UMC Healthcare Insurance 2025

Your supplementary insurance entitles you to (reimbursement of the costs of) care as described in these policy conditions subject to medical necessity. Medical necessity is the case if it is fair and reasonable to state that you are dependent on the type of care in terms of content and scope, and if the type of care is efficient and effective. A key factor in the content and scope of the type of healthcare is ‘what the relevant healthcare providers generally offer’.

Your healthcare provider must comply with certain conditions. The relevant healthcare article sets out which healthcare providers may provide the healthcare services and the supplementary conditions the healthcare provider must fulfil. For some types of healthcare, we offer contracted, preferred or accredited healthcare providers.

A list of our contracted, preferred and accredited healthcare providers is available from our website.

You are entitled to reimbursement of healthcare costs (covered), up to the maximum of the Wmg (Healthcare Market Organisation Act) rates applicable in the Netherlands. If no Wmg rates apply, we will reimburse the costs up to the market price perceived as reasonable in the Netherlands.

Healthcare provided by a contracted healthcare provider

If you make use of a healthcare provider we contracted, then we reimburse the cost of healthcare based on the rates agreed.

Healthcare provided by a non-contracted healthcare provider

If you selected a healthcare provider that we have not contracted for the care (relevant for you), then you may be required to personally pay all or some of the invoice. Non-contracted care providers also include preferred care providers. Please find more information in these policy conditions per type of care. If applicable, your claim on us for skin treatments, mindfulness for burn-out complaints or sex therapy cannot be transferred to healthcare providers or other parties without a contract for this type of healthcare. This is a clause as referred to in Article 3:83 paragraph 2 of the Civil Code. Any reimbursement for expenses relating to healthcare provided by a healthcare provider that we have not concluded a contract with will be remitted to the policy holder’s account number.

Healthcare provided by a non-preferred or non-accredited healthcare provider

Did you select a non-preferred or non-accredited healthcare provider? Then we do not reimburse the cost. Please find more information in this reference guide per type of care.

Budget

Do you have a budget for the relevant healthcare? In that case, the total reimbursement will never exceed the maximum budget stated in the relevant care provision.

We also reimburse some healthcare types if the care is provided by a care provider established abroad, provided that this care provider offers comparable care. This is set out in the relevant care provisions. If these insurance terms and conditions entitle you to reimbursement of a statutory personal contribution on the grounds of the healthcare insurance, we will also reimburse you if this care has been provided abroad and is covered for reimbursement under the healthcare insurance policy.

Most healthcare providers send us the invoices directly. If you have received an invoice yourself, you can submit your claims online via the Mijn UMC Zorgverzekering or via the UMC Zorg app. You must retain the original invoice for at least one year after submitting the relevant claim form. We may request the invoices for inspection. If you are unable to submit the invoices, we may recover the amounts paid out to you, or settle the relevant amounts with amounts due to you. Submitting claim forms by post is also possible. Send the original invoice to Postbus 25030, 5600 RS Eindhoven. In some cases, we may also ask you to complete a claim form and send it to us. Visit our website for more information.

Please do not send us a copy or reminder. We can only process original invoices. We can only reimburse invoices that we have received within 3 years. This period of 3 years starts on the first day after the day that you become aware the claim is due.

Please check that at least the following details are listed in the invoice:

• the date on which the invoice was made by the care provider and the invoice number (in the right order, and each invoice number may only occur once);
• your name, address and date of birth;
• type of treatment, amount per treatment and date of treatment;
• the name and address of the healthcare provider.

These invoices, together with any attachments, have to be specified, ensuring that the reimbursements we must pay out can be derived from the specifications directly and without any ambiguity. For conversion of foreign invoices in currencies other than euros, we use the historical rates available from www.XE.com. This is based on the rate on the day you were treated. Invoices and any attachments must be in Dutch, English, French, German or Spanish. If a translation is necessary to our discretion, we may request you to provide a certified translation of the invoice. We will not refund the translation expenses.

We may pay the healthcare costs directly to the healthcare provider. This means you are not entitled to reimbursement.

