Survey of reimbursements for 2019 - IAK Uniek Health Care Insurance

 
Survey of reimbursements for 2019 - IAK Uniek Health Care Insurance
Survey of reimbursements
for 2019
IAK Uniek Health Care Insurance
Three steps to your Unique Health Care Insurance
1 Choose one of the 3 basic insurances
 IAK Zorg Plan Selectief                                                      IAK Zorg Plan Natura                                                        IAK Zorg Plan Restitutie

    Choice of a select number of contracted care providers                      Broad selection of contracted care providers                               Free choice of care providers
    100% reimbursement for planned care at a limited number                     100% reimbursement at all contracted care providers                        Visit any hospital in the Netherlands in case of an emergency
     of hospitals and all contracted care providers                              Visit any hospital in the Netherlands in case of an emergency              Reimbursement of 100% of statutory rate or rate
    Visit any hospital in the Netherlands in case of an emergency               Do you visit a non-contracted care provider?                                in line with the market
    Do you visit a non-contracted care provider?                                 > Reimbursement of 75% of the average contracted rate                      Higher premium
     > Reimbursement of 75% of the average contracted rate                       Good price / quality ratio
    Lowest premium

2 Optional: choose your supplementary health care package
 Jong                                         Compact                                       Compleet                                      Extra                                         Comfort
                                                                                                                                          compleet
 Main reimbursements:                         Main reimbursements:                          Main reimbursements:                          Main reimbursements:                          Main reimbursements:
 • Physiotherapy €250                         • Full reimbursement for                      • Orthodontic treatment (up to 18)            • Full reimbursement for                      • Physiotherapy €1,500
 • Alternative care €200                        emergency care abroad                         one-off €1,000                                emergency care abroad                       • Alternative care € 750
 • Glasses and contact lenses €50 / 3         • Preventive care: €100                       • Ample reimbursement for                     • Preventive care: €200                       • Glasses and contact lenses €250 / 3 years
   years                                                                                      maternity care                              • Ample reimbursement for                     • Full reimbursement for
 • Full reimbursement for                                                                   • Full reimbursement for                        maternity care                                emergency care abroad
   emergency care abroad                                                                      emergency care abroad                       • Orthodontic treatment                       • Convalescent home / health resort
 • Preventive care: €200                                                                    • Preventive care: €150                         18– > 100%, 18+ > €1,000 once                 €1,250 / 3 years
                                                                                                                                                                                        • Hearing aids €750
                                                                                                                                                                                        • Preventive care €200

3 Optional: choose your desired toppings with these 3 supplementary insurances
                                              Physiotherapy      Off 200 300 400            Physiotherapy      Off 400 550 700            Physiotherapy       Off 700 850 1000
                                              Alternative care   Off 100 250 400            Alternative care   Off 400 550 650            Alternative care    Off 650 750 85
                                              OptiekPlan             Off On                 OptiekPlan              Off On                OptiekPlan                 On
                                                                                            Extrazorg               Off On
                                                                                            Childbirth care         Off On

                                                                                                                                                                                                                                      2
Reimbursements                         Basic insurance (in conformity with                     Jong                         Compact                      Compleet                      Extra Compleet                Comfort
                                       statutory provision under Zvw for 2019)
Medical care
General practitioner care
this also includes: assistance to      
stop smoking, foot care in case of
diabetes mellitus, health advice and
preconception care

Specialist medical care                                                                                                                                  - sterilisation              - sterilisation
this also includes: care provided by     (subject to medical necessity)
                                       No reimbursement for:
thrombosis service, second opinion,
                                       - anti-snoring treatment
haemodialysis at a dialysis centre,
                                       - sterilisation (man/woman)
chronic intermittent artifical
                                       - sterilisation reversal (man/woman)
respiration and the necessary
equipment, ‘stop smoking’
programme

Rehabilitation
this also includes: oncological        
rehabilitation, quick scan and
geriatric rehabilitation

