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First-line-in-patient stay

Reimbursement first-line in-patient stay 2019

 

1. What is a first-line in-patient stay?

2. Referral required for first-line in-patient stay
3. Transitional arrangement
4. Reimbursement first-line in-patient stay in 2019
5. Maximum rates non-contracted providers
6. 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).

1. What is a first-line in-patient stay?

A first-line in-patient stay in this context is a short-term stay required on medical grounds in connection with medical care such as general practitioners provide. First-line in-patient stays are aimed at recovery and return to the home situation in the short term or relate to palliative terminal care.

 

The care does not include:

  • stay;
  • stays in connection with the temporary takeover of care to release a family caregiver (respite care);
  • stays you require in connection with a psychiatric disorder or impairment if you are younger than 18;
  • stays for insured parties with a care assessment under the Long-Term Care Act (Wlz).

2. Referral required for first-line in-patient stay

You require a referral from a GP for a first-line in-patient stay.

3. Transitional arrangement

If, on 31 December 2016, you were dependent on the grounds of a care assessment decision by the Care Assessment Centre (CIZ) on first-line in-patient stays as referred to in article 1.2.2 of the 2016 First-line in-patient stays subsidy regulations (Subsidieregeling eerstelijnsverblijf 2016), as applicable on 31 December 2016, then you will be entitled to continuation of the care by the same care provider.

This entitlement to continuation of the care shall apply if and insofar as on the grounds of the care assessment decision you were dependent on one of the performances of short-term in-patient stay, as referred to in article 1.2.2 of the 2016 First-line in-patient stays subsidy regulations.

 

If the care assessment decision by the CIZ was issued after 1 October 2016 and is valid until 31 December 2016, you will be entitled to continuation of the care by the same care provider until:

three months after the start of the care assessment decision, if and insofar as you are dependent on basic first-line in-patient stay or intensive first-line in-patient stay, or
three years after the start of the care assessment decision, if and insofar as you are dependent on palliative terminal first-line in-patient stay.

 

We may deviate from this transitional arrangement if your health situation has changed such that there are no longer medical grounds for the first-line in-patient stay or if you are otherwise no longer dependent on that care.

4. Reimbursement first-line in-patient stay in 2019

By virtue of the public healthcare insurance, you are entitled to reimbursement of a first-line in-patient stay.

 

Health insurance Reimbursement 2019
Public healthcare insurance 100%

 

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

5. Maximum rates non-contracted providers

If you are planning on seeing a care provider with whom we have not concluded an agreement for a first-line in-patient stay, the rates of the rate list for non-contracted care apply. If the rates of the non-contracted care provider are higher than our maximum rates, the difference will be at your expense.

6. Statutory personal contribution

There is no personal contribution for a first-line in-patient stay.

7. Excess

If you are aged 18 or older, the costs count towards the compulsory and, if applicable, voluntary excess.

8. Who can you go to?

In situations like this, you can contact an institution for first-line in-patient stays.

9. Apply for consent

Your stay for the following types of admission is subject to our prior written consent:

  • stays in an institution that is not contracted by us;
  • care that is provided for longer than three months.

Please send requests for consent to:

HollandZorg
Medical advisor
Antwoordnummer 30
7400 VB Deventer

No stamp required.

 

Our Care Finder helps you find a contracted care provider near you. You can also contact our Customer services +31(0)570 687 123. Our expert staff will be pleased to answer your queries.

 

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