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1 This brochure is also available on Health insurance abroad 2013 #/> Medical care during a temporary stay in the Netherlands

2 2

3 Temporary stay in the Netherlands Together with a number of other countries, the Netherlands have signed an agreement on the provision of medical care. If you live in one of these countries, and you are insured against medical expenses, you are entitled to medical care while staying in the Netherlands. A number of conditions apply. International insurance form One of the conditions is that you have the relevant international insurance form with you. Please do not forget to request this form from your health insurance fund before you leave for the Netherlands. We recommend that you make several copies of this form. Your health care supplier needs this copy to declare the costs for medical care to us. The insurance form must be valid on the date on which you request medical care. Registered health care supplier Another condition is that the medical care that you use is covered by the Agis Basispolis or the AWBZ (the Exceptional Medical Expenses Act). In addition, the health care supplier that you seek medical care from must be registered. This brochure contains brief information about the medical care to which you are entitled, and the type of international insurance form you will need. 3

4 Which countries? The information included in this brochure is intended for anyone insured against medical expenses in one of the following countries: Member states of the European Union (EU) and the European Economic Area (EEA): Austria Belgium Bulgaria Cyprus Czech Republic Denmark Estonia Germany Finland France Greece Hungary Iceland Ireland Italy Latvia Liechtenstein Lithuania Luxembourg Malta Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden The United Kingdom of Great Britain and Northern Ireland Switzerland Countries participating in the Convention for the Navigation of the Rhine Countries bordering the Rhine (Germany, France, Switzerland), Belgium and Luxembourg Other treaty countries Australia, Bosnia-Herzegovina, Cape Verde, Croatia, Macedonia, Montenegro, Serbia, Tunisia and Turkey. 4

5 Which form? Please find below an overview listing the forms you will need for reimbursement of the costs of your medical care. EU-, EER-countries and Switzerland European Health Insurance Card (EHIC) For medical care required for the duration of the insured party s stay in the Netherlands. The EHIC will be issued by your health insurance fund. The expiry date is stated on the card. Provisional health insurance certificate For emergency situations, for example in case of theft or loss of the EHIC. You can request this provisional (paper) health insurance certificate from your health insurance fund. Important: Form E 112/S2 Do you come to the Netherlands especially to undergo medical treatment? Make sure you get approval from your own country s national health service first. Form E 112/S2 If you call on medical assistance, for which you specifically need to travel to the Netherlands. In certain situations you may prefer to receive certain medical care in the Netherlands rather than in your country of residence. It is important that you contact your health insurance fund well before your departure for the Netherlands. If your health insurance fund agrees, it will issue you with Form E 112/S2. Form E 123/DA1 If you require medical care due to an accident (at work) or an occupational disease. 5

6 Rhine-bordering countries Form R 110 If you are employed on a vessel navigating the Rhine. You must fill in two original Forms R 110, both of which must be signed by your employer. Give these forms to the health care supplier. Form R 123 If you require medical care due to an accident (at work) or an occupational disease. Other Treaty countries If you are insured in one of the other treaty countries, you are only entitled to (a reimbursement of costs resulting from) emergency medical care. You will require one of the following forms: Form HR/NL 111 If you are insured against medical expenses in Croatia. Form K/N 111 If you are insured against medical expenses in Cape Verde. Form RM/NL 111 If you are insured against medical expenses in Macedonia. Form TUN/N 111 If you are insured against medical expenses in Tunisia. Form TUR/N 111 If you are insured against medical expenses in Turkey. Form YN 111 If you are insured against medical expenses in Bosnia-Herzegovina, Montenegro and Serbia. 6

7 Agis Basispolis The Agis Basispolis is legally determined and is comparable to the Dutch Zorgverzekeringswet. Please find below an overview listing a number of common forms of medical care covered by the Agis Basispolis. General practitioner Care provided by a general practitioner includes: a visit to the GP during surgery hours (a consultation) a GP s visit to your home, if you are unable to visit the GP during surgery hours (a home visit) a telephone consultation The costs for an influenza vaccination or a medical examination for a job are not covered. Pharmaceutical care This concerns medical, bandaging and diet products. Only products prescribed by a doctor are covered. For some medicines a personal contribution will be applicable. For instance, this is the case for products that can be replaced by cheaper alternatives with the same effect. There are also medicines that are not covered by the Dutch Health Insurance Act. Your pharmacist can tell you more about this. You are only entitled to reimbursement of products that you need during your stay in the Netherlands 7

8 Specialist care Amongst other things, specialist care includes medical care provided by a specialist in his/ her surgery, or at a hospital s outpatients department. Such care requires a written referral from a general practitioner, dentist, midwife or other specialist. Specialist care also includes medical care provided by a specialist during a hospital stay. There is limited cover for plastic surgery. In all cases, the specialist must submit a written application together with a letter of motivation. Hospital admission If it is necessary for you to be admitted to hospital during your stay in the Netherlands, the costs involved are covered. The amount of the reimbursement depends on the price arrangement agreed on with the hospital. Admission for plastic surgery is only possible after the specialist has submitted an application and approval from us. 8

