Insurance terms and conditions Menzis Basis Vrij 2020

Which care?

The terms and conditions as specified below for the different care types in the insurance terms and conditions apply to care abroad. You are entitled to care provided by a foreign care provider contracted by Menzis. If care is provided by a non-contracted care provider, you will be reimbursed for the costs of care that you would receive in the Netherlands from a non-contracted care provider. If you are residing or staying in another EU/EEA country or Treaty Country and not the Netherlands, you can choose from:

• right to care in accordance with the statutory scheme of that country,
• right to care from a care provider contracted by Menzis, or
• reimbursement of costs for care from a non-contracted care provider that you would be reimbursed if you would receive care from a non-contracted care provider in the Netherlands.

This choice will also be available to you if you reside in another EU/EEA country or Treaty Country and are staying in the Netherlands or another EU/EEA country or Treaty Country temporarily. If you reside or are staying in a country that is not an EU/EEA country or Treaty Country, you will be entitled to the reimbursement of the costs of care that you would be given in the Netherlands by a non-contracted care provider.

Permission

For hospital care abroad, that is to say medical care with admission in an institution of at least one night in another country than the country where you reside, you will require prior permission from Menzis. Call the Menzis Care Advisor on 088 222 40 40 for more information. Prior permission is not required when care is needed while you are abroad and the care involved cannot be deferred in all reasonableness until you return to the Netherlands.

Additional information

You can find additional information about care abroad on menzis.nl/buitenland.

Which care?

You are entitled to the reimbursement of costs of :

• hearing disorder investigation,
• advice about hearing aids to be purchased,
• information provision about the use of the aids,
• psychosocial care when you are having problems with regard to the affected hearing,
• assistance when making a diagnosis with regard to speech and language disorders with regard to a child.

Which care provider?

You can visit an audiological centre for audiological assistance.

Referral

You are only entitled to the reimbursement of costs of audiological assistance when you have a written referral from your general practitioner or medical specialist (paediatrician or throat, nose and ear specialist).

Additional information

Would you like more information about hearing aids? Hearing aids are part of Medical aids. More information can be found in the Insurance Rules and Regulations and the Health Insurance Regulations. These rates can be found by visiting menzis.nl.

Which care provider?

You can visit a dietician who is earmarked as “Quality Registered” in the Paramedic Quality Register with regard to this care. You can find this register on kwaliteitsregisterparamedici.nl.

Referral

No referral is required when you visit a contracted dietician who is immediately available for consultation. For this purpose can see whether a dietician can be accessed immediately in the Paramedic Quality Register.

In the following cases, a prior written referral from your general practitioner, medical specialist or youth healthcare doctor is always required, or from your company doctor when the complaints are related to your work:

• when you visit a contracted dietician who is not immediately available for consultation,
• when you visit a non-contracted dietician,
• when you visit a dietician who works at a hospital, care home or rehabilitation centre,
• when you want dietetics outside of the dietician’s practice, except for treatment at home.

Welke zorg

You are entitled to the reimbursement of costs of polymer, oligomer, monomer and modular dietary preparations. You will only be entitled to the reimbursement of costs of dietary preparations when you cannot manage on an adjusted normal diet and/or other special diet products and if you:

• suffer from a metabolic disorder,
• suffer from a food allergy,
• suffer from a resorption disorder,
• suffer from a illness-related malnutrition determined through a validated screening instrument or are at risk of suffering from this, or
• are dependent on dietary preparations in accordance to the guidelines that have been accepted by the relevant professional groups in the Netherlands.

Which care provider?

For dietary preparations, you can visit a dispensing chemist’s, a general practitioner with dispensing facilities or a supplier of dietary preparations.

Treatment advice

You require treatment advice from a general practitioner, a medical specialist or a dietician.

Maximum period

You are entitled to the reimbursement of costs of dietary preparations for at most a month for each prescription.

Permission

If you use a contracted care provider, you should hand over a medical certificate completed by your general practitioner, medical specialist or dietician together with the prescription. If the indication conditions have been met, you will immediately be given the dietary preparations. If you use a care provider who has not concluded a contract with Menzis you will require prior permission from Menzis. You can in this case use a Menzis request form for pharmaceutical care. With the form you must enclose a written well-founded explanation from the doctor who is treating you. You can find the request form by visiting menzis.nl.

Which care?

You are entitled to the reimbursement of costs of stay during the 24 hours that are required medically in relation to medical care as general practitioners usually offer. You are also entitled to the related required nursing, care and paramedical care. Your admittance is insured for an uninterrupted period of 1,095 days. An interruption of a maximum of 30 days is not considered to be an interruption but does not count for the calculation of the 1,095 days. An interruption due to weekend or holiday leave does, however, count.

Which care provider?

Primary care institution takes place at an institution that is accredited under the Care Institutions (Accreditation) Act (WTZi) as an institution for nursing and care or is accredited as an institution for nursing, care and treatment.

Indication and permission

You are only entitled to the reimbursement of costs of staying in a primary care institution if you have a prior written indication from your general practitioner, medical specialist (who can delegate this to a transfer nurse), geriatric specialist, doctor for the mentally challenged or social worker. If the stay is for a period that is longer than 6 months, you will require prior permission from Menzis. Your treating physician (GP, geriatric specialist or doctor for the mentally challenged) can request this permission on your behalf.

Which care?

You are entitled to the reimbursement of costs of :

• central diagnostics, coordination and registration of supplied blood and bone marrow preparations,
• the examination into and of inherited defects by means of genealogical tests, chromosome tests, biochemical diagnostics, ultrasound and DNA tests,
• hereditary advice and the psychosocial supervision related to this care,
• testing of other people should this be necessary to provide advice. Advice can also be provided to the other people.

Which care provider?

You can visit a centre for genetic testing for this type of testing. This is an institution holding a permit pursuant to the Dutch Special Medical Procedures Act [Wet op de bijzondere medische verrichtingen (Wbmv)] for the application of clinical genetic research and advice on matters concerning hereditary diseases.

Referral

You are only entitled to the reimbursement of costs of genetic testing when you have a written referral from your general practitioner or medical specialist issued in advance.

Which care?

You are entitled to the reimbursement of costs of at most 10 treatment hours of occupational therapy per calendar year when the objective is stimulating and restoring your ability to care for yourself and your ability to live independently.

Which care provider?

You can visit an occupational therapist who has the entry of “Quality Registered” in the Paramedic Quality Register. You can find this register on kwaliteitsregisterparamedici.nl.

Referral

You do not need a referral if you visit a contracted occupational therapist who is available immediately. You can find out whether an occupational therapist is available immediately in the Paramedic Quality Register.

In the following cases, a prior written referral from your general practitioner, medical specialist or youth healthcare doctor is always required, or from your company doctor when the complaints are related to your work:

• when you visit a contracted occupational therapist who is not immediately available for consultation,
• when you visit a non-contracted occupational therapist,
• when you visit an occupational therapist who works at a hospital, care home or rehabilitation centre.

Which care?

Registered medication

With the exception of the excluded products referred to under the header ‘Preference policy’, you are entitled to the reimbursement of costs of all medication that the Minister of the Dutch Ministry of Health, Welfare and Sport has included in the insurance package. Which medication has been included can be found in Annex 1 of the Healthcare Insurance Rules and Regulations. You can consult the Health Insurance Regulations and annexes by visiting overheid.nl. If you want to find out whether a specific medication is on the list, you can also contact our Customer Service on 088 222 40 40.

