Changes in 2019

 

Each year, the government determines the cover provided under the public healthcare insurance. Sometimes, we also make changes to our own offer. The changes to be made to the basic insurance package in 2019 are outlined on this page. You can also read what changes are made to our supplementary and dental insurances.

 

In 2019, you will pay €4.40 per hour for maternity care at home instead of €4.30. You pay €17.50 per day for yourself and your child for maternity care at an institution. In 2018, this was €17. You also pay a personal contribution if the daily rate of the institution is more than €125. In 2018, this was €122.50. This personal contribution does not apply if you have a medical indication for childbirth at the hospital.

If you need care for more than 3 months, you no longer need approval in advance when it concerns palliative care.

  • Added to the reimbursement of insured persons from the age of 18: supervised remedial therapy for COPD, if it concerns stage II or higher of the GOLD Classification for spirometry. In that case, you are entitled to:
    • Class A of the GOLD Classification for symptoms and a risk of exacerbation: no more than the first 5 treatments during a maximum of 12 months;
    • Class B of the GOLD Classification for symptoms and a risk of exacerbation: a maximum of 27 treatments during a maximum of 12 months after the start of the treatment and a maximum of 3 treatments per 12 months in subsequent years;
    • Class C of the GOLD Classification for symptoms and a risk of exacerbation: a maximum of 70 treatments during a maximum of 12 months after the start of the treatment and a maximum of 52 treatments per 12 months in subsequent years.
  • If you visit a non-contracted care provider, you do not have to include a declaration from your care provider with the bill when it concerns supervised remedial therapy in connection with:
    • peripheral arterial disease (PAD) in Fontaine stage 2 (intermittent claudication);
    • arthrosis in your hip or knee joint;
    • COPD, if it concerns stage II or higher of the GOLD Classification for spirometry.
  • The following care providers can give a referral for supervised remedial therapy for COPD if it concerns stage II or higher of the GOLD Classification for spirometry: GPs, medical specialists, paediatricians, doctors for the mentally disabled, specialist geriatric doctors or company doctors.
  • In 2019, the statutory personal contribution for medicines is subject to a maximum of €250.
  • Preference policy: with effect from 2019, we will apply a preference policy for medicines. This means we will only reimburse the one with the lowest price in a group of mutually replaceable medicines. All preference medicines can be found on the page about the preference policy. This is also where you can find more details and a number of frequently asked questions. You do not pay excess for preference medicines. The delivery costs, the counselling consultation for a preference medicine and inhaler instructions do still fall under the excess.
  • Sometimes, you can be reimbursed for a non-registered medicine. These medicines need to meet a number of conditions. These conditions will be adjusted with effect from 01 January 2019.
    • The Public Health Supervisory Service has to give its approval before a medicine can be sold due to a shortage of medicines. This medicine does have to be available for sale in another EU country or in a third country.
    • In the case of a shortage of medicines, you can ask the supplier for another medicine if that medicine is available for sale in another EU country and if the Board has granted a trade licence for the assessment of medicines.
  • If you suffer from a chronic disorder and you have been using a medicine for at least 6 months, the pharmacy will give you 3 months’ worth of medicine. This does not apply to benzodiazepines, hypnotic drugs and anxiolytic drugs. You will only get no more than one month’s worth of those. The person who issues the prescription determines whether it concerns a chronic disorder.
  • In 2019, you no longer need a Dietary Preparations Declaration if you use dietary preparations. You do still need a prescription, a doctor’s note and a dispensing chemist’s instruction.

