Your health in 2015 With a handy benefit schedule
This brochure contains details about: Advice and assistance 3 New: 3 In need of care advice? 4 How it works 4 Personal care report 4 ZilverKorting discount 4 Alterations in long-term care (AWBZ) 5 The AWBZ will alter in 2015 5 Personal health care coach 5 Finding the right care online 5 What does contracting mean and why do we do it? 6 What can you find in the benefit schedule and where? 7 Benefit schedule 8 Extra supplementary packages 13 Organise everything online with Mijn Zilveren Kruis 15 Contact details and practical information 16 2
Advice and assistance We know that health care is sometimes complex and that many changes are taking place. This leads to questions. We know a lot of these questions, because we spend a lot of time talking to our clients and listening to them. We answer all questions. Do you have a question? Send it to us via zilverenkruis.nl, and we will start searching for the answer. The answers to 50 FAQs can be found at zilverenkruis.nl. This is Zilveren Kruis Achmea's way of offering you advice and assistance. Take out against unexpected high costs with the New: the Basis Plus Module The basic sometimes covers less than you may think. This is why we offer you the Basis Plus Module as a supplement to the basic. For instance, urgent medical care abroad, medically necessary transport back to a healthcare institution in the Netherlands and dental care after an accident are not reimbursed under the basic. The will insure you, for a low monthly premium, against unexpected high costs. The reimbursements under the Basis Plus Module are included as standard elements of the 1 to 4 star Insurance. What is reimbursed under the? Full reimbursement for: a second opinion via best doctors; putting care-related questions to a top medical specialist of Best Doctors; urgent medical treatment abroad; urgently necessary medical transport back to a healthcare institution in the Netherlands; 100% reimbursement of physiotherapy in cases of cancer, heart and vascular diseases and a stroke. A reimbursement for: rehabilitation programme Herstel & Balans for cancer; dental costs after an accident; assistance at home after hospitalisation; the for medicines. For a complete overview, go to zk.nl/basisplusmodule 3
Need advice about care? Has your doctor given you a diagnosis, but you doubt whether it is correct? Or do you want to know more about treatment options? In that case take advantage of the international network of top-specialists via Best Doctors. You discuss the right treatment for you, together with your doctor, based on the advice of the international top-specialist. This is our way of providing you with advice and assistance. Here's how it works: 1. Contact your doctor Tell your doctor that you would like a second opinion on the assessment, diagnosis or treatment plan. You do not need a referral. You do need a supplementary with Zilveren Kruis. 2. Contact a personal health care coach Complete the online contact form. We will soon contact you. Alternatively, you can call on (071) 751 00 98. 3. A personal health care coach will give you a telephone-intake He or she determines whether your question is suitable for Best Doctors. If it is, then the personal health care coach will pass your details on to Best Doctors. 4. Best Doctors will contact you by telephone You discuss, in Dutch, what it is you want and the options that exist. 5. Best Doctors will request your medical file from the doctor in charge of your treatment Obviously, they only do this with your permission. 6. You receive a personal report After your medical file has been received, you will receive a personal report, in Dutch, within 6 to 8 weeks. This contains the advice of a specialist and/or replies to your medical questions. You discuss this with your own doctor. Personal Health Care Report: working together to find the hospital that suits you best We enjoy helping you make the right health care choices. Choices suited to your situation. For example, using the personal health care report. This is another way in which we offer you advice and assistance. What is a personal health care report? This is a report in which we compare hospitals based on what you feel is important. For instance, travelling distance, waiting lists and the number of treatments given by the hospital. This information helps you make a better choice. How do you apply for this personal report? This is really simple. Just call the personal health care coach and ask your care-related question. A telephone-intake takes place immediately. The personal health care coach draws up a report on this. A medical advisor assesses this health care report. You will receive the health care report by e-mail within 5 working days. After this your personal health care coach will contact you by telephone in order to discuss the health care report. More information? See