Non-registered medication

You are entitled to the reimbursement of costs of medication that is prepared in the dispensing chemist’s itself. You are also entitled to the reimbursement of costs of medication that your doctor orders for you for use if this medication is prepared by a manufacturer in the Netherlands as referred to in Article 1, paragraph 1, mm of the Dutch Medicines Act. If an order of medication is involved that is not available on the Dutch market but is available in another country, this is only allowed if you are suffering from an illness that does not occur more than 1 time in every 150,000 residents in the Netherlands. In all cases this must involve a rational pharmacotherapy. That is to say, the treatment is taking place with a medication form that is suitable for the patient regarding which the effectiveness and efficacy has been demonstrated based on scientific literature and which also is the most economical for the healthcare insurance.

Advice and support

The advice and the support by the person who has made the medication available are included in this care.

Preference policy

All medication has an active ingredient. You are entitled to the reimbursement of costs of all active ingredients that are present in the medication listed in annex 1 of the Health Insurance Regulations. Often, different medications with the same active ingredient are available on the market. You will only be entitled the reimbursement of costs of to some medicines with the same active substance and the same form of administration to those medicines that are indicated by Menzis. These are the preferred medications. The Insurance Rules and Regulations list and on menzis.nl/preferentiebeleid for which active ingredients preferred medication has been indicated and which medication this involves. It may be the case in exceptional cases that treatment with a preferred medication is not medically safe. In such cases you are entitled to the reimbursement of costs of receive a different medication from Annex 1 of the Health Insurance Regulations. You can consult the Health Insurance Regulations and the annexes by visiting overheid.nl.

Preferred medication

If treatment with a preferred medication is not justifiable medically and, therefore, you wish to use another, non-preferred medication, you require prior permission from Menzis. If you visit a dispensing chemist’s with which Menzis has a contract in place, the pharmacist will immediately give you the medication when you submit a prescription signed by a doctor on which the doctor has written “Medisch noodzakelijk” (Medically Required) or “MN” (MR). The same applies when you submit a declaration completed by your Municipal Health Service, dentist, medical expert, obstetrician or a Municipal Health Service doctor together with the prescription. If you visit a dispensing chemist’s with which Menzis has not concluded a contract in place, use the Pharmaceutical Care Request Form to ask permission from Menzis. Enclose the motivated explanation of your doctor with this form.

If medication is involved that you are using for the very first time, you will also be entitled to the reimbursement of costs of the medication for the first 15 days without Menzis’ permission. You must, however, submit your request for permission at Menzis within those 15 days. If you do not submit the request on time or if the use of the preferred medication is justifiable at Menzis’ discretion, you will no longer be entitled to be reimbursed for the non-preferred medication after the 15th day has elapsed.

Indication

You will only be entitled to reimbursement of the costs of certain medication when you have an indication that is described in the legal regulations. You can find information about these medications and indications in Annex 2 related to the Health Insurance Regulations. You can consult the Health Insurance Regulations and annexes by visiting overheid.nl. Other conditions also apply to some medicines that are specified in Annex 2. These conditions are specified in the Insurance Rules and Regulations. You can find the Insurance Rules and Regulations on menzis.nl or you can request them from Menzis Customer Service on 088 222 40 40.

Location where administered

Some drugs may only be administered and/or given in a hospital when the relevant medication needs to be taken except when Menzis has given permission for the drugs to be administered or given elsewhere. These drugs are listed in table 2 of the Insurance Rules and Regulations. The drugs that are listed in table 3 of the Insurance Rules and Regulations may only be administered and/or given in a hospital when required. Administration or giving outside the hospital is not insured. The Insurance Rules and Regulations also define what is understood by a hospital.

Minimum and maximum supply period for medicines

The doctor’s prescription and the prescribed quantity of medicine is guiding for the quantity of medicine supplied by your pharmacy, unless this exceeds the abovementioned quantities. Another reason may be that the shelf life of a medicine means that you are only supplied with part of the medicine. The pharmacist will always discuss this with you.

• In case of a newly prescribed medicine, you will be supplied with medicine for 15 days. Or you will receive the smallest medicine package. You will receive the smallest package of the preferred medicine if it concerns a medicine to which the preference policy applies.
• Contraceptive pills are subject to a delivery term of 3 months for a newly prescribed medicine. A term of 6 or 12 months, to be decided by the insured person in consultation with the pharmacist or the pharmacist’s assistant, also applies.
• Medicines that are more expensive than €1,000 per month are supplied for a period of at most 1 month after they have been issued. HIV medication may be supplied for a period of at most 3 months after an adjustment period of 3 months.
• At least 3 months and at most 6 months for all medicines you have to take for a prolonged period of time (for chronic use). At least 3 months and at most 12 months for generic medicines and medicines included in Menzis’ preference policy (for chronic use).
• 1 month for sleeping pills and sedatives.
• A period of 15 days applies in principle in case of medicine use during intensive care at home (pharmaceutical care during the palliative and terminal phase). A custom arrangement may also be concluded in consultation between the insured person, the doctor or general practitioner, district nurse and the pharmacist.
• At least 1 month for all other cases.

Personal contribution

You may have to pay a personal contribution. All medicines that you are entitled to be reimbursed for can be found in Annex 1 of the Health Insurance Regulations. This Annex has a section A and a section B. All medicines for which a reimbursement limit has been set can be found in section A. If you use medication that costs more than the reimbursement limit, you need to pay the part that is higher than the limit. This also applies when the medication that you use is prepared from a medication that costs more than the reimbursement limit. If the medication can be found in section B, there is no reimbursement limit.

Exclusions

You are not entitled to the reimbursement of costs of medication:

• in the cases specified in the Health Insurance Regulations,
• in the case of there being a risk of becoming ill when travelling,
• for tests as referred to in Article 40, third paragraph, b, of the Dutch Medicines Act,
• that are equivalent or virtually equivalent to any non-designated, registered medicine, unless the medicine is included in Appendix 3, part A, of the Healthcare Insurance Regulations,
• which are included in Appendix 3, part B, of the Healthcare Insurance Regulations,
• as referred to in Article 40, third paragraph, e, of the Dutch Medicines Act.

Which care provider?

You can visit a dispensing chemist’s or a general practitioner with dispensing facilities for medication.

Prescription

You require a prescription from a general practitioner, dentist, medical specialist, obstetrician, company doctor or Municipal Health Service doctor. Or from a geriatric specialist if you are staying in a first-line care facility (ELV).

Permission

For some medication you will require prior permission from Menzis. The specific medication that is involved has been specified in the Insurance Rules and Regulations in table 1. Your doctor can complete a doctor’s declaration related to this medication. There are special forms for this. They can be found by visiting znformulieren.nl. If you visit a dispensing chemist’s with which Menzis has a contract with this doctor’s declaration, the chemist will assess whether you are entitled to the reimbursement of costs of this medication. You do not have to first ask Menzis’ permission. If you decide to use a dispensing chemist’s for the medication with which Menzis has not concluded a contract in place, you must ask prior permission from Menzis.

Which care?

You are entitled to the reimbursement of costs of :

• general medical care except the flu jab,
• laboratory tests, representational diagnostics and function tests requested by a general practitioner,
• medical specialist care that borders on to the general practitioner medicine domain regarding which Menzis and the general practitioner have made agreements,
• care for mental disorders. The general practitioner arranges for the initial support in case of mental disorders and assesses whether he/she can treat you himself/herself or if you should be referred to the general basic mental healthcare (GBGGZ) of the specialist mental healthcare (SGGZ),
• chain care that is paid by applying the policy rule that has been defined based on the Dutch Healthcare (Market Regulation) Act for GP Care and multidisciplinary care. Visit menzis.nl/zorgvinder to find out with which general practioners Menzis has made these
• agreements. Chain care is a care programme especially developed for people who suffer from type 2 diabetes, COPD (Chronic Obstructive Pulmonary Disease) and VRM (Vascular Risk Management) in which multiple care providers participate to better harmonise the care. Visit menzis.nl for more information.
• a combined lifestyle intervention (GLI) that has been assessed as proven effective by the National Institute for Public Health and Environmental Protection (RIVM) and has been included in the list that can be found at Loketgezondleven.nl, if you have a moderate or strongly increased weight- related health risk (in ac cordance with the obesity care standard: BMI of 25 or higher with an increased risk of a chronic affliction or BMI higher than 30). This must have been established by a general practitioner or medical specialist. You can find the obesity care standard at zorginzicht.nl.

