Medicinal care

Reimbursement HollandZorg healthcare insurance 2020

  1. What is medicinal care?
  2. When will you qualify for reimbursement?
  3. A prescription is required for medicines
  4. Reimbursement for medicines in 2020
  5. Maximum reimbursement for a non-contracted care provider
  6. Statutory personal contribution
  7. Policy excess
  8. Who may provide this type of care?
  9. 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 which, following prior consent of the Public Health Supervisory Service and in accordance with rules to be stipulated ministerial regulation, are delivered following an order placed at the initiative of a doctor and which are intended for your use 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 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;
    3. these medicines are sold in another EU country or in a third country and are imported into Dutch territory as a replacement medicine on account of a shortage of medicines;
  • medicines for which the Board has granted a trade licence for the assessment of medicines for public health reasons, if those medicines are not sold in the Netherlands but are sold in another EU country as a replacement medicine on account of a shortage of medicines.
  • 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. You are not entitled to reimbursement under the supplementary insurance of gastric acid inhibitors that fall within the cover of the public healthcare insurance.
  • 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

Preference policy

For a number of groups of mutually replaceable medicines, we have allocated a preferred medicine. If you are entitled to a preferred medicine, you are not entitled to another medicine, unless you have a 'medical need' or a 'logistical need'.

 

Medical need

You have a medical need when it would be medically irresponsible for you to use the preferred medicine. Your prescriber may only note 'medical need' on the prescription if he can substantiate that need. The chemist will check the existence of a medical need. In the event of doubt, the chemist and the prescriber will decide together on the medical need. If the prescriber and the chemist cannot agree, the prescriber's opinion prevails.

 

Logistical need

You have a logistical need if the preferred medicine is not available in the Netherlands for a prolonged period of time and no other preferred medicine has been allocated.

If you have a medical or a logistical need, your chemist will decide which other medicine he will dispense, on the basis of the active ingredient and associated explanation prescribed by the prescriber.

The list of preferred medicines forms a part of the Pharmacy Regulations. We may change the list of preferred medicines at any time. Changes are announced on the page about the preference policy, where you can also read more about the preference policy itself.

In the case of other medicines that we have allocated and that do not appear on the list of preferred medicines, you are entitled to the medicine according to the so-called Lowest Price Guarantee policy. The Pharmacy Regulations explain which conditions apply to that policy. If your prescriber, by noting ‘medical need’ on the prescription, indicates that the medicine allocated under that policy is not medically advisable, the chemist will check the existence of a medical need. In the event of doubt, the chemist and the prescriber will decide on the medical need. If the prescriber and the chemist cannot agree, the prescriber's opinion prevails. If you are entitled to another registered medicine, your chemist will decide which other medicine he will dispense, on the basis of the active ingredient and associated explanation prescribed by the prescriber.

3. You need a prescription.

A physician (which also includes a GP, a medical specialist, a doctor for the mentally disabled, a sports doctor, a specialist geriatrics doctor, a nursing specialist and A&E doctor), an orthodontist, a dentist, an obstetrician and 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.

4. Reimbursement for medicines in 2020

Under the HollandZorg public healthcare insurance you qualify for the reimbursement of certain medicines (determined by the government). Under the supplementary insurance you are entitled to reimbursement of other medicines and the statutory personal contribution. You can see which medicines these are in our conditions. A separate scheme applies to the reimbursement of the statutory personal contribution for contraceptives. and our supplementary insurance.

 

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

 

Supplementary Insurance                   Reimbursement 
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**
No Risk I none 
No Risk II 100% reimbursement of the statutory personal contribution

 

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

  • 15 days or the smallest supply packaging 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.

**) The reimbursement applies for the medicines and the statutory personal contribution together. 

5. 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.

6. 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.

 

In the years 2020 and 2021, the extent of your statutory personal contribution will be a maximum of €250 per calendar year. If your public healthcare insurance does not commence or end on 1 January of a calendar year, the statutory personal contribution for your public healthcare insurance for that calendar year is set lower, in proportion to the number of days insured. The calculated amount is rounded off to whole Euros.

7. 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.

8. 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 be 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.

9. 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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