VGZ Aanvullend Goed, Beter, Best VGZ Tand Goed, Beter, Best 2015 Supplementary insurance conditions. Manage everything online with My VGZ

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1 , Beter, Best VGZ Tand Goed, Beter, Best 2015 Supplementary insurance conditions Manage everything online with My VGZ

2 Welcome to VGZ These are the insurance conditions that apply to your VGZ supplementary healthcare insurance policy. 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 Contents I. General section 5 Article 1. Insured care 5 Article 2. General provisions 7 Article 3. Premium 10 Article 4. Other obligations 11 Article 5. Change in premium and policy conditions 11 Article 6. Commencement, duration and termination of the supplementary insurance 12 Article 7. Complaints and disputes 13 Article 8. Care Advice and Mediation 14 II.,, 15 Article 9. Alternative care 15 Article 10. Movement-related care 16 Article 11. Contraceptives 17 VISUAL AIDS 18 Article 12. Glasses and contact lenses 18 Article 13. Laser eye treatment or lens implants 18 ABROAD 18 Article 14. Urgent care while on holiday and during a temporary stay abroad 18 Article 15. Repatriation 19 PREVENTION 19 Article 16. Courses 19 Article 17. Lifestyle check 20 Article 18. Weight consultant 20 Article 19. Sports medical advice 20 Article 20. Menopause care 21 Article 21. Preventative vaccinations and medicines in connection with a holiday 21 DELIVERY-RELATED CARE 21 Article 22. Obstetric care 21 Article 23. Personal contribution for maternity care 21 Article 24. After-care of mother and newly born 22 Article 25. Maternity package 22 Article 26. Electrical breast pump 22 Article 27. Lactation consultation 22 SKIN TREATMENTS 23 Article 28. Acne treatment 23 Article 29. Camouflage therapy 23 Article 30. Epilation 23 CARE AIDS 24 Article 31. Audiological care aids 24 Article 32. Hand or finger splint for temporary use 24 Article 33. Breast prosthesis 24 Article 34. Wigs or head scarves 24 Article 35. Support pessary 25 SPECIALIST MEDICAL CARE 25 Article 36. Medical circumcision 25 Article 37. Abdominal wall surgery 25 Supplementary insurance conditions VGZ Goed, Beter Best

4 Article 38. Eyelid correction 26 Article 39. Redression helmet 26 Article 40. Sterilisation 27 PSYCHOLOGICAL CARE 27 Article 41. Mindfulness following symptoms of burnout 27 Article 42. Sexological care 27 FOOT TREATMENTS 28 Article 43. Foot care for rheumatoid and diabetic foot 28 Article 44. Podotherapy 28 Article 45. Arch supports and therapeutic soles 29 DIETARY ADVICE 29 Article 46. Dietary advice 29 CARE FOR ONCOLOGICAL PATIENTS 29 Article 47. Herstel en Balans (Recovery and Balance) rehabilitation programme 29 INFORMAL CARE 30 Article 48. Informal care broker 30 Article 49. Substitute informal care 30 INPATIENT CARE 31 Article 50. Convalescent homes and care hotels 31 Article 51. Hospice 31 Article 52. Ronald McDonald House/family house 32 Article 53. Transport in connection with an organ transplant 32 DENTAL CARE/ORAL CARE 33 Article 54. Dental prostheses (dentures) 33 Article 55. Crowns required as a result of an accident 33 III. Tand Goed Pakket, Tand Beter Pakket, Tand Best Pakket 34 Article 56. Dental care 34 Article 57. Orthodontic care 34 IV. Glossary 36 4 General section