• Medical Care for Specific Patient Groups (GZSP) provided by a Geriatric Specialist or a Doctor for the Mentally Handicapped.

Which care provider?

You should consult a general practitioner for general medical care. General practitioner care can also be provided by a care provider who works under the responsibility of a GP such as, for example, a doctor’s assistant, nurse practitioner, somebody who supports the practice or a care provider with whom Menzis has made agreements about the general practitioner care. You can visit the GP out-of hours surgery or the general practitioner who is on call in the evenings, nights or during the weekend for GP care related to critical emergency issues. Ask your GP about which GP is on duty or to which GP station you can go. You will also find information on vereniginghuisartsenposten.nl.

For laboratory, representational diagnostics and function tests requested by a general practitioner you can go to a first-line diagnostics centre, a production group practice, a hospital or an independent treatment centre.

To have an IUD placed (to prevent pregnancy) you can also visit a obstetrician.

For the purpose of the Combined Lifestyle Intervention (GLI), you can apply to:

• a lifestyle coach who is registered in the BLCN register. BLCN stands for Beroepsvereniging Leefstijl Coaches Nederland (Professional Association of Lifestyle Coaches in the Netherlands).
• a paramedic (dietician, physiotherapist or exercise therapist) with the indication of lifestyle coach in the relevant register (the Central Quality Register or the Paramedic Quality Register),
• a partnership (such as a dietician and a physiotherapist) trained in the performance of the CLI designated as proven effective by RIVM.

If you have any questions concerning the GLI, please call the Menzis Care Advisor at 088 222 40 40.

You can visit a podiatrist for preventive foot care outside the care pathway for diabetes mellitus.

If you require GZSP you can visit a Geriatric Specialist or a Doctor for the Mentally Handicapped.

Foot care referral with regard to diabetes mellitus

You are only entitled to the reimbursement of costs of foot care when you have a written referral from your general practitioner or medical specialist issued in advance.

Referral combined lifestyle intervention (GLI)

You are only entitled to the reimbursement of costs of combined lifestyle intervention if you have obtained a written referral from your general practitioner or medical specialist in advance.

Referral Medical Care for Specific Patient Groups

You are only entitled tothe reimbursement of costs of Medical Care for Specific Patient Groups if you have obtained a written referral from your general practitioner or medical specialist in advance.

Please note: The mandatory excess applies.

Which care?

You are entitled to the reimbursement of costs of functional aids that the Dutch Minister of Health, Welfare and Sport has included in the insurance package. Which aids these are can be found in the Health Insurance Regulations. Some groups of medical aids are described specifically in the Health Insurance Regulations while others are described based on their function. In the last case, this means that you are entitled to a medical aid that fits in with a described function restriction. Menzis has included an overview of medical aids in its Insurance Rules and Regulations that fall under the Health Insurance Regulations. Menzis has also set further conditions in the Insurance Rules and Regulations with regard to obtaining these medical aids.

Do you require a medical aid that belongs to function-based aids but this medical aid is not included in the Insurance Rules and Regulations? In this case, submit a request with Menzis. Menzis will assess your request. The assessment criteria are also included in the Health Insurance Regulations that you must meet to be entitled to the medical aid. You can find the Health Insurance Regulations and the Insurance Rules and Regulations by visiting menzis.nl. If you want to know whether a specific medical aid is on the list, you can also contact our Customer Service on 088 222 40 40.

Personal contribution

A (percentage) statutory personal contribution or a maximum reimbursement applies to certain medical aids. You can find out from the Health Insurance Regulations whether this is the case and how much the personal contribution or maximum reimbursement will be. You pay the personal contribution to the supplier. The statutory personal contributions and maximum reimbursements can also be found in the Insurance Rules and Regulations.

Which care provider?

You can approach a supplier of medical aids in order to receive these. They are listed for each medical aid in the Insurance Rules and Regulations. You can also call Customer Service on 088 222 40 40.

Permission

Whether permission from Menzis is required is specified in the Insurance Rules and Regulations for each medical aid. This may involve the first issue but also replacements, corrections or repairs to the medical aid. You do not require permission from Menzis for most medical aids that are supplied by a contracted supplier. The supplier will assess your application. If the supplier is unsure whether Menzis will issue or reimburse the medical aid, the supplier will pass on the application to Menzis for permission.

Use of the medical aid

If you expressly damage the medical aid or if it is damaged because the medical aid has not been cared for properly due to you, you will not be entitled to a replacement, correction or repair of the medical aid before the use duration as specified in the Insurance Rules and Regulations has elapsed. If you have the medical aid on loan and you have expressly damaged it or if it is damaged because the medical aid has not been cared for properly by you, Menzis is entitled to recover the costs from you.

Which care?

Your age will determine what you are entitled to exactly. Ask your care provider to inform you well before you start the treatment or ask the Menzis Care Advisor on 088 222 40 40.

Younger than 38

You are entitled to the reimbursement of costs of the 1^st, 2^nd and 3^rd IVF attempt per pregnancy to be realised. You are only entitled to the reimbursement of costs of the 1^st and 2^nd IVF attempt per pregnancy to be realised when a maximum of 1 embryo is placed back in the uterus. With the 3^rd attempt a maximum of 2 embryos may be placed back in the uterus.

Age of 38 up to the age of 42

You are entitled to the reimbursement of costs of the 1^st, 2^nd and 3^rd IVF attempt per pregnancy to be realised. With each attempt a maximum of 2 embryos may be placed back in the uterus per attempt.

Which care provider?

You can visit an IVF centre for IVF treatment that has the authorisations that are required by law for this purpose.

Referral and permission

You will only be entitled to the reimbursement of costs of IVF if you have a prior written referral from your medical specialist.

Additional information

A full IVF attempt consists of the following 4 phases:

1. you are given hormones that stimulate the maturation of egg cells in your body,
2. next, the follicular puncture takes place (fertilised egg cells are harvested),
3. the egg cells are fertilised and embryos are incubated in a laboratory,
4. finally, 1 or 2 embryos are implanted in the uterus once or multiple times.

An attempt will only be deemed an attempt when a successful follicular puncture has taken place. Only an attempt that has ended between the moment that a follicular puncture was successful and the moment that a continued pregnancy is involved counts with regard to the number of attempts. A continued pregnancy is a pregnancy of at least 10 weeks as from the moment of the follicular puncture. A continued pregnancy is a pregnancy of at least 9 weeks and 3 days as from the implant when cryopreserved (frozen) embryos are transferred. The transfer of all embryos obtained during the attempt (either interim cryopreserved or not) is a part of the attempt with which the embryos are obtained. A pregnancy of at least 12 weeks after the first day of the last menstruation that has occurred without medical intervention is also deemed to be a continued pregnancy.

Which care?

You are entitled to the reimbursement of costs of maternity care for up to 10 days at most as from the date on which you gave birth.

Protocol

The number of hours of maternity care is determined based on the National Recommended Protocol for Maternity Care (Landelijk Indicatieprotocol Kraamzorg). You can find the protocol on menzis.nl.

