Chapter III: Health careChapter III: Health care
LegislationLaw of 1 November 1941.
Health Insurance Act (ZFW): Law of 15 October 1964.
Exceptional Medical Expenses Act (AWBZ):
Law of 14 December 1967 introducing general insurance for serious risks.
BeneficiariesHealth Insurance Act (ZFW):
All persons under 65 in paid employment.
Recipients of social security benefits up to the age of 65.
Persons of 65 or older when insured under the Health Insurance Act before reaching the age of 65.
Option for persons of 65 or older if taxable household income is below HFL 35,550 (ECU 15,960).
Exceptional Medical Expenses Act (AWBZ):
All residents.
Non residents liable to Dutch wages and salaries tax in connection with employment in the Netherlands.
Health Insurance Act (ZFW):
Insured persons under 65:
HFL 62,200 (ECU 27,934) per year,
Exceptional Medical Expenses Act (AWBZ):
No ceiling.
Subject to certain conditions covered under the Health Insurance Act can be extended to the partner (up to the age of 65) of an insured person (subject to the insured person being the breadwinner) and children (depending on their being largely maintained by the insured person).
Insurance under the Health Insurance Act (ZFW):
Beneficiaries of incapacity pensions if the incapacity is over 45 %
Beneficiaries of widows' or orphans' pensions.
Beneficiaries of unemployment benefits calculated to 70 % of reference earnings if they were member of the compulsory scheme.
ConditionsNo qualifying period required.
Entitlement to care subject to registration with a health insurance fund.
From beginning of illness.
Unlimited.
Physiotherapy: entitlement to Physiotherapy of 9 treatments per indication per year.
OrganisationAll doctors qualified to practise with whom a health insurance fund has entered into a contract.
Direct payment of fees by the sickness fund: Flat-rate per insured person according to the system of lists (family doctor principle).
Public hospitals: Rates fixed by the public authority.
BenefitsFree choice of doctor (twice a year) by registering with a doctor who has entered into contract with a health insurance fund.
Benefit in kind: No fees. Direct payment (flat-rate per insured person) by the health sickness fund.
Share borne by insured person: 20% of the costs with a maximum of HFL 200 (ECU 90) per year. Exceptions are made for doctor, dentist, obstetric care and medical care during confinement. For certain categories of people (pensioners/ low income) the maximum share borne is HFL 100 (ECU 45) per year. Under the Exceptional Medical Expenses Act (AWBZ) a share must be borne by insured persons over 18, for nursing home care with a maximum of HFL 3,150 (ECU 1,414) per month.
Free choice among hospitals or institutions approved by the Minister of Health.
No share borne by the beneficiary in the lower class of accommodation. Admission must be authorised by the health insurance fund.
Duration of benefit: as long as indicated (after a year taken over by cover under the Exceptional Medical Expenses Act AWBZ).
See "Hospitalisation".
No benefits.
Comprising dental care for children including preventive maintenance work, fluoride applications up to twice a year from the age of six, sealing, periodontal care and surgical treatment.
Comprising for adults preventive dental care (check up at least one a year), dentures and specialist surgical treatment.
Registration of insured person with a chemist who entered into contract with the health insurance fund.
Benefit in kind. Insured person is entitled to a qualitatively good package of medicines without it being necessary to make additional payment. Besides this medical package medicines can be supplied and charged to the health insurance funds up to the average price per standard dosage of medicines which belong to a certain classified medical package, with an additional payment to be paid by the insured himself.
Subject to prior approval of health insurer. No cost sharing except for:
Artificial breasts: payment of cost in excess of maximum HFL 390 (ECU 175).
Orthopaedic shoes: share in cost of HFL 106 (ECU 48) per year up to age 16; HFL 211.50 per year (ECU 95) for age 16 and over.
Spectacles and contact lenses: After first purchase entitlement without cost-sharing only on specific medical indication.
Hearing appliances: payment of cost in excess of HFL 1,249.50 (ECU 561).
Wigs: payment of cost in excess of HFL 540.50 (ECU 245).
Transport of patients by ambulance, taxi or private car: share in the cost of HFL 147 (ECU 66) per 12 months.
Maternity care:
home maternity care: HFL 3.15/ per hour (ECU 1.4) contribution.
in a maternity clinic or a hospital (without a medical indication): HFL 24.50 (ECU 11) per day for mother and child each, plus the cost in excess of HFL 355,50 (ECU 160) per day
Haemodialysis.
Services for patients with chronic recurring respiratory problems.
Services of thrombosis prevention unit.
Services of a genetic testing centre.
Care and nursing for the physically disabled and mentally handicapped.
Services of a home nursing association.
Rehabilitation.
Psychiatric care (clinical or non clinical, Regional Institute for Out-patient Mental Health Care, sheltered accommodation etc.).
Physiotherapy: entitlement to physiotherapy of 9 treatments per indication per year.
Vaccinations.