Medical specialist care

Under the public health insurance, the following treatments fall under medical specialist care too:

• medical aids which you receive as part of an admission or medical specialist treatment, provided they form (or are supposed to form) part of that admission or treatment
• medicines you receive within the framework of an admission or medical specialist treatment, provided they form (or are supposed to form) part of that admission or treatment
• Conditional medical specialised care included in the List of conditional care (in Dutch)
• Plastic surgery treatment as mentioned in our insurance conditions

The following treatments do not fall under medical specialist care:

• treatment for snoring with uvuloplasty
• sterilisation of the insured party or the reversal thereof (either man or woman)
• circumcision of male insured parties, unless in the event of a medical need
• treatment of asymmetrical flattening of the back of the head (plagiocephaly) and central flattening of the back of the head (brachycephaly) in young children using a cranial remodelling helmet without the premature fusing of the cranial sutures (craniosynostosis)
• medicines as referred to in Appendix 0 of the Healthcare Insurance Regulations (Regeling zorgverzekering), subject to the conditions stipulated therein. The number of medicines and the conditions are subject to change in the interim. An up-to-date version of the Healthcare Insurance Regulations can be found at www.hollandzorg.com/conditions.
• external devices as part of treatment of diabetes to monitor and control blood sugar disorders, including ketone test strips and insulin pumps.
• laboratory testing at the request of an alternative care provider.
  
  

Plastic surgery

Plastic surgery only falls under medical specialist care if it concerns:

• defects in your appearance related to demonstrable physical functional disorders.

• mutilation resulting from a disease, accident or medical operation.

• paralysis or weakening of the upper eyelids, if this seriously restricts the range of vision or is caused by a congenital defect or a congenital chronic disorder.

• the following congenital malformations: cleft lip, jaw and palate, malformation of the facial bone structure, benign morbid growth of blood vessels, lymphatic vessels or connecting tissue, birth marks or malformation of the urinary organs or genitals.

• primary sexual characteristics in the event of diagnosed transsexuality.

Medical specialist care does not include:

• treatment of paralysis or weakening of the upper eyelids, if this does not seriously restrict the range of vision or if caused by a congenital defect or a congenital chronic disorder

• liposuction of the stomach

• plastic surgical treatment to reconstruct the breast or replace a breast prosthesis, other than following full or partial mastectomy or in the case of agenesis or aplasia of the breast in women and a comparable situation in the event of diagnosed transsexuality

• the operative removal of a breast prosthesis without a medical need

• an abdominal wall correction (abdominal plastic surgery), except in the case of mutilation or serious functional disability

Read our insurance conditions for more information.

Stays outside the institution

You are entitled to reimbursement of the costs of stays near the institution for your treatment if this is medically necessary in connection with medical specialist care, not involving nursing or (paramedical) care. However, some conditions apply, i.e.:

• you have an informal carer during your stay; and
• he travel time between the hospital where you receive treatment and your place of residence is more than 60 minutes; and
• the travel time between the hospital where you receive treatment and your place of accommodation is a maximum of 60 minutes.

The reimbursement of the accommodation costs is a maximum of € 91 per night. You arrange the stay yourself.

Referral required

For medical specialist care, you will require a referral from a general practitioner, clinical technologist, house officer, medical specialist, obstetrician, youth healthcare doctor, doctor for the mentally disabled, specialist geriatrics doctor, infectious disease and tuberculosis prevention doctor, A&E doctor, physician assistant, nursing specialist, sports doctor, clinical physicist-audiologist, company doctor, dental hygienist, dentist, dental surgeon, optometrist, orthoptist or triage hearing specialist. This condition will not apply to urgent care. The referral will remain valid for a period of twelve months, commencing on the day the referral was issued.

Reimbursement under public health insurance

The HollandZorg public healthcare insurance reimburses the cost of treatment and stay in a hospital or in an independent treatment centre. Read our insurance conditions for a full overview.