zk.nl/zorgcoach. You can also call a personal health care coach on working days on telephone number (071) 751 00 98. ZilverKorting (discount) Do you have supplementary? In that case, you are also entitled to attractive discounts, which can be as high as 25%, on all sorts of care-related products and services. From refractive eye surgery to home care, from a pair of spectacles to discounts on cosmetic treatments. For instance: Eye Wish Groeneveld: Eye Wish Groeneveld will give you a 60.00 discount on a complete, simple pair of spectacles. Or a 15% discount on contact lenses and accessories. Specsavers: At Specsavers you choose from 2 pairs of spectacles with no additional payments. Or receive a 20% discount on a complete pair of sunglasses or spectacles, a month's supply of contact lenses and much more. Assistance at home: for 3 months you receive a 7.5% discount on housekeeping assistance via info@ homeworks.nl Cosmetic treatment: 10% to 20% discount on various forms of treatment at Bergman Clinics. 4
Alterations in long-term care (AWBZ) Health care in the Netherlands is under pressure. We are living longer and there are more old people, which means people need more care. Long-term care is wellorganised in the Netherlands. We want it to stay that way. Older people want to continue to live in their own homes for longer, and people with a disability want to live as independently as possible. Long-term care must remain good, accessible and affordable. This is why central government is changing the statutory arrangements for long-term care as of 1 January. The AWBZ will alter in 2015 Long-term care will change radically as of 1 January 2015. Longterm care includes, for instance, district nursing, guidance and support or care in an institution. This is currently organised via the Exceptional Medical Expenses Act (Algemene Wet Bijzondere Ziektekosten (AWBZ)). Central government pays for this care. As of 1 January 2015, municipalities and health insurers will take over some of the tasks involved in long-term care and support. The present AWBZ will be dismantled and split up into different parts: 1. Municipalities will be responsible for the Social Support Act (Wet maatschappelijke ondersteuning (Wmo)) and the Young Persons Act This includes, for instance, support with household tasks or daytime care for people who live independently. But it also includes guidance for people with a disability or who have mental problems. And children and families will soon be able to get customised assistance close to their homes when they need it. Every municipality will organise this for its own residents. 2. Health Insurance Act (Zorgverzekeringswet (Zvw)) The basic will be expanded to include, among other things, district nursing (nursing and caring) in people's own environment. Obvious examples include taking care of wounds or administering an injection. The care of children with serious medical problems and/or disabilities, treatment of people with a sensory impairment and intensive child care will also be covered by the basic. This information can be found in the policy terms. 3. The Regional Care Offices (zorgkantoren) will regulate the Long-term Care Act (Wet langdurige zorg (Wlz)) The Regional Care Offices will continue to be responsible for people who live in an institution and who need care 24 hours a day. Intensive care and supervision are available all day long in an institution. The right care and support via a personal health care coach We gladly provide you with advice and assistance about this change. One of the ways we do this is with our personal health care coaches. They help with questions about, for instance, your entitlement to a reimbursement. They will also gladly tell you what special services we have for informal care givers, and point you in the right direction if you have questions about the complicated laws and legislation on long-term care. Call your personal health care coach for: Advice and/or questions about long-term care; Requesting a second opinion; Mediation help with waiting lists; Advice and information about care providers; A reply to a specific question about your disorder. Finding the right care online We also gladly will provide you with online help in finding your way to the right care. Our online tool on zk.nl/zorgcoach helps you find out, in 3 easy steps, where to go with your question. For more information and changes in the system, see dezorgverandertmee.nl. 5
