IAK Supplementary Health Care Insurances - IAK Verzekeringen

1 Definitions
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11
1.12
1.13
1.14
1.15
1.16
1.17
1.18
In the policy conditions below, the following words/terms shall have the following meaning:
I General section
Alternative and special remedies: remedies that differ from regular remedies in terms of both their nature and the
treatment methods used.
Authorisation: prior written permission granted to the insured person by or on behalf of the health care insurer for
the acquisition of specific health care.
AWBZ: Exceptional Medical Expenses Act (Algemene Wet Bijzondere Ziektekosten).
Beautician: a beautician with the Beauty Care diploma B plus the Camouflage diploma for camouflage therapy, the
Electrical Epilation diploma for electrical hair removal and the Acne diploma for the treatment of acne.
Care hotel: an establishment contracted as such by the health care insurer that guarantees 24-hour care and service
consisting at least of nursing and care in a hotel-like setting.
Cesar/Mensendieck remedial therapist: a person entitled to use the title of remedial therapist under article 18 of
the Decree for dieticians, occupational therapists, speech therapists, oral hygienists, remedial therapists,
orthopaedists, and podotherapists.
Child physiotherapist: a physiotherapist listed as a child physiotherapist in the Register of Specialist
Physiotherapists maintained by the KNGF (Royal Dutch Society of Physiotherapists).
Child psychologist: a person listed as a child psychologist in the Register of Child Psychologists maintained by the
NIP (Dutch Institute of Psychologists).
Clinical psychologist: a health care psychologist registered according to the conditions referred to in article 14 of the
Wet BIG (Individual Health Care Professions Act).
Company doctor: a physician listed as a company doctor in the Register of Recognised Social Physicians maintained
by the SGRC (Social-Medical Registration Committee) of the KNMG (Royal Dutch Medical Association). Said physician
may be employed by the Arbodienst (Dutch Health and Safety Executive) or may have entered into a contract with the
health care insurer.
Convention territory: countries not belonging to the European Union or EEA with which the Netherlands has entered
into a social security convention including an arrangement for the provision of medical care, namely: Australia (for
holidays/temporary stay), Bosnia-Herzegovina, Cape Verde Islands, Croatia, Macedonia, Morocco, Serbia-Montenegro,
Tunisia and Turkey.
Dental surgeon: a dental specialist listed in the Register of Specialists in Oral Disease and Dental Surgery maintained
by the NMT (Dutch Dental Association).
Dentist: a person listed as such in the register referred to in section 3 of the Wet BIG.
DBC: Diagnosis Treatment Combination (Diagnose Behandeling Combinatie) A DBC details the completed and
validated trajectory of medical specialist care and specialist medical health care (second-line curative mental health care
(GGZ)) by means of a DBC performance code established by the NZa (Dutch Care Authority). This encompasses the
request for care, the care type, the diagnosis and the treatment. The DBC trajectory begins from the moment that the
insured person submits his/her care request and ends when the treatment has been completed or after 365 days.
Dispensing general practitioner: a general practitioner who is licensed to dispense medicines under article 61
paragraph 10/11 of the Geneesmiddelenwet (Medicines Act).
Doctor: a person listed as such in the register referred to in article 3 of the Wet BIG.
Establishment:
• an establishment in the sense of the WTZi (Health Care Establishments Licensing Act);
• a legal entity based abroad that provides care in the country concerned under that country's social security
system, or that provides care to specific groups of public officials.
European Union and EEA member states: in addition to the Netherlands, these include the following countries in
the European Union: Belgium, Bulgaria, Cyprus (the Greek part), Denmark, Germany, Estonia, Finland, France,
Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Austria, Poland, Portugal, Romania, Slovenia,
Slovakia, Spain, Czech Republic, the United Kingdom and Sweden. Switzerland has also been accorded equal status
under treaty provisions. Also included are the three EEA-EFTA states, namely Lichtenstein, Norway and Iceland.
Together for a perfectly insured future 5