Asking for prior authorisation

If you need non-urgent transportation by ambulance over a distance greater than 200 km, or if you need other means of transport, you need our prior approval. Your healthcare provider will apply for this approval with a written explanation of why the transport is necessary. Our permission is not required in urgent situations.

If you go abroad for healthcare, you need prior authorisation in the following cases:

1. If you need authorisation for a certain type of care in the Netherlands, you also need it abroad. If you wish to go to a foreign hospital for plastic surgery, for example. Refer to the 'Plastic surgery' coverage for the conditions.

2. Admission for one day or more. In this case, refer to 'Abroad: (day) admission' below.

Even if you do not need prior authorisation, we still advise you to apply for it. This gives you certainty about whether the costs are covered and how much will be reimbursed.

Your request for prior authorisation should include, at the least:
• Referral from a GP or the doctor you are under treatment of in the Netherlands, stating the reason for the referral
• Explanation of why you want to go abroad for this care
• Treatment plan
• Quotation

Reimbursement according to the rules of the country where the care takes place

If you live in a country that is an EU/EEA member state or a treaty country and you receive the health care in another EU/EEA member state or Switzerland, you can opt for reimbursement according to the rules of the country where you receive the treatment. This applies to surgery or a hospital admission, and only when:

1. you cannot get that care in the Netherlands, or
2. you would have to wait too long for this care given your medical condition

You will need a so-called S2 form to do so. Apply for this form at least 10 working days before treatment starts using the S2 application form. You fill in one part of the form yourself. The other part should be filled in and signed by your physician abroad. Send us the form together with the referral and treatment plan. Make sure that the form is filled in completely.

Where to send your application?
If your application is related to medical-specialist care, use the online application form (NL). For other types of care, you can use the contact form. Or send in your application by mail.

Are you going to a foreign hospital or private clinic to be admitted? If so, you need prior authorisation from ONVZ. This does not apply for emergency admissions.
If you are going abroad for another kind of treatment you may also need our approval. See 'Abroad: non-urgent (scheduled) healthcare' above.

What is a (day) admission?
Day admission means that your treatment - in a day admission nursing ward - lasts longer than two hours, but you will go home the same day. For a regular admission you will stay in the hospital for at least one night.

Consultations and diagnostics
If you are visiting the hospital for just a consultation or an examination, such as an MRI, CT scan or colonoscopy, you do not need to apply for authorisation.
Please note: if an examination indicates (day) admission is required, you do need our approval for that (day) admission.

Exception
If you go to one of the following hospitals for a (day) admission, you do not need our prior approval. We have made special arrangements with these healthcare providers.

Belgium:

• Ghent University Hospital (Ghent)
• University Hospital Antwerp (Edegem)
• AZ Klina (Brasschaat)
• Vitaz (Sint-Niklaas, Beveren, Sint-Gillis-Waas, Hamme, Temse, Lokeren)
• AZ Zeno (Knokke-Heijst, Blankenberge, Maldegem)
• AZ Alma (Eeklo en Sijsele-Damme)
• Hospital East Limburg (Genk, Lanaken, Maaseik)
• AZ Sint-Jan (Brugge, Oostende)

Germany:

• Augenkliniek Ahaus
• Helios clinic Krefeld-Uerdingen
• Helios clinic Krefeld-Hüls
• Helios clinic Duisburg
• Helios clinic Lengerich
• Helios clinic Wuppertal
• Helios clinic Berlin-Buch
• Helios Endo- clinic Hamburg
• Helios clinic Bonn Rhein-Sieg

How to apply for prior authorisation?
Apply for authorisation easily via our online application form (NL). Make sure you have the following documents at hand:

• referral from your GP
• treatment plan from your specialist, including medical indication
• itemised quotation
• any other important documents, such as the report from the Dutch specialist

You can also send us the requested documents by mail. Please note that this means processing your application will take longer.