What does contracting mean and why do we do it? The demand for care continues to grow. The affordability of care is under pressure due to rising costs. This is why we are working together with care providers and suppliers (hospitals, pharmacists, physiotherapists, maternity centres, etc.) on quality, patient safety and price. This is our way of improving care, together, and being able to guarantee the affordability of health care, both now and in the future. The quality of care providers and suppliers is important In order to improve health care together, the care provided by care providers will have to meet requirements. This will ensure that you receive the right care at the right moment. Zilveren Kruis expects care providers and suppliers with whom they enter into agreements to meet quality requirements. We also make agreements with hospitals about specific treatments, because not all hospitals provide the same quality. With whom has Zilveren Kruis entered into agreements? We are currently involved in negotiations with care providers. On our website you can see the care providers with whom we have currently made agreements. The current list can be found via our care-seeker on zk.nl/zorgzoeker. Has a care provider been contracted by us? In that case, these agreements apply for the whole of 2015. Unless we have agreed differently with your care provider. I want to visit a care provider or supplier with whom Zilveren Kruis has not made any agreement. And that s possible. In that case, however, a lower reimbursement will apply. At the most it will be 80% of the average agreed tariff. This lower reimbursement also applies for treatment in a noncontracted hospital. A lower reimbursement, 75% of the average agreed tariff, applies to mental health care (GGZ), paramedical care and transport. Handy information on your health Basic for everyone aged 18 years or older always has a mandatory excess. For the year 2015 the government has decided that the mandatory excess will be 375.00. This means that you have to pay the first 375.00 of your medical expenses in 2015 yourself. If you require little care, then you may want to opt for a voluntary chosen excess. This can save you up to 250.00 per year on your premium. Calculation example: You underwent treatment in a hospital (e.g., a visit to an ophthalmologist) costing 400.00. The ophthalmologist sends us the invoice. The mandatory excess for 2015 is 375.00. You pay these costs yourself. We reimburse the remaining sum 25.00 ( 400.00 375.00). You will not pay any further mandatory excess for any subsequent health costs in 2015. You are not required to pay an excess for: care from a general practitioner; care that is reimbursed from your supplementary and dental ; care provided for children up to the age of 18 years; items on loan, excluding maintenance costs and costs of use; maternity care and obstetric or midwifery care (excluding medicines, blood tests, chorionic villus sampling and patient transport); integrated care; after-care for a donor. The donor's travel expenses, if the donor receives a reimbursement of these from his/her own basic ; District nursing; How do the and the mandatory excess work precisely? If you need medicines for which a personal applies, then you pay that personal yourself. The sum that remains is set off against the mandatory excess and any voluntarily chosen excess that you may have chosen. Do you have supplementary? In that case we reimburse the personal up to a maximum of 750.00. 6
What can you find in the benefit schedule and where? On the next few pages you can see what we reimburse from the basic and the supplementary (dental). The layout of this schedule differs from the one you were used to. Choose a topic, then find the care you are looking for. For each topic we indicate what we reimburse from the basic and the supplementary (dental). Are you unable to find the care you are looking for? In that case, see zk.nl/vergoedingen. Psychological care E and ears Bones, muscles and joints Physiotherapy Oral health care Pregnancy/ baby/child Speech and reading Skin Alternative Medical devices Transport Other medical care Extra Abroad Medicines Hospital, treatment and nursing No rights can be derived from the benefit schedule This schedule summarises the reimbursements. No rights can be derived from this benefit schedule. The policy terms and the applicable regulations determine the reimbursement to which you are entitled. These can be downloaded from zk.nl or requested from our Customer Service Department (071) 751 00 51. The stated reimbursement tariffs only apply for the care providers contracted by us. The benefit schedule only lists the reimbursement tariffs that apply to care provided by our contracted care providers. Unless otherwise indicated, the specified reimbursements apply per person per calendar year. You will find our contracted care providers on zk.nl/zorgzoeker. You can also find a list of reimbursements for care from non-contracted care providers on our website or you can request it from our Customer Service Department (071) 751 00 51. 7
