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4. or one of the following conditions:1º. chronic obstructive pulmonary disease if t<strong>here</strong> is a FEV1/VC less than 60%;2º. congenital anomaly of the respiratory tract;3º. lymph edema4º. scar tissue of the skin after a trauma or otherwise;5º. status after admission to a hospital, a nursing facility or an institution for rehabilitation or else after aday treatment at an institution for rehabilitation and the assistance intends to accelerate the recovery afterdischarge to home or the termination of day treatment; for a maximum period of 12 months followingdischarge or termination of the treatment;6º. intermittent claudication (vascular) grade 2 or 3 Fontaine; for a maximum period of 12 months;7º. soft tissiue tumoren;8º. diffuse interstitial lung disease in case of respiratory limitation and diffusion impairment.4.6 Dental CareThe insured individual younger than 18 years (juvenile) is entitled to dental care by an institute for juveniledental care; by a dentist or by dental specialist.The dental care for the insured juvenile encompasses the following treatments within the scope and subjectto the conditions of the Regulation.• periodic preventive dental examination once a year unless more care is required from a dental careperspective;• incidental consultation;• the removal of tartar;• fluoride application from the age of 6 up to a maximum of twice a year,. In special cases t<strong>here</strong> can be aclaim to fluoride application more than twice a year;• sealing;• periodontal support (assistance with inflammation surrounding tooth);• anesthesia;• endodontic treatment (assistance with root canal inflammation);• restoration of teeth elements with plastic materials;• gnathological assistance (assistance with mandibular jointand muscles);• removable prosthetic devices;• tooth replacement assistance with non-plastic materials ifthis concerns the replacement of one or more missing,permanent incisive or eye teeth that are not in place orelse because the absence of that tooth or those teeth is thedirect result of an accident;• dental surgery assistance, except for the fitting of a dentalimplant;• X-ray exam, except for X-ray exam for orthodontic assistance.Orthodontics except for esthetic orthodontics is partially covered for insured individuals younger than 18years. The coverage amounts to US$ 2,500 for the entire term of the insurance (contract) for fixed equipmentand US$ 500 for removable devices.13
The insured of 18 years and older (adult) is entitled to:• Removable full prosthetic devices for the upper and lower jaw• Dental surgery and the related x-ray exam, with the exception of periondontal surgery, straightforwardextractions and the placement of a dental implant• The placement of a dental implant and the related surgical assistance if it concerns a severely atrophiedtoothless jaw and the application serves the placement of a removable prosthesis.The adult is entitled to a one-time remediation. The remediation consists of an x-ray, anesthesia, restorationof the teeth elements with plastic materials and extractions.The insured has other than the abovementioned treatments, if those treatments are necessary in view of asevere congenital or acquired dental, physical or mental disorder, and that without that care he will not beable to maintain or acquire dental function.The dental care takes place in a practice space set up by the dentist and within the regular practice hours. Inspecial cases exceptions may be made. If the assistance is provided outside the regular practice hours theinsured must pay a contribution equivalent to the amount of additional costs.The dental care does not include treatment that is unnecessarily costly, unnecessarily complicated or that isdentally ineffective.permission of the ‘ZVK’.The insured younger than 18 years needs permission of the ‘ZVK’ prior to the following treatments.• periodontal surgery (surgery on inflammation surrounding tooth);• extraction under general anesthesia;• osteotomy;• placing of a dental implant.The ‘ZVK’ must give permission for other treatments related to severe congenital or acquired dental, physicalor mental disorders.4.7 Pharmaceutical careThe insured is entitled to:• advice and guidance from the pharmacists regarding medication and the responsible use of medicines;• polymer, oligomer, monomer and modular diet preparations if the insured cannot manage with adjustedstandard nutrition and other products of special nutrition.The pharmaceutical care also includes the flu vaccine.The insured is only entitled to pharmaceutical care that has been prescribed by a physician, dentist,obstetrician, or a person or institution that provides care of specific medical, specific behavioral scientific orspecific paramedical nature.In the pharmaceutical care, in principle, only generic medicines will be prescribed based on a list to bepublished.14
Page 1 and 2: ZorgverzekeringskantoorInformation
Page 3 and 4: Chapter 5 Legal protection ........
Page 5 and 6: Chapter 2 The healthcare insurance
Page 7: Chapter 3 The insured and the insur
Page 10 and 11: Various forms of transplantation tr
Page 12 and 13: 4.4 Hospital CareThe insured is ent
Page 16 and 17: The insured up to 21 years of age a
Page 18 and 19: 4.11 Patient TransportThe insured i
Page 20 and 21: e. the coverage referred to under s
Page 22: 5.3 National OmbudsmanIf the insure

here - Rijksdienst Caribisch Nederland

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