S1 / (E) 106 form
Declaration Dutch health insurance
With the S1/E106 form, you can prove to healthcare insurers in your country of residence that you have Dutch health insurance. As such, you are entitled to medical care in your country of residence. If you are insured with HollandZorg, you can ask HollandZorg for the 106 form.
Apply for the S1/E106 form from HollandZorg
If you have taken out HollandZorg Public Healthcare Insurance, you can ask for a S1/106 form by calling our Customer Services on +31 (0)570 687 123 or by using our online application form.
What's even more important to know:
- when you enroll in your municipality in Netherlands (Dutch primary registration people (BRP)) then comes the S1/E106 form lapses.
- We fill the form S1/E106 after request fully in. This fully completed forms as soon as possible, usually you must personally and within 6 months in to the health insurance of your home country.
- The S1/E106 form is valid with effect from registration date to the date of deregistration of your health insurance.
Register with a healthcare insurer in your country of residence with a S1/E106 form
Once you have received the S1/E106 form from HollandZorg, you use it to register with a healthcare insurer in your country of residence. Do you have a (legal) partner or children? The healthcare insurer in your country of residence decides which family members will be co-insured.
Which healthcare is available with the S1/E106 form?
With the S1/E106 form, you are entitled to the statutorily insured medical care in your country of residence. You are also entitled to all care covered by the HollandZorg Public Healthcare Insurance. The reimbursements of this healthcare are according to Dutch criteria. Costs you incur in your country of residence will not always be reimbursed in full. This depends on the healthcare and your country of residence. Read the HollandZorg insurance conditions (PDF) for more information.