Heredity tests
                                       
IVF and fertility-stimulating          - 3 attempts up to age 43 (incl. ICSI and
treatments                                medicines)
                                       - other fertility treatments if medically indicated
                                          (incl. medicines)
                                       - sperm freezing
                                       - ovum/embryo freezing in relation to oncological
                                          treatment

Audiological care
examination of hearing capacity,       
hearing aid advice

Plastic/reconstructive surgery         - correction of mutilations, congenital and other                                                                Subject to prior permission   Subject to prior permission
                                          malformations, subject to specific medical                                                                     - correction of protruding   - correction of protruding
                                          indication                                                                                                        ears                          ears
                                       - eyelid/abdominal wall corrections, subject to
                                          specific indication and prior permission
                                       - primary sexual characteristics, subject to medical
                                          indication.

Transplantation of tissue/organs
                                         (if within EU-EEA member state including
                                       donor’s expenses)

Second opinion                                                                                 a second opinion             a second opinion             a second opinion              a second opinion              a second opinion
                                        (for care under basic insurance provided by
                                       medical specialist)
                                                                                               performed by Royal Doctors   performed by Royal Doctors   performed by Royal Doctors    performed by Royal Doctors    performed by Royal Doctors

Chain care
(care programmes) for diabetes         
mellitus type 2, COPD,
cardiovasculair risk management and
asthma

                                                                                                                                                                                                                                                  3
Reimbursements                     Basic insurance (in conformity with                  Jong    Compact               Compleet              Extra Compleet              Comfort
                                   statutory provision under Zvw for 2019)
Psychological care
General basic mental health care
from age 18                        
(first-line mental health care)

Specialist mental health care
from age 18                        
(second-line mental health care)

Psychiatric hospitalisation
from age 18                        
Neurofeedback treatment                                                                                                                     €1.000; treatment must
for children with ADHD/ADD                                                                                                                  be done by NIP-affiliated
                                                                                                                                            psychologist

Paramedical care
Physiotherapy and remedial         up to age 18: full reimbursement if chronic1,        € 250   choice of toppings:   choice of toppings:   choice of toppings:         € 1.500
therapy                            if acute 1 - 18 sessions per diagnosis.                      - € 400               - € 700               - € 1.000
physiotherapy for adults and       From age 18: reimbursement from 21st session                 - € 300               - € 550               - € 850
children, oedema therapy, Cesar/   in case of treatment of chronic disorders1;                  - € 200               - € 400               - € 700
Mensendieck remedial therapy and   first 9 sessions of pelvic floor therapy relating            - no reimbursement    - no reimbursement    - no reimbursement
pelvic                             to urinary incontinence; 37 treatments of
floor therapy                      physiotherapy to treat leg pain caused by stage II
                                   intermittent claudication (restricted blood supply
                                   to the legs); first 12 remedial therapy treatments
                                   for osteoarthritis on hip and knee joints; COPD
                                   exercise therapy (maximum number of treatments
                                   depending on the severity of the condition)

Speech therapy
                                   
Podotherapy                                                                             € 100   € 100                 € 125                 € 125                       see reimbursement for
                                                                                                                                                                        alternative care

Ergotherapy                        10 treatment hours

Dietary advice                     medically focused information on diet and eating
                                   habits: 3 hours per year

                                                                                                                                                                                                4
Reimbursements                       Basic insurance (in conformity with                       Jong                              Compact                       Compleet                         Extra Compleet                   Comfort
                                     statutory provision under Zvw for 2019)
Oral health care
Dental care                          up to age 18: full reimbursement for named                - from age 18: € 250             dental care costs following   - up to age 18: € 500 for       - up to age 18: € 750 for       dental care costs following
                                     treatments                                                   (if insured)                   an accident: € 10,000 per        brdiges and crowns               brdiges and crowns            an accident: € 10,000 per
                                     (limitative list, see terms and conditions²);             -d  ental care costs following   accident (subject to prior       (to Zvw provision)               (to Zvw provision)            accident (subject to prior
                                     (deferred) front tooth replacement with implants             an accident: € 10,000 per      permission)                   - dental care costs following   - dental care costs following   permission)
                                     from 18 to 23                                                accident (subject to prior                                      an accident: € 10,000 per        an accident: € 10,000 per
                                                                                                  premission)                                                     accident (subject to prior       accident (subject to prior
                                                                                                                                                                  premission)                      premission)

Dental surgery from age 18
                                       for dental surgery carried out by dental
                                     surgeon with the exception of placement of
                                     implants, gum treatment and uncomplicated
                                     extractions

Dental care and orthodontic
treatment in special cases             for dental care (incl. any implants and technical
                                     costs) and orthodontic treatment in case of
                                     specific medical indication. In some cases
                                     an individual contribution will apply.

