Insurance terms and conditions Menzis Basis Collectief 2021

Dentistry work will be reimbursed up to a maximum amount. This maximum amount is per calendar year:

You will be reimbursed for the membership fee up to a maximum amount. This maximum amount is per calendar year:

You will be reimbursed for therapies up to a maximum amount. This maximum amount is per calendar year:

Menzis is the one that carries the risk of your insurance. Menzis refers to the following: Menzis Zorgverzekeraar N.V. when it involves the Basic Insurance and Menzis N.V. when it involves the additional insurance or the dental insurance. Coöperatie Menzis U.A. is the only shareholder of Menzis Zorgverzekeraar N.V. and Menzis N.V. By taking out the insurance you will become a member of Coöperatie Menzis U.A. as a Menzis insured party. This Cooperation focuses on promoting the interests of its members. Coöperatie Menzis U.A., Menzis Zorgverzekeraar N.V. and Menzis N.V. are non-profit organisations.

Menzis Basis is a Basic Insurance that is meant for everybody who lives in or outside the Netherlands and who must take out a Basic Insurance.

The insurance will become effective on the date that is shown on your healthcare policy. Your insurance will run up to 1 January of the next calendar year. The insurance will be tacitly extended by a year on 1 January for as long as the insurance is not cancelled.

• If your Basic Insurance with Menzis was taken out within 4 months after you were obliged to insure yourself, this Basic Insurance cover will have a retroactive effect up to the day on which you were obliged to take out insurance.
• If your Basic Insurance with Menzis was taken out within a month after you terminated another Basic healthcare insurance, this Basic Insurance will have a retroactive effect up to the day on which your previous healthcare insurance terminated.

If you are the policyholder, you can change your insurance as from 1 January of any year. You can change your voluntary excess or select another additional insurance or dental insurance. Menzis must have received your request no later than on 31 December. You can implement these changes online at Mijn Menzis (MyMenzis). You can also call Customer Service on 088 222 40 40, send an email or complete a change form.

Only the policyholder can cancel an insurance policy through a letter.

• If your email address is on record at Menzis, you can also cancel by email.
• Please clearly specify which insurance you exactly wish to cancel: your Basic Insurance, your additional insurance or your dental insurance. Also please clearly specify to which insured the cancellation applies.

If you are the policyholder, you can:

• always cancel as from 1 January. Menzis must have received the cancellation no later than on 31 December. Insurers have developed a transfer service. This entails that if you take out healthcare insurance by 31 December at the latest for the following calendar year, the new insurer will cancel the Menzis healthcare insurance and, if you specify this, the additional insurance and dental insurance on your behalf,
• cancel the insurance of an insured during the interim period if the insured has taken out a Basic Insurance somewhere else. The cancellation will become effective on the day on which the insured is covered by virtue of another Basic Insurance. The cancellation must have been received prior to this day by Menzis. If the cancellation is received later, the cancelation will start on the first day of the 2nd calendar month after the day on which cancellation took place,
• cancel in the interim period if you have a group insurance with your employer and you wish to participate in the group insurance of a new employer. Menzis must have received your cancellation within 30 days after your new employment has started. The cancellation will apply as from the day on which you are insured by virtue of another Basisverzekering (Basic Insurance) healthcare insurance. The condition that applies is, however, that the cancellation must have been received prior to this day by Menzis. If the cancellation is received later, the cancelation will start on the first day of the 2nd calendar month after the day on which cancellation took place,
• also cancel your insurance if Menzis changes the terms and conditions and the new terms and conditions are disadvantageous not to your advantage. Menzis must have received your cancellation at least one month after you have been informed about the change. The cancellation will become effective as from the day on which the change applies. You cannot cancel the insurance if Menzis is required to change the terms and conditions by law.
• not cancel the Basic Insurance if you have not paid the premium and have been sent a reminder for this unless Menzis has suspended cover of this insurance or has confirmed the cancellation within 2 weeks, cancel the Basic insurance within the first 12 months after the CAK has registered you for an insurance with Menzis. If you can prove that you were already insured with another healthcare insurer during the period mentioned in article 9d, section 1 of the Health Insurance Act, you can declare the Basic Insurance with Menzis null and void. You have to do this within 2 weeks after the CAK has notified you that they have registerd you with Menzis.

