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.

Field agreements

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.

Transitional arrangement

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.

Quality standard

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.

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.

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.