IAK Supplementary Health Care Insurances - IAK Verzekeringen

More documents

Recommendations

Info

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. 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. 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. 14 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. 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.
17 Psychological care 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. 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 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. 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. 18 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. 19 Preventive care 19.1 19.2 19.3 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 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). 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. 19.4 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 person per policy year. Samen voor een perfect verzekerde toekomst 35
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 14 and 15: 14 6.5 6.6 The policyholder may giv
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 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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?