IAK Supplementary Health Care Insurances - IAK Verzekeringen

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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.
Together for a perfectly insured future 11