Physiotherapy and remedial therapy from 18 years

Remedial therapy is provided by Cesar and Mensendieck remedial therapists. The object of physiotherapy or remedial therapy is to prevent, end or reduce limitations and focuses on pain control and the improvement of mobility, among other things.

When will you qualify for reimbursement?

Your age will largely determine the reimbursement you receive. Public health insurance distinguishes between insured parties up to the age of 18 and insured parties aged 18 and older. On this page, we will provide you with information about reimbursements for physiotherapy and remedial therapy for insured parties aged 18 and older.

If you are 18 or older, you are entitled to reimbursement from the public healthcare insurance:

• reimbursement starting after the 21st treatment, for a disorder stipulated on the Appendix 1 to the Health Insurance Decree (Besluit zorgverzekering), This is the list of disorders for physiotherapy and remedial therapy (PDF).
• pelvic physiotherapy in connection with incontinence, subject to a maximum of nine treatments (once-only);
• supervised remedial therapy for peripheral arterial disease (PAD) in Fontaine stage 2. In that case you will be entitled to a maximum of 37 treatments during a maximum of 12 months. Also the first 20 treatments are reimbursed, which isn't the case with other cases;
• supervised remedial therapy for arthrosis in your hip or knee joint. In that case you will be entitled to a maximum of the first 12 treatments during a maximum of 12 months;
• supervised remedial therapy for COPD, if it concerns stage II or higher of the GOLD Classification for spirometry. In that case, you are entitled to:
  
  • if it concerns Class A of the GOLD Classification for symptoms and a risk of exacerbation: no more than the first five treatments during a maximum of twelve months;
  • if it concerns Class B of the GOLD Classification for symptoms and a risk of exacerbation and a moderate burden of disease or sufficient physical capacity: no more than the first twenty-seven treatments during a maximum of twelve months after the start of the treatment and a maximum of three treatments per twelve months in subsequent years;
  • in the case of class B of the GOLD Classification for symptoms and risk of exacerbations and a high burden of disease and limited physical capacity or if it concerns Class C or D of the GOLD Classification for symptoms and a risk of exacerbation: no more than the first seventy treatments during a maximum of twelve months after the start of the treatment and a maximum of fifty-two treatments per twelve months in subsequent years.
• conditional physiotherapy and remedial therapy as referred to in the article on Conditional care.

Under our supplementary insurance, you will qualify for reimbursement of a number of treatments by a contracted provider, depending on your supplementary insurance.

Referral required for certain treatments

You need a referral from a general practitioner, medical specialist, youth healthcare doctor, doctor for the mentally disabled, specialist geriatrics doctor, company doctor, dentist, nursing specialist, physician assistant or a coordinating practitioner within the framework of medical care for specific groups of patients (GZSP):

• for treatment of a complaint on the List of disorders for physiotherapy and remedial therapy;
• for treatment by a pelvic physiotherapist in connection with urine incontinence;
• for supervised remedial therapy for peripheral arterial disease (PAD) in Fontaine stage 2;
• for supervised remedial therapy in the event of arthrosis in your hip or knee joint;
• for supervised remedial therapy for COPD, if it concerns stage II or higher of the GOLD Classification for spirometry;
• for care provided at home or in an institution by a non-contracted care provider.

If you go to a non-contracted care provider, you must include a copy of the referral when you submit the first invoice. You must also include a statement from your care provider when submitting the first invoice. This statement must list any historic physiotherapy or remedial therapy received for that same disorder. This does not apply if:

• the insured is under the age of 18 or if
• it concerns the costs of pelvic physiotherapy in connection with incontinence;
• if it concerns supervised remedial therapy in connection with:
  
  • peripheral arterial disease (PAD) in Fontaine stage 2 (intermittent claudication);
  • arthrosis in your hip or knee joint;
  • COPD, if it concerns stage II or higher of the GOLD Classification for spirometry.

Reimbursement for physiotherapy and remedial therapy

If you are 18 years or older, you qualify for a reimbursement for physiotherapy and remedial therapy under the public healthcare insurance and our supplementary insurance.

*) Is there a maximum period for treatment of the disorder? If so, you will qualify for the reimbursement of care up to the end of the maximum period.

Note: Will you be receiving physiotherapy and remedial therapy from a care provider with whom we have not made any agreements? In this situation, the maximum rates for non-contracted care providers will apply. With your first invoice, you must also include a statement that lists any historic physiotherapy or remedial therapy received for that same disorder.

*Explanation of reimbursement under the supplementary insurance
A treatment is calculated as follows:

**Reimbursement of manual therapy
The reimbursement for manual therapy does not include manual therapy E.S. (Eggshell / Van der Bijl) and therapy by an orthomanual therapist or orthomanual doctor. In that case, the reimbursement for alternative medicine applies.