Coverage summary for supplementary health-care plans ONVZ 2012 Vrije Keuze Zorgplan

Transcription

1 Coverage summary for supplementary s 2012 Vrije Keuze Zorg Insured costs Vrije Keuze Extrafit Vrije Keuze Benfit Vrije Keuze Optifit Vrije Keuze Topfit Vrije Keuze Superfit Abroad Planned treatment 2) for the hospitals referred to, see s list of hospitals abroad Unforeseen treatment country, max. the current rate in the country of short-term stay rate in the country, max. the current rate in the country of short-term stay rate in the rate in the countries, max. the current rate in the International telephone costs for calls to Accident coverage 5,000 in the event of death. Max. 20,000 in the event of permanent loss of function Acne treatment Adoption payment No payment 250 upon adoption of child 1) for practitioner see s list of recognised professional associations Arch supports Bed-wetting alarm If treated by a, max. 27 per treatment, max. 1 treatment per day, max. 20 treatments per calendar year (homeopathic and anthroposophical) investigations: no coverage attending and supplied If treated by a or acupuncturist, max. 27 per treatment, max. 1 treatment per day, max. 20 treatments per (homeopathic and anthroposophical) investigations: no coverage attending and supplied 350 upon adoption of child If treated by a, max. per day, max. 750 per. If treated by a max. 250 per anthroposophical max. 250 per calender year, if and supplied by a pharmacy attending and supplied 455 upon adoption of child If treated by a, max. per day, max. 1,000 per. If treated by a max. 500 per anthroposophical max. 500 per calender year, if or practitioner and supplied by a pharmacy attending and supplied attending 500 upon adoption of child If treated by a, max. per day, max. 1,250 per. If treated by a max. 500 per anthroposophical max. 750 per calender year, if or practitioner and supplied by a pharmacy, supplied by an orthopaedic technician of the hire or purchase of the hire or purchase Breastfeeding specialists Max. 2 consultations Max. 4 consultations Carer relief Max. 8 per calendar association, when rs are ill Child in case of hospitalisation of parent (from 4th day of hospitalisation) Contraceptives (pill, IUD, diaphragm) Cosmetic skin camouflage treatment Dental surgery from the age of 18 (exc. orthodontics) Dental surgery up to the age of 18 (exc. orthodontics) Max. 8 per calendar association, when rs are ill Max. 16 per calendar association, when rs are ill Max. 25 per day, max. 60 consecutive working for co-insured children up to the age of 12 for serious skin defects in for up to max. 200 IUD and diaphragm: for serious skin defects in for up to max. 4,540 IUD and diaphragm: for serious skin defects in for up to max. 4,540 IUD and diaphragm: Max. 24 per calendar association, when rs are ill Max. 25 per day, max. 60 consecutive working for co-insured children up to the age of 12, inc. camouflage means, inc. camouflage means Max. 1,600 per for general dental Max. 500 per for general dental Dietetics Max. 120 per for sessions with a dietitian Domestic assistance after discharge from hospital Electrical epilation/laser treatment Max. 200 per for sessions with a dietitian Max. 205 via for general dental for general dental per for sessions with a dietitian Max. 450 via Max. 1,500 for the whole per for sessions with a dietitian Max. 750 via Max. 2,000 for the whole

