what are the changes for you in 2014?

Transcription

1 Your healthcare insurance in Useful to know 2 What are the changes for you? Basic Insurance 4 Additional insurance ExtraVerzorgd 1 6 ExtraVerzorgd 2 7 ExtraVerzorgd 3 9 JongerenVerzorgd 12 Dental insurance TandVerzorgd 1 13 TandVerzorgd 2 13 TandVerzorgd 3 13 what are the changes for you in 2014? This is how this PDF works You can find the information that you want immediately in this PDF. If you want to print this PDF or pages from this PDF, click the Print icon on the left-hand side of the screen. You can search in this PDF at the righthand-side at the top by using a keyword. i Go to this page You can find more information on Menzis website Previous/next page BR eng

2 2 What will change in 2014? Changes apply to the Basic Healthcare Insurance, the additional insurance, the dental insurance and the general terms and conditions as of 1 January The changes in cover for the Basic Healthcare Insurance are determined by the government. Should changes be made after producing this online folder, we will inform you about them by post and/or . Visit for all information about your healthcare insurance in Full terms and conditions This folder contains short descriptions of the changes that are being implemented in Conditions may have been included in the insurance terms and conditions that refer to the different care forms. You will only be entitled to claim for this care if you meet these conditions. Examples of these conditions are a referral from your general practitioner as well as the condition that your care provider is a member of a specific professional association or that you must first obtain permission from Menzis. These conditions have not been included in this overview but you can find them in the insurance terms and conditions. Restrictions may also apply such as a maximum number of treatment sessions. i Cover If you are looking for information about a reimbursement from the Basic Insurance, and/or additional and/or dental insurance, consult the online A to Z list. i Insurance terms and conditions and Insurance Rules and Regulations Also always read the insurance terms and conditions and the Insurance Rules and Regulations with regard to medical resources or medication. You will then know exactly how much the reimbursement will be and which terms and conditions apply. i i Find a care provider Are you looking for a care provider? You can easily and quickly find a contracted care provider in your area by using the Zorgvinder (Care Finder). i ExtraVerzorgd 4 is being cancelled The additional insurance ExtraVerzorgd 4 will no longer be available as of 1 January Insured with the ExtraVerzorgd 4 product will automatically be given the additional insurance ExtraVerzorgd 3 as from this date. If you currently have taken out ExtraVerzorgd 4, you will have received a letter about this in October. Read more

3 3 Your personal page Were you aware that you can also find all the information about your healthcare insurance on your personal page? The information covers a personal policy clip, a full overview of changes to an explanation about the most important services offered by Menzis. Keep your policyholder number at hand and simply log in. i An additional insurance for children Parents who have an additional insurance, can co-insure children younger than 18 on their family policy free of charge for the same additional insurance. i The excess and personal contribution Everyone who is 18 or older has a mandatory excess with regard to the Basic Insurance of 360 per year. When you incur care expenses, you have to pay this amount yourself. A legal personal contribution applies to some care. This is the part of the expenses that you must pay yourself. The amount of this contribution is determined by the government and is the same for everyone. If you use care regarding which a personal contribution applies, first you will pay the personal contribution. The amount that remains after having made this payment is part of the 360 mandatory excess. i For more information and calculation examples visit Arranging your issues online You can make your arrangements easily and securely online through My Menzis. You can, for example, easily change your insurance or payment data, consult your excess and claim online. You can log in easily by using your DigiD. You can do the following in My Menzis 24 hours a day: View your care expenses; Consult your excess; Claim online; View the status of your claims; Change insurance data; Change payment data; Save points with SamenGezond (TogetherHealthy); Request and view a digital copy of your policy document. i

4 4 Changes to the Basic Insurance Deductible 360 (this was 350). Medication Mental healthcare Medical aids Personal contribution / maximum reimbursement Home dialysis equipment Vacuum pump with accessories Fertility hormones are now covered by medical specialist care. These resources and aids are now all reimbursed if the treatment takes place in or by a hospital. General basic mental healthcare is replacing what previously called firstline psychological care. This means that the personal contributions and the maximum of 5 sessions with regard to first-line psychological care no longer apply. Part of the care that is/was part of specialist mental healthcare (second-line mental healthcare) up to 1 January 2014 will also be part of general basic mental healthcare as of 1 January Read more about the changes in psychological care. The personal contribution and maximum reimbursement have changed for some aids and resources. 1) Orthopaedic footwear ( changes to , and 69 changes to 71) 2) Spectacles and contact lenses ( changes to and 107 changes to 109) 3) Footwear for bandaged feet ( 149 changes to 152) 4) Non-allergenic footwear ( changes to and changes to 339, 69 changes to 71 and 263 changes to ) 5) Wigs ( 393 changes to 409) Now covered by medical specialist care. Now covered by medical specialist care. Read more

5 5 Changes in the Basic Insurance (continuation) Maternity care (personal contribution) Home Hospital/institution without medical requirement Speech therapy Conditional admission 4.10 per hour (this was 4) per day (this was 16) (if the rate of the institution is more than per day, you must pay the additional costs yourself (this was ). You are only entitled to speech therapy in a school or child care centre when Menzis has given consent. Your speech therapist can apply for this permission from Menzis on your behalf. The following have been added: Transluminal endoscopic step-up approach with patients infected with pancreatic necrosis; Autologous stem cell transplantations in case of therapy refractory patients with Crohn s disease. It has been determined that you must participate in the study that is specified with the treatment as of 1 January 2014 with regard to treatments that had already been permitted conditionally in If you already received the care on 31 December 2013 that was permitted conditionally in 2013 but did not take part in the study, you will continue to be entitled to this care during the period of the conditional admission if you met all the conditions that applied on 31 December Non-emergency patient transport (excess) 96 (this was 95).