9 Dental Care Dental care for insured under 18 years of age All dental care is covered with the exception of crowns, bridges, implants and orthodontic care. Dental care for insured from 18 years of age Reimbursement is only possible for prosthetic services and special dentistry (only with our prior approval). For prosthetic services please taking into account that: Only the costs for complete upper and lower dentures will be reimbursed. You do need to pay a minimum of 25% towards the cost. You will also be reimbursed for the repair or relining of existing complete dentures. Midwife and maternity care Any costs associated with giving birth in a hospital are completely covered if the birth is a result of a medical indication. This also applies to a home birth at a Dutch address. If you choose to give birth in a hospital without having a medical reason for doing so, then you would need to pay a contribution of 312,87. The hospital would provide you with an invoice in such cases. You need to settle this invoice direct with the hospital, after which it can beforwarded onto us. You will then be reimbursed for part of these costs. You are entitled to 10 days maternity care straight after the birth. The maternity centre will determine how many hours of maternity care you are entitled to. You will pay an own contribution of 4,- for every hour of maternity care. 9

10 Paramedical care Paramedical care includes physiotherapy, remedial therapy, speech therapy, occupational therapy and dietary advice. Physiotherapy and remedial therapy With the reimbursement of physiotherapy and remedial therapy a distinctionis made between a chronic and a non-chronic condition and between two age groups. The government has decided in which cases reimbursement is possible. Chronic condition Non-chronic condition Up to 18 years old All medically required treatments are reimbursed. A reimbursement applies for a maximum of nine treatments per condition per year. An inadequate result means you have the option of an additional maximum nine treatments. 18 years or above Reimbursement for medically required treatments from the twentyfirst treatment applies. The first twenty treatments are at your own expense. All treatment are at your own expense. On the invoice the care provider must state the diagnosis code, the indication code and the treatment date. Hip physiology For insurance holders aged 18 years and above, a maximum of nine sessions for the treatment of urine incontinence are reimbursed. 10

11 Speech therapy All necessary treatments will be reimbursed, except treatments related to language development disorders in connection with a dialect or because a person speaks a different language. Occupational therapy A maximum of 10 hours per calendar year applies. Dietary advice A maximum of 3 hours per calendar year applies. Patient transport Ambulance Transport by ambulance is completely paid for by us. You do not need to contribute to this. Important: Transport from the Netherlands to another country and/or vice versa will not be reimbursed by us (this also applies for transport to and from a bordercrossing or an airport). Transport by car (own transport or taxi) and public transport Here, a reimbursement will only apply to: insured parties who need to undergo kidney dialysis treatment insured parties who need to undergo oncological treatment with chemotherapy or radiotherapy insured parties who are completely restricted to a wheelchair visually handicapped people, who cannot travel without the assistance of others as a result of their disability 11

12 You need to request prior permission from us regarding any transport needs. The request needs to be accompanied by a declaration from the relevant GP, from which it should be apparent he is part of one of the aforementioned groups. For transport by car and public transport you will need to pay a contribution of 95,- per calendar year. GGZ (Mental Health Care) First line psychological care This includes visits to healthcare suppliers like a first line psychologist, mental health psychologist, but also the orthopediatric, youth psychologist and sexological assistance. The first 5 sessions are covered. You will pay a personal contribution of 20,- per full session. It may be that you have to pay a higher amount yourself. This depends on the rate that the health care supplier will charge. The healthcare provider must charge for expenses on the basis of performance codes. There is no reimbursement possible for care bearing no relation to mental disorders. Examples of the latter are remedial teaching, homework support and career counselling. Second line mental health care (non-clinical and clinical mental health care) This includes treatment by psychotherapists, clinical psychologists, psychiatrists and mental health care institutions. The healthcare supplier must charge for expenses on the basis of the DBC-system, DBC standing for Diagnose (Diagnosis) Behandeling (Treatment) Combination. 12

13 AWBZ The AWBZ is an insurance covering exceptional medical expenses. Currently, the AWBZ covers expenses for: nursing care in a hospital or sanatorium, if your stay extends beyond a year care provided by a homecare organisation nursing care in a nursing home nursing care in a retirement home nursing care in an institution for the physically disabled nursing care in an institution for the mentally disabled placement in a daycentre for the disabled placement in a surrogate family unit home care If you would like to know whether you are entitled to any of the abovementioned care, and whether or not you yourself will have to pay part of the costs involved, please contact our colleagues of Groep AWBZ on telephone number +31 (0)

14 Important additional information Working for a Dutch employer If you are going to work for a Dutch employer during your stay, you have to pay income tax. You also come under the Dutch Zorgverzekeringswet (Health Care Insurance Act), which means that you must be insured in the Netherlands. The Zorgverzekeringswet prevail over your foreign health insurance. As soon as you are employed by a Dutch employer, it is very important that you notify us and your foreign health insurance fund of this. Reimbursement of medical costs If, due to circumstances, you have paid for medical care yourself, please do not worry. Just send us the original invoice(s), together with a copy of your international insurance form and we will ensure that (full or partial) reimbursement occurs wherever appropriate. Please do not forget to state your bank or giro account when requesting the reimbursement of any costs incurred. If it concerns a (bank) account number abroad, please also state in addition to the name and address the swift code and IBAN of the applicable foreign bank. 14

15 15

16 Questions? This brochure is intended to provide you with general information. Should you have any questions, please do not hesitate to contact us. We will be only too pleased to be of assistance to you. You can contact us from Monday to Friday from 8.30 am to 5.00 pm on telephone number + 31 (0) Contact Agis Zorgverzekeringen Groep Buitenlands Recht Postal address Postbus BS Amersfoort Telephone +31 (0) #/> This brochure is also available on Internet buitenland Fax +31 (0) No rights may be derived from the text in this brochure. a.034br Agis is part of Achmea

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