Benefit Schedule Overview of the health insurances For you: services, discount and excellent reimbursements

Transcription

1 Benefit Schedule Overview of the health s 2014 F you: services, discount and excellent reimbursements

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3 Good health care means the right care at the right time and in the right place. Are you an 18-year-old student? A 50-plusser? Single with a family of your own? Avéro Achmea is there f you, whenever you need good health care. We have a really broad basic and excellent supplementary policies We are there f you in the moments that matter: services Our Zgversneller (care accelerat), f when you have to wait f treatment. This is to make sure you get rapid access to the best care and arrange all your appointments. Our Zggarantie (care guarantee), if you are uncertain and want assistance with making appointments. We guarantee that you will have a consultation f the most common complaints within 5 days, and any subsequent treatment by, at the most, 10 days later. Our Second Opinion Service (S.O.S), f when you are in doubt about a diagnosis treatment. Our wldwide S.O.S. service provided by Best Docts. If you have one of our supplementary policies, you have a right to a reassessment of your diagnosis treatment method by the best docts in the wld. We are there f you, if you already have enough to wry about. We can help you find a new general practitioner, dentist physiotherapist. That makes life easier if you have just moved home. We are there f you, if you need medical care abroad. You can call our emergency assistance company, Eurocross Assistance, 24 hours a day, via Or the Vakantiedokter (holiday doct), via , if the help you seek is not medically urgent. We are there f you, if you care f vulnerable people. Our Zgregelaars (care regulats) help you find your way in the maze of rules and authities, so you receive the right government suppt from, e.g., the Exceptional Medical Expenses Act (AWBZ) and the Social Suppt Act (Wmo). 3

4 We enjoy giving you certain extras: discount Have you taken out a supplementary, in that case you profit from discounts on all sts of care products and services that can amount to as much as 25%. From refractive eye surgery to home care, from spectacles to fitness centres. 1 Spectacles and lenses Eye Wish Groeneveld: at Eye Wish Groeneveld discount on a simple pair of spectacles 15% discount on contact lenses and accessies Specsavers: at Specsavers 20% discount on a pair of (sun) glasses. 2 pairs of spectacles without extra payment f your reimbursement of spectacles and lenses on your Beter Af Plus Policy. Or free contact lenses f 1 month Collective of Independent Opticians (Collectief van Zelfstandige Opticiens): your independent optician will raise the reimbursement from your supplementary f spectacles and contact lenses by 25%. In addition you benefit from free eye tests and a discount on insuring your spectacles 2 Refractive eye surgery/lens implants VisionClinics: 10% discount on the fees f full refractive eye surgery lens implants Eyescan: 15% discount on Eyescan s fees f full refractive eye surgery lens implants Oogkliniek Heuvelrug: 10% discount on the fees f full refractive eye surgery lens implants 3 Medical devices You receive 20% discount on many medical devices f daily activities (rollats, lift chairs and ADL devices). You receive discount on 5 models of lift chairs from Vegro and Hartingbank/Ligtvoet And 25% discount on a turban from Capelle Haarwerken, the fashionable alternative to a wig 20% discount on Underwunder incontinence underwear 4 Spts at an Achmea Health Centre Achmea Health Centers: 20% discount on a package of your own choice ( afvallen & afblijven, flex, fit & vitaal, in balans ) at one of the Achmea Health Centres. And you do not have to pay registration costs 5 Diabetes test strips Via Mediq Direct Diabetes, a discount arrangement f diabetes test strips f insured clients with diabetes type 2 6 Cosmetic surgery Bergman Clinics: Up to 20% discount on treatments provided at Bergman Clinics. F instance, you get 20% discount on all MediSpa treatments such as facial and body treatments, laser hair removal and scar treatment. This does not include injectables. 15% discount on upper eyelid treatments. And 10% on all injectables, small and large abdominal wall crections, breast lift with without implants, varicose veins C1 and C2 7 Assistance at home Home care Zg vo U. Do you want extra home care in addition to the care provided under the AWBZ? Organise it quickly and simply via Zg vo U Interi care Via Home Wks. Cleaning activities in your home. Once f a longer period. You receive a 7.5% discount Private assistance Private assistance provides you with assistance at home (via Zg vo U) to help you avoid excessive exertion. Such assistance is customised Tempary child-minding Tempary child-minding at home via Zg vo U. You can also ganise specific child-minding (children with ADHD, autism and Down s Syndrome) 8 Personal alarm Eurocross Assistance. Opting f Eurocross Personal Alarm means you will have the right equipment in your home 20% discount on rental costs 20% discount on subscription costs 25% discount on once-only administration costs 25% discount on placement costs 4

5 9 Pedicure at home Pedicurebijuthuis.nl. Are you unable to visit the pedicure f any particular reason? In that case the pedicure will visit you at home You receive 10% discount If you make a second appointment you receive free Seawash/diabetic socks 10 Transpt Services of a driver Via Nieuwe Koetsiers. Rent an experienced driver if you have to travel long distances f wry-free family visits. This involves the driver using your car Surcharges apply f evenings, weekends and public holidays Transpt by taxi Connexxion. You can make use of individual combined transpt Taxi (combination transpt) No objection to fellow passengers (combination transpt)? That makes a difference to the price per trip! You can use this as long as you reserve 24 hours in advance. You receive an 18-31% discount on the statuty tariff. The discount depends on the region in which you live Taxi (individual) Travel to your destination in a comftable car with a private driver (individual). You can use this as long as you reserve 24 hours in advance. You receive an 11-25% discount on the statuty tariff. The discount depends on the region in which you live (Discounts and agreements with suppliers are subject to alterations and only apply if you have a supplementary with Avéro Achmea.) 5

