A Guide to Dutch Health Insurance
Health insurance is mandatory for everyone who lives and works in the Netherlands. This article aims to give an introduction to the Dutch health insurance system, drawing attention to the ways in which it differs from the American health insurance system.
Obtaining Health Insurance
Unlike (a majority of the states of) the US, health insurance is required in the Netherlands. You must take out health insurance with a Dutch health insurance company within 4 months of your arrival date in the Netherlands. This requirement applies regardless of any existing health insurance in your home country. Limited exceptions apply to foreign students and individuals working in the Netherlands for employers who are based outside of the Netherlands. Unemployed EU citizens living in the Netherlands can use their European Health Insurance Card (“EHIC”) for a limited time.
The insurance cannot apply retroactively and therefore you will not be charged for any period before taking out the health insurance but you also cannot derive any benefit from the insurance retroactively. Therefore, if you receive any health care within the first month of your arrival in the Netherlands before you have taken out health insurance, you must pay the costs out of pocket.
If you fail to take out health insurance within the four-month period, you may receive a fine from the central office for exceptional medical insurance (“het CAK”). The first CAK fine is 437.25 euros. If you continue to not take out health insurance, you will receive a secondary fine after 6 months. After 9 months the monthly premium will be removed from your salary.
Types of health insurance
There are two types of health insurance in the Netherlands. The first type is an in-kind policy (natura polis) where the health insurance company will cover treatment given by a list of care providers. The list of available health care providers includes most GPs in the Netherlands. With this policy, the care providers will bill directly to the insurance company. If you receive treatment outside of the list of providers, the health insurance company will cover 70-80% of the bill.
The second type is a restitution policy. With the restitution policy, you choose your own healthcare provider and pay the bill for the care you receive up front. You can them send the receipt for the care to your health insurance provider for reimbursement. If you receive care from a provider that does not have a contract with the insurance provider, you can still be reimbursed for 100% of the costs. The advantage of a restitution policy is therefore that you are not limited in the places from which you can receive care.
Within both restitutiepolis and naturapolis, there are two options for insurance coverage—basic health insurance (“basisverzekering”) and a supplementary health insurance (“aanvullende verzekering”). The majority of people in the Netherlands subscribe to a basic health insurance package that covers, among other treatments, doctors appointments, hospital services, prescriptions, mental health care, pregnancy care, and aged care. It is also possible to purchase, for a higher cost, the supplementary healthcare package that includes things like hearing aids, glasses, dental care, and emergency service abroad.
While insurers are legally obligated to accept any applications for the basic health insurance package for all individuals regardless of age, gender, or health condition, insurers have discretion as to whether they accept an individual’s application for the supplementary health insurance package.
Popular health insurance companies in the Netherlands are CZ, FBTO, Zilveren Kruis, VGZ, United Consumers, and Unive Verzekeringen. You can use the websites Independer or Zorgwijzer to find and compare different policies.
Unlike the US, the same healthcare insurance fees apply to people of all ages and health conditions in the Netherlands. Similarly, to most US health insurance policies, there are two different fees that apply to Dutch healthcare. The first fee is a monthly premium for access to the healthcare system. In 2021, the average health insurance premium was 120 euros per month. The second fee is your deductible (“eigen risico”). The maximum deductible payment for the Netherlands is set by the Dutch government and in 2022 is 885 euros. The minimum deductible amount is 385 euros.
Although rare, some Dutch employers offer a corporate health insurance discount scheme which will enable you to obtain healthcare at a discounted price. If this is the case, your employer will likely draw your attention to this.
Health insurance for low income
Individuals with a low income—classed in the Netherlands in 2022 as 29,500 euros or less annually –may be eligible for a healthcare benefit. The maximum monthly healthcare benefit for those individuals is 99 euros per month. Eligibility can be assessed through this website.
Health insurance for children
All children in the Netherlands under the age of 18 are required to have health insurance. However, there are no monthly premium payments or deductibles for the children’s insurance. Dutch insurance companies allow the child to be registered under their parents’ health insurance as a supplement to the original insurance. This means that children are insured at no additional cost to the parents.
It is worth noting that if you are unhappy with your insurance provider, you can switch between providers once a year. If you decide to switch (“overstappen”), then your new insurance provider will notify your former insurance company.
If you decide to leave the Netherlands, you must sign out of your local municipality and cancel your health insurance policy to avoid further fines from the CAK.
Dutch health care v. American health care
There are many differences between the Dutch and American healthcare systems. Firstly, as alluded to above, the costs of health insurance are much cheaper in the Netherlands than the US. The price difference also extends to medicines—one American expat in the Netherlands claimed that she now pays under 5 euros for prescription eye drops that cost her 295 dollars in the US. Secondly, the Dutch healthcare system works on a referral basis. In order to get specialized care, you will first need to receive a referral from your family doctor (“huisarts”). Thirdly, in contrast to the high antibiotic prescription rate in the US, doctors in the Netherlands rarely prescribe antibiotics. In fact, the Netherlands have the lowest antibiotic use rate in Europe. It is therefore difficult to obtain antibiotics outside of an urgent medical need.
When comparing the health insurance systems, it is clear that the Dutch health insurance system is more navigable and cost effective than the American health insurance system. Some of our American clients have found that the benefits of the Dutch healthcare were a contributing factor in their move to the Netherlands.
Are you an American who is interested in moving to the Netherlands? Mynta Law frequently handles American immigration and migration cases. Please feel free to contact us to discuss your options for moving to the Netherlands.