How does the state health insurance system work?
The Netherlands are in line with most EU countries with regard to medical insurance. The basic coverage (basisverzekering) system has emerged out of a group of private health insurers and has been revised within the last 15 years: the government is responsible for it, but does not run it. Funding comes from taxes and compulsory health insurance fees. It is a two-tier system, consisting of:
- basisverzekering (compulsory basic insurance)
- aanvullende verzekering (optional additional insurance)
If you are on a low income, you may be able to apply to have your monthly premiums partly covered by the healthcare allowance (zorgtoeslag).
There are three types of basic health insurance:
- Naturapolis: the most common policy, contracted to a number of clinics and hospitals
- Budgetpolis: the cheapest option, but with a more limited choice of healthcare providers
- Restitutiepolis: a wider choice of providers which offers 100% reimbursement of any costs, but with higher premiums
Under Dutch law, you are only allowed to switch your medical insurance provider once a year (the switch-over deadline is December 31st).
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Who is eligible for state healthcare?
Health insurers are obliged by law in the Netherlands to offer insurance to everyone, regardless of age, employment status, or existing state of health.
As above, signing up with the state system is compulsory for everyone, including expats. There are a few exceptions, such as people who possess a European Health Insurance Card (EHIC), which also entitles you to basic state treatment. You might need to pay upfront and then claim the costs back. You can check whether you need to do this by contacting the Sociale Verzekeringsbank (SVB).
How do you apply to join the state health insurance system?
You will either need to register within four months of receiving your residency permit or, if you are from an EU nation, within four months of registering yourself at the local city hall. This will get you your basic Dutch health insurance. You will need your Citizen Service Number (burgerservicenummer), which you will need to obtain from your employer or via an application to either the local municipal authority or the Dutch Tax and Customs service. You will also need to take:
- your passport
- proof of residence
A letter from your employer would also be helpful.
It is important that you do all this promptly, because otherwise you will come to the attention of the Centraal Administratie Kantoor, the government organisation which locates people who are uninsured. They will write to you to remind you to sign up, but if you still do not do this, then you could be fined nearly €400. A second fine will follow within six months if you still do not sign up, and after nine months from the original letter, CAK will register you with an insurer and deduct your monthly premiums from your salary.
If you are not applying via your employer, finding a health insurer can be confusing, as many of the insurers’ websites are in Dutch, with no English translations. Listed below are some companies who specialise in expat assistance and who speak English. Your supplementary insurance can be with a different insurer from your basic cover; this dual strategy can lower your costs.
After you have signed up, when you visit the doctor, you will need to take your ID card and your Dutch insurance card with you.
What is covered by the state health insurance system?
The national health insurance scheme covers the following:
- visits to your GP (huisarts)
- hospital visits
- emergency treatments
- blood tests
- ambulance services
- mental health services
- appointments with some specialists, such as dermatologists or allergy specialists
- care for the aged
- maternity care
- anti-smoking programs
- dietary advice
- cover for any children under the age of 18 (including dental treatment)
- some additional services such as speech and occupational therapy
The Dutch government is continuing to revise the system. In 2018, it added some treatments and related costs to the basic insurance scheme: physiotherapy sessions for patients with arthritis, and some travel costs for cancer patients who need to go to hospital every day for chemotherapy and radiotherapy. New drugs, such as treatment for congenital breast cancer, are also being added to the prescription package.
Are retirees covered by state medical insurance?
Yes. If you are planning to retire to the Netherlands, you will be covered under national health insurance.
Are students covered by state medical insurance?
Although health insurance is mandatory for all residents, the Dutch government does not regard international students as falling into this category, because their stay is temporary. Whether or not you will be covered by state health insurance will depend on the length of time that you remain in the country and whether you are working during the course of your studies, including zero-hour contracts.
If you are working, you may be covered under the Wlz scheme (the Long-term Care Act); you can check your eligibility with the Sociale Verzekeringsbank. If you are paying into the national insurance system via your pay cheque, you may be able to apply for the healthcare allowance (zorgtoeslag) to cover part of your monthly premiums.
If you are studying without working and you are from the EU, your EHIC card will cover you, but otherwise you will need private insurance. Some insurers offer reduced rates for students.
Will your family be covered by your insurance?
If you have children, then you must put them on your policy. They will then be covered under the national insurance scheme and you will not have to pay premiums for them. However, if your child is born in the Netherlands, you must register them with the national scheme within four months of their birth.
You can also put your partner on your policy, but you will then have to pay the premium for a family policy.
If your family members do not have jobs outside of the Netherlands, they must also take out health insurance. If you are unsure about their eligibility, contact the Centraal Administratie Kantoor (CAK), or the Sociale Verzekeringsbank.
Is dental treatment covered by state health insurance?
The exception to universal coverage is dentistry: some dental treatment is free but you might have to top it up, depending on what you need to have done.
What are the contribution rates for state health insurance?
You will need to make two principal contributions for your basic cover:
- the premie (monthly premium) which is deducted from your bank account each month. It is currently around €118.
- the eigen risico (own risk) amount: this is an annual deductible which you must pay to cover any medical treatment which occurs before the premie insurance is applied. This is currently €385 per annum. If you do not need any top-up treatment, however, you will not have to pay it. For example, if you have a hospital bill of €500, you will have to pay the initial €385, but then your next visit will be free.
Your employer will also make a contribution of around 6.95%, up to a maximum income of €54,000.
Why buy private health insurance?
Private health insurance has some inbuilt advantages: for example, private rooms, but also more comprehensive coverage for inpatient and outpatient care and maternity care.
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What is covered by private health insurance?
Private insurance covers those treatments which do not fall under the basic state scheme, including:
- glasses/contact lenses
- hearing aids
- plastic surgery
- emergency cover for travel abroad
The state system is so comprehensive that, along with your eigen risico covering alternative treatments, you might not wish to take out private insurance. You may have private cover via your employer, or in your home nation with an insurer who has a reciprocal agreement with private companies in the Netherlands. However, as treatment in the Netherlands might be more expensive than at home, you could find that your premium doesn’t cover the full cost of your medical bills.
You may also be waiting for your residence card, in which case you will not yet be eligible for state insurance and for peace of mind, you may wish to take out private cover to protect you during this interim period. You will still be able to visit the doctor — who is legally obliged to treat you — but you might find that you have to cover the costs yourself. However, if you have already applied for health insurance but have not had your insurance number yet, and you need to get medical help, you can apply to be reimbursed.
How much does private health insurance cost?
Numerous variables can have an impact on the cost of private health insurance in The Netherlands.
The most important variables are:
- Age (the higher the more expensive)
- Area of cover (i.e. just The Netherlands or other areas too? If those other areas include any of the US, the Caribbean, Singapore, China, Hong Kong or Dubai this can significantly increase the overall price)
- Product choice (higher end insurance products are more expensive)
Other variables include:
- Payment frequency
- Country of residence
As so many variables have an effect on the cost of private medical insurance in The Netherlands it becomes very difficult to give accurate estimates without knowing the full details of the coverage required. However, as a very rough guide, using a standard profile of a 40 year old British male with no deductibles, no co-insurance, a middle tier plan/product, all modules included and worldwide coverage excluding the US, a ballpark price of around £4,000/$5,000 might be expected. Were coverage to be expanded to include the US then the premium could increase to almost double that amount.
Which companies offer private health insurance?
You may prefer to sign up with one of the big international insurers, such as Cigna Global, but there are lots of choices:
- Allianz Care
- BUPA Global
- Cigna Global
- Independent Expert Finance (English-speaking, specialises in insurance for expats)
- HollandZorg (group health insurance for expat employees)
- LoonZorg (does not insist on a mandatory excess fee)
- OOM Voorlopig Verblijf Nederland (can arrange interim cover while you are waiting for your residency)
- Partner Pete (English-speaking, specialises in insurance for expats)
As noted above, some websites may not be in English, so if that is your first language, seek one which is English-speaking. When you are looking for a private insurer, you will need to bear a few questions in mind: whether you have a pre-existing condition; whether you have children; and whether you might be travelling extensively. Your insurer will be able to tailor your policy to your own particular needs.
You can also visit one of the comparison sites or the Zorgverzekering Informatie Centrum (Health Insurance Information Centre). These should give you a list of possible options.
Glossary of health insurance terms
aanvullende verzekering - optional additional insurance
basisverzekering - compulsory basic insurance
buitenlanddekking - supplementary insurance which covers additional emergency medical expenses when you are abroad
collectiviteitskorting - group discount, e.g. on behalf of a company
eigen bijdrage - top up amount for medical aids such as orthopaedic shoes, and dentures, and for long term care
eigen risico - own risk deductible
naturapolis - the most common healthcare policy
overstappen - switching your health insurance at the end of the year
premie - monthly premium
restitutiepolis - a more extensive (and expensive) form of coverage than the naturapolis (covers you for most hospitals and will pay all your costs)