IAK Supplementary Health Care Insurances - IAK Verzekeringen

IAK Supplementary 

Health Care Insurances 

Terms and conditions 2012

Welcome to IAK Verzekeringen 

This document tells you everything about your IAK Supplementary Health Care Insurance. The table of contents will help you 

find the precise information you need. Where appropriate, extra details or explanatory notes have also been included in text 

boxes for your convenience. 

Below is a list of important telephone numbers and addresses. 

You can also access the information about your IAK Supplementary Health Care Insurance online via www.iak.nl/zorg 

Important telephone numbers and addresses: 

Customer Service Zorg- en Inkomensverzekeringen 

List of contracted care providers 

Patient transport 

+31 (0)40 – 261 18 88 /email: info@iak.nl 

IAK Customer Service has specialised staff available 

to provide clear, full and accurate answers to your 

questions. You can contact them on workdays 

between 8.30 a.m. and 6 p.m. 

For details of those care providers with whom 

contracts have been signed, go to www.iak.nl/zorg or 

call Customer Service. 

The application form for seated patient transport 

(which includes a section to be completed by your GP 

or attending practitioner) can be downloaded via the 

website. Alternatively, you can call Customer Service 

and ask for a form. 

Care advice and mediation For care advice or mediation, call our Zorgadvies 

department on +31 (0)40 – 261 18 09 

SOS International alarm centre +31 (0)20 – 651 51 51 

IAK maternity care Call +31 (0)40 – 261 15 34 for general information. 

For specific information, go to your personal account 

on www.iak.nl/zorg. 

Applications for authorisation You can send your application for authorisation to 

undergo treatment to: 

IAK Verzekeringen, Postbus 90165, 5600 RV 

Eindhoven 

The cases in which you need to apply for authorization 

are clearly indicated in these terms and conditions. 

Submitting invoices If you have received an invoice, you can complete a 

declaration form and send it together with the original 

invoice to: 

IAK Verzekeringen, Postbus 90164, 5600 RV 

Eindhoven 

Alternatively, you can submit your invoice online via 

your personal account on www.iak.nl/zorg. 

This is a translation of the original Dutch text. This translation is furnished for the customer’s convenience only. The original 

Dutch text will be binding and shall prevail in case of any variance between the Dutch text and the English translation. 

Together for a perfectly insured future 3

4 

I General section 5 

1 Definitions 5 

2 General conditions 9 

3 Premium 11 

4 Other obligations 12 

5 Amendments to premium and conditions 13 

Table of contents 

6 Inception, term and termination 13 

7 Exclusions 14 

8 Complaints and disputes 14 

9 Care mediation and waiting list mediation 15 

10 Final provision 15 

II Jong 16 

1 Alternative and special medicine 16 

2 Abroad 16 

3 

4 I 

5 10 

Pharmaceutical care 

Physiotherapy General section and remedial therapy 

Skin Final therapy provision 

17 

17 

17 

6 Medical aids 17 

7 Preventive care 18 

8 Psychological care 18 

9 Dental care 19 

III Compact 20 


2 Abroad 20 

3 Pharmaceutical care 21 

4 Physiotherapy and remedial therapy 21 

5 Skin therapy 21 




9 Seated patient transport 23 

IV Compleet 25 


2 Childbirth and maternity care 25 

3 Abroad 26 



6 Group therapy for rheumatism patients 27 



9 Membership of patient associations / patient 

interest groups 27 

10 Overnight stay facilities 27 

11 Specialist medical care / plastic surgery or 

reconstructive treatment 28 

12 Overnight stay following oncological treatment 28 

13 Preventive examinations 28 



16 Second opinion 29 

17 Anti-stuttering therapy 29 



Contents 

V Extra Compleet 31 


2 Childbirth and maternity care 31 

3 Abroad 32 

4 Dietary advice 32 



7 Group therapy 33 



10 Membership of patients associations / patient 


11 Overnight stay facilities 34 

12 Informal care 34 

13 Specialist medical care / plastic surgery or 

reconstructive treatment 35 


15 Menopause consultation 35 

16 Pedicure for diabetics and patients with 

rheumatism 35 





21 Anti-stuttering therapy 37 


23 Therapeutic camps 37 


VI Comfort 38 


2 Abroad 38 

3 Dietary advice 39 



6 Group therapy 40 

7 Convalescent homes, health resorts, pilgrimages 

and holidays for the disabled 40 



10 Incontinence support 41 

11 Membership of patients associations / patient 


12 Informal care 41 


14 Pedicure for diabetics and patients with 

rheumatism 42 


16 Preventive vaccinations and medicines 42 




VII Supplementary Insurance Dental Care 44 

1 Cover 44 

2 Exclusions 44 

VIII Supplementary Insurance Hospital Plus 45 

1 Cover 45 

2 Obligations of the insured person 45 

IX Supplementary Insurance Home Help 46 

1 Cover 46

1 Definitions 

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In the policy conditions below, the following words/terms shall have the following meaning: 

I General section 

Alternative and special remedies: remedies that differ from regular remedies in terms of both their nature and the 

treatment methods used. 

Authorisation: prior written permission granted to the insured person by or on behalf of the health care insurer for 

the acquisition of specific health care. 

AWBZ: Exceptional Medical Expenses Act (Algemene Wet Bijzondere Ziektekosten). 

Beautician: a beautician with the Beauty Care diploma B plus the Camouflage diploma for camouflage therapy, the 

Electrical Epilation diploma for electrical hair removal and the Acne diploma for the treatment of acne. 

Care hotel: an establishment contracted as such by the health care insurer that guarantees 24-hour care and service 

consisting at least of nursing and care in a hotel-like setting. 

Cesar/Mensendieck remedial therapist: a person entitled to use the title of remedial therapist under article 18 of 

the Decree for dieticians, occupational therapists, speech therapists, oral hygienists, remedial therapists, 

orthopaedists, and podotherapists. 

Child physiotherapist: a physiotherapist listed as a child physiotherapist in the Register of Specialist 

Physiotherapists maintained by the KNGF (Royal Dutch Society of Physiotherapists). 

Child psychologist: a person listed as a child psychologist in the Register of Child Psychologists maintained by the 

NIP (Dutch Institute of Psychologists). 

Clinical psychologist: a health care psychologist registered according to the conditions referred to in article 14 of the 

Wet BIG (Individual Health Care Professions Act). 

Company doctor: a physician listed as a company doctor in the Register of Recognised Social Physicians maintained 

by the SGRC (Social-Medical Registration Committee) of the KNMG (Royal Dutch Medical Association). Said physician 

may be employed by the Arbodienst (Dutch Health and Safety Executive) or may have entered into a contract with the 

health care insurer. 

Convention territory: countries not belonging to the European Union or EEA with which the Netherlands has entered 

into a social security convention including an arrangement for the provision of medical care, namely: Australia (for 

holidays/temporary stay), Bosnia-Herzegovina, Cape Verde Islands, Croatia, Macedonia, Morocco, Serbia-Montenegro, 

Tunisia and Turkey. 

Dental surgeon: a dental specialist listed in the Register of Specialists in Oral Disease and Dental Surgery maintained 

by the NMT (Dutch Dental Association). 

Dentist: a person listed as such in the register referred to in section 3 of the Wet BIG. 

DBC: Diagnosis Treatment Combination (Diagnose Behandeling Combinatie) A DBC details the completed and 

validated trajectory of medical specialist care and specialist medical health care (second-line curative mental health care 

(GGZ)) by means of a DBC performance code established by the NZa (Dutch Care Authority). This encompasses the 

request for care, the care type, the diagnosis and the treatment. The DBC trajectory begins from the moment that the 

insured person submits his/her care request and ends when the treatment has been completed or after 365 days. 

Dispensing general practitioner: a general practitioner who is licensed to dispense medicines under article 61 

paragraph 10/11 of the Geneesmiddelenwet (Medicines Act). 

Doctor: a person listed as such in the register referred to in article 3 of the Wet BIG. 

Establishment: 

• an establishment in the sense of the WTZi (Health Care Establishments Licensing Act); 

• a legal entity based abroad that provides care in the country concerned under that country's social security 

system, or that provides care to specific groups of public officials. 

European Union and EEA member states: in addition to the Netherlands, these include the following countries in 

the European Union: Belgium, Bulgaria, Cyprus (the Greek part), Denmark, Germany, Estonia, Finland, France, 

Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Austria, Poland, Portugal, Romania, Slovenia, 

Slovakia, Spain, Czech Republic, the United Kingdom and Sweden. Switzerland has also been accorded equal status 

under treaty provisions. Also included are the three EEA-EFTA states, namely Lichtenstein, Norway and Iceland. 


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Family: two married or registered partners, or long-term cohabiting couples and unmarried biological children, 

stepchildren, adopted children or foster children up to the age of 18, or a single person with one or more children as 

described above. The term 'registered partner' means the person with whom the insured person has entered into a 

registered partnership by means of a deed of registration drawn up by the civil registrar; the term 'long-term 

cohabiting person' refers to a person who has proof of cohabiting for at least one year with the insured person in a 

joint household or a person who has signed a cohabitation contract with the insured person, in which case the health 

care insurer shall have the exclusive discretion to assess the durability of cohabitation. 

First-line psychologist: a health care psychologist listed as such in the Register of first-line psychologists maintained 

by the NIP. 

Fraud: the perpetration or attempted perpetration of forgery, deceit, suppression of facts that may be relevant to 

effecting the insurance, prejudicing the rights of claimants and/or fraudulent diversion by the persons and 

organisations party to a non-life insurance contract in the process of entering into and/or performing such a contract 

with the intention of obtaining a benefit or performance to which there is no entitlement or obtaining insurance cover 

under false pretences. 

General practitioner: a doctor listed as a general practitioner in the register maintained by the HVRC (registration 

committee for general practitioners, nursing home doctors and doctors for the mentally handicapped) of the KNMG. 

GGD: Municipal Health Service (Gemeentelijke Gezondheidsdienst). 

Group health insurance contracting party: the legal entity or individual with whom the group health insurance 

policy for health care costs and/or health care insurance has been entered into. A group health care policy is a policy 

entered into between the health care insurer and an employer or legal entity with the purpose of offering participants 

the opportunity to take out IAK Health Care Insurance (and, if desired, IAK supplementary insurances) under the 

conditions described in the policy. 

Health care insurance: a non-life insurance contract between the health care insurer and the policyholder for the 

benefit of a person obliged to take out insurance, which should comply with what has been provided in this respect in 

or pursuant to the Zvw (Health Care Insurance Act). The performances insured by it should not extend beyond the 

provisions laid down in or pursuant to the Zvw. 

Health Care Insurance Decree (Besluit zorgverzekering): Decree of 28 June 2005 providing for an Order in Council 

as referred to in articles 11, 20, 22, 32, 34 and 89 of the Zvw. 

Health Care Insurance Regulations (Regeling Zorgverzekering): Regulations issued by the Minister of Health, 

Welfare and Sport dated 1 September 2005, number Z/VV-2611957, containing rules on the implementation of the 

Zvw as published in the Staatscourant (Government Gazette) 2005, no. 171. 

Health care insurer: the health care insurer as named on the policy schedule or other proof of insurance, in whose 

name and for whose risk IAK Verzekeringen B.V. offers and implements these insurances as authorised agent as 

referred to in the Wft (Act on Financial Supervision). 

Health care psychologist: a person listed as such in the register referred to in section 3 of the Wet BIG. 

Hospital: an establishment for specialised medical care that is duly licensed under the WTZi. Stays of 24 hours or 

more are covered. 

IAK Health Care Insurance (IAK Zorgverzekering): a health care insurance policy (including main insurance) 

concluded between the health care insurer and the policyholder in relation to the person obliged to take out insurance 

pursuant to the Zvw and in whose name and for whose risk IAK Verzekeringen B.V. offers and performs this insurance 

as authorised agent. 

IAK Verzekeringen B.V.: the authorised agent granted a mandate by the health care insurer as referred to in the 

Wft in respect of health care insurances. 

Independent treatment centre: an establishment for specialised medical care that is duly licensed under the WTZi and 

with which the health care insurer has entered into a contract for certain forms of care. This does not cover stays of 24 

hours or more for treatments for which the DBC in question falls under the A segment. 

