Vergoedigenoverzicht Juist Voor Jou (Engels) 2014

For you: services, discount and excellent reimbursements

Benefit Schedule Overview of the health insurance Juist voor Jou 2014

Good health care means the right care at the right time and in the right place. We

are there for you, whenever you need good health care. We have a really broad

basic insurance and excellent supplementary insurance policies

We are there for you in the momentsthat matter: services

Our Zorgversneller (care accelerator), for when you have to wait for treatment.

This is to make sure you get rapid access to the best care and arrange all your appointments.

Our Zorggarantie (care guarantee), if you are uncertain and want assistance with making appointments.

We guarantee that you will have a consultation for the most common complaints within 5 days, and any subsequent

treatment by, at the most, 10 days later.

Our Second Opinion Service (S.O.S), for when you are in doubt about a diagnosis or treatment.

Our worldwide S.O.S. service provided by Best Doctors. If you have one of our supplementary insurance policies, you have a

right to a reassessment of your diagnosis or treatment method by the best doctors in the world.

We are there for you, if you already have enough to worry about.

We can help you find a new general practitioner, dentist or physiotherapist. That makes life easier if you have just moved

home.

We are there for you, if you need medical care abroad.

You can call our emergency assistance company, Eurocross Assistance, 24 hours a day, via 071 364 18 50. Or the

Vakantiedokter (holiday doctor), via +31 71 36 41 802, if the help you seek is not medically urgent.

We are there for you, if you care for vulnerable people.

Our Zorgregelaars (care regulators) help you find your way in the maze of rules and authorities, so you receive the right

government support from, e.g., the Exceptional Medical Expenses Act (AWBZ) and the Social Support Act (Wmo).

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1 Spectacles and lenses

• Eye Wish Groeneveld: at Eye Wish Groeneveld € 60.00

discount on a simple pair of spectacles or 15% discount

on contact lenses and accessories

• Specsavers: at Specsavers 20% discount on a pair of (sun)

glasses. 2 pairs of spectacles without extra payment for

your reimbursement of spectacles and lenses from your

supplementary insurance. Or free contact lenses for 1

month

• Collective of Independent Opticians (Collectief van

Zelfstandige Opticiens): your independent optician will

raise the reimbursement from your supplementary

insurance for spectacles and contact lenses by 25%. In

addition you benefit from free eye tests and a discount

on insuring your spectacles

2 Refractive eye surgery/lens implants

• VisionClinics: 10% discount on the fees for full refractive

eye surgery or lens implants

• Eyescan: 15% discount on Eyescan’s fees for full

refractive eye surgery or lens implants

• Oogkliniek Heuvelrug: 10% discount on the fees for full

refractive eye surgery or lens implants

3 Medical devices

You receive 20% discount on many medical devices for daily

activities (rollators, lift chairs and ADL devices).

• You receive € 650.00 discount on 5 models of lift chairs

from Vegro and Hartingbank/Ligtvoet

• And 25% discount on a turban from Capelle

Haarwerken, the fashionable alternative to a wig

• 20% discount on Underwunder incontinence underwear

4 Sports at an Achmea Health Centre

• Achmea Health Centers: 20% discount on a package of

your own choice (“afvallen & afblijven”, “flex, fit &

vitaal”, “in balans”) at one of the Achmea Health

Centres. And you do not have to pay registration costs

5 Diabetes test strips

• Via Mediq Direct Diabetes, a discount arrangement for

diabetes test strips for insured clients with diabetes

type 2

6 Cosmetic surgery

• Bergman Clinics: Up to 20% discount on treatments

provided at Bergman Clinics. For instance, you get 20%

discount on all MediSpa treatments such as facial and

body treatments, laser hair removal and scar treatment.

This does not include injectables. 15% discount on

upper eyelid treatments.

And 10% on all injectables, small and large abdominal

wall corrections, breast lift with or without implants,

varicose veins C1 and C2

7 Assistance at home

• Home care

Zorg voor Jou. Do you want extra home care in addition

to the personal care provided under the AWBZ?

Organise it quickly and simply via Zorg voor Jou

• Interior care

Via Home Works. Cleaning activities in your home. Once

or for a longer period. You receive a 7.5% discount

• Private assistance

Private assistance provides you with assistance at home

(via Zorg voor Jou) to help you avoid excessive exertion.