Menzis can terminate the insurance if:

• the premium has not been paid; see Article A13,
• you have not given Menzis the full facts or you have provided incorrect information; see Article A24,
• you have not behaved appropriately with regard to Menzis or its staff,
• Menzis takes the insurance off the market and no longer offers it as an option. If the CAK has taken out an insurance policy with Menzis on your behalf, Menzis can declare this policy null and void if it later emerges that the person who the CAK insured did not have an obligation to insure himself or herself at that moment in time.

Your Basic Insurance will terminate automatically on the day after:

• your obligation to insure terminates,
• you die,
• Menzis changes the working area and you live outside this area,
• Menzis may not offer any Basic Insurances anymore.

Your Basic Insurance will end by operation of law on the 1st day of the 2nd month that follows on the day on which you start to live outside the working region of Menzis because of your move. If Menzis changes the working area or is no longer permitted to offer Basic Insurances, MMenzis will inform you about this no later than 2 months before your Basic Insurance terminates.

If you have taken out insurance with Menzis, you can cancel the insurance up to 14 days after receiving your healthcare policy. You do not have to specify a reason when cancelling within this period. This means that you do not have to pay premiums or costs. You will not be reimbursed for costs either. You can cancel the insurance using the same method as specified in Article A6.

• You are obliged to inform Menzis in writing and within 30 days about:
  
  • a change of address,
  • a demise,
  • a change of bank account number,
  • an entrance into active military service,
  • the start and end of a prison sentence,
  • you not longer being eligible to participate in group insurance,
  • you not longer being obliged to have a Basic Health insurance.
• You are also obliged to let us know who is your new healthcare insurer if you have cancelled your insurance with Menzis. Should Menzis come to the conclusion based on the data that you have provided that your Basic Insurance will be terminating or has been terminated, Menzis will immediately inform you about this.
• You are obliged to provide Menzis with the information they request from you, as far as you are able to provide this information. For example, about the reason for hospitalisation, for fraud being investigated or for checking. Should you not cooperate, your entitlement to receive care or to be reimbursed for costs may no longer apply.
• You are obliged to inform Menzis if a third party can be held liable for health care costs reimbursed by Menzis, for example, after a traffic accident or a medical mistake. You can then contact Customer Service at 088 222 40 40 or the Redress department at 050 523 43 77. You can also provide this information online on menzis.nl/klantenservice/schade-melden. Menzis can advise you and recover the loss with the liable party. You are not allowed to come to an arrangement yourself with the liable third party or his or her insurer should this not be to the advantage of Menzis.

A12.1 Premium

• The basis of the premium calculation for the Basic Insurance amounts to € 123 per calendar month as from 1 January 2021. The premium to be paid is the basis of the premium calculation from which any premium discount that may apply has been deducted. You can receive a premium discount due to participating in group insurance and by choosing a voluntary excess. The premium you have to pay is specified on your healthcare policy.
• Up til the age of 18, you do not have to pay a premium for the Basic Insurance. You do need to pay a premium for the Basic Insurance from the first day of the calendar month that follows the calendar month in which you reach the age of 18.
• Menzis must have received your premium before the period to which the premium relates has started.
• You may not settle the premium with a payment that you are expecting from Menzis.
• If you make a payment without stating the Menzis payment reference, Menzis will determine for which payment this applies and should be written off.
• If you do not pay through direct debit or a giro collection form email, you will receive a giro collection form from Menzis. € 2 will be charged for this.
• If you have agreed on a payment arrangement with Menzis, Menzis may charge costs.

A13.1 Basic Insurance and additional insurance

1. Menzis will send you a reminder. If you pay the premium within 14 days after receiving this reminder, your cover will not be affected.
2. Should you not pay within 14 days after this reminder, this will have the following consequences:
   • Menzis can suspend the cover of all insurances. You will no longer receive reimbursements from the start of the period to which the premium not being paid is related,
   • you will continue to be liable to pay the premium,
   • payment discounts will no longer apply,
   • you must pay for the collection costs due to the additional work that Menzis has had to do such as sending a payment slip and reminders and the work of the bailiff,
   • You must pay statutory interest based on the full claim.
3. If Menzis has received the premium, collection costs and the legal interest, the cover offered by the insurance will again be effective the day after your payment has been received. Costs that have been incurred during the suspension will not be paid/ reimbursed. This is also the case should Menzis have granted permission for a treatment or provision.
4. If you do not pay the premium even after having received a reminder, Menzis will terminate the insurance of all insured parties.
5. Menzis may transfer sending reminders and collecting payments to a collection partner. Should the payment have been transferred to a collection partner, Menzis may also transfer new outstanding payments without you receiving a reminder.