E-Health

You can use Babybalance. This is e-health in the form of videos about the care for your new-born baby. Babybalance can only by purchased in combination with maternity care at your home. The use of Babybalance is considered to form part of the maternity care hours within the National Recommended Protocol for Maternity Care. Babybalance costs 4 hours of maternity care; no personal contribution applies.

Personal contribution

A statutory personal contribution of € 4.50 per hour applies to maternity care at home. If you are having your baby in a hospital or a birth centre without a medical indication, you will pay a statutory personal contribution of € 36 per day that you are admitted (€ 18 for the mother and € 18 for the baby). If the hospital charges an amount that is higher than € 255 per day (€ 127,50 for the mother and € 127,50 for the baby), you must, in addition to the € 36, also pay the amount that is higher than € 255 per day.

Which care provider?

Maternity care is granted by a qualified maternity care provider that is related to a maternity care institution.

Registration

Call the Menzis Care Advisor on 088 222 40 40 for advice on maternity care. You can then apply for the maternity pack too. You can also do this through menzis.nl/zorgadvies/aanvraagformulier-gratis-medisch-kraampakket.

Which care?

You are entitled to the reimbursement of costs of speech therapy if:

• this has a medical objective, and
• it can be expected that the treatment will lead to the recovery or improvement of speech or the power of speech.

Which care provider?

You can visit a general speech therapist for most complaints. Some speech therapist have an entry for specific complaints. Examples of this include the following:

• stutter/stammering therapy: treatment for stuttering of which the seriousness is such that smooth speech is clearly impeded,
• aphasia therapy: treatment for a language and speech impediment as a result of brain injury,
• preverbal speech therapy: the treatment of eating and drinking problems and/or swallowing disorders with regard to young children,
• Hänen Programme for the Elderly: step-by-step support for parents in a practical manner when improving the communication with and stimulating speech development of their child when there are language problems. The Hänen Programme for the Elderly is not the right form of assistance for all language problems. That is why extensive speech therapy examination and an interview in advance are always required,
• integral stuttering care group treatment.

We recommend asking your speech therapist whether he or she specialises in the treatment of your complaints.

You can consult a speech therapist for this care who is registered in the Paramedic Quality Register. You can find this register on kwaliteitsregisterparamedici.nl. The speech therapists who have a specific entry can be found in the relevant subregister of the NVLF (Nederlandse Vereneging voor Logopedie en Foniatrie). They can be found on nvlf.nl.

Referral

No referral is required when you visit a contracted speech therapist who is immediately available for consultation. You can find out whether a speech therapist is immediately available in the Paramedic Quality Register.

In the following cases a prior written referral from your general practitioner, dentist or medical specialist is always required:

• when you visit a contracted occupational therapist who is not immediately available for consultation,
• when you visit a non-contracted speech therapist,
• when you visit a dietician who works at a hospital, care home or rehabilitation centre,
• when you want speech therapy outside of the speech therapist’s practice, except for treatment at home.

Permission

You are only entitled to the reimbursement of costs of speech therapy at a school or day nursery with prior written permission from Menzis. Your speech therapist can apply for this permission from Menzis on your behalf.

Which care?

You are entitled to the reimbursement of costs of :

• being examined and diagnosed,
• treatment,
• materials used by the medical specialist such as medication, dressing material or medical aids;
• laboratory tests,
• mechanical breathing and the related medical specialist care, medication, overnight stays, nursing and care in or under the responsibility of a breathing centre

• an allowance towards the electricity costs in case of mechanical respiration at home.

Which care provider?

You can visit a hospital and consult the medical specialist who is linked to this hospital or you can consult a medical specialist who has his or her own practice for medical specialist care. You can also visit an independent treatment centre (in Dutch: ZBC) that offers care by a medical specialist.

Referral

You are only entitled to the reimbursement of costs of medical specialist care when you have a prior written referral from your GP, medical specialist, nurse specialist, physicians assistant obstetrician, specialist geriatric care provider (nursing home doctor), a doctor who works in youth health care or a doctor for the mentally challenged.

• For specialist eye care, an optometrist or orthoptist can also make a referral.
• For specialist hearing care, a triage-audiologist can make a referral to a throat-nose-ear specialist.
• The Municipal Health Service (GGD) doctor may also refer to the medical specialist if it concerns tuberculosis.
• If the complaints are related to your work, the company doctor may also make a referral.
• For the insertion of dental implants, you need a referral from a dentist in advance. Referral to an ophthalmologist, paediatrician or orthopaedic doctor may also take place by a youth doctor/doctor who works in youth healthcare.

You do not need a written referral for emergencies.

Permission

You require prior permission for a number of treatments:

1. Limitative list of medical specialist healthcare

You can find these treatments listed in the Limitative List of Medical Specialist Healthcare (in Dutch: Limitatieve Lijst Medische Specialistische Zorg) of the Association of Dutch Health Insurers (ZN). Which treatments does this refer to?

• Ophthalmology refraction surgery (eye laser treatment or lens implants that ensure the patient is less dependent on spectacles or contact lenses), developed ptosis and upper eyelid corrections.
• Throat, nose and ear surgery auricle corrections and treatment of nose shape defects.
• Surgery gynaecomastia (“man boobs”), mamma hypertrophy (abnormal size of breasts) and stomach wall corrections.
• Dermatology benign tumours, pigmentation disorders, vascular dermatitis (birthmarks).
• Gynaecology vulva and virginal defects.
• Plastic surgery various treatments.
• Breast prostheses.

2. Others

You are only entitled to these treatments when you have obtained permission from Menzis in advance:

• clinical pulmonary rehabilitation,
• care given by Stichting Merem Behandelcentra (Dutch Asthma Centre Davos) or Stichting MC Astmacentrum (SMCA) in Switzerland.

Which care?

You are entitled to the reimbursement of costs of haemodialysis and peritoneal dialysis, the related medical specialist care, examinations, treatment, nursing, medication and psychosocial supervision. Psychosocial supervision is also provided to people who assist in carrying out dialysis at home. You will also be entitled to the reimbursement of costs of the following with regard to home dialysis:

• reimbursement of the costs related to the training of the people that carry out the home dialysis or who help with regard to this,
• loan of dialysis equipment and accessories,
• regular control and maintenance of the dialysis equipment (including replacements),
• chemicals and liquids that are required for the dialysis,
• reimbursement of the costs for adjustments that must be carried out in your home in all reasonableness and the costs for removing these adjustments and there is no other statutory arrangement that will (partially) reimburse you for the costs for these adjustments and their removal,
• reimbursement of the costs that are directly related to home dialysis and are not refunded based on another scheme,
• the required expert assistance by the dialysis centre with regard to the dialysis,
• any other consumables that are required in all reasonableness for home dialysis.

The Insurance Regulations includes further conditions for the reimbursement of costs related to home modifications that are reasonably required in relation to home dialysis and the reimbursement of costs that are related directly to home dialysis.

Which care provider?

You can visit a dialysis centre, an independent treatment center or a hospital for this care.

Referral

You are only entitled to the reimbursement of costs of non-clinical dialysis when you have a prior written referral from your general practitioner or medical specialist.

Which care?

You are entitled to the reimbursement of costs of register and be examined and compared with the material present to ensure you have the best possible treatment plan.

Which care provider?

The care is provided by the Stichting Kinderoncologie Nederland (SKION).

Referral

You are only entitled to the reimbursement of costs of oncology assistance for children if you have a prior written referral from a general practitioner or a medical specialist.

Which care?