2 Insured costs Vrije Keuze Extrafit Vrije Keuze Benfit Vrije Keuze Optifit Vrije Keuze Topfit Vrije Keuze Superfit Exercise programmes Max. 250 per calender year, in total for KNGF (Royal Dutch intervention and the Herstel rehabilitation programme Exercise therapy: therapy for posture and exercise (physiotherapy is listed separately) GeboorteTENS (painkilling method when giving birth) and sensor mat Max. 100 for sports Max. 500 per calender sessions with a sports Max. 500 per calender year, in total for KNGF (Royal Dutch rehabilitation programme Max. 750 per calender sessions with a sports Hire of GeboorteTENS device Glasses/contact lenses Max. 150 per calender year, Guest house stay for a family member during admission Health check-up (1x per year) for KNGF (Royal Dutch rehabilitation programme, max. 50 per calender year for swimming programmes aimed at keeping senior citizens or those aged 50 or above fit Max. 1,000 per calender sessions with a sports Hire of GeboorteTENS device Max. 300 per calender year, Max. 25 per day Max. 25 per day Max. 25 per day Health resort Max. 500 per for rheumatoid arthritis or psoriasis Hospice or other palliative facility Max. 25 per day, max. 3 months if indicated by the Care Needs Assessment Centre (CIZ) or a Max. 25 per day, max. 3 months if indicated by the Care Needs Assessment Centre (CIZ) or a for KNGF (Royal Dutch rehabilitation programme, max. 50 per calender year for swimming programmes aimed at keeping senior citizens or those aged 50 or above fit Max. 1,500 per calender sessions with a sports Hire of GeboorteTENS device Max. 450 per calender year, Max. 500 per for rheumatoid arthritis or psoriasis Full personal contribution if indicated by the Care Needs Assessment Centre (CIZ) or a Hospital admission Privé Kamer for ned admission of more than one day in the Zorg Luxe of what is offered in a Dutch hospital Zorg Assistent Support in case of hospital admission in the and coverage for transport by contracted taxi or own transport( 0.25 per km) In vitro fertilisation (IVF), in hospital, in hospital Lymph drainage MammaPrint Maternity Maternity package maternity payment of 250, to use for e.g. personal maternity or incubator Medical appliances: crutches and rollators Medical appliances: personal the Basisverzekering Medical transportation Medicines Over and above that provided by the Reglement Farmaceutische Zorg [Pharmaceutical Care Regulations] Max. 50 for crutches, if the basic Max. 100 for registered, dressing material, and coverage for personal the basic Non-s, homeopathic and anthroposophic s, contraceptives, over-thecounter medication and IVF s: no coverage Max. 50 for crutches, if Coverage max. 250 per the basic. Max. 200 for registered, dressing material, and coverage for personal the basic Non-s, homeopathic and anthroposophic s, over-the-counter medication and IVF s: no coverage maternity payment of 350, to use for e.g. personal maternity or incubator Max. 100 for crutches, by an attending Coverage max. 500 per the basic. Max. 4,540 for registered, dressing material, and coverage for personal contribution Non-s: no coverage anthroposophic s, see maternity payment of 455, to use for e.g. personal maternity or incubator Max. 100 for crutches, by an attending Coverage max. 1,000 per the basic. Max. 4,540 for registered, dressing material, and coverage for personal contribution Non-s: no coverage anthroposophic s, see maternity payment of 500 to use for e.g. personal maternity or incubator Max. 200 for crutches, by an attending the basic. for registered, dressing material, and coverage for personal contribu tion health Non-s: no coverage anthroposophic s, see Menopause consultant Max. 120 per Max. 250 per Nursing equipment coverage for hire coverage for hire coverage for hire coverage for hire coverage for hire Occupational therapy Orthodontics Up to the age of 18, max. 1,365 for the whole duration of the Up to the age of 18, Up to the age of 18, from the age of 18 max. 500 per Orthoptics Max. 500 per, if Max. 750 per, if Max. 1,000 per calendar year, if prescribed by an attending Max. 1,500 per calendar year, if prescribed by an attending

3 Insured costs Vrije Keuze Extrafit Vrije Keuze Benfit Vrije Keuze Optifit Vrije Keuze Topfit Vrije Keuze Superfit Pedicure (foot ) Max. 100 per for diabetes and rheumatoid arthritis Physiotherapy, remedial therapy, max. 9 treatments per, max. 12 treatments per Max. 200 per for diabetes and rheumatoid arthritis, max. 35 treatments per Plastic surgery Correction of the position of In case of demonstrable physical dysfunction: for eyelid corrections, abdominoplasty and the replacement of breast prostheses, for diabetes and rheumatoid arthritis Correction of the position of All other costs of plastic or reconstructive surgery will only be covered in the case of demonstrable physical dysfunction Podiatry Preventive health-related courses 4) for courses see s list of recognised preventive health-related courses Preventive medical investigations Psoriasis day treatment in outpatients clinic Max. 250, max. 2 courses 4 per 50% up to max. 250 per by a general practitioner or medical specialist for preventive investigation or Max. 500 per, if Max. 500 per, if Max. 500 per, if Psychologist Max. 500 per (no coverage for personal the basic Recuperation homes 3) for recuperation homes see s list of recognised recuperation homes Repatriation Ronald McDonald House or Family House SIDS (cot death) monitoring equipment Sterilisation (and reversal operation) Stuttering therapy Therapeutic camp for young people Max. 250, max. 2 courses 4 per Max. 500 per by a general practitioner or medical specialist for preventive investigation or Max. 1,000 per calendar year (no coverage for personal the basic, -recognised recuperation home 3 if prescribed by a, upon approval from Max. 350 for the whole Max. 6 per day for the personal contribution required under the basic health-, max. 42 per in case of asthma Vaccinations for travel abroad Max. 75 per calendar ZorgConsulent health and prevention - Health- mediation - Arrangement of health (inc. maternity ), upon approval from, no coverage for reversal operation Max. 350 for the whole Max. 250 per for personal contribution in case Max. 1 camp per Max. 75 per calendar health and prevention - Health- mediation - Arrangement of health (inc. maternity ), upon approval from, no coverage for reversal operation Max. 500 for the whole Max. 300 per for personal contribution in case Max. 100 per calendar health and prevention - Health- mediation - Arrangement of health (inc. maternity, home help) Max. 11,345 for search and rescue Hire if prescribed by an attending, upon approval from for sterilisation and reversal operation for personal contribution in case health and prevention - Health- mediation - Arrangement of health (inc. maternity, home help, child) for diabetes and rheumatoid arthritis Correction of the position of All other costs of plastic or reconstructive surgery will only be covered in the case of demonstrable physical dysfunction Max. 250, max. 2 courses 4 per and once every 3 years an extra payment of max. 250 Max. 750 per by a general practitioner or medical specialist for preventive investigation or Max. 1,500 per calendar year (no coverage for personal the basic, -recognised recuperation home 3 if prescribed by a Max. 11,345 for search and rescue Hire if prescribed by an attending, upon approval from for sterilisation and reversal operation for personal contribution in case health and prevention - Health- mediation - Arrangement of health (inc. maternity, home help, child)