Such assistance is customised

• Temporary child-minding

Temporary child-minding at home via Zorg voor Jou.

You can also organise specific child-minding (children

with ADHD, autism and Down’s Syndrome)

8 Personal alarm

• Eurocross Assistance. Opting for Eurocross Personal

Alarm means you will have the right equipment in your

home

• 20% discount on rental costs

• 20% discount on subscription costs

• 25% discount on once-only administration costs

• 25% discount on placement costs

We enjoy giving you certain extras: discount

Have you taken out a supplementary insurance, in that case you profit from discounts on all sorts of care

products and services that can amount to as much as 25%. From refractive eye surgery to home care, from

spectacles to fitness centres.

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9 Pedicure at home

• Pedicurebijuthuis.nl. Are you unable to visit the pedicure

for any particular reason? In that case the pedicure will

visit you at home

10 Transport

• Services of a driver

Via Nieuwe Koetsiers. Rent an experienced driver if you

have to travel long distances or for worry-free family

visits. This involves the driver using your car

• Surcharges apply for evenings, weekends and public

holidays

Transport by taxi

• Connexxion. You can make use of individual or

combined transport

• Taxi (combination transport)

No objection to fellow passengers (combination

transport)? That makes a difference to the price per trip!

You can use this as long as you reserve 24 hours in

advance. You receive an 18-31% discount on the

statutory tariff. The discount depends on the region in

which you live

• Taxi (individual)

Travel to your destination in a comfortable car with a

private driver (individual). You can use this as long as

you reserve 24 hours in advance. You receive an 11-25%

discount on the statutory tariff. The discount depends

on the region in which you live

(Discounts and agreements with suppliers are subject to

alterations and only apply if you have a supplementary

insurance with Turien & Co.)

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Your health insuranceFor which health care are we insured in the Netherlands?

What is the difference between the basic insurance and the

supplementary insurance? Our health care system in a nut

shell.

The Dutch health care system

Our existing healthcare system was introduced by the

government on January 1, 2006 and comprises basic health

insurance including mandatory excess. Under this system,

everyone in the Netherlands is insured against medical

expenses with premiums payable from the age of 18.

You may be eligible for compensation towards the

premiums. This benefit is called ‘zorgtoeslag’. For further

information, visit www.toeslagen.nl.

The basic insurance

Basic insurance is the same for everyone in the Netherlands.

Each year the government determines what will be

reimbursed under the basic insurance. The supplementary

insurance Juist voor Jou is combined with the basic

insurance Select Zorg Plan (natura).

Select Zorg Plan

The Select Zorg Plan allows you to receive care from care providers with whom we have entered into contracts. For

this you pay a slightly lower premium. We pay invoices directly (except in respect of the statutory personal

contributions). A lower reimbursement will apply if you use other care providers than those we have contracted for

this policy.

Contracted care provider

A care provider with whom we have entered into agreements about the quality of care, its accessibility and the price.

The contracted care provider sends an invoice directly to us. Therefore, you will not receive an invoice from them. The

invoice will be paid in full if you have a right to full reimbursement, excluding the (mandatory) excess and the

(statutory) personal contributions.

Non-contracted care provider

A care provider with whom we have no agreements is a non-contracted care provider. You submit the invoice to us.

You will receive 70% of our average contracted tariff, except for paramedical care, transport and mental health care

(GGZ). Other, lower reimbursements apply to this, which can be found in the policy conditions and on our website. It

is therefore wise to check this in advance if you go to a non-contracted care provider. This will help you to avoid

disappointments.

What are your entitlements under the basic insurance Select Zorg Plan?

• medical care provided by General Practitioners, hospitals, specialists and obstetricians

• hospital stay

• medical devices

• medication

• obstetric care

• transport

• paramedical care (limited fysiotherapy / remedial therapy, speech therapy and occupational therapy)

• dental care (up to 18 years)

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What can you insure via supplementary insurance?

In addition to the basic insurance you can also take out

supplementary insurance, for instance for the

reimbursement of the statutory personal contributions, a

broader cover for physiotherapy, dental costs or a broader

cover for urgent medical care abroad.

