Permission for care

For certain types of care, you need prior written permission from us. Care will only be reimbursed once you have received this authorization. In most cases, your healthcare provider will request this on your behalf. Sometimes, you will need to submit the request yourself.

When do you need our permission?

The list below shows, per type of care, when written authorization is required and what steps you need to take. We aim to respond to all requests within 10 working days. Please note: this list is subject to change. For other types of care, prior authorization may also be required.

Granting permission to someone else

Would you like to authorize someone else to access your information? You can do this using our authorization form.

Privacy

We handle your personal data with care. More information can be found in our privacy statement. Your authorization request will be processed under the responsibility of our medical advisor. Employees handling your request are bound by the same confidentiality obligations as the medical advisor.

Submitting an authorization request

You can email your request for authorization to our medical advisor: toestemming@hollandzorg.nl.

Questions

Do you have any questions? Please feel free to contact our customer service team. They can also connect you with the relevant department.

Permission by type of care

Below are the categories of care for which prior permission is required.

Dental care

You are entitled to dental care. For certain types of dental care, you must obtain written authorization from us before the costs will be reimbursed. This applies to:

Oral care if:
- you have a severe developmental disorder, growth disorder or acquired abnormality of the teeth, jaws or mouth. The disorder or abnormality must be so severe that without oral care you cannot maintain or achieve dental function equivalent to the function you would have had if the disorder or abnormality had not been present.
- you have a non-dental physical or mental condition. The condition must be such that without oral care you cannot maintain or obtain dental function equivalent to the function you would have had if the condition had not been present.
- medical treatment without that dental care will demonstrably have insufficient results and without that other care you cannot maintain or obtain dental function equivalent to the function you would have had if the condition had not been present.
treatment of the jaw joint (gnathological care) in children under the age of 18
autotransplantation of teeth and/or molars in children under the age of 18
3rd or 4th fluoride treatment per year from the moment the permanent teeth erupt in children under the age of 18
panoramic X-ray if the insured person is under the age of 18
tooth replacement care with non-plastic materials if you are under the age of 23
treatments under general anaesthesia
osteotomy and combined orthodontic and osteotomy treatment
the manufacture and fitting of a Mandibular Repositioning Appliance (MRA; snoring and sleep disorder brace) and the associated diagnostics and aftercare by an oral surgeon
the fitting of a dental implant
specialist surgical dental care if hospitalisation is necessary
replacement of dentures within 5 years of placement
care provided by a centre for specialised dentistry.

When applying for care, you must enclose a written and substantiated treatment plan from the care provider, stating, among other things, the medical diagnosis(es) and the performance codes, supplemented with X-rays and any dental models.

Orthodontics in exceptional cases

You are entitled to orthodontic treatment if you have a very serious developmental or growth disorder of the teeth, jaws and mouth. The orthodontic treatment must be necessary to maintain or obtain dental function equivalent to the function you would have had if the disorder had not been present. The disorder or abnormality must be such that co-diagnosis or co-treatment by other forms of care than dental care (multidisciplinary treatment) is necessary.

You must have our written consent before receiving the care. When applying for the care, you must enclose a written and reasoned treatment plan from the care provider, stating, among other things, the medical diagnosis(es) and the performance codes, supplemented with X-rays and any dental models.

First-line in-patient stay

We will reimburse the costs of medically necessary first-line in-patient stay. You must obtain our prior written consent if you wish to stay in an institution that does not have a contract with us.

You can find the healthcare providers contracted by us on our healthcare finder. An application must be submitted to us before the end of the first 3 months of your stay. If we do not have sufficient information, our medical adviser may request additional information and the treatment plan.

Medicinal care

For registered medicinal products listed in Appendix 2 of the Health Insurance Regulations, additional conditions apply to the supply of the medicinal product.

Pharmacy preparations are unregistered medicines that are made in one pharmacy (magistral preparations) and supplied to another pharmacy. These medicines are also referred to as “supplied preparations”. For some pharmacy preparations, you must obtain our written premission before you can receive them. These are listed in the Pharmacy Preparations Reimbursement list.

When applying for permission, you must enclose a copy of the prescription and a report from the treating physician containing the medical diagnosis(es), a description of the current problem and the proposed treatment plan.

You need our prior permission for reimbursement of other registered medicines under the supplementary insurance. When applying for reimbursement, you must enclose (a copy of) the prescription.

Specialised mental healthcare

for medical mental healthcare provided by a non-contracted healthcare provider in combination with admission.
for care in a highly specialised mental healthcare setting provided by a non-contracted healthcare provider. One of the requirements for approval is that we reach a written agreement with yourhealthcare provider for the provision of care. If the application is not submitted by the healthcare provider on your behalf, but by yourself or another representative, then your explicit consent is required for us to contact your healthcare provider in order to reach a written agreement on the provision of care.