5 I General section Article 1. Insured care 1.1. Content and extent of the insured care Your supplementary insurance entitles you to care and the reimbursement of costs associated with that care as described in these policy conditions Medical indication You are entitled to care and the reimbursement of costs associated with that care as described in these policy conditions if you reasonably depend on the type of care in question in terms of its content and extent, and if the type of care provided is appropriate and effective. The content and extent of the type of care are partly determined by what the care providers concerned are in the habit of providing in terms of care. The content and extent of the type of care are also determined by the current state of science and professional practice. This is determined using the Evidence-Based Medicine (EBM) method. If information in this regard is lacking, the content and type of care are determined according to what is considered to be responsible and adequate care within the field of specialisation concerned Your care provider must meet certain criteria. For many care providers these criteria are set out in law and titles for medical professions are protected. This applies, for instance, to general practitioners, medical specialists, dentists, physiotherapists and health psychologists. See the relevant care article for the requirements that must be met by care providers for which these criteria are not set out in law or for which we have imposed additional conditions. We have made arrangements with contracted, designated or accredited care providers for specific types of care. This means that in those cases you will be entitled to only partial reimbursement, or no reimbursement at all, if you use non-contracted, non-designated or non-accredited care providers. The applicable restrictions are clearly explained under the relevant care articles. You are free to choose your own care provider, on condition that the other requirements set out in these policy conditions have been met. You will find a comprehensive list of our contracted and designated care providers on our website. The accredited care providers are specified in the relevant care article. We have made specific agreements with some suppliers. These are our preferred suppliers. Where we have a preferred supplier, this is stated in the relevant care article Reimbursement of the costs of care 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, we will reimburse the costs up to a maximum of the reasonable market price current in the Netherlands. If you receive treatment from one of our contracted care providers, we will reimburse the costs of care based on the rate agreed with the care provider concerned. 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 Submitting invoices Many care providers send their invoices directly to us. If you have received an invoice yourself, you can complete a claim form and send it to us, together with the original invoice. Please do not send us any copies or payment demands. We only process original invoices. You can submit invoices up to a maximum of three years after the start of the treatment in question. It is important that the invoice specifies the name and birth date of the insured person, the treatment, the date of treatment, the invoice amount and the name and initials of the care provider. Invoices must be itemised in such a way as to preclude the need for further queries to determine the reimbursement we are obliged to pay. To convert the amounts indicated on foreign invoices into euros, we use the historical rates provided at based on the exchange rates that applied on the day the treatment took place. Invoices must be made out in Dutch, German, Supplementary insurance conditions VGZ Goed, Beter Best

6 English, French or Spanish. If necessary, we may require a sworn translation of the invoice. The costs of translation are not eligible for reimbursement. We are authorised to refrain from paying the invoice until you have provided sufficient evidence that the costs have been paid. Submitting claims online You can submit your claims simply and fast online. To do this, go to mijn.vgz.nl. You are obliged to keep the original invoices for one year after having submitted the claim. We may ask you to provide the original invoice for inspection purposes. If you are unable to produce the invoice, we may reclaim the amounts paid out to you or settle these against any amounts owed to you Direct payment We are authorised to pay the costs of care directly to the care provider. In such a case, your entitlement to reimbursement will lapse Settlement of costs If we pay the care provider directly and reimburse more than we owe you under these conditions or if the costs of care are otherwise payable by you, you will as a policyholder owe the costs to us. We will charge these amounts to you at a later stage. You are obliged to pay these amounts. We are authorised to offset these amounts against any amounts owed to you Referral, prescription or permission For certain types of care you require a referral, prescription and/or prior written permission to prove that you depend on that care. This is specified in the relevant care article. Referral or prescription If the care article specifies that you need a referral or prescription, you can ask for this from the care provider listed in that article. In many cases, this care provider is the general practitioner. Permission Some types of treatment require our written prior permission. This permission may also be referred to as an authorisation. If you failed to obtain prior written permission, you will not be entitled to this care or to reimbursement of the costs. If you are you using the services of one of our contracted care providers, you will not need to apply to us for prior permission. Your care provider will, in this case, determine whether you satisfy the conditions and/or will apply for permission from us on your behalf. You may, for reasons of privacy, prefer to apply directly to us for prior written permission. In such cases you can send your application directly to us if you wish. You will find our address in these insurance conditions. If you are not using the services of one of our contracted care providers, you will need to apply to us directly for permission Derived right You are entitled to care and reimbursement of the associated costs if the treatment or delivery occurs during the term of the supplementary insurance cover. If you receive a particular treatment during two calendar years and the care provider is entitled to charge a single amount for it (for example, in the case of a Diagnosis Treatment Combination), we will reimburse the costs in question if the treatment began within the term of the supplementary insurance cover. Where these policy conditions refer to a year or calendar year, the actual treatment date or supply date specified by the care provider is decisive for determining the year or calendar year to which the costs claimed must be allocated Exclusions You are not entitled to: - forms of care or services that are financed by virtue of a statutory regulation such as the Long-Term Care Act (Wlz), the Youth Act or the Social Support Act (Wmo) 2015; 6 General section

