Changes 2021

General change

From 2021, we will no longer offer supplementary and dental insurance. If you already have supplementary insurance, you can continue this package. You can no longer make adjustments to the package.

Changes to the public healthcare insurance

Artificial respiration

You can now also receive a contribution towards the electricity costs you incur. The expense claim form for this can be found on our website.

Basic mental healthcare

We have clarified the right to treatment programmes:

“In principle, you are entitled to one treatment programme per year (365 days). If you have different care needs, your healthcare provider will deal with them in one and the same programme. You are not entitled to two (or more) treatment programmes simultaneously or consecutively within the same year. Your healthcare provider can adjust the treatment programme in the interim, in line with your care needs.

After closing a treatment programme, you will only be entitled to a new treatment programme within the same year (365 days) if your treatment programme has ended and you unexpectedly (unexpectedly for both you and your healthcare provider):

• return with the same symptoms (relapse); or
• are developing other symptoms .”

We have clarified the text about referrals: The text now reads:

“You need a referral from a general practitioner, medical specialist, coordinating practitioner (in case of a referral), an occupational physician or a doctor affiliated to Nederlandse Straatdokters Groep:

• at the start of the diagnosis and treatment;
• after 365 days have expired after the start of care, except in the case of the care product ‘Generalist Basic GGZ Chronic’;
• in the event of a new need for care. This is determined by your referrer.

The requirement for a referral does not apply:

• in the event of unforeseen care that cannot reasonably be postponed.
• in the case of mandatory treatment under the Dutch Mandatory Mental Healthcare Act;
• if the care is a direct continuation of;
• care provided to you by order of a judicial procedure;
• care provided to you by the same healthcare provider after the indication under the Long-Term Care Act has ended;
• care provided to you under the Dutch Youth Act;
• specialist mental healthcare for the same care need;
• in the case of a referral for the same care need between healthcare providers who are authorised to offer basic mental healthcare or specialist mental healthcare under these policy conditions.
  
  The term of validity of the referral is nine months (275 days), counting from the date on which you registered with a designated healthcare provider to provide the care.”

Combined lifestyle intervention

We have clarified the definition of the care programmes. The text now reads:

“A combined lifestyle intervention is offered in the form of a care programme. The care programme consists of individual sessions and sessions offered in groups and distinguishes between a treatment phase and a maintenance phase. The care programme takes a total of 24 consecutive months to complete.”

Dental care

We have reviewed the text on reimbursement for care by a dental hygienist. The text now reads:

“A dental hygienist, whether or not affiliated to a centre for special dentistry, may provide the care insofar as it concerns care that dental hygienists tend to provide.”

Extra care in connection with the coronavirus

People who have had COVID-19 can make use of extra care (physiotherapy and remedial therapy, occupational therapy and dietary advice) to recover from serious long-term symptoms (for example, fatigue, loss of muscle strength or shortness of breath). A pre-condition for this is that you participate in a specific study into this type of care (or that you indicate that you are prepared to do this if the study has not started yet).

This has been reimbursed from July 2020 and will continue into 2021. This type of care is subject to the excess.

Maternity care

The statutory personal contribution has been increased to € 4.60 per hour. A statutory personal contribution of € 18.50 per day and the amount by which the daily rate of the institution exceeds € 131 apply to both the mother and child in the case of maternity care in an institution without a medical indication.

Medical care for specific patient groups

• The following is now also covered by this reimbursement: care provided by other professional groups, such as behavioural scientists and paramedics, medical care provided for specific patient groups. A transitional arrangement applies for care started before 2021.
• The care may also be provided by a healthcare psychologist, clinical psychologist, child and adolescent psychologist NIP (Dutch Association of Psychologists) and remedial educationalist.

Medical specialist care

• You require prior written permission for treatments on the ‘Exhaustive List of Authorisations for Dental Surgery’.
• The following is not covered by medical specialist care: the use of external devices during the treatment of diabetes to monitor and control blood sugar disorders, including the ketone test strips and insulin pumps.

Non-residential nursing and care

A level-3 carer may provide this care as well. A level-C or D carer and an MBO level-2 qualified carer ‘health and personal care and welfare’ are no longer allowed to provide this care.

Other medical (GP) care

The test for cow’s milk allergy is performed in hospitals; this comes under specialist medical care. That is why the test is no longer reimbursed through other medical care (or GP care).

Pharmaceutical care

• Preference policy: when in doubt about the medical necessity of a medicine, the pharmacy and the prescriber discuss this in mutual consultation. If the prescriber and the pharmacy are unable to reach an agreement, the position of the pharmacist prevails.
• If you have a chronic condition and you have been using the medicine for at least 6 months, you will receive a medicine supply to last a minimum of 3 and a maximum of 12 months. The 6-month period does not start until you are properly adjusted to the drug.