WithTurien & Co. you can choose from various forms of

supplementary insurance and a separate dental

insurance.

When will I receive a reimbursement?

This is subject to a number of conditions. These

conditions are not included in this Benefit Schedule. All

conditions relating to eligibility for a reimbursement can

be found in the policy conditions. For instance, it tells you

whether you need a referral from a doctor, for which

indications reimbursement applies and when you will not

receive a reimbursement. The complete policy conditions

can be found on www.mijnonlinepolismap.nl.

What do I have to pay myself?

In the Netherlands a statutory personal contribution

applies to some treatments or medicines. The

government decides for which treatments or medicines a

personal contribution applies. You pay that yourself if you

use them.

What is a statutory personal contribution?

A statutory personal contribution is the portion of

medical costs covered by the basic insurance that you

have to pay yourself. Among other things, you will pay a

personal contribution for:

• Some medicines

• Some medical devices

• Maternity care

• Seated transport of patients

• Outpatient childbirth without medical indication

Please note!

The reimbursements mentioned in this Benefit Schedule

apply to care providers contracted by us, unless a specific

(lower) reimbursement is mentioned. You can find the

contracted care providers on

www.averoachmea.nl/zoekuwzorgverlener. The amount

of the reimbursement for non-contracted care providers

can also be found on our website. This Benefit Schedule is

a summary of the policy conditions. Always refer to the

policy conditions to see your exact entitlements and the

exact conditions. The conditions for reimbursement and

the exceptions do not appear in full in this Schedule.

Therefore always refer to the policy conditions on

www.mijnonlinepolismap.nl or call our Customer Service.

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Benefit Schedule 2014You can find all the benefits of the Select Zorg Plan and then the supplementary

insurance Juist voor Jou.

The reimbursements from the Select Zorg Plan can be found in one single column.

You find the reimbursements under the heading Select Zorg Plan’

(basic insurance).

Please see www.mijnonlinepolismap.nl for an overview of care providers that we

have contracted. On this website you can also find the Achmea regulations for

hulpmiddelen (medical aids), Achmea Regulations for farmacie (medicines) as well

as our policy conditions, brochures, forms and more information about our health

insurances.

This Benefit Schedule is a summary of the policy conditions and you can not

derive any rights from it. Always refer to the policy conditions before visiting a

care provider to see your exact entitlements and the exact conditions. You can

download the policy conditions www.mijnonlinepolismap.nl.

With the Select Zorg Plan the care providers must have made agreements with Avéro. If that is not the case, then you may have to pay extra. If you choose a provider with which Avéro does not have an agreement? Then please refer to your policy conditions to see if this involves a lower reimbursement. You can find the level of the reimbursement on our website at www.turien.nl or you can request it from us.

Bones, muscles and jointsSelect Zorg Plan(basic insurance)

Occupational therapyadvice, instruction, training or treatment by an occupational therapist

from Select Zorg Plan up to 10 hours per person per year

Footcare for insured persons with diabetes in case of increased or high risk of a diabetic foot (ulcers) Simm’s 1 and higher by pedicure or podiatrist

from Select Zorg Plan 100%

AbroadSelect Zorg Plan(basic insurance)

Urgent care abroadcare which cannot be postponed until after you return to your country of residence

Call Eurocross Assistance for urgent help abroad: +31 71 364 18 50 The telephone number is also mentioned on your health card

from Select Zorg Plan 100% of the tariff in the Netherlands

Non-urgent care abroadcare which can be postponed until after you return to your country of residence

from Select Zorg Plan maximum of 100% of the tariff in the Netherlands See the policy conditions

What do the following things mean in this Benefit Schedule:Year

A calendar year (1 January up to

and including 31 December)

Our permission

Before claiming a reimbursement,

you will need our prior permission.

For this care, which is covered by

the basic insurance, the mandatory

excess and any voluntary excess

you have chosen applies to insured

patients 18 years and older.