7 - care and reimbursement of the associated costs in connection with diseases or disorders already in existence before you took out the supplementary insurance policy and which were known to you or could have been known to you, or already produced symptoms at the time and which were not reported to us in writing. This exclusion does not apply if the supplementary insurance was taken out without medical or dental selection; - reimbursement of costs incurred because you failed to attend an appointment with a care provider; - reimbursement of costs of written statements, mediation costs charged by third parties without our prior written agreement, administrative costs or costs incurred due to a failure to pay invoices of care providers on time; - reimbursement of personal contributions or excess owed pursuant to any other insurance policy unless determined otherwise in these policy conditions; - care and reimbursement of the associated costs that could be claimed pursuant to the Healthcare Insurance Act (Zvw) if you were a person obliged to take out insurance within the meaning of that act; - reimbursement of costs pursuant to the Long-Term Care Act (Wlz), the Healthcare Insurance Act or any other act, provision or insurance, whether or not from an earlier date, if the supplementary insurance policy with us did not exist. In that case, this supplementary insurance policy will be the last to apply and, pursuant to these policy conditions, only the amount in damages that exceeds the amount that you could claim elsewhere will be eligible for reimbursement. We apply the Concurrence of Travel Insurances and Supplementary Healthcare Insurances Agreement (Convenant samenloop reisverzekeringen en aanvullende ziektekostenverzekeringen, which is available on our website; - reimbursement for damage that is an indirect consequence of acts or omissions on our part; - reimbursement of the costs of care made necessary by armed conflict, civil war, insurrection, internal civil commotion, riots and mutiny taking place in the Netherlands as provided in Section 3.38 of the Financial Supervision Act (Wft). - reimbursement of the costs of care made necessary through gross negligence or intent. - reimbursement if the costs are charged by you, your partner, child, parent or other family member living as part of the household Entitlement to care and other services as a result of acts of terrorism Should you need care as a result of one or more acts of terrorism, the following rule applies. If the total damages to be claimed in a year from non-life, life or funeral with in-kind benefits insurers (including healthcare insurers) according to the Dutch Terrorism Risk Reinsurance Company (Nederlandse Herverzekeringsmaatschappij voor Terrorismeschaden N.V., NHT) exceeds the maximum amount reinsured per year by this company, you will only be entitled to a specific percentage of the costs or value of the care. The NHT determines this percentage. This applies to life, non-life and funeral insurers (including healthcare insurers) that fall within the scope of the Financial Supervision Act (Wft). The exact definitions and provisions for the entitlement referred to above are set out in the NHT s Terrorism Cover Clauses Sheet (Clausuleblad terrorismedekking). Guaranteed payment in the event of claims due to terrorism To be able to guarantee that you will receive a payment in the event of a claim due to terrorism, almost all insurance companies in the Netherlands came together to set up the Nederlandse Herverzekeringsmaatschappij Terrorismeschaden N.V. (NHT). We are also affiliated with them. The NHT has set up a scheme to ensure that you will always receive at least part of your claim. The NHT has imposed a maximum on the total amount to be paid out in the event of an act of terrorism. The maximum, which is one billion euros per year, applies to all insured persons as a group. If the total damages exceed this amount, each insured person who has suffered damages will receive the same percentage of the maximum amount. In practice, this can therefore mean that you will receive less than the actual value of the damages. However, it also means that you are always guaranteed to receive at least part of your claim. Article 2. General provisions 2.1. Basis of the insurance The insurance contract is concluded on the basis of the details you provided on the application form or forwarded to us in writing Supplementary insurance The insurance contract applies to the supplementary insurance policy or policies stated on the policy schedule or confirmed to you in writing in another way. Supplementary insurance conditions VGZ Goed, Beter Best