Prosthetic devices from age 18       - 75% of the cost of a full set of removable
                                        dentures (including technical costs)
                                     - fully removable dental prosthesis on implants
                                        (incl. technical costs) in case of severely shrunken
                                        toothless jaw. Click tight dentures on implants:
                                        10% for lower jaw, 8% for upper jaw
                                     - 90% of the cost of repairing and rebasing (fitting)
                                        full prosthesis

Oral health care/orthodontic treatment
Orthodontic treatment                                                                                                                                          € 1.000
(teeth alignment) up to age 18                                                                                                                                 for entire insurance term        
Note! A waiting period of one year
may apply for this reimbursement.

Orthodontic treatment                                                                                                                                                                           € 1.000
(teeth alignment) from age 18                                                                                                                                                                   for entire insurance term
Note! A waiting period of one year
may apply for this reimbursement.

                                                                                                                                                                                                                                                               5
Reimbursements                          Basic insurance (in conformity with                    Jong                        Compact                       Compleet                        Extra Compleet                  Comfort
                                        statutory provision under Zvw for 2019)
Pharmaceutical care
Medicines
                                          in accordance with Health Care Insurance
                                        Regulations and the Pharmaceutical Care
                                        Regulations (an individual contribution applies
                                        to some medicines (with a maximum of € 250.00
                                        per year), and in some cases prior permission is
                                        required)

Contraceptives
such as contraceptive pill,               up to age 21 (an individual contribution
                                        applies to some pills/devices)
contraceptive implant, diaphragm,
ring or pessary
                                        from age 21 reimbursement only in case of              from age 21                from age 21                  from age 21                    from age 21
                                        treatment of endometriosis or menorrhagia              (no reimbursement for the   (no reimbursement for the     (no reimbursement for the       (no reimbursement for the
                                        resulting in aenemia                                   individual contribution)    individual contribution)      individual contribution)        individual contribution)

Dietary preparations
                                          in accordance with Health Care Insurance
                                        Regulations and the Pharmaceutical Care
                                        Regulations (subject to specific medical indication)

Medical aids
Medical aids and bandaging aids
                                          in accordance with Health Care Insurance
                                        Regulations and the Medical Aids Regulations
                                        (an individual contribution and/or maximum
                                        reimbursement applies to some
                                        medical aids)

Individual contribution                                                                                                    individual contribution       - hearing aid € 250             - hearing aid € 500             - hearing aid € 750
to medical aids                                                                                                            under Zvw € 150               - wigs € 125                   - wigs € 200                   - wigs
                                                                                                                                                                                                                              € 300
(in accordance with Health Care                                                                                                                          (if insured)
Insurance Regulations)

Special medical aids                                                                                                                                     - hand or finger splint for    -h and or finger plint for     - hand or finger plint for
                                                                                                                                                            short-term use: 2 per year     short-term use: 2 per year       short-term use: 2 per year
                                                                                                                                                         - support pessary, incl.      - support pessary, incl.        - support pessary, incl.
                                                                                                                                                            fitting                      fitting                         fitting
                                                                                                                                                            (if insured)                 - simply mobility aids: € 110   - simply mobility aids: € 110

Glasses, including                                                                             € 50 per 3 years            OptiekPlan (if insured)       OptiekPlan (if insured)         OptiekPlan                      € 250 per 3 years
frames/contact lenses                                                                                                      € 100 per year over 3 years   € 100 per year over 3 years     € 100 per year over 3 years
(OptiekPlan: incl. laser eye surgery)

