D-3598 Summary of Cover
Transcript of D-3598 Summary of Cover
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All he hg y
ca expec frm
Mre Care
Summary of health insurancereimbursements for 2011
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Avro Achmea
Postbus 1717
3800 BS Amersfoort
General telephone number: 0900 - 9590 (local rate)
Travel Line: 0900 - 23 02 340 ( 0.10 p/m)
Nursing articles line: 0900 - 20 08 010 ( 0.10 p/m)
Holiday doctor: +31 71 36 41 802
Emergency Centre: +31 71 36 41 850
www.averoachmea.nl/zorgverzekeringen
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Table of contents
3 More Care. For you to make the most of4 Faster assistance thanks to care mediation!
4 The Seven Certainties of good care
5 The deductible excess
6 No deductible excess thanks to care mediation
7 On paying bills and their reimbursement
7 When permission is required for treatment
8 What happens when things change?
8 Awareness and healthy living!
9 Some useful information
10 A cheap way to get fit
15 Your health insurance
16 What can you find where in the summary of reim-
bursements?
18 Summary of reimbursements 2011
30 Summary of the health insurance policies
31 Privacy
31 Applicable law and complaints procedure
31 Information about Avro Achmea
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More Care
For you to make the most of
3
Avro Achmea offers excellent care, in every sense. We
help you make all the right arrangements to ensure
excellent cover for an attractive price. As far as we are
concerned, no-one should have to wait for care. We also
believe that good care should be a matter-of-course.
You can always be sure of our Seven Certainties of Good
Care:
1. Care and waiting time mediation for everyone.
2. A care guarantee for all insured parties.
3. No obligatory deductible excess in the case of certain
operations.
4. Recourse assistance.
5. GP and dentist mediation.
6. Help when on holiday abroad.
7. Health programme.
You can find out more about the benefits of Avro
Achmea on the following pages. They also contain
practical information on paying bills and submitting
claims. In the summary of reimbursements you can find
out exactly what is reimbursed via the various(supplementary) insurance policies.
We hope you live a long and healthy life, but if you need
more care, Avro Achmea will always be there to help.
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We believe that good care should be a matter of course.
After all, nothing is more important than your health. It is
for this reason that we have made a number of key
arrangements. You can always be sure of the following
Seven Certainties:
1. Care and waiting time mediation
If you have medical problems, you will want good quality
assistance at the earliest opportunity. It is our job to provide
it. All you have to do is call the Avro Achmea care mediation
department and you will soon have an appointment with a
doctor or specialist.
2. Care guarantee
Care guarantee means you are guaranteed follow-up assistan-
ce for 65 common forms of treatment within 10 working days.
3. No obligatory deductible excess in the case of certain
operations
You do not pay any obligatory deductible excess for a
number of common operations if you make the necessary
arrangements via our care mediation service. The great
thing about this is that we also ensure that you are provi-
ded with good quality care at the earliest opportunity.
Faster assistance thanks to care mediation!
The fastest referrals
If you have medical problems, you will want rapid and good quality assistance. Your GP will usually refer you to the ne-
arest hospital. You may then be added to a waiting list. Care mediation helps to ensure that you receive assistance more
quickly.
All you need to do is call the care mediation department and we will start looking for hospitals that are specialised in cer-
tain forms of medical treatment. The main focus is on the speed and quality of the care. Our care mediators are in contact
with all hospitals in the Netherlands and even some in Belgium and Germany. If you agree to the care advice they provide,
our care mediator will make all the necessary arrangements. Thanks to our guarantee agreements you can often get an
appointment within two weeks. The sooner your problem is dealt with, the sooner your life can get back to normal.
Call 0900 - 9590 (local rate) or surf to www.averoachmea.nl/zorgbemiddeling to arrange assistance.
The Seven Certainties of
good care
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4. Recourse assistance
If you have suffered bodily injury as a consequence of an
accident, or wish to make a claim for compensation as a
consequence of a medical activity, we will help you recover
the costs.
5. GP and dentist mediation
If you are going to move house, we will help you find a new
GP or dentist. We will find out which practices are able to
accept new patients and will make the necessary
arrangements so that your registration is completed within
two weeks.
6. Help when abroad
It is nice to know that, when you are abroad,
Avro Achmea is there for you 24 hours a day. All you have
to do is call our Emergency Centre or our Holiday Doctor.
7. Health-programme
Health is a unique service which helps you improve your
health and develop a healthy lifestyle. For example, it offers
you a discount on a Health Check, so that you can find out
exactly how healthy you are. You also get a discount at the
Achmea Health Centers, and you will be eligible for the
regular special offers which can be found at
www.averoachmea.nl/health. We even reimburse the
majority of the costs of, for example, a first aid course.
Everyone who has to pay a premium for the basic insurancepolicy also has an obligatory deductible excess. In 2011 this
is 170.00 per insured party per calendar year. This deducti-
ble excess is set by the government to keep care affordable.
This means you have to pay the first 170.00 of the medical
costs incurred yourself. The costs on top of this are then
eligible for reimbursement.
Avro Achmea allows you to opt for a voluntary deductible
excess in addition to the obligatory deductible excess. The
higher your voluntary deductible excess, the lower your
premium will be. There are several ways in which you can in-
crease your deductible excess. The details can be found on
the back of your policy document. From all reimbursements
of care expenses which we issue during the course of the
year, we first deduct the obligatory deductible excess of
170.00 and then any self-selected voluntary deductible ex-
cess. If you want to adjust your voluntary deductible excess,
you can do so every year by calling 0900 - 9590 (local rate).
The deductible excess does not apply to:
GP visits (with the exception of subcontracted labora-tory tests).
Care which is reimbursed via your supplementary (den-tal) insurance policy.
Care and dental care for children aged up to 18. Articles on loan (such as VDU spectacles). Maternity care and obstetrical assistance. Chain-based care and follow-up checks of the donor.
The deductible excess
What you have to pay and what not
Your bills are always set off against the obligatory
deductible excess and lastly the voluntary deductible
excess (if you have opted for one).
Sample calculation 1:
obligatory deductible excess alone
Mr Jones only has the deductible excess required by law
of 170.00. He pays a bill of 190.00 to the care provider
himself and then submits the invoice to us as a claim. The
first 170.00 of this invoice are charged to his deductible
excess as required by law. We then reimburse the rest
( 20.00). Mr Jones will then pay no more deductible
excess for the rest of the year. Any treatment he under-
goes in that year will, therefore, be reimbursed.
Sample calculation 2:
obligatory and voluntary deductible excess
Mrs Smith has opted for a voluntary deductible excess of
200.00 over and above the obligatory deductible excess.
Her hospital submits a claim directly to us for treatment
costing 700.00. We pay the hospital directly. We then
additionally charge Mrs Smith her obligatory deductible
excess ( 170.00), followed by her voluntary deductible
excess ( 200.00). Mrs Smith therefore has to pay a total
of 370.00. After that Mrs Smith will pay no more
deductible excess for the rest of the year. Any treatment
she undergoes in that year will, therefore, be reimbursed.
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No deductible excess thanks to care mediation
In the case of a number of forms of specialist medical treatment
We want to help you find the best possible care as quickly as possible. We want to do this on the basis of consultation
with you because the Dutch healthcare system really offers you a number of choices. One example is the useful informa-
tion which is available on the quality of various forms of specialist medical treatment. If you ask us for advice regarding
which hospital offers the best treatment you can, in a number of cases, even become eligible for exemption from the
obligatory deductible excess. All you have to do is contact us on 0900 - 9590 (local rate) or surf to www.averoachmea.nl/
zorgbemiddeling to find out which forms of treatment this exemption applies to.
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* In the case of medical expenses incurred abroad, travel expenses incurred using your own or public transport and visiting or accommodation costs, youhave to complete a claims form and submit it with the original bill. The forms can be downloaded via www.averoachmea.nl/zorgverzekeringen under
Meer informatie [More Information] and then Declareren [Claims].
As an insured party you often do not receive any bills at all.
In fact, most care providers submit bills to us directly. This
is handy and relieves you of the worry! If you do receive a
bill, this may be because we do not have agreements with
all care providers regarding direct payments. You have to
pay the bill yourself and then claim the costs from us.
Good to know
Please let us know if the bill you have submitted is the con-
sequence of an accident.
On paying bills and their reimbursement
How to submit bills
When permission is required for treatment
How to get authorisation?
Step 1
Find the original bill.
Step 2
Check whether your name, address, place of residence
and date of birth are referred to on the bill.
Step 3
Write down the client number of the person who has re-
ceived the treatment in the top right-hand corner of the
bill. You can find the client number of the care card.
Step 4
Make a copy of the bill for your own records.
Step 5
Send the original bill without* any accompanying letter or
claims form* to:
Avro Achmea
Afdeling Declaratieservice
Postbus 59005
1040 KA Amsterdam
The bill will be processed within 10 days.
In some cases you will need
permission beforehand in order fortreatment, medicines or travel costs
to be reimbursed. We refer to this
approval as an authorisation. Dental
implants and an insulin pump are
examples of treatment or a nursing
article for which you need
authorisation.
