Reimbursement for non-contracted healthcare providers

If you choose to go to a healthcare provider who does not have a contract with us for the treatment in question, your reimbursement will generally be lower than if you were to go to a contracted healthcare provider. It all depends on the policy you have taken out with CZ.

Non-contracted healthcare

When choosing to go to a non-contracted healthcare provider, please bear the following in mind:

  • your reimbursement will generally be lower, depending on what policy you have taken out with us.
  • there will be no agreements in place on the quality of care.
  • you will have to pay the bill up front and then submit a claim to us for reimbursement.
  • from 1 January 2019, non-contracted healthcare providers can no longer submit bills to CZ directly on your behalf under a deed of assignment and they are no longer allowed to receive payments from CZ directly either. We can only still offer this option in the case of addiction care.
  • for some healthcare, you will need our prior permission. This is what we refer to as our approval.
  • healthcare providers who have signed a payment agreement with us can submit bills to CZ directly.

Reimbursement for non-contracted healthcare under the ‘Zorgbewustpolis’ or ‘Zorg-op-maatpolis’

If you have a Zorgbewustpolis or a Zorg-op-maatpolis as your general insurance policy, we will calculate your reimbursement for non-contracted healthcare based on the average rate we have agreed with healthcare providers that do have a contract with us for the treatment concerned.

You will then receive the following reimbursement for non-contracted healthcare:

  • Zorgbewustpolis: 70% of the bill up to a maximum of 70% of the The average of the rates we have agreed with contracted healthcare providers for the treatment concerned.
     
  • Zorg-op-maatpolis: 75% of the bill up to a maximum of 75% of the average agreed rate

Reimbursement for non-contracted healthcare under the 'Zorgkeuzepolis'

If you have a Zorgkeuzepolis as your general insurance policy, you will get 100% of your bill reimbursed up to a maximum of the  in the Netherlands. In some cases, a healthcare provider will charge a lot more than this reasonable rate. If they do, we will not reimburse the full amount.

We determine the market rate applicable in the Netherlands as follows:

  1. If a rate has been set by law, such as under the Dutch Healthcare (Market Regulation) Act (Average agreed rate: the average of the rates we have agreed with contracted healthcare providers for the treatment concerned. Market rate applicable in the Netherlands: the rate we consider reasonable for a specific treatment in the Netherlands. Rate under the Dutch Healthcare (Market Regulation) Act (‘Wet marktordening gezondheidszorg’, Wmg): The rate set by the government based on the Dutch Healthcare (Market Regulation) Act (‘Wet marktordening gezondheidszorg’, Wmg).
    ), healthcare providers will never charge more than this rate and we will reimburse the bill in full.
  2. In the absence of a rate set by law, we will look at the usual rates charged in the Netherlands.

Reimbursement for non-contracted physiotherapists or exercise therapists

If you have additional insurance and it covers physiotherapy and/or exercise therapy, sessions with a non-contracted therapist will be reimbursed at 75% of the bill up to a maximum of 75% of the rate that we have agreed with contracted therapists.

Finding out which healthcare providers and suppliers are contracted

To check whether your healthcare provider or supplier is contracted to CZ, or to find a contracted healthcare provider, use our ‘Zorgvinder’ search feature (in Dutch).

Please note!

If you are unable to find your healthcare provider or supplier in the ‘Zorgvinder’, please contact us. It may be the case that your healthcare provider has not been recognised by us. If so, the healthcare will not be covered at all.

CZ Customer Services