Insurance: one or more of the health insurances described in these policy conditions, entered into as a supplement to 

the IAK Health Care Insurance. 

Insured person: a person in respect of whom this insurance policy has been entered into and who is mentioned on 

the policy schedule or other proof of insurance issued by the health care insurer. 

Main insurance: the health care insurance policy entered into by the policyholder with the health care insurer 

pursuant to the Zvw. 

Manual therapist: a physiotherapist listed as a manual physiotherapist in the Register of Specialist Physiotherapists 

maintained by the KNGF or a person registered as an E.S. ® manual therapist with the NVMT (Dutch Society of Manual 

Therapists). 

Maternity assistant: a qualified maternity assistant or a nurse working in that capacity.

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Medical specialist: a doctor listed as a medical specialist in one of the registers established by the MSRC (Medical 

Specialists Registration Committee) of the KNMG. 

Medicines: the medicines referred to in article 2.8 paragraph 1 (header and under a and b) of the Besluit 

zorgverzekering. 

Menopause consultant: a nurse who has undergone specialist training with 'Care for Women' to become a 

menopause consultant or who is a member of the menopause practice 'Women’s Life'. 

Midwifery centre: an establishment licensed as such according to statutory regulations that has entered into a 

contract with the health care insurer or an establishment recognised as such by the health care insurer 

Nurse: a person listed as such in the register referred to in article 3 of the Wet BIG. 

NZa: Dutch Care Authority (Nederlandse Zorgautoriteit) as referred to in the Wmg (Health Care Market Regulation 

Act). 

Obstetrician: a person listed as such in the register referred to in article 3 of the Wet BIG. 

Oedema therapist: a physiotherapist listed as an oedema therapist in the Register of Specialist Physiotherapists 

maintained by the KNMF (Royal Dutch Physiotherapy Association). 

Oral hygienist: a person entitled to use the title of oral hygienist pursuant to article 14 of the Decree for dieticians, 

occupational therapists, speech therapists, oral hygienists, remedial therapists, orthopaedists and podotherapists 

and/or who has entered into a contract with the health care insurer. 

Orthodontist: a dental specialist listed in the Specialists Register for Dentomaxillary Orthopaedics maintained by the 

NMT. 

Pelvic floor physiotherapist: a physiotherapist listed as a pelvic floor therapist in the Register of Specialist 

Physiotherapists maintained by the KNGF. 

Pharmacist: a person listed in the register of pharmacists as referred to in article 61 paragraph 5 of the 

Geneesmiddelenwet. 

Physiotherapist: a person listed as such in the register referred to in article 3 of the Wet BIG. The term 

'physiotherapist' also includes a remedial gymnast / masseur by virtue of article 108 of the Wet BIG. 

Podotherapist: a person entitled to use the title of podotherapist under article 26 of the Decree for dieticians, 

occupational therapists, speech therapists, oral hygienists, remedial therapists, orthopaedists, and podotherapists. 

Policyholder/you/your: the person who has entered into the insurance policy with the health care insurer. 

Policy year: the year in which the insurance is entered into according to the date on the policy schedule, up to 1 

January of the subsequent year. 

Preferred supplier/preferred provider: a supplier/care provider with whom the health care insurer has entered 

into a contract and with whom specific arrangements have been made. 

Prosthodontist: a person entitled to use the title of prosthodontist pursuant to article 2 of the Decree for training 

requirements and expertise for prosthodontists and/or with whom the health care insurer has entered into a contract. 

Psychiatrist/neurologist: a doctor listed as a psychiatrist/neurologist in the Specialists Register established by the 

MSRC or the KNMG. 

Remedial educationalist (general): a person listed as such in the register maintained by the NVO (Dutch Society of 

Educationalists). 

RIAGG: Regional Institute for Ambulatory Mental Health Care. 

Skin therapist: a person entitled to use the title of 'skin therapist' pursuant to article 2 of the Decree on training 

requirements and area of expertise of the skin therapist. 

Sports medicine establishment: an establishment affiliated to the FSMI (Federation of Sports Medicine 

Associations). 

Stay: a stay of 24 hours or longer. 

Wmg rates: rates as determined or approved by the NZa according to the Wmg (Health Care Market Organization 

Act). 

Wet BIG: Individual Health Care Professions Act (Wet op de beroepen in de individuele gezondheidszorg). 


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Youth psychologist: a person listed as a youth psychologist in the Register of Youth Psychologists maintained by the 

NIP. 

Zvw: Health Care Insurance Act (Zorgverzekeringswet).

2 General conditions 

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2.4 

Basis 

This insurance contract is entered into on the basis of the information provided by the policyholder, whether or not in 

his/her own hand, on the application form or supplied to the health care insurer in some other written form (e.g. per 

email). The health care insurer will provide the policyholder and - if this person is not the insured person - the insured 

person with an insurance policy as soon as possible after the health insurance contract is entered into, and 

subsequently prior to the start of every calendar/policy year. The insured person(s) and the insurance policy/policies 

effected for said insured persons will be named on the policy schedule. These policy conditions form an integral part of 

the health care policy and are applicable to the following supplementary insurances: 

• Jong: chapter II; 

• Compact: chapter III; 

• Compleet: chapter IV; 

• Extra Compleet: chapter V; 

• Comfort: chapter VI; 

• Tandartskostenverzekering (Dental Care Insurance): chapter VII; 

• ZiekenhuisPlusverzekering (Hospital Plus Insurance): chapter VIII; 

• Huishoudelijke Hulpverzekering (Home Help Insurance): chapter IX; 

The supplementary insurances can be entered into by or on behalf of an insured person living in the Netherlands, 

unless the health care insurer specifies otherwise. 

The Jong supplementary insurance can only be entered into by insured persons aged between 18 and 27. 

The health care insurer can set special conditions to be applied to supplementary insurance. The supplementary 

insurances IAK Tandartskostenverzekering and IAK ZiekenhuisPlusverzekering can only be entered into if and insofar 

as the health care insurer specifically grants permission based on a dental inspection report or health certificate or the 

state of health of the prospective insured person. 

Unless otherwise specified, chapter I shall apply to all supplementary insurances. 

Group health insurance contract 

The provisions of the group health insurance contract entered into with the group contracting party shall prevail if and 

insofar as they deviate from the provisions laid out in these policy conditions. If the provisions in the group health 

insurance contract entered into with the employer are no longer applicable, the provisions of the IAK Supplementary 

insurances as they apply to individually insured persons shall once more become valid. It is not possible to be insured 

under more than one group insurance contract at one and the same time. 

The supplementary insurance will be terminated as soon as the criteria for participating in the group health insurance 

contract are no longer met, for example upon termination of the employment contract. The health care insurer can 

then offer the insured person an individual insurance policy. 

Medical necessity 

Entitlement to care or to the reimbursement of the costs of care as defined in these policy conditions shall only exist if 

and insofar as the insured person can reasonably be deemed to need the type of care in question (in terms of both the 

form the care takes and how extensive it is) and provided that the type of care is both appropriate and effective. 

Appropriate form and extensiveness will be defined in part on the basis of the latest scientific advances and current 

practice as identified via the Evidence-Based Medicine (EBM) method. In the absence of such information, the 

appropriate form and extensiveness of care will be determined on the basis of what constitutes responsible and 

adequate care within the relevant discipline. 

Who may provide the care 

The care provider has to meet certain requirements. For many categories of care provider (including general 

practitioners, medical specialists, dentists, physiotherapists and health care psychologists), these requirements are 

prescribed by law and the medical title is protected. For those care providers in respect of whom the requirements are 

not prescribed by law or to whom additional requirements apply, the exact requirements the care provider must meet 

are laid out in the relevant article of this document. 

For some types of care, certain care providers have been contracted, designated or recognised by the health care 

insurer. If a care provider is used that has not been not contracted, designated or recognised by the health care 

insurer, the insured person may receive a lower reimbursement or no reimbursement at all. In that case, this will be 

stated in the relevant article in this document. For other types of care, the insured person is free to select a care 

provider, provided that the other requirements laid down in the insurance terms and conditions are met. 

For a list of care providers that have been contracted and designated by the health care insurer, visit www.iak.nk/zorg 

or call the number given at the start of this document. The recognised care providers are named in the relevant article 

in this document. 

Specific agreements have been reached with certain suppliers. Where there are preferred suppliers, this is noted in the 

relevant article in this document. 


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Below are the types of care for which there are contracted, designated or recognised care providers: 

• Alternative and special medicine 

• Physiotherapy and remedial therapy 

• Dietary advice 

• Informal care 

• Convalescent homes and care hotels 

2.5 Basis for entitlement 

Entitlement to care or to the reimbursement of the costs of care shall only exist if and insofar as rights can be derived 

from the insurance policy, the determining factor being the date on which or the period within which the relevant form 

of care was provided. Where these policy conditions refer to a calendar/policy year, the actual date of treatment or 

date on which the services/goods were supplied as stated by the health care provider will determine to which 

calendar/policy year the costs involved should be allocated. In cases involving a DBC (Diagnosis Treatment 

Combination), the costs will be allocated to the calendar year in which the DBC was opened. In cases where treatment 

is spread across two calendar years and the care provider is entitled to charge a single amount (DBC), the costs will be 

reimbursed provided that treatment commenced within the term of the supplementary insurance. 

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2.9 

Entitlement to care and other services following acts of terrorism 

If the need for care or another service is the result of one or more acts of terrorism and the total damages claimed in 

any calendar year due to such acts from non-life, life or funeral services (benefits in kind for funerals) insurers to 

which the Wft (Act on Financial Supervision) applies, will - according to the expectations of the NHT (Dutch 

Reinsurance Company for Damages Resulting from Acts of Terrorism) - be higher than the maximum amount 

reinsured by this company per calendar year, the insured person will only be entitled to compensation of the costs of 

performances up to a maximum to be determined by the NHT, which for all insurances will be equal to the percentage 

of the costs or value of the care or other services. The precise definitions and provisions applicable to the above 

entitlement are detailed in the NHT Terrorism Cover Clauses Sheet. Said Clauses Sheet forms part of these policy 

conditions and is available on request. See also www.iak.nl/zorg. 

Protection of personal data 

The personal data provided when applying for or amending an insurance and any supplementary personal or 

administrative data to be submitted will be processed in IAK’s personal data file. Such data will be used to enter into 

and execute insurance contracts and manage the customer relationships arising therefrom. Such management will 

include the prevention and combating of fraud. The Gedragscode Verwerking Persoonsgegevens Zorgverzekeraar 

(Code of Conduct on the processing of personal data by health care insurers) shall apply to said file. The code of 

conduct is available on www.iak.nl or on request. From the inception date of the supplementary insurance, the health 

care insurer may: 

• contact third parties (e.g. health care providers and suppliers) to request or provide any information it considers 

necessary in order to fulfil its obligations under the supplementary insurance(s); 

• enter the BSN (social insurance and tax number) in the records. Care providers are required by law to quote the BSN 

in all communications. The health care insurer will quote the BSN in all communications with the care providers. 

The health care insurer will comply with privacy legislation in all such correspondence. 

Your insurance claims can be processed more quickly and easily if the care providers send your invoices directly to 

the health care insurer and the health care insurer then pays those invoices directly to the care providers. To that 

end, the care provider who treats you may need to know your insurance details. Care providers are therefore 

granted secure access to your address and policy details, but only if and when they are actually treating you. If 

there are urgent reasons why care providers should not be granted access to your address, you should inform your 

health care insurer, who will then arrange for your address to remain hidden. 

Notifications 

Notifications sent to the last postal address or email address known to the health care insurer will be deemed to have 

reached the policyholder or the insured person. If the policyholder opts to contact the insurer electronically, then the 

insurer will also send electronic notifications to the policyholder. Where the term ‘in writing’ is used in these insurance 

terms and conditions in this context, the term shall also be taken to mean ‘by email’. Similarly, ‘address’ shall also be 

taken to mean ‘email address’. 

Reimbursement of care costs 

Reimbursement of the costs of care shall take place exclusively on the basis of a maximum of the Wmg (Health Care 

Market Regulation Act) rates that apply in the Netherlands. If no Wmg rates apply, the costs will be reimbursed up to 

a maximum of the reasonable market prices applicable in the Netherlands or on the basis of the rate that the health 

care insurer has set or agreed in consultation with the care provider in question. If a rate applies that is lower than the 

statutory maximum, then the amount set by or on behalf of the health care insurer will determine the level of the 

reimbursement. 