In most cases, your pharmacy will assess whether the basic healthcare plan will cover your dietary preparations. If you meet the conditions for dietetic food, have a prescription and are allergic to cow’s milk, you must apply for prior authorisation in the following situations:

• the child is 2 years of age or older, or
• the child is between 1 and 2 years old and requires more than 500 ml of dietary food per day, or
• the child is between 0 and 1 years old and requires more than 1,000 ml of dietary food per day

In most cases, your doctor will take care of the application. If not, you have to apply yourself by sending us a reasoned statement from the doctor involved.

Primary-care admissions are usually short. If yours lasts longer than 3 months, you need our approval.

Often your healthcare provider will take care of the application for you. If not, you have to obtain approval yourself before the first 3 months are up. Have the application form (NL) filled in and signed by your doctor and send it to us. Make sure the form is fully completed.

If your stay lasts less than 3 months, you do not need to ask for permission.

If your primary-care admission related to palliative terminal care, you never need to ask permission, even after 3 months have passed.

You will receive physiotherapy, remedial therapy or occupational therapy at your therapist's practice or at your home. If you will be treated at another location, for example at your place of work, you have to obtain our approval. Are you receiving treatment for yourself, a family member or a relative in the 1st or 2nd line? Then our consent is also required.

Your therapist will often take care of this application process for you. If not, you must request approval yourself. Please send us a motivated statement from your therapist. This must clearly show the medical reason for treating you at another location.

We only reimburse the CLI if we have given permission before the programme starts.

You are to request prior authorisation using the application form (NL). You fill in one part of the form yourself. The other part should be completed and signed by your healthcare provider (your doctor supporting you during the CLI). Send the form to us. Make sure it is fully completed.

Mental healthcare requires our prior authorisation in some cases.

Healthcare provider without a contract

Will you be going to a healthcare provider that does not have a contract with ONVZ? You must ask for permission in the following cases:
• For treatment requiring more than 35 consultations
• In case of inpatient treatment
• If you are prescribed Esketamine nasal spray (Spravato)

You can find out whether your preferred healthcare provider has a contract with ONVZ in the Zorgzoeker (care finder). You should obtain approval before receiving the care.

Usually the healthcare provider will take care of the application, as it is quite extensive. If not, you have to ask for permission yourself. To do so, you must send us a reasoned statement from your healthcare provider containing a detailed medical indication, treatment plan and quotation. If inpatient treatment is involved, we need to know why it is necessary.

By applying, you grant us permission to ask your healthcare provider for more information if necessary. If you would like to know why we need this information, read our explanation here (NL).

Esketamine nasal spray

If you are prescribed esketamine nasal spray, apply for prior authorisation using the ZN application form esketamine nasal spray (NL). Your healthcare provider will usually take care of this for you.

You will need our prior permission if your health-care provider does not have a contract with ONVZ. The elderly medical care specialist or the doctor for the mentally disabled will almost always request our permission on your behalf.

If not, you have to ask permission yourself before the care is provided. Have the application form (NL) filled in and signed by your doctor. Make sure the form is fully completed before you send it to us.

For some medicines you need prior authorisation.
Usually the pharmacy takes care of this for you. If not, you request our approval yourself with a reasoned statement from your medical specialist. You must ask permission for:

1. medicines with no marketing authorisation in the Netherlands. Your pharmacist knows whether this applies.

2. some medicines:
• Epoprostenol (Flolan and Veletri)
• Iloprost for inhalation (Ventavis)
• Treprostinil (Remodulin)
This list is subject to change. New medicines may be added, for example. Always make sure to check this information beforehand or contact us.

3. tapering off antidepressants
Will you be tapering off antidepressants (SSRIs and SNRIs)? And will the pharmacist prepare medicines (pharmacy preparations) to make this possible? You will need our approval. You can apply with a reasoned statement from your healthcare provider and the taper schedule.

The application must include the following:

• one or more risk factors for ADS are present beforehand
• it is not an option for you to taper off with existing drops, suspensions or drinks
• you will be tapering off according to the taper schedule drawn up by the relevant professionals and patient association

4. Re-sold preparations not covered under the basic healthcare plan

What do we need to process your application?