You can find details of the types of
treatment for which you need an
authorisation in our summary of
reimbursements and policy
conditions. You or your care provider
can apply for authorisation using the
special form which can be found at
www.averoachmea.nl/zorgverzeke-ringen. You can also telephone our
Customer Services on: 0900 - 9590
(local rate).
Travel costs
Insured parties who have to undergo
certain forms of treatment or who are
wheelchair-dependent can receive a
reimbursement of (part of) the travel
costs from and to the hospital. For this
you need an authorisation for travel
costs. You can apply for this via the
special Travel Line: 0900 - 23 02 340
( 0.10 p/m).
Nursing articles without authorisation
For some nursing articles, for examplehearing aids, incontinence materials
and ortheses, you can simply contact
the supplier we have contracted using
the referral from your GP or specialist
without any authorisation. Details on
all our contracted suppliers can be
found at Find your care provider at
www.averoachmea.nl/zorgverzekerin-
gen. Alternatively you can call our
nursing articles line: 0900 - 20 08 010
( 0.10 p/m).
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When things change
How do you change your personal details?
Our health client benefit product is ideal for all our health-
conscious policyholders. It is a unique service which helps
you improve your health and develop a healthy lifestyle. It
includes things like the Health Check and various discounts.
For example you get a discount on participation in a first aid
course or a course on coping with heart problems. Informa-
tion on the special offers with which you can get even more
out of your health insurance can be found further on in this
booklet. We can make a real difference to your state of
health.
Awareness and healthy living!
The Avro Achmea Health programme
Sometimes things in life change. The
same applies to the details we have
on you. If you want to change your
policy and opt for another health
insurance, please contact your insu-
rance adviser. You can also use the
change form at www.averoachmea.
nl/zorgverzekeringen
We receive notification about you
moving house within the Netherlands,
a change in initial(s), additional name
details or surname, a marriage or
registered partnership, a divorce
(except in the event of a policyholder
change) or death via the municipal
records database. There is therefore
no need for you to inform us of these
changes yourself. Neither do you need
to inform us of any change in dentist,
GP or pharmacy.
For administrative changes relating to
a birth, moving house abroad (in that
case you should check whether you
retain your right to basic insurance in
the Netherlands), a different
telephone number, e-mail address,
account number or payment method,
you can simply call our Customer
Services on 0900 - 9590 (local rate) or
use the change form at www.avero-
achmea.nl/zorgverzekeringen.
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Care allowance
The care allowance is a financial contribution by the Tax
Authorities intended to keep the basic insurance afforda-
ble for everyone. Whether you are eligible depends on your
personal situation. The Tax Authorities determine the
amount of the care allowance on the basis of your income
and that of your partner if you have one.
If you have received care allowance this year and your
situation has not changed, you do not need to apply for it
again for next year. If you have not received any care
allowance this calendar year and you think you are entitled
to it in the coming year, you can submit an appropriate ap-
plication to the Tax Authorities. Surf to www.toeslagen.nl
or call the BelastingTelefoon on 0800 - 0543.
Complaints
We do our level best to resolve any problems you may
encounter. Nevertheless, you may still be unhappy about
some aspect of the services we provide. You should then
contact your insurance adviser. If you wish to submit a
complaint, please do so via www.averoachmea.nl/zorg-
verzekeringen or by post: Avro Achmea, Centrale Klach-
tencordinatie Achmea Zorg, Antwoordnummer 93200,
2200 XA Noordwijk.
The Care Regulator
The Algemene Wet Bijzondere Ziektekosten [Exceptional
Medical Expenses Act] (AWBZ) is a national medical expen-
ses scheme, for example for long-term home care and care
for handicapped people. It is an obligatory insurance for
everyone who lives and works in the Netherlands. If your
own health insurance does not reimburse your care
expenses you can, in some cases, claim via the AWBZ.
The Wet maatschappelijke ondersteuning [Social Support
Act] (Wmo) offers local authority assistance if you need
help and are unable to fall back on volunteer carers in your
community (family, friends, neighbours, volunteers).
For care issues related to the AWBZ and Wmo, you or your
carer can use our Care Regulator. Via the supplementary
health insurance we reimburse a number of hours of
support relating to complex care issues relating to the
AWBZ and the Wmo and the accompanying regulatory
tasks in the field of care, work, welfare, living and finances.
If you would like to be eligible for this support, please
contact our Customer Services on 0900 - 9590 (local rate).
A carefree holiday
Start your trip in a stress-free way. After all, you can always
turn to us for advice or assistance if you have a medical
query or in the event of an emergency. Make sure you have
the following numbers in your mobile telephone:
Some useful information
Useful addresses and numbers
The holiday doctor: +31 71 36 41 802For medical queries, not emergencies.
The Achmea Emergency Centre:+31 71 36 41 850The Achmea Emergency Centre can be contacted
in emergencies 24 hours a day.
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A cheap way to get fit
Get more out of your health insurance with Avro Achmeas Health programme
Getting fit makes you feel better. Its something we all want. That is why we are making it as attractive as possible. We
offer all kinds of offers and discounts. For example, there is a discount on a Health Check, help losing weight, a reimburse-ment for a first aid course and a discount on eye laser treatment. More information can be found on our website
www.averoachmea.nl/health
First Aid
First aid coursesIt can be very handy to know how to provide first aid in the
event of accidents. If you have supplementary insurance
the costs will be partially reimbursed, or even totally
reimbursed in the case of the Excellent variant.
www.averoachmea.nl/health
Sleeping
Sleeping courseSleeping better makes people healthier and fitter. If you
have supplementary insurance the costs will be partially
reimbursed, or even totally reimbursed in the case of the
Excellent variant. www.averoachmea.nl/health
First Aid
First aid for accidents involving childrenAccidents and injuries can happen at any time, especially
where children are concerned. Doing a first-aid course
helps you to know what you should do. You can attend a
course in first aid for childrens accidents at a home care
institution or the local First Aid association. Alternatively
you can do the Internet course on first aid for children
offered by Iedereen EHBO. If you have supplementary
insurance the costs will be partially reimbursed, or even
totally reimbursed in the case of the Excellent variant.
www.averoachmea.nl/health
Instructive
Diabetes courseThe Diabetesvereniging Nederland [Netherlands Diabetes
Association] (DVN) organises basic and follow-up courses
for patients with type 2 diabetes or people associated with
them. If you have supplementary insurance the costs will
be partially reimbursed, or even totally reimbursed in the
case of the Excellent variant. www.averoachmea.nl/health
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Well seen
Eye laser treatmentWouldnt it be great, if you are short or long sighted, to
wake up in the morning and immediately see everything
clearly, without first having to put on your glasses or put
in your lenses? Having your eyes lasered can make this a
reality. If you have supplementary insurance, you will be
eligible for an attractive discount if you have your eyes la-
sered at Vision- Clinics. No reimbursement for eye laser
treatment is available in the case of the Start supplemen-
tary insurance policy. The Extra and Royaal variants provi-de a reimbursement of up to 500.00 for eye laser treat-
ment over the entire term of your insurance policy. The
Excellent variant provides a reimbursement of up to
750.00 for eye laser treatment over the entire term of
your insurance policy. www.averoachmea.nl/health
Instructive
Coping with heart problemsA preventive course designed to help patients learn to cope
with heart problems. You can do this course at a home care
institution. If you have supplementary insurance the costs
will be partially reimbursed, or even totally reimbursed in
the case of the Excellent variant.
www.averoachmea.nl/health
Sauna
A discount on visits to the saunaGoing to the sauna is a great way to give your body and
mind a little break. As an Avro Achmea insured party you
are eligible for a discount on visits to the sauna. Details
on the special offer can be found at
www.averoachmea.nl/health
Welfare
Stopping smokingIf your basic insurance does not grant you eligibility for a stop-
ping smoking programme, you can always do a course. You
can choose between Stop smoking with Allen Carr, I Quit
Smoking at a home care institution, or laser therapy. If you
have supplementary insurance the costs will be partially
reimbursed, or even totally reimbursed in the case of the Ex-
cellent variant. www.averoachmea.nl/health
now
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Exercise
Achmea Health Centers: 20% discountAt the Achmea Health Centers, a personal plan and good
quality supervision will help you train.
www.averoachmea.nl/health
now
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Nutrition
A healthy weight in 15 weeks
Help losing weight might be just the boost you need. Depen-ding on your supplementary insurance policy, the reimburse-
ment may be as much as 100%. You can do a course at a home
care institution, or a correspondence or online Happy Weight
course, or complete the Sportief afslanken [Sports weight loss]
programme at one of the Achmea Health Centers.
www.averoachmea.nl/health
Health products
Health ShopDiscounts are available on the entire range of health
products from our Health Shop Internet store.
