CZ Health Insurance 2015

Transcription

1 CZ Health Insurance 2015 Cross-border workers

2 2

3 CZ helps you to choose the health insurance that's right for you You would like to be insured for the best healthcare. You would like healthcare that is available whenever you need it and that fulfils your wishes and needs. In order to ensure this, it is very important to choose the right health insurance for you. That is where we can help. Our advisers are available to provide you with advice tailored to you personally. Not only that, we also provide you with online support every step of the way towards finding the health insurance that suits your situation best. So please do not hesitate to give our advisers a call. We re happy to help you. CZ, everything for better healthcare This brochure provides you with further information about the health insurance policies offered by CZ. At CZ.nl (information in Dutch) you will find comprehensive information about our various health insurance policies and you can calculate your premium straight away. 3

4 CZ health insurance If you work in the Netherlands, but live in a country in the EU, EER, Switzerland or a treaty country, you are obliged by law to take out health insurance in the Netherlands. Health insurance consists of general insurance, usually together with an additional insurance package and/or dental insurance. But how do you know which insurance package is best for you? This brochure will help you to make your choice. The general insurance reimburses for the most essential healthcare costs. The government determines the reimbursements that form part of the general insurance. For example, general insurance includes healthcare from your general practitioner or medical specialist, ambulance transport, but also medicines and admission to hospital. You can find further information about the exact reimbursements at CZ.nl/english and in the package comparer. A general insurance policy lasts for 1 calendar year. At CZ, you can choose from 3 general insurances policies. The type of reimbursements in those general insurance policies are always the same. Sometimes the percentage that is reimbursed differs. The additional services that you receive as part of the policy also differ. You can find an overview showing the differences on the right-hand side. Do you have any other questions? Visit CZ.nl/english for further details, call CZ Customer Services or drop into one of our offices. EU, EER, Switzerland and treaty countries include: EU countries: Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Germany, Estonia, Finland, France, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, United Kingdom and Sweden; EER countries: Iceland, Liechtenstein and Norway; Treaty countries: Bosnia-Herzegovina, Cape Verde, Macedonia, Montenegro, Morocco, Serbia, Tunisia and Turkey. Switzerland 4

5 19% chose this 73% chose this 8% chose this You can find the premium for each policy at CZ.nl/english 'Zorgbewustpolis' 'Zorg-op-maatpolis' 'Zorgkeuzepolis' This policy is an in-kind policy. You go to care providers with whom CZ has a contract and this means that you pay a lower premium. CZ has made agreements with contracted care providers with regard to prices and quality of service provision. If you go to a non-contracted care provider, CZ will reimburse 65% of the bill up to a maximum of 65% of the agreed rate. The 'Zorgbewustpolis' is an internet-based policy. This is also an in-kind policy. You go to care providers with whom CZ has a contract. If you go to a non-contracted care provider, CZ will reimburse 75% of the bill up to a maximum of 75% of the agreed rate. This policy is a refund policy. If you choose this policy, you may go to any care provider or supplier that fulfils the requirements in the terms and conditions of insurance. You therefore pay a slightly higher premium for this policy. 100% reimbursement of contracted care 65% reimbursement of non-contracted care Choice of 2 deductibles Communications from CZ are always sent electronically via 'Mijn CZ' and by . You are always welcome to call CZ, of course Payment by direct debit 100% reimbursement of contracted care 75% reimbursement of non-contracted care Choice of 6 deductibles Correspondence by or by post Payment by direct debit or by giro payment form You receive a reimbursement of up to 100% of the statutory rate for the costs of the healthcare. Has a statutory rate not been set for a particular type of healthcare? In that case, we will reimburse the costs up to the reasonable market rate. Choice of 6 deductibles Correspondence by or by post Payment by direct debit or by giro payment form A second opinion using 'Best Doctors' Are you opting for the 'Zorg- op -maatpolis' or the 'Zorgkeuzepolis'? If so, you may use 'Best Doctors' in consultation with our care advisers. 'Best Doctors' is an international network of specialists. They can give you a second opinion on the best treatment for your illness or disorder. 5