A lot of parties jointly monitor the affordability of so-called expensive medicines. That is why certain medicines are not automatically included in the basic insurance package but first, we will look for suitable measures for affordable and effective inclusion. The minister first negotiates the price with the pharmacist. In 2019, therefore, the following cases no longer come under medical specialist care (general):
 

  • With effect from 01 January 2021: palbociclib, where provided in relation to the treatment of hormone receptor positive, HER2-negative, locally advanced breast cancer or of hormone receptor positive or HER2-negative metastatic breast cancer.
  • Daratumumab, insofar as provided within the framework of treatment of cancer, with the exception of:
    • the use of mono-therapy for the treatment of adult patients with relapsed and refractory multiple myeloma, whose previous treatment consisted of a proteasome inhibitor and an immunomodulator and who displayed illness progression during the last treatment;
    • until 01 January 2022: the use in combination with lenalidomide and dexamethasone or in combination with bortezomib and dexamethasone for the treatment of adult patients with multiple myeloma who have received at least one treatment;
    • until 01 January 2022: the use in combination with bortezomib, melphalan and prednisolone for the treatment of adult patients with a newly diagnosed multiple myeloma who do not qualify for autological stem cell transplantation;
  • Nusinersen, for the treatment of 5q spinal muscular atrophy, with the exception of provision up to 01 January 2021;
    • if the insured person is younger than 6 months and the first symptoms of 5q spinal muscular atrophy manifest themselves. The period of illness is less than 26 weeks at the start of the treatment.
    • if the insured person is between 6 and 20 months old and the first symptoms of 5q spinal muscular atrophy manifest themselves. The period of illness is less than 94 months at the start of the treatment;
    • if the insured person is an infant and no symptoms of 5q spinal muscular atrophy manifest themselves. The insured person does have a genetic diagnosis of 5q spinal muscular atrophy and 2 or 3 SMN2 copies.
  • With effect from 01 January 2021: ribociclib, where provided in relation to the treatment of hormone receptor positive, HER2-negative, locally advanced or metastatic breast cancer.
  • Atezolizumab, for the treatment of lung cancer or urothelial carcinoma.
  • With effect from 01 January 2020: atezolizumab, for the treatment of anything other than urothelial carcinoma.
  • Osimertinib, for the treatment of cancer, with the exception of the treatment of adult insured persons with locally advanced or metastatic non-small cell lung cancer with an epidermal growth factor receptor T790M mutation.
  • Tisagenlecleucel, for the treatment of cancer.
  • Axicabtagene ciloleucel, for the treatment of cancer.
  • Durvalumab, where provided in relation to the treatment of cancer.
  • Abemaciclib, where provided in relation to the treatment of cancer.
  • You no longer need permission for taking and assessing multidimensional photos of the jaw if the insured person is younger than 18.
  • You do need permission for the third or fourth fluoride treatment per year from the moment the adult teeth emerge if the insured person is younger than 18.
  • You no longer need to sign the care plan in the event of changes.
  • The indication for care must have been made in accordance with the Standards for indicating and organising nursing and care in the personal environment, drawn up by the Netherlands Association for Nurses & Carers [Vereniging Verpleegkundigen & Verzorgenden Nederland (V&VN)].
  • Currently, you already receive a reimbursement of seated patient transport if you have to undergo a kidney dialysis or if you receive oncological treatment (chemotherapy, immune therapy or radiotherapy). In 2019, transport regarding consultations, examinations and check-ups as part of the treatment will also fall under this reimbursement.
  • In 2019, the statutory personal contribution is no more than €103 per calendar year instead of €101.

If there is a moderately increased weight-related health risk in accordance with the indication criteria in the NHG guidelines for Obesity and the Obesity Care Standard, you may qualify for assistance in reducing your food intake and increasing your physical exercise. You may also receive psychological help, if necessary. Our conditions explain what you and the care provider have to comply with in order to qualify for reimbursement.

  • until 01 October 2022: breast reconstruction after breast cancer with autological fat transplantation, if you take part in the main research into the effectiveness of the care financed by ZonMw.
  • until 01 December 2020: treatment of lumbosacral radicular syndrome in the case of lumbar hernia with percutaneous transforaminal endoscopic discectomy, if you take part in the main research financed by ZonMw or in observational research (Article 2.2, paragraph 2(b) of the Healthcare Insurance Regulations [Regeling zorgverzekering].

You can also go to a non-contracted birth centre in order to qualify for the reimbursement of the statutory personal contribution.

You can also go to a non-contracted provider to get hearing aids.

A dental surgeon can provide implantology.