www.averoachmea.nl/health
Health Check
Check your health via the Health CheckThe Health Check is a quick and easy way for people to
get a good indication of their state of health. By determi-
ning the cholesterol and glucose levels in your blood, ta-
king your blood pressure, and measuring the length/body
mass ratio and lung function, the Health Check ensures
that any increased risk of heart and vascular diseases is
detected in good time. Avro Achmea offers an attractive
discount on the Health Check. In fact, the Excellent sup-
plementary insurance policy even offers a 100% reimbur-
sement of the Health Check. www.averoachmea.nl/health
A clear view of things
Reimbursements and discounts for glasses andcontact lensesNo-one wants their eyesight to deteriorate and no-one
wants to spend a fortune on glasses or lenses. Via the Start
supplementary insurance policy we reimburse, per person
per 3 calendar years, the costs of glasses and contact lensesup to an amount of 100.00. The reimbursement via the
Extra variant is 150.00. Via the Royaal variant, Avro
Achmea reimburses, per person per 3 calendar years, 1 set of
spectacles (including frame) or a pair of contact lenses for
long-term use up to an amount of 250.00. This means new
glasses or contact lenses on average once every 3 years! The
reimbursement for daily, weekly, monthly, six monthly and
yearly lenses is up to 65.00 per calendar year. The amounts
reimbursed via the Excellent variant are 350.00 and
75.00 per calendar year respectively. In addition, each
supplementary insurance policy offers a discount at Pearle
and Eye Wish stores. www.averoachmea.nl/health
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Summary of reimbursements 2011
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Your health insurance
For which types of care are we insured in the Netherlands? What is the difference between the basic insurance and the
supplementary insurance policies? Our care system in a nutshell.
The Dutch care system
The government introduced our current care system on
1 January 2006. It consists of a basic insurance policy
with an obligatory deductible excess. Everyone in the
Netherlands is obliged to be insured for medical expenses
and everyone aged 18 or over pays a premium. You may
be eligible for a premium costs subsidy. This subsidy is
called the care allowance. More information is available
at www.toeslagen.nl.
What is basic insurance?
Basic insurance is for everyone in the Netherlands. The
government sets the basic insurance reimbursements every
year.
Zorg Plan [Care Plan]
Zorg Plan means you receive care from care providers with
whom we have made agreements. As a result you pay a
slightly lower premium. If you use other care providers, the
reimbursement will be lower and you may have to pay an
additional charge. We pay bills directly (less the statutory
personal contributions).
Keuze Zorg [Options Care] Plan
The Keuze Zorg Plan gives you complete freedom to choose
whichever care provider you want. It does not matter
whether the care provider has a contract with us or not. You
always receive a full reimbursement to the maximum of the
statutory amount, or to the maximum of the rate (applica-
ble on the market) in the Netherlands (less the statutory
personal contributions).
What cover does the (Keuze) Zorg Plan provide?
Medical care provided by GPs, hospitals, specialists and
midwives.
Hospital admissions.
Nursing articles.
Medicines.
Maternity care.
Patient transport.
Paramedic assistance (limited physiotherapy/remedial
therapy, speech and language therapy, occupational thera-
py and dietary advice).
Dental care (up to the age of 18).
What cover does a supplementary insurance policy
provide?
You can take out supplementary insurance in addition to basic
insurance. For example for a reimbursement of the statutory
personal contributions, or for more comprehensive cover for
physiotherapy, dental costs or emergency help when abroad.
Avro Achmea allows you to choose from different supplemen-
tary insurance policies and separate dental insurance policies.
The higher the supplementary insurance policy, the more
extensive the cover and the higher the reimbursements.
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Alternative18 Alternative remedies and
therapies.
18 Homeopathic and anthropo-
sophic medicines
Bones, muscles and joints19 Exercise programmes
19 Exercising in extra heated wa-
ter for rheumatism sufferers
19 Occupational therapy
19 Orthopaedic medicine
19 Chiropodist care in the case of
rheumatism or diabetes
When abroad19 Repatriation
19 Emergency care
19 Non-emergency care
19 Vaccinations and
consultations
Skin20 Skin care
20 Psoriasis treatment
Physiotherapy and remedialtherapy (18 and older)20 Chronic disorder
20 Non-chronic disorder
20 Pelvic physiotherapy
Physiotherapy and remedialtherapy (younger than 18)20 Chronic disorder
20 Non-chronic disorder
Nursing articles21 Nursing articles via the basic
insurance
21 Equipment for negative
pressure therapy
21 CPM invalid buggy
21 Walking aids
21 Personal alarms
21 Breast prosthesis adhesive
strips
21 Incontinence alarm
21 Wig
21 Support pessary
21 Support soles
21 Transtherapy to alleviate in-
continence
Medicines22 Contraception
22 Medicines via the basic
insurance
22 Flu vaccination
22 Melatonin
Mouth and teeth (18 andolder with supplementary
dental insurance)22 Dentist, dental hygienist and
dental prosthetician
22 Other forms of treatment
22 Treatment which we do not
reimburse
Mouth and teeth (18 andolder)22 Dentures (prosthesis)
23 Orthodontics (brace)
23 Orthodontics (brace) 18 - 22
years old
23 Orthodontics (brace) from age
22 onwards
23 Dental costs as a consequence
of an accident from age 18
onwards
23 Care for handicapped people
23 Exceptional cases
Mouth and teeth (youngerthan 18)23 Any treatment by a dentist,
dental hygienist, dental
surgeon and dental
prosthetician
23 Crowns, bridges, inlays and
implants
23 Orthodontics (brace)
Eyes and ears23 Audiological centre
23 Prescription glasses and lenses23 Correction of upper eyelids
23 Correction of ear position
24 Hearing aid
24 Eye laser treatment
Psychological care24 Primary psychological care
24 Second-line mental health
care (GGZ)
24 Admission to a psychiatric
hospital
What can you find where in the summary of
reimbursements?
To find out what is reimbursed, choose the theme in the overview below and then look to see which page it is on. This is a
quick way of finding the care you are looking for. Each reimbursement is accompanied by information on what exactly is
reimbursed via the (Keuze) Zorg Plan (basic insurance) and via any of the supplementary insurance policies. If you cannotfind the care you are looking for, surf to our website www.averoachmea.nl/zorgverzekeringen or call our Customer Services
on 0900 - 9590 (local rate).
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Talking and reading24 Dyslexia-related care
24 Speech and language therapy
24 Stutter therapy
(Patient) transport25 Ambulance
25 Travel costs after care
mediation abroad
25 Accommodation and travel
costs incurred by family
members after care mediation
abroad
25 Patient transport
Hospital, treatment andnursing25 Asthma Centre in Davos
25 Treatment, examination and
operation in hospital
25 Cosmetic and plastic surgery
25 Dialysis
25 Hereditary research and con-
sultancy
26 Guest house
26 Dental surgery
26 Mechanical respiration26 Obesity change in behaviour
programme
26 Organ transplants
26 Preventive examinations
26 Second opinion
26 Sterilisation
26 Telemonitoring in the event of
chronic heart failure
26 Nursing outside hospital
26 Nursing in hospital
26 Independent treatment centre
(Becoming) pregnant / baby /child27 Maternity care for adopted
children or medical screening
in the event of adoption
27 Circumcision
27 Childbirth
27 Monitoring equipment to
prevent cot death
27 GeboorteTENS
27 IVF
27 Maternity pack
27 Maternity care
27 Breastfeeding assistance
27 Oncology examination for
children
28 Prenatal screening
28 Therapeutic holiday camps
28 Obstetrical care
28 Fertility-enhancing treatment
Other28 Dietary advice and nutritional
information
28 Health Check
28 Herstel en Balans [Recovery
and Balance]28 Convalescence home
28 Hospice
28 GP
28 Chain-based care for diabetes
and COPD
28 Childcare for children aged up
to 12 while their parent(s) is/
are admitted to hospital
28 Lifestyle training sessions
28 Substitute volunteer care
28 Menopause consultant
28 Patient associations
29 (Preventive) courses
29 Rehabilitation
29 Sports doctor
29 Sport-medical examination
29 Stopping smoking programme
29 Therapeutic holiday camps for
handicapped people
29 Thrombosis service
29 Payment in the event of a
functional loss
29 Holiday hotels or sailing
holidays
29 Care Regulator
Extra insurance policies29 Ziekenhuis Extra [Hospital
Extra] Insurance Policies
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Alternative(Keuze) Zorg Plan(basic insurance)
Start Extra Royaal Excellent
A. Alternative remedies andtherapiesBy a practitioner at a professionalassociation recognised by us, for
example: acupuncture, homeo-pathy, chiropractic treatment,osteopathy and manual therapyand other forms of treatment.
40.00 per day.
B. Medicines (anthroposophic andhomeopathic)The medicines have to be registeredand supplied by a pharmacy.
See www.averoachmea.nl/ zorg-
verzekeringen or call 0900 - 9590(local rate).
100% 100%
A + B added up together 440.00per person per year.
640.00per person per year.
Medicines (anthroposophic andhomeopathic)The medicines have to be registeredand supplied by a pharmacy.
See www.averoachmea.nl/ zorg-
verzekeringen or call 0900 - 9590(local rate).
100% 100%
Alternative remedies and therapiesSee www.averoachmea.nl/ zorg-
verzekeringen or call 0900 - 9590(local rate).
