We are there for you

The changes to the health insurance in 2015
We are there
for you
The changes to the basic insurance
The basic insurance is an obligatory insurance policy for
Valid for the Select Zorg Plan and Keuze Zorg Plan:
everyone in the Netherlands. The basic insurance policy
reimbursements are set by the government.
Dealing with a complaint or reassessment
The deadline for dealing with a complaint or reassessment
The reimbursements can be found at www.averoachmea.
is currently 20 working days (was 3 weeks).
nl/ vergoedingen. The terms and conditions, regulations
and other contributions can be found at www.
Non-registered allergens
averoachmea.nl/ voorwaardenzorg
New: non-registered allergens are, in principle, not eligible
for reimbursement unless treatment with a registered
medication is impossible. The prescribing doctor can apply
Select Zorg Plan and Keuze Zorg Plan basic insurance
for a permit for the reimbursement of a non-registered
policies
allergen.
Obligatory excess
Medical necessity
The obligatory excess in 2015 is € 375 instead of € 360 in
The term ‘medical necessity’ when prescribing medicines in
2014.
the Reglement farmaceutische zorg VGZ [VGZ
Pharmaceutical Care Regulations] has been defined more
Obligatory and voluntary excess
specifically so that the terms and conditions are clearer.
The obligatory and voluntary excess does not apply to
nursing and care in your own neighbourhood (district
Vakantieformulier Medicijnen [Medicines Holiday Form]
nursing), nor to travel expenses of a donor if these are
The Medicines Holiday Form in relation to a longer stay
reimbursed via the donor’s own basic insurance policy.
abroad has been discontinued If you need medicines for a
longer period of time, your pharmacist can make the
necessary agreements with us.
The following only apply to the Select Zorg Plan:
Frozen embryo
Turnover ceiling
If a frozen embryo is placed back into the uterus after a
In order to keep care affordable, turnover ceilings are
lasting pregnancy, this transfer is interpreted as a first
agreed with care providers with which we have entered
attempt and not as part of the attempt at a pregnancy
into a contract. If the ceiling is reached, we are allowed to
during which it was created.
remove parties (temporarily) from the list of contracted
care providers (Zorgzoeker [Care Finder]). This means that
Reglement Hulpmiddelen [Nursing Articles Regulations]
the contracted care providers on 1 January 2015 may not be
The Reglement Hulpmiddelen [Nursing Articles
the same as the contracted care providers on (for example)
Regulations], which is part of the nursing articles
1 December 2015.
entitlement contains a number of changes. We refer to two
here:
Non-contracted care provider
If you receive assistance from a non-contracted care
Article 4.7 Nursing Articles to be used in conjunction with
provider, we reimburse up to a maximum of 75% of the
skin function disorders.
average contracted price. This is a higher reimbursement
This is a new functional description. This covers dressings,
than in 2014.
allergen-free shoes and medical shoes. The maximum
reimbursement for allergen-free shoes has been
discontinued. The personal contribution for medical shoes
no longer applies.
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Article 4.13 External nursing articles to be used to check and
Foot care for insured parties with diabetes mellitus
regulate abnormal blood sugar levels.
We reimburse an annual examination within the
The article has been extended to include test strips for
framework of foot care for insured parties with diabetes
women with gestational diabetes. They are entitled to 400
mellitus if a care profile has been drawn up. During the
test strips for the term of the pregnancy.
annual examination the GP or specialist will determine
whether there is a risk of foot problems due to the diabetes.
Serious dyslexia care
A care profile will only be drawn up if that is the case.
As of 1 January the serious dyslexia care is no longer going
Whether an appointment with a chiropodist is reimbursed
tobe reimbursed via the basic insurance but via the
via the basic insurance depends on your care profile.
Jeugdwet [Youth Act].
