VGZ MiX Aanvullende Verzekering 2015 Supplementary insurance conditions. Manage everything online with My VGZ

Transcription

1 VGZ MiX Aanvullende Verzekering 2015 Supplementary insurance conditions Manage everything online with My VGZ

2 Welcome to VGZ These are the insurance conditions that apply to your MIX Aanvullende Verzekering at VGZ. Visit our website at for further information on topics such as submitting claims or our various healthcare insurance packages. Taking care of good car together My VGZ You can make changes to your insurance cover, view your claims and pay your premium contribution at My VGZ. Log in with your DigiD and discover the possibilities at Important information Contact: Go to for our contact information. Contracted care A list of our contracted care providers is available at Requesting permission Do you want to know for which types of care you will need prior permission from us? This information can be found in these policy conditions. To request permission, download the consent form at Print out the form, make sure it is completed and send it to: VGZ Postbus RS Eindhoven Simple online cost claiming Submitting your claims online is easy using Log in securely with DigiD. The amount that we reimburse will be transferred to your account within 10 working days. Would you rather submit your claims by post? In that case, send the original invoice, accompanied by a claim form, to: VGZ Postbus RS Eindhoven 2

3 Reader s guide The MiX Aanvullende Verzekering is a special supplementary insurance policy that combines reimbursements in re-lation to care and absenteeism prevention. This insurance policy offers reimbursements or additional reimbursements and/or services in the field of prevention to promote a healthy lifestyle and to prevent absenteeism. If you have taken out a supplementary insurance policy with VGZ, there will be some areas of overlap between the MiX Aanvullende Verzekering and your supplementary insurance. This applies, provided this care is also covered by your supplementary insurance policy, to movement-related care, elements of prevention, mindfulness following symptoms of burnout and dietary advice. If, under the MiX Aanvullende Verzekering, you qualify for a reimbursement of the costs of this care, your entitlement under your supplementary insurance policy will no longer apply. Due to this overlap, the premium for your supplementary insurance is lower. The supplementary insurance policies are: VGZ Aanvullend Goed, VGZ Aanvullend Beter, VGZ Aanvullend Best, VGZ Jong Pakket, VGZ Fit & Vrij Pakket, VGZ Gezin Pakket and VGZ Vitaal Pakket. Supplementary insurance conditions VGZ MiX Aanvullende Verzekering

4 Contents Reader s guide 3 I. General section 5 Article 1. General 5 Article 2. Reimbursement of the costs of care 5 Article 3. Commencement, duration and termination of the MiX Aanvullende Verzekering 5 Article 4. Movement-related care 6 PREVENTION 7 Article 5. Courses 7 Article 6. Lifestyle check 7 Article 7. Weight consultant 8 Article 8. Sports medical advice 8 Article 9. Menopause care 8 Article 10. Flu vaccination 8 Article 11. Preventative vaccinations and medicines in connection with a holiday 9 DIETARY ADVICE 9 Article 12. Dietary advice 9 Article 13. Mindfulness following symptoms of burnout 10 ABSENTEEISM 10 Article 14. Domestic help 10 Article 15. Taxi transport 11 4 General section

5 I. General section Article 1. General Articles 1.2, 1.5, (1.6 of VGZ Eigen Keuze), 1.7 up to and including 1.12, 2.3 up to and including 2.8, 2.11, 3, 4, 5.1, 6.1, 6.2, 6.4 and 10, and Chapter III of the 2015 VGZ healthcare insurance policy conditions apply equally to the MiX Aanvullende Verzekering. The MiX Aanvullende Verzekering is also subject to the provisions regarding the premium and payment of the premium, joining times, registration and acceptance as set out in the group contract concluded between your employer and VGZ. In addition to or in derogation from the above, the following provisions apply: Article 2. Reimbursement of the costs of care You are entitled to care and the reimbursement of costs associated with that care as described in these policy conditions. You are entitled to reimbursement of the costs of care up to a maximum of the statutory WMG rates currently applicable in the Netherlands. If statutory WMG rates do not apply, the costs will be reimbursed up to a maximum of the reasonable market price current in the Netherlands. If you engage one of our contracted care providers, the costs of care will be reimbursed based on the rate agreed with the care provider concerned. We have contracted care providers for the flu vaccination, domestic help, the Lifestyle Check and taxi transport. In the movement-related care budget, preferred care providers apply for the alternative movement-related therapies. This means that, where those types of care apply, you must engage these care providers to qualify for reimbursement of the costs. For the other types of care you are free to choose any care provider. If you are not using the services of one of our contracted care providers, note that you may have to pay a portion of the costs, or all the costs, yourself. See the relevant care article for further details. The maximum reimbursement rates can be found in the List of Maximum Reimbursements for Non-Contracted Care Providers, which is available on our website. Does a budget apply to the relevant type of care? If so, the total reimbursement will never exceed the maximum amount of the budget referred to in the relevant article. Article 3. Commencement, duration and termination of the MiX Aanvullende Verzekering Termination by operation of law The MiX Aanvullende Verzekering will end by operation of law on the date subsequent to the one on which: - due to a change in or the withdrawal of its licence to act as a non-life insurer, VGZ is no longer authorised to offer or effect healthcare insurance. We will inform you of this no later than two months before this date; - the insured person dies; - VGZ ceases to offer and effect the MiX Aanvullende Verzekering. We will inform you of this no later than three months before this date; - you are no longer able to participate in the group contract or the healthcare insurance of VGZ ends. As a policyholder, you are obliged to inform us as soon as possible about the death of an insured person or about other facts and circumstances concerning the insured person that led or could lead to termination of the MiX Aanvullende Verzekering. If we establish that the MiX Aanvullende Verzekering has ended or will end, we will send you a statement that the MiX Aanvullende Verzekering has ended as soon as possible. Supplementary insurance conditions VGZ MiX Aanvullende Verzekering