For some types of care, certain care providers have been contracted, designated or recognised by the health care 

insurer. If a care provider is used that has not been not contracted, designated or recognised by the health care 

insurer, the insured person may receive a lower reimbursement or no reimbursement at all. In that case, this will be 

stated in the relevant article in this document. For other types of care, the insured person is free to select a care 

provider, provided that the other requirements laid down in the insurance terms and conditions are met.

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2.12 

For a list of care providers that have been contracted and designated by the health care insurer, visit www.iak.nk/zorg 

or call the number given at the start of this document. The recognised care providers are named in the relevant article 

in this document. 

The health care insurer has the right to pay the costs of care (or any reimbursement that the insured person is 

already entitled to claim from the health care insurer on the basis of his/her policy) directly to the care provider who 

provided the care. Upon such payment, the insured person’s entitlement to reimbursement shall expire. 

If the health care insurer reimburses more to the care provider than he is obliged to pay in respect of the insured 

person or the costs of care are payable by the policyholder under the terms of these policy conditions, then the insured 

person shall owe the costs to the health care insurer. The health care insurer will charge these costs to the policyholder, 

who undertakes to pay them. By entering into the insurance policy, the policyholder authorises the health care insurer 

to settle the amount owed by the policyholder by means of direct debit from the policyholder's bank or giro account by 

or on behalf of the health care insurer, without prejudice to the health care insurer's general right of set-off. 

Fraud 

Substantive tests and fraud investigations will be carried out in compliance with the provisions pertaining to health 

care insurance laid down in the Zvw (Health Care Insurance Act). If IAK or the health care insurer detects fraud, this 

will result in any entitlement to care or reimbursement of the cost of care under this insurance being forfeited, 

including claims where no fraud has actually been detected. Detected fraud can also result in the health care insurer 

(or IAK on behalf of the health care insurer): 

• recording in the incident register of the health care insurer the personal data of the person committing fraud and 

the person considered to be an accessory or participant. This incident register is registered with the CBP (Data 

Protection Authority) and maintained by IAK and/or the health care insurer’s Veiligheidszaken department; 

• informing the CBV (Centre for Combating Insurance Fraud) that forms part of the Verbond van Verzekeraars 

(Association of Insurers); 

• terminating the insurance(s) and refusing to enter into new insurance policies for a period of 8 years; 

• terminating running non-life and other insurance(s); 

• recording the incident in the internal and external warning systems recognized by financial institutions, i.e. the 

IVR (Internal Referral Register) and the EVR (External Referral Register); 

• claiming back/recovering from policyholder and/or the insured person reimbursements already paid out; 

• submitting a statement to the police, the judiciary and/or the FIOD-ECD (Fiscal Intelligence and Investigation 

Service & Economic Investigation Service); 

• claiming/recovering the necessarily incurred costs relating to investigations etc. from the policyholder and/or the 

insured person. 

Reflection period 

Having entered into the insurance contract, the policyholder can cancel the policy in writing within 14 days after the 

insurance starts, or - if this is later - 14 days after receipt of the policy conditions, without giving reasons. The 

insurance contract will then be deemed not to have been concluded. 

Applicable law 

The insurance is governed by Dutch law. 

3 Premium 

3.1 

Premium payable 

The policyholder is required to pay premiums. Insured persons are not required to pay premiums in respect of the 

Jong, Compact, Compleet, Extra Compleet and Comfort supplementary health care insurances until the first day of the 

calendar month following the calendar month in which they reach the age of 18. 

Group health care contract: 

The premiums and conditions as agreed in the group insurance contract apply as from the day on which the insured 

person is covered under the contract and continue to apply until the day on which the insured no longer meets the 

criteria for participation in this group insurance contract. The policyholder/insured person can only participate in one 

group health insurance contract. The policy conditions (including the premium payments) as applicable under the 

individual policy, shall apply from the date following the day on which the insured person no longer meets the criteria 

for participation in the group health insurance contract in question. 

3.2 

Payment of the premium, statutory contributions and costs 

i. The policyholder is obliged to pay the premium as well as foreign and other statutory contributions monthly in advance 

for all insured persons, unless specifically agreed otherwise. If the premium is paid annually in advance, a premium 

discount will be awarded. The amount of the discount will be shown on the policy schedule. 

Premiums must be paid according to the method agreed with the health care insurer. In the case of payments made 

by payment slip, a charge of € 0.50 will apply per payment slip. 

Payment options with no extra charge attached 

The policyholder can authorise the health care insurer to collect the amounts owed by direct debit, or the policyholder 

can pay the premium via ‘AcceptEmail’. There is no extra charge attached to these payment methods. 


12 

Charge for payment via paper payment slip 

If the policyholder does not make use of the payment options for which no charge is made, the policyholder will be 

sent a paper payment slip, in which case a charge of € 0.50 will apply per payment slip. The policyholder will also be 

sent a paper payment slip if a direct debit cannot be executed. In such cases, a charge of € 0.50 per paper payment 

slip will also apply. 

3.2.2 Direct debit authorisation applies to the payment of premiums, excess, individual contributions and other expenses. 

The direct debit of excess, individual contributions and other expenses due is subject to a maximum of € 250.00 per 

month. A payment slip will be sent in respect of any amounts over and above € 250.00. There will be no charge to the 

policyholder in cases where the health care insurer opts to send a payment slip. 

3.3 

3.4 

3.5 

3.5.1 

3.5.2 

3.5.3 

3.5.4 

3.5.5 

3.5.6 

Claim 

The policyholder is not permitted to set off the amounts he/she owes against an amount to be received from the 


Death 

Should the insured person die, the premium already paid will be refunded from the day after the date on which he or 

she died. 

Overdue premium payments, statutory contributions and costs 

If the policyholder fails to meet the obligation to pay the premium, statutory contributions, excess and costs on time, 

the healthcare insurer will send a reminder. If payment is not made within the period named in the reminder (which 

period must be at least 14 days), the health care insurer may suspend coverage. 

In the event of suspension, there shall be no entitlement to care or reimbursement of care costs, as described in these 

policy conditions, from the last premium due date before the reminder or a later date (to be stipulated). The 

policyholder will continue to owe the premium for the period of the suspension. Cover will resume from the day 

following the date on which the full amount due plus the costs as referred to in clause 3.5.3 have been received by the 


In the event of termination of the insurance contract, a new application for insurance can be submitted following 

payment of the amount due and any costs. The insurance will then come into effect on 1 January of the subsequent 

calendar year. 

The health care insurer can charge the policyholder administration costs, collection charges (both statutory and nonstatutory) 

and statutory interest. 

If the policyholder has already been sent a reminder regarding failure to pay the premium, statutory contributions, 

excess, individual contributions or costs on time and the policyholder then fails to pay a subsequent invoice on time, 

the health care insurer shall not be required to send the policyholder a second written reminder. 

The health care insurer can set off overdue premium and costs as referred to in paragraph 3.5.3 against claims that 

the insured person has submitted and/or any other amounts the health care insurer owes to the insured person. 

If the insurance policy is terminated because of a failure to pay the premium on time, the health care insurer can 

refuse to conclude a new insurance contract with the policyholder for a period of 5 years. 

4 Other obligations 

4.1 

4.2 

Obligations 

The policyholder and the insured person are obliged: 

• to ask the attending practitioner to disclose the reasons for hospitalization to the health care insurer’s medical 

advisor; 

• to cooperate with the health care insurer, its medical advisor or those responsible for inspection so that the 

information can be acquired that is needed for the proper implementation of the insurance; 

• to submit a referral from the attending general practitioner, company doctor or medical specialist, stating that the 

care and/or transport being provided is medically necessary, in cases where authorisation is required under the 

policy conditions; 

• to inform the health care insurer about any facts that might mean that expenses may be recovered from liable (or 

potentially liable) third parties, and to provide the health care insurer with the necessary information in this 

regard. In this context, the insured person will not make any arrangements with any third parties without the prior 

written approval of the health care insurer. The insured person will refrain from any actions that may prejudice the 

interests of the health care insurer; 

• to inform the health care insurer as soon as possible (but no later than two months after the change has taken 

place) of all facts and circumstances that might be relevant to the proper implementation of the insurance. Such 

changes include birth, adoption, death or a different bank or giro account number. The health care insurer bears 

no risk whatsoever where the policyholder/insured person fails to inform it of the above changes. 

If the obligations are not fulfilled, thereby harming the interests of the health care insurer, the health care insurer may 

suspend entitlement to the reimbursement of health care costs. 

Deadline for submitting declarations 

When claiming reimbursement of the costs of care, the policyholder and the insured person must submit the original 

invoices within three years of the invoice date. These invoices must be itemised in such a manner that it can be 

deduced from them, without further enquiry, which reimbursement the health care insurer is required to make.

4.3 

Invoices generated by computer must be initialled by the care provider. Submitted invoices on the basis of which 

payments have been made will not be returned to the insured person. 

Submitted invoices must be made out in Dutch, German, English, French or Spanish. 

Interests 

If the interests of the health care insurer are prejudiced as a result of failure to perform the obligations mentioned in 

clause 4.1, the health care insurer can suspend entitlement to care or care cost reimbursement as outlined in these 

policy conditions. 

5 Amendments to premium and conditions 

5.1 

5.2 

Amendments to premium and conditions 

The health care insurer is entitled to amend these policy conditions and the premium for the health care insurances to 

which they refer at any time. The health care insurer will notify the policyholder of the intended amendments. Such 

amendments will take effect on a date to be specified by the health care insurer. In the case of group insurance, the 

terms under which conditions and/or premiums may be reviewed can be laid down in greater detail in the group health 

insurance contract. 

Right to give notice 

If the health care insurer increases the premiums and/or changes the conditions of the policy to the disadvantage of 

the policyholder or insured person, the policyholder will be entitled to give notice of termination of the contract from 

the day on which the increase or change becomes effective, and in any event for a period of one month after the 

policyholder has been notified of the change. However, the policyholder does not have this right to give notice if the 

change to the policy conditions is a direct consequence of statutory measures, legislation or provisions, or if the 

increase in the premium is a direct result of the insured person to whose age the premium is linked having reached a 

certain age. 

6 Inception, term and termination 

6.1 Inception and term 

The insurance will commence on the date stated on the policy schedule or on 1 January of a calendar year and will 

apply throughout the calendar year in which the policy inception date falls. After this period has expired, the policy will 

be renewed tacitly from one calendar year to another. 

From the date on which the insurance takes effect, the health care insurer may supply information to and gather 

information from third parties (health care providers, suppliers and the like) as far as deemed necessary to be able to 

fulfil the obligations of the insurance. 

6.1.1 The Jong insurance described in these insurance terms and conditions will end from the first day of the month 

following the month in which the insured person reaches the age of 27. 

6.1.2 All insured persons aged 18 and older who are included on the policy have the option of taking out a supplementary 

insurance policy of their choice. Children under 18 years of age are covered under the same supplementary insurance 

as the adult included on the policy who has the highest level of cover. This does not apply where insured persons aged 

18 or older have taken out a Comfort supplementary insurance policy. 

6.2 

6.3 

6.3.1 

6.3.2 

6.3.3 

6.3.4 

6.3.5 

6.4 

Policy changes 

On 1 January of each year, the policyholder has the right to change to a different insurance policy. The policyholder 

must inform the health care insurer of any such change by 31 December at the latest. The health care insurer can set 

special conditions to be applied to the granting of supplementary insurance, such as the requirement to submit a 

completed and signed health certificate. 

Cancellation by operation of law 

The health care insurances described in these policy conditions will be terminated by operation of law on the day 

following the date on which: 

the health care insurer is no longer allowed to offer health care insurances, due to changes in or a revocation of its 

licence to operate a non-life insurance company; 

the insured person dies; 

the insured person’s obligation under the Zvw to take out insurance terminates; 

the insured person takes up permanent residence abroad, unless the health care insurer stipulates otherwise. 

the health care insurer ceases to offer and perform these insurances. 

The policyholder will inform the health care insurer immediately of all facts and circumstances about the insured 

person that have led or might lead to the termination of the insurance. If on the basis of the information referred to 

above the health care insurer comes to the conclusion that the insurance will be terminated or has already been 

terminated, it will notify the policyholder to that effect immediately, stating the reason and the date on which the 

insurance was terminated or will be terminated. 