Treatment of Obstructive Sleep Apnea Syndrome (OSAS)
GGZ [Mental healthcare] for children aged up to 18
You will need prior permission from us for an osteotomy
As of 1 January the GGZ care for children aged up to 18 is
(jaw operation) for the treatment of Obstructive Sleep
no longer going to be reimbursed via the basic insurance
Apnea Syndrome (OSAS).
policy, but via the Jeugdwet [Youth Act]. For insured parties
aged 18 year and older, this care will continue to be part of
Care for insured parties with an auditive, visual and/or
the basic insurance.
communicative disability
The care for insured parties with an auditive, visual and/or
Long-term mental healthcare (GGZ)
communicative disability who are aged up to 23 as a
From 2015 onwards the costs of the first 3 years of
consequence of a primary language development disorder
admission for the purposes of treatment in the event of
is included in the basic insurance.
long-term mental healthcare (GGZ) will be covered by your
basic insurance. This used to be just for the first year.
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Geriatric rehabilitation care
The AWBZ
Geriatric rehabilitation care is to be made more accessible.
A lot of changes are taking place as regards care covered
The care must be provided within 1 week after your
by the General Exceptional Medical Expenses Act (AWBZ).
admission to a hospital or after an acute medical problem
In the brochure we explain what exactly the changes are.
which includes an acute mobility disorder.
Kleur je leven [Colour Your Life] online self-help course
District nursing care
In 2015 the costs of the Kleur je leven [Colour Your Life]
The reimbursement for district nursing care has
online self-help course will fall under the obligatory and/or
been transferred from the AWBZ to the basic insurance.
voluntary excess.
Prenatal care
Statutory personal contributions and statutory maximum
The reimbursement for prenatal care has been extended to
reimbursements
include the NIPT (Non-Invasive Prenatal Test). The
The government indexes the statutory personal
combination test will now only be reimbursed if a GP,
contributions and maximum statutory reimbursements
obstetrician or medical specialist has referred you.
every year.
Repairing a removable complete prosthesis (dentures)
Sports doctor
Addition: We now reimburse the costs of repairing a
New: your sports doctor is now allowed to refer you on to a
removable complete prosthesis (dentures) if the work is
medical specialist.
carried out by a dental technician.
General
Avéro Achmea is entitled to change a product or withdraw
it from the market. However, if it does so a suitable
alternative must be offered. This applies to all products.
Changes to the supplementary insurance policies
Start supplementary insurance policy
Artificial nipple or breast prosthesis
New: we reimburse the costs of an artificial nipple or
Smarter Pregnancy [Slimmer Zwanger]
breast prosthesis.
New: we reimburse the subscription costs relating to the
Slimmer Zwanger [Smarter Pregnancy] self-help programme
Chiropodist care in the case of rheumatism or diabetes
once for the entire term of the insurance policy.
For chiropodist care in the case of rheumatism or diabetes we
reimburse € 25 per appointment instead of € 23 to a maximum
Dental healthcare accident cover
of € 100.
The dental healthcare accident cover has been changed.
A number of exclusions have been added.
Royaal supplementary insurance policy
Incisor replacement for insured parties aged between
18 and 24
Smarter Pregnancy [Slimmer Zwanger]
New: we reimburse the costs of incisor replacement for insured
New: we reimburse the subscription costs relating to the
parties aged between 18 and 24 in the event of damage before
Slimmer Zwanger [Smarter Pregnancy] self-help programme
they reached the age of 18.
once for the entire term of the insurance policy.
Alternative forms of treatment, therapies and medicines
Dental healthcare accident cover
The overview of alternative healers and therapists that we
The dental healthcare accident cover has been changed.
reimburse is to change.
A number of exclusions have been added.
Artificial nipple or breast prosthesis
Incisor replacement for insured parties aged between
New: we reimburse the costs of an artificial nipple or breast
18 and 24
prosthesis.
New: We reimburse the costs of incisor replacement for insured
parties aged between 18 and 24 in the event of damage before
they reached the age of 18.
Extra supplementary insurance
Alternative forms of treatment, therapies and medicines
Slimmer Zwanger [Smarter Pregnancy]
The overview of alternative healers and therapists that we
New: we reimburse the subscription costs relating to the
reimburse is to change.
Slimmer Zwanger [Smarter Pregnancy] self-help programme
once for the entire term of the insurance policy.
Artificial nipple or breast prosthesis
New: we reimburse the costs of an artificial nipple or
Dental healthcare accident cover
breast prosthesis.