A statement from your doctor showing:
• Which medicines have been tried before;
• For each medicine: how long it was tried;
• Per medicine: what the effect was;
• Per medicine: description of any side effects,
• Why the previously tested medicines were not suitable.

You can check whether our permission is required for your medical appliance in our General rules and regulations and coverage.

In most cases your supplier will take care of the application for prior authorisation. If not, you need to ask for approval yourself. To do so you send us, for example, a prescription and a quotation for the medical aid. You can find exactly what you need to send us in our General rules and regulations and coverage. If a prescription is requested, it should be function-oriented. This means that the prescription states what criteria the device must meet to best suit your care needs.

Do you need an appliance that is not listed, but still fits the description? We may reimburse that appliance. This too requires prior authorisation.

Some treatments from an oral and maxillofacial surgeon (OMS) require prior authorisation. The OMS will almost always take care of the application process for you.

If you need to ask for permission yourself, send us a reasoned statement from your oral surgeon. It must clearly state the medical necessity of your treatment.

The treatments for which prior authorisation is required are listed on the exhaustive list of authorisations for specialist medical care. In brief, these are:
• extraction of teeth under anaesthesia
• jaw surgery (osteotomy)
• implants
• bone remodelling or insertion
• fitting of so-called bone anchors. These are titanium plates placed before orthodontic treatment
• treatment of advanced gum disease
• fitting and provision of braces against snoring or sleep apnoea (MRA)

Different rules apply to specialist dental care and dental healthcare after an accident. See Dental healthcare on this page.

Do you need intensive rehabilitation treatment from a team of healthcare providers (this is called interdisciplinary specialist medical rehabilitation)? And does this rehabilitation not require you be admitted? This means you sometimes need to ask our permission.

This depends on the hospital or rehabilitation centre. Does your hospital or rehabilitation centre appear in our list of rehabilitation centres for which our permission is not required? This means you do not have to do anything. We have already made arrangements with these healthcare providers concerning giving permission.

Is your hospital or rehabilitation centre not listed? Then you must ask us for permission beforehand. If your healthcare provider has not been included on the list, you will need to ask our permission in advance yourself.

The rehabilitation centre will often take care of the application for you. If not, you must ask permission yourself. Have the application form filled in and signed by your rehabilitation doctor. You can do this online (NL) or using the application form (NL). Make sure the form is fully completed and enclose your referral.

Some medical-specialist treatments require prior authorisation. The medical specialist will almost always arrange this for you.

If you need to request approval yourself, send us a reasoned statement from your doctor showing the medical necessity for your treatment, describing your ailments and how the treatment can relieve them. To further support your request, for example in the case of correction of eyelids or other parts of the body, please enclose photographs.

The treatments for which authorisation is required are on the exhaustive list of authorisations for specialist medical care. In brief, these are:

• laser treatment of the eye to improve vision
• implantation or replacement of an (artificial) lens in the eye
• correction of a (drooping) upper eyelid, lower eyelid and/or eyebrow
• correction of the ears
• correction of the nose
• surgery to reshape the face
• facelift, forehead lift or neck lift
• correction of chicken breast or funnel breast
• male breast removal
• breast reduction and/or breast lift
• removal or (re)insertion of breast prosthesis(s) or expander
• breast reconstruction or reshaping of the breast
• nipple reconstruction and/or tattooing
• abdominoplasty
• correction of pubic lip(s)
• removal or suctioning of excess fat under the chin
• removal or suctioning of excess fat in the breast area
• removal of excess skin and subcutaneous tissue near the upper arm
• removal of excess skin and subcutaneous tissue from the thigh area
• removal or suctioning of excess fat in the lower leg region
• removal or suctioning of excess fat from the leg, hip or buttock
• grafting of own fat
• transplantation of the patient's own skin in the head or neck area
• transplantation of the patient's own skin
• scar correction
• removal of superficial skin irregularities
• skin surgery for benign disorders
• cryotherapy (nitrogen treatment) or diathermy (heat treatment) for skin disorders
• laser treatment of the skin
• tattooing of the skin

Do you need specialist medical rehabilitation or ivf or icsi? These are listed separately as different rules apply.