8 These policy conditions form part of the insurance contract and apply to the following supplementary insurance policies: Chapter II Chapter II Chapter II VGZ Tand Goed Chapter III VGZ Tand Beter Chapter III VGZ Tand Best Chapter III If you have MiX Aanvullende Verzekering cover pursuant to the group contract concluded between your employer and VGZ, then you are entitled to the reimbursement of the costs of movement-related care, prevention, mindfulness following symptoms of burn-out and dietary advice under the MiX Aanvullende Verzekering insurance policies. You will in that case be entitled to reimbursement of the costs under, Beter of Best. Chapters I General Section and IV Glossary apply to all supplementary insurance policies Accompanying documents These policy conditions refer to the documents that form part of the present policy conditions insofar as applicable and are as follows: - Appendix 1 to the Healthcare Insurance Decree; - Healthcare Insurance Regulations; - Terrorism Cover Clauses Sheet; - overview of Contracted and Preferred Care Providers; - Protocol governing referral to a lactation expert of the Dutch Association of Lactation Experts (NVL); - Prevention of Diabetic Foot Ulcer Care Module. You will find these documents on our website Fraud Actual inspection and fraud investigation are carried out in accordance with the provisions laid down for healthcare insurance under or pursuant to the Healthcare Insurance Act. The commitment of fraud, either full or partial, will result in no payments being made and the recovery of any payments already made. If you commit fraud, your entitlement to care and the reimbursement of associated costs will lapse, and we will reclaim reimbursements paid to you. You will also be obliged to pay any costs incurred by us that arise from the fraud investigation. Upon detection of fraud, we will enter your personal data and the personal data of the accessory or co-perpetrator in our Incidents Register. This Incidents Register is registered with the Dutch Data Protection Authority (CBP) and is administered by our Security Affairs Department. Your personal data and the personal data of the accessory or co-perpetrator can also be registered: - at the Centre for Combating Insurance Fraud of the Dutch Association of Insurers; - in the external reference register of the Stichting CIS (Netherlands Central Information System Foundation). In addition, we may report the fraud to the police and investigative authorities. Fraud in relation to an insurance policy from us may result in the termination of your supplementary insurance policy/policies and you will not be permitted to take out supplementary insurance policies with any company that is a member of the Coöperatie VGZ U.A. (the VGZ U.A. Cooperative) for a period of eight years Protection of your personal data Your privacy is a serious matter to us. We need to collect and process your personal data in order to effect and perform your healthcare and other insurance policies, including supplementary policies. We will enter your personal data in our insured persons administration. Processing personal data We process your personal data for the following purposes: - to enter into and perform your insurance policy or financial service; - to conduct surveys amongst insured persons to ascertain whether the care was indeed provided; - to conduct surveys amongst insured persons to establish the quality of the care provided; - for statistical analysis; 8 General section

9 - to comply with statutory obligations; - within the framework of safety and integrity of the financial sector (to prevent and combat fraud); - if you participate in a group contract: to exchange information with the contracting party of the group agreement for the purpose of assessing your right to premium discount; - advertising for this insurance policy and advertising for the insurer s own and similar services and products and the associated marketing activities (up to one year following the termination of the agreement). The processing of your personal data is subject to privacy legislation, including the Personal Data Protection Act, the ZN (Netherlands Health Insurers) Code of Conduct for the Processing of Personal Data by Health Insurers, the Citizen Service Number (General Provisions) Act, the Use of BSN in the Healthcare Sector Act, and the Privacy Statement of the Coöperatie VGZ U.A. This code of conduct can be consulted on our website. We are obliged to keep your your Citizen Service Number (BSN) in our records and to use it when communicating with care providers (as part of data exchange). The BSN is also used as part of the claims process. Both uses of your BSN have a legal basis. We may need to consult your personal details at the Stichting CIS (Netherlands Central Information System Foundation) in Zeist in the interests of the safety and integrity of the financial sector. Would you like more information, view your personal data, correct it or lodge an objection? Please contact our privacy manager via the address you will find under the heading Privacy. Use of personal data by care providers If we receive your invoices directly from your care providers and pay the amounts owed directly to them, your supplementary insurance policy will be effected more rapidly and simply. To that end, it may be necessary for a care provider to know how you are insured. For this reason, care providers can inspect your address and policy details as well as your Citizen Service Number in a secure manner. They may only do so if they are actually treating you. If there is an urgent reason to prevent care providers from inspecting your address details, please let us know and we will ensure that these details remain inaccessible Communications Communications sent to your last address known to us are deemed to have reached you. If you prefer to contact us by , we will also contact you by in the future. Wherever reference is made in these policy conditions to in writing, this will extend to communication by . In such a situation the term address will be taken to mean address Membership of the Cooperative By taking out this supplementary insurance, you will also become a member of the Coöperatie VGZ U.A. (VGZ U.A. Cooperative) as a policy holder, unless you indicate in writing that you do not wish to become a member. The Cooperative represents the interests of its members in the area of healthcare and other types of insurance. Membership can be terminated at any time with due observance of a notice period of one month. Membership will in any case end at the moment at which the insurance contract ends Reflection period When entering into a supplementary insurance contract, as a policy holder you will be granted a period for reflection of 14 days. You will be authorised to cancel the supplementary insurance within 14 days of having concluded the contract or, if this occurs later, within 14 days of having received the policy conditions. The insurance contract will then be deemed not to have been concluded Dutch law The supplementary insurance policy is governed by Dutch law. Supplementary insurance conditions VGZ Goed, Beter Best