Arch supports                                                                                                              € 100                         € 125                           € 125                           € 125

Stay in an institution
Hospital-based nursing
                                        
Primary care stay                       in institutions under the responsibility of the
(with a medical indication)             general practitioner: full reimbursement

Stay in hospice                                                                                                                                          € 35 per day                    € 35 per day                    € 35 per day

                                                                                                                                                                                                                                                         6
Reimbursements                      Basic insurance (in conformity with                    Jong   Compact   Compleet                     Extra Compleet               Comfort
                                    statutory provision under Zvw for 2019)
Nursing and care
Home-based nursing and care
(can be in the form of a personal   
budget)

Care for people with a sensory handicap
Multidisciplinary care relating
to a visual, auditory or            
communicative handicap

Childbirth and maternity care
Childbirth                          - at home or in (contracted) birthing centre:
                                       full reimbursement                                                     of individual
                                                                                                            contribution (if insured)
                                                                                                                                           of individual
                                                                                                                                         contribution
                                    - outpatient/short-stay delivery (without medical
                                       necessity): € 215 per day for mother and
                                       child together (€ 250 minus € 35 individual
                                       contribution to maternity care in hospital)
                                    - outpatient/short-stay delivery (with medical
                                       necessity): full reimbursement

Prenatal screening                  counselling, examination, test
                                    (subject to medical indication)

Maternity care                      - at home or in (contracted) birthing centre:
                                       max. 10 days (individual contribution of € 4.40                        of individual
                                                                                                            contribution (if insured)
                                                                                                                                           of individual
                                                                                                                                         contribution
                                       per hour applies) applications for maternity care
                                       at home via Aon Customer Service Health Care
                                    - in hospital (without medical indication): max.
                                       10 days (individual contribution of € 35 per day
                                       applies to mother and child together)
                                    - in hospital (with medical indication):
                                       full reimbursement

Maternity package via Aon
                                                                                                            (if insured)                
Multiple births                                                                                             € 200 once only for 2nd      € 200 once only for 2nd
                                                                                                            and subsequent children      and subsequent children
                                                                                                            (if insured)

Lactation care                                                                                              € 115 per delivery           € 200 per delivery
                                                                                                            (if insured)

Maternity care in case of                                                                                   up to 12 hours spread over   up to 12 hours spread over
adoption                                                                                                    max. 4 days for insured      max. 4 days for insured
                                                                                                            mother (if insured)          mother

Incubator-based aftercare                                                                                   12 hours (if insured)        12 hours

Maternity courses                                                                                           € 75 (if insured)            € 100

                                                                                                                                                                                7
Reimbursements                        Basic insurance (in conformity with                  Jong                        Compact                     Compleet                    Extra Compleet               Comfort
                                      statutory provision under Zvw for 2019)

Patient transport
Transport by ambulance
                                      
Seated patient transport                                                                                               - other indications         - other indications         - other indications          - other indications
                                        for taxi and lowest class of
                                      public transport; private vehicle € 0.30 per km:
                                                                                                                       - individual contribution   - individual contribution   - individual contribution    - individual contribution
                                                                                                                                                                               - private vehicle: € 0.10   -p rivate vehicle: € 0.10
                                      in case of indication relating to haemodialysis,
                                                                                                                                                                                  per km extra                per km extra
                                      oncological treatment, wheelchair use, limited
                                      vision, intensive child care or chronic condition:
                                      individual contribution of € 103; >200 km
                                      permission required

Care mediaton
Care and waiting list mediation       mediation in case of unacceptably long waiting
                                      time via Health Care Advice department and help
                                      with looking for a new general practitioner or
                                      dentist following a house move

Abroad
Emergency assistance
                                        based on Dutch or prevailing market rates
                                      (permission via SOS International required)
                                                                                                                                                                                                        
Non-urgent                                                                                                                                                                     max. 200% of the Dutch       max. 200% of the Dutch
(predictable) care                       based on Dutch rates
                                      (prior permission required)
                                                                                                                                                                               rate in Belgian and German   rate in Belgian and German
                                                                                                                                                                               hospitals.                   hospitals.