You are entitled to the reimbursement of costs of the treatment of a plastic surgical nature when it involves the correction of the following:

• defects or abnormalities in your appearance that are coupled with demonstrable physical functional disorders,
• mutilation due to illness, an accident or medical activity,
• paralysed or drooping upper eyelids if:
  1. The paralysis or slackening is the result of a congenital defect, or
  2. The paralysis or slackening is the result of a chronic defect present during the birth, or
  3. The paralysis or slackening leads to a severe visual impairment,
• the next congenital malformation: cleft lip, jaw and palate, malformation of the facial bony area, benign tumours of blood vessels, lymph vessels or connective tissue, birth marks or malformations of urinary passage and genital organs,
• appearance of the primary sexual characteristics with regard to a determined transsexuality.

Which care provider?

You can visit a hospital and a medical specialist that is linked to this hospital for plastic surgery. You can also visit an independent treatment centre (in Dutch ZBC) if a medical specialist is linked to this centre.

Referral

You are only entitled to the reimbursement of costs of plastic surgery when you have a prior written referral from your general practitioner, medical specialist or specialist geriatric care provider (nursing home doctor).

Permission

For reimbursement of treatments on the ‘Limitatieve Lijst Medisch Specialistische Zorg’ of ‘Zorgverzekeraars Nederland’ (ZN) you require permission from Menzis prior to the treatment. If we give you permission, it is valid for 1 year, starting on the date on which you received our written permission. If the permission is valid for a shorter or longer period of time, we will mention this explicitly when giving the permission.

Which care?

You will be entitled to a the reimbursement of costs of second opinion when:

• the second opinion refers to medical care as already discussed with the first person providing treatment, and
• you will be returning to the original person providing treatment with the second opinion; this person is responsible for your treatment.

Which care provider?

You can visit a GP, medical specialist, midwife, physiotherapist, clinical psychologist, mental healthcare institution or an (out-patients’ department of a) psychiatric department of a hospital.

Referral

You are fully entitled to the reimbursement of costs of a second opinion when you have a prior written referral from the person who is treating you.

Which care?

You are entitled to the reimbursement of costs of a programme to quit smoking once per calendar year:

• that focuses on changing behaviour, and
• that has the goal of quitting smoking,
• that may be in combination with medication.

Which care provider?

For behaviour-based support when quitting smoking you can visit a care provider for this type of care. You can also visit your general practitioner for behaviour-based support.

Which care?

You are entitled to the reimbursement of costs of a transplant of tissues or organs if the transplant takes place:

• in a member state of the European Union,
• in a state/nation/country within the European Economic Area, or
• in the state/nation/country where the donor lives when the donor is your spouse, registered partner or a blood relative in the first, second or third degree.

You are also entitled to be reimbursed for the costs related to:

• specialist medical care in relation to the selection of the donor,
• specialist medical care in relation to the operational removal of the transplant material with regard to the selected donor,
• the examination, preservation, removal and transport of the post mortem transplant material in connection with the intended transplant,
• care for the donor with regard to admission to an institution for selection and removal of the transplant material during at most 13 weeks and/or half a year in case of a liver transplant after the date of discharge from the institution. This care for the donor includes the care to which you are entitled based on this Basic Insurance,
• transport of the donor within the Netherlands with regard to the selection, admission and discharge from the hospital in connection with the care as described in the preceding item of this list,
• the costs of the lowest class of public transport within the Netherlands or, if this is required medically, transport by car within the Netherlands is reimbursed,
• transport to and from the Netherlands of a liver, kidney or bone marrow donor who lives outside the Netherlands.

Other costs incurred due to the transplant and the donor living abroad are also reimbursed except the costs linked to staying in the Netherlands and lost income.

Which care provider?

For a transplant, you can visit a medical specialist in a hospital that is licensed to perform transplants.

Referral

You are only entitled to the reimbursement of costs of a transplant when you have a prior written referral from your general practitioner or medical specialist.

Which care?

You are entitled to the reimbursement of costs of :

• the regular drawing of blood samples,
• laboratory tests if this is required for determining the coagulation time of blood,
• the use of equipment and accessories with which you can measure the coagulation time of your blood,
• training to learn how to use the abovementioned equipment and supervision when taking measurements,
• advice about the application of medication that influences coagulation.

The Insurance Regulations includes further conditions for the reimbursement of costs related to blood coagulation self-measurement equipment.

Which care provider?

You can visit an intensive care department for thrombotic patients.

Referral

You will only be entitled to the reimbursement of costs of care offered by an intensive care department for thrombotic patients if you have a prior written referral from your general practitioner or medical specialist.

Which care?

You are entitled to the reimbursement of costs of stay during the 24 hours that are required medically in relation to obstetrician care, oral surgeon dentistry care of a specialist nature, medical specialist care and geriatric rehabilitation. You are also entitled to the reimbursement of costs of the related required nursing, care, paramedical care and medication. You are also entitled to the related required nursing, care, paramedical care and medication. You admittance is insured for an uninterrupted period of 1,095 days. An interruption of a maximum of 30 days is not considered to be an interruption but does not count for the calculation of the 1,095 days. An interruption due to weekend or holiday leave does, however, count.

Which care provider?

The stay must take place in an institution for medical specialist care (hospital or independent treatment centre or a rehabilitation centre) or a nursing home.

Permission

You are only entitled to the reimbursement of costs of rehabilitation if you have prior permission from Menzis with regard to:

• admission,
• clinical pulmonary rehabilitation,
• care given by Stichting MC Astmacentrum (SMCA; MC Asthma Centre Foundation) in Switzerland.

Which care?

You are entitled to the reimbursement of costs of obstetric care and prenatal screening.

The prenatal screening consists of:

• counselling (providing information and advice),
• if you have a medical indication: a combination test, a non-invasive prenatal test (NIPT) and an invasive diagnosis (chorionic villus sampling and fertility test). You must, in any case, have a medical indication:
  • for a non-invasive prenatal test (NIPT) if a combination test shows that there is a considerable probability that the foetus has a chromosome abnormality such as Down’s syndrome,
  • for an invasive diagnosis (chorionic villus sampling and fertility test) if a combination test shows that there is a considerable probability that the foetus has a chromosome abnormality such as Down’s syndrome,
• structural echoscopic examination in the second trimester (the 20-week echo).

Which care provider?

For obstetric care you can visit a general practitioner who is registered in the Obstetrician Register of the College voor huisartsen met bijzondere bekwaamheden (CHBB; Board of General Practitioners with Special Competences) or an obstetrician. If there is a medical requirement, obstetric care is given in a hospital under the supervision of a medical specialist. See the article about medical specialist care. For laboratory. representational diagnostics and function tests requested by a general practitioner or obstetrician you can go to a first-line diagnostics centre, a production group practice, a hospital or an independent treatment centre.

Obstetric care personal contribution

A statutory personal contribution of € 4.50 per hour applies to maternity care at home. If you deliver your baby in a hospital or a birth centre without a medical indication, you must pay a statutory personal contribution of € 36 per admittance day (€ 18 for the mother and € 18 for the baby). If the hospital charges an amount that is higher than € 255 per day (€ 127,5 for the mother and € 127,5 for the baby) you must, in addition to the € 36, also pay the amount that is higher than € 255 per day.

Which care?

You are entitled to the reimbursement of costs of :

• transport to a care provider or institution to receive care. This care must be insured in full or partially by the Basic Insurance,
• transport to an institution where you will be staying and will be fully or partially paid through the Wlz (Long-term Care Act),
• transport from a Wlz (Long-term Care Act) institution to a care provider or institution for examination or treatment that will be fully or partially paid through the Wlz (Long-term Care Act),
• transport from a Wlz (Long-term Care Act) institution to a care provider or institution for measuring, fitting and repairing prostheses that are fully or partially covered through the Wlz (Long-term Care Act),
• transport to your home or, if you cannot receive the required care there, to another private address if you came from one of the care providers or institutions referred to above,
• if you are younger than 18, transport to a person from whom or an institution where you will receive mental healthcare regarding which the costs will be fully or partially be at the expense of the mayor and aldermen by virtue of the Dutch Youth Care Act.