6 Your health F which health care are we insured in the Netherlands? What is the difference between the basic and the supplementary? Our health care system in a nut shell. The Dutch health care system Our existing healthcare system was introduced by the government on January 1, 2006 and comprises basic health including mandaty excess. Under this system, everyone in the Netherlands is insured against medical expenses with premiums payable from the age of 18. You may be eligible f compensation towards the premiums. This benefit is called zgtoeslag. F further infmation, visit The basic Basic is the same f everyone in the Netherlands. Each year the government determines what will be reimbursed under the basic. With Avéro Achmea you can choose from 2 different fms of basic : (restitution) and the (in kind) The gives you complete freedom to choose any care provider you like. It doesn t matter whether the care provider has a contract with us not. You receive full reimbursement up to, at the most, the statuty sum the maximum tariff in the Netherlands accding to market conditions, except f the (mandaty) excess and the (statuty) contributions. The allows you to receive care from care providers with whom we have entered into contracts. F this you pay a slightly lower premium. We pay invoices directly (except in respect of the statuty contributions). A lower reimbursement will apply if you use other care providers than those we have contracted f this policy. Contracted care provider A care provider with whom we have entered into agreements about the quality of care, its accessibility and the price. The contracted care provider sends an invoice directly to us. Therefe, you will not receive an invoice from them. The invoice will be paid in full if you have a right to full reimbursement, excluding the (mandaty) excess and the (statuty) contributions. Non-contracted care provider A care provider with whom we have no agreements is a non-contracted care provider. You submit the invoice to us. You will receive 70% of our average contracted tariff, except f paramedical care, transpt and mental health care (GGZ). Other, lower reimbursements apply to this, which can be found in the policy conditions and on our website. It is therefe wise to check this in advance if you go to a non-contracted care provider. This will help you to avoid disappointments. What are your entitlements under the basic of? medical care provided by General Practitioners, hospitals, specialists and obstetricians hospital stay medical devices medication obstetric care transpt paramedical care (limited fysiotherapy / remedial therapy, speech therapy and occupational therapy) dental care (up to 18 years) 6

7 What can you insure via supplementary? In addition to the basic you can also take out supplementary, f instance f the reimbursement of the statuty contributions, a broader cover f physiotherapy, dental costs a broader cover f urgent medical care abroad. With Avéro Achmea you can choose from various fms of supplementary and a separate dental. F the supplementary s Start, Extra, Royaal and Excellent applies the following: The me higher your supplementary gets, the broader the cover and the higher the reimbursements. The supplementary Beter vo Nu is specially developed f insured of 50 years and older who have no children under the age of 18. The supplementary Juist Vo Jou provides f youth and students a proper. When will I receive a reimbursement? This is subject to a number of conditions. These conditions are not included in this Benefit Schedule. All conditions relating to eligibility f a reimbursement can be found in the policy conditions. F instance, it tells you whether you need a referral from a doct, f which indications reimbursement applies and when you will not receive a reimbursement. The complete policy conditions can be found on What do I have to pay myself? In the Netherlands a statuty contribution applies to some treatments medicines. The government decides f which treatments medicines a contribution applies. You pay that yourself if you use them. In addition, in the Netherlands there is also a mandaty excess. This too is determined annually by the government. F the year 2014 the government has decided that the mandaty excess will be per person. F children up to 18 years no mandaty excess applies. And you can opt f a voluntary chosen excess by increasing the mandaty excess of You have a higher risk, but you pay less premium. F example, if you choose f a voluntary chosen excess of , then your total excess will be (mandaty) (voluntary) = What is a statuty contribution? A statuty contribution is the ption of medical costs covered by the basic that you have to pay yourself. Among other things, you will pay a contribution f: Some medicines Some medical devices Maternity care Seated transpt of patients Outpatient childbirth without medical indication You do not pay excess f: Care from a general practitioner Care that is reimbursed from your supplementary and dental Care f children up to 18 years of age Items on loan, excluding maintenance costs and costs of use Maternity care and obstetric care (but excluding medicines, blood tests, chionic villus sampling transpt of patients) Integrated care After-care f a don Please note! The reimbursements mentioned in this Benefit Schedule apply to care providers contracted by us, unless a specific (lower) reimbursement is mentioned. You can find the contracted care providers on The amount of the reimbursement f non-contracted care providers can also be found on our website. This Benefit Schedule is a summary of the policy conditions. Always refer to the policy conditions to see your exact entitlements and the exact conditions. The conditions f reimbursement and the exceptions do not appear in full in this Schedule. Therefe always refer to the policy conditions on call our Customer Service (2.76 euro cent per minute plus a start rate of 9.4 euro cent). The supplementary Juist Vo Jou can be found in the back of this schedule (p. 32). The Juist Vo Jou can only be taken out in combination with a (the basic in kind). 7

