Healthcare in the Netherlands

If you are a UK expat in the Netherlands, or thinking of working there, then you need to keep up to date with the compulsory private medical covers which apply to expats as well as Dutch citizens.

As of 1 January 2006 the two-tier public-private healthcare system was replaced by basisverzekering, or a base level health insurance, for everyone (zorgverzekeringswet). It is obligatory for all residents of the Netherlands to have one of the basic health insurance plans. All resident children under the age of 18 are insured as part of their parent insurance policies for free.

You are free to choose one of any number of health insurers (zorgverzeraars) who all offer a basic coverage package, as well as a dizzying array of extras, like supplementary coverage for: dental, after-pregnancy care, extra physiotherapy, etc.

The government has opted to have private insurance companies provide the coverage to use market forces to cut healthcare costs. In addition, the insurers are not permitted to refuse anyone the basic package regardless of age, employment status or general health, but may refuse anyone for supplementary insurance (aanvullende verzekering).

The cost has risen 10 percent for 2007, with more increases expected in 2008.

The Dutch government continues to change the coverage of the basic insurance package. For example, in 2008 the birth control pill will be included once again, as will a yearly check-up with the dentist. However, pre-natal screening for women under the age of 36 has been removed. So it is essential if you have specific health insurance needs that you check your policy carefully.

For expats there is a lack of clear information and you are quite likely to get several different answers to the same question. Whatever the local officials may say, the facts are that if you are from the UK, unless you have a residence permit based on study, you are legally required to have the minimum, basic insurance. Your residence may be at risk if you do not get insured within 4 months of officially residing in the Netherlands.

If you are here on a temporary stay/ holiday, or are a student, you are not eligible to have the basic, Dutch health insurance, but will be required to have a health insurance, either international, or from your country of residence.

If you are applying for residency international health insurance is only considered acceptable for the period until you receive your residency, once you are officially a resident you will be required to have Dutch health insurance.

Do you need your residence permit before you apply for health insurance, or do you need health insurance before you apply for your residency permit? Unfortunately it’s apparently both, depending on who you speak to on any given day. Our advice: Follow what you are told when you register.

Your eligibility for resident status is partially dependent on having sufficient health care coverage.

The government has estimated the cost of the nominal premium for basic insurance this year will be about EUR 1,115 – 1,250 annually, or EUR 92 - 105 per month.

Until January of 2008, under a no-claims regulation, you can receive a deduction (maximum EUR 255) on your premium. Doctor's appointments won't be counted under the no-claims system. You can also opt for a higher personal liability (EUR 100 to EUR 500 per year) to help reduce the premium.

After January of 2008 the no-claims regulation will disappear and a personal liability will be in place for everyone.

You may wish to take out supplementary insurance (aanvullende verzekering) to cover elective treatments, as well as dentistry and physiotherapy and other treatments the government considers to relate to be the individual's 'own responsibility'. This is also where the real differences in policies show up – from no frills and basic to private hospitals.

No one who qualifies for the basic insurance package may be refused for that package, however, insurers are allowed to impose conditions and determine the pricing for supplementary insurance, and may refuse anyone supplementary insurance coverage. You can choose to switch your basic coverage to another provider once a year.

An essential part of the new system is that insurers can offer a choice of basic policies: healthcare in kind (the insurer organises everything and pays the medical bills); a policy under which you arrange and pay for the treatment and the insurer reimburses you; or a mixture of the two. Hospitals are encouraged to compete with each other and between insurers, who will seek to make deals with specific health bodies and hospitals in order to provide their clients with the most attractive treatment prices. The government hopes this will lead to hospitals specialising in particular areas of medicine.

The down side for patients can be longer travel times to the appropriate hospital. Also, be warned, insurance companies are only required to reimburse you for what is considered ‘reasonable costs’. Therefore always check with your insurer before you have expensive treatment done or you could be in for a shock.

For those UK expats working in the Netherlands, you may get misleading advice from international health insurers and brokers. They may tell you that an international health policy can be bought instead of using the official system - this is wrong. They may tell you that you can have an international health policy as well as the official cover. Those insurers who have studied it are agreed on one thing, the legal situation is confusing, but on balance it is felt that it is legal to have a top up international health policy, but may be illegal to have a full policy as well as an authorised local one. On the other hand, some insurers have suggested that such possession is only a technicality.

IF you are a UK citizen who works or wants to work in the Netherlands, you have to comply with local law. Failure to comply can mean the loss of your residence permit. Local officials do seem to have the capacity for interpreting the law how they each think it works, so our advice is to play it safe and buy cover locally.

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