If the insurance is to be terminated on the basis of 6.3.5 above, the health care insurer undertakes to inform the 

policyholder at least 3 months beforehand of said termination. 

Notice by the policyholder 


14 

6.5 

6.6 

The policyholder may give notice of termination in writing or per email: 

• no later than 31 December of any year, to take effect from 1 January of the subsequent calendar year; 

• simultaneously with the termination of the statutory IAK Zorgverzekering; 

• in the situations referred to in article 5.2. 

Cancellation, dissolution or suspension by the health care insurer 

The health care insurer may cancel, dissolve or suspend the insurance: 

• because of failure to pay the premium on time as outlined in article 3.5; 

• in cases of fraud as outlined in article 2.10; 

• in the event of deliberately not supplying, not completely supplying or falsely supplying the health care insurer 

with information or documents relevant to the performance of the insurance that may/will disadvantage the health 

care insurer; 

• if the policyholder and/or the insured person has deliberately acted with the intention of misleading the health 

care insurer or if the health care insurer would not have entered into a health care insurance if it had been aware 

of the true state of affairs. In such cases, the health care insurer can cancel the insurance within two months of 

discovery and with immediate effect. The health care insurer will not, then be required to make any payments, or 

may opt to reduce the payment amount. The health care insurer may set off the debt owed as a result of the 

above deception against other benefits. 

Health risk 

The health care insurer cannot terminate or change the insurance in response to an increase in the health risk, insofar 

as said risk relates to the insured person as an individual. 

7 Exclusions 

There is no entitlement to care or reimbursement of care costs: 

• relating to illnesses or disorders that already existed before or at the time when the insurance was entered into and 

of which the insured person was aware or could have been aware or in relation to which he was already experiencing 

symptoms but of which the health care insurer was not informed in writing. This exclusion shall not apply in cases 

where the insurance was effected without prior medical or dental selection; 

• relating to written statements, mediation fees that are not accompanied by a written agreement from the health care 

insurer, administration charges, costs of missed appointments or costs incurred as a result of failure to pay the 

invoices submitted by health care providers on time; 

• where these are incurred as a result of gross negligence or intention; 

• arising from individual contributions or excess payable under a different insurance, unless otherwise specified in 

these policy conditions; 

• relating to which a claim could be submitted under the AWBZ (Exceptional Medical Expenses Act), where the insured 

person was insured under this act; 

• relating to which a claim could be submitted under a different insurance (possibly dated earlier) or under a different 

act or provision if the insurance with the health care insurer had not existed. In such cases, all the alternative 

options listed above will apply before this insurance applies, and even then payment under these policy conditions 

will remain restricted to any amount exceeding the amount that the insured person would be able to claim 

elsewhere; 

• where a claim can or could be made under a health care policy based on the Zvw or an equivalent health care or 

medical insurance; the health care insurer operates in accordance with the Convenant samenloop 

zorgverzekering/reisverzekering (Agreement on the concurrence of health care/travel insurance policies). See also 

www.iak.nl/zorg; 

• caused by or resulting from armed conflict, civil war, uprising, civil disorder, riots or mutiny, as defined in article 

3.38 of the Wft; 

• resulting from damage that is indirectly caused by actions taken by or negligence on the part of the health care 

insurer; 

• in cases where the costs are charged by a partner, child, parent or other family member living in the same house, 

unless the health care insurer has granted prior authorisation. 

8 Complaints and disputes 

8.1 

8.1.1 

8.1.2 

8.1.3 

Complaints and disputes relating to the performance of the insurance 

Complaints and disputes relating to the performance of the insurance should be addressed to the management of the 

health care insurer’s Zorgklachten department. They can also be addressed per email via zorgklachten@iak.nl. 

Complaints can also be submitted via our website www.iak.nl/zorg. The Zorgklachten department acts on behalf of the 

management. 

A 'dispute' is a difference of opinion with regard to a decision relating to the performance of the insurance taken by the 

health care insurer and upheld following reconsideration, as a result of which the interests of the policyholder or 

insured person are affected. All other cases are referred to as 'complaints'. 

The health care insurer will decide on its final position or reconsider its original decision within a period of 30 days. If 

the policyholder or the insured person does not agree with the opinion of the health care insurer or if the health care 

insurer has not responded within a period of 30 days, the policyholder or the insured person can submit his/her 

complaint or dispute to the SKGZ (Health Insurance Complaints and Disputes Commission), Postbus 291, 3700 AG

8.2 

8.2.1 

8.2.2 

Zeist, or via www.skgz.nl. Alternatively, in such cases the policyholder or the insured person may submit his/her 

complaint or dispute to the competent court. 

Complaints about forms used by the health care insurer 

Complaints about forms used by the health care insurer should be submitted to the health care insurer's Zorgklachten 

department. It is also possible to download a complaints form via www.iak.nl/zorg. 

Once the health care insurer has been informed of a complaint and the health care insurer has made its definitive 

position known or has not responded within a period of 30 days following submission of the complaint, a complaint as 

detailed under paragraph 8.2.1 can be submitted by the policyholder or the insured person to the NZa (Dutch Care 

Authority), Information Line/Complaints Office, Postbus 3017, 3502 GA Utrecht, e-mail: informatielijn@nza.nl. 

The above complaints relate to forms that, in the opinion of the policyholder or insured person, are redundant or 

unnecessarily complicated. The decision of the NZa will be binding on the policyholder, insured person, health care 

provider and health care insurer. 

9 Care mediation and waiting list mediation 

The insured person will be entitled to care mediation in cases where there the waiting time is unacceptably long for 

medical specialist care, dental surgery, psychological care or any other form of care to which waiting time applies and 

which care can be provided by a health care provider under this policy. If there is an unacceptably long waiting time, 

the insured person can request care mediation by calling the health care insurer’s Zorgadvies department on +31 

(0)40 261 18 09. The insured person can also call this department to ask general questions about care, for instance 

when looking for a care provider with a certain type of expertise or for help with how to go about finding the right 

care. The health care insurer will examine all the options together with the insured person. 

10 Final provision 

The health care insurer will decide on all matters not covered by these policy conditions. 


16 

Cover 

II Jong 

Extent of the cover 

Reimbursement will be provided for the following costs of care or services insofar as there is no entitlement (or no 

longer any entitlement) to such reimbursement under the IAK Zorgverzekering based on the Zvw (Health Care 

Insurance Act) or pursuant to one or more of the supplementary insurances described in these policy conditions that 

have been entered into supplementary to the IAK Zorgverzekering (main insurance). 

1 Alternative and special medicine 

1.1 

1.2 

1.3 

1.4 

Reimbursement of the cost of alternative treatments and consultations that fall under the following categories: 

a. acupuncture and other traditional Eastern medicines; 

b. anthroposophy; 

c. homeopathy; 

d. natural remedies; 

e. psychosocial care. 

• The forms of care named under a to d (above) must be provided by a doctor listed in the register referred to in 

the Wet BIG (Individual Health Care Professions Act) or a care provider contracted by the health care insurer; 

• The care named under e (above) must be provided by a care provider contracted by the health care insurer. 

You can find a list of contracted care providers on our website. Alternatively, you can call us and ask for a list. 

For more information, see article 2.4 of ‘General conditions’ in these insurance terms and conditions. 

Reimbursement of the costs of treatments and consultations provided by: 

• a podotherapist who is a member of the NVvP (Dutch Association of Podotherapists), with the exception of the 

costs of the aids made for treatment, including arch supports, unless these are insured under a different category; 

• a haptotherapist who is a member of the VVH (Association of Haptotherapists); 

• a craniosacral therapist whose name appears on the RCN (Dutch Craniosacral Therapy Register). 

Reimbursement of the costs of medicines classified as homeopathic and/or anthroposophical medicines under the 

Geneesmiddelenwet (Dutch Medicines Act) and that are prescribed by a physician, medical specialist, dental surgeon, 

dentist or obstetrician and supplied by a pharmacy or dispensing general practitioner. 

Reimbursement of the costs of the care named in this article is subject to a total maximum of € 200.00 per insured 

person per policy year. A maximum of € 75.00 per insured person per day will be reimbursed for the costs of 

consultations and/or treatments provided by the above-named physicians and/or therapists, subject to said 

consultations and/or treatments being standard within this occupational group. 

2 Abroad 

2.1 

2.2 

2.3 

2.4 

Urgent care during holiday or temporary stay 

Reimbursement of the costs of emergency medical care relating to an unforeseen illness that has arisen during the 

first 12 months of a stay in a foreign country on holiday, on a work-related trip or for study, up to a maximum of 

200% of the costs that would have been reimbursed for equivalent treatment in the Netherlands. Entitlement to 

reimbursement exists exclusively subject to the maximum reimbursement payable under the policy and provided that 

there is an entitlement to care under the IAK Health Care Insurance. In such cases, the reimbursement granted will be 

of a supplementary nature. 

Urgent care/Alarm centre 

In the event of acute hospitalisation abroad, immediate contact must be made with the health care insurer or with the 

alarm centre of the Dutch emergency organisation SOS International. SOS International is available day and night, 

also at weekends, on +31 (0)20 651 51 51. 

Transport 

Reimbursement of the costs of medically necessary patient transport to the nearest hospital by ambulance or taxi. 

Repatriation 

Reimbursement of the costs of repatriation of patients or injured persons by ambulance and/or airplane, including the 

costs charged for accompaniment in cases where this is medically necessary. Intended repatriation must be reported 

in advance to the health care insurer or the SOS International alarm centre so that the degree of medical necessity 

can be assessed.

3 Pharmaceutical care 

3.1 

Contraceptives 

Reimbursement of the costs of contraceptives that may be provided under the Regeling Zorgverzekering (Health Care 

Insurance Regulations), such as the contraceptive pill, a contraceptive implant, IUD, ring or pessary, prescribed by a 

general practitioner or medical specialist and supplied by a pharmacy or dispensing general practitioner to insured 

persons aged 21 and above, for the first prescription for a new contraceptive pill/device, up to a maximum of the 

amount laid down in the Regeling Zorgverzekering and the GVS (Medicines Reimbursement System). 

The cost of the placement and removal of a contraceptive device such as an IUD will be reimbursed under the health 

care insurance irrespective of your age. If you are under 21 years of age, you are entitled under the health care 

insurance to the reimbursement of contraceptives such as the contraceptive pill, a contraceptive implant, IUD, ring or 

pessary. 

a. Medication to help you stop smoking 

Reimbursement of the cost of medication (nicotine replacement products and prescription-only remedies) used in 

support of behavioural therapy in the context of a ‘stop smoking’ programme, up to a maximum of € 115.00 for the 

entire term of the insurance. 

4 Physiotherapy and remedial therapy 

Reimbursement of the costs of care such as is usually provided by physiotherapists and remedial therapists from a 

child physiotherapist, manual therapist or Cesar/Mensendieck remedial therapist, oedema therapist, psychosomatic 

therapist or pelvic floor physiotherapist, exclusively if and insofar as there is no entitlement (or no longer any 

entitlement) to such reimbursement under the IAK Health Care Insurance or one or more of the supplementary 

insurances described in these policy conditions. Reimbursement will take place up to a maximum of € 250 per insured 

person per policy year. 

In the case of treatment of chronic conditions as defined in Appendix 1 of the Besluit zorgverzekering (Health Care 

Insurance Decree), the invoice must be accompanied by a certificate from the attending practitioner showing the 

indication. It must be evident from the indication that the treatment is medically indicated. Oedema therapy may also 

be provided by a skin therapist. 

You can find a list of care providers contracted by the health care insurer on our website. Alternatively, you can call us 

and ask for a list. For more information, see article 2.4 of ‘General conditions’ in these insurance terms and conditions. 

The costs of the following will not be reimbursed: antenatal exercises and maternity exercises, sports massage, 

occupational therapy and individual or group treatment or types of fitness training intended to improve the level of 

fitness. 

5 Skin therapy 

5.1 

5.2 

Skin therapy 

Reimbursement of the costs of the following, up to a maximum of € 150.00 per insured person per policy year: 

• camouflage lessons and the cost of purchasing the aids needed for these lessons; 

• facial epilation by laser or other means; 

• peeling in the case of severe acne; 

• lymph drainage. 