Specifically referredto doctors (2) 75 per
day; specificallyreferred to non-doctors (3) 40 perday; together 20consultations.
Doctors who prac-tise alternative me-
dicine 75 per day;specifically referredto non-doctors (3)
50 per day;together 24 consul-
tations.
8
Summary of reimbursements 2011
This overview details the reimbursements via both the (Keuze) Zorg Plan and the
supplementary insurance policies.
The reimbursements via the Keuze Zorg Plan and Zorg Plan are described in asingle column. These reimbursements can be found under the heading (Keuze)
Zorg Plan (basic insurance).
Surf to www.averoachmea.nl/zorgverzekeringen for an overview of contracted
care providers, the Achmea Reglement Hulpmiddelen [Achmea Nursing Articles
Regulations], the Achmea Reglement Farmaceutische Zorg [Achmea Pharmaceuti-
cal Care Regulations], our terms and conditions, brochures, forms and information
about our insurance policies.
No rights can be derived from the summary of reimbursements. A detailed
description of the terms and conditions and entitlements can be found in the
policy conditions. You should always consult these first before you contact a care
provider. You can download the policy terms and conditions from our website or
we will send it to you on request.
What does it
mean?
Year
A calendar year, which runs from1 January to 31 December.
One-off
A reimbursement for the term of
the insurance policy.
Permission from us
You need our permission before
you can claim a reimbursement.
You can request this permission
by telephoning our Customer
Services on 0900 - 9590 (local
rate).
(2) Alternative doctors are: an acupuncturist doctor, homeopathic doctor, naturalmedicines doctor, anthroposophic doctor, doctor-enzyme therapist, Sickeszdoctor, manual doctor or Moerman doctor established in the Netherlands.
(3) Alternative non-doctors are: an acupuncturist, physiotherapist acupuncturist,classic homeopath, manual therapist, chiropractor, hapto therapist or naturalmedicine therapist established in the Netherlands.
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Bones, muscles and joints (Keuze)Zorg Plan (basic insurance)
(Keuze) Zorg Plan(basic insurance)
Start Extra Royaal Excellent
Exercise programmesFor people with:
obesity BMI > 30
previous heart failure
type 2 diabetes
COPD in Gold 1 and 2 stages witha lung value of FEV1/VC > 60%.
175.00per person per year.
350.00per person per year.
Exercising in extra heated waterRemedial therapy for rheumatismsufferers.
150.00per person per year.
100% reimburse-ment ( 1), togetherwith other costs up to 500.00.
100%per person per year.
Occupational therapy Via (Keuze) Zorg Plan 100% up to 10 hours per person per year.
Orthopaedic medicineVia the Vereniging van Artsen voorOrthopedische Geneeskunde[Association of OrthopaedicDoctors] (VAOG).
150.00per person per year.
300.00per person per year.
100% reimburse-ment (1), together withother costs up to 500.00.
500.00per person per year.
Chiropodist care
For insured parties with diabetes orrheumatism.
21.00 per appoint-ment up to 126.00
per person per year.
100% reimbursement (1), together with
other costs up to 500.00.
100%per person per year.
For insured parties with acerebral infarction (CVA).
100%per person per year.
Podotherapie/podologie/podoposturale therapie(Stichting LOOP of Omni PodoGenootschap).Foot treatment and the measuring,manufacturing and delivering of po-
diatric soles and nursing articles, noshoes or shoe adaptations.
100,-per person per year.
100% reimburse-ment (1), together withother costs up to 500.00.
100%
per person per year.
When abroad(Keuze) Zorg Plan(basic insurance) Start Extra Royaal Excellent
Repatriation of insured party andtransport of human remains to theNetherlands
100% after permission from Eurocross Assistance.
Urgent careCare which cannot wait until youare back in the Netherlands.Call Eurocross Assistance foremergency assistance abroad on+31 71 36 41 850. This telephone
number can also be found on yourcare card.
100% of the rate inthe Netherlands viathe (Keuze) Zorg Plan.
100% of the rate in the Netherlands via the (Keuze) Zorg Plan.
Via Start, Extra, Royaal and Excellent.Supplement to 100% of the cost price for an uninterrupted stay of up to 12 months.Cost price = usual rate in the country in question.
Non-emergency careReimbursement in accordance withthe terms and conditions and
reimbursements
100% of the rate inthe Netherlands via
the (Keuze) Zorg Plan.See the policyconditions.
100% of the rate in the Netherlands via the (Keuze) Zorg Plan, see the policy conditions.
Via Start, Extra, Royaal and Excellent.In accordance with the reimbursement in the Netherlands with due regard for the conditionsand exclusions.
Vaccinations and consultationsDTP, yellow fever, typhoid, cholera,
rabies, Lyme disease and hepatitisA/B or medicines against malaria inconnection with a trip abroad.
Via Meditel and Achmea Vitale Travel Clinics 100%.Via the eFarma Internet pharmacy 100%.
Or via another care provider 150.00 per person per year.More information about a location close to where you live can befound at www.meditel.nl and www.achmeavitale.nl.
Via Meditel andAchmea Vitale Travel
Clinics 100%, via theeFarma Internetpharmacy 100%, orvia another care pro-vider 100% per person
per year.More informationabout a location closeto where you live canbe found at
www.meditel.nl andwww.achmeavitale.nl.
(1) ) For these care activities, insured via Royaal, a total of max. 500 is reimbursed per insured party per calendar year.
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Skin(Keuze) Zorg Plan(basic insurance)
Start Extra Royaal Excellent
Skin care By a beautician (ANBOS) or derma-
tologist:
acne treatment
camouflage therapy
facial depilation for women
300.00
per person per year.
600.00
per person per year.
100%
per person per year.For epilation you needpermission from us.
PsoriasisHire costs relating to UV B lighttherapy at home.
Via the (Keuze) Zorg Plan 100% after permission from us.
Treatment in a day treatment centre(skin).
750.00per persoon per year.
1.000.00per person per year.
18 and older
Physiotherapy and remedialtherapy
(Keuze) Zorg Plan(basic insurance)
Start Extra Royaal Excellent
Chronic disorder
Your doctor and/or physiotherapist
diagnoses the disorder.
You pay for appoint-
ments 1 to 12 yourself.
You pay for appoint-
ments 1 to 12 yourself.
You pay for appoint-
ments 1 to 12 yourself.
You pay for appoint-
ments 1 to 12 yourself.
You pay for appoint-
ments 1 to 12 yourself.
(Manual lymph drainage inconnection with seriouslymphoedema may also beperformed by a dermatologist
rather than a physiotherapist or re-medial therapist.)
Via the (Keuze) ZorgPlan as from appoint-ment 13, 100%.
Via the (Keuze) ZorgPlan as from appoint-ment 13, 100%.
+Via Start 12 appoint-ments per year.
Via the (Keuze) ZorgPlan as from appoint-ment 13, 100%.
+Via Extra 12 appoint-ments per year.
Via the (Keuze) ZorgPlan as from appoint-
ment 13, 100%.+Via Royaal 12 appoint-ments per year.
Via the (Keuze) ZorgPlan as from appoint-
ment 13, 100%.+Via Excellent 12 ap-pointments per year.
Non-chronic disorderYour doctor and/or physiotherapist
diagnoses the disorder.
Manual lymph drainage i n connec-tion with serious lymphoedemamay also be performed by a
dermatologist rather than a phy-siotherapist or remedial therapist.
12 appointments peryear.
27 appointments peryear.
27 appointments peryear.
All appointments.
Pelvic physiotherapy Via the (Keuze) ZorgPlan appointments 1to 9.
Via the (Keuze) ZorgPlan appointments 1to 9.
+Via Start 12 appoint-ments per year.
Via the (Keuze) ZorgPlan appointments 1to 9.
+Via Extra 27 appoint-ments per year.
Via the (Keuze) ZorgPlan appointments 1
to 9.+Via Royaal 27 appoint-ments per year.
Via the (Keuze) ZorgPlan appointments 1
to 9.+Via Excellent allappointments.
A number of chronic and non-chronic disorders or pelvic physiotherapyIf you have a number of disorders, you should always contact our Customer Services on 0900 - 9590 (local rate). Our staff would be only too pleased to explain whatreimbursements you can expect.
Younger than 18
Physiotherapy and remedialtherapy (Keuze) Zorg Plan(basic insurance) Start Extra Royaal Excellent
Chronic disorderYour doctor and/or physiotherapist
diagnoses the disorder.Manual lymph drainage in conne c-tion with serious lymphoedema mayalso be performed by a dermato-logist rather than a physiotherapist
or remedial therapist.
Via the (Keuze) Zorg Plan 100%.
Non-chronic disorderYour doctor and/or physiotherapistdiagnoses the disorder.Manual lymph drainage i n connec-
tion with serious lymphoedema
may also be performed by a der-matologist rather than a physio-therapist or remedial therapist.
Via the (Keuze) ZorgPlan 18 appointmentsper diagnosis.
Via the (Keuze) ZorgPlan 18 appointmentsper diagnosis.
+Via Start 12 appoint-
ments per year.