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Younger than 18

Fysiotherapy and excercise therapy

See www.averoachmea.nl/paramedisch for the brochure ‘Paramedische Zorg’

Select Zorg Plan(basic insurance)

Disorder that is listed by the Minister of Public Health, Welfare and Sport (Appendix 1 with article 2.6 of the Health Insurance Decision (Besluit zorgverzekering)) your doctor and/or physiotherapist diagnoses the disorder

Manual lymphatic drainage in case of serious lymphoedema may also be carried out by a skin therapist instead of a physiotherapist

from Select Zorg Plan all treatments

Disorder that is not listed by the Minister of Public Health, Welfare and Sport (Appendix 1 with article 2.6 of the Health Insurance Decision, this can be found in the brochure ‘Paramedische Zorg’)your doctor and/or physio therapist diagnoses the disorder

from Select Zorg Plan per diagnosis 1 to 18 treatments

18 years and older

Fysiotherapy and excercise therapy

See www.averoachmea.nl/paramedisch for the brochure ‘Paramedische Zorg’


1 disorder that is listed by the Minister of Public Health, Welfare and Sport (Appendix 1 with article 2.6 of the Health Insurance Decision (Besluit zorgverzekering)) your doctor and/or physio therapist diagnoses the disorder


from Select Zorg Plan from 21st treatment

treatment 1 to 20 you pay youself

Pelvic physiotherapy in case of urinary incontinence from Select Zorg Plan treatment 1 to 9

The above stated reimbursement is only applicable if you suffer from 1 disorder! Do you have several disorders for which you visit a physiotherapist/remedial therapist? Then always contact our Customer Service. They are happy to inform you to what reimbursement you are entitled to.

Medical devices

See www.mijnonlinepolismap.nl


Medical devices from the basic insurancereimbursement according the conditions mentioned in the Achmea Regulations on medical devices (Achmea Reglement Hulpmiddelen) see www.mijnonlinepolismap.nl

(the statutory excess does not apply in case of loan)


you must submit a request for certain medical devices in advance

a maximum reimbursement or statutory personal contribution may apply

Personal alarmwith medical indication

We must have given you prior permission

from Select Zorg Plan after prior permission 100% for personal alarm unit via Eurocross Assistance

Also see Achmea Regulations on Medical Devices (Achmea Reglement Hulpmiddelen)

Wig (personal contribution) from Select Zorg Plan € 409.00 per wig

Also see Achmea Regulations on Medical Devices (Achmea Reglement Hulpmiddelen)

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Medication (medicines) and diet preparationsSelect Zorg Plan(basic insurance)

Contraceptives for instance the pill or an intrauterine device

up to 21 years from Select Zorg Plan reimbursement according to Achmea’s Regulations on Pharmaceutical Care (Achmea Reglement Farmaceutische Zorg)

you pay the statutory personal contribution yourself (the upper limit GVS price - GVS stands for Medicinal Products Reimbursement System (Geneesmiddelenvergoedings systeem)) this differs per medicine

See www.turien.nl.nlfor more detailed information

21 years and older from Select Zorg Plan only reimbursement in case of medical necessity (endometriosis or menorrhagia) according to Achmea’s Regulations on Pharmaceutical Care (Achmea Reglement Farmaceutische Zorg)

medicines from the basic insurance from Select Zorg Plan reimbursement according to Achmea’s Regulations on Pharmaceutical Care (Achmea Reglement Farmaceutische Zorg)you pay the statutory personal contribution yourself (upper limit GVS price) this differs per medicine

See www. turien.nl for more detailed information

Younger than 18 with supplementary insurance

Oral health care and dentistry

see www.mijnonlinepolismap.nl for the brochure ‘Mondzorg’


All treatments by dentist, oral hygienist, dental surgeon and clinical dental technicianwith the exception of cast fillings, crowns, bridges, inlays and implants


18 years and older with supplementary dental insurance




Dental surgery no parodontal surgery, dental implants and uncomplicated extraction


Set of false teeth (dentures) • purchase full set of removable initial dentures, replacement dentures or

overdentures made by dentist or clinical dental technician

from Select Zorg Plan 75% statutory personal contribution 25%we must have given you permission in advance: • if the costs are higher than € 575.00 for an upper prosthesis;• if the costs are higher than € 600.00 for a lower prosthesis; • if the costs are higher than € 1,230.00 for a complete prosthesis• in case of replacement within 5 years.

