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Breast prosthesis

Reimbursement health insurance 2019

  1. What is a breast prosthesis?
  2. Prescription required for breast prosthesis
  3. On loan or owner?
  4. Reimbursement breast prosthesis in 2019
  5. Maximum rates non-contracted provider
  6. No statutory personal contribution
  7. Excess
  8. Who can you go to?
  9. Apply for consent

Note: the information on this page is a brief outline of the reimbursement. You can only derive rights from our insurance conditions (pdf) and the Medical Aids Regulations (pdf).

1. What is a breast prosthesis?

A breast prosthesis is an exterior aid that fully or partially replaces the breast. Ready-to-use breast prostheses are available, but you can also have one customised for you. The breast prosthesis falls under medical aids.

2. Prescription required for breast prosthesis

You need a prescription from a general practitioner or mamma care nurse for a breast prosthesis. If you need a customised breast prosthesis, you will need a statement, along with the prescription, that a ready-to-use breast prosthesis is not possible or safe in your case.

3. On loan or owner?

You will be the owner of the breast prosthesis. The minimum useful life of a breast prosthesis is 24 months. Read the Medical Aids Regulations (pdf) for more information about replacing a breast prosthesis.

4. Reimbursement breast prosthesis in 2019

Public Healthcare Insurance           Reimbursement 2019
HollandZorg public healthcare insurance 100% in the case of contracted care

 

Supplementary Insurance                    Reimbursement 2019              
Start none
Extra none
Plus none
Top none

5. Maximum rates non-contracted provider

If the medical aids are available from a contracted care provider in time, but you prefer to go to a non-contracted care provider, we will apply a maximum reimbursement. The non-contracted provider has to comply with the conditions set out in the Medical Aids Regulations (pdf).

A medical aid that we sell to you is reimbursed up to a maximum of 75% of the costs we would incur if you would have received the care from a contracted care provider. In that case, we also reimburse a maximum of 75% of any repair costs in connection with the medical aid.

6. No statutory personal contribution

A breast prosthesis is not subject to a statutory personal contribution.

7. Excess

The costs of a breast prosthesis count towards the compulsory and, if applicable voluntary excess.

8. Who can you go to?

If you need a breast prosthesis, you can go to a contracted provider of medical aids. A non-contracted provider has to be an S.E.M.H-recognised provider of medical aids. Our Care Guide helps you find a (contracted) provider near you. You do not need our prior consent when visiting a contracted provider.

For more information, please call our Care Advice Line on +31(0)570 687 123. Our expert staff will be pleased to answer your questions.

9. Apply for consent

Do you want to use a provider with whom we have not concluded an agreement?  In that case, you need our prior consent. Send your prescription and offer to:

HollandZorg
Medisch adviseur
Antwoordnummer 30
7400 VB Deventer

No stamp required.

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