You are entitled to the reimbursement of costs of transport with another means of transport than an ambulance (for example, a helicopter) when ambulance transport is not possible.

Which care provider?

Ambulance transport is provided by a permit holder designated by the Ministry of VWS.

Referral

You are only entitled to the reimbursement of costs of plastic surgery when you have a prior written referral from your general practitioner, medical specialist or specialist geriatric care provider (nursing home doctor). You are only entitled to the reimbursement of costs of transport by helicopter when you have a prior written referral from the Ambulance Central Control Room (Meldkamer Ambulance Zorg) or a centre for neonatal and child surgery intensive care unit. You do not require a referral for emergency transport.

Indication

The transport must have been indexed by the doctor in charge of treatment.

Which care?

You are entitled to the reimbursement of costs of nursing and care. Nursing and care mean the following: care as offered by nurses that

1. is related to the need of GP care, medical specialist care or a high risk of this,
2. is not linked with admittance and,
3. does not involve maternity care.

You are also entitled to the reimbursement of costs of specialized pediatric daycare and care at a pediatric care facility if you are less than 18 years old and need care because of complex somatic issues or a physical disability where

• continuous supervision is required, or
• there must be care 24 hours a day in the vicinity and this care is linked to one or more specific nursing action.

Person-linked budget

A person-linked budget (PLB) is an amount that you can use to purchase nursing and care services yourself. If you are entitled to the reimbursement of costs of nursing and care, you may also possible apply for the reimbursement of this care in the form of a person-linked budget. The Insurance Regulations provide information when you are eligible for this, what your responsibilities are with regard to this and how the PLB is paid. You can find the Insurance Regulations on our website. You can also request these regulations from Menzis Customer Service on 088 222 40 40.

Which care provider?

You can hire a nurse or carer with training level of 3 or higher who is employed by an institution that has been accredited for nursing and caring (home care institution) based on the Dutch Care Institutions (Accreditation) Act (in Dutch: Wet toelating zorginstellingen; WTZi) or that has been accredited for admission or as a nursing home or an institution for disabled care that provides outpatient care. You can also hire a nurse or caregiver with training level 3 or higher who is has a KIWA-certification for the self-employed in the healthcare business.

Indication and care plan

You are only entitled to the reimbursement of costs of nursing and care when you have an indication. This indication must meet the standards for indexing and organising of nursing and care in your own environment as established by the professional association of community nurses, Verpleegkundigen & Verzorgenden Nederland (V&VN). To be eligible for reimbursement you must have a nursing indication with a care plan that describes the care that you need with regard to its nature, scope and duration including the set goals. This care plan must be drawn up by a HBO-community nurse (education level 5) and must be signed by you and the care provider.

Medical specialist nursing at home (MSVT)

If you need nursing and care at the instructions and under the responsibility of a medical specialist, the medical specialist must have issued a medical specialist nursing in the home situation execution request to the care provider that must contain the following:

• scope of the nursing required,
• frequency of the nursing,
• duration of the nursing (start and end dates).

Permission

The costs incurred are not fully reimbursed if you opt for treatment by a care provider that has not concluded a contract with Menzis. You also require Menzis’ prior approval. You can contact the Menzis Care Advisor at 088 222 40 40 in order to request this approval.

Advice

Do you have any questions about nursing and care? Call the 088 222 40 40 on 088 222 40 40 for more information on the options.

You will find the care options that are permitted conditionally in the Insurance Terms and Conditions and on menzis.nl.

This care consists of:

• diagnostic research,
• interventions that focus on learning to deal with the disability physically, and
• interventions that remove the impairments or that compensate and, therefore, increase self- sufficiency.

In addition to the treatment of the person who has the sensory impairment, it also concerns (indirect) system-focused co-treatment of parents or carers, children and adults around the person with the sensory impairment who will learn skills in the interest of the person with the sensory impairment.

Support with being able to perform socially and the complex, log-term and life-wide support to adults who are deaf and blind and adults who are pre-lingual deaf does not fall under sensory care for the disabled.

Which care?

You are entitled to the reimbursement of costs of multidisciplinary care (care where different specialists are involved). You need this care because you have a:

• visual impairment (you are blind or visually impaired,
• hearing impairment (you are deaf or hearing impaired), or
• communication impairment (serious difficulties with speech/language) as a result of a language development disorder and you are younger than 23.

The care focuses on learning to cope, removing or compensating with/for the impairment to ensure that you can perform as independently as possible.

Which care provider?

You can visit an institution that has been accredited in accordance with the Dutch Care Institutions Accreditation Act for giving sensory care to the disabled and which mainly focuses on providing out- patient treatment for the sensory impaired.

Referral and indication

You are only entitled to the reimbursement of costs of sensory care for the disabled if you have a referral in advance. If it concerns the treatment of a visual impairment, you need a referral from a medical specialist who has established rehabilitation and a referral based on the evidence-based NOG (Nederlands Oogheelkundig Gezelschap; Dutch Ophthalmic Society) guideline Visual Disorders that a visual impairment is involved.

If it concerns the treatment of an auditive and/or communication impairment, you need a referral from a clinical physicist-audiologist from the audiology centre or a doctor who has established based on the applicable FENAC (Federatie van Nederlandse Audiologische Centra; Federation of Dutch Hearing Centres) guidelines that an auditive and/or communication impairment is or are involved.

Permission

You will require prior permission from Menzis for sensory care for the disabled from a care provider who does not have a contract with Menzis. Please enclose a written well-founded explanation and a treatment plan from the care provider with your request.

Which care?

You are entitled to the reimbursement of costs of public transport of the lowest class or the reimbursement of the costs of using a vehicle. When a private car is used, you are entitled to be reimbursed € 0.32 per kilometre. You are entitled to the reimbursement of costs of transport using a different means of transport, when you cannot be conveyed by public transport or by using your own transport. If supervision is required or when a child younger than 16 is involved who needs to be supervised, the costs of public transport and personal transport or transport using a different means of transport of the attendant/ carer will also be paid/reimbursed. In special cases, Menzis will allow the reimbursement of the costs of public transport and personal transport or the transport using a different means of transport for 2 attendants/carers.

You are entitled to the reimbursement of costs of transport if:

• it involves the transport from and to persons, institutions and the private addresses as referred to in the Article about ambulance transport, and
• you must receive kidney dialysis, or if you have to attend consultations, examinations or check-ups that are necessary as part of the treatment, or
• you must receive oncology treatment with chemotherapy, immunotherapy or radiotherapy, or if you have to attend consultations, examinations or check-ups that are necessary as part of the treatment, or
• your mobility is solely dependent on a wheelchair, or
• your mobility is dependent on supervision due to your visual impairment, or
• you depend for a prolonged period of time on transport for the treatment of a long-term illness or complaint and the check-ups, examinations and consultations, which are necessary as part of that treatment and refusing said transport or the reimbursement of the costs will be highly unfair to you, or
• you are younger than 18 and need care because of complex somatic issues or because of a physical disability that means that there is a need for permanent supervision or round the clock care in the vicinity and this care is linked to one or more specific nursing actions, or
• you depend on geriatric rehabilitation.

Overnight stay

If you are entitled to reimbursement of travel expenses and you require such transport on three or more consecutive days, you may opt for reimbursement of the costs of overnight stay. The reimbursement of the costs of overnight stay is at most €75 per night and partially replaces the reimbursement of the travel expenses.