If you are admitted for sensory disability care, you must apply for prior authorisation. In most cases, your health-care provider will take care of the application for you.

If not, you must ask permission yourself. To do so, send us a reasoned statement from your care provider stating:
• the treatment objectives for which admission is necessary
• why your treatment cannot succeed without hospitalisation
• how long your care provider expects your admission to last

Do you want to arrange nursing and other care in your personal environment yourself using a personal budget? Then you must first have our approval to do so.

Obtaining this approval involves filling out an application form and having a 'conscious choice interview'. How this works can be found in our regulations Zvw-pgb 2023 (NL).

Some dental treatments at the dentist, orthodontist or centre for specialist dental centre require prior authorisation.

You must seek prior authorisation for:
1. specialist dental healthcare
2. front tooth replacement
3. dentures (false teeth)
4. maxillary orthodontics up to 18 years of age
5. additional fluoride treatment up to the age of 18
6. transplant of one's own tooth (auto transplant) up to 18 years of age
7. MRA (Mandibular Reposition Device)
8. dental care after an accident in OntzorgPlus or Tandfit insurance
9. orthodontics from the age of 18 in Topfit or Superfit

For treatments 1 to 8, the dentist will almost always take care of the application for you. If you need to apply for approval yourself, send us a written explanation with medical indication from your dentist, the treatment plan, a quotation and (X-ray) photos.

If you need dental care after an accident (8), please use the designated application form for dental healthcare after an accident and enclose the aforementioned documents.

We also have an application form for orthodontics (9).

In special cases, the basic healthcare plan also covers care not listed in our General rules and regulations and coverage. You will need prior authorisation.

To do so, send us information about the desired treatment and a reasoned statement from your doctor. Make sure to apply well before treatment would start and wait to start your treatment until you have our approval.

You must apply for prior authorisation if your healthcare provider (home care organisation) does not have a contract with ONVZ.

You can check whether this is the case in our Zorgzoeker [care finder].

Do you need nursing and other care in your personal environment in 2023?

You ask for approval before the care starts. You do so using the application form. It is to be filled in together with the nurse who sets the indication. Make sure the form is filled in completely and send it to us. Include all the information requested.

Does the care have to start immediately? For example, if care is needed in your personal environment upon discharge from hospital? This is possible, even if we have not yet given permission. However, the indication and care plan must be ready within 7 days after the care has started. Coverage is not retroactively provided for more than those 7 days.

You have to ask our approval for medical transportation.

Do you need transport by taxi in 2023?

Ask our prior approval. You can do so online online (NL) or with an application form (NL). Make sure to completely fill in and sign the form.

If you will be traveling by taxi and you have our approval, you can contact Transvision. They will arrange your taxi transport and submit any claims directly.

Your application may be urgent. If you need medical transport to get to the following treatments, you can also apply for prior authorisation by telephone:

• Kidney dialysis
• Chemotherapy, immunotherapy or radiotherapy for cancer

Our transport line can be reached Monday to Friday from 9 am to 5 pm at 030 639 62 29.

You need prior authorisation to stay in a Zorghotel [care hotel].

Have the application form (NL) completed and signed by your doctor and send it to us. Make sure the form is filled in completely.

Our approval is valid for a specific period. If you need to stay longer than expected, you must apply for an extension. Do so before the first approved period ends. Explain in your application why you need to stay longer.

If you send in your request digitally, you will also receive our decision or questions digitally, in a secure message. If you would like to receive our reply in a different way, please contact us.

The employees that process your application work under the responsibility of our medical advisor and operate under the same duty of confidentiality. More about this, and other privacy rules, can be found in our privacy statement (NL).