Via the (Keuze) ZorgPlan 18 appointmentsper diagnosis.
+Via Extra 27 appoint-
ments per year.
Via the (Keuze) ZorgPlan 18 appointments
per diagnosis.+Via Royaal 27 appoint-
ments per year.
Via the (Keuze) ZorgPlan 18 appoint-
ments per diagnosis.+Via Excellent all
appointments.
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Nursing articles(Keuze) Zorg Plan(basic insurance)
Start Extra Royaal Excellent
Nursing articles via the basicinsuranceReimbursement in accordance withthe terms and conditions in theAchmea Reglement Hulpmiddelen(Keuze) Zorg Plan [Achmea (Options)
Care Plan Nursing Articles Regulati-
ons]. See www.averoachmea.nl/zorg-verzekeringen or call 0900 - 9590 (localrate). Call 0900 - 20 08 010 ( 0.10 p/m)for personal alarms, workchairs, chairs
adapted for people with disabilities(not stand-up chairs) and nursing beds.
Via the (Keuze) Zorg Plan 100%.
Certain nursing articles are subject to prior permission from us, a max.reimbursement or statutory personal contribution.
250.00 statutorypersonal contributionfor other nursingarticles, no wig,hearing aid, ortho-
paedic shoes andallergy-free shoes.
100% statutorypersonal contributionfor other nursingarticles, no wig, hearing
aid, orthopaedic shoesand allergy-free shoes.
In addition to the above reimbursement, all insured parties with a supplementary insurance
policy are eligible, upon production of their care pass at Vegro and Harting-Bank/Ligtvoet, fora discount for rollators, stand-up chairs and ADL nursing articles.
Equipment for negative pressuretherapyE.g. for the removal of wounddischarge. Call the nursing articles
line: 0900 - 20 08 010 ( 0.10 p/m)
Via the (Keuze) Zorg Plan 100%.
CPM invalid buggyNursing article used after knee orankle joint operations.
Via the (Keuze) Zorg Plan 100%.
Walking aidsElbow crutches, walking aids and 3or 4 leg sticks and walking frames.
Only via suppliers we have selected 100%.
Personal alarms
On medical grounds
Call the nursing articles line:0900 - 20 08 010 ( 0.10 p/m)
Via the (Keuze) ZorgPlan, requested via thenursing articles line100% for personalalarm unit. See also the
Achmea Reglement(Restitutie) Hulpmid-
delen [Achmea NursingArticles (Restitution)Regulations].
Via the (Keuze) Zorg Plan, requested via the nursing articles line 100% for personal alarmunit Eurocross Assistance alarm system.
Via Start, Extra, Royaal and Excellent 100% for alarm system subscription costs Action Line
via Eurocross Assistance.
Or via an other alarm system provider 35.00 per year for subscription costs after permis-
sion from us.
On social grounds. Via Excellent 100% foralarm system subscrip-tion costs Action Linevia Eurocross Assistan-ce or via an other alarm
system provider 35.00 per year afterpermission from us.
Breast prosthesis adhesive strips 100%
Incontinence alarmIn the event of bedwetting
problems.
One-off 100.00 perperson.
100% reimburse-ment (1), together with
other costs up to 500.00.
100%
Wig Via the (Keuze) Zorg Plan 386.50 per wi g.
See also the Achmea Reglement (Restitutie)Hulpmiddelen [Achmea Nursing Articles(Restitution) Regulations].
462.00 per wig with
386.50 via the(Keuze) Zorg Plan 75.50 via Extra.
486.50 per wig with 386.50 via the(Keuze) Zorg Planmax. 100.00 viaRoyaal.
486.50 per wig with 386.50 via the(Keuze) Zorg Plan.Extra reimbursementis possible.
Support pessaryIn the event of a prolapse of the womb.
100%
Support solesNo podotherapeutic or podologicalsupport soles.
35,-per person per year.
100% reimburse-ment (1), 1 pair, toge-ther with other costs
up to 500.00.
100%.
Transtherapy to alleviate incontinenceHire of neuromodulator (BioStim). 100%
Hire of bio feedback equipment(FemiScan).
100%
(1) For these care activities, insured via Royaal, a total of max. 500 is reimbursed per insured party per calendar year.
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Medicines(Keuze) Zorg Plan(basic insurance)
Start Extra Royaal Excellent
Contraception
Up to age 21,
for example the pill or coil.
Via the (Keuze) Zorg Plan in accordance with Achmea Reglement Far-
maceutische Zorg [Achmea Pharmaceutical Care Regulations] (Keuze)Zorg Plan.You yourself pay the statutory personal contribution, the Geneesmid-delen Vergoedingen Systeem [Medicine Reimbursements Scheme](GVS), which differs per medicine.
See www.averoachmea.nl/zorgverzekeringen for detailed informati-on.
Via the (Keuze) Zorg Plan in accordance wi thAchmea Reglement Farmaceutische Zorg[Achmea Pharmaceutical Care Regulations](Keuze) Zorg Plan.+
Via Royaal and Excellent 100% reimbursement
of statutory personal contribution (the GVSupper limit price).
From age 21,
for example the pill or coil.
100%. No reimbursement personal contributi-
on (GVS upper limit price).
100%
+Via Royaal and Excellent 100% reimbursementof statutory personal contribution (the GVSupper limit price).
Medicines via the basic insurance Via the (Keuze) Zorg Plan in accordance with Achmea Reglement Farmaceu-tische Zorg [Achmea Pharmaceutical Care Regulations] (Keuze) Zorg. You
yourself pay the statutory personal contribution, the Geneesmiddelen Ver-goedingen Systeem [Medicine Reimbursements Scheme] (GVS), which dif-fers per medicine. See www.averoachmea.nl/zorgverzekeringen for de-tailed information.
Via the (Keuze) Zorg Plan in accordance wi thAchmea Reglement Farmaceutische Zorg
[Achmea Pharmaceutical Care Regulations]. +Via Royaal and Excellent 100% reimbursementof statutory personal contribution (the GVSupper limit price).
Flu vaccination 100%
MelatoninMedication for, among other things,insomnia.
Via the eFarma Inter-net pharmacy 100%or via another phar-macy 100.00 after
permission from us.
Via the eFarma Inter-net pharmacy 100%or via another phar-macy 150.00 after
permission from us.
100% afterpermission from us.
18 and older with supplementary dental insurance
Mouth and teeth(Keuze) Zorg Plan(basic insurance)
T Start T Extra T Royaal T Excellent
A. Dentist, dental hygienist anddental prosthetician:
consultations (C codes) andsecond opinion
oral hygiene (M codes)
fillings (V codes) extraction of teeth/molars
(H codes).
100%
B. Other forms of treatment 75% 100%
A + B added up together 225.00 per personper year.
450.00 per personper year.
900.00 per personper year.
1.150.00 per personper year.
C. Treatment which we do notreimburse:
inspection report (C70 and C75)
missed appointments (C90)
orthodontics (D codes)
subscriptions (Z codes)
external bleaching of teeth and
molars (E97, E98 and E00)
mandibular advancement devices(MRA G71, G72 and G73).
18 and older
Mouth and teeth(Keuze) Zorg Plan(basic insurance)
Start Extra Royaal Excellent
Dentures (prosthesis) Via the (Keuze) Zorg Plan 75%.Statutory personal contribution 25%.Costs higher than 600.00 per jaw after permission from us.
Replacement within 5 years after permission from us.
The purchase of fully removabledentures made by a dentist ordental prosthetician.
Repair or refitting (rebasing) of fully
removable dentures made by adentist or dental prosthetician.
Via the (Keuze) Zorg Plan 100%.
Implants for removable dentures, inthe case of serious dental, jaw ormouth development or growth dis-
orders, made by a dentist, dentalsurgeon or centre for special dentaltreatment.
Via the (Keuze) Zorg Plan 100% after permission from us.
2
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18 and older
Mond en tanden(Keuze) Zorg Plan(basic insurance)
Start Extra Royaal Excellent
Dentures (prosthesis)Fully removable complete prosthe-sis on implants, in the case of seri-ous dental, jaw or mouth develop-ment or growth disorders, made bya dentist, dental prosthetician or
centre for special d ental treatment.
Via the (Keuze) Zorg Plan 100% after permission from us.Statutory personal contribution 125.00 per upper or lower jaw.
Orthodontics (brace)In the case of serious dental, jaw ormouth development or growth dis-orders.
Via the (Keuze) Zorg Plan 100% after permission from us.
Orthodontics (brace) 18 - 22 years oldBy dentist/orthodontist. With theexception of repair/replacementafter damage/loss due to your own
fault/negligence.
One-off 90%reimbursement up to 2,500.00 per person.
100% per person.
Orthodontics (brace) from age 22onwardsBy dentist/orthodontist. With the ex-ception of repair/replacement after
damage/loss due to your own fault/negligence.
One-off 70% up to 1,000.00 per person,no score 1 and 2 of
the Index for Ortho-
dontic TreatmentNeed (IOTN).
One-off 70% up to 500.00 per person,no score 1 and 2 of
the Index for Ortho-
dontic TreatmentNeed (IOTN).
