Clear communication is essential in my job. I expect the same from my health insurance company.

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1 Health insurance for university medical centers Reimbursement overview 2014 Clear communication is essential in my job. I expect the same from my health insurance company. Jaap Fogteloo, internist (acute medicine) Good care is your choice

2 2 Reimbursement overview for 2014 Reader s guide This reimbursement overview provides an overview of reimbursements of the UMC Zorgverzekering and the UMC Aanvullende Verzekering supplementary insurances. All items listed in the overview of reimbursements marked with a are covered by your UMC Zorgverzekering. Reimbursements are specified, unless stated otherwise. When we use the abbreviation max., we mean up to a maximum of. Additional conditions Additional conditions, such as authorisation requirements, necessary referrals and authorised care providers, are specified in the policy conditions. If you require care, we recommend that you first consult the policy conditions. You will find these on Non-contracted care UMC Zorgverzekering is a non-contracted care policy. If you are covered by this type of insurance, you are entitled to reimbursement of the costs of care and you are entirely free to choose your own care provider. It does not matter whether the care provider you choose has agreements with UMC Zorgverzekering or not. The only requirement is that the care provider satisfies the requirements set out in our policy conditions. You are entitled to reimbursement of the costs of care up to a maximum of the statutory rates current in the Netherlands. If statutory rates do not apply to the relevant care, the costs will be reimbursed up to a maximum of the reasonable market price current in the Netherlands. If you obtain care from a contracted care provider, rates will have been agreed upon with the relevant care providers up to a maximum of the reasonable market price current in the Netherlands. Compulsory and voluntary excess If you are aged 18 or older, a compulsory excess of 360 applies to the UMC Zorgverzekering. You can voluntarily increase your compulsory excess to 460, 560, 660, 760 or 860. You are then eligible for a discount on the premium. The excess does not apply to expenses incurred for visits to a general practitioner, obstetric care, maternity care, preferred medications designated by us, care aids on loan, follow-up checks for kidney or liver donors and care programmes. Reimbursements from supplementary insurance Your UMC supplementary insurance policy or policies entitle you to reimbursement of the costs of care up to a maximum of the statutory rates currently applicable in the Netherlands. If statutory rates do not apply to the relevant care, the costs will be reimbursed up to a maximum of the reasonable market price current in the Netherlands. If you choose to take out care provided by a care provider contracted by us, the costs of care are reimbursed based on the rate agreed with the care provider concerned. Preferred, accredited or contracted care Please note! Preferred, accredited or contracted care may also apply to your supplementary insurance package. This is indicated in the overview. If you take out care from non-contracted, non-accredited or non-preferred care providers you may not be reimbursed for the full amount or not receive reimbursement altogether. Further information can be found in the policy conditions. Budgets If you choose to take out supplementary insurance, UMC Zorgverzekering offers you freedom and convenience in determining your reimbursement. As UMC Zorgverzekering has grouped the available treatments, you are able to see at a glance which care is reimbursed. A maximum reimbursement applies for each group of treatments; we refer to this maximum using the term budget. You decide which treatment, within the given treatment group, you use your budget for. This enables you to get the most out of your reimbursement amount. Budgets are available for e.g. movement related care, care aids and dental care. You can find these budgets in the reimbursements overview. Good care is your choice