• repair or refitting (rebasing) of full set of removable overdentures or initial dentures by dentist or clinical dental technician


• implants for full set of removable dentures in case of serious development disorder, growth disorder or acquired defect of the teeth-jaw-mouth made by dentist, dental surgeon or Centre for Special Dental Surgery (Centrum voor Bijzondere Tandheelkunde)

from Select Zorg Plan 100% we must have given you permission in advance

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18 years and older with supplementary insurance




Orthodontics (brace) in special casesin case of serious development disorder, growth disorder or acquired defect of the teeth-jaw-mouth no repair, replacement due to damage and loss if through own fault/negligence

from Select Zorg Plan 100%we must have given you permission in advance

Dental care for handicapped personsyour dentist knows whether you are eligible for the reimbursement

from Select Zorg Plan 100% if there is no entitlement to reimbursement from the Exceptional Medical Expenses Act (AWBZ) we must have given you permission in advance

Dental care in special casesyour dentist knows whether you are eligible for the reimbursement

from Select Zorg Plan 100% in some cases a statutory personal contribution applieswe must have given you permission in advance

Eyes and earsSelect Zorg Plan(basic insurance)

Audiological centre from Select Zorg Plan 100%

Hearing aid from Select Zorg Plan 75%statutory personal contribution 25%

See Achmea Regulations on Medical Devices (Achmea Reglement Hulpmiddelen) at www.mijnonlinepolismap.nl

Psychological careSelect Zorg Plan(basic insurance)

General Basic GGZ due to non-complex mental disorderPrinciple carer: clinical psychologist, healthcare psychologist, psychiatrist, psychotherapist, nursing specialist, general remedial educationalist (Dutch NVO), psychologist specialized in children and/or juveniles (NIP)

no treatment for adjustment disorders, work-related and relationship problems, psychiatric complaints without mental disorder and psychological interventions (see list on website)


Non-clinical specialised GGZ due to complex mental disorder (second-line GGZ) psychiatrist, GGZ institution, clinical psychologist or psychotherapist



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Psychological careSelect Zorg Plan(basic insurance)

Psychiatric hospitalisationadmission to a GGZ institution (psychiatric university clinic, psychiatric hospital or psychiatric ward of a hospital)Principle carer: psychiatrist, clinical psychologist, psychotherapist or a healthcare psychologist in an MDO (multidisciplinary consultation) construction



Speech and readingSelect Zorg Plan(basic insurance)

Dyslectic care (diagnosis and treatment of serious dyslexia) for children aged 7 to 12 yearsin compliance with the protocol for the Diagnosis and Treatment of Dyslexia (protocol Dyslexie Diagnose en Behandeling) see www.mijnonlinepolismap.nl or contact our Customer Service


Speech therapyno dyslexia or language development disorder

More information can be found in the brochure ‘Paramedische Zorg’ see www.mijnonlinepolismap.nl


Stutter therapy• with a speech therapist


TransportSelect Zorg Plan(basic insurance)

Ambulance from Select Zorg Plan 100%

Transport of patients(with public transport, own car or (multi-person) taxi transport in case of kidney dialysis, oncology treatment in case of radio/chemotherapy, visual handicap and if you cannot travel without assistance or are dependent on a wheelchair)

from Select Zorg Plan

up to 200 kilometres single journey: own transport € 0,31 per kilometrepublic transport (second class) 100%(multi-person) taxi transport 100%

you pay a statutory personal contribution of € 96.00 per person we must have given you permission in advance

Hospital treatment and nursingCall our Health Care Mediation team (Zorgbemiddeling) 072 518 12 40or see www.averoachmea.nl/zorgbemiddeling


Asthma Centre in Davos from Select Zorg Plan 100%we must have given you permission in advance

Treatment, examination and operation in hospital from Select Zorg Plan 100%we must have given you permission in advance

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Genetic research and advice from Select Zorg Plan 100%

Mechanical respiration from Select Zorg Plan 100%

Medical specialist care outside the hospital (extramural)

Call our Health Care Mediation team (Zorgbemiddeling) 072 518 12 40 or see www.averoachmea.nl/zorgbemiddeling


Medical specialist care in the hospital (outpatient)

Call our Health Care Mediation team (Zorgbemiddeling)072 518 12 40 or see www.averoachmea.nl/zorgbemiddeling

from Select Zorg Plan 100%in case of plastic surgery and dental surgery we must have given you permission in advance

