Specialist mental health care
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.
Nationally, field agreements for mental healthcare are established by representatives of the government, healthcare providers, health insurers and patients. The care provider must provide the care in accordance with nationally established field agreements. You can view and download the nationally determined field agreements at www.zorgprestatiemodel.nl.
If you turn 18 in the year 2021 and you receive care at that time from a coordinating practitioner with a post-Master registration in the register of the Youth Quality Register Foundation (Stichting kwaliteitsregister Jeugd (SKJ)) or BIG register (usually a remedial educationalist or child and adolescent psychologist who is registered as a child and adolescent psychologist registered in the Netherlands Institute of Psychologists (NIP)), these care providers may continue to provide care as a coordinating practitioner for a maximum period of 365 days, starting from the day after the day on which you turn 18.
The healthcare provider must have a valid quality standard, based on the quality standard that is included in the Register of Quality Standards and Measuring Instruments of the National Health Care Institute and must comply with the quality standard. We make agreements with contracted care providers about the quality and deployment of the coordinating practitioner.
In the case of non-contracted care, when submitting the invoice, we check, among other things, whether the deployment of the coordinating practitioner has been provided in accordance with the applicable quality standard. If necessary, we request additional information. Partly on the basis of this information, we decide on the reimbursement of the costs of care.
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.
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.
Reimbursement payable by your health care insurance
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|
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.
No statutory personal contribution
There is no statutory personal contribution for specialist mental health care.
If you are aged 18 or older, the costs count towards compulsory excess.
Where can you go?
The following care providers can provide specialist mental healthcare as the coordinating practitioner:
- clinical psychologists;
- a clinical neuropsychologist;
- 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.
If you will reach the age of 18 in JaartalEno 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.
You must obtain our written authorisation, prior to you receiving the care:
- for the medicine Esketamine nasal spray (Spravato);
- for care in the setting of highly specialist mental healthcare with a non-contracted care provider. One of the requirements for authorisation is that we come to a written agreement with your care provider for the provision of the healthcare. If the application is not submitted by your care provider on your behalf but by yourself or another representative, we need your explicit permission to contact your care provider in order to reach written agreement about the provision of the care;
- for specialist mental healthcare by a non-contracted care provider in combination with a stay;
- for specialist mental healthcare in combination with a stay for the second consecutive year and the third consecutive year, every year.
You must enclose a (copy of the) Checklist for prolonged medically necessary stay (GZZ) (PDF) with your application.
Each time you apply for care, you will need to send us a copy of a report from the attending coordinating practitioner with the medical diagnosis/diagnoses, a description of the current problem and the medical need for the requested care.
You can send a request for permission to:
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.
Also view the Reimbursements 2022.
The information on this page is a brief outline of the reimbursement. You can only derive rights from our insurance conditions.