3 3 UMC Zorgverzekering and UMC Extra Zorg Alternative care A budget to use for the care types specified below: - Treatments and consultations (by a doctor or preferred care provider) included in the following categories: a. acupuncture and other traditional Eastern therapies; b. anthroposophic alternative therapies; c. homeopathy; d. naturopathy; e. psychosocial care. - Homeopathic and/or anthroposophic medicines Contraceptives E.g.: the contraceptive pill, birth control implant, intrauterine contraceptive device (coil), ring or pessary Audiological care Examination of auditory function, hearing aid advice Delivery and maternity care Maternity package Maternity care at home by a maternity centre Maternity care by a private nurse or maternity care provider Maternity care not given by a maternity centre, hospital or private nurse Maternity care given by a hospital or contracted birth centre (without medical necessity) For persons under the age of 21 (personal contribution is payable for some contraceptives) Up to a maximum of 10 days (a personal contribution of 4.10 per hour applies) Up to 10 days at most of 4.10 per hour applies) Up to 10 days at most of 33 per day for both mother and child applies) Alternative Care Budget: max. 300 per calendar Full amount for persons from the age of 21 (personal contribution is payable for some contraceptives) Care in kind via UMC Kraamzorg Max. 100 per day for a max. of 10 days Alternative Care Budget: max. 300 per calendar Full amount for persons from the age of 21 (personal contribution is payable for some contraceptives) Care in kind via UMC Kraamzorg Max. 100 per day for a max. of 10 days Alternative Care Budget: max. 500 per calendar Full amount for persons from the age of 21 (personal contribution is payable for some contraceptives) Care in kind via UMC Kraamzorg Full amount of the personal contribution Max. 100 per day for a max. of 10 days Max. 296 Max. 296 Max. 296 Max. 296 Alternative Care Budget: max. 750 per calendar Full amount for persons from the age of 21 (personal contribution is payable for some contraceptives) Care in kind via UMC Kraamzorg Full amount of the personal contribution Max. 100 per day for a max. of 10 days Maternity care in a hospital (with medical necessity) Lactation consultation Max. 50 per delivery Max. 100 per delivery 100% per delivery Home delivery Delivery in a hospital (with medical necessity) Delivery in a hospital or contracted birth centre (without medical necessity) Preconception care (this includes advice on a healthy diet, use of folic acid and other medicines) Extended maternity care TENS device 200 per day (accommodation costs) Max. 12 hrs distributed across max. 4 days Max. 12 hrs distributed across max. 4 days Max. 12 hrs distributed across max. 4 days Max. 80 for the entire term of the insurance Max. 12 hrs distributed across max. 4 days Max. 150 for the entire term of the insurance Electrical breast pump Max. 110 per delivery Max. 150 per delivery A budget to spend on the care types specified below: Up to the age of 18: physiotherapy, Cesar/Mensendieck remedial therapy, oedema therapy and manual therapy Max. 18 sessions per complaint, per calendar. Additional sessions only for complaints listed in Appendix 1 of the Health Insurance Decree (Besluit ZV) (chronic complaints) budget: max. 250 per calendar budget: max. 500 per calendar All items listed in the overview of reimbursements that are marked with a are covered by your UMC Zorgverzekering. budget: max per calendar budget: max per calendar

4 4 From the age of 18: physiotherapy, Cesar/Mensendieck remedial therapy, oedema therapy and manual therapy Occupational therapy Only for complaints listed in Appendix 1 of the Health Insurance Decree (Besluit ZV), except for the first 20 sessions Max. 10 hours Alternative movement-related therapy (by a preferred care provider) Glasses and contact lenses A budget to spend on the care types specified below: - glasses and contact lenses - eye laser treatment or lens implants Care abroad Non-urgent care Based on NL rates Full amount, based on NL rates Urgent care while on holiday or a temporary stay abroad Repatriation (patient transport and transport of mortal remains from abroad) Care for dyslexics Care related to severely dyslexic children aged 7 or older who are attending primary education Genetic testing Examination to identify and investigate possible hereditary defects Mental healthcare Cogmed for children up to the age of 18 with developmental and learning disorders General mental healthcare treatment (basic) Group therapy for children up to the age of 18 with parents with a mental condition or addiction Neurofeedback (for ADHD and ADD up to the age of 18) Psychosocial care for oncology patients Sexological care Specialised medical mental healthcare Medical care Medically necessary circumcision In vitro fertilisation (IVF) up to 43 s of age Additional conditions apply Other fertility treatments (women up to the age of 43) Reconstructive and cosmetic or aesthetic surgery Redression helmet: treatment for children up to the age of 14 months on specific medical grounds (by a contracted care provider) Sterilisation and reversal (male or female) Based on NL rates A personal contribution may apply to insured persons aged 18 and older First, second and third attempt On a number of medical grounds Full amount for urgent care via the UMC Alarm Centre Full amount via the UMC Alarm Centre Max. 100 every 3 calendar s Full amount, based on NL rates Full amount for urgent care via the UMC Alarm Centre Full amount via the UMC Alarm Centre Max. 60 per session. Max. 4 sessions per calendar Max. 200 every 3 calendar s Full amount, based on NL rates Full amount for urgent care via the UMC Alarm Centre Full amount via the UMC Alarm Centre Max Max. 60 per session. Max. 4 sessions per calendar Max. 250 every 3 calendar s Full amount, based on NL rates Full amount for urgent care via the UMC Alarm Centre Full amount via the UMC Alarm Centre Max Max. 60 per session. Max. 4 sessions per calendar Max. 600 Max. 600 Max. 600 Max. 600 Full amount on a number of medical grounds not accepted by the health insurer and 50% for cosmetic or aesthetic surgery due to specific medical circumstances Fourth attempt Full amount on a number of medical grounds not accepted by the health insurer and 50% for cosmetic or aesthetic surgery due to specific medical circumstances Full amount Fourth and fifth attempt Full amount Full amount Full amount Full amount on a number of medical grounds not accepted by the health insurer and 50% for cosmetic or aesthetic surgery due to specific medical circumstances Full amount

