Physiotherapy and remedial therapy from 18 years

Reimbursement physiotherapy and remedial therapy 2020

  1. What are physiotherapy and remedial therapy?
  2. When will you qualify for reimbursement?
  3. A referral is required for certain treatments
  4. Reimbursement for physiotherapy and remedial therapy in 2020
  5. Maximum reimbursement for a non-contracted care provider
  6. No statutory personal contribution
  7. Policy excess
  8. 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 physiotherapy and remedial therapy?

Physiotherapy is care of the type that physiotherapists generally provide. Remedial therapy is care of the type that remedial therapists generally provide. Remedial therapy is provided by Cesar and Mensendieck remedial therapists. The object of physiotherapy or remedial therapy is to prevent, end or reduce limitations and focuses on pain control and the improvement of mobility, among other things.

2. When will you qualify for reimbursement?

Your age will largely determine the reimbursement you receive. Public health insurance distinguishes between insured parties up to the age of 18 and insured parties aged 18 and older. On this page, we will provide you with information about reimbursements for physiotherapy and remedial therapy for insured parties aged 18 and older.

 

If you are 18 or older, you are entitled to reimbursement from the public healthcare insurance:

  • reimbursement starting after the 21st treatment, for a disorder stipulated on the Appendix 1 to the Health Insurance Decree (Besluit zorgverzekering), This is the list of disorders for physiotherapy and remedial therapy (pdf)
  • pelvic physiotherapy in connection with incontinence, subject to a maximum of nine treatments (once-only);
  • supervised remedial therapy for peripheral arterial disease (PAD) in Fontaine stage 2. In that case you will be entitled to a maximum of 37 treatments during a maximum of 12 months. Also the first 20 treatments are reimbursed, which isn't the case with other cases;
  • supervised remedial therapy for arthrosis in your hip or knee joint. In that case you will be entitled to a maximum of the first 23 treatments during a maximum of 12 months;
  • supervised remedial therapy for COPD, if it concerns stage II or higher of the GOLD Classification for spirometry. In that case, you are entitled to:
    • if it concerns Class A of the GOLD Classification for symptoms and a risk of exacerbation: no more than the first five treatments during a maximum of twelve months;
    • if it concerns Class B of the GOLD Classification for symptoms and a risk of exacerbation: no more than the first twenty-seven treatments during a maximum of twelve months after the start of the treatment and a maximum of three treatments per twelve months in subsequent years;
    • if it concerns Class C or D of the GOLD Classification for symptoms and a risk of exacerbation: no more than the first seventy treatments during a maximum of twelve months after the start of the treatment and a maximum of fifty-two treatments per twelve months in subsequent years.

Under our supplementary insurance, you will qualify for reimbursement of a number of treatments by a contracted provider, depending on your supplementary insurance.

3. Referral required for certain treatments

You need a referral from a general practitioner, medical specialist, youth healthcare doctor, doctor for the mentally disabled, specialist geriatrics doctor or company doctor.

  • for treatment of a complaint on the List of disorders for physiotherapy and remedial therapy;
  • for treatment by a pelvic physiotherapist in connection with urine incontinence;
  • for supervised remedial therapy for peripheral arterial disease (PAD) in Fontaine stage 2;
  • for supervised remedial therapy in the event of arthrosis in your hip or knee joint;
  • for supervised remedial therapy for COPD, if it concerns stage II or higher of the GOLD Classification for spirometry;
  • for care provided at home or in an institution by a non-contracted care provider.

The referral must contain an explanation which clearly demonstrates the need for that type of physiotherapy or remedial therapy.

 

If you go to a non-contracted care provider, you must include a copy of the referral when  you submit the first invoice. You must also include a statement from your care provider when submitting the first invoice. This  statement must list any historic physiotherapy or remedial therapy received for that same disorder. This does  not apply if:

  • the insured is under the age of 18 or if
  • it concerns the costs of pelvic physiotherapy in connection  with incontinence;
  • if it concerns supervised remedial therapy in connection with:
    • peripheral arterial disease (PAD) in Fontaine stage 2 (intermittent claudication);
    • arthrosis in your hip or knee joint;
    • COPD, if it concerns stage II or higher of the GOLD Classification for spirometry.