Benefit schedule, alphabetically Alternative Alternative treatments, therapies and medicines (anthroposophic and homeopathic) ) 40.00 per day up to 450.00 incl. medicines 40.00 per day up to 650.00 incl. medicines Orthopaedic medicine 150.00 300.00 500.00 Bones, muscles and joints Exercise programmes (obesity, former heart failure, diabetes type 2, COPD or rheumatoid arthritis) Remedial therapy in a hot water pool for rheumatoid arthritis ) 175.00 for the, only with a contracted physiotherapist or exercise therapist 350.00 for the, only with contracted physiotherapist or exercise therapist 40.00 per day up to 850.00 incl. medicines 150.00 200.00 350.00 for the, only with a contracted physiotherapist or exercise therapist Occupational therapy, 10 hours up to 18 years: 3 hours up to 18 years: 4 hours Pedicure care (rheumatoid arthritis or diabetes) Podiatry/podology/podopostural therapy and/or arch supports Foot care for insured persons with diabetes Abroad Best Doctors InterConsultation AskTheExpert Non-urgent care abroad Non-urgent care in Europe via Royal Doctors Non-urgent care in hospital Accommodation expenses and transport costs of family members following care mediation if care is provided in Belgium or Germany accommodation expenses and transport costs of family members via Royal Doctors (abroad) Urgent pharmaceutical care abroad (which is not reimbursed from the basic ) Urgent care abroad Vaccinations, consultations and medicines in case of a journey abroad Transport of insured person and transport of mortal remains to the Netherlands (repatriation) Transport costs in case of treatment abroad, via Royal Doctors Transport costs following care mediation if care is provided in Belgium or Germany Physiotherapy and remedial therapy Pelvic physiotherapy to treat urinary incontinence* Physiotherapy and remedial therapy up to 18 years: disorder included in the list established by the Dutch Minister of Health, Welfare and Sport (VWS) (Annex 1 of article 2.6 of the Health Insurance Decree (Besluit Zorgverzekering)), see foot care, limited ), up to the Dutch tariff, up to the Dutch tariff ), treatments 1 to 9 incl. all treatments 25.00 per treatment, up to 100.00 100.00, including 1 pair of arch supports care according to the reimbursement in the Netherlands with due regard to the conditions and exceptions care according to the reimbursement in the Netherlands with due regard to the conditions and exceptions care according to the reimbursement in the Netherlands with due regard to the conditions and exceptions accommodation expenses: 35.00 per day for all family members combined, own transport, public transport or taxi 0.31 per km up to a max. of 700 km per admission care according to the reimbursement in the Netherlands with due regard to the conditions and exceptions accommodation expenses: 35.00 per day for all family members combined, own transport, public transport or taxi 0.31 per km up to a max. of 700 km per admission 50.00 50.00 50.00 50.00 50.00 supplemented up to cost price supplemented up to cost price supplemented up to cost price supplemented up to cost price 25.00 per treatment, up to 150.00 135.00, including 1 pair of arch supports care according to the reimbursement in the Netherlands with due regard to the conditions and exceptions 25% extra above the Dutch tariff accommodation expenses: 35.00 per day for all family members combined, own transport, public transport or taxi 0.31 per km up to a max. of 700 km per admission accommodation expenses: 125.00 per day for all family members combined, own transport, public transport or taxi 0.31 per km up to a max. of 600.00 per hospitalisation or day treatment at a hospital supplemented up to cost price 600.00 for a stay in hospital or per day treatment at a hospital, own transport, public transport and taxi 0.31 per km taxi or public transport taxi or public transport taxi or public transport (2nd class) and own (2nd class) and own (2nd class) and own transport 0.31 per km transport 0.31 per km transport 0.31 per km 9 treatments 12 treatments 27 treatments 40 treatments 8
Physiotherapy and remedial therapy Physiotherapy and remedial therapy up to 18 years: disorder not included in the list established by the Dutch Minister of Health, Welfare and Sport (VWS) (Annex 1 of article 2.6 of the Health Insurance Decree (Besluit Zorgverzekering)) Physiotherapy and remedial therapy, 18 years or older: 1 disorder* included in the list established by the Dutch Minister of Health, Welfare and Sport (VWS) (Annex 1 of article 2.6 of the Health Insurance Decree (Besluit Zorgverzekering)) Physiotherapy and remedial therapy, 18 years or older: 1 disorder* not included in the list established by the Dutch Minister of Health, Welfare and Sport (VWS) (Annex 1 of article 2.6 of the Health Insurance Decree (Besluit Zorgverzekering)) Physiotherapeutic (after-) care path (for oncology, heart and vascular diseases and after a stroke) ) Treatments 1 to 18 incl., per diagnosis as of the 21st treatment (treatments 1 to 20 incl. you pay yourself) all treatments after the 19th treatment all treatments after the 19th treatment 9 treatments (10 to 20 incl. you pay yourself) all treatments after the 