10 Article 3. Premium 3.1. Premium owed The policyholder is required to pay a premium. No premium is owed for an insured person under age 18 until the first day of the month following his or her 18th birthday. From age 18, the premium is linked to the age of the insured person. You can find an overview of the premiums per age on our website. Once a new age category has been reached, we will adjust the premium amount as from the first day of the calendar month following the month in which this category has been attained. With respect to death, premium is owed up to and including the date of death. In the event of a change in the supplementary insurance we will recalculate the premium owed from the inception date of the change. Example: A person who turns 18 on 1 July will owe premium from 1 August Premium discount by virtue of a group contract The premiums and conditions as agreed in the group contract apply from the date that you become a participant in the group contract From the date that you are no longer able to participate in the group contract, the premium discount and terms and conditions as agreed in the group contract will lapse. The supplementary insurance policy will be continued on an individual basis from that date You can only participate in one group contract at a time Payment of premium, statutory contributions and costs You are obliged to pay the premium and national or foreign statutory contributions owed for all insured persons on a monthly basis in advance unless agreed otherwise. If you pay the premium on an annual basis in advance, you will receive a discount on the premium owed. The amount of the discount is stated on the policy schedule You are obliged to pay the premium and personal contributions and to pay back any erroneous reimbursements using the payment method agreed with us when you took out the policy. Payment methods that are free of charge a. You can authorise us to deduct the amounts owed by direct debit. b. You can also download a digital invoice via in which case you are responsible for ensuring timely payment. If you wish, you can pay us directly using ideal. c. Your employer deducts the premium from your salary and transfers it to us. This method can only be used for the payment of premium contributions. These payment methods are free of charge. Costs associated with paper giro collection forms (for premium payments) If do not opt for one of the free payment methods, you will receive a paper giro collection form. An administrative fee of 1.50 applies to each payment with a giro collection form in order to cover the costs of maintaining, drawing up, sending and processing these forms. You will also be sent a paper giro collection form if we are unable to collect your premium payment through direct debit. In this case you will also be charged the applicable fee of Your direct debit authorisation applies to the payment of premiums, personal contributions and any erroneous reimbursements. A direct debit authorisation will also grant your bank a standing authorisation to deduct a specific amount in accordance with our instructions. The authorisation will be valid for the term of the insurance agreement and may continue to apply after its termination, if necessary. We will inform you at least three days before the amount will be debited, stating the amount and the date on which it will be debited. If you are not in agreement with a direct debit collection, you can request to have the entry reversed. Please note that you must contact your bank about this within eight weeks of the debit date. The amount to be deducted by direct debit for the personal contributions and other amounts owed is capped at 220 per month. We will send a giro collection form for amounts above 220. If we choose to send you a giro collection form, you will not be charged any additional administrative costs Offsetting You are not permitted to offset the amount you owe against an amount that you expect from us. 10 General section

