The following is an overview of the health insurance requirements in the Netherlands, specific laws related to health insurance, how the Dutch healthcare system works and receiving care in Holland and abroad…
Beginning in 2006, health insurance in the Netherlands has been regulated by the Zvw (Health Insurance Act). Dutch law requires that every resident in the country (as well as non-residents who pay Dutch payroll tax) take out a basic health insurance policy provided by a private Dutch insurance company.
Dutch Health Insurance Act
For the past decade, the Dutch health insurance industry has operated as a collaborative effort between public and private entities that work together to ensure:
a) every individual is guaranteed acceptance by every Dutch health insurance company that offers the national ‘basic’ health insurance plan (regardless of pre-existing health conditions)
b) each individual pays the same cost for a treatment covered by the basic plan
c) that the annual cost of the national basic health insurance plan is affordable
Most people commonly handle procuring their own health insurance policy, but it is also possible to take out a policy that covers someone else (such as a spouse, child/ren or someone whom is physically or mentally unable to handle the process themselves).
Exceptions to Health Insurance Legal Requirement
There are two exceptions to the legal requirement that every resident must take out a health insurance policy in the Netherlands:
a) Dutch Military Personnel (who are provided with healthcare automatically during their enlistment)
b) Conscientious Objectors (people who object to insurance on principle. These individuals are allowed to not take out the basic insurance policy, but are still subject to the same income-related contribution as all other taxpayers. The deduction on their payslip is noted as ‘substitute tax’.
Dutch Health ‘Care Insurers’
The Dutch government refers to Zvw-registered health insurance companies collectively as ‘care insurers‘, in order to stress the key role they play as effective, customer-driven organisers of care for the people they insure.
Before they are permitted to offer health the national basic health insurance policy, Dutch health insurers need to meet the following conditions:
a) Licence from the Dutch Central Bank
Health insurance companies in the Netherlands are not obliged to offer the Dutch national ‘basic’ health insurance policy. In order to do so they must agree to specific Zvw requirements, one of which is being licensed to sell non-life insurance services in a specific sector. Licences are issued by the Dutch Central Bank (De Nederlandsche Bank (DNB)) or same regulatory body in another EU Member State.
b) Register with the Netherlands Health Care Authority
Health insurers also have to be registered with the Netherlands Health Care Authority (NZa) to facilitate supervision of the services they provide under the Zvw and to qualify for payments from the adjustment fund.
Insurer Coverage Area
Dutch health insurers must offer services and sell insurance policies across the Netherlands. An exception to this rule is for small insurers who insure less than 850,000 customers. The reason for this is to allow smaller insurance companies to break in to enter the market, which in turn fosters competition and offers the consumer more health insurance options. Such smaller companies are required to offer services and sell insurance policies across an entire province (i.e. they cannot operate in a single municipal region).
Enrolling in a Dutch Health Insurance Policy
Health insurance must be taken out with a care insurer within four months of moving to the Netherlands. Because the requirement to have a Dutch health insurance policy begins at the time your register with your local municipal authorities, the premium cost of the insurance begins on that date (irregardless if you register with an insurer during the first, second or third month).
A resident is free to choose which care insurer they sign up with (as long as it operates in the province in which the resident lives). When choosing a care insurer, expats will want to consider various factors including the type of payment associated with the policy (i.e. no-pay or pay up front with reimbursement after), the voluntary deductible, the nominal premiums and the types of services available from the insurer.
Penalty for Not Getting a Dutch Basic Health Insurance Policy
Anyone who fails to get a basic health insurance policy from a Dutch insurer within the required time will incur a penalty equal to 130% of premium cost dating back to when the person registered as a resident, with a maximum penalty of 5 years (60 months). The cost of any care that was obtained during the period without insurance remains the responsibility of the individual even after the back payment penalty has been paid.
If you would like to have insurance to cover treatments not covered by the national basic health insurance policy (for example, dental or vision care), you will need to get a ‘supplemental insurance’ policy. This can be from the same or a different care insurer.
A supplemental insurance policy is a separate policy from the national basic health insurance policy. This extended healthcare policy is not required by Dutch law. If you already have an international health insurance policy, it may include coverage for the types of treatments not covered by your Dutch national basic health insurance policy. Before enrolling with an international health insurer it’s always a good idea to check how many care providers they are contracted with in the Netherlands and the proximity of the nearest care provider. If the international health insurers network is limited in the Netherlands, you will probably be better off enrolling in a supplemental insurance policy from a Dutch insurer.
Note that unlike the Dutch national basic health insurance, where insurers are obligated to accept all people who register, acceptance into a supplemental insurance policy is at the discretion of the insurer. The amount of coverage and annual cost/premium costs are also established by the insurer and are not regulated in any way by the government.