Organ transplantin hospital or independent treatment centre from Select Zorg Plan 100%

• hospital nursing of person who has donated an organ (donor)

from Select Zorg Plan 3 months, in case of liver transplantation 6 months

Plastic surgery (with medical indication)such as breast prostheses after breast amputation (not breast enlargement, surgical removal breast prostheses without medical necessity, liposuction of stomach, upper eyelid correction and ear position)

from Select Zorg Plan 100%we must have given you permission in advance

Convalescence (medical specialist or geriatric convalescence)


Second opinionfor care from basic insurance


Home dialysis from Select Zorg Plan 100%we must have given you permission in advance

nursing at home (outside the hospital/ extramural)no home respiration or relieving care with terminal patients (palliative care)


Nursing at hospital (medical specialist and dental surgery care).

from Select Zorg Plan 100% in case of plastic surgery and dental surgery we must have given you permission in advance

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Independent treatment centreclinic recognized by the government for medical specialist care where nursing, examination and treatment takes place.

from Select Zorg Plan 100%in case of plastic surgery and dental surgery we must have given you permission in advance

Pregnancy / baby / child

see www.mijnonlinepolismap.nl for the brochure ’Zwangerschap en geboorte


Childbirth without medical necessity• childbirth at home


• outpatient childbirth in hospital or birth centre at own request from Select Zorg Plan € 200.00 for use of delivery room the outstanding balance is the (statutory) personal contribution

Childbirth with medical necessity• outpatient childbirth from Select Zorg Plan 100%

• clinical childbirth (multi-day stay in hospital) from Select Zorg Plan 100%

In-vitro fertilisation (IVF)fertility treatment

from Select Zorg Plan first 3 attempts per attempted pregnancy. Medicines according to GVS for first 3 attemptsfor treatment abroad we must have given you permission in advance

Maternity care• at home

number of hours is determined based on the National Indication Protocol on Maternity Care (Landelijk Indicatieprotocol Kraamzorg)

from Select Zorg Plan 100%, you pay the statutory personal contribution of € 4.10 per hour yourself

• in a hospital with medical indication from Select Zorg Plan 100%

• in a hospital or in a birth or a maternity centre without medical indication from Select Zorg Plan 100% (10 days)you pay the statutory personal contribution of € 33.00 per hospital day yourself (€ 16.50 for the mother and € 16.50 for the child) + the amount higher than € 233.00 per day (€ 116.50 for the mother and € 116.50 for the child) if the hospital charges this

• parturition assistance from Select Zorg Plan 100% you pay the statutory personal contribution of € 4.10 per hour yourself

Oncology examination for childrenexamination for cancer

from Select Zorg Plan 100% only with Dutch Foundation for Children and Cancer (Stichting Kinderoncologie Nederland (SKION))

Prenatal screening• counselling (advice) from Select Zorg Plan 100%

• structural ultrasound examination (20-weeks echo) from Select Zorg Plan 100%

• combination test (a nuchal scan combined with blood test)

from Select Zorg Plan 100% • up to 36 years with medical indication

• 36 years or older from Select Zorg Plan 100%

Sperm freezing from Select Zorg Plan 100%

Obstetric care from Select Zorg Plan 100%

Vitrification (freezing) of human oocytes and embryos from Select Zorg Plan 100%

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Pregnancy / baby / child

see www.mijnonlinepolismap.nl for the brochure ’Zwangerschap en geboorte


Fertility treatments (not IVF) from Select Zorg Plan 100% for treatment abroad we must have given you permission in advance

MiscellaneousSelect Zorg Plan(basic insurance)

Dietary advice and nutrition education• dietary advice by dietitian (with medical indication)

no nutrition education

from Select Zorg Plan 3 hours per person per year

General practitioner care from Select Zorg Plan 100%

Integrated care in case of diabetes mellitus type 2 (for insured persons who are 18 years and older) and COPD

from Select Zorg Plan 100% only with one of our contracted care groups

Laboratory and radiography (on prescription from general practitioner or medical specialist)