Dental costs as a consequence of anaccident from age 18 onwards
75% up to 200.00 per element and up to 2,500.00 per accident per person per year.
Care for handicapped peopleYour dentist will know whether
you are eligible for the reimburse-ment.
Via the (Keuze) Zorg Plan 100% in the absence of an entitlement to reimbursement via the AWBZ and after permissionfrom us.
Exceptional casesUw tandarts weet of u in aan-merking komt voor de vergoeding.
Your dentist will know whether you are eligible for the reimbursement.Via the (Keuze) Zorg Plan 100% after permission from us.In some cases a statutory personal contribution applies.
Younger than 18
Mouth and teeth (Keuze) Zorg Plan(basic insurance)
Start Extra Royaal Excellent
Any treatment by a dentist, dentalhygienist, dental surgeon anddental prostheticianWith the exception of cast fillings,crowns, bridges, inlays and implants.
Via the (Keuze) Zorg Plan 100%.
Crowns, bridges, inlays andimplantsBy dentist/dental surgeon.
225.00
per person per year.
450.00
per person per year.
100%
per person per year.
100%
per person per year.
Orthodontics (brace)By dentist/orthodontist. With theexception of repair/replacement af-
ter damage/loss due to your own
fault/negligence.
One-off 90%,reimbursement up to 1,500.00 per person.
One-off 90%,reimbursement up to 2,000.00 per person.
One-off 90%,reimbursement up to
2,500.00 per person.
100% per person.
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Eyes and ears(Keuze) Zorg Plan(basic insurance)
Start Extra Royaal Excellent
Audiological centre Via the (Keuze) Zorg Plan 100%.
Prescription glasses and lenses 100.00 per personfor glasses and lenses
together once every 3years.
150.00 per personfor glasses and lenses
together once every 3years.
Glasses or contactlenses for long-term
use: 1 pair of glassesor 1 pair of lenses upto 250.00 per 3
years or contact len-ses for shor t-term
use, such as daily,weekly, monthly, sixmonthly and yearlylenses is up to 65.00 per year.
Glasses or contact
lenses for long-termuse: 1 pair of glassesor 1 pair of lenses upto 350.00 per 3
years or contact len-
ses for short-termuse, such as daily,weekly, monthly, sixmonthly and yearlylenses is up to
75.00 per year.
In addition to the above reimbursement, all insured parties with a supplementary insurancepolicy are eligible for a discount upon production of their care pass at Pearle Opticiens - Neder-land, Eye Wish or Specsavers.
Correction of upper eyelidsOn medical grounds.
100% per person per year only via care provi-der selected by us.
100% per person per year.
Correction of ear position 100% per person aged up to 18 per year onlyvia care provider selected by us.
100% per person per year.
Eyes and ears(Keuze) Zorg Plan(basic insurance)
Start Extra Royaal Excellent
Hearing aid
From age 16 onwards.
From age 16.
683.00 per aid.CROS, BiCROS or bone anchored hearing aids included in a glasses
frame: 65.00 extra. See also the Achmea Reglement Hulpmiddelen[Achmea Nursing Articles Regulations].
800.00 per hearingaid with an amount
being reimbursed viathe (Keuze) Zorg Planand a supplement toa maximum of 250.00 via Royaal.
800.00 per hearing
aid with an amountbeing reimbursed viathe (Keuze) Zorg Planand the rest viaExcellent after
permission from us.Via the (Keuze) Zorg Plan.Initial purchase: 501.50.
Replacement within 5 years: 501.50.Replacement after 6 to 7 years: 592.00.Replacement after 7 years: 683.00.
CROS, BiCROS or bone anchored hearing aids included in a glassesframe: 65.00 extra. See also the Achmea Reglement Hulpmiddelen
[Achmea Nursing Articles Regulations].
With remote control on medicalgrounds.
185.00 extra per de-vice after permissionfrom us.
Eye laser treatment One-off 500.00 perperson.
One-off 500.00 per
person.
One-off 750.00 per
person.
In addition to the above reimbursement, all insured parties with a supplementary insurancepolicy are eligible for a discount upon production of their care pass at VisionClinics.
Psychological care(Keuze) Zorg Plan(basic insurance)
Start Extra Royaal Excellent
Primary psychological carePrimary psychologist, clinicalpsychologist, primary health carepsychologist or general remedial
educationalist (generalist).
Via the (Keuze) ZorgPlan 8 sessions perperson per year. A
statutory personalcontribution of 10.00 applies persession.
Via the (Keuze) ZorgPlan 8 sessions perperson per year. A sta-
tutory personal con-tribution of 10.00applies per session.+Via Start 4 extra
sessions per personper year.
Via the (Keuze) ZorgPlan 8 sessions per
person per year. A sta-tutory personal con-tribution of 10.00applies per session.+
Via Extra 6 extrasessions per personper year.
Via the (Keuze) Zorg
Plan 8 sessions perperson per year. A sta-tutory personal con-tribution of 10.00applies per session.
+Via Royaal 8 extrasessions per personper year.
Via the (Keuze) ZorgPlan 8 sessions perperson per year. A sta-tutory personal con-tribution of 10.00
applies per session.+Via Excellent 8 extrasessions per personper year.
Reimbursement of the statutorypersonal contribution for primarypsychological care.
Reimbursement of the statutory personal contribution of 10.00 persession up to 80.00 per person per year.
Second-line mental health care (GGZ)
Psychiatrist, neurologist, mentalhealth institution, clinical psychologistor psychotherapist.
Via the (Keuze) Zorg Plan 100%.
Psychiatric hospital admissionsAdmission to a mental healthinstitution (psychiatric hospital orpsychiatric ward of a hospital).
Via the (Keuze) Zorg Plan 100%.
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Talking and reading(Keuze) Zorg Plan(basic insurance)
Start Extra Royaal Excellent
Dyslexia careDiagnosis and treatment of seriousdyslexia for 7 to 10 year old children.
Via the (Keuze) Zorg Plan 100%.
Speech and language therapyNo dyslexia and language develop-ment disorders.
Via the (Keuze) Zorg Plan 100%.
Stutter therapy
In v arious s tu tter centres . Via the (Keuze) Zorg Plan 10 0%.
According to the Del Ferro, Hausdr-fer and BOMA methods.
One-off 225.00 perperson.
One-off 450.00 perperson.
One-off 1,000.00per person.
One-off 1,250.00per person.
(Patient) transport(Keuze) Zorg Plan(basic insurance)
Start Extra Royaal Excellent
Ambulance Via the (Keuze) Zorg Plan 100%.
Travel costs in the context of care me-diation abroadIn Belgium and Germany in theevent of care mediation.
Call the Travel Line for permission on0900 - 23 02 340 ( 0.10 p/m).
Via taxi company 100%.
Own car 0.27 per kilometre.Public transport (second class) 100%.
Accommodation and travel costs in-curred by family members after caremediation abroadIn Belgium and Germany in the event
of care mediation as from the 15thday of admission.
Accommodation costs: 35.00 per day for the whole of the family.Own vehicle 0.27 per kilometre for max. 700 kilometres per admission.
Patient transport
By public transport, own car, hire car
or taxi in the event of kidney dialysis,oncological care with radio/chemo-therapy, visual handicap and if you
are unable to travel or are wheel-chair-dependent.
Call the Travel Line for permission on0900 - 23 02 340 ( 0.10 p/m).
Via the (Keuze) Zorg Plan.
Up to 200 kilometres one way:Own car 0.27 per kilometre.
Public transport (second class) 100%.By taxi 100%.
You pay a statutory personal contribution of 92.00 per person after permission from us.
By own vehicle or taxi in the event ofother medical grounds which mean
you cannot use public transport.
Call the Travel Line for permission on0900 - 23 02 340 ( 0.10 p/m).
Up to 200 kilometresone way and, if you
cross a border, up to55 kilometres acrossthe border: ownvehicle 0.27 per kilo-metre, by taxi 100%.
You pay 92.00 peryear, total maximumreimbursement 1,000.00 per personper year after permis-
sion from us.
If you cross a border
up to 55 kilometresacross the border:own vehicle 0.27 perkilometre, by taxi100% per person per
year after permissionfrom us.
If you cross a borderup to 55 kilometresacross the border:own vehicle 0.27 perkilometre, by taxi
100% per person peryear after permissionfrom us.
Statutory personal contribution forpatient transport.
100%
Hospital, treatment and nursing(Keuze) Zorg Plan(basic insurance)
Start Extra Royaal Excellent
Asthma Centre in Davos Via the (Keuze) Zorg Plan 100% after permission from us.
Treatment, examination and opera-tion in hospital
Via the (Keuze) Zorg Plan 100%.
Cosmetic and plastic surgery
Cosmetic surgery, not Botox, fillers,(autologous) lip augmentation,peeling, laser or refraction surgery.
500.00 per personper calendar year.
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Plastic surgery on medical groundssuch as a breast prosthesis after abreast amputation (not a breastenhancement, an operation to re-
move a breast prosthesis withoutany medical necessity, liposuctionof the abdomen, correction of up-per eyelids and ear position).