11 3.5. Overdue payment If you fail to pay the premium, statutory contributions and personal contributions and to pay back any erroneous reimbursements on time, we will send you a demand for payment. If you do not pay within the term of at least 14 days specified in the demand for payment, we will be authorised to suspend the insurance cover. In that case, there will be no entitlement to care and reimbursement of the associated costs from the last premium due date prior to the demand for payment. You will remain obliged to pay the premium even in the event of suspension of the insurance cover. Entitlement to care and reimbursement of the associated costs will resume on the date subsequent to the one on which we have received the amount due and any costs owed. We are entitled to terminate the supplementary healthcare insurance policy or policies if you fail to pay on time. In the event of termination of the insurance contract, supplementary insurance policy or policies can again be applied for after payment of the amount and any costs owed. If we accept your application, the supplementary insurance will commence on 1 January of the subsequent calendar year We are authorised to charge collection costs and statutory interest to you If a demand for payment has already been sent to you for overdue payment of premiums, statutory contributions, excess, personal contributions or costs, we will not be required to send you a separate, written demand for payment in the event of a failure to pay a subsequent invoice on time We are authorised to offset overdue premiums and costs against costs of care claimed by you or other amounts to be received from us If we terminate the supplementary insurance policy or policies due to a failure to effect timely payment of premiums owed, we will be authorised to refuse to conclude any insurance contract with you for a period of five years. Article 4. Other obligations You are obliged: - to ask the care provider to make the reason for admission known to our medical adviser; - to cooperate with our medical adviser or employees tasked with obtaining all information needed for verifying the execution of the supplementary insurance; - to inform us about facts that enable or could enable costs to be recovered from liable or potentially liable third parties, and to provide all necessary information to us in that regard. You may not enter into any arrangement whatsoever with a third party without our prior written agreement. You must furthermore refrain from acts that may harm our interests; - to inform us as soon as possible about facts and circumstances pertinent to the proper execution of the supplementary insurance. Among other things, these facts and circumstances include the start and end of a period of detention, separation or divorce, a birth, an adoption or a change in bank or giro account number. We will bear no risk whatsoever for a failure to comply with the foregoing provisions. If you fail to meet your obligations and our interests are harmed as a result, we will be authorised to suspend your entitlement to care and the reimbursement of associated costs. Article 5. Change in premium and policy conditions 5.1. Change in premium and policy conditions We are authorised at all times to change the policy conditions and premium of the supplementary insurance policy or policies. We will inform you, the policyholder, accordingly in writing. Such a change will come into effect on a date set by us Right of termination If we change the policy conditions and/or premium of the supplementary insurance policy or policies to your detriment, you will be authorised as a policyholder to terminate the insurance contract from the date on which the change enters into force. You will be able to terminate the contract within a period of one month after the change has been reported to you. This right of termination will not apply if a change in the policy conditions is a direct result of an amendment to statutory measures, regulations or provisions, or if your premium changes due to your having reached a new age category (see Article 3.1). Supplementary insurance conditions VGZ Goed, Beter Best

12 Article 6. Commencement, duration and termination of the supplementary insurance 6.1. Commencement and duration The insurance contract comes into effect on the date on which our healthcare insurance commences or on 1 January of a calendar year. If you apply to us for healthcare insurance, you give us permission to cancel your old policy with a Dutch healthcare insurer. This permission also applies to supplementary healthcare insurance policies. Please notify us on the application form if you do not wish us to cancel any of the supplementary insurance policies. The supplementary insurance contract is concluded for the calendar year in which the supplementary insurance is effected. After the end of this term, the insurance is tacitly renewed each year for a period of one calendar year Acceptance for supplementary policies Acceptance for supplementary insurance policy or policies You may take out one or more supplementary insurance policies to augment your VGZ health insurance. This is not subject to a medical selection Family insurance cover Children under age 18 will be covered by the supplementary insurance of a parent or other caregiver specified on the policy schedule that is the most comprehensive. If one of the insured parents and/or caregivers specified on the policy schedule has taken out VGZ Gezin Pakket cover, children under age 18 will likewise qualify for VGZ Gezin Pakket cover. If both parents and/or caregivers specified on the policy schedule have taken out VGZ Jong Pakket, VGZ Fit & Vrij Pakket or VGZ Vitaal Pakket cover, children under 18 will qualify for cover Dental insurance For Tand Beter Pakket and Tand Best Pakket dental insurance cover, you are required to complete a dentist s statement for persons aged 8 or older Changing supplementary insurance You may change your supplementary insurance subject to the provisions set out in and As a policyholder, you must report the change to us by 31 December at the latest. The change will come into effect on 1 January of the subsequent calendar year. For care subject to reimbursement terms of longer than one calendar year, these terms will continue in the event of a change of supplementary insurance within VGZ. This means that reimbursements previously paid out by us pursuant to your previous supplementary insurance cover will be carried over to the new supplementary insurance policy. These previous reimbursements will count towards calculating the reimbursement amount to which you are entitled Termination by operation of law The supplementary insurance 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 supplementary insurance referred to in these policy conditions. We will inform you of this no later than three months before this date. 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 that could lead to the end of the supplementary insurance policy or policies. If we establish that the supplementary insurance has ended or will end, we will send you a statement that the supplementary insurance has ended as soon as possible Times at which you may cancel your insurance Annually As a policyholder, you may cancel the supplementary insurance in writing as from 1 January of each year, provided that we have received your cancellation no later than on 31 December of the previous year. You may cancel your supplementary insurance from 1 January of each year, provided that we have received your cancellation no later than 31 December. 12 General section

