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Non-contracted care 

We enter into contracts with a large number of healthcare providers throughout the Netherlands, so that you can always visit a healthcare provider with whom we have a contract. In these contracts, we set out agreements regarding the quality, accessibility and effectiveness of care.
If you visit a non-contracted healthcare provider, we have no agreements regarding the care you receive. This means that we will need to carry out additional checks before we pay the bill. We do this because we want to ensure that the care provided is eligible for reimbursement under the policy conditions and that it was of sufficient quality..

Are you entitled to reimbursement?

You will not automatically receive reimbursement for non-contracted care. There are rules governing this. These are set out in the policy conditions and in our reimbursement overview. This also states whether you are required to pay an excess or a personal contribution.

Please note that for non-contracted care:

  • You must always apply for prior authorisation for district nursing, for specialist mental healthcare during a stay in a mental healthcare institution, and for rehabilitation care during a stay in a rehabilitation institution.
  • You may not be reimbursed for the full amount of the bill. Check the maximum amount you will be reimbursed via our rate lists.
  • You must first pay the invoice to your care provider. You then claim the cost from us.
  • It is not possible to submit a so-called deed of assignment to us whereby you transfer the claim (the reimbursement you are owed by us) to your care provider.
  • We may ask for further information in response to your claim to check whether the care provided to you meets the insurance conditions.
  • The time it takes for us to settle the invoice may be longer.
  • Even at a non-contracted pharmacy, you will only be reimbursed for medicines from the preferred manufacturers on our list of preferred medicines. So please check carefully whether your medicine is on this list and whether it is supplied by the preferred supplier.
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The benefits of contracted care

We have agreements in place with a large number of healthcare providers, healthcare institutions and suppliers. You can find these in our care finder.
Here are the benefits for you:

  • The invoice will be fully reimbursed if you are entitled to this under the policy conditions.
  • You do not need to pay the invoice in advance. The contracted healthcare provider will claim the invoice directly from us.
  • We make agreements with the healthcare providers we have contracted regarding, among other things, quality, accessibility and efficiency. Read more about our healthcare procurement here.
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Barrier to non-contracted care (hinderpaal in Dutch)

Do you feel that the level of the maximum reimbursement for non-contracted care makes it effectively impossible for you to access that care? If so, we refer to this as a barrier. In that case, you can send us a request to grant a higher reimbursement for that non-contracted care.  You can submit the request via the contact form on our website. You must specify which non-contracted care is involved, when the care starts and why you believe there is a practical barrier to using the care. We will contact you within 5 working days of you submitting the contact form.