Insight into rates
If you are going to be receiving medical treatment, you will probably want to know which costs ONVZ will reimburse. In most cases, we can tell you right away if your health-care plan covers the treatment, and when the excess applies. This way, you get a good idea of the financial consequences of your choice.
Do you have an ONVZ Bewuste Keuze basic health-care plan?
If you do, yours is an ‘in-kind policy’, which means that if your health-care provider has a contract with us, we reimburse the health care in full. This is, of course, subject to our general rules and regulations and coverage, as well as to the compulsory and (if applicable) voluntary excess.
If you want to go to a health-care provider that does not have a contract with us, maximum reimbursements apply.
Do you have an ONVZ Vrije Keuze basic health-care plan?
If so, you have complete freedom of choice when it comes to your health care, meaning that ONVZ will in most cases cover the costs of your health care in full. This is, of course, subject to our general rules and regulations and coverage, as well as to the compulsory and (if applicable) voluntary excess.
We have contracts with many health-care providers and we reimburse the health care they provide in full. If your health-care provider does not have a contract with us, some types of health care are subject to maximum reimbursements. Reimbursement of other non-contracted health care is subject to the health-care provider’s prices being in line with the going prices for the health care in question. These going prices are also referred to as ‘market’ prices.
Prices for hospital care
Most hospital care is priced based on a free price system. Hospitals and health insurers enter into price agreements for this health care. These agreements can differ per hospital, based on factors such as the quality of care and the number of patients treated. As a result, ONVZ may pay more at one hospital than it does at another for the same treatment.
Prices charged for hospital care are calculated using the DBC system. How exactly this calculation is made can change from year to year, making it difficult to compare prices across different years.
If you want to know what health care costs at a certain hospital, we can give you an indication of the costs you can expect. ‘Indication’ is the operative word here, because we can never tell you in advance how much health care in your specific case will cost exactly.
This is due to several reasons. We can never determine with certainty which DBC, or diagnosis-treatment combination, you will be charged for: an additional consultation or a complication in the treatment in itself can already lead to a new DBC, and to other costs. Sometimes, the price of a DBC is not yet final on 1 January.
If you would like us to give you an idea of the costs, be as specific as possible on what kind of treatment you and your doctor think will be necessary, or tell us that it is just a consultation. We will then also ask you what health-care provider you intend to go to. In most cases, we will be able to tell you right away if the health care will be covered and whether any of the costs come under your excess.
For the indication to be as accurate as possible, ask the health-care provider for the code of the expected DBC. We will then give you an indication of the costs you can expect within five working days.
Good to know
In order to be able to help you as well as possible, please make sure you have the details of your chosen health-care provider to hand.
This means that you have to pay any costs up to the amount of your excess out of your own pocket. The government has set the compulsory excess for 2024 at €385. If you have opted for the maximum voluntary excess of €500, your total excess for 2024 will be €885. This means that you will sometimes have to pay the complete invoice for health care yourself. And if the treatment continues into the next calendar year and the hospital opens a follow-up DBC, you will be charged the excess again in the new year.
Bear this in mind to avoid being unpleasantly surprised by costs charged to your excess.