Via the (Keuze) Zorg Plan 100% after permission from us. 100% of other formsof treatment withmedical necessityafter permission
from us.
Dialysis Via the (Keuze) Zorg Plan 100%.
Hereditary research andconsultancy
Via the (Keuze) Zorg Plan 100%.
Hospital, treatment and nursing(Keuze) Zorg Plan(basic insurance)
Start Extra Royaal Excellent
Guest house
Accommodation in a guest house inthe event of a cycle of outpatient
treatment.
35.00 per person per year. 35.00 per personper day (1), togetherwith other costs up to
500.00.
35.00 per personper year.
Accommodation or travel expensesof you or your family members in
the event of a hospital admission,not being a psychiatric hospital.
As from 15th day of admission travelbetween home and hospital is at least 50
kilometres 35.00 per day up to 500.00per year for all family members together.Own car 0.27 per kilometre or publictransport (second class) 100%.
As from 15th day ofadmission 100%(1) per
year for all familymembers together.Own car 0.27 perkilometre, togetherwith other costs up to 500.00.
As from 15th day ofadmission 100% per
year for all familymembers together.Own car 0.27 perkilometre.
Dental surgery Via the (Keuze) Zorg Plan 100%.
Mechanical respiration Via the (Keuze) Zorg Plan 100%.
Obesity change in behaviourprogrammeBMI greater than 40.
Via NOK: one-off
750.00 per person af-ter permission from us.
Via NOK: one-off 1,000.00 per person after
permission from us.
Organ transplants Via the (Keuze) Zorg Plan 100% in hospital or independent treatment centre.
Nursing of person who has donatedthe organ (donor). Via the (Keuze) Zorg Plan 3 months, 6 months in the case of liver transplant.
Preventive examinations:
cervicalcancer(smear)breastcancer
heartandvasculardiseasesprostatecancer.Not a population screening (isreimbursed via the AWBZ).
100%
A periodic general check-up. 1x per 2 years per person.Rate major general GP che ck-up.
Second opinionFor care via the basic insurance bymedical specialist.
Via the (Keuze) Zorg Plan 100%.
SterilisationNot a reversal operation.
100%
TelemonitoringIn the event of chronic heart failure
hire and supervision.
Via the (Keuze) Zorg Plan 100%.
Nursing (extramural)Outside the hospital at home, notartificial respiration at home or alle-
viating care for terminal patients(palliative care).
Via the (Keuze) Zorg Plan 100%.
Nursing in hospitalCare provided by a specialist medicaland dental surgeon.
Via the (Keuze) Zorg Plan 100%.
Independent treatment centreA clinic certified by the governmentfor specialist medical care at whichexaminations and outpatient treat-
ment takes place.
Via the (Keuze) Zorg Plan 100%.In the case of plastic surgery and dental surgery after we have granted permission.
(1) For these care activities, insured via Royaal, a total of max. 500 is reimbursed per insured party per calendar year.
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(Becoming) pregnant / baby /child
(Keuze) Zorg Plan(basic insurance)
Start Extra Royaal Excellent
Maternity care for adopted babies(younger than 12 months)or
Medical screening in the event ofadoption
3 days up to 3 hours a dayor
300.00 per adopted child.
CircumcisionOn religious grounds.
Only by care providers we have selected 250.00.
Childbirth
Giving birth at home. Via the (Keuze) Zorg Plan 100%.
Outpatient childbirth in hospital atown request (without medicalgrounds).
Via the (Keuze) ZorgPlan 192.00 for use
of delivery room,remaining amount isstatutory personalcontribution.
Via the (Keuze) Zorg Plan 192.00 for use ofdelivery room, remaining amount is statutory
personal contribution.+Via Start and Extra 50% reimbursement ofstatutory personal contribution.
100% via the (Keuze) Zorg Plan 192.00 foruse of delivery room, remaining amount is
statutory personal contribution.+Via Royaal and Excellent 100% reimbursementof statutory personal contribution.
Childbirth in birth centre in hospital
at own request (without medicalgrounds).
Via the Keuze Zorg
Plan 192.00 for useof delivery room,remaining amount isstatutory personal
contribution.
Via the (Keuze) Zorg Plan 192.00 for use of delivery room, remaining amount is statutory per-
sonal contribution.+Via Start, Extra, Royaal and Excellent 100% reimbursement of statutory personal contribution.
Outpatient childbirth with medicalgrounds.
Via the (Keuze) Zorg Plan 100%.
Childbirth in hospital (stay inhospital for several days).
Via the (Keuze) Zorg Plan 100%.
Monitoring equipment to preventcot death
Monitoring equipment (hire). 100% for 12 months after permission from us.
Nanny Care sensor mat (purchase). 100% after referral by doctor.
GeboorteTENSOn loan.
100%, you arrange this via your midwife.
In Vitro Fertilisation (IVF)Fertility-enhancing treatment.
Via the (Keuze) Zorg Plan first 3 attempts for each attempted pregnancy. Medicines, in accordance with GVS for first 3attempts. In Vitro Fertilisation (IVF) abroad after permission from us.
Maternity packOrder your maternity pack via www.
averoachmea.nl/ zorgverzekeringenor call 0900 - 9590 (local rate).
100% (request before the 7th month of the pregnancy).
Maternity care
At home o r in a birth centre. Via the (Keuze) Zorg
Plan 10 days,statutory personalcontribution of 3.90per hour.
Via the (Keuze) Zorg Plan 10 days, statutory
personal contribution of 3.90 per hour.+Via Start and Extra, statutory personalcontribution for 24 hours.
Via the (Keuze) Zorg Plan 10 days, statutorypersonal contribution of 3.90 per hour.+Via Royaal and Excellent 100% reimburse-ment, statutory personal contribution of
3.90 per hour.
In hospital on medical grounds. Via the (Keuze) Zorg Plan 100%.
In hospital without medicalgrounds.
Via the (Keuze) Zorg Plan 10 days.+Statutory personal contribution 15.50 per day of admission and
hospital rate amount above 111.50.
100% via the (Keuze) Zorg Plan 10 daysstatutory personal contribution 15.50 perday of admission and hospital rate amount
above 111.50.+Via Royaal and Excellent 100% reimbursementof statutory personal contribution.
Postponed on medical grounds (for
example in the event of a caesareansection or premature birth).
15 hours, personalpayment 3.90 perhour.
15 hours, personal payment 100%.
Breastfeeding assistanceHelp and advice during
breastfeeding.
75% up to 115. 00 per per son per year. 115.0 0per person per year.
Oncology examinationOncology examination for children.
Via the (Keuze) Zorg Plan 100% via Stichting Kinderoncologie Nederland (Skion).
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(Becoming) pregnant / baby /child
(Keuze) Zorg Plan(basic insurance)
Start Extra Royaal Excellent
Prenatal screening
Counselling. Via the (Keuze) Zorg Plan 100%.
Structural Echoscopic Examination(20 week scan).
Via the (Keuze) Zorg Plan 100%.
Combination test (neck fold measu-
rement in combination with a bloodtest) up to the age of 36 on medicalgrounds.
Via the (Keuze) Zorg Plan 100%.
Combination test (neck fold measure-ment in combination with a bloodtest) 36 years or older.
Via the (Keuze) Zorg Plan 100%.
Therapeutic holiday camps forchildren Via Stichting Gezond Ge-wicht, Stichting de Luchtballon, Di-abetes Jeugdvereniging Nederland,
Stichting Kinderoncologische Va-kantiekampen, Stichting de Ster,Nederlandse Hartstichting.
150.00per person per year.
250.00 (1) per personper year, togetherwith other costs up to 500.00.
500.00per person per year.
Obstetrical care Via the (Keuze) Zorg Plan 100%.
Fertility-enhancing treatment andfreezing sperm Not IVF.
Via the (Keuze) Zorg Plan 100%.Or abroad after permission from us.
Other(Keuze) Zorg Plan(basic insurance)
Start Extra Royaal Excellent
Dietary advice and nutritionalinformation
Dietary advice via a dietician
(on medical grounds).
Via the (Keuze) Zorg Plan 100%.
Up to 4 hours per person per year.
Via (Keuze) Zorg Plan 100% up to 4 hours per person per year.
+ Via Extra, Royaal and Excellent 115.00 per person per year.
Nutritional information via dieticianor weight consultant.
115,- per person per year.
Health Check 1x 100% per person
per year.
Herstel en Balans [Recovery andBalance] Aftercare training ex-can-cer patients.
800.00 per personper year.
1,000.00 per personper year.
1,000.00 per personper year.
1,200.00 per personper year.
Convalescence homeNot psychosomatic care.
50.00 per day up to28 days per person per
year after permissionfrom us.
48 days per personper year after permis-sion from us.
Hospice 40.00 per day up to 3,600.0 0. 50.00 per day up to 4,500.00.
General Practitioner Via the (Keuze) Zorg Plan 100%.
Chain-based care for type 2
diabetes mellitus and COPD
Via the (Keuze) Zorg Plan 100% only via contracted care groups.