If we pay directly to the healthcare provider, sometimes a small contribution is required from you. Sometimes we have reimbursed more than you are formally entitled to pursuant to your supplementary insurance policies. Or the cost of care will be charged to you for some other reason. In that case, as the policyholder, such costs are payable to us. We will charge these amounts to you later. You have a legal obligation to pay such amounts. We reserve the right to settle such amounts with amounts due to you.

For some forms of healthcare, you require a referral, prescription and/or prior approval in writing demonstrating that you are dependent on this healthcare. The healthcare article provides more details.

Referral or prescription

Does the healthcare article set out that you require a referral or a prescription? Then you can request one from the healthcare provider mentioned in the article. This is generally the general practitioner.

Permission (authorisation)

Sometimes you need our permission before you are granted reimbursement for certain care. Such approval is also called an authorisation. If you have not received such an authorisation beforehand, you are not entitled to (reimbursement of the costs of) care.

If you use a care provider with whom we have not concluded a contract for the care in question, you must request permission from us personally. For certain care, the care provider may request permission on your behalf. Visit our website for more information. In order to grant permission, we check whether your care provider is of irreproachable behaviour. If your care provider is not of irreproachable behaviour, this may affect the response to your request for permission.

You are entitled to healthcare or reimbursement of such healthcare if the healthcare was delivered during the term of your supplementary insurance policy. In these Policy Terms and Conditions, this is based on years or calendar years. To determine the year or calendar year associated with the submitted expenses, we check the date the healthcare service was delivered by the healthcare provider. This is the reference date for this purpose. Suppose that your treatment falls in two calendar years and the healthcare provider may charge the cost as a single amount (for example a Diagnosis Treatment Combination), Then we will reimburse these costs if the treatment started within the term of the supplementary insurance and the costs were incurred in the calendar year in which your treatment started.

If you need healthcare as a result of one or more terrorist events, then the following rule applies. If the total amount of claims submitted within a year or calendar year for non-life, life or in-kind funeral insurers (including healthcare insurers) according to the Nederlandse Herverzekeringsmaatschappij voor Terrorismeschaden N.V. (NHT or Dutch Reinsurance Company for Terrorism-Related Claims) exceeds the maximum amount that this company reinsures annually, you are entitled to only a certain percentage of the cost or value of the healthcare. The NHT determines the exact percentage. This applies for non-life, life and funeral insurers (including healthcare insurers) that are subject to the Financial Supervision Act. The exact definitions and provisions of this claim have been set out in the NHT's Terrorism Cover Clauses Sheet.

The insurance contract has been concluded on the basis of the information that you have entered online, by telephone, in writing or on the application form.

After taking out the healthcare insurance policy, you will receive a policy from us as soon as possible. Furthermore, you will receive a new policy prior to each new calendar year. These policy conditions form an integral part of the policy. The policy schedule will state the persons insured and the supplementary healthcare insurance taken out for them.

The insurance contract applies to the supplementary insurance policy/policies shown on the policy schedule or otherwise confirmed to you in writing. These policy conditions are part of the insurance agreement and apply to UMC Extra Zorg and UMC Extra Tand. These packages are referred to in these policy conditions as: supplementary insurance.

In these insurance conditions, we refer to documents. These form an integral part of the policy conditions insofar as applicable. It concerns the following documents:

• Appendix 1 to the Healthcare Insurance Decree
• Healthcare Insurance Scheme
• Clauses Sheet Terrorism Cover
• List maximum reimbursements non-contracted healthcare providers supplementary insurance policies
• List of maximum reimbursements abroad
• Overview contracted and preferred healthcare providers
• Reference protocol to the lactational NVL en VSBB
• Healthcare Module Prevention Diabetic Foot Ulcers
• We adhere to the covenant on overlap of travel insurance policies and supplementary health insurance.

You can find these documents on our website.

If we suspect fraud, we will conduct an investigation (or have one conducted). You are required to cooperate with this investigation and provide us with relevant and accurate information. During this investigation, we will not pay out any of your claims. Does the investigation reveal that you have, or someone else on your behalf has, committed fraud (for some or all of the relevant claims)? Then your right to (reimbursement of the cost of) care will lapse. In addition, we will recover from you any amounts paid out on the relevant claims. You are also required to pay the costs resulting from the fraud investigation.