13 In the interim period As a policyholder, you may cancel the supplementary insurance in the interim period in writing: - in the event of a change in the premium and/or policy conditions as stated in Article 5.2; - at the same time as cancelling our healthcare insurance Cancellation service You can also make use of the Dutch health insurers cancellation service to cancel the supplementary insurance policy or policies as referred to in and This means that you give the new insurer offering the new supplementary insurance policy or policies permission to cancel the old supplementary insurance policy or policies Grounds on which we may cancel, terminate or suspend the supplementary insurance We will be authorised to cancel, terminate or suspend the supplementary insurance policy or policies in writing: - in the case of overdue payments as stated in Article 3.5; - in the case of fraud (see Article 2.4); - if you have deliberately withheld information or documents from us, or provided incomplete or inaccurate information or documents to us, as a result of which we are or could be adversely affected; - if you have acted with the deliberate intention of misleading us or if we would not have concluded the supplementary insurance contract had we been aware of the true state of affairs. In these cases, we will be authorised to cancel the supplementary insurance with immediate effect within two months following discovery. We will in those cases not owe any payment or may reduce any payment due. In addition, we may offset claims that have arisen against other payments. Article 7. Complaints and disputes 7.1. Our complaints procedure. Submitting complaints to the Complaints Management Department We make every effort to ensure that all matters pertaining to your supplementary insurance policy or policies are properly arranged. Nevertheless, it is possible that you are not entirely satisfied about all aspects. We are open to your complaints and suggestions. You can submit a complaint online via our website. You can also send a letter to the Complaints Management Department at the following address: Afdeling Klachtenmanagement Postbus 1256, 5602 BG Eindhoven. The Complaints Management Department acts on behalf of management. Tips when submitting a complaint: Please describe as accurately as possible what has happened, why you are not satisfied and what, in your view, would be the best solution. Send copies of all relevant documents together with your complaint. Do not send original documents with your complaint, as you may need these yourself at some point in the future. If you are unwilling or unable to submit your complaint yourself, someone else may do so on your behalf. To protect your privacy, however, we need your written permission before we can address your complaint You will receive a response to your complaint from us within 30 days. If you are unsatisfied with the decision or have not received a response within 30 days, you can submit your complaint or dispute to the Health Insurances Complaints and Disputes Foundation (Stichting Klachten en Geschillen Zorgverzekeringen, SKGZ), Postbus 291, 3700 AG Zeist, You can also submit a dispute to a competent court Complaints about our forms If you consider a form to be superfluous or unnecessarily complicated, you can submit a complaint about this online via our website. You can also send a letter to the Complaints Management Department at the following address: Afdeling Klachtenmanagement Postbus 1256, 5602 BG Eindhoven You will receive a response to your complaint about our forms within 30 days. If you are unsatisfied with the reply or have not received a response within 30 days, you can submit your complaint to the Dutch Healthcare Authority (Nederlandse Zorgautoriteit) for the attention of the Informatielijn/het Meldpunt, Postbus 3017, 3502 GA Utrecht, informatielijn@nza.nl. For instructions on how to submit a complaint about forms, consult the website of the Dutch Healthcare Authority at Supplementary insurance conditions VGZ Goed, Beter Best