19th treatment 12 treatments (13 to 20 incl. you pay yourself) all treatments after the 19th treatment all treatments after the 19th treatment 20 treatments 20 treatments 9 treatments 12 treatments 27 treatments 40 treatments 100% only with a 100% only with a 100% only with a 100% only with a 100% only with a contracted PlusPraktijk contracted PlusPraktijk contracted PlusPraktijk contracted PlusPraktijk contracted PlusPraktijk * This reimbursement applies only for 1 disorder. Do you have several disorders for which you visit a physiotherapist/remedial therapist? Then please contact us. Skin ) Skin care, acne treatment, camouflage therapy and/or epilation treatment/ipl Medical devices Medical devices from the basic Artificial nipple or mamilla prothesis (customised prosthesis) personal alert system on medical grounds ), see the Achmea Medical Devices Regulations, for a personal alert system 300.00 600.00, subscription costs for a personal alert system, only by a contracted supplier, subscription costs of a personal alert system, only by a contracted supplier Adhesive strips for breast prosthesis Bedwetting alarm 100.00 for the 100.00 for the, subscription costs for a personal alert system, only by a contracted supplier 100.00 for the Wig 414.50 per wig 75.50 190.50 Support pessary for prolapsed bladder or uterus Toupim or headwear 1x up to 150.00 1x up to 150.00 Trans-therapy for treatment of incontinence (rental costs) Medicines and dietary preparations Contraceptives up to 21 years Contraceptives 21 years or older medicines from the basic Registered medicines and pharmacy preparations that are not reimbursed under the basic Melatonin (for sleep-related problems) Oral health care and dentistry Replacement of front teeth with implants (delayed) from 18 to 24 years Implants for full set of removable dentures Dental surgery Crowns, bridges, inlays and implants up to 18 years ), except for the, only for endometriosis or menorrhagia, except for the statutory personal, see the Achmea Pharmaceutic Care Regulations (Achmea Reglement Farmaceutische Zorg) ), in the case of a serious development or growth disorder that affects the teethjaw-mouth, up to 750.00 (excl. ADHD medicines), and the statutory personal, only by a contracted dispensing general practitioner or pharmacist, up to 750.00 (excl. ADHD medicines), only by a contracted supplier, and the statutory personal, only by a contracted dispensing general practitioner or pharmacist, up to 750.00 (excl. ADHD medicines), only by a contracted supplier, and the statutory personal, only by a contracted dispensing general practitioner or pharmacist, up to 750.00 (excl. ADHD medicines), only by a contracted supplier 750.00 750.00 750.00 750.00 750.00 10,000.00 for the 10,000.00 for the 10,000.00 for the, only from the internet pharmacy, efarma 10,000.00 for the, and the statutory personal, only by a contracted dispensing general practitioner or pharmacist, up to 750.00 (incl. ADHD medicines), only from the internet pharmacy, efarma 10,000.00 for the 225.00 450.00 900.00 9
Oral health care and dentistry ) False teeth (dentures), except for the 25% Repair or adjustment of false teeth (dentures) Orthodontics (brace) incl. second opinion, up to 18 years Dental costs as a consequence of an accident, 18 years or older Dental care or orthodontics in special cases Dental care for insured persons with a handicap Dental care up to the age of 18 Full set of removable implant-retained dentures (overdentures) E and ears Audiology centre Spectacles and/or contact lenses Upper eyelid correction (medical) Ear position correction up to the age of 18 years, except for the of 125.00 per upper or lower set of dentures ) Hearing aid, except for the 25% Refractive eye surgery / lens implants (additional costs for non-standard lens) Sensory impairment care Other medical care Dietary advice by a dietician (with a medical indication) Herstel & Balans (Recovery & Balance) Convalescent home or care hotel Hospice General practitioner care Assistance at home in cases of loss of ADL (activities of daily living) following hospitalisation (18 years or older) Integrated care in cases of diabetes mellitus type 2 (18 years or older), COPD, asthma or vascular risk management (VRM) Child care at home (children up to 12 years) during and after hospitalisation of parent(s) X-rays and laboratory tests Lifestyle training courses for heart patients, whiplash patients and people with stress and burnout-related complaints Informal care replacement for handicapped and chronically ill persons ) 10,000.00 per accident 10,000.00 per accident 10 10,000.00 per accident 100.00 per 3 calendar years, only by contracted care providers, only by contracted care providers 2,000.00 for the 10,000.00 per accident 150.00 per 3 calendar years, only by contracted care providers, only by contracted care providers 500.00 for the 2,500.00 for the 10,000.00 per accident 