Termination of insurance policy/policies

If you commit fraud, we will terminate your healthcare insurance policy. In that event, you will not be accepted for a new healthcare insurance policy for 5 years. We will also terminate your supplementary insurance. In that case, you cannot take out supplementary insurance cover with the insurers of Coöperatie VGZ for 8 years.

Fraud committed by healthcare providers

We list any healthcare providers who commit fraud on the External Referral Registry (EVR). We do not reimburse care from health care providers who are on this registry and will inform these providers accordingly. Prior to providing care, the health care provider is required to inform you that we will not reimburse their care.

We process your private data when we carry out your insurance policies. This is completed in compliance with legislation and regulations, including the General Data Protection Regulation (GDPR). Please find more details about this in the privacy statement on our website. The privacy statement also states your rights.

If you have any questions regarding processing private data, please contact our Data Protection Officer. For more information about privacy, please check the Privacy page on our website.

Communications sent to the last address known to us will be deemed to have reached you. If you want to receive all our messages in electronic format, please indicate your choice in Mijn UMC Zorgverzekering or in the UMC Zorg app.

Upon acceptance for this healthcare insurance policy, you, as the policyholder, also become a member of the cooperative society Coöperatie VGZ U.A., unless you notify us in writing that you prefer not to do so. The Cooperative looks after the interests of its members in the field of health and other insurance policies. You may terminate your membership at any time, subject to a one-month notice period. The membership will in any case be terminated on the termination date of the insurance contract.

Upon taking out supplementary insurance, you have a 14-day cooling-off period as the policyholder. You are entitled to cancel the supplementary insurance policy in writing within 14 days of signing the contract. In that event the insurance contract is deemed to have never been concluded.

The supplementary insurance is governed by Dutch law.
Do the provisions of these English insurance conditions conflict with the provisions of the Dutch version of these insurance conditions? Then what is determined in the Dutch insurance conditions takes precedence.

The policyholder is required to pay premium. For an insured person younger than 18 years of age, no premium needs to be paid until the first day of the calendar month following the 18th birthday. Example: someone who turns 18 on 1 July will pay premiums starting 1 August.

Upon death of an insured, premium is due up to the date of death. After a change of the supplementary insurance policy, we will recalculate the premium as per the effective date of the change.

What requirements does the account number have to meet?

The name that goes with the account number must correspond to the name of the policyholder. In addition, the account number must be registered in a country that participates in the Single Euro Payments Area (SEPA).

The premiums and conditions as set out in the group contract apply from the first day of your participation in the group contract.

From the day you can no longer participate in the group contract, the premium discount and conditions of the group contract will expire. From this day onwards, the supplementary insurance will be converted into supplementary insurance on an individual basis if you belonged to the target group as described in Article 6.2.1.

You can only participate in 1 group contract at a time.

You are required to pay the premium and (foreign) statutory contribution monthly in advance for all insured, unless otherwise agreed.

If you do not use digital correspondence, you will be charged a fee for paper post. The cost amounts to €1.25 per month. You do not pay any fees for the policy and the European Health Insurance Card (EHIC). More information on paper post costs is available from our website.

You will pay the premium, excess, personal contributions, fees for paper invoices and benefits paid to you in error using the payment method agreed with us.

Payment options

1. You authorise us for automatic direct debit of the amounts due (see also Article 3.3.4).
2. You make use of the option of receiving a digital invoice free of charge via Mijn UMC Zorgverzekering. In that case you are expected to personally ensure on-time payment. Direct online payment via iDeal is an option.
3. Your employer deducts the premium and any charges for paper post from your salary and remits these amounts to us.
4. You make use of the option of receiving a paper invoice. In that case you are expected to personally ensure on-time payment. You will also receive a paper invoice if the direct debit transaction cannot be executed.

Your authorisation for direct debit applies to the payment of premiums, excess, personal contributions, charges for paper post and any amounts paid to you in error. Such an authorisation applies during and if necessary also after expiration of the insurance contract. Please refer to your policy schedule to check the date of direct debit collection of the premium for the entire calendar year. For the other costs, we will notify you at least 3 days before the date on which the amount is collected, stating the amount to be taken out of your account and the direct debit transaction date. If you disagree with a processed payment, you can have the payment reversed later. Please contact your bank within 8 weeks of processing the payment.