Assistance during stay abroad                                                              via SOS International       via SOS International       via SOS International       via SOS International        via SOS International
This includes: repatriation of                                                             alarm centre                alarm centre                alarm centre                alarm centre                 alarm centre
the sick/injured from abroad

Alternative care
Alternative medicine and special                                                           € 200                       choice of toppings:         choice of toppings:         choice of toppings:          € 750
remedies                                                                                   € 40 per day                - € 400                     - € 650                     - € 850                      € 40 per day
these include the following:                                                                                           - € 250                     - € 550                     - € 750
acupuncture and other traditional                                                                                      - € 100                     - € 400                     - € 650
Eastern remedies, anthroposophy,                                                                                       - no reimbursement          - no reimbursement          - no reimbursement
homeopathy, natural remedies,
psychosocial care and certain forms                                                                                    € 40 per day                € 40 per day                € 40 per day
of alternative movement-related
therapy

Homeopathic and                                                                            € 200 on doctor’s           € 125 on doctor’s           € 250 on doctor’s           € 500 on doctor’s            € 500 on doctor’s
anthroposophic remedies                                                                    prescription, supplied by   prescription, supplied by   prescription, supplied by   prescription, supplied by    prescription, supplied by
(counted together with                                                                     pharmacy                    pharmacy                    pharmacy                    pharmacy                     pharmacy (exceptional
reimbursement for alternative                                                                                                                                                                               reimbursement)
treatments)

                                                                                                                                                                                                                                         8
Reimbursements                     Basic insurance (in conformity with                    Jong                      Compact                   Compleet                       Extra Compleet                 Comfort
                                   statutory provision under Zvw for 2019)

Skin therapy
Skin therapy: camouflage,                                                                 € 150                     - a cne therapy:         - acne therapy:               - acne therapy:               - a cne therapy:
facial epilation for female                                                                                           € 150 per year             € 250 per year                 € 300 per year                € 300 per year
insured persons, peeling in case                                                                                    - camouflage: € 100 per   - camouflage: € 200 per        - camouflage: € 250 per        - camouflage: € 250 per
of severe acne                                                                                                      year                      year                           year                           year
(subject to referral by gp or                                                                                       - epilation: € 150 once   - epilation: € 250 once        - epilation: € 570 once        - epilation: € 570 once
medical specialist and performed
by designated skin therapist or
beautician)

Pedicure for rheumatism
patients and diabetics with care                                                                                                                                                                          
profile 1

Preventive care
Preventive courses                                                                        preventive care budget:   preventive care budget:   preventive care budget:        preventive care budget:        preventive care budget:
                                                                                          € 200                     € 100                     € 150                          € 200                          € 200
Vaccinations/medication in
connection with foreign travel
(not business-related)

Sports medicine advice /
sports medicine

Stopping smoking’ programme        via GP, medical specialist or clinical psychologist,
                                   aimed at behavioural change and including
                                   support medication

Personal Health Check                                                                                                                         €50 (NIPED)                                                   €50 (NIPED)

Other
Replacement informal care                                                                                                                                                    5 days                         10 days

Informal care broker                                                                                                                                                         € 250                          € 500

Combined lifestyle intervention
(GLI) aged 18 and over             
Anti-stuttering therapy            treatment at various anti-stuttering centres or
                                   by specialist speech therapist (see terms and
                                   conditions)

Menopause consultant                                                                                                                                                         € 160 once only

Overnight stay facility                                                                                                                       cost of overnight stay for     cost of overnight stay for
                                                                                                                                              parents if child under age     parents if child under age
                                                                                                                                              18 is in hospital € 35 per     18 is in hospital € 35 per
                                                                                                                                              day with a maxium of           day with a maxium of
                                                                                                                                              € 500 per year                 € 500 per year

Childcare in case of                                                                                                                          €200 per year, starting on     €200 per year, starting on
hospitalisation parent                                                                                                                        day 4 of the hospitalisation   day 4 of the hospitalisation

