IAK Supplementary Health Care Insurances - IAK Verzekeringen

2 General conditions
2.1
2.2
2.3
2.4
Basis
This insurance contract is entered into on the basis of the information provided by the policyholder, whether or not in
his/her own hand, on the application form or supplied to the health care insurer in some other written form (e.g. per
email). The health care insurer will provide the policyholder and - if this person is not the insured person - the insured
person with an insurance policy as soon as possible after the health insurance contract is entered into, and
subsequently prior to the start of every calendar/policy year. The insured person(s) and the insurance policy/policies
effected for said insured persons will be named on the policy schedule. These policy conditions form an integral part of
the health care policy and are applicable to the following supplementary insurances:
• Jong: chapter II;
• Compact: chapter III;
• Compleet: chapter IV;
• Extra Compleet: chapter V;
• Comfort: chapter VI;
• Tandartskostenverzekering (Dental Care Insurance): chapter VII;
• ZiekenhuisPlusverzekering (Hospital Plus Insurance): chapter VIII;
• Huishoudelijke Hulpverzekering (Home Help Insurance): chapter IX;
The supplementary insurances can be entered into by or on behalf of an insured person living in the Netherlands,
unless the health care insurer specifies otherwise.
The Jong supplementary insurance can only be entered into by insured persons aged between 18 and 27.
The health care insurer can set special conditions to be applied to supplementary insurance. The supplementary
insurances IAK Tandartskostenverzekering and IAK ZiekenhuisPlusverzekering can only be entered into if and insofar
as the health care insurer specifically grants permission based on a dental inspection report or health certificate or the
state of health of the prospective insured person.
Unless otherwise specified, chapter I shall apply to all supplementary insurances.
Group health insurance contract
The provisions of the group health insurance contract entered into with the group contracting party shall prevail if and
insofar as they deviate from the provisions laid out in these policy conditions. If the provisions in the group health
insurance contract entered into with the employer are no longer applicable, the provisions of the IAK Supplementary
insurances as they apply to individually insured persons shall once more become valid. It is not possible to be insured
under more than one group insurance contract at one and the same time.
The supplementary insurance will be terminated as soon as the criteria for participating in the group health insurance
contract are no longer met, for example upon termination of the employment contract. The health care insurer can
then offer the insured person an individual insurance policy.
Medical necessity
Entitlement to care or to the reimbursement of the costs of care as defined in these policy conditions shall only exist if
and insofar as the insured person can reasonably be deemed to need the type of care in question (in terms of both the
form the care takes and how extensive it is) and provided that the type of care is both appropriate and effective.
Appropriate form and extensiveness will be defined in part on the basis of the latest scientific advances and current
practice as identified via the Evidence-Based Medicine (EBM) method. In the absence of such information, the
appropriate form and extensiveness of care will be determined on the basis of what constitutes responsible and
adequate care within the relevant discipline.
Who may provide the care
The care provider has to meet certain requirements. For many categories of care provider (including general
practitioners, medical specialists, dentists, physiotherapists and health care psychologists), these requirements are
prescribed by law and the medical title is protected. For those care providers in respect of whom the requirements are
not prescribed by law or to whom additional requirements apply, the exact requirements the care provider must meet
are laid out in the relevant article of this document.
For some types of care, certain care providers have been contracted, designated or recognised by the health care
insurer. If a care provider is used that has not been not contracted, designated or recognised by the health care
insurer, the insured person may receive a lower reimbursement or no reimbursement at all. In that case, this will be
stated in the relevant article in this document. For other types of care, the insured person is free to select a care
provider, provided that the other requirements laid down in the insurance terms and conditions are met.
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.
Specific agreements have been reached with certain suppliers. Where there are preferred suppliers, this is noted in the
relevant article in this document.
Together for a perfectly insured future 9