Physiotherapy and remedial therapy

• The reimbursement for supervised remedial therapy in the case of COPD, for stage II or higher of the GOLD Classification for spirometry, has been extended. The reimbursement now is as follows:
  
  • in the case of class A of the GOLD Classification for symptoms and risk of exacerbations: no more than the first five treatments during a maximum of twelve months;
  • in the case of class B of the GOLD Classification for symptoms and risk of exacerbations and a moderate burden of disease or sufficient physical capacity: no more than the first twenty-seven treatments for a maximum of 12 months after the start of treatment and a maximum of three treatments per 12 months in the following years;
  • in the case of class B of the GOLD Classification for symptoms and risk of exacerbations and a high burden of disease and limited physical capacity or in the case of class C or class D of the GOLD Classification for symptoms and risk of exacerbations: no more than the first seventy treatments during a maximum of twelve months after the start of treatment and a maximum of fifty-two treatments per 12 months in the following years.
• Supervised remedial therapy in the case of peripheral arterial disease (intermittent claudication: the physiotherapist or remedial therapist must be affiliated to Chronisch ZorgNet (instead of ClaudicatioNet).

Referrals

For some types of care, you first need a referral before you qualify for the care. The list below is an extension of referrers, unless we state that this referrer can no longer refer.

• Preventive foot care by a chiropodist or podiatrist: nursing specialist or physician assistant.
• Specialist medical care: clinical technologist, dental surgeon, optometrist, orthoptist or triage hearing specialist.
• Rehabilitation care: a clinical technologist or occupational physician.
• Geriatric rehabilitation care: you can no longer be referred by a general practitioner or a doctor for mentally disabled people.
• Dialysis without admission: clinical technologist.
• Cancer research in children: clinical technologist
• Thrombosis care: clinical technologist, doctor for mentally disabled people, geriatrician or obstetrician.
• Genetic counselling: clinical technologist
• Audiological care: clinical technologist
• Logopaedics: doctor for the mentally disabled, occupational physician, nursing specialist, physician assistant or a coordinating practitioner in the context of medical care for specific patient
• groups (GZSP). You can no longer be referred by a remedial educationalist.
• Occupational therapy: nursing specialist, physician assistant or a coordinating practitioner in the context of medical care for specific patient groups (GZSP).
• Dietetics: nursing specialist, physician assistant or a directing practitioner in the context of medical care for specific patient groups (GZSP).
• Dental care
• For care in a special dentistry centre: dental surgeon.
• For care by a dental surgeon: another dental surgeon.
• For the measuring, making, fitting and placing by a dental prosthetist of removable (full) prosthetic provisions on dental implants: dental surgeon and an orthodontist.
• Orthodontics in special cases: general practitioner or a dental specialist.
• Primary care stay: medical specialist.
• Ambulance transport: a physician assistant may issue a prescription as well.
• Other medical care (or GP care): nursing specialist or physician assistant
• Medical care for specific patient groups: paediatrician. Transitional arrangement for referrals: an indication issued by the Care Needs Assessment Centre (CIZ) before 1 January 2021 is valid as a referral until 31 March 2021 at the latest. If the care has not started by then, you will need a new referral for the care.
• Transplant care: clinical technologist.
• Mechanical respiration: clinical technologist.
• Physiotherapy and remedial therapy: nursing specialist, physician assistant or a coordinating practitioner in the context of medical care for specific patient groups (GZSP).

Seated patient transport

• This reimbursement has now been extended to include the following: you are dependent on daycare treatment that is provided in a group and that is part of a care programme for chronically progressive degenerative disorders, non-congenital brain damage or in connection with a mental impairment.
• The maximum reimbursement for an overnight stay changes to € 76.50.
• The statutory personal contribution for seated patient transport has been increased to € 108 per calendar year.

Specialist mental healthcare

We have clarified the text about referrals: The text now reads:

“You need a referral from a general practitioner, medical specialist, coordinating practitioner (in case of a referral), an occupational physician or a doctor affiliated to Nederlandse Straatdokters Groep:

• at the start of the diagnosis and treatment;
• in the event of a relapse pertaining to the same care need after 365 days after the care started;

• in the event of a new need for care. This is determined by your referrer.

The requirement for a referral does not apply:

• in the event of unforeseen care that cannot reasonably be postponed (acute GGZ/crisis DTC (diagnosis treatment combination)/urgent care);
• in the case of mandatory treatment under the Dutch Mandatory Mental Healthcare Act;
• if the care is a direct continuation of;
  
  • care provided to you by order of a judicial procedure;
  • care provided to you by the same healthcare provider after the indication under the Long-Term Care Act has ended;
  • care provided to you under the Dutch Youth Act;
  • basic mental healthcare for the same care need;
• in the event of a referral for the same care need between healthcare providers who are authorised to offer basic mental healthcare or specialist mental healthcare under these policy
• conditions.
• for opening one or more DTCs if a first DTC has already been opened (so-called parallel DTCs).
  
  The term of validity of the referral is nine months (275 days), counting from the date on which you registered with a designated healthcare provider to provide the care.”

Transplant care