Childcare for children aged up to 12while their parent(s) is/are admittedto hospital. Not admissions to a psy-chiatric hospital.
50 hours per week after we permission from us.
Lifestyle training sessionsBasic training for heart patients, whip-lash patients and people with stressand burn-out related problems.
Via Leefstijl Training & Coaching (LTC) in Dalf-sen 1,000.00 per person per year.
Via Leefstijl Training& Coaching (LTC) inDalfsen 1,500.00per person per year.
Substitute volunteer careCare for handicapped and chronical-ly ill people in the absence of carevia family/friends (volunteer care).
Via stichting Handen-in-huis 21 days per per-son per year.
Via stichting Handen-in-huis 100% per per-son per year.
Menopause consultantIn the event of menopause-related pro-blems Care for Women or the VVOC.
In the event of menopause-related problems Care for Women or theVVOC.
Patient associations 25.00 (1) per mem-bership, together
with other costs up to 500.00.
100%
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Other(Keuze) Zorg Plan(basic insurance)
Start Extra Royaal Excellent
(Preventieve) cursussen:
coping with heart problems
lymphoedema awareness and/orself-management course
coping with rheumatoid arthritis,
arthrosis or Bechterews disease
type 2 diabetes patients, basic or
follow-up losing weight
stopping smoking
Vrij van alcohol [Alcohol Free]training course
basic resuscitation course
First Aid
first aid for accidents involving
children
sleep therapy
75% to 115.00
per course per person per year.
75% up to 115.00
per course (1) per per-
son per year togetherwith other costs up to 500.00.
100% per course per
person per year.
course and/or training in preven-
ting falls
exercise programmes for the elderly
memory training.
100% per course perperson per year.
Rehabilitation Via the (Keuze) Zorg Plan 100%.
Sports doctorInjury or repeat consultation.
Via a sports medical institution 2 x per person per year.Check www.sportgeneeskunde.com/fsmi for a location close to your home.
Sport-medical examinationNot an obligatory sports
examination.
Via a sports medical institution 1 x per person per 2 years.Basic Examination 85.00.
Basic Examination Plus 100.00.Major Examination 135.00.Check www.sportgeneeskunde.com/fsmi for a location close to yourhome.
Via a sports medicalinstitution 1 x per
person per 2 years Ba-sic Examination, BasicExamination Plus,Major Examination.Check ww w.sportge-
neeskunde.com/fsmifor a location close to
your home.
Stopping smoking programme
Therapeutic holiday camps forhandicapped people
150.00 per person
per year.
250.00 (1) per person
per year, togetherwith other costs up to 500.00.
500.00 per personper year.
Thrombosis service Via the (Keuze) Zorg Plan 100%.
Payment in the event of the functio-nal loss of any part, capacity or or-gan of the body, due to an accident
250.00 per accident.
Holiday hotels (Red Cross) or sailingholidays (Red Cross or Zonnebloemorganisation) For handicappedpeople and the chronically ill.
25%
Care Regulator (also for insured carer)Telephone number: 0900 - 9590(local rate).
3 hours per personper year. 6 hours per person per year. 9 hours per personper year.
Supplementary Ziekenhuis Extra [Hospital Extra] Insurance Policies
Extra comfort cover
Contracted care. 100%
Non-contracted care. 150.00 per day.
Daily monetary payment 70.00 per day up to 4,900.00 * per person per year.
When abroad: room supplement class room / fee surcharge
Contracted care. 100%
Non-contracted care. 70.00 per day up to 4,900.00 per person per year, no reimbursement of the fee surcharge.
* Reimbursement in the Netherlands and abroad together.
(1) For these care activities, insured via Royaal, a total of max. 500 is reimbursed per insured party per calendar year.
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Keuze Zorg Plan(basic insurance)
This reimbursement policy givesyou the freedom to choose your
own care providers.
Zorg Plan(basic insurance)
With this combination of non-monetary and reimbursement you
receive care from our contractedcare providers.
The basic insurance
Should you become ill, our health insurance policies offer
you the right care without any nasty financial surprises.
However, even if you are in good health, you want to
know you can rely on us to be there whenever you need
help. You can opt for one of our basic insurance policies.
If you have the Avro Achmea basic insurance you are
already assured of the Seven Certainties of good care,
irrespective of which basic insurance you choose.
Supplementary insurance
In addition to the basic insurance policies we also offer four supplementary insurance policies - Start, Extra, Royaal and
Excellent. They range from a very competitively priced insurance policy to insurance with very comprehensive cover. The fol-
lowing is a brief overview of the supplementary insurance policies you can choose for.
Dental insurance
The basic insurance does not cover regular dental care from the age of 18.
For that reason it is a good idea to supplement your basic insurance with a dental insurance, for family members aged over 18.
Disclaimer:
In the event of contrariety between the English and Dutch versions of this document, the Dutch version will prevail.
Types of care Start Extra Royaal Excellent
1 Alternative therapies 440.00 per year 640.00 per year 1.500.00 per year 1.800.00 per year
2 Contracep tion 100% 100% 100% 100%
3 Glasses and lenses 100.00per 3 calendar years
150.00per 3 calendar years
250.00per 3 calendar years
350.00per 3 calendar years
4 Eye laser treatment none 500.00 500.00 750.00
5 Primary psychology 4 extraappointments
A reimbursement of the
personal contribution 80.00 + 6 extraappointments.
A reimbursement of the
personal contribution 80.00 + 8 extraappointments.
A reimbursement of the
personal contribution 80.00 + 8 extraappointments.
6 Physiotherapy and remedial therapy 12 times 27 times 27 times 100%
7 Help when abroad includingvaccinations
100% 100% 100% 100%
8 Or thodontics Up to 18 years of age 90%
and max. 1,500.00
Up to 18 years of age 90%
and max. 2,000.00
Up to 22 years of age 90%
to max. 2,500.00, fromage 22 onwards 70% tomax. 1,000.00
Up to 22 years of age
100%, from age 22 70% tomax. 1,500.00
Type of care T Start T Extra T Royaal T Excellent
9 Dental care A maximum reimburse-ment of 225.00 per year
A maximum reimburse-ment of 450.00 per year
A maximum reimburse-ment of 900.00 per year
A maximum reimburse-ment of 1,150.00 per year
Summary of the health insurance policies
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Disclaimer
Privacy
We need personal data to process applications for an insu-
rance policy or a financial service. This data is used within the
Achmea Group to enter into and implement insurance agree-
ments, to inform you about relevant products and/or services,
to guarantee the security and integrity of the financial sector,
for statistical analyses, customer relationship managementand in order to comply with statutory obligations. The use of
your personal details is subject to the Gedragscode Verwerking
Persoonsgegevens Financile Instellingen [Code of Conduct
for the Processing of Personal Data by Financial Institutions].
Health insurers also have to comply with the Gedragscode
Verwerking Persoonsgegevens Zorgverzekeraars [Code of
Conduct for the Processing of Personal Data by Health Care
Insurers].
If you do not wish to receive information about our products
and/or services, or if you wish to withdraw your permission
for the use of your e-mail address, please write to us at Avro
Achmea, Postbus 1717, 3800 BS Amersfoort. With a view to
maintaining a sound acceptance policy, we are allowed, as
the Achmea Group, to consult details kept at the StichtingCentraal Informatie Systeem [Central Information System
Board] (CIS) in Zeist. Within that framework, those affiliated
to the Stichting CIS are also allowed to exchange data among
themselves. The aim is to manage the risks and combat fraud.
This is subject to the privacy regulations of the Stichting CIS.
More information can be found at www.stichtingcis.nl.
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 klacht doorgeven [submit complaint] section) or in
writing to Avro Achmea, Centrale Klachtencordinatie,
Antwoordnummer 93200, 2200 XA Noordwijk. 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, namely: Stichting Klachten en Geschillen Zorgver-
zekering [Health Care Insurance Complaints and Disputes
Foundation] (SKGZ), Postbus 291, 3700 AG Zeist, tel. +31 (0)30
69 88 360, www.skgz.nl.
Information about Avro Achmea
Avro Achmea is a provider of insurance products and uses
independent brokers and advisers. Avro Achmea is a trade nameof Achmea Zorgverzekeringen N.V., which is located in Noordwijk
and registered with the AFM under number 12000647, and
of Avro Achmea Zorgverzekeringen N.V., which is located in
Utrecht and registered with the AFM under number 12001023.
The office of Avro Achmea is located on the Van Asch van Wijck-
straat 55, 3811 LP Amersfoort, the Netherlands.
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Avr Achmea ha acqre he Klagerch Verzekere [Cmer-ree irace] qaly mark.
Confidence and certainty are essential for the quality of services provided in the insurance sector. The Klant-
gericht Verzekeren quality mark is issued by the independent Stichting toetsing verzekeraars [Insurers Assess
Basic insurance policies (Keuze) Zorg [(Options) Care] Plan
Supplementary insurance policies Start, Extra, Royaal, Excellent
Dental insurance policies T Start, T Extra, T Royaal, T Excellent
Comfort nursing Ziekenhuis Extra [Hospital Extra]