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Several elements of the BES Healthcare Insurance Claims Regulation (Regeling Aanspraken Zorgverzekering BES) will change as of January 1st, 2020. The changes concern several new claims, and clarification and further requirements for existing claims and provisions.
New
Medical Devices
The claims for medical devices have been expanded with wheelchairs, shower chairs and toilet chairs.
Stop smoking programmes and Combined Lifestyle Intervention
In line with the European Netherlands, insured individuals may qualify for reimbursement of the costs for a stop smoking programme and a combined lifestyle intervention (CLI). Both must be prescribed by a general practitioner or specialist.
Claims for the stop smoking programme concern medical assistance and any pharmaceutical help following the authorisation of the Healthcare Insurance Office (Zorgverzekeringskantoor, hereinafter referred to as ZVK).
Care related to CLI may be reimbursed in full or partially for insured individuals of 18 years and older. CLI is aimed at a healthier diet, more physical exercise and psychological support. Additional costs, such as costs related to sports, are not reimbursed.
Physiotherapy and remedial therapy for rehabilitation
The coverage of physiotherapy and remedial therapy for rehabilitation is new as well. It concerns treatment for a better recovery after hospitalisation or day treatment. In that case physiotherapy or remedial therapy for rehabilitation are reimbursed for up to twelve months.
Clarification and tightening of requirements
Speech therapy
Speech therapy is only covered for medical purposes, on referral from a general practitioner, specialist or dentist. Speech therapy for non-medical purposes, such as speaking in public or singing training, is not covered.
Dietary preparations and stop smoking medication
Reimbursement of these care products requires the ZVK’s prior consent.
Orthopaedic shoes
This is only is covered when prescribed by a specialist.
Prescription glasses and contact lenses
Adults are entitled to claim reimbursement up to an amount of USD 170.00 per three years. For insured persons up to 18 years, the amount is USD 170.00 per year.
Companionship in case of medical referral abroad
The entitlement to a companion may apply to the entire referral abroad or to a necessary part thereof. The entitlement to a companion no longer depends on a disorder but on the limitation(s) suffered by an insured person. Therefore the criterion ‘older than 70 years’ is no longer used. An insured individual younger than 18 years who is very sick can get companions. These do not have to be both parents. In case of a medical referral abroad for birth, the ZVK reimburses the flight costs of one companion for the period around the birth. The companion will not receive a daily allowance.
Information
The ‘Who is insured with the ZVK? What is covered by the healthcare insurance?’ information leaflet contains a brief summary of the entitlements of persons insured with the ZVK.
Detailed information on the healthcare insurance and claims which can lawfully be made on the basis of the BES Healthcare Insurance Claims Regulation is available on the website: www.zvkcn.nl under ‘Care entitlements’.
RCN