IAK Supplementary Health Care Insurances - IAK Verzekeringen

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.
32 Preventive care
14.1
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
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 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;
• reanimation courses given by an instructor or organisation certified by the NRR (Dutch Reanimation Council).
Samen voor een perfect verzekerde toekomst 27