You may not settle any amounts due with any amounts payable to you.

If you do not pay the premium, statutory contributions, personal contributions, excess, paper post charges and any amounts paid out to you in error before the due date, we will send you a reminder. If you do not pay within the term of at least 14 days as stated in the reminder letter, we may suspend cover of the supplementary insurance policy/ policies. In that case you are not entitled to healthcare and reimbursement of healthcare costs from the last premium due date before the reminder. Your obligation to pay the premium will continue during any period of suspension. Entitlement to (reimbursement of costs of) healthcare is restored on the date following the date on which the amount due plus any fees were received. We reserve the right to terminate the supplementary insurance policy/policies if payments are in arrears. In the event of termination of the insurance contract, you may submit an application for supplementary insurance after payment of the amount and any fees due. Do you have an active debt repayment/restructuring arrangement and are all the creditors in agreement (MSNP/ WSNP)? Then you can apply for supplementary insurance. If we accept the application, the supplementary insurance cover will take effect on 1 January of the next calendar year.

If you have already been reminded for failure to pay premiums, statutory contributions, excess, personal contributions, paper post charges or any amounts paid out to you in error, we are not required to give you separate written notice if you fail to pay a subsequent charge on time.

We reserve the right to directly settle the premium due, fees and statutory interest with any amounts of claimed healthcare costs or other amounts payable to you.

If we terminate the supplementary insurance policy/policies because of overdue payment of the premiums, we reserve the right to not accept you for any new insurance contracts for a period of 5 years.

We reserve the right to change the conditions and the premium of the supplementary insurance policy/policies at any time. We will inform you, the policyholder, accordingly in writing. Such changes shall become effective on a date at our discretion.

If we amend the conditions and/or the premium of the supplementary insurance policy/policies to your disadvantage, you, as the policyholder, have the right to cancel the insurance contract as per the effective date of the change. You may cancel the contract in any case during one month after being notified of the amendment. You do not have the right to cancellation if amendment of the policy conditions directly ensues from statutory measures, arrangements or provisions.

The insurance contract becomes effective on the date that we have designated as the start date of the healthcare cover, on the date on which you participate in the group contract, or on 1 January of a calendar year. The supplementary insurance policy is taken out for the calendar year in which the supplementary insurance became effective. Upon expiration of this term, the supplementary insurance policy is subject to automatic renewal for a period of one calendar year.

Acceptance for supplementary insurance

The supplementary insurances of Zorgverzekeraar UMC insurance can only be taken out as a supplement to the healthcare insurance policies of Zorgverzekeraar UMC insurance if healthcare insurance is mandatory for you within the meaning of the Healthcare Insurance Act (Zorgverzekeringswet). You can take out the UMC Extra Zorg and UMC Extra Tand supplementary insurance policies (see chapters II and III) only if you are part of the target group for which group contracts have been made and you are actually insured with us through a Zorgverzekeraar UMC contract. UMC Extra Tand 3 is subject to a 12-month qualification period for crowns and bridges (R codes), partial dental prostheses (P codes), implants (J codes and the fees invoiced by the oral surgeon) and orthodontic care (F codes). Insured up to age 18 in UMC Extra Zorg 2 en UMC Extra Zorg 3 are subject to a qualification period for orthodontic care (F codes). This means that during the qualification period, you are charged a premium, but you do not receive any reimbursement for crowns, bridges, partial dental prostheses, implants and orthodontic care.

The table below shows you in which cases we consider your current reimbursement to be equivalent. Visit our website for more information.

Family cover

Children under age 18 will have the same supplementary insurance policy/policies as the highest level insured for a parent/foster parent on the policy.

Change to supplementary insurance

You may decide to change your supplementary insurance policy/policies. This is subject to the provisions of 6.2.1 and 6.2.2 As the policyholder, you are required to forward us such changes latest by 31 January 2025. The change will then become effective as per 1 January 2025 (with retroactive effect). A change is defined as switching to another supplementary insurance we offer.

