Medical care for specific groups of patients

You are entitled to medical care for specific groups of patients. This care comprises general medical care for specific patient groups under or pursuant to the Healthcare Insurance Act (Zorgverzekeringswet).

Reimbursement

The care can include diagnostics, consultations, targeted consultation with your attending physician and implementation of or management of the treatment plan. This concerns care for vulnerable groups living at home, for example vulnerable elderly people, people with chronically progressive degenerative diseases, people with non-congenital brain damage and people with a mental impairment aged eighteen and older. This care focuses on improving independent living, preventing the restrictions from worsening and learning to live with the (continuing) restrictions.

You are not eligible for this type of care if you have a Wlz indication or if you qualify for one.

Reimbursement medical care for specific groups of patients

The costs of medical care for specific groups of patients is fully reimbursed under the public healthcare insurance.This care does not include care that forms part of other types of care, such as first-line in-patient stays and geriatric rehabilitation care.

Transitional arrangement for care

If the care was started before 2021, you will continue to receive the care for the duration you need.

No statutory personal contribution

There is no statutory personal contribution for medical care for specific groups of patients.

Excess

The costs of medical care for specific groups of patients do not count towards the compulsory and, if applicable, voluntary excess.

Who should you approach?

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

  • a specialist geriatrics doctor
  • a doctor for the mentally disabled
  • a healthcare psychologist
  • a clinical psychologist
  • a child and adolescent psychologist NIP (Dutch Association of Psychologists)
  • a remedial educationalist

You need a referral from a general practitioner or a paediatrician

Transitional arrangement for referrals
An indication issued by the Care Needs Assessment Centre (CIZ) before 1 January 2021 is valid as a referral up to 31 March 2021. If the care has not started by then, you will need a new referral for the care.

Reimbursements 2021

Also view the Reimbursements 2021.

Note

The information on this page is a brief outline of the reimbursement. You can only derive rights from our insurance conditions (PDF).

More information

Use our Care Guide to find a (contracted) care provider near you. For more information, contact customer services on +31(0)570 687 123. Our expert employees will be pleased to help you.