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Medicinal care

Reimbursement HollandZorg healthcare insurance 2019

  1. What is medicinal care?
  2. When will you qualify for reimbursement?
  3. No preference policy
  4. A prescription is required for medicines
  5. Reimbursement for medicines in 2019
  6. Maximum reimbursement for a non-contracted care provider
  7. Statutory personal contribution
  8. Policy excess
  9. Who may provide this type of care?
  10. Request permission

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 is medicinal care?

Medicines help recovery or can prevent or reduce an illness or complaint. Another word for medicines is drugs. Medicines are often only available with a prescription from a general practitioner or medical specialist.

2. When will you qualify for reimbursement?

Under the HollandZorg public healthcare insurance, you will qualify for the reimbursement of:

The registered medicines authorised by us are specified in the Pharmacy Regulations.

 

  • The following non-registered medicines:
    • medicines that have been prepared on a small scale by or on the instructions of the dispensing chemist, in his own pharmacy;
    • medicines that are sold following an order on the initiative of a doctor, which are intended to be used by you under his supervision, if:
    1. these medicines have been prepared in the Netherlands by a manufacturer with a licence for preparing medicines pursuant to the Medicines Act (Geneesmiddelenwet), and prepared in accordance with the specifications of that doctor; or
    2. these medicines are sold in another EU or EEA country or in a third country, and are imported into Dutch territory at the request of that doctor if you suffer from an illness suffered by no more than 1 in 150,000 inhabitants in the Netherlands;
  • Dietary preparations as referred to in Appendix 2 of the Healthcare Insurance Regulations.

Medicinal care also includes the advice and support which dispensing chemists generally provide for the assessment and responsible use of prescribed medicines.

 

Read the HollandZorg Conditions of Insurance (pdf) for further information about the reimbursement of medicines under the public healthcare insurance, as referred to above.

 

Under our supplementary insurance you will qualify for the reimbursement of:

  • Statutory personal contribution
    You will qualify for the reimbursement of the statutory personal contribution for medicinal care if you need the medicines for at least three consecutive months.This does not include the statutory personal contribution for anticonceptives. Herefor applies another reimbursement.
  • Gastric acid inhibitors
    You will qualify for the reimbursement of gastric acid inhibitors and combination preparations with a gastric acid inhibitor that are included in the Z-Index.
  • Other registered medicines

    You are entitled to reimbursement of other registered medicines, if:

    • the use of the medicine is required for a minimum period of three consecutive months; and

    • there is no suitable alternative medicine available for reimbursement under the public healthcare insurance; and

    • it is not an over-the-counter medicine or an alternative medicine; and

    • according to the Farmacotherapeutisch Kompas of the Health Insurance Board (College voor Zorgverzekeringen) there are symptoms corresponding to the complaint for which the medicine is prescribed.

*) You can look up whether a gastric acid inhibitor is listed in the Z-index at www.cbg-meb.nl under the heading 'geneesmiddeleninformatiebank voor mensen' ('medicines database for people').

 

Medicines we do not reimburse

By virtue of the public healthcare insurance and supplementary insurances, you are not entitled to:

  • medicines to prevent travel sickness;
  • medicines for research;
  • medicines that are (virtually) equivalent to a registered medicine, but not included in appendix 1 of the Healthcare Insurance Regulations (Regeling zorgverzekering);
  • medicines that are still being clinically tested and that will be made available for distressing cases;
  • medicines administered to you when hospitalised or for medical specialist treatment. In that case, those medicines form part of that care

3. Appropriate care

You qualify for the reimbursement of appropriate care. This means that your dispensing chemist may not provide you with any medicines that are unnecessarily expensive. We have made agreements about this with dispensing chemists.

 

Your doctor will prescribe a medicine on the basis of its active ingredients and your dispensing chemist will choose the appropriate medicine. Dispensing chemists and dispensing general practitioners are free to give you the medicine that is most appropriate for your situation. There is one limitation. The medicines may be a maximum of five percent more expensive than the cheapest variant with the same active ingredient. In practice, this means that almost any branded medicine will be reimbursed in full. If the dispensing chemist still provides a more expensive medicine, he will not be able to charge us for any more than the bandwidth of five percent. This makes it possible for us to limit the increase in the costs of medicines and, by doing this, keep your healthcare insurance premium affordable.

 

If you are dependent on a brand medicine (which is usually more expensive) for medical reasons, this will be reimbursed in full if your doctor prescribes this specific medicine. In this situation, the prescription must include the abbreviation M.N..