The dental healthcare accident cover has been changed.
A number of exclusions have been added.
Statutory personal contribution for hearing aids
The reimbursement of the statutory personal contribution of a
Incisor replacement for insured parties aged between
hearing aid is to change. The reimbursement amounts to a
18 and 24
maximum of € 200 per person per device (was: € 250.00
New: we reimburse the costs of incisor replacement for insured
per person per calendar year)
parties aged between 18 and 24 in the event of damage before
they reached the age of 18.
Excellent supplementary insurance policy
Alternative forms of treatment, therapies and medicines
The overview of alternative healers and therapists that we
Smarter Pregnancy [Slimmer Zwanger]
reimburse is to change.
New: we reimburse the subscription costs relating to the
Slimmer Zwanger [Smarter Pregnancy] self-help programme
once for the entire term of the insurance policy.
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Dental healthcare accident cover
Personal contribution (GVS upper limit price)
The dental healthcare accident cover has been changed.
Restriction: The costs of certain medicines will be paid partially
A number of exclusions have been added.
by you and will also be partially reimbursed via the basic
insurance policy. We refer to the part you have to pay yourself as
Incisor replacement for insured parties aged between
the statutory personal contribution. In recent years there has
18 and 24
been a very significant increase in the reimbursements
New: we reimburse the costs of incisor replacement for insured
connected to this personal contribution, particularly of ADHD
parties aged between 18 and 24 in the event of damage before
medication. The 100% reimbursement is therefore going to be
they reached the age of 18.
limited to a maximum of € 500 per insured party per calendar
year. This includes the statutory personal contribution towards
Alternative forms of treatment, therapies and medicines
the costs of contraception for insured parties aged 21 and over.
The overview of alternative healers and therapists that we
reimburse is to change.
Juist Voor Jou [Right For You] supplementary insurance policy
Artificial nipple or breast prosthesis
New: we reimburse the costs of an artificial nipple or
Terminating the insurance
breast prosthesis.
On the grounds of the policy terms and conditions which apply
Convalescent home
up to and including 2014, your Juist Voor Jou insurance policy
The reimbursement scheme (was referred to in Article 40
ends, in any event, as of 1 January following your 30th birthday.
‘convalescent homes’) has been changed. The reimbursement
This provision will no longer apply as of 2015. This means that
now also relates to a care hotel. The maximum reimbursement
you will have Juist Voor Jou insurance after your 30th birthday as
amounts to € 100 per day to a maximum of 28 days per calendar
well. As a consequence of this change, an amended premium
year. (Was: to a maximum of 48 days per calendar year).
(table) will apply as of 1 January 2015 for insured parties aged
31 and over. From now on the premium will depend on your age.
If your premium increases due to you exceeding an age limit, the
Better for Now [Beter Voor Nu] supplementary insurance policy
premium will change on the first day of the month following the
month in which you reached that age. We will publish details of
Dental healthcare accident cover
the applicable premium as soon as possible. As a consequence,
The dental healthcare accident cover has been changed.
the following articles in your terms and conditions will change.
A number of exclusions have been added.
Article: 5.3 ‘Sometimes it is not possible to cancel after a change’
Incisor replacement for insured parties aged between
The sentence after the 2nd dash in the list is to be changed
18 and 24
as follows:
New: we reimburse the costs of incisor replacement for insured
Your premium increases because you are no longer an insured
parties aged between 18 and 24 in the event of damage before
student and/or have exceeded an age limit.
they reached the age of 18.
Article 8 ‘When do we terminate your supplementary insurance?’
Alternative forms of treatment, therapies and medicines
The provision that Juist Voor Jou ends, in any event, as of
The overview of alternative healers and therapists that we
1 January following your 30th birthday included under
reimburse is to change.
e is to be deleted.
Artificial nipple or breast prosthesis
Article 10 ‘Definition of terms’
New: we reimburse the costs of an artificial nipple or
The term ‘insured young person’ is to be deleted.
breast prosthesis.
Alternative forms of treatment, therapies and medicines
Statutory personal contribution for hearing aids
The overview of alternative healers and therapists that we
The reimbursement of the statutory personal contribution of a
reimburse is to change.
hearing aid is to change.
The reimbursement amounts to a maximum of € 200 per
person per device (was: € 250 per person per calendar year)
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Disclaimer
Your privacy - why do we ask for your details?
We ask for your personal details and other details if you apply to us for an
insurance policy or a financial service. We use your details within the
Achmea Group to conclude and execute agreements. We also provide you
with information about products and services which may be important
to you.
What else do we use your details for?
We also use your details:
• to manage our customer database;
• to prevent and combat fraud;
• to perform statistical analyses;
• to meet our legal requirements.
Whenever we use your personal data, we observe the applicable rules,
such as:
• the Wet Bescherming Persoonsgegevens [Personal Data Protection Act];
•the Gedragscode Verwerking Persoonsgegevens Financiële Instellingen
[Code of Conduct for the Processing of Personal Data by Financial
Institutions];
•the Gedragscode Verwerking Persoonsgegevens Zorgverzekeraars
[Code of Conduct for the Processing of Personal Data by Health Insurers].
If you would prefer not to receive any information about our products and
services,
or do you not want us to use your e¬mail address, please send a letter or
e-mail to:
Avéro Achmea
Postbus 101
7300 AC Apeldoorn
www.averoachmea.nl
Information about the Stichting Centraal Informatie Systeem [Central
Information System Board] (CIS)
We may request your details from, or have them included in, the files of the
Stichting CIS in The Hague. This is the central information system used by
insurance companies that operate in the Netherlands. We may do so if you
have failed to submit important information and we want to terminate the
insurance. It is a way for us to manage risks and prevent fraud.
More information can be found at www.stichtingcis.nl. There, you can also
read what the Board actually does with your details.
Applicable law and complaints procedure
The insurance policies are exclusively subject to Dutch law. It goes without
saying that we do our very best to provide you with an optimal service at all
times. Nevertheless, you may still be unhappy about some aspect of the
services we provide. In such instances, you should first contact your adviser
or contact person. If you still feel it is necessary to submit a complaint, you
can do so by e-mail via our website www.averoachmea.nl (under the
section klacht doorgeven [‘submit complaint’]) or in writing to Avéro
Achmea, Centrale Klachtencoördinatie, Antwoordnummer 2241, 8000 VB
Zwolle. If, in your opinion, we do not manage to solve the problem
satisfactorily and if you are a natural person that is not involved in running
a business or engaged in a profession, you can submit your complaint to the
authorised complaints board to which we are affiliated: Stichting Klachten
and Geschillen Zorgverzekeringen (SKGZ), Postbus 291, 3700 AG Zeist,
tel. +31 (0)30 698 83 60, www.skgz.nl
What do we do and who are we?
We offer insurance policies and other financial services. We do not sell
our products and solutions to our clients ourselves. Instead we work
together with advisers. Our advisers can give you independent advice.
This means you will always have insurance that is appropriate.
We are a brand of Achmea, Avéro Achmea Zorgverzekeringen N.V. in Leiden.
Achmea is the largest insurer in the Netherlands. Avéro Achmea
Zorgverzekeringen N.V is registered with the Chamber of Commerce under
number 30208633 and with the AFM (Stichting Autoriteit Financiële
Markten [Netherlands Authority for the Financial Markets]) under number
12001023.
The office addresses of Avéro Achmea are:
Dellaertweg 1
2316 WZ Leiden
Lange Marktstraat 26
8911 AD Leeuwarden
www.averoachmea.nl
Avéro Achmea has acquired the Klantgericht Verzekeren
[Customer-oriented Insurance] quality mark
Confidence and certainty are essential for the quality of services provided
in the insurance sector. The Klantgericht Verzekeren quality mark is issued
by the independent Stichting toetsing verzekeraars [Insurers Assessment
Foundation] (Stv). The quality mark is only awarded to insurers that provide
honest information and dynamic services, are easy to contact, assess
customer satisfaction and use the ensuing results to improve services, and
pursue a consistent quality policy.
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75(4285F) 14-11

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