Health insurance

In mid-November, everyone receives a new offer from their current health insurance provider. You would be deceiving yourself if you think that means the only thing to change is the price. It is important to check the policy conditions. If you have a restitutiepolis (non-contracted care policy), you are free to choose your healthcare providers. If you have a naturapolis (contracted care policy) or budgetpolis (low-budget policy) and you want to stay with the same insurer, you should check whether your HIV treatment centre, general practitioner and other care providers (e.g. physiotherapist and dentist) will continue to be reimbursed under the same conditions in 2021. If that is not the case, it is better to switch to the slightly more expensive restitutiepolis.

In brief:

Policy conditions change every year: what was reimbursed in 2020 will not necessarily be reimbursed in 2021.
31 December 2020: the final date for cancellation of your health insurance.
31 January 2021: the final date for taking out a new health insurance policy, as long as you have terminated the old one no later than 31 December 2020 (your health insurance policy will then start retroactively on 1 January 2021).
Use a comparison website to check whether you are not paying too much for your health insurance.
A restitutiepolis give you a free choice with healthcare. Choice is limited with a naturapolis or a budgetpolis and sometimes you have to pay extra.
The Hiv Vereniging (Dutch HIV Association) offers its members a group discount on a number of health insurance policies.
If you have a low income, you might be able to take out a gemeentepolis (a group health insurance plan offered by your local municipality).
Membership of the Hiv Vereniging is sometimes fully, or partially, reimbursed by aanvullende zorgverzekering (supplementary health insurance).

Which insurance is best?

It is not possible to recommend one particular insurance for people with HIV. Everyone is different and everyone needs different kinds of care. One person may want a lot of physiotherapy, another a lot of dental care, a third may want both. Also, constant telephone access to a customer service might be extremely important to you. On the other hand, you may prefer to do your business online. So it's important to figure out which health insurance policy is best for you.

Important dates

The health insurers must announce the premiums for their new policies by 12 November 2021. If you switch to a new insurer before or on 31 December 2021, you automatically cancel the policy with your old insurer. Your new insurance then starts on 1 January 2022. If you need more time to think about it, you can cancel your old health insurance by 31 December 2021, and apply for a new insurance by 31 January 2022. Your new insurance then will take effect retroactively, starting on 1 January 2022.

What type of policy? Take a critical look!

If you want to avoid unpleasant surprises wherever possible, then take a restitutiepolis, under no circumstances a budgetpolis, and preferably not a naturapolis either. The differences between types of policy (restitutiepolissen, naturapolissen and budgetpolissen) are becoming increasingly large. We know from past experience, that more and more insured people are faced with unpleasant surprises, like additional payments for medicines or treatments. So take a critical look at your policy and the policy conditions.

restitutiepolis

The Hiv Vereniging advises everyone with HIV to take out a restitutiepolis. This policy may be more expensive, but it means you avoid having to pay extra for part of a doctor’s or hospital bill. It also means you avoid travel expenses to a hospital or clinic that the insurer has a contract with. With a restitutiepolis, you are always free to choose your doctors and other healthcare providers, at no extra cost.

combinatiepolis

A Combinatiepolis is a combination of a restitutiepolis and a naturapolis. A combination policy allows you to choose most of your healthcare providers. This means you can often choose which healthcare provider you want to go to. However, you should always check the contracts that your health insurer has signed with the healthcare providers. If you go to a contracted healthcare provider, your entire bill will be reimbursed. If you choose a non-contracted provider, your bill will only be reimbursed up to the standard amount. In most cases this means the entire bill will be reimbursed. Because you don't have full freedom of choice, the combinatiepolis is slightly cheaper than the restitutiepolis.

naturapolis

If you choose a naturapolis, then you will have to pay extra if you go to healthcare providers your health insurer doesn’t have a contract with. You might have to run up more travel expenses to get the right care. If you go for planned care to a care provider with whom your insurer doesn't have a contract, you will have to pay part of the bill yourself. If it’s a hospital stay, you could be running up a significant bill. The advantage of a naturapolis is that it is often an inexpensive health insurance policy compared to the restitutiepolis.

budgetpolis

The budgetpolis is a stripped-down version of the naturapolis. The policy is also called a natura (online). The Hiv Vereniging advises people with HIV not to take this cheap budgetpolis. Once you have checked whether your HIV care is included in this policy, you must also check whether you can go to each other practitioner you are referred to (e.g. physiotherapy, or a referral from your GP or specialised HIV doctor), without paying extra. If the insurer has not agreed to a low-budget contract with him, you will have to pay the healthcare provider yourself. It is also possible that the insurer only has contracts with a small number of hospitals, in which case you may have to travel a long way for the required care. You don't realise this until it's too late.