Entitlement to reimbursement of these costs is subject to the care being provided by a skin therapist or beauty 

specialist. 

Psoriasis day-care treatment 

Reimbursement of the costs of psoriasis day-care treatment aimed at preventing and combating the chronic skin 

condition psoriasis in a day-care treatment centre with which the health care insurer has entered into a contract, up to 

a maximum of € 150.00 per insured person per policy year. 

6 Medical aids 

6.1 

Reimbursement of the individual contributions that the insured person owes over and above the maximum 

reimbursement payable under the applicable Regeling Zorgverzekering, subject to a maximum of € 150.00 per insured 

person per policy year. A maximum may apply to the reimbursement of the individual contributions. Said maximum 

will be set at the discretion of the health care insurer. The health care insurer may make the reimbursement of the 

costs of purchasing or renting medical aids subject to its prior consent, at the discretion of the health care insurer 

and/or in conformance with the Reglement Huplmiddelen (Medical Aids Regulation). See www.iak.nl/zorg, 'IAK 

Vergoedingsregeling hulpmiddelen' for the reimbursement rates. 


18 

6.2 

Glasses / contact lenses 

Reimbursement of the costs of prescription spectacle lenses (including the accompanying frames) and prescription 

contact lenses, up to a maximum of € 50.00 in total once per three policy years. In the case of contact lenses that are 

replaced monthly/quarterly/annually, this reimbursement will be granted every three years, regardless of the number 

of lenses. The costs of sunglasses and tinted spectacle glasses/lenses are not included. 

7 Preventive care 

7.1 

7.2 

7.3 

A budget that can be spent on the following types of prevention: 

Courses 

• courses during pregnancy to prepare for delivery organised by a home-care organisation, a midwifery centre, an 

obstetrician or a yoga teacher who is a member of the VYN (Netherlands Association of Yoga Teachers); 

• courses designed to help participants cope with an illness and/or condition such as asthma, COPD, diabetes, a 

joint disorder, cancer and cardio-vascular disease, subject to such courses being organised by a patient society 

that is a member of or is affiliated to the NPCF (Dutch Patient Consumer Federation) or a home-care organisation; 

• courses on coping with dementia organised by a home-care organisation, the GGD (Municipal Health Service) or a 

GGZ (mental health care) institution; 

• first aid courses run by a society recognised by the Oranje Kruis (Orange Cross) - see www.oranjekruis.nl for a list 

of courses available in your area; 

• reanimation courses given by an instructor or organisation certified by the NRR (Dutch Reanimation Council). 

For a list of patient societies, go to www.npcf.nl. Under the heading ‘organisatie’ you will find a link ‘onze leden’. 

Sports medicine advice 

Treatment sessions, consultations and physical examinations provided by a sports medicine doctor working for a 

sports medicine organisation affiliated to the FSMI (Federation of Sports Medicine Organisations). 

Vaccinations in connection with foreign travel 

Reimbursement of essential vaccinations, consultations and/or preventive medication in connection with travel to 

foreign countries against: hepatitis A/B, DTP, yellow fever, typhoid, cholera, meningococcal or other meningitis, rabies 

or malaria, subject to these being provided/administered by a general practitioner or a doctor who is recognised by the 

LCR (National Coordination Centre for Advice to Travellers) and qualified to vaccinate against yellow fever. See 

www.lcr.nl for a list of addresses. 

Vaccinations and/or medication in connection with business trips or business-related visits to other countries do not 

qualify for reimbursement. 

7.4 Incontinence support 

Advice on daily living and a medical assessment for women suffering from involuntary loss of urine. Having completed 

a digital questionnaire in a diagnostic expert system, you will receive a medical assessment online, with 

recommendations. You can find the digital questionnaire on www.incontinentiezorgservice.nl. 

Reimbursement: 

Reimbursement of the preventive care named in this article is subject to a total maximum of € 200.00 per insured 


8 Psychological care 

Reimbursement of the costs of a maximum of two sessions per calendar year over and above the first-line psychology 

care sessions covered under the IAK Health Care Insurance, up to a maximum of € 60.00 per session, subject to the 

care being provided by a first-line psychologist who is a member of the NIP (Dutch Institute of Psychologists) or a 

health care psychologist. 

The term 'first-line psychology care' refers to the diagnostic and short-term, general treatment of non-complex 

psychological disorders / illnesses. For insured persons younger than 18 this care may also be provided by a child 

psychologist, youth psychologist or general educationalist. The care location may be the psychiatric department of a 

general hospital, a GGZ institution or an independent practice. 


For more information, see article 2.4 of ‘General conditions’ in these insurance terms and conditions.

9 Dental care (if included in insurance) 

For insured persons aged 18 and over 

Reimbursement of the costs of care usually provided by dentists based on the rates agreed with the care provider by 

or on behalf of the health care insurer, unless stipulated otherwise by the health care insurer. 

Invoices must be prepared according to the Wmg (Health Care Market Regulation Act) description and coding as drawn 

up by the NZa (Dutch Care Authority). 

Reimbursement of the costs of treatment provided by a dentist, dental prosthesist or oral hygienist, including technical 

costs, will be subject to a maximum of € 250.00 per insured person per policy year. 

Reimbursement of the above costs will include the technical costs linked to treatments provided by a dentist or a 

dental prosthesist on the basis of the rates recommended to their members by the NTG (Dutch Dental Technical 

Society), the VLHT (Association of Laboratory Dental Technicians) and the ONT (Organisation of Dutch Dental 

Prosthesists). 


20 

Cover 

III Compact 







1.1 

1.2 

1.3 

1.4 

Reimbursement of the costs of alternative treatments and consultations that fall under the following categories: 
















Reimbursement of the costs of the treatments and consultations named under 1.1 and 1.2 above are subject to a total 

maximum of € 250.00 per insured person per policy year. 

A maximum of € 75.00 per insured person per day will be reimbursed for the costs of consultations and/or treatments 

provided by the above-named physicians and/or therapists, subject to said consultations and/or treatments being 

standard within this occupational group. 

Reimbursement of the costs of medicines classified as homeopathic and/or anthroposophical medicines on the basis of 

the Geneesmiddelenwet (Medicines Act) and that are prescribed by a physician, medical specialist, dental surgeon, 

dentist or obstetrician and supplied by a pharmacy or dispensing general practitioner. Reimbursement will be granted 

up to a maximum of € 125.00 per insured person per policy year. 

11 Abroad 

2.1 

2.2 

2.3 


Reimbursement of the costs of essential emergency medical care relating to an unforeseen illness that has arisen 

during the first 12 months of a stay in a foreign country on holiday, on a work-related trip or for study purposes, up to 

a maximum of 200% of the costs that would have been reimbursed for equivalent treatment in the Netherlands. 

Entitlement to reimbursement exists exclusively subject to the maximum reimbursement payable under the policy and 

provided that there is an entitlement to care under the IAK Health Care Insurance. In such cases, the reimbursement 

granted will be of a supplementary nature. 





Repatriation 




can be assessed.


3.1 

3.2 


Reimbursement of the costs of contraceptives that may be provided under the Regeling Zorgverzekering (Health Care 

Insurance Regulations), such as the contraceptive pill, a contraceptive implant, IUD, ring or pessary, prescribed by a 

general practitioner or medical specialist and supplied by a pharmacy or dispensing general practitioner to insured 

persons aged 21 and above, for the first prescription for a new contraceptive pill/device, up to a maximum of the 

amount laid down in the Regeling Zorgverzekering and the GVS (Medicines Reimbursement System). 

The cost of the placement and removal of a contraceptive device such as an IUD will be reimbursed under the health care 

insurance irrespective of your age. If you are under 21 years of age, you are entitled under the health care insurance to 

the reimbursement of contraceptives such as the contraceptive pill, a contraceptive implant, IUD, ring or pessary. 

Individual contribution 

Reimbursement of the individual contribution owed pursuant to the GVS set up by the government, subject to a 

maximum of € 200.00 per insured person per policy year. The GVS falls under the Regeling Zorgverzekering. 

3.3 Medication to help you stop smoking 






child physiotherapist, standard physiotherapist, manual therapist or Cesar/Mensendieck remedial therapist, oedema 

therapist, psychosomatic therapist or pelvic floor physiotherapist, exclusively if and insofar as there is no entitlement 

(or no longer any entitlement) to such reimbursement under the IAK Health Care Insurance or one or more of the 

supplementary insurances described in these policy conditions. Reimbursement shall take place subject to a maximum 

of € 350.00 per insured person per policy year. 

In the case of treatment of chronic conditions as defined in Appendix 1 of the Besluit Zorgverzekering (Health Care 








fitness. 


5.1 

5.2 

Skin therapy 

Reimbursement of the costs of the following, up to a maximum of € 150.00 per insured person per policy year: 



• peeling in the case of severe acne; 



specialist. 






22 


6.1 

6.2 

Individual contributions 


reimbursement payable under the applicable Regeling Zorgverzekering referred to in the IAK Health Care Insurance, 

up to a maximum of € 150.00 per insured person per policy year. A maximum may apply to the reimbursement of the 

individual contributions. Said maximum will be set at the discretion of the health care insurer. The health care insurer 

may make the reimbursement of the costs of purchasing or renting medical aids subject to its prior consent, at the 

discretion of the health care insurer and/or in conformity with the Reglement Hulpmiddelen (Medical Aids Regulations). 

See www.iak.nl/zorg, 'IAK Vergoedingsregeling hulpmiddelen' for the reimbursement rates. 

Arch supports 

Reimbursement, up to a maximum of € 50.00 per insured person per policy year, of the costs of arch supports or 

insoles that support the joints, ligaments and joint capsules of the foot, on prescription from the general practitioner, 

medical specialist or podotherapist. These must be supplied by an orthopaedic shoemaker or shoemaking business or a 

podotherapist. 


7.1 

7.2 

7.3 


Courses 





affiliated to the NPCF (Dutch Patient Consumer Federation) or a home-care organisation; 

• courses on coping with dementia organised by a home-care organisation, the GGD (Municipal Health Service) or a 

GGZ (mental health care) institution; 

• first aid courses run by an society recognised by the Oranje Kruis (Orange Cross) - see www.oranjekruis.nl for a 

list of courses available in your area; 






















Reimbursement of the costs of a maximum of two sessions per calendar year over and above the first-line psychology 




The term 'first-line psychology' refers to the diagnostic and short-term, general treatment of non-complex 

psychological disorders / illnesses. For insured persons younger than 18 this care may also be provided by a child





18 Seated patient transport 

Reimbursement of: 

• the costs of seated patient transport (taxi, private vehicle or lowest class of public transport) if and insofar as 

there is no entitlement (or there is no longer entitlement) on the basis of the medical indications as mentioned in 

the IAK Health Care Insurance and the Decree and the Regeling Zorgverzekering that form part thereof, all at the 

discretion of the health care insurer and subject to the prior written permission of the health care insurer (in the 

event of transport by private vehicle, a certain amount will be reimbursed per kilometre, as laid down in the 

Regeling Zorgverzekering); 

• the statutory individual contribution as mentioned in the Regeling Zorgverzekering that forms part of the IAK Health 

Care Insurance, per insured person per calendar year for seated patient transport (taxi or private vehicle). 

Reimbursement applies to medically necessary patient transport within the Netherlands, to and from a hospital or the 

address of the medical specialist's practice or to and from facilities that fall fully or partially under the AWBZ 

(Exceptional Medical Expenses Act). Transport to and from an AWBZ establishment for a care session lasting part of a 

day qualifies for reimbursement under the AWBZ. 


24 

Cover 

IV Compleet 







1.1 

1.2 

1.3 

1.4 















• a haptotherapist who is a member of the VVH (Association of Haptotherapists). 







Reimbursement of the costs of medicines classified as homeopathic and/or anthroposophical medicines on the basis of 

the Geneesmiddelenwet (Medicines Act) and that are prescribed by a physician, medical specialist, dental surgeon, 

dentist or obstetrician and supplied by a pharmacy or dispensing general practitioner. 

Reimbursement will be granted up to a maximum of € 250.00 per insured person per policy year. 

