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Health insurance in The Netherlands for expats

6/6/2015 Koen - Zorgwijzer Health Insurance

Expats that are living and/or working in the Netherlands are usually required to take out basic health insurance to cover the costs of (unexpected) medical care, such as consulting a General Practitioner (GP), medication and hospital treatment. Optionally, additional insurance, such as coverage for dental care, is available at a higher monthlt premium. This FAQ discusses several questions related to health insurance for expats residing in the Netherlands.

When are expats required to obtain a Dutch health insurance?

Expats are obliged to obtain a health insurance in The Netherlands when they:
Have a (part-time) job or paid traineeship in The Netherlands And/or:
Live in The Netherlands and do not have a job abroad

Family members must also take out health insurance unless they have a job outside The Netherlands.

NOTE: an exception is made for students under the age of 30 that are temporally in The Netherlands for study purposes only. Please refer to the infographic below for specific information about their insurance status.

Upon arrival in The Netherlands expats must choose and close a basic Dutch private health insurance within four months after their residence permit commences. Optionally, they may select a supplemental insurance. It is not possible to take a health insurance without a residence permit.

How does the Dutch health care system work? The Dutch healthcare system consists of several compartments:
1. Short-term medical care, for example, consulting a GP, hospital treatments, medication, certain therapies and mental care
2. Long-term medical care for elderly, people with disabilities or chronically diseased
3. Supplementary health care, for instance, physiotherapy, dental care and alternative medications/treatments

Only 1 and 2 are part of the mandatory basic health insurance. Supplementary health care is paid out of pocket or insured via a supplementary private health insurance.

General Practitioner (GP)

The GP is the first contact point when you become ill or other health problems arise. The GP will provide an examination and may prescribe medication that can be collected at the pharmacy. If this does not suffice, the GP can refer to specialists, institutions and hospitals for further examinations, treatments and care. After taking a health insurance it is important to register with a doctor’s practice nearby as finding a GP when you become ill, will often be difficult. When a GP is not available a doctors post (huisartsenpost) can be contacted for matters that can be resolved without hospital care.

Medication

Registering to a local pharmacy is also highly recommended as prescription medications can only be collected there. Hospitals Hospitals in The Netherlands are usually nearby and provide a high level of care. Some hospitals are specialized in certain treatments or areas. The GP will refer you to the right hospital except if emergency medical care is required. In that case hospital care will be immediately available by calling 112.

Insurance companies and healthcare providers

Health insurance companies sign contracts with healthcare providers, such as hospitals, clinics and therapists. Healthcare providers that have a standing agreement with the health insurance company are referred to as ‘contracted healthcare providers’. Reimbursements may be lower when care or treatment is supplied by a healthcare provider that does not have a standing agreement with the insurer. The reimbursement percentage mainly depends on the chosen policy
Which health insurance plans are available and what do they cover? The Dutch basic health insurance has identical cover, regardless of the chosen health insurer. However, the different health insurers may have slight changes in their policies’ terms and conditions. Furthermore, the basic health insurance can be expanded by selecting a supplemental health insurance.

Coverage
Basic health insurance covers the most essential medical care. It includes:
Visits and treatments by a GP Medication (prescribed medicines only)
Certain medical aids and health programs
Hospital treatments and consultations with a specialist
Hospital stays Midwifery (birth-care)
Mental care
Physiotherapy for people with chronic diseases/conditions
Basic dental care (under the age of eighteen)
Emergency medical care abroad up to the Dutch tariffs
Speech-language pathology

Additional coverage
If desired, supplemental health insurance is available. These optional insurance plans may cover a wide range of extras, such as acupuncture, homeopathy, vaccinations, pedicure, orthodontics and dental care for adults.

Policies
In general there are three main types of basic health insurance:
Naturapolis
This is the most common policy and has average premiums. Policy holders with a ‘naturapolis’ may choose from a wide range of contracted hospitals and clinics. Usually most healthcare providers have a standing agreement with the insurer. Reimbursement is around 50 to 75 percent when a policy holder decides to go to a healthcare provider that does not have a standing agreement with the insurer.
Budgetpolis
The budgetpolis is generally the cheapest option for basic health insurance. However, there are often several limitations regarding choice of healthcare providers. For most ‘budget’ policies, plannable treatments, such as a knee operation or cancer treatment is only available in a selection of contracted hospitals. In other words, the choice of health care providers is generally lower compared to the regular naturapolis. Reimbursement is around 50 to 75 percent when a policy holder decides to go to a healthcare provider that does not have a standing agreement with the insurer.
Restitutiepolis
The restitutiepolis usually offers a slightly wider choice of contracted healthcare providers. Moreover, the reimbursement percentage in case of non-contracted healthcare is up to 100 percent. The downside of the restitutiepolis is a higher premium.

Comparing
When comparing and choosing a health insurance it is recommended to study the policy terms and conditions carefully. If necessary, ask a Dutch speaking friend or colleague to assist you. Also see: http://www.zorgwijzer.nl/zorgvergelijker/english 

How much does a Dutch health insurance cost?
Healthcare in The Netherlands is funded by means of income tax, premium and deductibles. Lower incomes may apply for financial support to pay their health insurance bills.

Income tax
Employers pay a percentage of their employees’ income to the tax payer (6,95 percent in 2015) with a maximum income of 51.414 euro. Employers, freelancers and people with their own company pay 4,85 percent of their income with the same maximum. In addition, everyone pays 9,65 percent of their income (with a maximum of 33.589 euro) in order to fund long-term medical care.

Premiums
Premiums are paid directly by each person to the chosen health insurance company. The amount depends on the chosen healthcare policy, deductible excess and selected supplemental coverages (if applicable). The average premium in 2015 is about 98 euro per month.

Deductible excess
Everyone that has basic health insurance has a standard, obligatory deductible excess of 375 euro’s (2015). This amount is to be paid when medical cost are made by the insurance policy holder. The health insurer will start to reimburse when the deductible excess is fully paid for. In some cases direct reimbursement is applicable, for example, when consulting a GP, for midwifery, supplemental care and health care for those below eighteen years old. The deductible excess can be increased with a maximum of 500 euro. This lowers the monthly premium about 15 tot 25 euro depending on the insurance company. However, this also means that the deductible excess is 875 euro instead of 375. Zorgtoeslag (compenstation for health insurance premium) 

If your income is lower than 26.000 euro per year you may be eligible for financial support for the health insurance premium. This is called ‘zorgtoeslag’ in Dutch. Contact the tax payer (via belastingdienst.nl) for more information.

Source: http://www.zorgwijzer.nl/faq/expats