250.00 per 3 calendar years, only by contracted care providers, only by contracted care providers 750.00 for the, 3 hours 120.00, only by contracted care groups 1,200.00 for the 1,000.00 following hospitalisation (depends on the calculated loss of your ability to perform general daily activities (ADL loss)) 1,200.00 for the 1,000.00 following hospitalisation (depends on the calculated loss of your ability to perform general daily activities (ADL loss)) 1,200.00 for the 1,000.00 following hospitalisation (depends on the calculated loss of your ability to perform general daily activities (ADL loss)) from the 3 rd day of admission up to the 3 rd day after discharge, up to 50 hours per week. And file costs. Only with a contracted institution. 1,200.00 for the 100.00 per day up to 2,800.00 40.00 per day up to 3,600.00 1,000.00 following hospitalisation (depends on the calculated loss of your ability to perform general daily activities (ADL loss)) from the 3 rd day of admission up to the 3 rd day after discharge, up to 50 hours per week. And file costs. Only with a contracted institution. 1,000.00, only with Leefstijl Training & Coaching (LTC) 21 days, only with the Handen-in-Huis foundation Menopause consultation 75% up to 115.00, only with Care for Women at the VVOC Preventative courses Sports doctor Sports medical examination 75% up to 115.00 per course 75% up to 115.00 per course 1.200.00 for the 100.00 per day up to 2,800.00 40.00 per day up to 3,600.00 1,000.00 following hospitalisation (depends on the calculated loss of your ability to perform general daily activities (ADL loss)) from the 3 rd day of admission up to the 3 rd day after discharge, up to 50 hours per week. And file costs. Only with a contracted institution. 1,250.00, only with Leefstijl Training & Coaching (LTC) 21 days, only with the Handen-in-Huis foundation 75% up to 115.00, only with Care for Women at the VVOC 75% up to 115.00 per course 130.00 for injury or 130.00 for injury or 130.00 for injury or 130.00 for injury or follow-up consultation follow-up consultation follow-up consultation follow-up consultation 100.00 per 2 calendar years 100.00 per 2 calendar years 100.00 per 2 calendar years 100.00 per 2 calendar years
Other medical care Stop smoking programme ), 1x Therapeutic holiday camp for children 150.00 150.00 Therapeutic holiday camp for handicapped persons Thrombosis service Holiday hotels/bungalows or sailing holidays for handicapped and chronically ill persons Nutrition education by dietitian or weight management consultant Mental health care General Basic mental health care (GGZ) 18 years or older Non-clinical specialist mental health care (GGZ) 18 years or older Psychiatric hospitalisation or admission to a GGZ institution, 18 years or older Speech and reading Speech therapy Stutter therapy with a speech therapist Stutter therapy (according to the method Del Ferro, Hausdörfer, BOMA and McGuire) Transport Ambulance Transport (seated patients transport) for insured patients who are: undergoing kidney dialysis; undergoing oncological treatment (radiotherapy or chemotherapy); visually impaired and unable to travel without supervision; wheelchair dependent. Patient transport for other medical indications than under the basic and if there are medical reasons why you are unable to make use of public transport Hospital, treatment and nursing Asthma Centre in Davos ), for a non-complex mental disorder, for a complex mental disorder ) ) Own transport 0.31 per km, public transport (2 nd class), (multi-person) taxi, except for the of 97.00. ) 225.00 for the 150.00 150.00 25%, only with Rode Kruis or Zonnebloem 450.00 for the 25%, only with Rode Kruis or Zonnebloem 60.00 900.00 for the own transport 0.31 own transport 0.31 per km, transport by per km, (multi-person) (multi-person) taxi. You transport by taxi. pay 97.00 yourself. Total reimbursement Total reimbursement 2,000.00 1,000.00 Male circumcision (medical) Male circumcision (religious) Cosmetic surgery (without medical indication) Genetic research and advice Guest house, during an outpatient treatment cycle (accommodation expenses) Guest house for your family members (accommodation expenses and transport costs of your family members in case of a hospital stay) MammaPrint diagnostic breast cancer test Mechanical respiration Specialist medical care; Obesity treatment (BMI equal to or higher than 40) Plastic surgery (medical) Rehabilitation Second opinion (for care from the basic ) Sterilisation Home dialysis Transplantation of organs and tissue, limited, only with Agendia laboratory, only with Agendia laboratory 250.00, only with a contracted care provider 250.00, only with a contracted care provider 250.00, only with a contracted care provider 250.00 per 3 calendar years 35.00 per day 35.00 per day 35.00 per day 35.00 per day up to 500.00 for all family members combined, public transport (2 nd class) or own transport or taxi 0.31 per km, only with Agendia laboratory 35.00 per day up to 500.00 for all family members combined, public transport (2 nd class) or own transport or taxi 0.31 per km, only with Agendia laboratory 750.00 for the, only with Santrion, only by contracted care providers 35.00 per day for all family members combined, public transport (2 nd class) or own transport or taxi 0.31 per km, only with Agendia laboratory 1,000.00 for the, only with Santrion, only by contracted care providers 11