8 How to use this Benefit Schedule? This is how you can find the reimbursements: firstly choose the theme in the index and check out the pagenumber. You will then easily find the care that you are looking f. We will infm you which entitlement derives from the basic s and which entitlement may derive from the supplementary s. Are you unable to find the care you are looking f? Please check our website contact our customer service: (2.76 euro cent per minute plus a start rate of 9.4 euro cent) Alternative 10 Acupuncture 10 Alternative medicine 10 Antroposophical and homeopathical medicines 10 Chiropractic 10 Homeapathy 10 Manuel therapy 10 Orthopaedic medicine 10 Osteapathy 10 Other alternative medicines Bones, muscles and joints 11 Exercise programmes 11 Exercise in extra heated water in case of rheumatism 11 Occupational therapy 11 Pedicure care in case of rheumatoid arthritis diabetes 11 Podiatry/podology/ podo postural therapy arch suppts 11 Foot care f insured persons with diabetes mellitus Abroad 12 Best Docts 12 Malaria vaccinations 12 Repatriation 12 Urgent farmaceutical care 12 Urgent medical care 12 Non urgent medical care 12 Vaccinations 12 Transpt costs to Belgium Germany in case of health care mediation 12 Transpt of insured person and transpt of mtal remains (repatriation) 12 Overnight stay and transpt costs of family members to Belgium Germany in case of health care mediation Physiotherapy and remedial therapy 14 Pelvic physiotherapy in case of urinary incontinence 14 Physiotherapy and remedial therapy up to 18 years 14 Physiotherapy and remedial therapy from 18 years and older Skin 14 Acne treatment 14 Camouflage therapy 14 Epilation treatment 14 Skin care Medical devices 15 ADL medical devices 15 Medical devices from the Basic 15 Personal alarm 15 Adhesive strips breast prosthesis 15 Bedwetting alarm 16 Wigs 16 Toupim headwear 16 Suppt pessary 16 Trans-therapy Medication (medicines) and dietary preparations 16 Contraceptives 17 Medication from the Basic 17 Flu vaccination 17 Melatonin Oral health care and dentistry 19 Implants 19 Dental surgery 19 False teeth (prosthesis) 20 Orthodontics (brace) up to 18 years 20 Orthodontics (brace) from 18 years and older 19 Orthodontics (brace) in exceptional cases 20 Dental care as a result of an accident 18 Dental care up to 18 years 18 Dental care from 18 years and older 20 Dental care of insured persons with a handicap 20 Dental care in exceptional cases Eyes and ears 20 Audiological centre 20 Spectacles 20 Contact lenses 20 Upper eyelid crection 20 Ear position crection 21 Hearing aid 21 Refractive eye surgery Psychological care 21 Basic GGZ 22 Specialised GGZ 22 Psychiatric hospitalisation Speech and reading 22 Dyslexia care 22 Speech therapy 23 Stutter therapy 8

9 Transpt 23 Ambulance 23 Transpt of patients Hospital, treatment and nursing 24 Asthma Centre in Davos 24 Treatment, research and surgery in hospital 24 Circumcision 24 Cosmetic surgery 24 Genetic research and advice 24 Guest house 26 health Check 24 Mammaprint 24 Mechanical respiration 25 Medical specialised care outside the hospital (extramural) 25 Medical specialised care in the hospital (outpatient) 25 Obesity treatment 25 Organ transplantation 25 Plastic surgery 25 Preventative examination 25 Convalescence 26 Second opinion 26 Sterilisation 26 Kidney dialysis at home 26 Nursing at home 26 Nursing inside the hospital 26 Independent treatment centre Pregnancy/baby/child 27 Maternity care related to adoption medical screening related to adoption 27 Delivery 27 Breast pump (electrical) 27 In vitro fertilisation (IVF) 27 Maternity package 27 Maternity care 28 Breast feeding advice 28 Oncology examination f children 28 Prenatal screening 28 Sperm freezing 27 TENS during delivery 28 Obstetric care 29 Freezing (vitrification) of human oocytes and embryos 29 Fertility treatments (not IVF) 29 Antenatal classes Miscelleaneous 29 Dietary advice 29 Recovery and Balance, f fmer cancer patients 29 Convalescent homes 29 Hospice 29 General practitioner care 29 Home help in case of ADL loss 30 Integrated care in case of diabetes mellitus type 2 and COPD 30 Child care (up to 12 years) during hospitalisation of parent(s) 30 Labaty and x-rays 30 Lifestyle trainings 30 Infmal care replacement 30 Menopause consultant 30 Patients associations 30 (Preventative) courses 31 Spts doct 31 Spts medical examination 31 Stop smoking programme 31 Therapeutic holiday camp f handicapped persons 31 Therapeutic holiday camp f children 31 Thrombosis service 31 Payment f loss of function due to an accident 31 Sailing, hotel bungalow holidays 31 Zgregelaar Extra supplementary packages 32 Juist Vo Jou 33 Supplementary Tandartskosten 34 Supplementary Ziekenhuis Extra Insurance 9

10 Benefit Schedule 2014 You can find all the benefits of the and as well as all the supplementary s, in this Benefits Schedule. The reimbursements from the and can be found in one single column. You find the reimbursements under the heading Keuze Zg Plan. Please see f an overview of care providers that we have contracted. On this website you can also find the Achmea regulations f hulpmiddelen (medical aids), Achmea Regulations f farmacie (medicines) as well as our policy conditions, brochures, fms and me infmation about our health s. This Benefit Schedule is a summary of the policy conditions and you can not derive any rights from it. Always refer to the policy conditions befe visiting a care provider to see your exact entitlements and the exact conditions. You can download the policy conditions from our website obtain them from us. What do the following things mean in this Benefit Schedule: Year A calendar year (1 January up to and including 31 December) Our permission Befe claiming a reimbursement, you will need our pri permission. F this care, which is covered by the basic, the mandaty excess and any voluntary excess you have chosen applies to insured patients 18 years and older. With the the care providers must have made agreements with Avéro. If that is not the case, then you may have to pay extra. If you choose a provider with which Avéro does not have an agreement? Then please refer to your policy conditions to see if this involves a lower reimbursement. You can find the level of the reimbursement on our website at you can request it from us. With the the reimbursement is the maximum of the legal amount the maximum of the nmal market price in the Netherlands. Alternative Start Extra Royaal Excellent Beter Vo Nu A. Alternative fms of treatment and therapies consultations/treatments such as f instance: acupuncture, homeopathy, chiropractic, osteopathy, manual therapy by practitioners who are affiliated to professional associations that meet our criteria. See alternatief of call (2.76 euro cent per minute plus start rate of 9.4 euro cent) per day f docts who practice alternative fms of treatment and f alternative non-docts per day f docts who practice alternative fms of treatment and f alternative non-docts per day f alternative non-docts per day f docts who practice alternative fms of treatment 16 consultations per day f alternative non-docts per day f docts who practice alternative fms of treatment 20 consultations per day f alternative non-docts per day f docts who practice alternative fms of treatment 20 consultations B. Alternative medicines (anthroposophic and homeopathic) See alternatief call (2.76 euro cent per minute plus start rate 9.4 euro cent) A B added up per per Orthopaedic medicine diagnosis and non operative treatment of complaints of musculo-skeletal disders perfmed by thopaedic physicians affiliated to the Association of Physicians f Orthopaedic Medicine (VAOG - Vereniging Artsen vo Orthopedische Geneeskunde) per per per per 10

11 Bones, muscles and joints Start Extra Royaal Excellent Beter Vo Nu Exercise programmes f people with obesity BMI > 30 fmer heart failure diabetes type 2 COPD pulmonary function value of FEV1/VC<0.7, distress sce >2 (MRC scale) and health sce >1 to >1.7 (CCQ scale) rheumatism, we use the definition of rheumatism as determined by the Dutch Reumafonds per person per disder f the entire duration of the supplementary per person per disder f the entire duration of the supplementary Exercise in extra heated water remedial therapy f rheumatism patients per per per Occupational therapy advice, instruction, training treatment by an occupational therapist from Select Zg Plan up to 10 hours per person per year Zg Plan up to 10 hours per person per year from Extra f insured persons up to 18 years: 3 hours per from Select Zg Plan up to 10 hours per person per year from Royaal Excellent f insured persons up to 18 years: 4 hours per Zg Plan up to 10 hours per person per year Pedicure Care with rheumatism diabetes (Simm s 0) no removal of callouses cutting nails (unless medical necessity) per treatment up to per per treatment up to per per treatment up to per f insured persons with a cerebrovascular accident (CVA) Podiatry/podology/ podopostural therapy Register Podiatrist B affiliated to the LOOP foundation podopostural therapist affiliated to Omni Podo Association (Omni Podo Genootschap) and Arch suppts supplier must be member of the NVOS Orthobanda per, including 1 pair of arch suppts per, including 1 pair of arch suppts including 1 pair of arch suppts per, including 1 pair of arch suppts No shoes shoe adjustments, feet examinations and treatment of diabetic foot (Simm s 1 and higher) Footcare f insured persons with diabetes in case of increased high risk of a diabetic foot (ulcers) Simm s 1 and higher by pedicure podiatrist from 11

12 Abroad Start Extra Royaal Excellent Beter Vo Nu Best Docters InterConsultation (second opinion ) AskTheExpert (additional medical infmation) Always call our Health Care Mediation team (Zgbemiddeling) f permission in advance (2.76 euro cent per minute plus startrate 9.4 euro cent) see zgbemiddeling Urgent care abroad care which cannot be postponed until after you return to your country of residence Call Eurocross Assistance f urgent help abroad: The telephone number is also mentioned on your health card Zg Plan Select Zg Plan of the tariff in the Netherlands from of the tariff in the Netherlands See the policy conditions from Start, Extra, Royaal, Excellent and Beter Vo Nu supplemented to cost price (regular tariff in the country in question) f a continuous stay of a maximum of 12 months. Urgent pharmaceutical care abroad which is not reimbursed from the basic (medicines f urgent care) Non-urgent care abroad care which can be postponed until after you return to your country of residence Overnight stay and transpt costs of family members after health care mediation to Belgium Germany Transpt costs after health care mediation to Belgium Germany Always call the Transpt Telephone Line (Vervoerslijn) f permission Transpt of insured person and transpt of mtal remains to the Netherlands (repatriation) Call Eurocross Assistance: Zg Plan Select Zg Plan maximum of of the tariff in the Netherlands See the policy conditions 50 per from maximaal of the tariff in the Netherlands See the policy conditions from Start, Extra, Royaal, Excellent and Beter vo Nu accding to the reimbursement in the Netherlands with due regard to the conditions and exceptions costs of overnight stay: per day f the family combined own transpt, public transpt and taxi 0.31 per kilometre up to a maximum of 700 kilometres per admission taxi own transpt 0.31 per kilometre public transpt (second class) Eurocross Assistance must have given you permission in advance Vaccinations and consultations in case of a journey abroad with one of our contracted care providers with one of our contracted care providers with one of our contracted care providers with one of our contracted care providers Medicines against malaria f a journey abroad accding to advice from National codination centre Passenger Advice (Landelijk coördinatiecentrum Reizigersadvisering) via Internet pharmacist efarma via another provider per person per year via Internet pharmacist efarma via another provider per via Internet pharmacist efarma via another provider per via Internet pharmacist efarma via another provider per 12

13 Jonger dan 18 jaar Fysiotherapy and excercise therapy See paramedisch f the brochure Paramedische Zg Start Extra Royaal Excellent Beter Vo Nu Disder that is listed by the Minister of Public Health, Welfare and Spt (Appendix 1 with article 2.6 of the Health Insurance Decision (Besluit zgverzekering)) your doct and/ physiotherapist diagnoses the disder from all treatments Manual lymphatic drainage in case of serious lymphoedema may also be carried out by a skin therapist instead of a physiotherapist Disder that is not listed by the Minister of Public Health, Welfare and Spt (Appendix 1 with article 2.6 of the Health Insurance Decision, this can be found in the brochure Paramedische Zg ) Zg Plan Select Zg Plan per diagnosis 1 to 18 treatments Zg Plan per diagnosis 1 to 18 treatments from Start via one of our contracted providers all treatments from the 19th treatment (therefe jointly reimbursement) Zg Plan per diagnosis 1 to 18 treatments from Extra via one of our contracted providers all treatments from the 19th treatment (therefe jointly reimbursement) Zg Plan per diagnosis 1 to 18 treatments from Royaal via one of our contracted providers all treatments from the 19th treatment (therefe jointly reimbursement) Zg Plan per diagnosis 1 to 18 treatments from Excellent all treatments from the 19th treatment (therefe jointly reimbursement) Zg Plan per diagnosis 1 to 18 treatments from Beter vo Nu via one of our contracted providers all treatments from the 19th treatment (therefe jointly reimbursement) from Start via a noncontracted provider 12 treatments per year from Extra via a noncontracted provider 27 treatments per year from Royaal via a noncontracted provider 27 treatments per year from Beter van Nu via a non-contracted provider 27 treatments per year 13

14 18 years and older Fysiotherapy and excercise therapy See paramedisch f the brochure Paramedische Zg Start Extra Royaal Excellent Beter Vo Nu 1 disder that is listed by the Minister of Public Health, Welfare and Spt (Appendix 1 with article 2.6 of the Health Insurance Decision (Besluit zgverzekering)) your doct and/ physiotherapist diagnoses the disder Manual lymphatic drainage in case of serious lymphoedema may also be carried out by a skin therapist instead of a physiotherapist Zg Plan Select Zg Plan from 21st treatment treatment 1 to 20 you pay yourself Zg Plan from 21st treatment from Start 12 treatments per year treatment 13 to 20 you pay yourself Zg Plan from 21st treatment from Extra 20 treatments per year Zg Plan from 21st treatment from Royaal 20 treatments per year Zg Plan from 21st treatment from Excellent 20 treatments per year Zg Plan from 21st treatment from Beter vo Nu 20 treatments per year 1 disder that is not listed by the Minister of Public Health, Welfare and Spt (Appendix 1 with article 2.6 of the Health Insurance Decision, this can be found in the brochure Paramedische Zg ) your doct and/ physiotherapist diagnoses the disder 12 treatments per year 27 treatments per year 27 treatments per year all treatments 27 treatments per year Manual lymphatic drainage in case of serious lymphoedema may also be carried out by a skin therapist instead of a physiotherapist Pelvic physiotherapy in case of urinary incontinence Zg Plan Select Zg Plan treatment 1 to 9 Zg Plan treatment 1 to 9 from 12 Start treatments per year Zg Plan treatment 1 to 9 from Extra 27 treatments per year Zg Plan treatment 1 to 9 from Royaal 27 treatments per year Zg Plan treatment 1 to 9 from Excellent all other treatments Zg Plan treatment 1 to 9 from Beter vo Nu 27 treatments per year The above stated reimbursement is only applicable if you suffer from 1 disder! Do you have several disders f which you visit a physiotherapist/ remedial therapist? Then always contact our Customer Service (2,76 euro cent per minute plus start rate 9,4 euro cent). They are happy to infm you to what reimbursement you are entitled to. Skin Start Extra Royaal Excellent Beter Vo Nu Skin care by beautician (ANBOS) skin therapist acne treatment (facial) camouflage therapy epilation treatment and IPL f women in case of serious disfiguring facial hair (laser epilation only by a skin therapist) per per 1, per per no (cosmetic) products 14

15 Medical devices See hulpmiddelen ADL medical devices (Algemeen Dagelijkse Levensverrichtingen) Start Extra Royaal Excellent Beter Vo Nu 75% up to per only with bij Vegro en Harting-Bank/ Ligtvoet f ADL medical devices, which are not reimbursed by Select Zg Plan Medical devices from the basic reimbursement accding the conditions mentioned in the Achmea Regulations on medical devices (Achmea Reglement Hulpmiddelen) see hulpmiddelen from you must submit a request f certain medical devices in advance a maximum reimbursement statuty contribution may apply Zg Plan Select Zg Plan you must submit a request f certain medical devices in advance Zg Plan Select Zg Plan you must submit a request f certain medical devices in advance Zg Plan Select Zg Plan you must submit a request f certain medical devices in advance (the statuty excess does not apply in case of loan) a maximum reimbursement statuty contribution may apply from Royaal statuty contribution f other medical devices no wig, hearing aid, thopaedic shoes and allergen-free shoes a maximum reimbursement statuty contribution may apply from Excellent statuty contribution f other medical devices no wig, hearing aid, thopaedic shoes and allergen-free shoes a maximum reimbursement statuty contribution may apply from Beter vo Nu statuty contribution f other medical devices no wig, hearing aid, thopaedic shoes and allergen-free shoes Personal alarm with medical indication Call the Hulpmiddelenlijn on social indication Adhesive strips breast prosthesis Zg Plan Select Zg Plan requested at the Hulp middelenlijn f alarm unit via Eurocross Assistance Also see Achmea Regulations on Medical Devices (Achmea Reglement Hulpmiddelen) from requested at the Hulpmiddelenlijn f alarm unit via Eurocross Assistance from Start, Extra, Royaal, Excellent Beter vo Nu f subscription costs of Action Line alert system via Eurocross Assistance via other provider of alert steem per year f subscription costs after our permission f subscription costs of Action Line alert system via Eurocross Assistance via other provider of alert system per year after our permission Bedwetting alarm in case of bedwetting problems per person f the entire duration of the supplementary 15

16 Medical devices See hulpmiddelen Start Extra Royaal Excellent Beter Vo Nu Wig ( contribution) from Select Zg Plan per wig Also see Achmea Regulations on Medical Devices (Achmea Reglement Hulpmiddelen) per wig of which from Select Zg Plan and from Extra per wig of which from Select Zg Plan and from Royaal per wig of which from Select Zg Plan and from Excellent extra reimbursement may apply in case of proven allergic reaction per wig of which from Select Zg Plan and from Beter vo Nu Toupim headwear in case of alopecia (hair loss) (tempary) hair loss due to chemotherapy other medical treatments Suppt pessary in case of uterine prolapse x per Trans-therapy f the treatment of incontinence rental costs Medication (medicines) and diet preparations Contraceptives f instance the pill an intrauterine device Start Extra Royaal Excellent Beter Vo Nu up to 21 years from reimbursement accding to Achmea s Regulations on Pharmaceutical Care (Achmea Reglement Farmaceutische Zg) you pay the statuty contribution yourself (the upper limit GVS price - GVS stands f Medicinal Products Reimbursement System (Geneesmiddelenvergoedingssysteem)) this differs per medicine See f me detailed infmation Zg Plan Select Zg Plan reimbursement accding to Achmea s Regulations on Pharmaceutical Care (Achmea Reglement Farmaceutische Zg) from Royaal * reimbursement statuty contribution (the upper limit GVS price) per from Select Zg Plan reimbursement accding to Achmea s Regulations on Pharmaceutical Care (Achmea Reglement Farmaceutische Zg) from Excellent and Beter vo Nu reimbursement statuty contribution (the upper limit GVS price) 16

17 Medication (medicines) and diet preparations Start Extra Royaal Excellent Beter Vo Nu 21 years and older Zg Plan Select Zg Plan only reimbursement in case of medical necessity (endometriosis menrhagia) accding to Achmea s Regulations on Pharmaceutical Care (Achmea Reglement Farmaceutische Zg) from Select Zg Plan only reimbursement in case of medical necessity (endometriosis menrhagia) accding to Achmea s Regulations on Pharmaceutical Care (Achmea Reglement Farmaceutische Zg) from Start of en Extra you pay the statuty contribution yourself (upper limit GVS price) this differs per medicine Zg Plan Select Zg Plan only reimbursement in case of medical necessity (endometriosis menrhagia) accding to Achmea s Regulations on Pharmaceutical Care (Achmea Reglement Farmaceutische Zg) from Royaal and * reimbursement statuty contribution (upper limit GVS price) per person per year from Select Zg Plan only reimbursement in case of medical necessity (endometriosis menrhagia) accding to Achmea s Regulations on Pharmaceutical Care (Achmea Reglement Farmaceutische Zg) from Excellent and Beter Vo Nu reimbursement statuty contribution (upper limit GVS price) medicines from the basic from reimbursement accding to Achmea s Regulations on Pharmaceutical Care (Achmea Reglement Farmaceutische Zg) you pay the statuty contribution yourself (upper limit GVS price) this differs per medicine See me detailed infmation Zg Plan reimbursement accding to Achmea s Regulations on Pharmaceutical Care (Achmea Reglement Farmaceutische Zg) from Royaal * reimbursement statuty contribution (upper limit GVS price) per from Select Zg Plan reimbursement accding to Achmea s Regulations on Pharmaceutical Care (Achmea Reglement Farmaceutische Zg) from Excellent Beter Vo Nu reimburesment statuty contribution (upper limit GVS price) * the reimbursement of the statuty contribution (upper limit GVS price) to applies f these reimbursements together Flu vaccination up to 60 year (no flu vaccination in case of AWBZ) Melatonin medication in case of insomnia with internet pharmacy efarma via other pharmcacy we must have given you permission in advance with internet pharmacy efarma via other pharmacy we must have given you permission in advance with internet pharmacy efarma via other pharmacy we must have given you permission in advance with internet pharmacy efarma via other pharmacy we must have given you permission in advance 17

18 See f me infmation Younger than 18 with supplementary Oral health care and dentistry see mondzg f the brochure Mondzg Start Extra Royaal Excellent Beter Vo Nu All treatments by dentist, al hygienist, dental surgeon and clinical dental technician with the exception of cast fillings, crowns, bridges, inlays and implants from Dental treatment by dentist/dental surgeon per f crowns, bridges, inlays and implants per f crowns, bridges, inlays and implants Orthodontics (brace) second opinion by dentist/thodontist no repair, replacement due to damage and loss if through own fault/negligence See f me infmation 18 years and older with supplementary dental 90% up to 1, per person f the entire duration of the supplementary 90% up to 2, per person f the entire duration of the supplementary 90% up to 2, per person f the entire duration of the supplementary Oral health care and dentistry see mondzg f the brochure Mondzg A. Dentist/al hygienist, dental surgeon and clinical dental technician consultations (C-codes) and second opinion al hygiene (M-codes) filling (V-codes) pull teeth/molars (h-codes) T Start T Extra T Royaal T Excellent B. Other treatments 75% 75% 75% A B added up per person per year per person per year 1, per 1, per person per year C. We do not reimburse the costs of: test repts and dental statements (C70, C75 and C76) a non-fulfilled appointment (C90) thodontics subscriptions external bleaching of teeth and molars (E97, E98 and E00) mandibular advancement splint (MAS; a prosthesis against sning) and the diagnostics and aftercare (G71, G72 and G73) complete anaesthesia 18

19 See f me infmation 18 years and older with supplementary Oral health care and dentistry see mondzg f the brochure Mondzg Start Extra Royaal Excellent Beter Vo Nu Dental surgery no parodontal surgery, dental implants and uncomplicated extraction from we must have given you permission in advance in case of some treatments Set of false teeth (dentures) purchase full set of removable initial dentures, replacement dentures overdentures made by dentist clinical dental technician from 75% statuty contribution 25% we must have given you permission in advance: : if the costs are higher than f an upper prosthesis; if the costs are higher than f a lower prosthesis; if the costs are higher than 1, f a complete prosthesis in case of replacement within 5 years. repair refitting (rebasing) of full set of removable overdentures initial dentures by dentist clinical dental technician from implants f full set of removable dentures in case of serious development disder, growth disder acquired defect of the teethjaw-mouth made by dentist, dental surgeon Centre f Special Dental Surgery (Centrum vo Bijzondere Tandheelkunde) from we must have given you permission in advance full set of removable dentures on implants in case of serious development disder, growth disder acquired defect of the teethjaw-mouth made by dentist, clinical dental technician Centre f Special Dental Surgery from statuty contribution per upper lower prosthesis we must have given you permission in advance Orthodontics (brace) in special cases in case of serious development disder, growth disder acquired defect of the teethjaw-mouth no repair, replacement due to damage and loss if through own fault/negligence from we must have given you permission in advance 19

20 See f me infmation 18 years and older with supplementary Oral health care and dentistry see mondzg f the brochure Mondzg Start Extra Royaal Excellent Beter Vo Nu Orthodontics (brace) 18 up to 22 jaar second opinion by dentist/thodontist no repair, replacement due to damage and loss through own fault/negligence Orthodontie (beugel) van 22 jaar en ouder of second opinion by dentist/thodontist no repair, replacement due to damage and loss through own fault/negligence Dental costs as a consequence of an accident 10, per accident we must have given you permission in advance 90% up to 2, per person f the entire duration of the supplementary 70% up to 1, per person f the entire duration of the extra, no sce of 1 and 2 of the IOTN sce We must have given you permission in advance. 70% up to 1, per person f the entire duration of the extra, no sce of 1 and 2 of the IOTN sce We must have given you permission in advance. Dental care f handicapped persons your dentist knows whether you are eligible f the reimbursement from if there is no entitlement to reimbursement from the Exceptional Medical Expenses Act (AWBZ) we must have given you permission in advance Dental care in special cases your dentist knows whether you are eligible f the reimbursement from in some cases a statuty contribution applies we must have given you permission in advance Eyes and ears Start Extra Royaal Excellent Beter Vo Nu Audiological centre from Spectacles and contact lenses per person per period of 3 years f spectacles and contact lenses together per person per periode van 3 jaar vo brillen en contactlenzen samen per person per period of 3 years f spectacles and contact lenses together per person per period of 3 years f spectacles and contact lenses together per person per period of 3 years f spectacles and contact lenses together Upper eyelid crection with medical indication Crectie ostand only with one of our contracted care providers only with one of our contracted care providers up to 18 jaar 20

21 Eyes and ears Start Extra Royaal Excellent Beter Vo Nu Hearing aid from 75% statuty contribution 25% See Achmea Regulations on Medical Devices (Achmea Reglement Hulpmiddelen) at Zg Plan Select Zg Plan 75% statuty contribution 25% See also Achmea Reglement Hulpmiddelen at www. averoachmea.nl/ hulpmiddelen from Royaal reimbursement statuty contribution per Zg Plan Select Zg Plan 75% statuty contribution 25% See also Achmea Reglement Hulpmiddelen at www. averoachmea.nl/ hulpmiddelen from Excellent reimbursement statuty contribution per appliance Zg Plan Select Zg Plan 75% statuty contribution 25% See also Achmea Reglement Hulpmiddelen at www. averoachmea.nl/ hulpmiddelen from Beter vo Nu reimbursement statuty contribution per Refractive surgery/ lens implantation (extra costs nonstandard lens) by refraction surgeon registered with the Dutch Ophthalmic Society (Nederlands Oogheelkundig Genootschap (NOG)) per person f the entire duration of the supplementary per person f the entire duration of the supplementary per person f the entire duration of the supplementary Psychological care Start Extra Royaal Excellent Beter Vo Nu General Basic GGZ due to noncomplex mental disder Principle carer: clinical psychologist, healthcare psychologist, psychiatrist, psychotherapist, nursing specialist, general remedial educationalist (Dutch NVO), psychologist specialized in children and/ juveniles (NIP) from no treatment f adjustment disders, wk-related and relationship problems, psychiatric complaints without mental disder and psychological interventions (see list on our website) 21

22 Psychological care Start Extra Royaal Excellent Beter Vo Nu Non-clinical specialised GGZ due to complex mental disder (second-line GGZ) psychiatrist, GGZ institution, clinical psychologist psychotherapist from no treatment f adjustment disders, wk-related and relationship problems, psychiatric complaints without mental disder and psychological interventions (see list on website) Psychiatric hospitalisation admission to a GGZ institution (psychiatric university clinic, psychiatric hospital psychiatric ward of a hospital) Principle carer: psychiatrist, clinical psychologist, psychotherapist a healthcare psychologist in an MDO (multidisciplinary consultation) construction from no treatment f adjustment disders, wk-related and relationship problems, psychiatric complaints without mental disder and psychological interventions (see list on website) Speech and reading Start Extra Royaal Excellent Beter Vo Nu Dyslectic care (diagnosis and treatment of serious dyslexia) f children aged 7 to 12 years in compliance with the protocol f the Diagnosis and Treatment of Dyslexia (protocol Dyslexie Diagnose en Behandeling) see contact our Customer Service (2.76 euro cent per minute plus start rate 9.4 euro cent) Speech therapy no dyslexia language development disder from from Me infmation can be found in the brochure Paramedische Zg (zie 22

23 Speech and reading Start Extra Royaal Excellent Beter Vo Nu Stutter therapy with a speech therapist from accding to method Del Ferro, Hausdörfer, BOMA and McGuire per person f the entire duration of the supplementary per person f the entire duration of the supplementary 1, per person f the entire duration of the supplementary 1, per person f the entire duration of the supplementary Transpt See vervoer f the brochure Vervoer Start Extra Royaal Excellent Beter Vo Nu Ambulance from Transpt of patients (with public transpt, own car (multi-person) taxi transpt in case of kidney dialysis, oncology treatment in case of radio/chemotherapy, visual handicap and if you cannot travel without assistance are dependent on a wheelchair) from up to 200 kilometres single journey: own transpt 0,31 per kilometre public transpt (second class) (multi-person) taxi transpt you pay a statuty contribution of per person we must have given you permission in advance Always call the Transpt Telephone Line (Vervoerslijn) f permission with own transpt (multiperson) taxi transpt in case of other medical indications making it impossible f you to make use of public transpt Always call the Transpt Telephone Line (Vervoerslijn) f permission up to 200 kilometres single journey and when crossing the bder up to 55 kilometres from the bder: own transpt 0.31 per kilometre, (multi-person) taxi transpt. You pay yourself per year, maximum total reimbursement 1, per. when crossing the bder up to 55 kilometres from the bder: own transpt 0.31 per kilometre, (multi-person) taxi transpt. we must have given you permission in advance when crossing the bder up to 55 kilometres from the bder: own transpt 0.31 per kilometre, (multi-person) taxi transpt. we must have given you permission in advance we must have given you permission in advance Statuty contribution f patient transpt 23

24 Hospital treatment and nursing Call our Health Care Mediation team (Zgbemiddeling) (2.76 euro cent per minute plus start rate 9.4 euro cent) see zgbemiddeling Start Extra Royaal Excellent Beter Vo Nu Asthma Centre in Davos from we must have given you permission in advance Treatment, examination and operation in hospital from in case of plastic surgery and dental surgery we must have given you permission in advance Male circumcision on religious grounds with medical indication Cosmetic surgery (without medical indication) no botox, (autologous) lipofilling, peeling, laser refractive surgery, sclerotherapy (varicase vein treatment) only with one our contracted care providers in case of contracted care providers, in case of non-contracted care providers we must have given you permission in advance per Genetic research and advice from Guest house your costs of an overnight stay in a hospital in case of outpatient treatment cycle per person per day overnight stay and transpt costs of your family members in case of a hospitalisation, no psychiatric hospital (single) journey house-hospital a minimum of 50 kilometres and across the bder up to 55 kilometres over the bder per day up to per year f all family members combined own car 0.31 per kilometre public transpt (second class) (single) journey house-hospital across the bder up to 55 kilometres over the bder per day up to per year f all family members combined own car 0.31 per kilometre public transpt (second class) (single) journey house-hospital across the bder up to 55 kilometres over the bder per day up to 1, per year f all family members combined own car 0.31 per kilometre public transpt (second class) (single) journey house-hospital a minimum of 50 kilometres and across the bder up to 55 kilometres over the bder per day up to per year f all family members combined own car 0.31 per kilometre public transpt (second class) Mammaprint only with labaty Agendia Mechanical respiration from 24

25 Hospital treatment and nursing Call our Health Care Mediation team (Zgbemiddeling) (2.76 euro cent per minute plus start rate 9.4 euro cent) see zgbemiddeling Start Extra Royaal Excellent Beter Vo Nu Medical specialist care outside the hospital (extramural) from Call our Health Care Mediation team (Zgbemiddeling) (2.76 euro cent per minute plus start rate 9.4 euro cent) see zgbemiddeling Medical specialist care in the hospital (outpatient) from in case of plastic surgery and dental surgery we must have given you permission in advance Call our Health Care Mediation team (Zgbemiddeling) (2.76 euro cent per minute plus start rate 9.4 euro cent) see zgbemiddeling Obesity treatment (behavioural change programme) BMI equal to higher than 40 Organ transplant in hospital independent treatment centre from only with Santrion: per person f the entire duration of the supplementary we must have given you permission in advance only with Santrion: 1, per person f the entire duration of the supplementary we must have given you permission in advance hospital nursing of person who has donated an gan (don) from 3 months, in case of liver transplantation 6 months Plastic surgery (with medical indication) such as breast prostheses after breast amputation (not breast enlargement, surgical removal breast prostheses without medical necessity, liposuction of stomach, upper eyelid crection and ear position) from we must have given you permission in advance Zg Plan Select Zg Plan from Excellent f other treatments with medical necessity we must have given you permission in advance. Zg Plan Select Zg Plan we must have given you permission in advance Preventative examination Periodic general examination (check up) 1x per 2 years per person (tariff of a full examination by general practitioner) 25