Personal contribution

You pay a personal contribution of € 105 per calendar year. The personal contribution does not apply to the reimbursement of overnight stay.

You do not pay a personal contribution for transport:

• if you are admitted to an institution at the expense of the health insurer or under the Long-Term Care Act and must be transported to a different institution where you will be admitted because you require specialist examination or specialist treatment that cannot be provided in the first institution;
• if you are admitted to an institution at the expense of the health insurer or under the Long-Term Care Act and must be transported to a different institution or person for specialist examination or specialist treatment at the expense of the health insurer. This applies only if that treatment could not be provided at the first institution. This applies to outward and return journey.
• if you are admitted to an institution at the expense of the health insurer or under the Long-Term Care Act and must be transported to a different institution or person because you require specialist dental treatment that cannot be provided in the first institution.

Which care provider?

The transport will be provided by a transport company or a private person (for example, a member of your family or an acquaintance). If you decide to use a transport company that has not concluded a contract with Menzis, you will receive a maximum of € 0.85 per kilometre. You will receive € 0.32 per kilometre when the transport is provided by a private person.

Permission

You must request prior permission from Menzis. Call the Transport Service Line on 0317 492 051 or send the request form “non-emergency patient transport”. The request form can be downloaded by visiting menzis.nl. Menzis will determine whether you will be given permission and for which type of transport (public transport, personal transport or transport with a different vehicle) you will be given permission.

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

You are entitled to be reimbursed when the treatment is provided by a skin therapist (or someone who works under his responsibility, such as a beautician), who has been recognised by Menzis. A list of recognised skin therapists can be found at menzis.nl/zorgvinder.

You will be reimbursed for treatments, homeopathic and anthroposophic medicines up to a maximum amount. The reimbursements for treatments (€ 40 per treatment day) and medicines (100%) are added together until the specified maximum amount is reached. This maximum amount is per calendar year:

You will be reimbursed if:

• the (individual) treatment is provided by a practitioner who is affiliated to a professional association approved by Menzis as a certified member. You can find out which professional associations are approved by visiting menzis.nl/zorgvinder,
• the homeopathic medicine is registered in accordance with the Dutch Medicines Act,
• it is a WALA or Weleda anthroposophic medicine,
• a doctor prescribes the medicine, and
• a dispensing chemist’s or a general practitioner with dispensing facilities provides the medicine.

Breastfeeding

You will be reimbursed for the costs related to support and aids (that are part of the support) up to a maximum amount of € 200. You are entitled to this reimbursement if the support given and the aids are prescribed by a lactation consultant who is approved by Menzis. You can find out who the lactation consultants are by visiting menzis.nl/zorgvinder.

Maternity care

You will be reimbursed for the statutory personal contribution for maternity care.

Maternity care after adoption

Maternity care after adoption will be reimbursed up to a maximum of 16 hours.

Maternity care after admission

Maternity care after admission of your baby will be reimbursed up to a maximum of 16 hours.

Multiple birth payment

You will receive an amount of € 250 for a multiple birth. You are entitled to receive this payment/ reimbursement once, when you insure the children with Menzis.

Delivery room

If there is no medical indication for delivery your baby in a hospital (when you stay shorter than 24 hours) you need to pay a personal contribution for use of the delivery room from the Basic Insurance. You will be reimbursed for this statutory personal contribution for use of the delivery room in a hospital or an institution approved by Menzis. You can find out which hospitals or approved institutions they are by visiting menzis.nl/zorgvinder.

You will be reimbursed for spectacles (glasses on prescription including the frame) and (night time) contact lenses up to a maximum amount. The reimbursements for spectacles and contact lenses are added together up to the specified maximum amount has been reached. This maximum amount is as follows for 2 calendar years:

You will be reimbursed for camouflage therapy and camouflage aids up to a maximum amount. The reimbursements for camouflage therapy and aids are added together up to the specified maximum amount has been reached. This maximum amount is per calendar year:

You are entitled to this reimbursement if the treatment is provided by a skin therapist (or someone who works under his responsibility, such as a beautician), who has been recognised by Menzis. A list of recognised skin therapists can be found at menzis.nl/zorgvinder.

You will be reimbursed for health courses up to a maximum amount. The reimbursements for these courses are added together up to the specified maximum amount has been reached. This maximum amount is per calendar year:

You are entitled to a reimbursement of the healthcare course if the course has been fully completed and the course is given by an organization approved by Menzis. You can find out which they are by visiting menzis.nl/zorgvinder.

Dietetics is partly insured in the Basic Insurance. The additional insurance offers an extra reimbursement. You will be reimbursed for dietetics for a maximum number of treatment hours per calendar year:

You are entitled to be reimbursed when the dietician has a contract with Menzis. You can find the contracted supplier on menzis.nl/zorgvinder.

Dietary preparations will be reimbursed up to a maximum amount. This maximum amount is per calendar year:

You are entitled to be reimbursed when:

• this is prescribed by a doctor or dietician, and
• the preparation is supplied by a dispensing chemist’s, general practitioner with dispensing facilities or a supplier with whom Menzis has a contract. Visit menzis.nl/zorgvinder to find out who they are.

You will be reimbursed for 80% of the costs of epilation if abnormal hair growth in the face and neck up to a maximum amount. This maximum applies for the full duration of the insurance.

You are entitled to this reimbursement if the treatment is provided by a skin therapist (or someone who works under his responsibility, such as a beautician), who has been recognised by Menzis. A list of recognised skin therapists can be found at menzis.nl/zorgvinder.

Occupational therapy is partly insured in the Basic Insurance. If it is an addition to the reimbursement from the Basic Insurance, you will be reimbursed for occupational therapy for a maximum number of hours per calendar year:

You are entitled to be reimbursed when the occupational therapist has a contract with Menzis. Visit menzis.nl/zorgvinder to find out who these therapists are.

You will be reimbursed for physiotherapy treatments and exercise therapy up to a maximum number of treatment sessions. This maximum number of treatments per calendar year is:

You are entitled to be reimbursed when your therapist has a contract with Menzis. Visit menzis.nl/zorgvinder to find out who these therapists are.

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

You will be reimbursed for the flu jab and its administration once per calendar year.

You are entitled to be reimbursed when the jab is administered by a general practitioner who has a contract with Menzis. Visit menzis.nl/zorgvinder to find out who these GPs are.

You will be reimbursed up to € 35 per day up to an overall maximum amount. The overall maximum amount is:

You are entitled to this reimbursement if the hospitium or ‘Bijna-Thuis huis’ is approved by Menzis. You can find out which institutions are approved by visiting menzis.nl/zorgvinder.

You will be reimbursed € 20 per day as a contribution towards the costs of child care from the 11^th day that you have been hospitalized. The reimbursement applies for up to a maximum of 3 months per calendar year.

You are entitled to be reimbursed when 1 or more children within your family are younger than 12 years.

You will be reimbursed up to a maximum amount. This amount applies to the whole of the insurance period.

You are entitled to be reimbursed when the menopause consultant has been approved by Menzis. You can find out who they are by visiting menzis.nl/zorgvinder.

You will be given a bed-wetting alarm once for the whole insurance period.

You are entitled to be reimbursed when the supplier has a contract with Menzis. You can find the supplier by visiting menzis.nl/zorgvinder.