Hospital, treatment and nursing Nursing and care in your own surroundings (extramural) Nursing in hospital Independent treatment centre Hospital treatment, examination, operation and stay - hospital nursing of person who donated an organ (donor) ) 3 months, 6 months for a liver transplant Care advice (online) Pregnancy/baby/child Maternity care during adoption (child younger than 12 months) or medical screening related to adoption Childbirth with medical necessity Outpatient, hospital or birth centre childbirth, without medical necessity Childbirth at home, without medical necessity Breast pump (electrical) In-vitro fertilisation (IVF) up to 43 years ), clinical or outpatient 202.00 for use of the delivery room (the outstanding balance is the ), first 3 attempts per attempted pregnancy 10 hours maternity care or 300.00 for a screening per adopted child 75.00 per delivery, only by a contracted supplier 10 hours maternity care or 300.00 for a screening per adopted child 75.00 per delivery, only by a contracted supplier Maternity package Maternity care at home or in a birth centre or a maternity centre Maternity care in hospital (medical) Maternity care in hospital (not medical) Maternity care (parturition assistance) Postponed maternity care (medical), except for the of 4.15 per hour, except for the of 33.00 per day (admitted) + the sum exceeding 235.00 per day if charged by the hospital, except for the personal of 4.15 per hour 15 hours per pregnancy, except for the personal of 4.15 per hour, only by a contracted maternity centre Lactation care 80.00 115.00 Oncological examination of children Prenatal screening Sperm cryopreservation TENS, during delivery (to combat pain) Obstetric or midwifery care Freezing (vitrification) of human oocytes and embryos Fertility treatments Slimmer Zwanger pregnancy self-help programme only by Dutch Foundation for Children and Cancer (Stichting Kinderoncologie Nederland (SKION)) 1 apparatus for the, only by a contracted supplier 1 subscription for the 1 apparatus for the, only by a contracted supplier 1 subscription for the 10 hours maternity care or 300.00 for a screening per adopted child 75.00 per delivery, only by a contracted supplier 15 hours per pregnancy, only by a contracted maternity centre 1 apparatus for the, only by a contracted supplier 1 subscription for the Antenatal classes 50.00 per pregnancy 50.00 per pregnancy 75.00 per pregnancy 12
Extra supplementary packages 1, 2, 3 or 4 star Dental Insurance Description of treatment A. Dentist/oral hygienist, dental surgeon and clinical dental technician consultations (C codes) and second opinion oral hygiene (M codes) filling (V codes) pulling teeth/molars (H codes) Dental Dental Dental 100% 100% 100% 100% B. Other dental treatments 75% 75% 75% 100% A plus B 250.00 500.00 1,000.00 1.250.00 Extra Sport, Extra Fit and Extra Vitaal Description of treatment Extra Sport Extra Fit Extra Vitaal ADL medical devices (general activities of daily living) Counselling 75% up to 100.00, only by counsellor affiliated to the General Professional Association for Counselling (Algemene Beroepsvereniging voor Counselling (ABvC)) Flu vaccinations, up to 60 years Running coaching to prevent or accommodate injuries Health Check (preventive health test) HelloFysio Hearing aid ( ) Dentures (full set of removable dentures) or implantretained dentures (overdentures) ( ) 1 online coaching path, from FysioRunning 3 online treatment paths 1 online coaching path, from FysioRunning 1x, only by a contracted care provider 75% up to 100.00, only from Vegro and Harting-Bank/ Ligtvoet 1x, only by a contracted care provider 300.00 per hearing aid 250.00 Dental Informal care packages relaxation package, only for the informal care giver relaxation package, for the informal care giver and the patient together medical fitness, with a physiotherapist or exercise therapist Optometrist Orthopaedic shoes Pedicure care after a cerebrovascular accident (CVA) Personal training (introductory package) a personal alert system and the subscription costs, with a social indication 125.00 per day up to 6 days 250.00 per day up to 6 days, only with Opkracht 125.00, only with a contracted PlusPraktijk 125.00, only with a contracted PlusPraktijk 1 consult per 3 calendar years 25.00 per treatment, up to 100.00, only from providers with whom we have made agreements, only by a contracted supplier personal alert system and the subscription costs, for temporary use, 4 weeks, only by a contracted supplier Preventive exercise programmes 75% up to 115.00 75% up to 115.00 Preventive courses 75% up to 115.00 per course 75% up to 115.00 per course Grief and bereavement support Second opinion by a sports doctor Sports doctor injury and follow-up consultations Sports or ice pack brace Sports eyewear and/or contact lenses Sports check-up, only with the Sportmedical Institutions Papendal, Zeist and Centrum Topgeneeskunde in Utrecht 50.00, 1x per 2 calendar years 50.00 per period of 3 calendar years 100.00 for 1 sports checkup 50.00, 1x per 2 calendar years 75% up to 1,250.00, only with Interapy 13
