What is the difference and what is covered?
In 2016, another tenner will be added to the mandatory deductible. This may not seem like much, but the deductible has since risen sharply: from €150 when it was introduced in 2008 to €385 in 2016. In addition, you sometimes have to pay a personal contribution. What is the difference between the deductible and the deductible? And which care falls under the deductible?
The deductible has been introduced as a means of making patients more economical with the care they use. If patients feel in their wallets that medicines or a visit to the specialist are expensive, they will incur less unnecessary costs, according to then Minister of Health Hans Hoogervorst (VVD).
Which care falls under the deductible? Many patients are not aware of this, according to a survey conducted in the spring by research agency Markteffect among 1,400 Dutch people. For example, 29 percent paid for care that they did not know in advance was covered by the deductible. A similar picture emerges from a survey by health insurer VGZ in September, conducted by TNS Nipo; for example, one in three patients thinks (wrongly) that you pay the deductible when you visit the GP. Ignorance means that the already high deductible can lead to unpleasant surprises. How are you?
Difference deductible and personal contribution
Since 2008, a ‘deductible’ has been applied to healthcare costs: the amount that you as a patient must first pay each year before your health insurer reimburses your healthcare costs. The deductible is mandatory for everyone and applies to most healthcare costs that are included in the basic package. You can choose to increase the deductible (up to a maximum of €500 extra) in exchange for a discount on the premium of the basic insurance. If you’re a Additional insurance For example, for physiotherapy, this care is not covered by the deductible. But with additional insured care you may have to deal with a ‘personal contribution’.
Some care is included in the basic package and is therefore reimbursed, but you still have to pay a personal contribution for it. The personal contribution is in addition to the deductible. It is therefore possible that you have already used your deductible, but that you also have to pay a personal contribution. The government determines each year for which care a personal contribution applies. There are three types:
- You have to pay a part (per year) yourself (for example with certain patient transport).
- You have to pay a percentage yourself (for example with hearing aids).
- The care is reimbursed from the basic package (up to a certain maximum) and you have to pay the rest yourself (for example with some medical aids).
What is the deductible?
Not
- The doctor.
- The practice assistant of the general practitioner (eg for care for COPD, diabetes, cardiovascular diseases).
- The district nurse.
- The GP post in the hospital, if your own GP practice is closed (any ‘extra’ care in the hospital does fall under the deductible).
- Care for which you have taken out additional insurance (such as physiotherapy, dental care, alternative medicine).
Well
- Medicines*.
- Blood tests and (lab) research.
- Ambulance transport.
- Hospital admissions and surgeries.
- Specialists in the hospital (examination, treatment).
- Emergency First Aid in the hospital.
- ‘Explanation meeting’ from the pharmacy when you receive a new medicine.
- Psychologist/mental health care professional.
- Some tools.
- Revalidation.
* There are exceptions. Some health insurers have a preferential policy for (cheaper) unbranded products; it differs per insurer whether such a substance falls under the deductible or not. Furthermore: if you want a (more expensive) branded medicine without medical necessity, but because you like it, you have to pay for it in full yourself (does not fall under the deductible). If you want a medicine that is not included in the basic package, you have to pay for it yourself (no deductible).
Tips
If you incur healthcare costs during a holiday, those costs fall under the deductible. Good to know: the part of the costs that the health insurer does not reimburse because of the deductible, is often reimbursed by the travel insurance.
At the end of the year – when the deductible has already been ‘deducted’ – many patients hoard medicines that they will need for the coming year. Of course, there is a good chance that you will still have to use the deductible in the new year. But it can take some time to breathe. Sometimes a prescription is needed for medicines for the coming months.
Do you know in advance that you will fully use the deductible, for example because you are chronically ill and are taking medication? You can ask the health insurer whether you can pay the deductible in installments. The insurer then adds it to the premium. According to TNS Nipo, 20 percent of the over-55s have such a payment arrangement.
Follow all developments regarding health insurance for 2016 in our special.
Sources):
- Plus Magazine