Menzis is entitled to change the terms and conditions, the premium and discounts at any given time. If Menzis changes the basis of the premium of the Basic Insurance, this change will not come into effect until 7 weeks have elapsed after the day on which you were informed about the change.

Menzis is entitled to make agreements with your employer or representatives about group insurances. You can participate in a group insurance if you meet the terms and conditions. The premium discount and the different agreements will no longer apply to you from the moment that you no longer meet the terms and conditions for participation in the group insurance. The premium discount and the different group agreements will also no longer apply from the moment that the agreement between your employer or representative and Menzis has terminated. Your insurances will, however, continue to run without premium discounts and different group agreements.

Menzis often pays care providers directly. Sometimes, however, you may receive a bill. You can submit a bill online:

• you can do this on Mijn Menzis, or by using our claims-app,
• a scanned bill will be regarded as an original,
• Menzis may ask you to send in the original bill,
• you must keep the original bill for 3 years.

You can submit a bill by standard mail:

• the original bill must be sent and not a copy, duplicate or reminder,
• bills will not be returned.

If you are unsatisfied about the services Menzis provides, please let Menzis know at your earliest convenience. How should you deal with this situation and to whom should you be submitting it?

You are not entitled to care or a reimbursement for costs if they are a result of an armed conflict, revolts, civil war, national riots, insurrection and/or mutiny. These 6 specified forms of damage as well as the definitions of this can be found in the text that has been filed under number 136/1981 by the Verbond van Verzekeraars (Dutch Association of Insurers) in the Netherlands on 2 November 1981 with the registry of the district court in The Hague.

If you need care due to an act of terrorism, the following applies regarding the Basic Insurance:

If the Nederlandse Herverzekeringsmaatschappij voor Terrorismeschaden N.V.(NHT) expects the total loss that will be claimed due to such acts in any calendar year from non-life, life or funeral services (benefits in kind for funerals) insurers to which the Dutch Financial Supervision Act applies, will be higher than the maximum amount reinsured by this company per calendar year, you will only be entitled to care or the reimbursement thereof up to a percentage of the costs or value of the care or other services to be determined by the NHT which is equal for all insurances. It is possible that after a terrorist act an additional amount is provided to Menzis based on Article 33 of the Dutch Care Insurance Act or Article 3.16 of the Healthcare Insurance Decree. If this is the case, you will be entitled to the provisions with regard to which the scope is established in the scheme as referred to in Article 33 of the Dutch Care Insurance Act or Article 3.16 of the Healthcare Insurance Decree as well as the provisions as referred to in the first sentence of this article.

Menzis cannot be held liable for damages that you suffer as the result of any action or omission of a care provider whose care you have used. Any liability on Menzis’ part for damages as a result of Menzis’ own shortcomings is limited to the amount of the costs that would have been charged to Menzis should the insurance have been executed correctly.

You are not entitled to the reimbursement of costs that you are charged if you have missed an appointment with your care provider.

If you or the policyholder deliberately mislead Menzis, you are no longer entitled to reimbursement. Menzis will then also have the right to terminate all your insurances. The amounts that Menzis may already have paid either to yourself or directly to the care provideras a direct result of the deception, must be paid back. You must also pay Menzis for the incurred investigation costs. Menzis will report you and your data will be registered. This will be done in the registers in accordance with the Insurance and Criminality Protocol (Protocol Verzekeraars en Criminaliteit) of the Dutch Association of Insurers.

• You have entrusted us with your personal data such as your name, address and date of birth. Menzis will deal with your data carefully. Your personal data will be used for taking out and executing your insurance. Menzis also uses your personal data for executing legal obligations and statistical analyses. Menzis also uses your personal data to inform you about products and services that may be of interest to you. Should you wish to examine your data or if you do not wish to receive information about our products and services, please let us know in writing. More information is provided on the website.
• The Code of Conduct for Dutch Healthcare Insurers applies to processing personal data. Menzis keeps to the rules of the Code of Conduct. Material control, processing medical data and fraud investigation are performed as defined in the Code of Conduct.
• Other parties are also involved and not just Menzis when executing your insurance such as care providers or a factoring agency (debt collecting agency) that collects outstanding amounts. It is sometimes necessary that Menzis provides these people with your personal data and that they provide your personal data to us to ensure your insurance is correctly executed. It is assumed that you have given your permission to this.
• If you claim online for a bill, Menzis shall be entitled to check with the care provider to verify that this care provider has sent the bill to you. It is assumed that you have given your permission to this.
• Menzis will include your personal public service number (BSN) in its administration. Your care providers, other care service providers and Menzis use your personal public service number in all forms of communication.