6 6 ExtraVerzorgd 1 ExtraVerzorgd 2 ExtraVerzorgd 3 JongerenVerzorgd Changes to ExtraVerzorgd 1 Alternative treatment methods and medicines Childbirth and maternity care (maternity package) 0 (this was 80% up to 50 for treatments and 80% up to 50 for medicines). The reimbursement no longer applies (this was 100%). Foreign prevention (vaccinations) " 100 (this was " 60). Dietary preparations " 100 (this was " 75). Physiotherapy, Cesar/ Mensendieck exercise therapy and exercise programme Mental healthcare Patients associations Membership Therapy 9 treatments (this was 7). You need a referral from your GP or medical specialist for treatment outside the practice of a therapist. The reimbursement no longer applies because this is insured under the Basic Insurance (is covered by General Basic Mental Healthcare). The reimbursement no longer applies (this was " 25). The reimbursement no longer applies (this was " 50). Bed-wetting alarm The reimbursement no longer applies (this was 100%). Wigs and alternatives Sports medical advice " 100 (this was " 100 for wigs or " 25 for alternatives). " 100 including physicals (this was " 100 without a physical). Support pessary The reimbursement no longer applies (this was 100%). Accommodation expenses related to guest houses or hospices for a visiting family member Foot care (orthopedic support soles, pedicure, podology and chiropody) The reimbursement no longer applies (this was " 150). 100% (this was 75%) Pedicure care for diabetes Simms 0 no longer applies

7 7 ExtraVerzorgd 1 ExtraVerzorgd 2 ExtraVerzorgd 3 JongerenVerzorgd Changes to ExtraVerzorgd 2 Acne treatment 200 (this was 185). Alternative treatment methods and medicines 80% up to 400 (this was 80% up to 300 for treatments and 80% up to 250 for medicines). Circumcision 100% with a medical indication (this was " 0). Childbirth and maternity care Maternity care Maternity care after admission Multiple birth payment Delivery room Spectacles and contact lenses 100% (this was 160). 16 uur (this was 160). 250 (this was 0). 100% (this was 160). 100 per 2 calendar years (this was 80 per 2 calendar years), The reimbursement for eye laser treatment and lens implants no longer applies. Foreign prevention (vaccinations) 100 (this was 75). Camouflage products and therapy Dietary advice 200 (this was 100 for aids and 100 voor therapy). 2 hours (this was 1 hour). You need a referral from your GP or medical specialist for treatment in your home. Depilation 80% up to 500 (this was 75% up to 500). Reimbursement of the expenses after treatment by a dermatologist and plastic surgeon no longer applies. Physiotherapy, Cesar/ Mensendieck exercise therapy and exercise programme 18 treatments (this was 12). You need a referral from your GP or medical specialist for treatment outside the practice of a therapist. Read more

8 8 ExtraVerzorgd 1 ExtraVerzorgd 2 ExtraVerzorgd 3 JongerenVerzorgd Changes to ExtraVerzorgd 2 (continuation) Mental healthcare Travel for curative purposes The reimbursement no longer applies because this is insured under the Basic Insurance (is covered by General Basic Mental Healthcare). De vergoeding vervalt (was 1250 voor Reumatoïde artritis, ziekte van Bechterew of artritis psoriatica en 2150 voor psoriasis). Voluntary care (courses) 100 (this was 75). Menopause consultant 200 (this was 75). Patients associations (membership) 50 (this was 25). Bed-wetting alarm Wigs and alternatives The reimbursement in items on loan no longer applies. 200 (this was 200 for wigs or 50 voor alternatives). Patient visit travelling expenses 150 (this was 120). Soft brace or splint 50 (this was 25). Sports medical advice The reimbursement for sports physicals has been added. Holiday camp for children The reimbursement no longer applies (this was 150). Red Cross or Zonnebloem holiday therapy programmes Accommodation expenses related to guest houses or hospices for patient Foot care (orthopedic support soles, pedicure, podology and chiropody) Contraceptives The reimbursement no longer applies (this was 500). 350 (this was 0). Pedicure care for diabetes Simm s 0 no longer applies. 50 (this was 30 for the pill or 50 for a coil etc.).

9 9 ExtraVerzorgd 1 ExtraVerzorgd 2 ExtraVerzorgd 3 JongerenVerzorgd Changes to ExtraVerzorgd 3 Acne treatment 200 (this was 185). General check-up (PreventionConsult) Alternative treatment methods and medicines The reimbursement no longer applies (this was 70). 80% up to 600 (this was 80% up to 500 for treatments and 80% tot 500 for medicines). Circumcision 100% with a medical indication (this was " 0). Childbirth and maternity care Multiple birth payment Delivery room 250 (this was 230). 100% (this was 300). Spectacles and contact lenses 150 per 2 calendar years (this was 130) The reimbursement for eye laser treatment and lens implants no longer applies. Foreign prevention (vaccinations) 150 (this was 125). Camouflage products and therapy Courses (first aid, reanimation/aed and health courses) Dietary advice 200 (this was 100 for aids and 100 for therapy). 100 (this was 75). 4 hours (this was 1 hour). You need a referral from your GP or medical specialist for treatment at your home. Depilation 80% up to 1000 (this was 75% up to 1000). Reimbursement of the expenses after treatment by a dermatologist and plastic surgeon no longer applies. Read more

10 10 ExtraVerzorgd 1 ExtraVerzorgd 2 ExtraVerzorgd 3 JongerenVerzorgd Changes to ExtraVerzorgd 3 (continuation) Occupational therapy Physiotherapy, Cesar/ Mensendieck exercise therapy and exercise programme Mental healthcare Travel for curative purposes You need a referral from your GP or medical specialist for treatment at your home. 40 treatments (this was 100% provided that it was required medically). You need a referral from your GP or medical specialist for treatment outside the practice of a therapist. The reimbursement no longer applies because this is insured under the Basic Insurance (is covered by General Basic Mental Healthcare). The reimbursement no longer applies (this was 1250 for rheumatoid arthritis, Bechterew disease or psoriatic arthritis and 2150 for psoriasis). Menopause consultant 200 (this was 110). Patients associations Course Membership Personal alarm Bed-wetting alarm Wigs and alternatives 100 (this was 75). 50 (this was 45). The reimbursement no longer applies (this was 5 per month). The reimbursement in items on loan no longer applies. 300 (this was 300 for wigs or 75 for alternatives). Travelling costs 250 (this was 230). Soft brace or splint 50 (this was 40). Sporting Medical Advice Stutter therapy The reimbursement for sports physicals has been added. The reimbursement for SpeechEasy no longer applies. Read more

11 11 ExtraVerzorgd 1 ExtraVerzorgd 2 ExtraVerzorgd 3 JongerenVerzorgd Changes to ExtraVerzorgd 3 (continuation) Vascular and/or pigmentation treatment Reimbursement of the expenses after treatment by a dermatologist and plastic surgeon no longer applies. Holiday camp for children The reimbursement no longer applies (this was 150). Red Cross or Zonnebloem holiday therapy programmes Foot care (orthopedic support soles, pedicure, podology and chiropody) Contraceptives The reimbursement no longer applies (this was 500). Pedicure care for diabetes Simm s 0 no longer applies. 50 (this was 30 for the pill or 50 for a coil, etc.).

12 12 ExtraVerzorgd 1 ExtraVerzorgd 2 ExtraVerzorgd 3 JongerenVerzorgd Changes to JongerenVerzorgd Onderdeel JongerenVerzorgd Acne treatment 200 (this was 185). Spectacles and contact lenses 100 per 2 calendar years (this was 130), the reimbursement for eye laser treatment and lens implants no longer applies. Foreign prevention (vaccination) 100 (this was 75). Camouflage products and therapy Dietary advice 200 (this was 100 for aids and 100 voor therapy). The reimbursement no longer applies (this was 1 hour). Depilation 80% up to 500 (this was 75% up to 500). Reimbursement of the expenses after treatment by a dermatologist and plastic surgeon no longer applies. Physiotherapy, Cesar/ Mensendieck exercise therapy and exercise programme Mental healthcare 9 treatments (this was 7). You need a referral from your GP or medical specialist for treatment outside the practice of a therapist. The reimbursement no longer applies because this is insured under the Basic Insurance (is covered by General Basic Mental Healthcare). Soft brace or splint 50 (this was 25). Sports medical advice 250 (this was 225). Foot care (orthopedic support soles, pedicure, podology and chiropody) Contraceptives Pedicure care for diabetes Simm s 0 no longer applies. 50 (this was 30 for the pill or 50 for a coil, etc.).

13 13 The dental insurances Not all treatments are insured. You will be reimbursed the expenses in accordance with a table with services and related service codes. The service codes are reimbursed up to a maximum percentage or amount but not all service codes are reimbursed. You will find the extensive tables with the reimbursement percentages at dental reimbursements. Changes to TandVerzorgd 1 Component TandVerzorgd 1 No changes in 2014 Changes to the TandVerzorgd 2 Component Tandverzorgd 2 Dentistry (Dental care from 18 years of age) Parodontology 50% (this was 0%) Changes to the TandVerzorgd 3 Component TandVerzorgd 3 No changes in 2014 The Dutch text is binding should any disputes arise from the interpretation of the text.