.nl/wijzigingenzorg (Dutch only) Changes in reimbursements under the basic insurance package in 2016 New reimbursements under the basic insurance package Contracting Reimbursement for non-contracted care Other changes to the basic insurance package Ambulance transport for mental health care for younger persons (legislative and regulatory amendment having retroactive effect to 1 January 2015). Prenatal invasive diagnosis if an NIPT (non-invasive prenatal test) shows a significant risk of a chromosome defect in the child (previously only following a combined test). Medically necessary seated patient transport for intensive childcare. A few care providers have been selected and contracted for various treatments, operations and medical aids. These care providers offer a particular level of quality or are involved in care innovation. This means that fewer or more care providers might be contracted for certain types of care than in To find out more about selective contracting and to see a full list of the contracted care providers, visit iak.nl/zorgverleners (Dutch only) IAK Goede Keuze: the maximum reimbursement for care by non-contracted care providers has been raised from 50% to 70% of the average contracted rate. IAK Ruime Keuze: the maximum reimbursement for specialist mental health care by non-contracted care providers has been raised from 75% to 80% of the average contracted rate. The regulations relating to medical aids, pharmaceutical care and personal budgets for nursing and care have changed; see iak.nl/zorgdownloads Prior approval is needed for specialist mental health care that requires admission (see the approval procedure in the conditions). Specialist medical care may also be provided by a sports medicine doctor if it falls within the scope of his or her area of expertise. To have an IUD inserted or removed, you may also visit a contracted obstetrician (this does not fall within the scope of your excess). The frozen embryos that remain if an IVF attempt leads to pregnancy may be replaced. If the attempt does not yield a result, a new cycle of IVF treatment can be started, which then qualifies as the first attempt. A note from a general practitioner or medical specialist is needed to qualify for palliative terminal care at home. New care providers qualified to make referrals for specialist medical care and mental health care have been added (for a full list of these qualified providers, see the policy conditions). 6

7 Changes to the supplementary health care packages for 2016 Breast pump reimbursement Circumcision (medical indication only) Cogmed and neurofeedback Lens implantation Eyelid correction Psychosocial alternative care Pressure helmet STD prevention Arch supports Dental care following an accident Dental care: increased reimbursement for preventive dental care Fall prevention MiX AV Aanvullend Goed Aanvullend Beter Aanvullend Best arch supports no longer covered by budget for foot treatments, but will still be reimbursed up to max. 70 per year if manufactured by a podotherapist or orthopaedic shoemaker/shoemaking business reimbursement for fall prevention course max. 50 during entire policy term reimbursement for rent or purchase of electric breast pump max. 80 during entire policy term reimbursement for treatment with pressure helmet no longer applies arch supports no longer covered by budget for foot treatments, but will still be reimbursed up to max. 125 per year if manufactured by a podotherapist or orthopaedic shoemaker/shoemaking business reimbursement for crowns and bridges following an accident for insured patients aged under 22 no longer applies; a reimbursement for dental care following an accident is included under the Tand Goed, Tand Beter and Tand Best insurance options reimbursement for fall prevention course max. 100 during entire policy term Tand Goed Tand Beter Tand Best reimbursement for rent or purchase of electric breast pump max. 80 during entire policy term - neurofeedback in relation to ADHD and ADD max. 1,000 per year up to age 18 - Cogmed in relation to learning disorders caused by ADHD and ADD max. 400 per year up to age 18 coverage extended to include reimbursement of additional costs of toric lens implant during cataract surgery - eyelid correction now reimbursed for more indications - reimbursement for levatorplasty reimbursement for treatment with pressure helmet no longer applies arch supports no longer covered by budget for foot treatments, but will still be reimbursed up to max. 125 per year if manufactured by a podotherapist or orthopaedic shoemaker/shoemaking business reimbursement for crowns and bridges following an accident for insured patients aged under 22 no longer applies; a reimbursement for dental care following an accident is included under the Tand Goed, Tand Beter and Tand Best insurance options reimbursement for fall prevention course max. 150 during entire policy term Replacement informal care reimbursement increased from 4 to 5 days reimbursement increased from 9 to 10 days reimbursement increased from 14 to 15 days Transport Maternity courses maternity courses no longer covered by preventive care budget budget for maternity courses (was covered by preventive care budget) max. 50 per year for courses such as Zwanger Fit, Samen Bevallen and Slimmer Zwanger budget for maternity courses (was covered by preventive care budget) max. 75 per year for c ourses such as Zwanger Fit, Samen Bevallen and Slimmer Zwanger budget for maternity courses (was covered by preventive care budget) max. 100 per year for courses such as Zwanger Fit, Samen Bevallen and Slimmer Zwanger max. 10,000 dental care costs following an accident reimbursement for periodic checkups (C11) and problem-oriented appointments (C13) increased from 80% to 100% (no change to annual budget amount) max. 10,000 dental care costs following an accident reimbursement for periodic checkups (C11) and problem-oriented appointments (C13) increased from 80% to 100% (no change to annual budget amount) max. 10,000 dental care costs following an accident reimbursement for periodic checkups (C11) and problem-oriented appointments (C13) increased from 80% to 100% (no change to annual budget amount) 7

8 Changes to the supplementary All-in-1 health care packages for 2016 Breast pump reimbursement Circumcision (medical indication only) Cogmed and neurofeedback Lens implantation Eyelid correction Psychosocial alternative care Pressure helmet STD prevention Arch supports Dental care following an accident Dental care: increased reimbursement for preventive dental care Fall prevention Jong Pakket Gezin Pakket Vitaal Pakket Fit & Vrij Pakket reimbursement for preventive STD examination reimbursement for periodic checkups (C11) and problem-oriented appointments (C13) increased from 80% to 100% (no change to annual budget amount) reimbursement for rent or purchase of electric breast pump max. 80 during entire policy term - neurofeedback in relation to ADHD and ADD max. 1,000 per year up to age 18 - Cogmed in relation to learning disorders caused by ADHD and ADD max. 400 per year up to age 18 reimbursement for treatment with pressure helmet arch supports no longer covered by budget for foot treatments, but will still be reimbursed up to max. 70 per year if manufactured by a podotherapist or orthopaedic shoemaker/shoemaking business reimbursement for periodic checkups (C11) and problem-oriented appointments (C13) increased from 80% to 100% (no change to annual budget amount) - eyelid correction now reimbursed for more indications - reimbursement for levatorplasty arch supports no longer covered by budget for foot treatments, but will still be reimbursed up to max. 125 per year if manufactured by a podotherapist or orthopaedic shoemaker/shoemaking business reimbursement for periodic checkups (C11) and problem-oriented appointments (C13) increased from 80% to 100% (no change to annual budget amount) reimbursement for fall prevention course max. 100 during entire policy term Replacement informal care reimbursement increased from 9 to 10 days reimbursement increased from 9 to 10 days Transport Maternity courses maternity courses no longer included covered by preventive care budget budget for maternity courses (was covered by preventive care budget) max. 150 per year for courses such as Zwanger Fit, Samen Bevallen and Slimmer Zwanger coverage extended to include reimbursement of additional costs of toric lens implant during cataract surgery arch supports will only be reimbursed if manufactured by a podotherapist or orthopaedic shoemaker/shoemaking business reimbursement for periodic checkups (C11) and problem-oriented appointments (C13) increased from 80% to 100% (no change to annual budget amount) Please note: this is an abridged version of the changes to reimbursements for No rights (including rights to reimbursement) may be derived from the content of this summary of changes. For precise, up-to-date details of the reimbursements, log on to iak.nl/mijniak and consult the insurance terms and conditions. Go to iak.nl/mijniak and log in for the complete survey of reimbursements for

9 New: video clips Why try to describe a complicated issue in hundreds of words if we can explain it more clearly in a short video clip? We now also provide visual answers to FAQs about your health care insurance. For example, one of our people at IAK will show you how to submit your claims online, or explain the difference between an individual contribution and an excess. These and other short video clips are available on our website. 9

10 New: 2-in-1 health insurance card You currently have an IAK Health Insurance Card. The EHIC (European Health Insurance Card) is a card for care outside of the Netherlands but within Europe. From now onwards, the two cards will be combined. On the card you will see an SOS telephone number. This is the emergency number for the international alarm centre. Call this number if you need emergency medical assistance abroad. If you already have an EHIC or recently applied for one, you will receive the new combicard automatically. 10

11 Digital convenience We are working to create a sustainable future. By minimising the amount of paperwork that we send by post, we are cutting back on our printed matter and helping the environment. Will you join us? To help us, go to iak.nl/mijniak under the tab labelled Correspondentie Zorg, and in your Correspondentieprofiel change your settings to receive correspondence from IAK by from now on. 11

12 We are here for you Visit iak.nl For more information. Call (040) Our customer service staff are available to assist you. Make an appointment with our adviser Our advisers regularly hold walk-in consulting sessions at many business locations. Visit one of our service desks At Beukenlaan 70 or at the High Tech Campus in Eindhoven. The content of this brochure has been compiled with the greatest possible care, and is provided for your information. Please be aware, however, that no rights (including rights to reimbursement) may be derived from the content of this brochure. For precise, up-to-date reimbursement details, always log on to iak.nl/zorgdownloads and consult the insurance terms and conditions, or contact Customer Service. web ZV-PB ENG ( ) IAK Verzekeringen B.V. IAK Volmacht B.V. Postbus 90165, 5600 RV Eindhoven Beukenlaan 70, Eindhoven T (040) , F (040) IAK Verzekeringen B.V. Chamber of Commerce: IAK Volmacht B.V. Chamber of Commerce: AFM licence number: