CZ Package Comparer 2016

Transcription

1 CZ Package Comparer 2016 Group health insurance

2 Step 1 Under each policy you can go to the same contra cted care providers Step 2 Which policy is right for you? When you choose new group health insurance, it is vital that you choose an insurance package that is right for your situation. This package comparer provides a handy overview of all the group insurance packages. This allows you to see at a glance which package is best for you. If you are in any doubt about which insurance is best for you, please call CZ Customer Services on (free). Our customer advisers would be pleased to help you decide. At CZ you can choose from three general insurance packages: the Zorgbewustpolis, the Zorg-op-maatpolis (both are in-kind policies) and the Zorgkeuzepolis (refund policy). The care reimbursed under the general insurance is the same for all three general insurance packages. The amount of the reimbursement is also the same if you go to care providers with whom we have a contract. If you use a non-contracted care provider, you may have to pay the difference. This amount depends on the insurance you have chosen. Contracted care provider You can find a list of our contracted providers at (information in Dutch). Deductible Everyone over the age of 18 years pays a deductible for most of the care under the general insurance. The deductible for 2016 is 385. This has been set by the government. Once you ve paid the deductible, all further care is reimbursed according to the conditions of your general insurance. You will find more information about the deductible at (information in Dutch). Statutory For some care you have to pay a statutory. This has been set by the government. This amount is not reimbursed under the general insurance policy. The package comparer shows whether you have to pay a statutory. If the care from the general insurance is marked with a, the care is reimbursed. Non-contracted care provider Zorgbewustpolis 100% 65% of the bill up to a maximum of 65% of the agreed rate Zorg-op-maatpolis 100% 75% of the bill up to a maximum of 75% of the agreed rate Zorgkeuzepolis 100% 100% of the bill (up to a reasonable market price) Would you like to take out more comprehensive insurance? You can choose from one of our group additional insurance packages. CZ has a number of additional insurance packages that you can choose from: Start, Basis Collectief, Plus Collectief or Top Collectief. Or you can choose a package to suit your life phase, such as Jongeren or 50+. Everyone can choose from all additional insurance packages, irrespective of age. Step 3 Dental insurance The Jongeren additional insurance package already provides cover for the dentist. Have you chosen another group additional insurance package and require reimbursement for dental charges? The last page contains an overview of the two group dental insurance packages you can choose from: Tandarts Collectief and Uitgebreide Tandarts Collectief. Additional insurance cover If this package comparer shows the mark for healthcare provided under an additional insurance package, this means that the bill will be reimbursed up to a reasonable market price. Taking out insurance for the whole family If you take out insurance for yourself and your family members, you are all covered by the general insurance. For everyone over 18 years of age, you can select different additional insurance packages. Children below the age of 18 years are included free of charge. They automatically receive the most expensive additional insurance package that you choose for yourself or your partner. Contents 4 Hospital care, healthcare in an institution or recognised ZBC (independent treatment centre) 4 General practitioner (GP care) 4 Medication and pharmacy 6 Nursing and personal care 6 Alternative treatments and medication 6 Therapies (incl. physiotherapy) Compare our insurance packages online At you can choose the best package for you. Are you insured via an intermediary? If so, contact your intermediary: he or she will be able to help you make your choice. Important to note The amounts in this package comparer are maximum amounts per calendar year, unless specified otherwise. To receive reimbursement, CZ must recognise your care provider and/or institution. The conditions explain when we recognise a care provider and/or an institution, and when you are eligible for a reimbursement. For example, if you need a referral from a care provider, which indications are covered and whether you need prior permission from CZ. You will find the conditions at or contact CZ Customer Services: (free). 8 Healthcare abroad 8 Childbirth and obstetric care 10 Transport 10 Hospice 10 Hereditary disease investigation and advice 10 Audiological care 10 Artificial respiration 10 Assistance with the treatment of children with cancer 10 Medical aids 12 Mental healthcare 12 Preventive care 12 Advice 12 Courses and exercise programmes 12 Oral care after an accident 14 Dentistry and orthodontics 2 3

3 Hospital care, healthcare in an institution or recognised ZBC Are you in doubt about the reimbursement of a hospital treatment, e.g. for non-contracted care, at an Independent Treatment Centre or a reimbursement from the additional insurance package? If so, you should first call the Ziekenhuislijn (013) Hospitalisation nursing and care yes specialist costs during hospitalisation 1 yes additional costs during hospitalisation, such as use of the operating room, medication and dressings, X-rays, laboratory tests and physiotherapy in hospital yes Outpatient consultant costs specialist costs 1 yes use of operating room yes X-rays, laboratory tests, radiation treatment, kidney dialysis, medicines and dressings yes Thrombosis service yes Correction of upper eyelids (after CZ s permission and with a care provider contracted by CZ) for severe sight restriction whereby at least half the pupil is covered Ear protrusion correction (elephant ears) up to 18 years of age Circumcision with medical indication without medical indication 275 Sterilisation male: 400 female: 1,250 Second opinion by a doctor yes male: 400 female: 1,250 male: 400 female: 1,250 Rehabilitation yes Hospitalisation and/or treatment in connection with specified organ transplants heart, bone, kidney, liver, skin, cornea, bone marrow, lung, heart and lung, kidney and pancreas yes tissue typing yes costs of after-care for donor if you have received a donor organ (operation and nursing donor) 13 weeks yes 2 Travel costs if you are an organ transplant donor Healthcare for persons with sensory impairment yes Lodging costs for 1 room (for example Ronald McDonald Huis) Childcare for hospitalisation of at least 3 days General practitioner (GP care) General practitioner (GP care) Preventive foot care for diabetics possible 3 Medication and pharmacy Medication under the medicines Reimbursement System (GVS) yes possible Reimbursement of Medicines Reimbursement System (GVS) 500 Contraceptives under the Medicines Reimbursement System (GVS) Up to 21 years of age yes possible From 21 years of age Condoms (order via 50 per year Dietary preparations (for certain disorders) yes 1 This does not apply to the following non-medical treatments: sterilisation, reversing sterilisation, circumcision, snoring remedies, corrections of the eyelids, ears and breasts (breast prosthesis) other than due to amputation. 2 You do not pay a deductible for the donor follow-up visit if you have received a kidney or liver. 3 You do not pay a deductible if the care falls under multidisciplinary care. 4 5

4 Nursing and personal care Home nursing Replacement volunteer care (once a year) 14 days 14 days 14 days 14 days 14 days Alternative treatments and medication Total reimbursement for alternative treatments and medication Alternative healthcare 30 per day 40 per day 40 per day 30 per day 40 per day Alternative medication (registered as homeopathic or anthroposophical medicine) 100% 100% 100% 100% 100% Therapies (incl. physiotherapy) Physiotherapy and exercise therapy from 18 years of age physiotherapy, manual therapy, oedema therapy, pelvic therapy and exercise therapy (Cesar/ Mensendieck) up to the 21st treatment if you receive a reimbursement for the treatment under the general insurance or if you receive no reimbursement under the general insurance 4 9 treatments 27 treatments 42 treatments 9 treatments 15 treatments physiotherapy for intermittent claudication (Supervised Walking Therapy, SWT) up to the 21st treatment by a physiotherapist who is affiliated to ClaudicatioNet (the 21st and subsequent treatments will be reimbursed under the general insurance policy) 4 21st and subsequent treatments, for indications included in the list of disorders 5 for physiotherapy and exercise therapy (Cesar/Mensendieck) (for certain indications a maximum of 3, 6 or 12 months) yes Physiotherapy and exercise therapy up to 18 years of age physiotherapy and exercise therapy (Cesar/Mensendieck) per indication 9 trt. and 9 trt. extra for indications on the list of disorders 5 for physiotherapy and exercise therapy (Cesar/ Mensendieck) (for certain indications a maximum of 3, 6 or 12 months) physiotherapy, manual therapy, physiotherapy for children, oedema therapy, pelvic therapy and exercise therapy (Cesar/Mensendieck) 4 9 treatments 27 treatments 42 treatments 15 treatments Pelvic therapy for urinary incontinence 9 treatments yes Occupational therapy 10 hours yes Occupational therapy up to 18 years of age in addition to the general insurance 2 hours 2 hours 2 hours Instruction and assistance for volunteer carers for insured persons receiving occupational therapy 2 hours 2 hours 2 hours 2 hours Speech therapy yes Stammer therapy (CZ consent required) Del Ferro therapy costs, B.O.M.A, Hausdörfer Instituut voor Natuurlijk Spreken (once for the entire term of insurance) lodging costs 15 per day 15 per day 15 per day Foot treatment and advice (prescribed by a doctor) - for the medical grounds: serious arterial disorders in the legs, treatment and advice by a podotherapist (CZ consent required) - for the medical grounds: rheumatoid arthritis by a medical pedicure, pedicure with annotation for rheumatic foot or podotherapist (CZ consent required) Foot treatment other situations (by podiatrist or podotherapist, prescribed by a doctor) Skin therapy (prescribed by a doctor) facial acne treatment face/neck camouflage therapy (once for the entire term of insurance) facial hair removal (once for the entire term of insurance) UV B light equipment (for certain conditions, CZ permission required) yes 910 1,365 1, Therapy camp for children (for certain indications) The reimbursement under the additional insurance packages applies to a contracted physiotherapist. In case of a non-contracted physiotherapist, the same number of treatments will be reimbursed. The reimbursement will then be 75% of the rate we agreed with contracted physiotherapists. You pay the remaining amount yourself. 5 This list is determined by government. The list is available at 6 7

5 Healthcare abroad Non-urgent assistance abroad 100% 6 yes Urgent medical care abroad (during a temporary stay) 100% 6 yes EU/EEC countries, Switzerland, Australia, Bosnia-Herzegovina, Cape Verde Islands, Macedonia, Morocco, Montenegro, Serbia, Tunisia and Turkey 100% 100% 100% 100% 100% 100% in countries other than the above 200% 6 200% 6 200% 6 200% 6 200% 6 200% 6 organisational costs incurred by emergency centre medically indicated repatriation of insured patient dental care Childbirth and obstetric care Obstetric care in a hospital with medical necessity in maternity centre or hospital without medical necessity 16.50/day 7 at home 10 days 4.20 per hour reimbursement of for obstetric care without medical grounds 75% extra obstetric care with medical necessity 4 days 4 days 4 days obstetric care after hospitalisation 6 hours 6 hours 6 hours Use of delivery room Obstetric care by midwife, general practitioner or obstetrician Aftercare following care in an incubator 12 hours 12 hours 12 hours Lactation consultant Maternity package yes Outpatient birth without medical indication yes reimbursement of for outpatient childbirth without medical indication Fertility treatments yes IVF/ICSI (at an institution designated by the government) and corresponding hormone preparations for women up to 43 years of age attempts 1, 2 and 3 yes other fertility treatments yes Prenatal screening prenatal screening with medical indication prenatal screening without medical indication Fit en Gezond course for childbirth According to the usual (market) rate applicable in the Netherlands. 7 The is per person. If your care provider claims an amount higher than 119 per person per day, you pay the higher amount per person 8 as an additional contribution. 9

6 Transport Ambulance transportation 200km one-way yes Seated patient transport (CZ permission required) 200km one-way 98 per year own car 0.30 per km yes taxi/public transport yes Seated patient transport is covered only in the following situations: - for kidney dialysis treatments, for radiotherapy or chemotherapy treatments - if you are blind, partially sighted or dependent on a wheelchair - for a long-term illness or disorder for which your doctor has provided a certificate indicating that you need long-term transport - for intensive childcare: the transport from and to a medical day nursery, with medical indication Hospice Reimbursement hospice 30 per day 30 per day 30 per day Hereditary disease investigation and advice Hereditary disease investigation and advice (by a recognised centre) yes Audiological care Audiological care (by a recognised audiological centre) yes Artificial respiration Mechanical respiration yes Assistance with the treatment of children with cancer Assistance with the treatment of children with cancer (SKION) Medical aids The general insurance (partly) covers a number of medical aids, such as: breast prosthesis, hairpieces, hearing aids, bandage shoes, non-allergenic shoes, orthopaedic shoes, prostheses and ortheses, special visual aids, stoma care appliances, diabetes and incontinence and therapeutic elastic stockings. See Medical aids regulation 8 yes 9 possible 8 Pairs of glasses, contact lenses and eye laser treatments (per two calendar years) Support soles and therapeutic soles (including measuring up) Bedwetting alarm, rental for max. 4 months or purchase (both once for the entire term of insurance) Test strips for non-insulin dependent diabetes patients Reimbursement of statutory under the general insurance policy hairpiece or other head cover (CZ consent required) hearing aids (per item) Support pessary (for prolapse) Medical aids for general daily vital functions (ADL) Home monitor (CZ permission required) 24 months 24 months 24 months Home care products (prescribed by a doctor, CZ consent required) 50% 50% 75% Epilepsy alarm Redression helmet 8 The maximum reimbursement and the statutory are listed in the Medical aids regulations at Except for medical aids on loan. 11

7 Mental healthcare Specialised mental healthcare from 18 years of age Psychiatric care (with our without hospitalisation) yes Psychotherapy (for certain disorders) yes Basic mental healthcare from 18 years of age yes Open homes for (former) cancer patients and their families Oncological follow-up care (at recognised institutions, per treatment programme) Preventive care Preventive examination (once a year) - cardiovascular examination - risk factors affecting work (except 50+ ) Flu jab (once a year) injection consultation max. 26 max. 26 max. 26 max. 26 Preventive care for travel abroad 10 (vaccinations and tablets) 50% 75% Trauma processing (relief after shocking occurrences) Stoppen-met-roken (stop smoking) course yes Problematic alcohol consumption programme yes Dealing with depression programme yes Fall prevention (once for the entire term of insurance) Advice Sports medical advice from sport (diving) doctor, (consultation, examination) Consultations for women Dietetics (prescribed by a doctor) 3 hours yes Dietary advice Courses and exercise programmes Health courses (by home care, GGD or RIAGG, hospital or by institute/care provider recognised by CZ or recognised patients association) Exercise programmes (only for certain conditions, per 3 years) Self-management course for chronic conditions (by GGD, home care organisation or patients association, once for the entire term of insurance) Volunteer care training course (by recognised organisation, once for the entire term of insurance) Oral care after an accident Unforeseen dental care after an accident 11 (per accident, on dental recommendation and CZ permission required) 10,000 10,000 10,000 10,000 10,000 10, The injections and tablets this applies to are listed in the conditions It does not matter which additional insurance package(s) you have; you will receive a maximum of 10,000 per accident for unforeseen dental care. 13

8 Dentistry and orthodontics If you undergo a treatment the reimbursement is a percentage of the statutory rate up to a maximum annual amount. For example: you opt for the additional insurance package Tandarts Collectief and you have dental cleaning (other dentistry). You then receive a reimbursement of 100% of the statutory rate up to a maximum of 450. Step 1 Step 3 Total reimbursement for this column Dental insurance packages contribution Tandarts Collectief Uitgebreide Tandarts Collectief 14 Jongeren Total cover for dentistry 450 1, Dentistry up to the age of 18 Check-up (on dentist indication, several a year possible) 1x per year Fluoride treatment 2x per year Other dentistry 12 Dentistry from the age of 18 Check-up 1st and 2nd preventive examination 100% 100% 100% Other dentistry % 100% 75% Dentistry for all ages Crowns, inlays, bridgework, dummy root cap 75% 75% 75% Dental prosthesis complete set of dentures (upper and/or lower) 75%, 1 x per 5 years yes 25% for full set of dentures repair and rebasing of full set of dentures (upper and/or lower) yes partial dentures or frame dentures 75% 75% 75% Implants (for certain conditions, CZ consent required) fee for dentist or dental surgeon yes additional outpatient or clinical costs (hospital) yes superstructure yes upper or lower set of dentures on implant yes 125 upper and lower set of dentures on implant yes 250 Dental insurance packages contribution Tandarts Collectief Uitgebreide Tandarts Collectief 14 Jongeren Orthodontics Orthodontics up to the age of 22 (once for the entire term of insurance) 100% 100% Orthodontics from the age of 22 (once for the entire term of insurance) 80% up to % 350 Orthodontics in special circumstances CZ consent required for some indications/handicaps yes Oral care after an accident Unforeseen dental care after an accident 13 (per accident, prescribed by a dentist and CZ permission required) Reimbursement Dentistry in special circumstances CZ consent required for some indications/handicap yes Deductible Dental insurance packages contribution Tandarts Collectief Uitgebreide Tandarts Collectief 14 Jongeren 10,000 10,000 10, Other dentistry includes regular treatments such as pulling teeth, fillings, nerve and root canal treatments and paradontology. The treatments are listed under the head Dentistry for all ages and dental whitening are not covered by other dentistry. 13 It does not matter which additional insurance package(s) you have; you will receive a maximum of 10,000 per accident for unforeseen dental care. 14 In the case of the Uitgebreide Tandarts Collectief additional insurance package, CZ will assess the condition of your teeth on the basis of a statement from the dentist and tell you if you can take out this insurance later

9 Everything for better healthcare No rights can be derived from this package comparer. See the general terms and conditions and the reimbursements overview for information on this subject