Description of treatment Extra Sport Extra Fit Extra Vitaal Sports massage by a sports masseur Sports medical examination Sports medical advice (supplementary diagnostics) MRI-scan, laboratory tests, X-rays and echography Sports equipment (discount arrangement) Arch supports especially for sports shoes up to 18 year 50% up to 50.00, only from a sports masseur affiliated with the Dutch Association for Sports Massage (Nederlands Genootschap voor Sportmassage (NSG)) 100.00 per 2 calendar years 100.00 per 2 calendar years 75% up to 150.00 10% discount at the shops of Runnersworld from VSO netwerk: 65.00 or from a different supplier: 35.00 10% discount at the shops of Runnersworld 18 years or older Fall prevention course Patient transport by public transport, own transport or (multi-person) taxi transport from VSO netwerk: 65.00 from VSO netwerk: 65.00 per 2 years or from a different per 2 years or from a different supplier: 35.00 per supplier: 35.00 per 2 calendar years 2 calendar years Nutrition education 120.00 120.00 120.00 150.00 for the duration of the, only with a contracted PlusPraktijk and home-care institution and a personal for medically necessary patient transport of 97.00, under the basicand the supplementary Ziekenhuis Extra (new policies can no longer be purchased). (Applies only if you already have the Ziekenhuis Extra package) Description of treatment Extra comfort facilities in a hospital in the Netherlands that: we have contracted for this purpose we have not contracted for this purpose (in 1 or 2 person room) Daily allowance Extra comfort facilities in a hospital abroad that: we have contracted for this purpose (in a private room or twin room and a possible fee surcharge) we have not contracted for this purpose (in a private room or twin room, no reimbursement of a possible fee surcharge) * reimbursement in the Netherlands and abroad combined. Convalescent home, not for psychosomatic care Taxi transport from your home address to and from the hospital Reimbursement 150.00 per day 70.00 per day up to 4,900.00* 70.00 per day up to 4,900.00* 100.00 up to 28 days 4 taxi transfers per hospital stay 14
Organise everything online with Mijn Zilveren Kruis We enjoy making things easy for you Using Mijn Zilveren Kruis, you were already able to submit your care invoices online, and to check and alter your personal details. Now you can do even more. You can now access your care costs, and let us know what you would prefer to receive digitally. 24-7 access to Mijn Zilveren Kruis The Zilveren Kruis apps make everything even easier DeclaratieApp (Claim app) Make a photo of your invoice, enter the details, and send the invoice to Zilveren Kruis via your cell phone. It couldn't be easier! Alter your here Altering my Examining your policy The Vakantiedokter (holiday doctor) app Suddenly taken ill during your holiday? Or a strange skinrash after a visit to the swimming pool? Take a photo and app the Vakantiedokter for advice. A Dutch-speaking medical expert will advise you. Zilveren Kruis offers you advice and assistance, even when you are on holiday. Download the apps from Direct access to your claims history 15
Visit our website www.zilverenkruis.nl www.zilverenkruis.nl/zorgzoeker www.zilverenkruis.nl/vergoedingen Call us Customer Service (071) 751 00 51 Claiming your health care costs Zilveren Kruis Achmea Claims Service Department Postbus 70001 3000 KB Rotterdam Write to us Zilveren Kruis Achmea Postbus 444 2300 AK Leiden From postal services to digital services Would you like us to keep you informed about your health digitally in 2015? In that case go to zk.nl/2015digitaal or scan the code! 90485-1501 See www.zilverenkruis.nl for a summary of contracted care providers, the Achmea Medical Devices Regulations (Achmea Reglement Hulpmiddelen), Achmea's Pharmaceutical Care Regulations (Achmea Reglement Farmaceutische Zorg), Professional Associations of alternative care providers who fulfil Achmea's criteria, conditions, brochures, forms and information about the we offer. Zilveren Kruis Achmea Zorgverzekeringen N.V. (Chamber of Commerce 30208637) is the insurer for health policies offered by Zilverzen Kruis Achmea. Achmea Zorgverzekeringen N.V. (Chamber of Commerce 28080300) is the 16