Integrated care

Reimbursement healthcare insurance 2019

1. What does integrated care include?
2. Referral required for integrated care
3. Reimbursement for integrated care in 2019
4. Maximum rates for non-contracted care providers
5. No statutory personal contribution
6. Policy excess
7. Where can you go?

Note: the information on this page gives an abbreviated outline of the reimbursement provided. You can only derive any rights from our insurance conditions (pdf).

1. What does integrated care include?

Integrated care is care that is financed under the policy rule for performance-related financing of multidisciplinary care provision for chronic disorders, laid down pursuant to the Healthcare Market Regulation Act (Wet marktordening gezondheidszorg). Integrated care comprises a care programme, set up for a particular disorder, that involves different care providers. There is only one rate for the entire care programme. The objective is for care providers to work closely together and to coordinate the patient's care properly.

Integrated care can be available to people aged 18 and older with Diabetes Mellitus type II, for vascular risk management, for chronic obstructive pulmonary disease (COPD) and asthma.

2. A referral is required for integrated care

You need a referral from a general practitioner or medical specialist for integrated care.

3. Reimbursement for integrated care in 2019

Your public health care insurance entitles you to the reimbursement of costs in connection with integrated care.

4. Maximum rates for non-contracted care providers

For integrated care, do you see a care provider we have not made any arrangements with? Reimbursement is subject to maximum sums. In that case, the rates in accordance with the rates list for non-contracted care applies. If the rates of the non-contracted care provider are higher than our listed maximum rates, then the difference will be for your account.

5. No statutory personal contribution

There is no statutory personal contribution for integrated care.

6. No policy excess

The costs are not counted for the compulsory and voluntary excess. The compulsory and, if applicable, voluntary excess do include the costs of any (laboratory) testing in a hospital or independent laboratory at the request of a general practitioner.

7. Where can you go?

The following care providers are permitted to provide this type of care:

• a contracted care group;
• a care provider who is listed for providing general practitioner care, preventive foot care and dietetics, each for the relevant part of the clinical pathway. This is subject to the condition that the clinical pathway concerns 'separately' contracted care providers. The coordination and organisation are financed on the basis of a 'per capita tariff'.

Use our care guide to find a contracted care group in your neighbourhood. Or call the Care Advise Line +31(0)570 687 123. Our expertly trained staff will be pleased to help you on your way.

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