• The date on which you were treated, medication has been prepared or an aid delivered is the determining factor for the reimbursement and the excess. The date on which the bill has been issued or paid is unimportant with regard to this.
  If the treatment is funded through a Diagnosis Treatment Combination (DBC), the opening date of the DBC-care product is the determining factor for reimbursement. For a DBC-care product which was opened in 2021 and closed in 2022 you will therefore be reimbursed according to 2021 terms and conditions.
• You grant Menzis the authorisation to reclaim amounts that have been paid but to which you were not entitled.
• If you visit or call Menzis and Menzis makes a verbal promise, you can ask Menzis to confirm this promise in writing. A verbal promise that is not confirmed in writing will be deemed not to have been made.
• Dutch law applies to the insurance.

The general terms and conditions (2) only apply to the additional insurance and the dental insurance. The Dutch text is binding should any disputes arise from the interpretation of the text.

If you are the policy holder and you cancel the Basic Insurance, you can have your Menzis additional insurance and dental insurance continued or cancelled as from the same date.

Menzis can cancel the additional and dental insurance when:

• you take up residence in another country than the Netherlands, or
• you are staying for more than 12 months in another country than the Netherlands, or
• Menzis takes the relevant additional or dental insurance off the market and no longer offers it as an option.

If you are a policyholder and you change your additional or dental insurances successively for another Menzis additional or dental insurance, this will not interrupt the insurance period. Not even when this change is because you or other insured listed on the healthcare policy sheet will be participating in a group insurance or the participation in such insurance ends. Nor after suspension of cover due to non- payment. An existing term for reimbursement will then not restart. The insurance period will, however, be interrupted if you end the additional and dental insurances and you do not successively take out a Menzis additional or dental insurance.

• Menzis N.V. has authorised Menzis Zorgverzekeraar N.V. to collect the premium for the additional insurances and dental insurances and possibly also other payments (such as personal contributions) on its behalf. Even when a bailiff is called in or legal proceedings are started.
• Menzis can charge a personal contribution from the policyholder or the insured who is involved.
• For the additional insurance of someone who is not yet 18 years old, no premium has to be paid. For a dentist insurance of someone who is not yet 10 years old, no premium has to be paid. This only applies if there is another person on the same policy who does pay premium for this insurance (or a more extensive one). People who have a JongerenVerzorgd insurance have to pay premium, regardless of their age.

Menzis will accept you without medical selection for the additional insurances and dental insurances. Additional insurance with more extensive cover than for one of the insured specified on the healthcare policy who is 18 or older cannot be requested for children younger than 18. An adult premium will then be charged for the child.

The additional insurance and dental insurance do not offer cover for costs for losses that are already being reimbursed based on another insurance that may or may not be of a later date or an Act, a treaty, an agreement or some other provision.

The additional insurance and dental insurance do not offer cover for costs for losses that would already have been reimbursed based on another insurance that may or may not be of a later date or an Act, a treaty, an agreement or some other provision if you had not taken out the additional insurance or dental insurance.

If you rely on the additional or dental insurance while you could rely on another insurance or provision, for example, travel insurance, you must inform Menzis about this other insurance or provision.

When terrorist acts are involved, the following will apply to the additional insurance and dental insurance. You are not entitled to care or reimbursement of costs if these are the result of terrorism, malicious infection or preventive measures to avert the danger of terrorism or malicious infection. This will be different if these costs are reinsured with the Dutch Terrorism Risk Reinsurance Company. The Clauses Sheet Terrorism Cover is a part of the insurance and can be consulted through menzis.nl or terrorismeverzekerd.nl and will be sent to you upon request.

Care or the reimbursement of the costs related to care as a result of a nuclear reaction is not covered by the additional and dental insurances. A nuclear reaction is deemed any nuclear reaction where energy is released such as nuclear fusion, nuclear fission and artificial or natural radioactivity.

Menzis may reject the application to conclude an additional or dental insurance if (this is not an exhaustive list):

• you still need to pay premiums for another insurance with Menzis,
• you have committed (insurance) fraud.