Stop smoking programme from Select Zorg Plan 1x per person per year

Thrombosis Service from Select Zorg Plan 100%

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Alternative Juist Voor Jou

A. Alternative forms of treatment and therapies consultations/treatments such as for instance: acupuncture, homeopathy, chiropractic, osteopathy, manual therapy by practitioners who are affiliated to professional associations that meet our criteria. See www.mijnonlinepolismap.nl or contact our Customer Service

€ 40.00 per day for doctors who practice alternative forms of treatment and for alternative non-doctors

B. Alternative medicines (anthroposophic and homeopathic)See www.mijnonlinepolismap.nl or contact our Customer Service

100%

A + B added up € 250.00 per person per year

Bones, muscles and joints Juist Voor Jou

Podiatry/podology/podopostural therapyRegister Podiatrist B affiliated to the LOOP foundation or podopostural therapist affiliated to Omni Podo Association (Omni Podo Genootschap) andArch supports1 pair (supplier must be member of the NVOS Orthobanda)

No shoes or shoe adjustments, feet examinations and treatment of diabetic foot (Simm’s 1 and higher)

€ 100.00 per person per year, including 1 pair of arch supports

Abroad Juist Voor Jou

Best Doctors• InterConsultation (second opinion )• AskTheExpert (additional medical information)

Always call our Health Care Mediation team (Zorgbemiddeling) for permission in advance 072 518 12 40 or see www.averoachmea.nl/zorgbemiddeling

100%100%

Urgent care abroadcare which cannot be postponed until after you return to your country of residence

Call Eurocross Assistance for urgent help abroad: +31 71 364 18 50 The telephone number is also mentioned on your health card

supplemented to cost price (regular tariff in the country in question) for a continuous stay of a maximum of 12 months

Urgent pharmaceutical care abroad which is not reimbursed from the basic insurance(medicines for urgent care)

€ 50.00 per person per year

Non-urgent care abroad(care which can be postponed until after you return to your country of residence)

according to the reimbursement in the Netherlands with due regard to the conditions and exceptions

Vaccinations and consultations in case of a journey abroad

Medicines against malaria for a journey abroad

according to advice from National coordination centre Passenger Advice (Landelijk coördinatiecentrum Reizigersadvisering)

100% with one of our contracted care providers

via Internet pharmacist eFarma 100%

or via another provider € 150.00 per person per year

Transport of insured person and transport of mortal remains to the Netherlands (repatriation)Call Eurocross Assistance: +31 71 364 18 50

100% Eurocross Assistance must have given you permission in advance

Juist Voor Jou

Please note! The Juist Voor Jou can only be taken out in combination with the basic insurance Select Zorg Plan. The Select Zorg Plan can be found in the previous schedule.

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Younger than 18 years

Fysiotherapy and excercise therapy See www.mijnonlinepolismap.nl for the brochure Paramedische Zorg

Juist Voor Jou

Disorder that is not listed by the Minister of Public Health, Welfare and Sport (Appendix 1 with article 2.6 of the Health Insurance Decision)Your doctor and/or physiotherapist diagnoses the disorder

Appendix 1 with article 2.6 of the Health Insurance Decision can be found in the brochure ‘Paramedische Zorg’

via one of our contracted providers all treatments from the 19th treatment (therefore jointly 100% reimbursement)

or via a non-contracted provider 12 treatments per year

18 years and older

Fysiotherapy and excercise therapy See www.mijnonlinepolismap.nl for the brochure ‘Paramedische Zorg’

Juist Voor Jou

Disorder that is listed by the Minister of Public Health, Welfare and Sport (Appendix 1 with article 2.6 of the Health Insurance Decision (Besluit zorgverzekering)) your doctor and/or physiotherapist diagnoses the disorder

Appendix 1 with article 2.6 of the Health Insurance Decision can be found in the brochure ‘Paramedische Zorg’


12 treatments per year

treatment 13 to 20 you pay yourself

Disorder that is not listed by the Minister of Public Health, Welfare and Sport (Appendix 1 with article 2.6 of the Health Insurance Decision) your doctor and/or physiotherapist diagnoses the disorder Appendix 1 with article 2.6 of the Health Insurance Decision can be found in the brochure ‘Paramedische Zorg’


12 treatments per year

The above stated reimbursement is only applicable if you suffer from 1 disorder! Do you have several disorders for which you visit a physiotherapist/remedial therapist? Then always contact our Customer Service. They are happy to inform you to what reimbursement you are entitled to.

Medication (medicines) Juist Voor Jou

Anticonceptiva bijvoorbeeld de pil of een spiraaltje

• 21 years and older 100% you pay the statutory personal contribution yourself (upper limit GVS price) this differs per medicine

18 years and older with supplementary dental insurance

Oral health care and dentistrySee www.mijnonlinepolismap.nl for the brochure ‘Mondzorg’

T Start

A. Dentist/oral hygienist, dental surgeon and clinical dental technician • consultations (C-codes) and second opinion• oral hygiene (M-codes)• filling (V-codes)• pull teeth/molars (h-codes)

100%

B. Other treatments 75%

A + B added up € 250.00 per person per year

C. We do not reimburse the costs of:• test reports and dental statements (C70, C75 and C76)• a non-fulfilled appointment (C90)• orthodontics• subscriptions• external bleaching of teeth and molars (E97, E98 and E00)• mandibular advancement splint (MAS; a prosthesis against snoring) and the diagnostics and

aftercare (G71, G72 and G73)• complete anaesthesia

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eyes and ears Juist Voor Jou

Spectacles and contact lenses € 100.00 per person per period of 3 years for spectacles and contact lenses together

Hospital, treatment and nursing Call our Health Care Mediation team 072 518 12 40 or see www.averoachmea.nl/zorgbemiddeling

Juist Voor Jou

Male circumcision with medical indication

100% in case of contracted care providers, in case of non contracted care providers we must have given you permission in advance

Mammaprint 100% only with laboratory Agendia

Miscellaneous Juist Voor Jou

Sports doctorinjury or follow-up consultation

€ 130.00 per person per year with a Sports Medical Institute, affiliated to the Federation of Sports Medical Institutions (Federatie van Sport Medische Instellingen (FSMI)) See www.sportzorg.nl for a location in your neighbourhood

Sports medical examinationnot mandatory sports examinationSee www.averoachmea.nl/sportmedischonderzoek for the examinations which we reimburse

€ 100.00 per person per 2 years with a Sports Medical Institution, affiliated to the Federation of Sports Medical Institutions (FSMI) See www.sportzorg.nl for a location in your neighbourhood

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Disclaimer

Your privacy – why do we ask for your personal details?We ask for your personal details and other details if you apply to us for insurance or for a financial service. We use your details within the Achmea Group in order to enter into contracts and to implement them. We also give you information about products and services that may be important for you.

For what other purposes do we use your personal details?In addition we use your personal details:• to manage our database of relationships;• to prevent and combat fraud;• to carry out statistical research;• to comply with the law.

Would you prefer not to receive information about our products and/or services? Or that we do not use your e-mail address? In that case send a letter to:Turien & Co. Assuradeuren Postbus 216, 1800 AE Alkmaar

About the CIS FoundationWe can approach the CIS Foundation in The Hague to obtain your personal details or to have them entered into their files. This is the central information system for insurance companies that operate in the Netherlands. For instance, if you have not passed on important information and we want to terminate the insurance. This is how we control risks and prevent fraud.

For more information, see www.stichtingcis.nl. Read on this website about what the Foundation does with your personal details.

Applicable law and processing complaintsOnly Dutch law applies to these insurance policies. We will of course do our utmost best to provide you with the best possible service. You may nevertheless be dissatisfied about something. In that case we ask you to first contact your advisor or contact person. If you still want to submit a complaint, please do so by e-mail via our website www.turien.nl (‘klacht doorgeven’) or in writing to Turien & Co. Centrale Klachtencoördinatie, Postbus 216, 1800 AE Alkmaar. You may feel that we have failed to solve your problem satisfactorily. In that case, if you are a legal person who is not acting on behalf of a company or a profession, you can apply to the recognised disputes authority with which we are affiliated: the Health Insurance Complaints and Disputes Board (SKGZ), Postbus 291, 3700 AG Zeist, tel. 030 698 83 60, www.skgz.nl.

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Turien & Co. Assuradeuren

Postbus 216

1800 AE Alkmaar

Vergoedigenoverzicht Juist Voor Jou (Engels) 2014

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Transcript of Vergoedigenoverzicht Juist Voor Jou (Engels) 2014