Supplementary insurance

People are increasingly doing without supplementary insurance. This is a way of reducing their monthly expenses. But if you expect higher healthcare costs when it comes to physiotherapy (especially if you play sports and are at risk of sports injuries), or alternative medicine, or dental costs, you have to weigh up the risks against the costs. The longer we live with HIV, the more likely we are to have HIV-related symptoms of old age. These can include mobility, muscle and joint problems. Physiotherapy is then important.

Supplementary insurance covers healthcare costs that are not covered by basic insurance. This mainly concerns dental care, physiotherapy, alternative medicine and orthodontics. If you expect high or higher healthcare costs, supplementary insurance can sometimes be advantageous. Please note: if you don’t yet have supplementary insurance, some insurers will ask questions about your health. Sometimes they don't want chronically ill people, but sometimes they don't have a problem with HIV. They are allowed to refuse you supplementary insurance, so there is little you can do about it.

want everything covered?

If you have a low income and/or not much savings, it could be safer to opt for supplementary insurance. The monthly costs can increase substantially, maybe to more than €100. But then you have just about every risk covered. A rheumatic patient can be insured for unlimited visits to a physiotherapist, or for compensation for the eigen bijdrage (personal contribution) for certain medicines. But laser eye treatment or the procurement of medical aids could also be a reason to take out supplementary insurance. Find out more on ‘good calculations’.

dental insurance?

Dental costs can mount up considerably if you have to replace crowns or if you need a root canal treatment. But a good dental insurance can easily cost you around €35 a month. And some supplementary insurances only partially reimburse these costs. You pay around €25 in 2021 for a regular check-up without further treatment, so if you are someone who never has cavities, you end up paying more for the insurance than you do for the dental costs. Work it out for yourself; you can find examples of treatment costs here (in Dutch).

This general acceptance rule no longer applies to supplementary insurances. So you should check first whether another insurer will accept you. If you enter your preferences for supplementary insurance on a vergelijkingssite (comparison site) like the Consumentenbond (Dutch Consumer Association - in Dutch), you find out instantly whether they will accept you.

Don't cancel your supplementary insurance until you are sure your new health insurer has accepted you. By the way, you are not obliged to take out your basic insurance and your supplementary health insurance with the same health insurer. However, if you take out supplementary insurance with a different insurer, you may be charged extra. This can amount to more than 50% of the premium for the supplementary insurance.

Changes in 'eigen risico' (the excess that has to be paid for health costs) and 'premie' (premium)

The eigen risico and the price of the basic insurance can change every year. The maximum eigen bijdrage (personal contribution) can also vary each year.

price

In 2021 the basic insurance went once again go up in price, partly due to costs linked to the novel coronavirus. It concerned an increase of €59. This means an increase in the healthcare premium of just over €5 a month starting on 1 January 2021.

eigen bijdrage

Not all care covered by the basic insurance is fully reimbursed. When it’s not, you have to pay an eigen bijdrage (personal contribution). This could be a fixed amount, a percentage of the costs, or an additional payment. The government determines the type of care the eigen bijdrage applies to. And the amount of the eigen bijdrage. The amount can vary from year to year. In 2021, the eigen bijdrage is a maximum of €250 per calendar year for all medicines. Click here (in Dutch) for more about the eigen bijdrage in 2021.

Want to save money? Think about this!

It makes sense to fill in your details on a healthcare comparison site, because a lot changes every year. This shows you which basic insurance and which supplementary insurance is the cheapest. It is often cheaper to switch health insurers than to stay with the same health insurer for years on end.

comparison

You can compare the costs of basic and supplementary insurances by using the Consumentenbond Zorgvergelijker (Consumers’ Association Comparison Tool - in Dutch). Please note: the Consumentenbond has a broad selection, but also a slight commercial interest: sometimes you can join a group insurance plan through the Consumentenbond. Click here (in Dutch) for a list of all health insurances (including supplementary), the costs and what is reimbursed.

good calculations

It is useful to make a list of all the healthcare you expect to use: new glasses, contraception, dentist, vaccinations, physiotherapy, etc. Then make an estimate of those care costs. Then look at what is covered by which supplementary insurance, and whether taking out supplementary insurance will save you money. Also bear in mind that supplementary insurance does not always cover everything.

Example: you think you will need physiotherapy. Calculate in advance whether the costs of physiotherapy treatment are worth the extra premium you have to pay each month if you take out supplementary insurance. Normally you pay between €25 and €35 for a physiotherapy session of half an hour. But to be sure, check your physiotherapist's website for the exact costs. And don’t forget: with a naturapolis or a budgetpolis, you may have to pay extra to see the physiotherapist of your choice.

Example: you go to the dentist for a check-up twice a year. If no additional treatment is required, you pay around €25 each time. Supplementary dental insurance easily costs €10 a month. This comes to €120 a year. Work it out for yourself; you can find examples of treatment costs here (in Dutch).

Example: you take ADHD medication. You have to pay an eigen bijdrage for this. This is a maximum of €250 a year. The eigen bijdrage for ADHD medication is partly or fully reimbursed by some health insurers through the supplementary health insurance. So sometimes you incur fewer costs if you take out supplementary insurance. Click here (in Dutch) for the amount of the eigen bijdrage for each kind of care.

Use the Consumentenbond Vergelijker (in Dutch) to see which health insurance policy best suits your situation. Then see whether you get cheaper health insurance through the Consumentenbond or through the group insurance offered by the Hiv Vereniging (in Dutch).

group discount

Do you know which health insurance suits you best? You can save money by taking out a basic and/or supplementary health insurance policy with a group discount. The Hiv Vereniging offers its members a group discount on health insurance policies. It may also be a good idea to take out a gemeentepolis. Click here (in Dutch) for more information. But if you are a civil servant, a member of a trade union or a member of a sports club, there is often a group insurance plan which can save you some money.

yearly payment

You often get a small discount if you pay your yearly health insurance costs in one go. The maximum discount in 2021 is 2.1%. We understand that a large section of the population cannot afford to pay these costs all at once. You can sometimes get a discount as well, if you pay quarterly or half yearly. Check your health insurer's website to find out how much discount you can get.

Misconceptions

There are many misconceptions about health insurance. For example, about the healthcare providers available within a policy. Or that new pharmacy that has a different contract. Watch out for pitfalls.

medication

Every year, each insurer determines which medication it will reimburse and the level of that reimbursement. So the policy may look different every year, even though your situation has not changed. So it's possible your medication was fully reimbursed in 2020, but in 2021 you have to pay an additional charge. The restitutiepolis offers the best approach.

the same healthcare providers in 2021?

A health insurer who had a contract with the hospital in 2020 will not necessarily have one in 2021. This means that you can't automatically go there for the same treatment with a naturapolis. And you often don’t find this out until after the first treatment or laboratory tests in that hospital.

Insurers buy the best care at the best price, on behalf of their policyholders. But they no longer sign agreements with all healthcare institutions and healthcare providers. Sometimes that’s because they can make better arrangements with other institutions or healthcare providers. And sometimes because some healthcare providers or institutions can meet higher quality standards because they have more experience with certain operations or procedures.

The health insurers renegotiate the agreements every year. It's important for you to determine which healthcare providers and hospitals your policy allows you to go to for care in 2021. You can ask your health insurer. If you don't want to have to check this, then never take a budgetpolis or a naturapolis. With a restitutiepolis, you can always go to your doctor of choice.

pharmacies

If you do not have a restitutiepolis your choice of pharmacies may be limited. For example, if your own pharmacy is closed or if you want to get your HIV medication from another pharmacy while you are on holiday. Depending on your policy, your health insurer may then not reimburse the cost of medication (budgetpolis) or only partly (naturapolis). You don't have this problem with the restitutiepolis.

Health insurers and reimbursement of membership

The website zorgwijzer.nl (in Dutch) offers an overview of health insurers that reimburse membership fees fully, partially, or not at all. This overview lists what each health insurer has to offer. Health insurers often attach a condition to reimbursement. This is whether a patient organisation is affiliated to the Patiëntenfederatie (NPCF) and Ieder(in). The Hiv Vereniging is affiliated to both the Patiëntenfederatie and Ieder(in). Do they ask for proof of affiliation? The Patiëntenfederatie (NPCF - in Dutch) website states that the Hiv Vereniging is affiliated. Ieder(in) proof of affiliation - pdf download here (90 KB).

Inform yourself, search in the overview for your health insurance or contact your insurance company if you have questions. If your health insurer reimburses the membership from supplementary insurance, or partially does, please contact your insurer to get a refund of the membership costs.

Healthcare allowance

Healthcare allowance is a reimbursement from the Dutch government for people with a Dutch health insurance. To be eligible, you must meet certain conditions. For example, the allowance depends on the composition of your household and on the level of your income. You can calculate your entitlement yourself using a test calculation (in Dutch) on the website of the Belastingdienst (tax office).

Problems with delivery of HIV medication?

In recent years, relatively more people with HIV have had problems with delivery of their HIV medication to the pharmacy. According to the law, you are allowed to pick up a three-month supply of medication. Sometimes people still only receive a one-month supply of HIV medication. Since 2017, the Hiv Vereniging has been mapping out which insurers still have medication delivery problems.

Since 1 January 2020, all health insurers state in their terms and conditions: medication (including HIV medication) costing more than €1,000 a month may be given for a three-month period, as long as the person with HIV is properly adjusted (i.e. using a medication that suits them and suppresses the virus – usually after six months). Read more here (in Dutch). If you do experience problems with the delivery of medication, or do not receive a three-month supply of medication, we ask you to inform the Servicepunt of the Hiv Vereniging.