20 Childbirth and maternity care 

2.1 

2.2 

2.3 

2.4 

Individual contributions relating to maternity care 

Reimbursement of the statutory individual contributions for obstetric help and maternity care according to Regeling 

Zorgverzekering (Health Care Insurance Regulations) charged by the hospital or maternity centre. 

The supplementary reimbursement will be granted for the same number of hours or days as the number of hours or 

days of entitlement to maternity care under the IAK Health Care Insurance. 

Maternity package 

Supply of a maternity package put together by the health care insurer in consultation with obstetricians. To qualify for 

a maternity package, the maternity care must be requested from the IAK Customer Service Zorg- en 

Inkomensverzekeringen at least 5 months before the expected delivery date, by calling: +31 (0)40 261 18 88. 

Multiple births 

A one-off reimbursement of € 200.00 will be granted in respect of the second child (and, where relevant, subsequent 

children) in the case of multiple births included under the policy. 

Maternity care in case of adoption 

Reimbursement of the costs of necessary support, counselling and instructions associated with the care of and 

relationship with an adopted child of less than 3 months of age and how to fit said care into the daily routine. Such 

care must be provided by a maternity nurse affiliated to a maternity centre. The reimbursement will be restricted to

2.5 

the number of care hours indicated by the maternity centre, up to a maximum of 12 hours spread over a maximum of 

4 consecutive days. 

Lactation care 

Reimbursement of the costs of help and advice on breastfeeding provided by a lactation consultant who is a member 

of the NVL (Dutch Association of Lactation Consultants), up to a maximum of € 115.00 per delivery. 

21 Abroad 

3.1 

3.2 

3.3 

3.4 












Transport 


Repatriation 




can be assessed. 


4.1 

4.2 


Reimbursement of the costs of contraceptives that may be provided under the Regeling zorgverzekering, such as the 

contraceptive pill, a contraceptive implant, IUD, ring or pessary, prescribed by a general practitioner or medical 

specialist and supplied by a pharmacy or dispensing general practitioner to insured persons aged 21 and above, for the 

first prescription for a new contraceptive pill/device, up to a maximum of the amount laid down in the Regeling 

Zorgverzekering and the GVS (Medicines Reimbursement System). 





Reimbursement of the individual contribution owed pursuant to the GVS set up by the government. The GVS falls 

under the Regeling Zorgverzekering. 










supplementary insurances described in these policy conditions. Reimbursement is subject to a maximum of € 750.00 

per insured person per policy year. 





Samen voor een perfect verzekerde toekomst 25

26 





fitness. 

24 Group therapy for rheumatism patients 

Reimbursement of the costs of group therapy for members of the rheumatism patients association under the direction 

of a physiotherapist, up to a maximum of € 150.00 per insured person per policy year. 


7.1 

7.2 

Skin therapy 

Reimbursement of the costs up to a maximum of € 350.00 per insured person per policy year for: 



• peeling in the case of serious acne; 



specialist. 






8.1 

8.2 



reimbursement payable under the applicable Regeling Zorgverzekering referred to in the IAK Health Care Insurance, 

up to a maximum of € 150.00 per insured person per policy year. A maximum may apply to the reimbursement of the 

individual contributions. Said maximum will be set at the discretion of the health care insurer. The health care insurer 

may make the reimbursement of the costs of purchasing or renting medical aids subject to its prior consent, at the 

discretion of the health care insurer and/or in conformity with the Reglement Hulpmiddelen (Medical Aids Regulations). 

See www.iak.nl/zorg, 'IAK Vergoedingsregeling hulpmiddelen' for the reimbursement rates. 

Arch supports 

Reimbursement of the costs of arch supports or insoles that support the joints, ligaments and joint capsules of the foot 

on prescription from the general practitioner, medical specialist or podotherapist, subject to a maximum of € 100.00 

per insured person per policy year. These must be supplied by an orthopaedic shoemaker or shoemaking business or a 


27 Membership of patients associations / patient interest groups 

Reimbursement of the costs of membership of a patients association / patient interest group affiliated to the NPCF 

(Dutch Patients and Consumers Federation) or the CG-Raad (Dutch Council for the Chronically Ill and Disabled). 

Reimbursement will be granted upon submission of a copy of the proof of membership and proof of payment, up to a 


28 Overnight stay facilities 

Reimbursement of the overnight accommodation costs of parents staying in a guesthouse or lodgings located near the 

hospital and associated with that hospital in case of hospitalisation of a child under the age of 18 who is insured under 

the policy.

29 Specialist medical care / plastic surgery or reconstructive treatment 

Reimbursement of the costs of the following treatments: 

• uvuloplasty to correct snoring problems; 

• correction of upper eye lids or ear position; 

• the operative placement or replacement of breast prostheses, other than in the status following full or partial 

mastectomy; 

• circumcision of the insured person; 

• sterilisation for both men and women. 

For the first four treatments listed above, reimbursement will only be granted if and insofar as the treatment was 

medically necessary and subject to the prior written permission of the health care insurer, all at the discretion of the 

health care insurer's medical advisor. 

Indication for correction of upper eyelids: 

paralysed or weak upper eyelids, combined with a demonstrable impairment of the field of vision. This is the case if: 

• the pupil is fully or partially covered by the lower edge of the upper eyelid or by the overhanging fold of skin when 

the patient is relaxed and looking straight ahead, or; 

• there is distinct peripheral vision impairment due to severe drooping of the upper eyelid or an overhanging fold of 

skin to the outer edge, or; 

• there is demonstrably incurable chafing in the skin crease of the upper eyelid. 

A photo (taken by the hospital/independent treatment centre or by yourself) should be enclosed with the 

application/request for authorisation, on which the abnormality described in the indication is clearly visible. 

In the case of specialist treatment and/or nursing care in a hospital or independent treatment centre, reimbursement 

will be granted on the basis of the DBC (Diagnosis Treatment Combination) agreed with the health care insurer. 

Entitlement to reimbursement also exists in respect of this help in cases where there is no contractual arrangement 

between the health care insurer and the service provider / care provider. In such cases, the statutory rate will apply, 

and for treatments where there is no statutory rate, limited reimbursement will be granted per DBC. If the DBC 

trajectory started in the previous policy year, the declaration must be submitted to the health care insurer with which 

the insured person was insured when the treatment started. 

30 Overnight stay following oncological treatment 

Reimbursement of the costs of an overnight stay in a guesthouse associated with the hospital following outpatient 

radiotherapy or cytostatic treatment, up to a maximum of € 35.00 per night per insured person. 

31 Preventive examinations 

Reimbursement of the costs of: 

• electrocardiogram (E.C.G.) once per insured person per policy year; 

• cervical cancer test (smear) carried out by a general practitioner; 

• breast cancer examination; 

• prostate cancer examination once per insured person every two policy years, provided that the examination takes 

place in the Netherlands. 

The cost of preventive scans will not be reimbursed. 


14.1 


Courses 






• courses on coping with dementia organised by a home-care organisation, the GGD or a GGZ (mental health care) 

institution; 





28 

14.2 

14.3 





















Reimbursement of the costs of a maximum of four sessions per calendar year over and above the first-line psychology 










34 Second opinion 

Reimbursement of the costs of consulting another specialist (second opinion), if the attending medical specialist has 

proposed major medical treatment, exclusively if and insofar as there is no entitlement to such reimbursement under 


35 Anti-stuttering therapy 

Reimbursement of the costs of anti-stuttering therapy according to the Del Ferro, BOMA or Hausdörfer method, up to a 

maximum of € 500.00 per insured person for the entire term of the insurance.

36 Dental care 

18.1 

18.2 

For insured persons up to the age of 18 

Reimbursement of the costs of treatments by a dentist or a centre for specialist dentistry recognised by the 

authorities, whereby the reimbursement for bridges, bridge parts and crowns is subject to a maximum of € 500.00 per 

insured person per year. Within that overall maximum, the health care insurer may set a maximum amount for the 

reimbursement of each procedure / course of treatment. For further information, see our website or contact IAK 

Customer Service Zorg- en Inkomensverzekeringen. 

Orthodontic treatment (tooth-jaw alignment) for insured person up to 18 years old 

Reimbursement of the costs of orthodontic treatment (tooth-jaw alignment) by an orthodontist or dentist. If the 

orthodontic treatment has not been completed by the 18th birthday, the costs of continued treatment will also be 

reimbursed. The health care insurer may set a maximum amount for the reimbursement of each procedure / course of 

treatment. For further information, see our website or contact IAK Customer Service Zorg- en Inkomensverzekeringen. 





the IAK Health Care Insurance and the Decree and the Regeling Zorgverzekering that form part thereof, all at the 

discretion of the health care insurer and subject to the prior written permission of the health care insurer (in the 

event of transport by private vehicle, a certain amount will be reimbursed per kilometre, as laid down in the 

Regeling Zorgverzekering); 

• the statutory individual contribution as mentioned in the Regeling Zorgverzekering that forms part of the IAK 

Health Care Insurance, per insured person per calendar year for seated patient transport (taxi or private vehicle). 

Reimbursement will apply to medically necessary patient transport within the Netherlands, to and from a hospital or 

the address of the medical specialist's practice or to and from facilities that fall fully or partially under the AWBZ 


day qualifies for reimbursement under the AWBZ. 


30 

Cover 

V Extra Compleet 







1.1 

1.2 

1.3 

1.4 







The forms of care named under a to d (above) must be provided by a doctor listed in the register referred to in the 

Wet BIG (Individual Health Care Professions Act) or a care provider contracted by the health care insurer; 

The care named under e (above) must be provided by a care provider contracted by the health care insurer. 







• a craniosacral therapist whose name appears on the RCN (Dutch Craniosacral Therapy Register) 






Reimbursement of the cost of medicines classified as homeopathic and/or anthroposophical medicines under the 

Geneesmiddelenwet (Medicines Act) and that are prescribed by a physician, medical specialist, dental surgeon, dentist or 

obstetrician and supplied by a pharmacy or dispensing general practitioner, up to a maximum of € 500.00 per insured 


39 Childbirth and maternity care 

2.1 

2.2 

2.3 

2.4 

Individual contributions relating to maternity care 

Reimbursement of the statutory individual contributions for obstetric help and maternity care according to Regeling 

Zorgverzekering (Health Care Insurance Regulations) charged by the hospital or maternity centre. 

The supplementary reimbursement will be granted for the same number of hours or days as the number of hours or 

days of entitlement to maternity care under the IAK Health Care Insurance. 

Maternity package 

Supply of a maternity package put together by the health care insurer in consultation with obstetricians. To qualify for 

a maternity package, the maternity care must be requested from the IAK Customer Service Zorg- en 

Inkomensverzekeringen at least 5 months before the expected delivery date, by calling: +31 (0)40 261 18 88. 

Multiple births 

A one-off reimbursement of € 200.00 will be granted in respect of the second child (and, where relevant, subsequent 

children) in the case of multiple births included under the policy. 

Maternity care in case of adoption 

Reimbursement of the costs of necessary support, counselling and instructions associated with the care of and relationship 

with an adopted child of less than 3 months of age and how to fit said care into the daily routine. Such care must be

provided by a maternity nurse affiliated to a maternity centre. The reimbursement will be restricted to the number of care 

hours indicated by the maternity centre, up to a maximum of 12 hours spread over a maximum of 4 consecutive days. 

2.5 Lactation care 

Reimbursement of the costs of help and advice on breastfeeding provided by a lactation consultant who is a member 

of the NVL (Dutch Association of Lactation Consultants), up to a maximum of € 200.00 per delivery. 

40 Abroad 

3.1 

3.2 

3.3 

3.4 

3.5 












Transport 


Repatriation 





Non-urgent care abroad 

Reimbursement of the costs of medical care when staying abroad temporarily, exclusively if and insofar as the health 

care insurer would reimburse the costs under the IAK Health Care Insurance or under these supplementary policy 

conditions if they had been incurred in the Netherlands, up to a maximum of 200% of the Wmg (Health Care Market 

Regulation Act) rate applicable in the Netherlands, or, if this is not available, the current or standard rate for the 

medical care in question within the Dutch health care system. The temporary stay in the named countries must not 

exceed a maximum of 12 consecutive months. The costs of transport from and to the foreign country and transport 

within the foreign country itself are not included. 

Entitlement to reimbursement is subject to: 

• prior consent from the health care insurer, at which point further conditions can be laid down; 

• the understanding that the reimbursement granted is of a supplementary nature. 