4. Prescription required for medicines

You need a prescription. A GP, a medical specialist, an orthodontist, a dentist, an obstetrician, a doctor for the mentally disabled, a sports doctor, a specialist geriatrics doctor, a nursing specialist, an A&E doctor, or a physician assistant may issue a prescription for most medicines. This is subject to the condition that the prescribed medicine is related to the care that the prescribing party generally provides.

 

For dietary preparations, besides a prescription, a doctor's note and the dispensing chemist's instruction, you must also provide a Dietary Preparations Statement filled in by a dietician or medical specialist.

5. Reimbursement for medicines in 2019

Under the HollandZorg public healthcare insurance and our supplementary insurance, you qualify for the reimbursement of certain medicines and the statutory personal contribution (supplementary insurance).

 

Public Healthcare Insurance Reimbursement 2019
HollandZorg public healthcare insurance 100% reimbursement* for contracted care, minus any statutory personal contribution

 

Supplementary Insurance                   Reimbursement 2019
Start none
Extra a maximum of € 150 per calendar year*
Plus a maximum of € 300 per calendar year*
Top a maximum of € 450 per calendar year*

 

*) Per prescription, we will reimburse the costs of medicines for a maximum period of:

  • One month for medicines that are new for you.
  • One course or one month for antibiotics or chemotherapy to combat acute disorders.
  • Three months, if it concerns medicines for the treatment of chronic disorders, with the exception of benzodiazepines, hypnotic drugs and anxiolytic drugs and medicines that cost more than € 1.000 per month. The care provider issuing the prescription determines whether it concerns a chronic disorder;
  • 12 months for the contraceptive pill.
  • One month in all other cases.

6. Maximum rates for a non-contracted care provider

Will you be receiving medicines from a dispensing chemist or care provider with whom we have not made any agreements? If so, the rates indicated in the Rate List for Non-contracted Care will apply. If the rates charged by the non-contracted care provider are higher than our maximum rates, the difference will be for your account.

7. Statutory personal contribution

You must pay a statutory personal contribution for a medicine that has been classified as belonging to a group of interchangeable medicines if the purchase price is higher than the reimbursement limit. A statutory personal contribution is also due when a medicine is prepared from a medicine for which a statutory personal contribution is due. The Healthcare Insurance Regulations (Regeling zorgverzekering) stipulate how the personal contribution is calculated.

 

Under most of our supplementary insurances, you qualify for a reimbursement of the statutory personal contribution if the use of the medicines is necessary for at least three consecutive months. This does not apply the statutory personal contribution of contraceptives.

8. Policy excess

Are you 18 or older? The costs incurred for medicines will count towards your compulsory policy excess and any voluntary policy excess. The provision of contraceptives as referred to in appendix 2 of the Healthcare Insurance Regulations and medication assessment as stipulated under the conditions in the overview 'Designated Care Not Applicable to Compulsory Excess' are exempted from the compulsory excess.

9. Who may provide this type of care?

For medicines, you may use a (contracted) dispensing chemist or a dispensing general practitioner. Use our Care Guide to find a (contracted) dispensing chemist near you. Dietary preparations can also by provided by suppliers of dietary preparations.

 

For more information, contact customer services on +31(0)570 687 123. We will be happy to answer your questions.

10. Request permission

You will require our prior written permission for some medicines. See the Pharmacy Regulations (pdf) for details of which medicines these are. Do you have a prescription for these medicines? Send your request and a copy of the prescription to:

 

HollandZorg
Medical Advisor
Antwoordnummer 30
7400 VB Deventer

No stamp is necessary.

 

Separate rules apply to the medicines contained in appendix 2 of the Healthcare Insurance Regulations (Regeling zorgverzekering). The care providers that can issue prescriptions for these medicines are listed in the Pharmacy Regulations (Reglement Farmacie), per medicine.

 

Authorisation for resold preparations
Resold preparations are non-registered preparations prepared in one dispensing chemist (magistral preparations) and sold on to another dispensing chemist. The reimbursement of certain resold preparations designated by us is subject to our written consent before you receive the care. The resold preparations which
require consent are listed in the overview 'Resold preparations'.

 

When applying for care you will need to send us a copy of the prescription and a report from the attending  physician including the medical diagnosis/diagnoses, a description of the current problem and the proposed treatment plan.

 

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