Preventive foot care

Reimbursement health insurance 2020

  1. What is preventive foot care?
  2. Overview profiles and reimbursement foot care
  3. Maximum rates non-contracted care providers
  4. Reimbursement from the supplementary insurance
  5. Statutory personal contribution
  6. Excess
  7. Who can you go to?
  8. Referral for preventive foot care required

Note: the information on this page is a brief outline of the reimbursement. You can only derive rights from our insurance conditions (pdf).

1. What is preventive foot care?

Foot care is important if you have diabetes. That is why you are by virtue of the publice healthcare insurance entitled to preventive foot care. Preventive foot care encompasses the full package of activities within care profiles 1 to 4, as described in the ‘2014 Prevention of Diabetic Foot Ulcers Care Module’. An individual treatment plan determines the actual amount of treatment you will receive.

 

Preventive foot care includes:

  • an annual foot check,
  • specific foot examinations and any treatment of skin and nail problems, deviations in the foot shape and position and the treatment of risk factors. To qualify, you must have a moderately increased (Simm's Classification 1) or increased risk (Simm's Classification 2 or 3) of inflammation, artery problems and loss of sensation in your feet;
  • information and encouragement to modify your lifestyle as part of the treatment;
  • advice on suitable footwear.

Non-therapeutic actions, such as the removal of calluses for cosmetic or therapeutic reasons and the cutting of toenails, do not fall under preventive foot care.

 

Preventive foot care can also be part of integrated care or medical specialist care. When this is the case, you will receive reimbursement on the grounds of the article on integrated care or (general) medical specialised care.

2. Overview of profiles and reimbursements for chiropody

Reason for pedicure/podology treatment     Reimbursement
Diabetes mellitus type I or II Care Profile 0

You do not qualify for a reimbursement under the public healthcare insurance.

Diabetes mellitus type I or II Care Profile 1 You qualify for one foot examination once a year under the public healthcare insurance.
Diabetes mellitus type I or II Care Profile 2 to 4 You qualify for a reimbursement under the public healthcare insurance.

Podiatry, podology;

You qualify for a reimbursement for pedicure treatment if you suffer from:

  • rheumatoid arthritis (a form of rheumatism) affecting the feet; or
  • an impaired sensation in your feet (peripheral neuropathy) not caused by diabetes.

You do not qualify for a reimbursement under the public

healthcare insurance. Right, if any, to a reimbursement

for chiropody under the Plus and Top supplementary

insurance contracts.

3. Maximum rates non-contracted care provider

We apply a maximum reimbursement for preventive foot care provided by a non-contracted podiatrist. In that case, the reimbursement is limited to the rates in accordance with the rates list for non-contracted care.  

 

When you go to a non-contracted care provider, then you should send a copy of the referral in the presentation of the first note. The note should make clear what care you received.

4. Reimbursement from the supplementary insurance

From our supplementary insurances Plus and Top you are entitled to reimbursement of pedicure treatments if you have rheumatism (rheumatoid arthritis), where the feet are affected, or if you suffer from a reduced feeling in the feet (peripheral neuropathy ), which is not caused by diabetes.

5. No statutory personal contribution

There is no statutory personal contribution for preventive foot care.

6. Excess

The costs of preventative foot care do not count towards compulsory and, if applicable, voluntary excess.

7. Who can you go to?

The following care providers are permitted to provide this type of care:

 

For Sims classification 1 (care profile 1):

  • a general practitioner who is independently established or works in a general practitioner services structure (out-of-hours surgery) or a GP centre;
  • a podiatrist;
  • a pedicure provider.

 

For Sims classifications 2 and 3 (care profiles 2, 3 and 4):

  • a general practitioner who is independently established or works in a general practitioner services structure (out-of-hours surgery) or a GP centre;
  • a podiatrist.

And:

  • you can visit the chiropodist for a pedicure treatment under the supplementary insurance. The chiropodist must be listed in the Chiropodists Quality Register, specialising as a diabetic foot chiropodist or medical chiropodist or in foot care for rheumatics. If the care is provided by a contracted provider, he will claim the care as well. In that case, you do not have to pay the care provider yourself.

A chiropodist may perform the annual foot check for Sims classification 1 (care profile 1) independently. A chiropodist may provide care for Sims classification 2 and 3 (care profile 2 and higher) on behalf of the podiatrist. In that case, the podiatrist is the main practitioner and the podotherapist charges the care.

 

Our Care Guide helps you find a care provider near you. For more information, please call our Care Advice Line on 0570 68 74 70. Our expert staff will be pleased to answer your questions.

8. Referral for preventive foot care required

You need a referral from a general practitioner or medical specialist in order to receive foot care from a chiropodist or a podiatrist. The referral must state the type of diabetes and the care profile.

 

You need a referral from a gneral practitioner or medical specialist for foot care in virtue of the supplementary insurance. You must include a copy of the referral when you submit the first invoice.

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