14 Article 8. Care Advice and Mediation You are entitled to mediation for care if an unacceptably long waiting time applies to treatment from a care provider that is permitted to provide the treatment in question in accordance with your supplementary insurance or insurances. You can contact our Zorgadvies en bemiddeling (Care Advice and Mediation) Department to apply for this mediation service. You can also contact this department for general questions about care, such as finding a care provider with specific expertise or assistance in finding your way within the care sector. We will help you assess the options available. 14 General section /, Beter, Best

15 II., VGZ Aanvullend Beter, Article 9. Alternative care Alternative care comprises: 1. treatments and consultations that fall within the following categories a. acupuncture and other Eastern therapies; b. anthroposophic alternative treatments; c. homeopathy; d. naturopathy; e. for insured persons aged 18 and older: psychosocial care. One of our designated care providers. You will find a comprehensive list of our designated care providers on our website. If you are not using the services of one of our designated care providers, the cost of treatment will not be reimbursed. 2. Homoeopathic or anthroposophic medicines that are registered in accordance with the Medicines Act and homoeopathic or anthroposophic medicines that are listed as HA or HM in the Taxe Homeopathie of Z Index. The medicines must be prescribed by a doctor listed in the BIG register, a general practitioner, a medical specialist, a dental surgeon or an obstetrician and supplied by a pharmacist or dispensing general practitioner. If you wish to know whether you will be reimbursed for a specific medicine, please request the relevant article number in the Z Index from your care provider and contact us. You can find our telephone number on our website. We will then inform you, according to this information, whether or not you will be reimbursed for this medicine. Your pharmacy or dispensing practitioner can also see whether or not the medicine in question has been listed as HA or HM in the Taxe Homeopathie. The total budget for alternative care A maximum of 300 per calendar year The reimbursement amount for treatments and consultations is capped at 45 a day A maximum of 500 per calendar year The reimbursement amount for treatments and consultations is capped at 45 a day A maximum of 800 per calendar year The reimbursement amount for treatments and consultations is capped at 45 a day Please note 1. Alternative care does not include consultations and treatments, in a group context or otherwise, for: - prevention, well-being or personal development; - social services and coaching; - problems related to employment, child-rearing and/or school; - relationship therapy; - beauty; - dietary and exercise-related advice in relation to weight problems (see Article 18); - cell therapy and chelation therapy. 2. 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)). Supplementary insurance conditions VGZ Goed, Beter Best

16 Article 10. 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). Skin therapists must be listed in the Paramedics Quality Register (Kwaliteitsregister paramedici). 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 comprehensive 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 can find a list of designated care providers on our website. If you are not using the services of one of our designated care providers, the cost of treatment will not be reimbursed. Parties authorised to provide care Care may 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. The total budget for movement-related care A maximum of 200 per calendar year The reimbursement amount for alternative movement-related treatments therapies is capped at 45 a day A maximum of 400 per calendar year The reimbursement amount for alternative movement-related treatments therapies is capped at 45 a day A maximum of 600 per calendar year The reimbursement amount for alternative movement-related treatments therapies is capped at 45 a day If the care under points 1-4 is not provided by one of our contracted care providers, 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 1.4 of these policy conditions. Please note If you are 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. 16, Beter, Best

17 If you are aged 18 or older: 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 permission are required for this care. These chronic disorders are established by the Minister of Health, Welfare and Sport and specified in the List of Disorders for Physical and Remedial Therapy (Appendix 1 of the Healthcare 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 health 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)). Article 11. Contraceptives Contraceptives for insured persons aged 21 or older that can be provided based on the Healthcare Insurance Regulations, such as the contraceptive pill, birth control implant (Implanon rod), intrauterine contraceptive device (coil), ring or diaphragm. A pharmacist or dispensing general practitioner. Prescription (on the instructions of) A general practitioner, obstetrician or medical specialist for the first prescription of a new contraceptive. Reimbursement A maximum of the amount specified in the Healthcare Insurance Regulations and the Medicine Reimbursement System (GVS) The costs of the insertion and removal of a contraceptive device such as an intrauterine contraceptive device will be reimbursed under the health insurance regardless of your age. For persons under age 21: you are entitled to contraceptives such as the contraceptive pill, birth control implant (Implanon rod), intrauterine contraceptive device (coil), ring or diaphragm under your healthcare insurance. Supplementary insurance conditions VGZ Goed, Beter Best