Nationale-Nederlanden Zorg Vrij health insurance is a basic insurance scheme with a combined policy. This means that you choose your own healthcare providers. Most of the time the costs of your care are reimbursed completely. Also if you want to go to a non-contracted healthcare provider. Do you want to go to a non-contracted provider for GGZ, district nursing, physiotherapy or exercise therapy? Than we reimburse 75% of the bill, and this will never be more than the maximum rate.
The reasonable market price is the fee that is usual for a particular type of care in the Netherlands. This is at most the fee that is considered reasonable in the Dutch market. The costs of the care that are claimed must be proportionate to the price of similar care declared by healthcare providers in the Netherlands. The reasonable market price is also called ‘marktconform’, i.e. the rate that is in line with the market. A price is not considered to be a reasonable market price if an invoice for care diverges excessively from invoices for similar care by similar healthcare providers. In that case we do not pay that part of the invoice that is in excess of the reasonable market price. We thus pay no more than the reasonable market price. You always have the opportunity to ask your healthcare provider to what extent your care costs will be reimbursed.
Do you go to a healthcare provider with which we have no agreements? Do we have no contract with other healthcare providers for the specific type of care or treatment? Is there also no statutory rate and is it impossible or virtually impossible to determine a reasonable market price? In that case we will reimburse the fee that is claimed. We will reimburse the costs up to the amount that you are entitled to under your insurance. The reimbursement is never higher than the amount claimed.