Survey of reimbursements for 2020 - Uniek Health Care Insurance - Iak
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Survey of reimbursements for 2020 Uniek Health Care Insurance
Unique Health Care Insurance
1 Choose one of the 3 basic insurances
Basis Budget (Selectief) Basis Zeker (Natura) Basis Exclusief (Restitutie)
P Choice of a select number of contracted care providers P Broad selection of contracted care providers P Free choice of care providers
P 100% reimbursement for planned care at a limited number P 100% reimbursement at all contracted care providers P Visit any hospital in the Netherlands in case of an emergency
of hospitals and all contracted care providers P Visit any hospital in the Netherlands in case of an emergency P Reimbursement of 100% of statutory rate or rate
P Visit any hospital in the Netherlands in case of an emergency P Do you visit a non-contracted care provider? in line with the market
P Do you visit a non-contracted care provider? > Reimbursement of 75% of the average contracted rate P Higher premium
> Reimbursement of 75% of the average contracted rate P Good price / quality ratio
P 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 emergency care abroad • Alternative care € 750
• Glasses and contact lenses €50 / • Preventive care: €100 • Ample reimbursement for • Preventive care: €200 • Glasses and contact lenses €250 / 3 years
3 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 • Hearing aids €750
• Preventive care: €200 • Preventive care: €150 18– > 100%, 18+ > €1,000 once • Preventive care €200
3 Optional: choose your desired toppings with these 3 supplementary insurances
Physiotherapy Physiotherapy Physiotherapy
Alternative care Alternative care Alternative care
OptiekPlan OptiekPlan OptiekPlan On
Extrazorg
Childbirth care
2Reimbursements Basic insurance (in conformity with Jong Compact Compleet Extra Compleet Comfort
statutory provision under Zvw for 2020)
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
3Reimbursements Basic insurance (in conformity with Jong Compact Compleet Extra Compleet Comfort
statutory provision under Zvw for 2020)
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
4Reimbursements Basic insurance (in conformity with Jong Compact Compleet Extra Compleet Comfort
statutory provision under Zvw for 2020)
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.
5Reimbursements Basic insurance (in conformity with Jong Compact Compleet Extra Compleet Comfort
statutory provision under Zvw for 2020)
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
6Reimbursements Basic insurance (in conformity with Jong Compact Compleet Extra Compleet Comfort
statutory provision under Zvw for 2020)
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: full reimbursement
- outpatient/short stay or in birthing centre of individual
contribution (if insured)
of individual
contribution
(without medical necessity): € 219 per day
for mother and child together (€ 255 minus
€ 36 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 € 4.50 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 € 36
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 max. 10 days (there is an individual contribution
adoption of € 4.50 per hour)
Incubator-based aftercare 12 hours (if insured) 12 hours
Maternity courses € 75 (if insured) € 100
7Reimbursements Basic insurance (in conformity with Jong Compact Compleet Extra Compleet Comfort
statutory provision under Zvw for 2020)
Patient transport
Transport by ambulance
Transport (seated patient - other indications - other indications - other indications - other indications
transport) in case of: private vehicle € 0.32 per km, public transport
(lowest class) 100% or (multiple person) transport
- individual contribution - individual contribution - individual contribution - individual contribution
• renal dialysis - private vehicle: € 0.10 -p rivate vehicle: € 0.10
by taxi 100%, except for the statutory patient
• oncological treatment involving per km extra per km extra
contribution of €105
radiotherapy or chemotherapy
If 3 or more consecutive travel days are involved,
• geriatric rehabilitation care
you can choose to have your accommodation
• visual handicap (impaired vision)
expenses reimbursed rather than the transport
• dependence on wheelchair
costs. Accommodation is reimbursed at
• intensive childcare
€75 a night.
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)
8Reimbursements Basic insurance (in conformity with Jong Compact Compleet Extra Compleet Comfort
statutory provision under Zvw for 2020)
Skin therapy
Skin therapy: camouflage, € 150 - a cne therapy: - acne therapy: - acne therapy: - a cne therapy:
facial epilation, peeling in case € 150 per year € 250 per year € 300 per year € 300 per year
of severe acne (subject to referral - c amouflage: € 100 per - camouflage: € 200 per - camouflage: € 250 per - c amouflage: € 250 per
by gp or medical specialist and year year year year
performed by designated skin - epilation: € 150 once - epilation: € 250 once - epilation: € 570 once - epilation: € 570 once
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
Course informal care
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
Medical care by a geriatric
specialist or a physician
specialised in those with an
intellectual disability
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
9Dental 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 2020)’ 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 2020, 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 2020.
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.
10ZV-VERG-UNIEK ENG (2020)
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.You can also read
