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Sensory disability care

Reimbursement health insurance 2019

  1. What is sensory disability care?
  2. When do you qualify for reimbursement?
  3. Referral required for sensory disability care
  4. Reimbursement sensory disability care in 2019
  5. No personal contribution
  6. Excess
  7. Maximum rates non-contracted care
  8. Who can you go to?
  9. Request permission

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 sensory disability care?

You qualify for sensory disability care if you suffer from a serious impairment in your vision or hearing or suffer from serious speech/linguistic difficulties. Sensory disability care is aimed at learning to live with, the removal of or the compensation of the impairment, with the objective of allowing you to live as independently as possible.
 

The care consists of:

  • setting a diagnosis;
  • care aimed at learning to live with the impairment from a psychological viewpoint;
  • care that removes or compensates the impairment, thereby increasing your self-reliance.

The care also includes 'secondary' treatment of the people close to you. They will be learning certain skills, so they can help you. This is also covered by your health insurance.

2. When do you qualify for reimbursement?

Impaired vision

This is subject to:

  • visual acuity of < 0.3 in the best eye;
  • range of vision < 30 degrees; or
  • visual acuity between 0.3 and 0.5 in the best eye in combination with related, serious impairments in the daily functioning.

Impaired hearing

You are entitled to care if:

  • you suffer from a threshold loss in the audiogram of at least 35 dB, obtained by averaging the hearing loss at frequencies of 1000, 2000 and 4000 Hz, or
  • you suffer from a threshold loss in excess of 25 dB when measuring in accordance with the Fletcher index, the average loss at frequencies of 500, 1000 and 2000 Hz.

Speech and linguistic difficulties

You qualify for this type of care if you no more than 22 years old. You need to suffer from serious difficulty in acquiring your native language due to neurobiological and/or neuropsychological factors.  Other (psychiatric, physiological, neurological) issues need to be subordinate to the language development disorder.

 

An admission for sensory disability care is subject to our written consent prior to the admission commencing. You must enclose a (copy of the) treatment plan with your application.

3. Referral required for sensory disability care

You need a first referral from a medical specialist or a clinical physical audiologist. You need a second or subsequent referral from a medical specialist, clinical physical audiologist, youth doctor or general practitioner. A second or subsequent referral is not required if you have a visual impairment and the following conditions  are met:

  • you previously received sensory disability care for your visual impairment;
  • there has been a change in your medical or personal situation, as a result of which you have a new  requirement for treatment;
  • the healthcare provider who provides the sensory disability care establishes that your treatment requirement is noncomplex, which can be dealt with in a short programme, the so-called care programme 11.

4. Reimbursement sensory disability care in 2019

By virtue of the public healthcare insurance, you are entitled to sensory disability care.

 

Public Healthcare Insurance Reimbursement 2019                 
HollandZorg public healthcare insurance 100% in the case of contracted care

 

Supplementary Insurance Reimbursement 2019 
Start none
Extra none
Plus none
Top none

5. No personal contribution

There is no statutory personal contribution for sensory disability care.

6. Excess

If you are aged 18 or older, the costs count towards compulsory and, if applicable, voluntary excess.

7. Who can provide the care?

Centres for sensory disability care can provide this type of care.

8. Maximum rates non-contracted care

We apply a maximum reimbursement for sensory disability care provided by a non-contracted care provider. In that case, the reimbursement is limited to the rates in accordance with the rates list for non-contracted care.  We can also send it to you if you wish. If the rates of the non-contracted care provider are higher than our listed maximum rates, the difference will be at your expense.

 

Contracted care providers are listed at our care guide. You may also call our Care Advice Line: +31 (0)570 68 74 70.

9. Request permission

You will require our written permission for a hospitalization for sensory disabled care before the care is started. When applying for this type of care you must send (a copy of) the treatment plan.

 

Send a request for permission to:

 

HollandZorg

Medical advisor

Antwoordnummer 30

7400 VB Deventer

 

No stamp required.

 

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