5 5 Medicines and vitamins Medicines listed in Appendix 1 of the Healthcare Insurance Regulations and the VGZ Pharmaceutical Care Regulations Diet preparations (by specific suppliers and with prior permission 1 ) Vitamins to treat a serious vitamin deficiency Skin treatments Acne treatment (a list of our preferred providers can be found in the care guide on our website) Camouflage therapy (a list of our preferred providers can be found in the care guide on our website) Epilation (a list of our preferred providers can be found in the care guide on our website) General practitioner care General practitioner care. This includes assistance to help you quit smoking and foot care for diabetes mellitus type 1 and 2 patients. Care aids Care and bandaging aids in accordance with the Healthcare Insurance Regulations and the UMC Pharmaceutical Care Aids Regulations A budget for care aids that you can spend on: 1. a reimbursement of the statutory personal contributions/personal payments for the care aids specified below; or 2. the purchase of the care aids specified below (or of associated extras) that are not listed in the Healthcare Insurance Regulations - Arch supports and therapeutic soles - Support pessary - Support/compression hose, pressure class 1 - Alarm device/pad and buzzer - Hearing aids - Wigs - Breast prosthesis - Crutches Multi-disciplinary care Multi-disciplinary care for diabetes mellitus type 2, COPD and cardiovascular risk management ( care programmes ) Speech therapy Treatment or improvement of speech or ability to speak Specialist medical care This also includes: care provided by a thrombosis service, a second opinion, kidney dialysis, necessary treatment at home. Consult the policy conditions for a comprehensive list of the conditions. Oral care/dental care Up to the maximum statutory reimbursement amount (GVS) is payable for some medicines) For some aids on loan and/or partial reimbursement amount applies to some aids) Hearing aids of 25% applies) Wig: max. 409 On medical grounds Dental care for children up to the age of 18 Special dental care On a limited number of grounds (a personal contribution may apply in some cases) Max. 300 per for personal contribution Max. 500 per for personal contribution Full amount Full amount Full amount Full amount Max. 26 per treatment for a max. of 15 treatments Max. 165 every 3 calendar s Max. 26 per treatment for a max. of 15 treatments Max. 165 every 3 calendar s Care aids budget: max. 250 Max. 26 per treatment for a max. of 15 treatments Max. 165 every 3 calendar s Care aids budget: max. 350 Max. 26 per treatment for a max. of 15 treatments Max. 165 every 3 calendar s Care aids budget: max For this type of care you will need prior permission from UMC Zorgverzekering. Consult our policy conditions. All items listed in the overview of reimbursements that are marked with a are covered by your UMC Zorgverzekering.

6 6 Consultation, examination and prevention Gnathology G Codes* Implants in a non toothless jaw Implants in a toothless jaw by a dentist Crowns and bridges R Codes* On 2 specific grounds On a limited number of grounds For crowns replacing canines or molars on 2 grounds Dentures P Codes* Dental care for insured persons from the age of 18 Crowns (with implants, if medically necessary) and bridges required as the direct consequence of an accident for insured persons between the ages of 18 and 27 (with prior permssion 1 ) Special dental care Implants in a non toothless jaw Implants in a toothless jaw by a dentist, for persons with a seriously shrunken jaw Dentures (full) P Codes* Orthodontics Orthodontic treatment for children up to the age of 18 Orthodontic treatment from the age of 18 Paramedical care Pelvic physiotherapy related to urine incontinence for adults aged 18 and up Group swimming for rheumatic patients (for patients with serious cases) Podotherapy or pedicure for rheumatic patients (for foot care for diabetes patients, see General practitioner care and Multidisciplinary care) Dietary advice (the provision of information about diet and eating habits for a medical purpose) Preventive care Menopause care Substitute informal care Sports medicine Medical check-up (with the exception of preventive scans) Training courses (incl. pregnancy, coping with illnesses or disorders and reanimation) Vaccinations required in connection with a holiday abroad Rehabilitation Rehabilitation (this also includes a quick scan and geriatric rehabilitation) Geriatric rehabilitation Stopping smoking Stop smoking programme (medical care and support medications aimed at effecting a change in behaviour) On a limited number of grounds (a personal contribution may apply in some cases) On 2 specific grounds A personal contribution applies of 125 per denture for dentures on implants (A personal contribution of 25% applies) On a limited number of specific medical grounds (a personal contribution may apply) On a limited number of specific medical grounds (a personal contribution may apply) The first 9 treatment sessions Max. 3 hours of treatment (For max. 6 months) Once Full amount Full amount Full amount Full amount of grounds of grounds of grounds; cosmetic dental treatment 80% up to max of grounds of grounds; cosmetic dental treatment 80% up to max of grounds Full amount Full amount Full amount Full amount Full amount Max. 115 Max. 115 Max. 115 Full amount on a limited number of grounds; other orthodontic treatment once only up to max. 300 Max. 4 hours of treatment Max. 4 hours of treatment Max. 4 hours of treatment Max. 4 hours of treatment Max. 50 per consultation. Max. 4 consultations per calendar Max. 4 days per calendar Max. 55 per calendar Max. 75 every 2 consecutive calendar s Max. 50 per calendar Max. 50 per consultation. Max. 4 consultations per calendar Max. 8 days per calendar Max. 55 per calendar Max. 75 every 2 consecutive calendar s Max. 100 per calendar 80% up to max. 125 per calendar Max. 50 per consultation. Max. 4 consultations per calendar Max. 12 days per calendar Max. 125 per calendar Max. 75 every 2 consecutive calendar s Max. 150 per calendar 80% up to max. 175 per calendar Full amount per calendar Max. 24 days per calendar Max. 500 per calendar Full amount for 2 consecutive calendar s Max. 500 per calendar Full amount per calendar

