Specialist mental health care

Reimbursement HollandZorg healthcare insurance 2021

  1. What is specialist mental health care?
  2. Referral required
  3. Healthcare insurance reimbursement in 2021
  4. Maximum rates for non-contracted care providers
  5. No statutory personal contribution
  6. Policy excess
  7. Where can you go?
  8. Request permission

Note: the information on this page gives an abbreviated outline of the reimbursement provided. You can only derive any rights from our insurance conditions.

1. What is specialist mental health care?

Specialised mental healthcare includes diagnosis and specialist treatment of (highly) complex psychological
disorders such as psychiatrists and clinical psychologists generally provide.

Specialist mental health care does not include:

  • the treatment of adjustment disorders following a far-reaching event or change;
  • help with work and relationship problems;
  • indicated prevention in case of depression, panic disorders, anxiety disorders and problematic alcohol consumption;
  • Care in the case of a psychiatric disorder or restriction if the insured is younger than 18.

More information on which treatments meet the the state of the art and practice can be viewed at our website.

2. Referral required

You need a referral from a general practitioner, medical specialist, coordinating practitioner (in case of a referral), an occupational physician or a doctor affiliated to Nederlandse Straatdokters Groep:

  • at the start of the diagnosis and treatment;
  • in the event of a relapse pertaining to the same care need after 365 days after the care started;
  • in the event of a new need for care. This is determined by your referrer.


The requirement for a referral does not apply:

  • in the event of unforeseen care that cannot reasonably be postponed (acute GGZ/crisis DTC (diagnosis treatment combination)/urgent care);
  • in the case of mandatory treatment under the Dutch Mandatory Mental Healthcare Act;
  • if the care is a direct continuation of;
    • care provided to you by order of a judicial procedure;
    • care provided to you by the same healthcare provider after the indication under the Long-Term Care Act has ended;
    • care provided to you under the Dutch Youth Act;
    • basic mental healthcare for the same care need;
  • in the event of a referral for the same care need between healthcare providers who are authorised to offer basic mental healthcare or specialist mental healthcare under these policy conditions.
  • for opening one or more DTCs if a first DTC has already been opened (so-called parallel DTCs).
     

The term of validity of the referral is nine months (275 days), counting from the date on which you registered with a designated healthcare provider to provide the care.

3. Reimbursement payable by your health care insurance in 2021

Your basic insurance entitles you to reimbursement for specialist mental health care.

 

Public Healthcare Insurance Reimbursement
HollandZorg public healthcare insurance 100% from contracted health care providers

4. Maximum rates for non-contracted care providers

Do you see a care provider we have not made any arrangements with? In that case, the rates in accordance with the rates list for non-contracted care applies. If the rates of the non-contracted care provider are higher than our listed maximum rates, then the difference will be for your account.

5. No statutory personal contribution

There is no statutory personal contribution for specialist mental health care.

6. Excess

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

7. Where can you go?

The following care providers can provide specialist mental healthcare as the coordinating practitioner:

  • clinical psychologists;
  • a clinical neuropsychologist;
  • psychiatrists;
  • psychotherapists;
  • a specialist geriatrics doctor who works at an institution for the provision of specialist mental healthcare;
  • an addiction specialist who works at an institution for the provision of specialist mental healthcare;
  • a clinical specialist in geriatric medicine who works at an institution for the provision of specialist mental healthcare;
  • a specialist mental healthcare nurse who works at an institution for the provision of specialist mental healthcare;
  • a healthcare psychologist who works at an institution for the provision of specialist mental healthcare.

This is subject to the condition that the care provider has a quality status that is listed in the National Health Care Institute's Quality Standards Register.

 

Transitional arrangement
If you will reach the age of 18 in 2021 and are then receiving care from a remedial educationalist or a NIP child and adolescent psychologist, then these care providers may continue to provide the care as coordinating practitioners for a maximum period of 365 days, commencing on the day that you reach the age of 18.

 

Use our care guide to find a contracted care provider in your neighbourhood. For more information, call the Healthcare advise line: +31(0)570 687 123. Our expertly trained staff will be pleased to help you on your way.

8. Request permission

Reimbursement for specialist mental healthcare by a noncontracted care provider in combination with an in-patient stay is subject to our written authorisation, prior to you receiving the care. When applying for care you will need to send us a copy of a  report from the attending physician with the medical diagnosis/diagnoses, a description of the current problem and the medical need for in-patient stay.


For specialised medical mental care in combination with an in-patient stay, you must obtain written authorisation from us for the second and third consecutive years before the you receive the care. You must  enclose a (copy of the) national checklist for prolonged medical mental care (LGZZ) with your application.

 

You can send a request for permission to:

 

HollandZorg

Medical Advisor

Antwoordnummer 30

7400 VB Deventer

No stamp is necessary

 

If your healthcare provider sends the request on behalf of you, then we would like to know that you agree. This can be done by putting your signature on the application.

 

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