IAK Supplementary Health Care Insurances - IAK Verzekeringen

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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.
2.6
2.7
2.8
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.