7 7 Home care Housekeeping help (housekeeping help on specific grounds) Child care (on specific grounds) Max. 10 hours Max. 24 hours Max. 20 hours Max. 50 hours Tissue and organ transplants Transplantation carried out in an EU or EEA member state (incl. donor costs) Lodging Treatment at a health resort Max. 855 Max. 855 Max. 855 Max. 855 (in accordance with our list) A stay at a convalescent home or 50% for max. 6 weeks 50% for max. 6 weeks 50% for max. 6 weeks 50% for max. 6 weeks care hotel or holiday (for more than one night) (by contracted care provider) Accommodation expenses Max. 18 per day Max. 18 per day Max. 18 per day Max. 18 per day Hospice (by accredited care provider) Max. 130 per day Max. 130 per day Max. 130 per day Max. 130 per day A stay at a therapeutic holiday camp for children aged up to 16 on specific grounds A stay in a psychiatric or other hospital (medical specialist care and accommodation), mental health institution or rehabilitation centre Transport Ambulance transport Seated patient transport with own car on specific medical grounds Seated patient transport by public transport or a taxi on specific medical grounds Hospital care Outpatient care Admission to hospital (specialist medical care and accommodations) Care and waiting list mediation A personal contribution may apply to insured persons aged 18 and older Max. 0,31 per km on a limited number of grounds with personal contribution of 96 per On a limited number of grounds with personal contribution of 96 per With the exception of a number of grounds may apply to a stay by insured persons aged 18 and older) Max. 1 month Max. 1 month 1 For this type of care you will need prior permission from UMC Zorgverzekering. Consult our policy conditions. All items listed in the overview of reimbursements that are marked with a are covered by your UMC Zorgverzekering. Max. 1 month Max. 1 month UMC Extra Tand UMC Extra Tand 1 UMC Extra Tand 2 UMC Extra Tand 3 Dental care for insured persons from the age of 18 Dental care, with the exception of orthodontic care and general anaesthesia (including material costs and the costs of a dental technician) Full amount for consultations (Code C), preventive oral care (Code M), specific gum treatments by an oral hygienist (T22, T52, T54 and T56) and 80% for other treatments up to max. 250 Full amount for consultations (Code C), preventive oral care (Code M), specific gum treatments by an oral hygienist (T22, T52, T54 and T56) and 80% for other treatments up to max. 750 Full amount for consultations (Code C), preventive oral care (Code M), specific gum treatments by an oral hygienist (T22, T52, T54 and T56) and 80% for other treatments up to max * A number of treatments are precluded from reimbursement in all packages, such as the costs for missed appointments, examinations and study models for a treatment plan, physical examination reports and statements of good health, bleaching of teeth, sealing and polishing, indirect pulp caps, mouth protectors, general anaesthesia, a number of gnathologic treatments and restoration treatments such as composite inlays. A comprehensive overview is included in the insurance terms and conditions (see

8 More information Do you have any questions after reading this brochure? Or would you like additional information? Please visit If you want to stay informed of all the latest news from UMC Zorgverzekering, subscribe to our free online newsletter. UMC Zorgverzekering Health insurance for university medical centers D No rights may be derived from this brochure. The original version of this brochure was drawn up in the Dutch language. If, as a result of translation of the original text into the English language, there is a difference in content or interpretation in respect to the Dutch version, then only the text and content of the Dutch language version, which is in the possession of NV Zorgverzekeraar UMC, will be binding. N.V. Zorgverzekeraar UMC (Zorgverzekeraar UMC), located in Arnhem, CoC number: , DNB number: