Overview of Dutch health insurance for expats in the Netherlands, healthcare laws, legal minimum insurance required, how Holland’s health care system works and receiving treatment when 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 cost will be the same whether you sign up with an insurer in the first second or third month (i.e. your first bill will include any prior months premium costs back to the date you registered with the municipality).
A resident is free to choose which Dutch insurance company they want to register with (but make sure the insurer offers services in the province you live). When deciding on an insurance policy, expats will want to consider such factors as payments for treatments, voluntary deductible, monthly premium and the client 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 the first four months of residency are charged a penalty equal to 130% of premium costs from the date of registration, 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.
To be covered for treatments that are not included in the basic health insurance policy (for example, dental or vision care), you will need a ‘supplemental health insurance’ policy. The policy can be from the same or different insurance company.
The supplemental insurance policy is a separate policy from the national basic health insurance policy and is not mandatory under Dutch law. Some international health insurance policies provide coverage similar to that which is offered by Dutch supplemental insurance policies. Before purchasing an international health insurance policy, it is a good idea to see how many care providers they are contracted with in the Netherlands and the location of the nearest care provider. If the company has limited care partners in the Netherlands, you will better served by taking out a supplemental insurance policy with a Dutch insurance company.
Unlike the Dutch national basic health insurance, where insurers are obligated to accept all people who sign up with them, supplemental insurance is at the discretion of the insurance company. The extent of care coverage and the annual cost/monthly premiums for a supplemental insurance policy is set by individual insurance companies and not regulated by the government.
Health Insurance Information in English
Very few health insurance companies in the Netherlands provide information in English for non-Dutch speaking expats. One company that does is ONVZ.