4. Reimbursement for physiotherapy and remedial therapy in 2020

If you are 18 years or older, you qualify for a reimbursement for physiotherapy and remedial therapy under the public healthcare insurance and our supplementary insurance.

 

Public Healthcare Insurance Reimbursement 


HollandZorg public healthcare insurance

  • all treatments*  metioned under 2: when will you qualify for reimbursement.

 

*) Is there a maximum period for treatment of the disorder? If so, you will qualify for the reimbursement of care up to the end of the maximum period.

 

Supplementary Insurance                  Reimbursement 
Start 6 treatments* per calendar year
Extra 9 treatments* per calendar year
Plus 15 treatments* per calendar year of which a maximum of 9 treatments manual therapy
Top 25 treatments* per calendar year of which a maximum of 9 treatments manual therapy
No Risk I none
No Risk II none

 

Note: Will you be receiving physiotherapy and remedial therapy from a care provider with whom we have not made any agreements? In this situation, the maximum rates for non-contracted care providers will apply. With your first invoice, you must also include a statement that lists any historic physiotherapy or remedial therapy received for that same disorder.


*Explanation of reimbursement under the supplementary insurance
A treatment is calculated as follows:

 

Type of treatment Counts as
Telephonical treatment (including a report) 0,5 treatment
Screening (including a report) 0,5 treatment
Intake and research after screening 0,5 treatment
Group treatment 3 up to 10 persons 0,5 treatment
Other 1 treatment

5. Maximum rates for a non-contracted care provider

If you will be receiving physiotherapy and remedial therapy from a care provider which whom we have not made any agreements, the rates in the  Rate List for Non-contracted Care will apply. Do the rates charged by the non-contracted healthcare provider exceed our maximum rates? In this situation, the difference will be payable by you. This will apply for reimbursement under the public healthcare insurance and the supplementary insurance.

6. No statutory personal contribution

There is no statutory personal contribution for physiotherapy and remedial therapy.

7. Policy excess

Are you 18 or older? The costs incurred for physiotherapy and remedial therapy under the public healthcare insurance will count towards your compulsory policy excess and any voluntary policy excess.

8. Who may provide this type of care?

For physiotherapy and remedial therapy, you may use a:

  • physiotherapist for general physiotherapy;
  • pelvic physiotherapist for pelvic physiotherapy;
  • pelvic remedial therapist for pelvic remedial therapy;
  • geriatric physiotherapist for geriatric physiotherapy;
  • geriatric remedial therapist for geriatric remedial therapy;
  • physiotherapist or skin therapist for scar treatment;
  • manual therapist for manual therapy.
  • oedema therapist and skin therapist for oedema therapy and lymph drainage;
  • remedial therapist (Cesar or Mensendieck) for general remedial therapy;
  • psychosomatic remedial therapist for psychosomatic remedial therapy (this only apply to reimbursement under the supplementary insurance);
  • supervised remedial therapy in the event of peripheral arterial vascular disease (intermittent claudication): a physiotherapist or remedial therapist who is affiliated with the national ClaudicatioNet network. Affiliation with the ClaudicatioNet network is not compulsory if the provision of care started before 1 January 2018;
  • physiotherapy and remedial therapy in the event of Parkinson's disease: a physiotherapist or remedial therapist who is affiliated with the national ParkinsonNet network. Affiliation with the ParkinsonNet network is not compulsory if the provision of care started before 1 January 2018.

See our Care Guide to find a (contracted) care provider near you. For more information about physiotherapy and remedial therapy, call customer services on +31(0)570 687 123. We will be happy to answer your questions.

 

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