                                                                                                                                                                                                                                      9
Dental care insurance               € 350                                                € 500                                                € 950                                                  € 1.900
 Reimbursement of costs of           reimbursement up to € 350                            reimbursement up to € 500 per year for:              reimbursement up to € 950 per year for:                reimbursement up to € 1.900 per year for:
 dental care for insured persons     per year for:                                        - C (consultations)/second opinion/                 - C (consultations)/second opinion/                   - C (consultations)/second opinion/
 aged 18 and upwards                 - C (consultations)/second opinion/                    M (oral hygiene)/V (fillings)/                       M (oral hygiene)/V (fillings)/                         M (oral hygiene)/V (fillings)/
                                        M (oral hygiene)/V (fillings)/                       H (extractions) - codes: 100% of statutory rate      H (extractions) - codes: 100% of statutory rate       H (extractions) - codes: 100% of statutory rate
                                        H (extractions) - codes: 100% of statutory rate   - other treatments: 80% of statutory rate            - other treatments: 80% of statutory rate              - other treatments: 80% of statutory rate
                                     - other treatments: 80% of statutory rate

 Ziekenhuis Ontzorg Pakket
 Nursing in a hospital                                                                    € 70 per nursing day or reimbursement of excess          In the column ‘Basic insurance (in conformity with statutory provision under
                                                                                          costs for extra facilities, service, and comfort         Zvw for 2019)’ the insured care is named, but the level of the reimbursement can
                                                                                          up to € 200 per nursing day
                                                                                                                                                   depend on the type of basic insurance and the care provider you have chosen.
 Transportation by taxi relating to admission to/discharge from hospital                  4 journeys per admission

                                                                                                                                                   1   In accordance with Health Care Insurance Decree, chronic indications appendix 1.
 Home help in case of hospital admission                                                  10 hours per admission

                                                                                                                                                   2   In accordance with Health Care Regulations. These include preventive examinations, scaling,
 Childcare in case of hospital admission of parent                                        € 20 per child under age 13 per working day
                                                                                          from 4th day of admission, 60 working days                   sealing, anaesthetics, repairs (fillings), prosthetics, surgical treatment and X-rays.

Excess and individual contribution
Excess and/or statutory or voluntary individual contribution are always deducted before reimbursement of
health care costs is made. In 2019, a mandatory excess of € 385 applies to certain health care costs under the
basic insurance. You can increase this amount with a voluntary excess up to a maximum of € 885 per year.

Excess applies to almost all care that falls under your basic insurance. It does not apply to general practitioner
care, maternity care or care for children under the age of 18. You never pay excess on care that falls under
your supplementary insurance.                                                                                                                      All amounts mentioned in this list are the maximum reimbursements per
                                                                                                                                                   insured person for the policy year 2019.
In addition to excess, you sometimes pay an individual contribution as well, e.g. for certain medicines or aids.
The government determines which care is subject to an individual contribution and the level of this
                                                                                                                                                                     
                                                                                                                                                   If you see a “ ” in the reimbursement list, this care is covered by the insurance.
                                                                                                                                                   This is based on care provided by a contracted or designated care provider.
contribution. An individual contribution can be applied to care under both the basic insurance and the
supplementary insurance.                                                                                                                           This survey has been compiled with the greatest possible care, and is provided
                                                                                                                                                   for your information. However, no rights may be derived from it. For precise
                                                                                                                                                   details of the reimbursements, you should always refer to the insurance terms
For more information, see our website or the policy terms and conditions.                                                                          and conditions on iak.nl/zorg or contact Customer Service at (040) 261 18 88.

                                                                                                                                                                                                                                                          10
ZV-VERG-UNIEK IAK ENG (2019)

                               Aon Nederland C.V.
                               Postbus 90165, 5600 RV Eindhoven | Beukenlaan 70, 5651 CD Eindhoven | t +31(0)40 261 19 11 | e info.iak@aon.nl | www.iak.nl

                               Aon Nederland C.V. is registered with AFM under number 12009529. Aon Nederland C.V. has its registered office in Rotterdam and is registered with the Dutch Chamber of Commerce
                               under number 24061634.
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