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Physiotherapy and remedial therapy up to the age of 18

Reimbursement physiotherapy and remedial therapy 2019

  1. What are physiotherapy and remedial therapy?
  2. When will you qualify for reimbursement?
  3. When do you need a referral?
  4. Reimbursement for physiotherapy and remedial therapy in 2019
  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 avoid, end or reduce limitations. It focuses on pain control and on improving mobility, amongst other things. This page is only about physiotherapy and remedial therapy for persons under 18 years. Are you 18 years or older? View than the reimbursement of physiotherapy and remedial therapy if you are 18 years of age or older.

2. When will you qualify for reimbursement?

Under the public healthcare insurance, an insured party will qualify for a reimbursement for physiotherapy and remedial therapy if he or she has a disorder that has been included in the list of Disorders Requiring Physiotherapy and Remedial Therapy (pdf). An insured party up to the age of 18 with a complaint that has not been included on the list will always qualify for a reimbursement for a maximum of nine treatments per calendar year. If these treatments yield results that are not satisfactory, the insured party will qualify for a reimbursement for a maximum of nine additional treatments.

 

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

3. Referral necessary for certain treatments

For reimbursement under the public healthcare insurance and supplementary insurances 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 care provided at home or in an institution by a noncontracted 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. In order to be entitled to reimbursement of the costs of care by a non-contracted  care provider, you must 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.

4. Reimbursement for physiotherapy and remedial therapy up to the age of 18 in 2019

Insured parties under the age of 18 will qualify for a reimbursement for physiotherapy and remedial therapy under the public healthcare insurance and our supplementary insurance. The reimbursement under the supplementary insurance applies for all treatments physiotherapy and remedial therapy taken together.

 

Public Healthcare Insurance Reimbursement 2019

HollandZorg public healthcare insurance

  • all treatments* on the list 'Aandoeningen fysiotherapie en oefentherapie';
  • a maximum of nine treatments per calendar year for disorders that are not mentioned on the list. If the result achieved is not satisfactory: a maximum of nine extra treatments.

 

*) Does a maximum period apply to treatment of the disorder? If so, you will qualify for reimbursement of the care until the end of the maximum period in question.

 

Supplementary Insurance                    Reimbursement 2019
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

 

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. This will apply for reimbursement under the public healthcare insurance and the supplementary insurance. 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 Duration of treatment
Telephonical treatment (including a report) 0,5 treatment
Screening (including a report) 0,5 treatment
Intake and examination after screening 0,5 treatment
Group therapy 3 up to 10 persons 0,5 treatment
Other 1 treatment

5. Maximum rates for a non-contracted care provider

If you have decided to receive physiotherapy and remedial therapy from a care provider with whom we have not made any agreements, the rates in the Rate List for Non-contracted Care will apply. Are the rates charged by the non-contracted healthcare provider higher than our maximum rates? 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

Insured parties under the age of 18 do not have a policy excess.

8. Who may provide this type of care?

For physiotherapy and remedial therapy, you can use a:

  • physiotherapist for general physiotherapy;
  • pelvic physiotherapist for pelvic physiotherapy;
  • geriatric physiotherapist for geriatric physiotherapy;
  • children's pysiotherapist for children's physiotherapy;
  • physiotherapist or skin therapist for  scar treatment;
  • manual therapist for manual therapist;
  • oedema therapist and skin therapist for oedema therapy and lymph drainage;
  • children's remedial therapist for children's remedial therapy;
  • psychomatic remedial therapist for psychomatic remedial therapy (only applicable to reimbursement under the supplementary insurance).

Use 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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