Mental health care
Topfit covers general basic mental health care (GGZ). In 2018, adults were able to see either a health psychologist or clinical psychologist, who would then be that patient’s treatment coordinator. From 1 January 2019, the treatment coordinator may also be a psychotherapist.
Exercise programmes in cases of obesity
From 1 January 2019, the basic health-care plan will cover the costs of a combined lifestyle intervention, or CLI. If you are overweight, a health-care provider will support you in adopting a healthier diet and eating habits, getting more exercise and achieving behavioural change. However, the exercise itself is not covered. In 2018, the Topfit plan covered an exercise programme for obese patients; from 1 January 2019, you can use this coverage as well if you take part in a CLI.
Physiotherapy
The Topfit plan provides extensive coverage for physiotherapy. However, this health care must be medically necessary and meet the guidelines for the professional group. We may, at our discretion, also check whether you actually received the health care claimed and whether it was really needed. You must cooperate with this check. Although this is not a change to the terms and conditions of your health insurance, we would still like to bring this to your attention once again.
Physiotherapy: manual therapy
We are reducing the maximum number of manual therapy sessions covered: in 2019, Topfit will cover a maximum of 9 manual therapy sessions per calendar year.
If you will be receiving physiotherapy in 2019 and manual therapy will be part of this, you will be covered for a maximum of 9 sessions under the Topfit plan.
Foot care
We think it is important for a pedicurist to have the right qualifications and stay up to date professionally. To give you (and the pedicurist too) sufficient choice, the number of registers in which medical pedicurists may be registered will be extended as of 1 January 2019.
Sports doctor
Under the Topfit plan, the costs of a sports examination, including for diving, are covered. Diving is a high-risk sport so the doctor performing the examination must meet high requirements. There are not many sports doctors in the Netherlands who have also taken specific training for providing diving examinations, meaning your choice of a good health-care provider is limited. For this reason, from 1 January 2019, this examination can also be performed by other doctors who have followed this training.
Alternative/non-conventional medicine
Topfit covers alternative/non-conventional medicine. The coverage will change considerably on 1 January 2019. From then on, we will reimburse the same amount for such health care whether it is provided or prescribed by a doctor or another type of health-care provider. However, the latter must be a member of a professional organisation recognised by ONVZ. This means that, from 2019, one maximum amount of coverage will apply for this health care, regardless of the provider. Topfit also covers the costs of medicines and medical investigations (like diagnostic tests for example) under this maximum coverage amount. This will simplify the coverage.
Medicines
From 1 January 2019, we will no longer reimburse the costs of medicines for erectile dysfunction.
Medical appliances: personal contributions
Topfit reimburses the personal contributions that apply to medical appliances under the basic health-care plan. In 2018, the maximum reimbursement for the personal contributions applied to all medical appliances combined, including a wig. However, from 1 January 2019, a separate reimbursement will apply to the personal contribution for a wig. The maximum amounts reimbursed will not be changing.
Skin therapy: cosmetic camouflage instruction
The Topfit plan covers cosmetic camouflage instruction in cases of severe, disfiguring skin abnormalities on the face and/or neck. The coverage for this will be capped from 1 January 2019: under the Topfit plan, a maximum of €120 will be reimbursed for a maximum of 2 lessons. We no longer cover the costs of the camouflage products.
Carers: carer relief
Topfit covers the costs of carer relief, i.e. replacement care for a period during which a carer is sick or on holiday. From 1 January 2019, this supplementary health-care plan will also cover the carer relief required if you are the carer and need to have a short break. The coverage has been changed from a maximum number of days to a maximum reimbursement amount. The coverage is on the condition that you have the ZorgConsulent adviser arrange the carer relief for you.
Carers: support
To help carers maintain a healthy life balance, we offer support through our ZorgConsulent advisers under the Topfit plan. These advisers are trained to listen to your problems and they can also help you set boundaries, expand or re-expand your social network, or better combine your carer duties with your regular job.
Carers: professional support
A ‘care broker’ (mantelzorgmakelaar) can take over certain tasks carried out by a carer, e.g. relating to health care, wellbeing and financial matters. The care broker knows the ins and outs of long-term care provision in your region and is therefore able to provide the right advice for your specific situation. This helps you as the carer to see the whole picture, while you feel supported and can focus on caring for the sick or disabled person. From 1 January 2019, Topfit coverage will be expanded to include a maximum reimbursement for assistance from a care broker. You can contact our ZorgConsulent adviser for more information.
Carers: membership of a patients’ association or advocacy group
Topfit covers the cost of membership of a patients’ association or advocacy group affiliated with the Patiëntenfederatie Nederland [Federation of Patients in the Netherlands], Ieder(in) [Umbrella organisation for people with a physical disability, mental disability, or chronic illness], or the MIND Landelijk Platform Psychische Gezondheid [MIND National Psychological Health-Care Platform]. From 1 January 2019, this supplementary health-care plan will also cover the membership fee for the Mezzo carers’ organisation.