You will be reimbursed for a wig or the alternative up to a maximum amount per calendar year:

You will be reimbursed up to a maximum amount for the travelling expenses of a visiting family member when this person is a member of Menzis. The first 500 kilometres are at your own expense. The reimbursement will amount to € 0.25 per kilometre from the residence of the member of your family to the place where you have been admitted. The distance will be determined based on the fastest route using the route planner of the ANWB. The maximum amount is per calendar year:

You are entitled to be reimbursed when you have been hospitalized or admitted to a rehabilitation institution in the Netherlands or you have been admitted to a contracted hospital abroad after waiting time brokerage by Menzis and the admittance is reimbursed based on the Basic Insurance.

You will be reimbursed for the purchasing costs of a soft brace or splint up to a maximum amount per calendar year:

Sports Medical Advice is deemed to mean the following:

• basic physical medical exam,
• basic physical medical exam with ECG,
• basic physical medical exam with ECG and exercise ECG,
• elaborate physical medical exam (also called professional sports medical exam),
• physical medical supervision (training advice and individual training schedule),
• physical examination (mandatory according to the sports federation).

Sports medical advice will be reimbursed up to a maximum amount per calendar year:

You will be entitled to this reimbursement when the advice is provided by a sports doctor (or someone who falls under his or her responsibility) who works at an institution approved by Menzis. You can find out which they are by visiting menzis.nl/zorgvinder.

The costs related to sterilization are reimbursed up to a maximum amount of:

You will be reimbursed when the sterilization is performed by a medical specialist or GP.

The costs related to sterilization are reimbursed up to a maximum amount of:

You are entitled to be reimbursed when the sterilization is performed by a medical specialist.

Verwijzing

U heeft een verwijzing nodig van de huisarts.

You will be reimbursed for 1 support pessary:

You are entitled to be reimbursed when:

• support pessaries are provided by a pharmacy or a general practitioner who have a pharmacy.

Stuttering therapy will be reimbursed up to a maximum amount. This maximum amount is per calendar year:

The treatment related to removed blood vessels or pigmentation spots in the face and neck is reimbursed up to a maximum amount. This maximum amount is per calendar year:

You are entitled to this reimbursement if the treatment is provided by a skin therapist who has been recognised by Menzis. A list of recognised skin therapists can be found at menzis.nl/zorgvinder.

The accommodation expenses in a guest house or hospice for a visiting member of your family will be reimbursed up to a maximum amount. This maximum amount is per calendar year:

You are entitled to be reimbursed when the guest house or hospice has been approved by Menzis. You can find the list with guest houses or hospices on menzis.nl/zorgvinder.

The accommodation expenses in a guest house or hospice will be reimbursed up to a maximum amount. This maximum amount is per calendar year:

You are entitled to be reimbursed when the guest house or hospice has been approved by Menzis. You can find the list with guest houses or hospices on menzis.nl/zorgvinder.

Orthopaedic arch supports

An orthopaedic arch support is a loose insole for a shoe. Orthopaedic arch supports can have a relieving or supporting function or a correcting function. The foot and walking posture will be improved.

Pedicure care

A pedicure (chiropodist) looks after feet, toes and nails related to complaints. Pedicure care is insured in the Basic Insurance in specific cases.

Chiropody

The chiropodist treats feet function disorders and feet complaints. This can be achieved by applying corrective or protective techniques such as shoe and sole corrections, podiatric supports and providing advice about feet complaints.

Podiatry

The podiatrist treats all occurring complaints with regard to feet, toes and nails and complaints elsewhere in your body that may be influenced by feet, toe and nail corrections.

You will be reimbursed for orthopaedic support soles, repair of orthopaedic arch supports, pedicure, chiropody and podiatry up to a maximum amount. The treatments and medical aids are added together until the maximum amount is reached. This maximum amount is per calendar year:

You are entitled to be reimbursed when the supplier or care provider has been approved by Menzis. You can find out who they are by visiting menzis.nl/zorgvinder.

The costs of the following contraceptives are reimbursed: the pill, hormone-holding vaginal ring, injection contraception, implant contraception, copper coil, diaphragm and hormone-holding coil. You will be reimbursed for the costs of each service.

You are entitled to be reimbursed when:

• you are 21 or older,
• the contraceptive is being prescribed by a GP or medical specialist, and
• the contraceptive is being supplied by a pharmacy or a dispensing GP.

Care providers claim using codes. These codes represent specific services. For example: C11 – regular check-up. The services, codes and rates have been legally determined by the Dutch Healthcare Authority (NZa). You can find them by visiting nza.nl.

TandVerzorgd 250, 500 and 750 reimbursements

All treatments will be reimbursed up to the specified maximum amount with TandVerzorgd 250, 500 and 750. If you are covered through TandVerzorgd 750, a separate reimbursement applies to orthodontics. More information can be found in the Orthodontics article. The following will be reimbursed:

This maximum amount is per calendar year:

Note

The following are not reimbursed: external bleaching (E97), the jaw overview photo (X21) below the age of 18, general anaesthesia (A20), anti-snoring devices (G71, G72 and G73).

Waiting time for orthodontics

A waiting time of one year applies to orthodontics. This means that you will pay a premium during the waiting time, but will not yet be reimbursed for the orthodontics. The waiting time will apply if you switch to TandVerzorgd 750. The waiting time will start on the insurance’s TandVerzorgd 750 effective date. If you are insured with TandVerzorgd 750 in 2019, there will not be a waiting time in 2020 for you in TandVerzorgd 750. For more information about waiting times visit menzis.nl/wachttijd.

The following will be reimbursed:

Up to the maximum amount of € 150 per calendar year.

If you are 17 or younger, dental expenses after an accident are insured in the Basic Insurance. The dental insurance covers dental expenses after an accident if you are 18 or older. You will receive a reimbursement for dental expenses after an accident up to a maximum amount of € 10,000 for each accident in the following packages:

Dental expenses are fully reimbursed up to at most € 10,000 for each accident provided that:

• you were 18 or older when the accident occurred, and
• the accident took place in the Netherlands, and
• the treatment is given by a dentist or orthodontist in the Netherlands,
• the dental expenses are not covered by the Basic Insurance, and
• you have an additional insurance that covers dental expenses after an accident when the accident and treatment took place.

Any expenses related to the excess and personal contribution (Basic Insurance) will not be reimbursed.

Dental expenses after an accident do not fall under the maximum amount of TandVerzorgd 250, 500 en 750.

Exclusions

You are not entitled to a payment in case of dental damage that is due to:

• deliberate intent and/or wilful recklessness,
• when you were under the influence of alcohol or drugs,
• because of eating food,
• because of being active in a sport as a (sub)profession,
• because of already existing shortcomings of the denture (before the accident),
• because of being involved in a fight that cannot be classed as self-defence,
• when you have not taken the usual protective measures when pursuing a sport.

Permission

You need a statement of approval from Menzis before you start treatment. Your dentist or orthodontist can apply for this from us by drawing up a treatment plan and sending it to Menzis. If required, Menzis may request photos to make an assessment. You must also complete a statement with information about the accident. You can find the statement on menzis.nl/tandongeval

Assessment

We will assess whether the treatment is eligible for reimbursement based on the treatment plan of your dentist or orthodontist and your statement. We will then determine whether an accident has been involved that caused the damage, whether the exclusions are applicable and whether you meet the other conditions. We will also assess whether the proposed treatment will be effective. Care that is unnecessary or costs too much unnecessarily when compared to other types of care that is on an equal footing in view of the indication and your care need, will not be covered by the insurance.

If you meet all specified conditions, you will receive a statement of approval for the treatment At most, the amount of the treatment plan of your dentist or orthodontist will be reimbursed. Are third parties involved? Report this to Menzis. We will then recover the losses.

Bill because of an accident

Your dentist or orthodontist will claim the expenses for which consent has been granted for the accident cover directly from Menzis. You will not receive a bill for this. If you do receive a bill, contact your dentist or orthodontist.