Abroad: non-urgent (scheduled) health care
100% as per Dutch rates
Startfit coverage also applies abroad
Benfit coverage also applies abroad
Optifit coverage also applies abroad
Topfit coverage also applies abroad
Tandfit A coverage also applies abroad
Tandfit B coverage also applies abroad
Tandfit C coverage also applies abroad
Tandfit Preventief coverage also applies abroad
Abroad: urgent health care
100% as per Dutch rates
Startfit coverage also applies abroad
Benfit coverage also applies abroad
Optifit coverage also applies abroad
Topfit coverage also applies abroad
Supplement on top of basic health-care plan coverage
Abroad: vaccinations and preventive medicines
No coverage
€75 for 11 illness risks
€75 for 11 illness risks
€100 for 11 illness risks
100% (all illness risks)
Acne treatment
No coverage
€150 up to the age of 21
€200 up to the age of 21
€300 up to the age of 21
€400 up to the age of 21
Admission for medical mental health care (GGZ)
100% for a contracted health-care provider. Otherwise limited coverage.
In the event of diagnosed or suspected psychological disorders.
No coverage
No coverage
No coverage
No coverage
Adoption care
No coverage
No coverage
€250
€400
€550
Aid for third-party claims for injury
No coverage
€12,500 for a lawyer or claims management service (engaged by us)
€12,500 for a lawyer or claims management service (engaged by us)
€12,500 for a lawyer or claims management service (engaged by us)
€12,500 for a lawyer or claims management service (engaged by us)
Alternative/non-conventional medicine and movement-related care
No coverage
€30 per day, up to €100 No medicines
€40 per day, up to €350 No medicines
€50 per day + registered medicines, up to €550 combined
€65 per day + registered medicines, up to €1,000 combined
Antenatal screening
100%
No coverage
No coverage
No coverage
No coverage
Audiological health care
100%
No coverage
No coverage
No coverage
No coverage
Bed-wetting alarm
No coverage
No coverage
€85 for entire term of the health-care plan
€85 for entire term of the health-care plan
100% Once during the entire term of the health-care plan
Carer relief
No coverage
No coverage
€800
€1,200
€2,000
2 weeks In the case of emergency admission after a serious accident or diagnosis of a serious ailment
Childcare in case of hospital care
No coverage
No coverage
No coverage
No coverage
No coverage
Combined lifestyle intervention (CLI) for overweight patients
100% combined lifestyle intervention (CLI) for overweight patients
No coverage
No coverage
€250 for an exercise programme as part of a CLI and other exercise programmes combined
€500 for an exercise programme as part of a CLI and other exercise programmes combined
Contraceptives
100% up to the age of 21 in the event of contracted health care, otherwise limited coverage In certain cases also over the age of 21
Sometimes you will need to pay a personal contribution
100% from the age of 21 to 30
100% from the age of 21
100% from the age of 21
100% from the age of 21
Cosmetic camouflage instruction
No coverage
No coverage
€70 for 2 lessons
€70 for 2 lessons
€120 for 2 lessons
Dental health care after an accident
Some cases
No coverage
No coverage
No coverage
No coverage
€2,500
€5,000
€5,000
€10,000
€10,000
Dental health care from the age of 18
Limited, as per coverage for the Dental surgeon, Dental prosthesis, Front-teeth replacement and Specialist dental care
No coverage
No coverage
No coverage
No coverage
€200 of which up to €75 for preventive dental health care (M codes)
€500 of which up to €150 for preventive dental health care (M codes)
€1,250 of which up to €250 for preventive dental health care (M codes)
Dental health care up to the age of 18
100% of most treatments
No coverage
No coverage
€500
100%
Dental prosthesis (‘dentures’) from the age of 18
You pay a personal contribution for full dentures and repair/rebasing
No coverage
€120
€200
100%
€200 for the personal contribution, implants, partial dentures and other dental health care, under the coverage for Dental health care from the age of 18
€500 for the personal contribution, implants, partial dentures and other dental health care, under the coverage for Dental health care from the age of 18
€1,250 for the personal contribution, implants, partial dentures and other dental health care, under the coverage for Dental health care from the age of 18
No coverage
Dental surgery from the age of 18
100%
No coverage
No coverage
No coverage
No coverage
No coverage
No coverage
No coverage
No coverage
Diagnostics for primary health care
100%
No coverage
No coverage
No coverage
No coverage
Dialysis
100%
No coverage
No coverage
No coverage
No coverage
Dietary preparations
100% in certain situations in the event of contracted health care, otherwise limited coverage
No coverage
No coverage
No coverage
No coverage
Dietetics
3 hours
No coverage
€120
€200
100%
Domestic assistance
No coverage
No coverage
No coverage
9 hours After hospital admission
18 hours After hospital admission
1 week In the case of emergency admission after a serious accident or diagnosis of a serious ailment
Electrical epilation and laser treatment
No coverage
No coverage
€350 for entire term of the health-care plan
€750 for entire term of the health-care plan
€1,500 for entire term of the health-care plan
Exercise programmes
No coverage
No coverage
No coverage
€250 for all exercise programmes in the event of chronic illness, cancer, and the combined lifestyle intervention jointly
€500 for all exercise programmes in the event of chronic illness, cancer, and the combined lifestyle intervention jointly
100% only for exercise programmes during and after cancer
ExpertClean toothbrush
No coverage
No coverage
No coverage
No coverage
No coverage
No coverage
No coverage
No coverage
1 toothbrush, once per term of health-care plan and set of 4 brush heads per calendar year
Fertility treatment
Up to the age 43 For IVF: 1st, 2nd and 3rd attempts only, from IVF coverage
No coverage
No coverage
No coverage
4th and 5th IVF attempt (up to the
age of 43), from IVF coverage
Foot care
Annual foot check-up In the event of an increased risk of foot ulcers foot check-up and foot care
No coverage
No coverage
€200 for other foot care and insoles
€500 for other foot care and insoles
Front-teeth replacement
100%, until the age of 23, if necessity was determined before 18th birthday
Sometimes, coverage under Dental health care from the age of 18
Sometimes, coverage under Dental health care from the age of 18
Sometimes, coverage under Dental health care from the age of 18
Sometimes, coverage under Dental health care after an accident
Sometimes, from the OntzorgPlus coverage Dental health care after an accident
General practitioner (general medical care)
100%
No coverage
No coverage
No coverage
No coverage
Geriatric rehabilitation
100%
No coverage
No coverage
No coverage
€50 per day for extra facilities
Glasses, (contact) lenses and laser eye treatment
100% if there is a medical indication Covered under Glasses and contact lenses with medical indication
No coverage
€75 per 2 consecutive calendar years
€150 per 2 consecutive calendar years
€300 per 2 consecutive calendar years
Health care for sensory impairment
100%
No coverage
No coverage
No coverage
No coverage
Health resort
No coverage
No coverage
No coverage
No coverage
€500 for rheumatoid arthritis or psoriasis
Help for carers
No coverage
Carer support from ZorgConsulent adviser
Carer support from ZorgConsulent adviser
€350 for a care broker Carer support from ZorgConsulent adviser
€500 for a care broker Carer support from ZorgConsulent adviser
Hospice
No coverage
No coverage
No coverage
€25 per day for personal payment Max. 3 months
€50 per day for personal payment Max. 3 months
Hospital admission
100%
No coverage
No coverage
No coverage
No coverage
Hospital admission: assistance and extra services before and after
No coverage
No coverage
No coverage
No coverage
No coverage
Hospital admission: extra luxury and comfort
No coverage
No coverage
No coverage
No coverage
No coverage
In vitro fertilisation (IVF)
Up to the age of 43, 3 attempts
No coverage
No coverage
No coverage
Up to the age of 43, attempts 4 and 5
Individual budgets (under the Zorgverzekeringswet [Health Insurance Act]) (Zvw-pgb)
100% as per the Reglement Zvw-pgb
[Zvw-pgb regulations]
No coverage
No coverage
No coverage
No coverage
Influenza vaccination
No coverage
No coverage
Annually
Annually
Annually
Maternity care
100%, you will need to pay a personal contribution
No coverage
€250 for the personal contribution and extra maternity care
€400 for the personal contribution and extra maternity care
€550 for the personal contribution and extra maternity care
Maternity package
No coverage
No coverage
Once per birth
Once per birth
Once per birth
Mechanical ventilation
100%
No coverage
No coverage
No coverage
No coverage
Medical appliances
100% in the event of contracted health care, otherwise limited coverage Sometimes you will need to pay a personal contribution
No coverage
No coverage
€250 for personal contributions
€500 for personal contributions
Medical care for specific patient groups
100%
No coverage
No coverage
No coverage
No coverage
Medical mental health care (GGZ)
In the event of diagnosed or suspected psychological disorders:
100% for a contracted health-care provider, otherwise limited coverage
No coverage
No coverage
€500 for consultations for adjustment disorders and work and relationship problems
€1,000 for consultations for adjustment disorders and work and relationship problems
Medical specialist
100%
No coverage
No coverage
No coverage
No coverage
Medical transportation
In certain situations, you will generally need to pay a personal contribution of €118
No coverage
No coverage
No coverage
Personal contribution
Personal contribution
Medical transportation to a hospital far away up to 1 year after the serious accident or diagnosis of a serious ailment
Medical transportation by ambulance
100%
No coverage
No coverage
No coverage
No coverage
Medicines in supplementary health-care plans
No coverage
No coverage
€150 for personal contributions, some registered medicines and dressings
€300 for some registered medicines, dressings and melatonin, of which up to €250 for personal contributions
€1,500 for some registered medicines, dressings and melatonin, of which up to €250 for personal contributions
Medicines under the basic health-care plan
100% in the event of contracted health care, otherwise limited coverage Sometimes you will need to pay a personal contribution
According to preference policy
No coverage
The personal contribution under coverage for Medicines in supplementary health-care plans
The personal contribution under coverage for Medicines in supplementary health-care plans
The personal contribution under coverage for Medicines in supplementary health-care plans
Menopause consultant
No coverage
No coverage
No coverage
€200 for consultations
€350 for consultations
Nursing and other care in the personal environment
100% in the event of contracted health care, otherwise limited coverage
No coverage
No coverage
No coverage
No coverage
Occupational therapy
10 hours
No coverage
No coverage
No coverage
100%
OntzorgPlus: modification of home or vehicle
No coverage
No coverage
No coverage
No coverage
No coverage
Once during the entire term of the health-care plan €100,000 for modifications to your home, or €40,000 for modifications to your vehicle
Organ transplants and donation
100%
No coverage
No coverage
No coverage
No coverage
Orthodontics from the age of 18
For serious ailments only, under coverage for Specialist dental health care
No coverage
No coverage
No coverage
€500
Orthodontics up to the age of 18
For serious ailments only, under coverage for Specialist dental health care
No coverage
No coverage
From the start of treatment:
1st 12 months max. €1,000
2nd 12 months max. €1,000
From the start of treatment:
1st 12 months max. €1,000
2nd 12 months max. €1,000
3rd 12 months max. €1,000
Orthoptics
100% for certain ailments
No coverage
€500 for other eye complaints
€750 for other eye complaints
€1,000 for other eye complaints
Physiotherapy and remedial therapy from the age of 18
Sessions:
• List of chronic ailments for physiotherapy: from the 21st
• Intermittent claudication: max. 37
• Osteoarthritis in the knee or hip joint: max. 12
• COPD: depending on the GOLD grade, 0 to 70
• Urinary incontinence: max. 9
• Rheumatoid arthritis, axial spondyloarthritis and COVID-19: coverage under Provisionally approved treatments
• Exercise intervention for fall prevention
10 sessions, of which up to 9 manual therapy sessions
100% in the event of contracted health care, otherwise limited coverage
16 sessions, of which up to 9 manual therapy sessions
100% in the event of contracted health care, otherwise limited coverage
30 sessions, of which up to 9 manual therapy sessions
100% in the event of contracted health care, otherwise limited coverage
50 sessions, of which up to 9 manual therapy sessions
100% in the event of contracted health care, otherwise limited coverage
Physiotherapy and remedial therapy up to the age of 18
List of chronic ailments for physiotherapy: 100%
Other medical indications: 9 sessions, and 9 additional sessions on referral
10 sessions, of which up to 9 manual therapy sessions
100% in the event of contracted health care, otherwise limited coverage
16 sessions, of which up to 9 manual therapy sessions
100% in the event of contracted health care, otherwise limited coverage
30 sessions, of which up to 9 manual therapy sessions
100% in the event of contracted health care, otherwise limited coverage
50 sessions, of which up to 9 manual therapy sessions
100% in the event of contracted health care, otherwise limited coverage
Plastic surgery
In specific cases
No coverage
No coverage
In the case of physical dysfunction:
Upper eyelid corrections and replacement of breast prostheses
Correction of the position of the ears up to the age of 18
In the case of physical dysfunction:
Correction of the position of the ears up to the age of 18
Pregnancy and childbirth
100%, you will need to pay a personalcontribution in some cases
No coverage
€250 for the personal contribution and extra maternity care, under coverage for Maternity care
€400 for the personal contribution and extra maternity care, under coverage for Maternity care
€550 for the personal contribution and extra maternity care, under coverage for Maternity care
Preventive check-ups
On medical grounds, under coverage for General practitioner, Medical specialist or Testing for hereditary diseases
1 personal health check-up or sports health check-up
1 personal health check-up or sports health check-up
1 personal health check-up or sports health check-up. And 50% of other
health check-ups or a sports-medical examination, up to max. €200
1 personal health check-up or sports health check-up. And up to max. €350:
• 50% of other health check-ups or a sports-medical examination
• 100% for pharmacogenetic testing
Preventive health-related courses
No coverage
No coverage
No coverage
75% for first aid courses and 100% for other courses Total up to max. € 150
75% for first aid courses and 100% for other courses Total up to max. € 250
Primary-care admissions
100%
No coverage
No coverage
No coverage
€50 per day for extra facilities
Provisionally approved treatments
100% if you enter the clinical trial
No coverage
No coverage
No coverage
No coverage
Psoriasis day treatment
100% under Medical specialist coverage
No coverage
No coverage
€500
100%
Psychological health care with a general practitioner
100%
No coverage
No coverage
No coverage
No coverage
Quitting smoking
Programme aimed at quitting smoking, including nicotine replacement/medicines
No coverage
No coverage
€150 for quitting smoking and other preventive health-related courses, coverage under Preventive health-related courses
€250 for quitting smoking and other preventive health-related courses Coverage under Preventive health-related courses
Reimbursem*nt in exceptional cases
With our permission
No coverage
No coverage
No coverage
No coverage
Second opinion
100%
No coverage
No coverage
No coverage
No coverage
Specialist dental care
100%, you will need to pay a personal contribution in some cases
No coverage
No coverage
No coverage
No coverage
The personal contribution, coverage under Dental health care from the age of 18
The personal contribution, coverage under Dental health care from the age of 18
The personal contribution, coverage under Dental health care from the age of 18
The personal contribution, coverage under Dental health care from the age of 18
Specialist medical rehabilitation
100%
No coverage
No coverage
No coverage
No coverage
Speech therapy
100%
No coverage
No coverage
No coverage
No coverage
Stay in a guest house
No coverage
No coverage
Parents of the child: €12.50 per day, up to €260
Family member of the adult: €25 per day
100% for parents of the child and a family member of the adult
100% of the overnight costs after a transplant or cancer treatment
Sterilisation and reversal operation
No coverage
No coverage
Once during the entire term of the health-care plan €1,000 for female sterilisation
€350 for male sterilisation
Once during the entire term of the health-care plan €1,200 for female sterilisation
€400 for male sterilisation
100% for sterilisation and reversal operation 1 year wait for reversal operation
Stuttering therapy
No coverage
No coverage
€350 for entire term of the health-care plan
€500 for entire term of the health-care plan
100%
Support pessary
No coverage
No coverage
100%
100%
100%
Swimming for over 50s
No coverage
No coverage
No coverage
No coverage
€50
Tackling overweight and obesity in children
100%
No coverage
No coverage
€250 for an exercise programme as part of a CLI and other exercise programmes combined
€500 for an exercise programme as part of a CLI and other exercise programmes combined
TENS device
No coverage
No coverage
No coverage
€75
€75
Testing for hereditary diseases
100%
No coverage
No coverage
No coverage
No coverage
Therapeutic camp for young people
No coverage
No coverage
No coverage
€300 for asthma, diabetes, obesity, constitutional eczema, or cancer
100% for asthma, diabetes, obesity, constitutional eczema, or cancer
Thrombosis service
100%
No coverage
No coverage
No coverage
No coverage
Walking aids
No coverage
No coverage
No coverage
€100 for 5 kinds of walking aids
€100 for 5 kinds of walking aids
Wereldfit: coverage in the event of death
No coverage
No coverage
No coverage
No coverage
No coverage
Repatriation of the physical remains or €7,500 for funeral expenses
Travel companion’s extra travel and accommodation expenses
Costs of family coming over
Wereldfit: early return
No coverage
No coverage
No coverage
No coverage
No coverage
Extra travel and accommodation costs (abroad) that you incur when you have to return home unexpectedly
Wereldfit: hospital care in Belgium and Germany
100% as per Dutch rates
No coverage
No coverage
No coverage
No coverage
100% for medical specialists in Belgium and Germany
Wereldfit: repatriation
No coverage
No coverage
No coverage
No coverage
No coverage
Repatriation in the event of serious ailment or injury
Visitor
Wereldfit: replacement driver
No coverage
No coverage
No coverage
No coverage
No coverage
Replacement driver
Zorghotel
No coverage
No coverage
No coverage
No coverage
€200 per day, up to €2,000
In a zorghotel recognised by us
ONVZ Vrije Keuze Basic health-care plan
€ 151,20 p/m
View insurance
Startfit
€ 9,15 p/m
View insurance
Benfit
€ 22,75 p/m
View insurance
Optifit
€ 46,95 p/m
View insurance
Topfit
€ 74,40 p/m
View insurance
OntzorgPlus
€ 4,50 p/m Extra module
View insurance
Wereldfit
€ 3,50 p/m Extra module
View insurance
Tandfit A
€ 13,90 p/m
View insurance
Tandfit B
€ 33,25 p/m
View insurance
Tandfit C
€ 46,00 p/m
View insurance
Tandfit Preventief
€ 35,75 p/m
View insurance
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