6 Article 4. Movement-related care Movement-related care consists of: 1. physiotherapy; 2. oedema therapy; 3. Cesar/Mensendieck remedial therapy; 4. occupational therapy. In addition to these regular therapies, you can also make use of alternative movement-related therapies: 5. chiropractic, osteopathy, manual therapy E.S., manual and orthomanual therapy, craniosacral therapy, haptotherapy and Van Dixhoorn breathing and relaxation therapy. 1. Physiotherapy: physiotherapists and specialised physiotherapists listed in the Central Quality Register (Centraal Kwaliteitsregister, CKR) of the Royal Dutch Association for Physiotherapy, (Koninklijk Nederlands Genootschap voor Fysiotherapie, KNGF). Specialised physiotherapists are children s physiotherapists, pelvic physiotherapists, physiotherapists specialised in treating psychosomatic disorders, physiotherapists for the elderly and manual therapists; 2. Oedema therapy: an oedema therapist or skin therapist. Oedema therapists must be listed in the Central Quality Register of the Royal Dutch Association for Physiotherapy (Centraal Kwaliteitsregister, CKR) of the the Royal Dutch Association for Physiotherapy, (Koninklijk Nederlands Genootschap voor Fysiotherapie, KNGF). The skin therapist must be listed in the Paramedics Quality Register (Kwaliteitsregister paramedici, KP). 3. Cesar/Mensendieck remedial therapy: Cesar/Mensendieck remedial therapists and specialised remedial therapists listed in the Central Quality Register for Paramedics (Kwaliteitsregister Paramedici, KP). Specialised remedial therapists are children s remedial therapists and those specialised in treating psychosomatic disorders; 4. Occupational therapy: an occupational therapist. You will find a list of our contracted care providers on our website. If you are not using the services of one of our contracted care providers, a lower reimbursement applies per treatment (session). 5. Alternative therapies relating to movement: one of our designated care providers. You will find a list of the designated care provider on our website. If you are not using the services of one of our designated care providers, the cost incurred will not be reimbursed. Treatment location Care must be provided at the treatment location of your care provider or in a hospital, nursing home or care home. If your attending care provider considers this medically necessary, this care can also be provided at home. If the care under points 1-4 is provided by a care provider with whom we have not concluded a contract, the costs of care per treatment (session) are reimbursed up to a maximum of 80% of the average rates as agreed for the types of care concerned with the care providers involved. For more information, see Article 2 of these policy conditions. The total budget for movement-related care A maximum of 1,000 per calendar year. The reimbursement amount for alternative movement-related therapies is capped at 45 a day. Please note Under age 18: 1. Non-chronic disorders: You are entitled to reimbursement of the costs of physiotherapy or children s physiotherapy and Cesar/ Mensendieck remedial therapy or Cesar/Mensendieck remedial therapy for children from the nineteenth treatment session. The first eighteen treatment sessions are covered by the healthcare insurance; From age 18: 2. Chronic disorders: You are entitled to reimbursement, up to the maximum of your budget, of the costs of the first 20 treatment sessions. You are entitled to reimbursement of the costs under the healthcare insurance cover from the 21st treatment session. An advance referral from your general practitioner, company doctor or medical specialist and our 6 General section

7 permission are required for this care. These chronic disorders are established by the Minister of Health, Welfare and Sport and are specified in the List of Disorders for Physical and Remedial Therapy (Appendix 1 to the Health Insurance Decree); 3. Non-chronic disorders: You are entitled to reimbursement, up to the maximum of your budget, of the costs of the treatment. In this case you are not entitled to reimbursement under the healthcare insurance (your disorder is not specified in the List of Disorders for Physical and Remedial Therapy); 4. Pelvic physiotherapy to treat urine incontinence for insured persons from age 18: reimbursement of the costs of pelvic physiotherapy to prevent urine incontinence applies from the tenth treatment session. The first nine treatment sessions are charged to the healthcare insurance; 5. Reimbursement of the costs of occupational therapy applies from the 11th hour. The first ten hours are charged to the healthcare insurance; 6. You are not entitled to any treatment that is not regarded as movement-related care. Examples include: - curative processes within the context of occupational health or reintegration processes; - treatments and treatment programmes aimed at improving an individual s physical condition, such as medical training therapy, physio fitness, physical exercise for the elderly, physical exercise for overweight individuals and cardiovascular training; 7. You are not entitled to reimbursement of the costs of diagnostic examinations (e.g. laboratory tests, scans, psychological testing at school, intelligence tests and examinations for the purpose of obtaining, for example, a personal budget (PGB)). PREVENTION A budget for prevention consists of the following: Article 5. Courses - Courses during pregnancy to prepare for childbirth organised by a home care organisation, maternity centre, obstetrician or obstetrician practice or provided by a yoga teacher affiliated with the Yoga Teachers Association of the Netherlands (Vereniging Yogaleerkrachten Nederland, VYN); - Courses aimed at learning how to cope with an illness or disorder, such as asthma, COPD, diabetes, joint disorders, cancer, heart and vascular disease, organised by a patients association that is a member of or affiliated with the Dutch Federation of Patient-Consumers (Nederlandse Patiënten Consumenten Federatie, NPCF) or a home care organisation; - Courses in coping with dementia organised by a home care organisation, the Municipal Health Service (GGD) or a mental healthcare institution; - Courses on administering first aid (EHBO) following an accident, organised by an association that follows the guidelines of Oranje Kruis, the Dutch first aid organisation. Visit to find courses available in your area; - Reanimation course organised by an instructor or institution certified by the Dutch Reanimation Council (Nederlandse Reanimatie Raad, NRR). For a list of the patients associations, visit Under the heading NPCF, you will find a link entitled onze leden (our members). Article 6. Lifestyle check An integral medical Lifestyle Check for the prevention or early detection of illnesses and disorders followed by a recommendation. The check consists of the following tests: - a general questionnaire about your health; - measurement of blood pressure, waist size and BMI ( Body Mass Index ); - blood test: cholesterol and glucose; - urine test: protein, blood and glucose; - pulmonary function test; - audiological screening; - vision test; Supplementary insurance conditions VGZ MiX Aanvullende Verzekering

8 - cycling test; - a one-on-one interview with lifestyle coach; - a written final report with a recommendation and the results of the tests. A care provider contracted by us. You will find a comprehensive list of our contracted care providers on our website. If you are not using the services of one of our contracted care providers, the cost incurred will not be reimbursed. Please note You are not entitled to reimbursement of the costs if the Lifestyle Check is part of the Preventative Medical Examination of Workers (PMO) pursuant to the Working Conditions Act. Article 7. Weight consultant The provision of information about diet and exercise to healthy individuals with weight problems. If your excess weight has a medical or psychological cause, or in the case of extreme obesity, your weight consultant will refer you to a dietician. A weight consultant affiliated with the Dutch Professional Association of Weight Consultants (Beroepsvereniging Gewichtsconsulenten Nederland, BGN). Visit to find a weight consultant in your area. Article 8. Sports medical advice Treatments, consultations and sports tests. A sports physician working at a sports medical institution that is affiliated with the Federation of Sports Medical Institutions (Federatie van Sportmedische Instellingen, FSMI). Article 9. Menopause care Information, advice and assistance provided to women in menopause. A nurse specialised in the provision of advice in relation to women and hormones. Article 10. Flu vaccination A vaccination to prevent flu: the flu jab. A date is agreed once every year in consultation with your employer. Your employer will make a room available within the company. Parties authorised to provide the vaccination: A nurse to be hired by us. 8 General section

9 Article 11. Preventative vaccinations and medicines in connection with a holiday The necessary consultations, vaccinations and/or preventative medicines in connection with a holiday abroad for the prevention of hepatitis A and B, diphtheria, tetanus, and pertussis (DTP), yellow fever, typhoid, cholera, (meningococcal) meningitis, rabies or malaria, tuberculosis, Japanese encephalitis or tick-borne encephalitis. Immunisation bureaus and general practitioner practices with a doctor who has National Coordination Centre for Travel Advice (Landelijk Coördinatiecentrum Reizigersadvisering, LCR) accreditation and is registered to treat yellow fever. You can find care providers with an LCR accreditation on the organisation s website ( You can also consult this website to find out if your doctor is registered to treat yellow fever. Vaccinations and/or preventive medicines may be supplied directly by these immunisation bureaus or general practitioner practices. Dispensing general practitioners and pharmacies are permitted to supply these vaccinations and medicines on prescription by immunisation bureaus and general practitioner practices. The total budget for prevention A maximum of 750 per calendar year. DIETARY ADVICE Article 12. Dietary advice The provision of information about diet and eating habits for a medical purpose as provided by dieticians. The healthcare insurance entitles you to three hours of dietary advice. The reimbursement from the supplementary insurance comes on top of that entitlement. If you suffer from diabetes mellitus type 2, COPD (chronic obstructive lung disease) or have a heightened risk of cardiovascular disease and are receiving care via a care programme as specified in Article 12, dietary advice for this or a related medical condition will be provided through this care programme and you will not be entitled to any reimbursement under this article. A dietician. You will find a list of our contracted dieticians on our website. If you are not using the services of one of our contracted dieticians, the costs of care per treatment are reimbursed up to a maximum of 80% of the average rates as agreed for dietary advice with the relevant care providers. For more information, see Article 2 of these policy conditions. Where treatment may be provided The care must be provided at the treatment location of your care provider or in a hospital, nursing or care home. The care may also be provided at your own home based on a medical prescription. Reimbursement: A maximum of 500 per calendar year. Supplementary insurance conditions VGZ MiX Aanvullende Verzekering

10 PSYCHOLOGICAL CARE Article 13. Mindfulness following symptoms of burnout A reimbursement of the costs of an eight-week mindfulness-based cognitive therapy (MBCT) training or mindfulness-based stress reduction (MBSR) programme for insured person from age 18. These therapies combine scientific insights from the field of medical biology with mediation and yoga. A mindfulness trainer affiliated with professional association Mindfulness Based Netherlands Association (Vereniging Mindfulness Based Nederland, VMBN) and who is classed in category 1. You can find a list of these trainers on the association s website: Reimbursement: A maximum of 350 per calendar year. Medical indication Symptoms of burnout. Referral letter required from A general practitioner, company doctor ABSENTEEISM Article 14. Domestic help 1. The provision of domestic help to you, if you need this type of help, because you or your partner are currently temporarily unable to work due to circumstances such as illness, an accident or hospital admission; The provision of domestic help to you to promote recovery from your injury. At the time you request domestic help, you are expected to return to work within three months. The domestic help includes general organisation of the household, such as the usual cleaning tasks, provision of meals, taking care of family members and going shopping. The help is provided at the home address you have registered with us. The purpose of the domestic support is to: - prevent absenteeism in the event of emergency family situations; - promote recovery from injuries. The help is provided in blocks of at least 3 hours per day. This means a maximum of 10 blocks of 3 hours. The help must be scheduled over a maximum period of 10 weeks. Parties authorised to provide domestic support An organisation contracted by us. The help can be scheduled on working days between 07:00 hours and 20:00 hours. Weekends and public holidays are excluded. If you do not use an organisation contracted by us, the costs incurred will not be reimbursed. Medical indication Temporary unfitness for work leading to your absenteeism as an employee due to illness, an accident or hospital admission on the part of you or your partner, with a recovery expected to take place within three months. To be requested by Your immediate manager or one of your employer s HR staff. The request must include: - your client number, name, address, place of residence, date of birth; - a telephone number you can be reached on; - a brief description of the medical indication/situation. 10 General section

11 Reimbursement A maximum of 30 hours once per calendar year. Please note 1. Your manager or an HR staff member can send an to: vgz.werkgeversdesk@vgz.nl stating the following details: name, address, client number and telephone number of the employee. You can also call during office hours: ; 2. We will provide the domestic help at your home within three working days (provided we are notified before 10:30 hours and you have also contacted us before this time) after registration, unless you require the help at a later time. 3. You are not entitled to domestic help if your temporary unfitness for work is related to a chronic disorder. 4. The care is scheduled in advance for the full period. 5. Domestic help does not include nursing or medical procedures or personal care. 6. The domestic help is only offered in the Netherlands. Article 15. Taxi transport Taxi transport between your place of residence or stay and your work address provided you are unable to travel by public or private transport for medical reasons. Parties authorised to provide the transport A transport provider contracted by us. If you do not use an organisation contracted by us, the costs incurred will not be reimbursed. To be requested by Your immediate manager or one of your employer s HR staff. Permission You will require our written prior permission for this. The request must be accompanied by a declaration from your manager or an HR staff member stating that you are unable to use public transport or your own transport due to severely restricted mobility. You will find the application form for commuter transport on our website. Reimbursement A maximum of 350 per calendar year. Supplementary insurance conditions VGZ MiX Aanvullende Verzekering

12 for further information and contact details Taking care of good care together This translation of the VGZ Zorgverzekering 2014 policy conditions is intended as a service for persons insured with us who do not have a command of the Dutch language.rights may therefore only be derived from the Dutch version. D VGZ Zorgverzekeraar N.V. (VGZ). Registered office in Nijmegen, Chamber of Commerce No , DNB number: