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Medical aids

Reimbursement HollandZorg healthcare insurance 2019

  1. What are medical aids?
  2. A prescription will be required for medical aids
  3. Reimbursement for medical aids in 2019
  4. Maximum reimbursement for a non-contracted supplier
  5. Statutory personal contribution
  6. Policy excess
  7. Who may provide this type of care?

Please note: the information provided on this page is a summary of the reimbursement applicable. You will only be able to derive rights from the HollandZorg Conditions of Insurance (pdf).

1. What are medical aids?

The functioning medical aids and dressings indicated in our Medical Aids Regulations (pdf) fall under medical aids. The regulations also indicate the extent of care and whether you will loan or own the aid in question. You may need medical aids and dressings to treat a disorder or to help you with a limitation.

 

Medical aids do not include:

  • Medical aids and dressings that you receive while admitted or medical specialist treatment in connection with admission or treatment. During admission to a hospital, for example.
  • Medical aids and dressings to which you are entitled under the Long-Term Care Act (Wlz)), the Social Support Act (Wet maatschappelijke ondersteuning (WMO)), the Work and Income (Capacity for Work) Act (Wet inkomen naar arbeidsvermogen (WIA)) and the Personal Budgets (Special Needs) Act (Wet op de leerlinggebonden financiering;also referred to as rugzakje)
  • The costs of the normal use of medical aids, such as energy consumption and batteries, unless stipulated otherwise in these insurance conditions.

2. Prescription required for medical aids

You will require a prescription for medical aids. Medical Aids Regulations (pdf) outlines which care provider is able to issue a prescription and does so per category of medical aid.

 

The Medical Devices Regulations also state the cases in which you will require our prior written permission. Please also consult the regulations for the conditions applicable to your request.

3. Reimbursement for medical aids in 2019

Under the HollandZorg public healthcare insurance, you qualify for medical aids and dressings (care in kind)  that have been included in the Medical Devices Regulations. Depending on your supplementary insurance, you qualify for extra reimbursements for certain aids.

 

Public Healthcare Insurance                             Reimbursement 2019

HollandZorg public healthcare insurance

Medical aids and dressings from our Medical Aids Regulations (pdf)*

 

A lower reimbursement may apply for medical aids from non-contracted suppliers.

 

Some medical aids are subject to a personal contribution.

 

*Explanation of reimbursement under the public healthcare insurance
You will qualify for the medical aids and dressings that have been included in our Medical Aids Regulations (pdf). The regulations also state whether you will loan or own the aids and also other conditions for entitlement to medical aids.

 

Supplementary Insurance                    Reimbursement 2019
Start none
Extra a maximum of € 100,- per calendar year**
Plus a maximum of € 200,- per calendar year**
Top a maximum of € 300,- per calendar year**

 

**) Explanation of reimbursement under the supplementary insurance
The maximum reimbursement applies to the different kind of medical aids together: hip protectors, hearing aids, bed-wetting alarm, wigs and cranial remodelling helmet.

 

Hip protectors

You are entitled to reimbursement for hip protectors. The condition is that you have a prescription from a doctor. You must enclose a copy of the prescription when submitting the invoice.
 

Staturtory personal contribution hearing aids and (tinnitus) masks

You are entitled to reimbursement of the costs of your statutory personal contribution for hearing aids and tinnitus masks. The condition is that you bought the hearing aid from a care provider contracted to us.
 

Bed-wetting alarm

You are entitled to reimbursement of the costs of purchasing or renting a bed-wetting alarm. The condition is that you have a prescription from a doctor. You must enclose a copy of the prescription when submitting the invoice.
 

Wigs

You are entitled to reimbursement of the remaining costs of a wig over and above the maximum statutory reimbursement under the public health insurance. The condition is that you bought the wig from a care provider contracted to us.

4. Maximum reimbursement for a non-contracted supplier

 

Is the medical aid available on time from a contracted supplier, but you have still decided to use a non-contracted supplier? A maximum reimbursement will apply in this situation. The non-contracted supplier will be required to meet the conditions set out in our Medical Aids Regulations (pdf).

 

In this situation, a medical aid or dressing that we would normally sell to you is reimbursed up to a maximum of 75% of the costs we would incur if you had received the care from a contracted care provider. In this situation, we also reimburse a maximum of 75% of any repair costs in connection with the medical aid.

 

In this situation, the costs of a medical aid that we would normally give on loan are reimbursed per calendar year. In this situation, we will reimburse a maximum of 75% of the costs we would incur for providing this care on loan in the calendar year in question. Here, we offset the number of days in the calendar year that you qualify for medical aids against the number of days that you will have the medical aid at your disposal.

5. Statutory personal contribution

A statutory personal contribution may apply for medical aids and dressings. Our Medical Aids Regulations (pdf) set out the medical aids to which this applies.

 

Some medical aids are subject to a statutory maximum reimbursement. The statutory personal contribution also includes costs that exceed the statutory maximum reimbursement. You will bear these costs.

 

Depending on your supplementary insurance you are entitled to reimbursement of the statutory personal contribution (hearing aids) or a reimbursement of the personal contribution that remains after the statutory maximum reimbursement under the public healthcare insurance (wigs).

6. Policy excess

Are you 18 or older? The costs incurred for medical aids will count towards your compulsory policy excess and any voluntary policy excess.

 

You will not have any policy excess for medical aids that you receive on loan, except the consumables or usage costs corresponding to the medical aids.

7. Who may provide this type of care?

You may obtain medical aids and dressings from a contracted supplier. Use our Care Guide to find a care provider near you. You could also opt to use a non-contracted supplier. The Medical Devices Regulations  (Column G) outline which care providers may provide care in this situation.

 

If you have any questions or would like more information, contact customer services on +31(0)70) 687 123. We will be happy to answer your questions.


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