Most healthcare providers who are authorised to act as coordinating practitioners are affiliated with the national authorisation portal. Your healthcare provider can request permission digitally via this portal.

Your healthcare provider will receive a response to your application from us via the authorisation portal.

If you visit a healthcare provider who is not affiliated with the national authorisation portal or if you go abroad for treatment, you must request and obtain permission from us yourself before the treatment starts in order to be entitled to care. With each request, you must enclose (a copy of) a report from the coordinating practitioner who is treating you, which includes the medical diagnosis(es), a description of the current problems and the medical necessity for the requested care.

Do you use a mental health care privacy statement? If so, we naturally respect your decision not to disclose the diagnosis to us. However, we do ask you to contact us about sharing data that does not reveal the diagnosis. This data will help us assess your request for consent.

Care abroad

The same conditions apply to your right to care abroad as to your right to care in the Netherlands. This also means that you need permission for the same care as you would in the Netherlands. In addition, you will always need written permission from us in the event of care involving hospitalisation for at least one night. This does not apply in the case of emergency care.

If you opt for treatment abroad, we recommend that you apply for this in advance. That way, you will know in advance what you will be reimbursed.

Medical aids

We have made agreements with a large number of medical aid suppliers regarding the authorisation procedure. If you go to a contracted supplier, they will determine whether permission is required based on the agreements made with us. In most cases, no prior permission is required from our contracted suppliers.

If you choose a non-contracted supplier, you will need our prior permission. The supplier will usually arrange the application for you.

All conditions and the application procedure are laid down in our Medical Aids Regulations.

Medical specialist care (general)

Within specialist medical care, a national list has been drawn up containing the so-called care activities and diagnoses for which you must request written permission. This is called the List of Procedures Requiring Prior Permission. A separate list is available for oral surgery, namely the Exhaustive List of Permissions for Oral Surgery.
Two examples of care for which you must request permission are:

correction of a (drooping) upper eyelid, lower eyelid and/or eyebrow
implantation or replacement of a new (plastic) lens in the eye

Your doctor knows which treatments require permission and which conditions you must meet to be eligible for permission.

Most hospitals are connected to the national authorisation portal. Your doctor can request authorisation digitally via this portal. Your doctor will receive a response to your request from us via the authorisation portal.

If you visit a medical specialist who is not connected to the national authorisation portal or if you go abroad for treatment, you must request permission yourself before the treatment starts. When applying for care, you must enclose a report from the treating doctor containing the medical diagnosis(es), a description of the current problem, the proposed treatment plan (care activity) and, if applicable, relevant photographs.

If we grant permission, it will be valid for one year from the date of issue. The permission may be valid for a shorter or longer period if we have expressly stated this when issuing it.

Rehabilitation care

If you go to a non-contracted healthcare provider for rehabilitation care, you must obtain our written permission before receiving the care. When submitting your request, you must enclose (a copy of) a report from the treating physician containing the medical diagnosis(es), a description of the current problems and the proposed treatment plan (care activity).

If you go to a healthcare provider with whom we have a contract for rehabilitation care, you do not need our prior permission.

Geriatric rehabilitation care

The basic health insurance includes reimbursement for geriatric rehabilitation care for a maximum period of 6 months. If you require geriatric rehabilitation care for longer than this, you will need our written permission for the period beyond 6 months. Please request this permission before the first six months have elapsed.

Please include the following information with your application for care:

the reason why it is not yet possible to return home after a period of 6 months of rehabilitation
the treatment plan for further treatment, including the prognosis for recovery, return to the home situation and the expected duration of further treatment

Ambulance transport

You are entitled to ambulance transport. You must obtain our written permission in two cases before ambulance transport can take place:

transport over a distance of more than 200 kilometres
transport by means other than an ambulance

Permission is not required in cases of emergency care.

When applying for transport, you must enclose a report from the attending physician containing the medical diagnosis(es), a description of the current problems and the reasons for the application.

Patient transport

You are entitled to patient transport. In all cases, you must obtain our written permission before the transport takes place. You must also obtain our prior written permission for reimbursement of accommodation costs. When applying for transport or accommodation, you must include the reason for the application and the prescription. We have a special application form for patient transport that you must complete.

Sensory disability care

District nursing (nursing without in-patient care)

You must obtain our written consent before receiving care:

for reimbursement of nursing and care without accommodation by a non-contracted care provider. You can use the application form for non-contracted district nursing for this purpose.

for reimbursement of this care abroad. When submitting your application, you must enclose a copy of the care plan and a quote for the care, stating the type of care involved, the costs and the period for which the care will be provided abroad.

Personal budget: if you wish to be eligible for a personal budget for nursing and care without accommodation, you will also need permission for this. The conditions for the personal budget are laid down in our Personal Budget Regulations.

Various forms are available for the application. You can find them on our page about the personal budget.