6 Would you like a higher level of healthcare insurance? Further information can be found at cz.nl/english or use the package comparer Additional insurance package Some costs are not reimbursed or are only partially reimbursed from the general insurance, such as costs of physiotherapy. However, you can take out insurance for these costs separately in an additional insurance package. CZ offers various additional insurance packages to suit the stages in your life: 'Jongeren', 'Gezinnen' and '50+'. Or additional insurance packages that offer reimbursements to increase the cover: 'Basis', 'Plus' and 'Top'. You pay a premium for an additional insurance package from the age of 18 years. Co-insured children under the age of 18 years do not pay any premium. They receive the same additional insurance as the parent/carer with the most expensive additional insurance package. Your additional insurance package is valid for one full calendar year. You can therefore change the package every year if your needs change. CZ will accept you without a medical assessment. Dental insurance package We reimburse dental costs for children up to the age of 18 years from the general insurance. Once over the age of 18 years, an individual is liable for their own dental costs and you can take out insurance for these in the form of dental insurance. This lasts for one full calendar year. CZ offers 2 different dental insurance policies: 'Tandarts' and 'Uitgebreide Tandarts'. The difference between the two packages is the maximum amount that CZ reimburses per year. Both insurance policies also reimburse costs for orthodontics. If you take out the 'Jongeren' or 'Gezinnen' additional insurance package, you do not need to take out any separate dental insurance, because CZ already reimburses dental costs via these additional insurance packages. Anyone can apply for the 'Tandarts' dental insurance. CZ will accept you for this insurance without a medical assessment. In the case of the 'Uitgebreide Tandarts' dental insurance, CZ will assess the condition of your teeth on the basis of a statement from your dentist and will inform you if you can take out this insurance. 6

7 Medical care in your country of residence Treaty form 106 You are entitled to reimbursement of your medical costs in the Netherlands and in your country of residence. When you apply to CZ we will give you treaty form 106. With this form you apply to a health insurer in your country of residence. In this case, the costs incurred by you will be reimbursed to you under the conditions applicable in your country of residence. You can also choose to submit the costs directly to CZ. In that case, the costs will be reimbursed to you under the conditions of your CZ insurance policy. 7

8 Useful information about the deductible What is a deductible? Every Dutch person from the age of 18 years is liable for a compulsory deductible of 375 in This has been set by the government. The deductible is the amount you have to pay yourself, while the remainder is reimbursed. The deductible applies only to reimbursements from the general insurance policy. Exceptions to this are a visit to the general practitioner, midwifery care, obstetric care, multi-disciplinary care, a follow-up check on kidney or liver donors, costs of transport of a donor in the case of organ transplants, medical aids on loan and home nursing. Spread payment of compulsory deductible You may pay your deductible in equal instalments in advance. This means you avoid any nasty surprises as a result of receiving an invoice for treatment that we offset against your deductible. This way, you avoid any financial setback. For further information about this, visit CZ.nl/eigen-risico (information in Dutch). Voluntary deductible In addition to the compulsory deductible you can opt for a voluntary deductible. The higher your deductible, the lower your premium. The voluntary deductible applies to the same reimbursements as the compulsory deductible. Nice to have on holiday Accidents can happen when you least expect them. If something happens on holiday and you need medical care, call the CZ Helpline. You will receive advice and information from a Dutch expert. For instance if you should go to a doctor, or the location of the nearest hospital. With an EHIC card, which you can apply for from CZ, you do not have to pay up front for any healthcare costs incurred within Europe. CZ will settle the costs directly with the care provider. You can also use the 'CZ Reishulp' travel assistance app with ease whilst abroad. 8

9 Family members Please note: you should notify the ZiNL within four months If family members live abroad and don't work in the Netherlands, they will not be insured under the Exceptional Medical Expenses Act ('AWBZ') nor obliged to be insured under the Health Insurance Act. That is why they cannot take out any health insurance with CZ. Members of your family can be registered as co-insured family members in their country of residence. The insurer in your country of residence will assess if this is possible. The insurer will inform the 'ZiNL' of this by means of treaty form 106. The ZiNL must be informed within four months of the entitlement to co-insurance. It is important, therefore, that you tell your insurer in your country of residence as soon as possible. Medical care for family members Your family members are entitled in their country of residence to medical care according to the statutory terms and conditions of insurance of that country. For planned medical care in another EU/EER country or in Switzerland, they must have prior permission from the insurer in your country of residence. For medical care in the Netherlands, your family members use the EHIC, which will be given to them by ZiNL. In that case, your family members will not have to advance any healthcare costs incurred. The Dutch government has determined which health insurer settles these healthcare costs incurred directly with the care providers. This health insurer is Agis-Zilveren Kruis Achmea. Premium The premium is the amount you pay for general insurance. The premium for the different types of general insurance is shown on your quote or in the premium overview. Children up to the age of 18 years are co-insured and do not pay premiums; a deductible does not apply to them either. Family members over the age of 18 pay a contribution under the Health Insurance Act to the Netherlands Healthcare Institute ('Zorginstituut Nederland' or 'ZiNL'). Children up to the age of 18 do not pay this contribution. You can find more information about this at zorginstituutnederland.nl (information in Dutch) 9

10 Why does CZ conclude contracts with care providers? It is very important to CZ that care providers such as hospitals, pharmacists, physiotherapists and medical aids suppliers fulfil certain quality requirements. For that reason, we make agreements regarding treatments in order to assure ourselves that a specific treatment is being carried out effectively. We also make agreements concerning the price that these care providers may charge for the services they deliver. In this way, we endeavour to control the costs in the healthcare sector and to keep the healthcare system in the Netherlands affordable. Organise everything easily online 2014 With 'Mijn CZ', you can easily organise all of your insurance affairs. On 'Mijn CZ', you can: View your policy and reimbursements Change your details Claim for your bills Check the balance of your deductible Find out which bills have been paid directly to the care provider by us on your behalf CZ has been named as the health insurer with the best online service in 2014 CZ extras You can claim online for bills that you submit yourself to CZ. You may also claim by post, of course. The funds will be in your account within 10 days. Are you wondering how to arrange the best type of care for your condition, or how to find the best place for treatment? Our care advisers are happy to help you. All of our advisers have a medical background, so that they can properly assess your situation. They can offer advice, for instance, if you are on a waiting list, or if you want a second opinion from another doctor. With our single point of contact, we will help you find the best healthcare solution for you. 10

11 This must be within four months of starting work in the Netherlands Would you like to take out insurance with CZ? Then register with CZ We will provide all of the help you need in making your choice. We can also cancel your current health insurance for you. CZ Customer Services Our advisers are available to help you. Monday to Friday from 8:00 am to 9:00 pm and Saturdays from 10:00 am to 2:00 pm by calling (0800) Would you prefer to receive advice in person? If so, then simply visit one of the CZ offices. Address details can be found at CZ.nl/kantoor (information in Dutch). You may also use the application form, which you can find in this information pack. Package comparer The package comparer sets out the reimbursements for the different packages side by side, for easy comparison. You will find the package comparer with this brochure and at (information in Dutch). 11

12 Everything for better healthcare Legal information Organisation CZ Groep Zorgverzekeraar, name given in Articles of Association as OWM Centrale Zorgverzekeraars groep, Zorgverzerzekeraar U.A. (CoC no ) CZ Groep Aanvullende Verzekering Zorgverzekeraar, name given in Articles of Association as OWM Centrale Zorgverzekeraars groep, Aanvullende Verzekering Zorgverzekeraar U.A. (CoC no ) Address Postbus 90152, 5000 LD Tilburg CZ terms and conditions of insurance These can be obtained from (information in Dutch), a CZ office, the Chamber of Commerce, or by calling us. The insurance contract is subject to the law of the Netherlands. Dissatisfied? If so, please let us know. Our internal complaints procedure can be viewed at (information in Dutch). CZ is affiliated as a health insurer with the Healthcare Complaints and Disputes Mediation Body ('Klachten en Geschillen Gezondheidszorg'), (information in Dutch). The following bodies also monitor how we operate as an insurer: De Nederlandsche Bank, Netherlands Authority for the Financial Markets ('Autoriteit Financiële Markten') (permits / ), the Dutch Healthcare Authority ('Nederlandse Zorgautoriteit') en the Netherlands Healthcare Institute ('Nederlands Zorginstituut'). No rights may be derived from the contents of this brochure