4 Tandfit Module A Module B Module C Module D Accident coverage for dental Dental for insured persons from the age of 18 5) for check-up and prevention, see list of codes in the terms and conditions Privé Zorgpakket Privé Kamer Privé Zorg Totaal Zorg Assistent Zorg Luxe Max. 250 Max. 500 Max. 500 Max % up to max. 250 per calendar year including technical costs Modules for check-up and prevention 5 and 75% for other dental, inc. technical costs in total up to max. 750 per for check-up and prevention 5 and 75% for other dental, inc. technical costs in total up to max. 1,500 per up to max. 1,500 per including technical costs A single room for a ned admission of more than one day to a hospital in the. If a single room is not available: payment of 75 per day for each day admitted A complete package, consisting of Privé Kamer, Zorg Luxe and the Zorg Assistent. Privé Kamer module plus Privé Zorg Assistent, who will support you with all matters concerning your hospital stay and coverage for the transport costs. Privé Kamer plus Privé Zorg Luxe: including internet connection, luxury meals, newspaper and own refrigerator filled with soft drinks This is a summary of the coverage provided by our s. The coverage listed is per insured person per, unless otherwise indicated. Additional terms and conditions or a personal contribution sometimes apply. The policy terms and conditions determine the exact coverage provided. Since it is impossible to render the full policy terms and conditions on just a few pages, no rights can be derived from this coverage summary. You will find the policy terms and conditions at A copy can also be requested by telephone on +31 (0) All lists referred to in the summary are available on * Refer to the 2012 policy terms & conditions for full details

5 Coverage summary 2012 Vrije Keuze Basisverzekering Abroad Planned and unforeseen treatments, maximum: the current rate in the Audiological health, if Bone marrow investigation, children if provided by the Stichting Kinderoncologie Nederland (SKION) Childbirth in hospital. Personal contribution payable if there is no medical necessity* Contraceptives for insured persons up to the age of 21 Dental Insured persons up to the age of 18 Insured persons from the age of 18 Dental surgery Dietetics Dyslexia Fertility-enhancing treatment, with the exception of cast fillings, crowns, bridgework, dental imts and orthodontic Fully removable dental prosthesis (exc. personal contribution of 25%), specialist dentistry (exc. personal contribution*), fully removable dental prosthesis as part of specialist dental (exc. personal contribution of 125 per jaw section), with the exception of periodontal surgery, the placing of dental imts and uncomplicated extractions, max. 4 treatment hours per. Only as part of coordinated and multidisciplinary treatment of diabetes, COPD or cardiovascular risk in the case of serious, pure dyslexia (in accordance with protocol) OI, AI and IUI: of the specialist IVF and ICSI: for the 1st, 2nd and 3rd attempts only, for each potential pregnancy General practitioner Hospital admission (includes independent treatment centre) Kidney dialysis Lymph drainage, for 21st and subsequent treatments Maternity Min. 24 hours, max. 80 hours, max. 10 (exc. personal contribution of 4 per hour) Medical appliances Coverage in accordance with Medical Appliance Regulations. Personal contribution payable for certain medical appliances* Medical transportation With prior agreement: for public transport and taxi; up to a maximum of 0.30 per km for transport in private car. The coverage for other medical transportation is subject to a personal contribution of 93 per Mental health (specialist) exc. personal contribution, both for treatment ( 100 for treatment < 100 min, 200 for treatment > 100 min)* and admission to an institution ( 145 per month)* Occupational therapy, max. 10 hours per, if Organ transts, if the transt takes place in one of the countries listed in the policy terms and conditions Pharmaceutical Coverage for s in accordance with Pharmaceutical Care Regulations. Personal (including medication) contribution payable for certain s* Physiotherapy and remedial therapy Insured persons up to the age of 18 Chronic: ; Non-chronic: up to 18 medically necessary treatments Insured persons from the age of 18 Chronic: for the 21st and subsequent treatments; Non-chronic: no coverage Pelvic physiotherapy for urinary incontinence: up to 9 treatments Plastic surgery, in case of demonstrable physical dysfunction, mutilation and congenital abnormalities Preventive if prescribed by a or midwife*: - help to stop smoking (no coverage for s and over-the-counter medication) - prevention of depression (limited coverage) - preventive for obesity (limited coverage) - prevention of alcoholism (limited coverage) - prevention of panic disorder (limited coverage) Psychologist 5 sessions (exc. personal contribution of 20 per session and 50 for internet-based treatment), if Rehabilitation Second opinion Specialist medical, if Speech therapy, except for costs of treatment as part of educational support, if *) refer to the 2012 policy terms & conditions for full details