41 Dietary advice 

You are entitled to medically-oriented advice on diet and eating habits of the sort usually provided by dieticians, up to 

a maxim of 4 treatment hours per calendar year. 

Entitlement to reimbursement is subject to the treatment being: 

• prescribed by a general practitioner, company doctor or medical or other specialist; 

• given by a dietician. 




32 


5.1 

5.2 


Reimbursement of the costs of contraceptives that may be provided under the Regeling Zorgverzekering, such as the 

contraceptive pill, a contraceptive implant, IUD, ring or pessary, prescribed by a general practitioner or medical 

specialist and supplied by a pharmacy or dispensing general practitioner to insured persons aged 21 and above, for the 

first prescription for a new contraceptive pill/device, up to a maximum of the amount laid down in the Regeling 

Zorgverzekering and the GVS (Medicines Reimbursement System). 





Reimbursement of the individual contribution owed pursuant to the GVS set up by the government. The GVS falls 

under the Health Care Insurance Regulations. 










supplementary insurances described in these policy conditions. 








occupational therapy and individual or group treatment or types of fitness training intended to improve the level of fitness. 

7 Group therapy 

7.1 

7.2 

Group therapy for cancer patients 

Reimbursement of the costs of after-care for patients with cancer who, immediately following treatment by the 

attending medical specialist, want to regain physical and mental strength in a hospital, integral cancer centre, 

establishment certified by the Stichting Herstel en Balans (Recovery and Balance Institution) to provide Recovery and 

Balance group revalidation courses or an establishment affiliated to the IPSO (Institute of Psychosocial Oncology 

Establishments), up to a maximum of € 500.00 per insured person per policy year and subject to referral by the 

medical specialist. 

Group therapy for rheumatism patients 




8.1 

8.2 

Skin therapy 

Reimbursement of the costs of the following, subject to a maximum of € 1,500.00 per insured person per policy year: 





Entitlement to reimbursement of these costs is subject to the care being provided by a skin therapist or beauty specialist. 

Psoriasis day-care treatment





9.1 

9.2 

9.3 



reimbursement payable under the applicable Regeling Zorgverzekering referred to in the IAK Health Care Insurance. 

Reimbursement of individual contributions may be subject to a maximum. The level of that maximum is at the 

discretion of the health care insurer. The health care insurer may make the reimbursement of the costs of purchasing 

or renting medical aids subject to its prior consent, at the discretion of the health care insurer and/or in conformance 

with the Reglement Hulpmiddelen (Medical Aids Regulation). See www.iak.nl/zorg, 'IAK Vergoedingsregeling 

hulpmiddelen' for the reimbursement rates. 


Reimbursement of the costs of prescription contact lenses and/or prescription spectacle lenses (including the 

accompanying frames), up to a maximum of € 250.00 in total once per three policy years. In the case of contact 

lenses that are replaced monthly/quarterly/annually, this reimbursement will be granted every three years, regardless 

of the number of lenses. The costs of sunglasses and tinted spectacle glasses/lenses are not included. 

Arch supports 

Reimbursement of the costs of arch supports or insoles that support the joints, ligaments and joint capsules of the foot 

on prescription from the general practitioner, medical specialist or podotherapist, up to a maximum of 1 pair per 

insured person per policy year. These must be supplied by an orthopaedic shoemaker or shoemaking business or a 


9.4 Simple mobility aids 

Long-term loan or reimbursement of the costs of purchasing a 4-foot walking stick, walking frame, rollator or crutches. 

Long-term loan must be via care providers contracted by the health care insurer. See our website or call us for a list of 

contracted care providers. 






11 Overnight stay facilities 

Reimbursement of the overnight accommodation costs of parents staying in a guesthouse or lodgings located near the 

hospital and associated with that hospital in case of hospitalisation of a child under the age of 18 who is insured under 

the policy. 

12 Informal care 

12.1 Substitute care 

Reimbursement of the costs of the care an informal caregiver normally provides being taken over temporarily in order 

to give the informal caregiver a break. Substitute care can be provided where the insured person is either in receipt of 

informal care or is an informal caregiver. 

The substitute informal care is provided by ‘Handen-in-Huis’, the Dutch organization set up especially to coordinate 

substitute informal care, which can be contacted by calling +31 (0)30 659 09 70. Handen-in-Huis also takes care of 

the application for reimbursement. Reimbursement is subject to a maximum of 4 days per insured person per policy 

year. 



a. Informal care broker 

An informal care broker provides the informal caregiver with temporary professional support by taking over a range of 

administrative tasks in the area of care, welfare, finances, etc. The support provided by the informal care broker helps 

the informal caregiver feel better able to combine care with work and private life for longer. The informal care broker 


34 

can be called in where the insured person is either in receipt of informal care or is an informal caregiver. The informal 

care broker determines how many hours of support are required. 

Reimbursement is subject to a maximum of € 250.00 per policy year. The services an informal caregiver provides are 

eligible for reimbursement once only. Reimbursement of the costs of the services provided cannot be claimed by both 

the informal caregiver and the person in receipt of informal care. 



13 Specialist medical care / plastic surgery or reconstructive treatment 

Reimbursement of the costs of the following treatments: 

• uvuloplasty to correct snoring problems; 

• correction of upper eye lids or ear position; 

• the operative placement or replacement of breast prostheses, other than in the status following full or partial 

mastectomy; 

• circumcision of the insured person; 

• sterilisation for both men and women. 

For the first four treatments listed above, reimbursement will only be granted if and insofar as the treatment was 

medically necessary and subject to the prior written permission of the health care insurer, all at the discretion of the 

health care insurer's medical advisor. 

Indication for correction of upper eyelids: 

paralysed or weak upper eyelids, combined with a demonstrable impairment of the field of vision. This is the case if: 

• the pupil is fully or partially covered by the lower edge of the upper eyelid or by the overhanging fold of skin when 

the patient is relaxed and looking straight ahead, or; 

• there is distinct peripheral vision impairment due to severe drooping of the upper eyelid or an overhanging fold of 

skin to the outer edge, or; 

• there is demonstrably incurable chafing in the skin crease of the upper eyelid. 

A photo (taken by the hospital/independent treatment centre or by yourself) should be enclosed with the 

application/request for authorisation, on which the abnormality described in the indication is clearly visible. 

In the case of specialist treatment and/or nursing care in a hospital or independent treatment centre, reimbursement 

will be granted on the basis of the DBC (Diagnosis Treatment Combination) agreed with the health care insurer. 

Entitlement to reimbursement also exists in respect of this help in cases where there is no contractual arrangement 

between the health care insurer and the service provider / care provider. In such cases, the statutory rate will apply, 

and for treatments where there is no statutory rate, limited reimbursement will be granted per DBC. If the DBC 

trajectory started in the previous policy year, the declaration must be submitted to the health care insurer with which 

the insured person was insured when the treatment started. 



radiotherapy or cytostatic treatment, up to a maximum of € 35.00 per night per insured person. 

15 Menopause consultation 

Reimbursement of the costs of acquiring information, counselling and/or treatment for women undergoing menopause, 

provided by a menopause consultant, up to a maximum of € 160.00 per insured person for the entire duration of the 

insurance. 

16 Pedicure for diabetics and patients with rheumatism 

Reimbursement of the costs of foot care for an insured person who has diabetes or rheumatism. The health care 

insurer may require a doctor's certificate.


Reimbursement of the costs of a maximum of eight sessions per calendar year over and above the first-line 

psychology care sessions covered under the IAK Health Care Insurance, up to a maximum of € 60.00 per session, 

subject to the care being provided by a first-line psychologist who is a member of the NIP (Dutch Institute of 

Psychologists) or a health care psychologist. 









• electrocardiogram (E.C.G.) once per insured person per policy year; 

• cervical cancer test (smear) carried out by a general practitioner; 


• prostate cancer examination once per insured person every two policy years, provided that the examination takes 

place in the Netherlands. 



19.1 

19.2 

19.3 


Courses 


obstetrician or a yoga teacher who is a member of the VYN (Netherlands Association of Yoga Teachers). 




• courses on coping with dementia organised by a home-care organisation, the GGD or a GGZ (mental health care) 

institution; 
























36 





21 Anti-stuttering therapy 

Reimbursement of the costs of anti-stuttering therapy according to the Del Ferro, BOMA or Hausdörfer method, up to a 

maximum of € 750.00 per insured person for the entire term of the insurance. 

22 Dental care 

22.1 

22.2 

22.3 

For insured persons up to the age of 18 

Reimbursement of the costs of treatments by a dentist or a centre for specialist dentistry recognised by the authorities, 

whereby the reimbursement for bridges, bridge parts and crowns is subject to a maximum of € 750.00 per insured 

person per year. Within that overall maximum, the health care insurer may set a maximum amount for the 

reimbursement of each procedure / course of treatment. For further information, see our website or contact IAK 

Customer Service Zorg- en Inkomensverzekeringen. 

Orthodontic treatment (teeth alignment) for insured person up to 18 years old 

Reimbursement of the costs of orthodontic treatment (tooth-jaw alignment) by an orthodontist or dentist. If the 

orthodontic treatment has not been completed by the 18th birthday, the costs of continued treatment will also be 

reimbursed. The health care insurer may set a maximum amount for the reimbursement of each procedure / course of 

treatment. For further information, see our website or contact IAK Customer Service Zorg- en Inkomensverzekeringen. 

Orthodontic treatment (teeth alignment) for insured persons aged 18 or over 

For insured persons aged 18 years and older, the reimbursement is a maximum of € 1000.00 per insured person for 

the entire term of the insurance. The health care insurer may set a maximum amount for the reimbursement of each 

procedure / course of treatment. For further information, see our website or contact IAK Customer Service Zorg- en 

Inkomensverzekeringen. 

23 Therapeutic camps 

Reimbursement of the costs of attendance by an insured person under 18 years of age at a therapeutic camp for 

asthmatic children or a therapeutic camp run by the Diabetes Youth Club for children with diabetes in the Netherlands, 

up to a maximum of € 250.00 per insured person per policy year. Entitlement to reimbursement is subject to prior 

consent from the health care insurer. The request for consent must be accompanied by a medical certificate drawn up 

by the general practitioner or medical specialist. 





the IAK Health Care Insurance, the Decree and the Regeling Zorgverzekering that form part thereof, all at the 

discretion of the health care insurer and subject to the prior written permission of the health care insurer; in the 

event of transport by private vehicle, the costs will be reimbursed at the rate per kilometre laid down in the 

Regeling Zorgverzekering increased by € 0.10 per kilometre; 


Health Care Insurance, per insured person per calendar year for seated patient transport (taxi, private vehicle or 

public transport). 




day qualifies for reimbursement under the AWBZ.

Cover 

VI Comfort 







1.1 

1.2 

1.3 

1.4 






















Reimbursement of the cost of medicines classified as homeopathic and/or anthroposophical medicines under the 

Geneesmiddelenwet (Medicines Act) and that are prescribed by a physician, medical specialist, dental surgeon, dentist 

or obstetrician and supplied by a pharmacy or dispensing general practitioner, up to a maximum of € 500.00 per 

insured person per policy year. 

26 Abroad 

2.1 

2.2 

2.3 

2.4 












Transport 


Repatriation 




38 

2.5 



Non-urgent care abroad 

Reimbursement of the costs of medical care when staying abroad temporarily, exclusively if and insofar as the health 

care insurer would reimburse the costs under the IAK Health Care Insurance or under these supplementary policy 

conditions if they had been incurred in the Netherlands, up to a maximum of 200% of the Wmg (Health Care Market 

Regulation Act) rate applicable in the Netherlands, or, if this is not available, the current or standard rate for the 

medical care in question within the Dutch health care system. The temporary stay in the named countries must not 

exceed a maximum of 12 consecutive months. The costs of transport from and to the foreign country and transport 

within the foreign country itself are not included. 

Entitlement to reimbursement is subject to: 

• prior consent from the health care insurer, at which point further conditions can be laid down; 

• reimbursement not already having taken place under the IAK Health Care Insurance or one or more 

supplementary insurances named in these policy conditions. 

27 Dietary advice 

You are entitled to medically-oriented advice on diet and eating habits of the sort usually provided by dieticians, up to 

a maxim of 4 treatment hours per calendar year. 

Entitlement to reimbursement is subject to the treatment being: 

• prescribed by a general practitioner, company doctor or medical or other specialist; 

• given by a dietician. 




4.1 Individual contribution 

Reimbursement of the individual contribution owed pursuant to the GVS (Medicines Reimbursement System) set up by 

the government. The GVS falls under the Health Care Insurance Regulations. 










supplementary insurances described in these policy conditions. Reimbursement is subject to a maximum of €1,500.00 

per insured person per policy year. 









fitness.

6 Group therapy 

6.1 

6.2 

Group therapy for cancer patients 

Reimbursement of the costs of after-care for patients with cancer who, immediately following treatment by the attending 

medical specialist, want to regain physical and mental strength in a hospital, integral cancer centre, establishment 

certified by the Stichting Herstel en Balans (Recovery and Balance Institution) to provide Recovery and Balance group 

revalidation courses or an establishment affiliated to the IPSO (Institute of Psychosocial Oncology Establishments), up to 

a maximum of € 500.00 per insured person per policy year and subject to referral by the medical specialist. 

Group therapy for rheumatism patients 



7 Convalescent homes, health resorts, pilgrimages and holidays for 

the disabled 


• a stay in a convalescent home up to a maximum of € 70.00 per insured person per day and subject to a total 

maximum of € 1,250.00 per insured person per policy year; 

• stay in a health resort for the treatment of rheumatism or psoriasis within Europe, subject to a maximum of € 

1,250.00 per insured person per stay once every three policy years; 

• a pilgrimage or holiday for the disabled, subject to a maximum amount to be agreed. 

Entitlement to reimbursement is subject to prior consent from the health care insurer. The request for consent must 

be accompanied by a medical certificate from the general practitioner or medical specialist. Entitlement to 

reimbursement is also subject to there being no entitlement to this type of care under the AWBZ (Exceptional Medical 

Expenses Act). 



For more information on the types of care named above and for further details on the conditions applying to pilgrimmages 

and holidays for the disabled, please contact the IAK Customer Service Zorg- en Inkomensverzekeringen in 

advance on +31 (0)40 261 18 88. 


8.1 

8.2 

Skin therapy 

Reimbursement of the costs of the following, subject to a maximum of € 1,500.00 per insured person per policy year: 





Entitlement to reimbursement of these costs is subject to the care being provided by a skin therapist or beauty specialist. 






9.1 

9.2 



reimbursement payable under the applicable Regeling Zorgverzekering (Health Care Insurance Regulations) referred to 

in the IAK Health Care Insurance. Reimbursement of individual contributions may be subject to a maximum. The level 

of that maximum is at the discretion of the health care insurer. The health care insurer may make the reimbursement 

of the costs of purchasing or renting medical aids subject to its prior consent, at the discretion of the health care 

insurer and/or in conformance with the Reglement Hulpmiddelen (Medical Aids Regulation). See www.iak.nl/zorg, 'IAK 

Vergoedingsregeling hulpmiddelen' for the reimbursement rates. 


Reimbursement of the costs of prescription contact lenses and/or prescription spectacle lenses (including the 

accompanying frames), up to a maximum of € 250.00 in total once per three policy years. In the case of contact 


40 

9.3 

lenses that are replaced monthly/quarterly/annually, this reimbursement will be granted every three years, regardless 

of the number of lenses. The costs of sunglasses and tinted spectacles/lenses are not included. 

Other medical aids 

Reimbursement of the costs of renting BiPAP machines, CPM machines, Lympha Presses or UVB home treatment 

devices, on prescription from a doctor or medical specialist and subject to prior consent from the health care insurer. 

9.4 Simple mobility aids 

Long-term loan or reimbursement of the costs of purchasing a 4-foot walking stick, walking frame, rollator or crutches. 

Long-term loan must be via care providers contracted by the health care insurer. See our website or call us for a list of 

contracted care providers. 

10 Incontinence support 









12 Informal care 

12.1 Substitute care 

Reimbursement of the costs of the care an informal caregiver normally provides being taken over temporarily in order 

to give the informal caregiver a break. Substitute care can be provided where the insured person is either in receipt of 

informal care or is an informal caregiver. 

The substitute informal care is provided by ‘Handen-in-Huis’, the Dutch organization set up especially to coordinate 

substitute informal care, which can be contacted by calling +31 (0)30 659 09 70. Handen-in-Huis also takes care of 

the application for reimbursement. Reimbursement is subject to a maximum of 9 days per insured person per policy 

year. 



a. Informal care broker 

An informal care broker provides the informal caregiver with temporary professional support by taking over a range of 

administrative tasks in the area of care, welfare, finances, etc. The support provided by the informal care broker helps 

the informal caregiver feel better able to combine care with work and private life for longer. The informal care broker 

can be called in where the insured person is either in receipt of informal care or is an informal caregiver. The informal 

care broker determines how many hours of support are required. 

Reimbursement is subject to a maximum of € 500.00 per policy year. The services an informal caregiver provides are 

eligible for reimbursement once only. Reimbursement of the costs of the services provided cannot be claimed by both 

the informal caregiver and the person in receipt of informal care. 





radiotherapy or cytostatic treatment, up to a maximum of € 35.00 per night per insured person.

14 Pedicure for diabetics and patients with rheumatism 

Reimbursement of the costs of foot care for an insured person who has diabetes or rheumatism. The health care 

insurer may require a doctor's certificate. 



• cervical cancer test (smear), carried out by a general practitioner; 


• cholesterol examination, once per insured person per policy year. 

• electrocardiogram (E.C.G.): 

• cardiovascular examination; 

• prostate cancer examination. 


16 Preventive vaccinations and medicines 


foreign countries, up to a maximum of € 100.00 per insured person per year, against: hepatitis A/B, DTP, yellow fever, 

typhoid, cholera, meningococcal or other meningitis, rabies or malaria, subject to these being provided/administered 

by a general practitioner or a doctor who is recognised by the LCR (National Coordination Centre for Advice to 

Travellers) and qualified to vaccinate against yellow fever. See www.lcr.nl for a list of addresses. 

Vaccinations and/or medicines needed for work-related travel or work-related stays abroad do not qualify for 

reimbursement. 


Reimbursement of the costs of a maximum of four sessions per calendar year over and above the first-line psychology 

care sessions covered under the IAK Health Care Insurance, up to a maximum of € 60.00 per session, the care being 

provided by a first-line psychologist who is a member of the NIP (Dutch Institute of Psychologists) or a health care 

psychologist. 




general hospital, a GGZ (mental health care) institution or an independent practice. 











the IAK Health Care Insurance, the Decree and the Regeling Zorgverzekering that form part thereof, all at the 

discretion of the health care insurer and subject to the prior written permission of the health care insurer. In the 

event of transport by private vehicle, the costs will be reimbursed at the rate per kilometre laid down in the 

Regeling Zorgverzekering increased by € 0.10 per kilometre; 


Health Care Insurance, per insured person per calendar year for seated patient transport (taxi, private vehicle or 

public transport). 


42 




day qualifies for reimbursement under the AWBZ.

General 

VII Supplementary insurance 

Dental Care (Tandartskosten) 





20 Cover 

1.1 

1.2 

Reimbursement of 80% of the costs of care normally provided by dentists on the basis of the rate agreed with the care 

provider by or on behalf of the health care insurer, unless the health care insurer has stipulated otherwise. 

Invoices must be prepared according to the Wmg (Health Care Market Regulation Act) description and coding as drawn 

up by the NZa (Dutch Care Authority). 

Reimbursement will be granted up to a maximum of the amount indicated on the policy schedule per insured person 

per policy year including technical costs, in respect of the costs of treatment provided by a dentist, dental prosthesist 

or oral hygienist. 

Reimbursement will include the technical costs linked to treatments provided by a dentist or a dental prosthesist on 

the basis of the rates recommended by the NTG (Dutch Dental Technical Society), the VLHT (Association of Laboratory 

Dental Technicians) and the ONT (Organisation of Dutch Dental Prosthesists) to their members. 

21 Exclusions 

The following costs will not be reimbursed: 

• the filling in of diastemas that were already present at the time of the insurance application; 

• the placement of crowns on teeth to which root canal treatment had already been applied at the time of the 

insurance application, unless there was already a crown on the tooth in question; 

• orthodontics; 

• treatments that are unnecessarily expensive, unnecessarily complicated or inappropriate in dental terms. 


44 

General 

VIII Supplementary insurance 

Hospital Plus (ZiekenhuisPlus) 

Entitlement to reimbursement of costs under above supplementary insurance shall be subject said supplementary 

insurance being recorded on the policy schedule and if and insofar as there is no entitlement under the IAK Health 

Care Insurance pursuant to the Zvw (Health Care Insurance Act) or under any other supplementary health care 

insurance. This supplementary insurance is governed by the IAK Supplementary Health Care Insurance General 

Conditions. 

22 Cover 

1.1 Nursing/hospitalisation 

Nursing/hospitalisation of the insured person in a hospital in the Netherlands (or abroad, provided that said hospital is 

recognised by the overseas competent authorities), that exceeds the standard or lowest rate or category (facility), in 

cases where for medical reasons nursing, investigation and/or treatment can only be provided in a hospital and 

uninterrupted treatment by a medical specialist or dental surgeon is essential. In this context, nursing/hospitalisation 

shall be understood to mean a stay of 24 hours or longer. 

Reimbursements: 

1. Reimbursement will be granted in respect of the costs of nursing in a hospital that exceed the standard or lowest 

rate or category available, subject to a maximum of the standard rate charged in the Netherlands, this being 

determined at the discretion of the health care insurer. 

2. In cases where nursing is provided at the standard or lowest rate or category available, or where the hospital in 

question does not have different rates or categories, the health care insurer will reimburse € 70.00 per nursing 

day. 

3. If nursing takes place in a specially designed location or department within a hospital where the insured person 

has access to extra facilities, services and comforts that are not standardly provided by said hospital or institution, 

(or not provided under the standard or lowest or only available category), then the costs charged by the hospital 

will be reimbursed up to a maximum of € 200.00 per nursing day. 

No reimbursement will be made of the costs of a stay in the rehabilitation or psychiatric department of a hospital or 

psychiatric hospital. 

a. Convalescent homes 

Reimbursement of the costs of a stay in a convalescent home that provides somatic care selected by the health care 

insurer. Call us or visit our website for a list of the selected convalescent homes. Reimbursement is subject to a 

maximum of € 100.00 per day up to a maximum of 28 days per insured person per policy year. You are required to 

acquire prior written permission from the health care insurer. Reimbursement is subject to there being no entitlement 

(or no longer any entitlement) to reimbursement under another supplementary or other health care insurance. 

b. Transportation to and from the hospital by taxi 

Reimbursement of the costs of transportation by taxi on the first and last day of a hospital stay in the Netherlands. If 

the insured person is accompanied in the taxi by a second person, that person’s trip to and from the hospital will also 

be reimbursed. A maximum of 4 taxi journeys per hospital stay will be reimbursed. 

23 Obligations of the insured person 

The insured person must demonstrate his/her entitlement to reimbursement of the costs named in this supplementary 

insurance by submitting an original, stamped invoice, from which the health care insurer can deduce which 

reimbursement should be made.

General 

IX Supplementary insurance 

Home Help (Huishoudelijke Hulp) 


longer any entitlement) to such reimbursement under the IAK Health Care Insurance pursuant to the Zvw (Health 

Care Insurance Act) or under one or more of the supplementary insurances described in these policy conditions, that 

have been entered into supplementary to the IAK Health Care Insurance (main insurance). 

24 Cover 

Payment of the amount indicated on the policy schedule for each day that the person who is insured under the policy 

is being cared for in a hospital as a matter of medical necessity, provided that the costs of said care qualify for full or 

partial reimbursement by the health care insurer under the IAK Health Care Insurance or supplementary insurance. In 

this context, ‘being cared for’ shall be understood to refer to a stay of 24 hours or longer. 

Reimbursement of the costs of home help will not apply in the case of hospitalisation in a psychiatric institution, 

psychiatric hospital, the psychiatric department of a hospital, rehabilitation centre, sanatorium or the Dutch Asthma 

Centre in Davos. 


46 

ZV-VW-AV ENG (01-2012)

IAK Supplementary Health Care Insurances - IAK Verzekeringen

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