IAK Supplementary Health Care Insurances - IAK Verzekeringen

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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. Together for a perfectly insured future 15
Page 1: IAK Supplementary Health Care Insur
Page 4 and 5: 4 I General section 5 1 Definitions
Page 6 and 7: 6 1.19 1.20 1.21 1.22 1.23 1.24 1.2
Page 8 and 9: 8 1.65 1.66 Youth psychologist: a p
Page 10 and 11: 10 Below are the types of care for
Page 12 and 13: 12 Charge for payment via paper pay
Page 16 and 17: 16 Cover II Jong Extent of the cove
Page 18 and 19: 18 6.2 Glasses / contact lenses Rei
Page 20 and 21: 20 Cover III Compact Extent of the
Page 22 and 23: 22 15 Medical aids 6.1 6.2 Individu
Page 24 and 25: 24 Cover IV Compleet Extent of the
Page 26 and 27: 26 You can find a list of care prov
Page 28 and 29: 28 14.2 14.3 For a list of patient
Page 30 and 31: 30 Cover V Extra Compleet Extent of
Page 32 and 33: 32 5 Pharmaceutical care 5.1 5.2 Co
Page 34 and 35: 34 can be called in where the insur
Page 36 and 37: 36 20 Second opinion Reimbursement
Page 38 and 39: 38 2.5 in advance to the health car
Page 40 and 41: 40 9.3 lenses that are replaced mon
Page 42 and 43: 42 Reimbursement will apply to medi
Page 44 and 45: 44 General VIII Supplementary insur
Page 46: 46 ZV-VW-AV ENG (01-2012)

IAK Supplementary Health Care Insurances - IAK Verzekeringen

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