If you want to switch to a supplementary insurance policy provided by a different insurer, you need to cancel your current supplementary insurance policy. You must notify us of your cancellation by 31 December (see Article 6.4. When can you cancel your insurance policy/policies?).

In the cases of care for which reimbursement waiting periods of more than one calendar year apply, these periods will continue if any Zorgverzekeraar UMC supplementary insurance is changed. This means that reimbursements previously paid by us on the basis of a previous supplementary insurance will be included in the new supplementary insurance. This is subject to the condition that your new supplementary insurance includes reimbursements for this care.

Regulatory termination of the supplementary insurance cover is effective on the day following the day on which:

• the healthcare insurer is no longer permitted to offer or administer insurance policies due to change or suspension of its licence for general insurance activities. We will disclose any such changes at least 2 months in advance;
• the insured person dies;
• the insured is no longer subject to mandatory insurance under the Healthcare Insurance Act;
• the healthcare insurer suspends its activities in offering and executing the supplementary insurance policy/policies as set out in these policy conditions. We will disclose any such changes at least 3 months in advance.

As the policyholder, you are required to inform us as soon as possible of the death of an insured or other facts and circumstances relating to the insured that result in termination of the supplementary insurance cover. If we determine that the supplementary insurance policy is terminated or will be terminated, we will send you a termination certificate as soon as possible.

Annually

As the policyholder, you may cancel the supplementary insurance policy/policies in writing as per 1 January of any year, subject to our receipt of your notice of termination by 31 December of the previous year at the latest.

Cancellation service

Alternatively, you may make use of the cancellation service provided by the Dutch healthcare insurers to cancel your supplementary insurance policy/policies. Details are set out in Articles 6.4.1 and 6.4.2. This means you authorise the insurer of your new supplementary healthcare policy/policies to cancel the healthcare policy/policies with the previous insurer.

You may rest assured that we organise everything carefully relating to your supplementary insurance policy. However, one hundred percent satisfaction is not always achievable. We are open to hearing your complaints and suggestions. For more information regarding filing a complaint, please visit our website.

You will receive a response to your complaint from us within 30 days. If you are not satisfied with the decision or if you have not received any response within 30 days, please feel free to submit your complaint or dispute to SKGZ (Foundation Complaints and Disputes Healthcare Insurance), PO Box 291, 3700 AG Zeist, the Netherlands, www.skgz.nl. Alternatively, you may submit the dispute to the competent court of law.

Do you find a form redundant or complicated? Then you may submit a complaint. More information is available on our website. Alternatively, you can submit your complaint to the Dutch Healthcare Authority for the attention of the Information Line/the Notification Centre, PO Box 3017, 3502 GA Utrecht, the Netherlands, email: info@nza.nl. The website of the Dutch Healthcare Authority, www.nza.nl, sets out how to submit a complaint about forms.

This is your cover

The cost of:

1. treatments and visits that fall in the scope of acupuncture and other oriental medicine, antroposophic alternative medicine, chiropractice, craniosacral therapy, haptotherapy, Van Dixhoorn breathing and relaxation therapy, homeopathy, E.S. manual therapy, musculoskeletal medicine, natural medicine, osteopathy and psychiatric social care;
2. homeopathic of anthroposophic drugs and medication
   • registered in accordance with the Medicines Act
   • with an HA or HM registration in the Homoeopathy Taxe of the Z index.

This is where to go

Treatments and visits are only available from one of our preferred healthcare providers. A list is also available from our website. Please go to a pharmacist for drugs and medications. A doctor with a BIG registration, general practitioner, medical specialist, oral surgeon or obstetrician prescribes the medicines.

This is covered

The cost of:

1. Physiotherapy
2. Cesar/Mensendieck remedial therapy
3. Oedema therapy
4. Scar therapy
5. Hand or finger splints for temporary use

This is who to see

1. Physiotherapy: a physiotherapist, pediatric physiotherapist, pelvic physiotherapist, psychosomatic physiotherapist, geriatric physiotherapist or manual therapist.
2. Cesar/Mensendieck remedial therapy: a Cesar/Mensendieck remedial therapist, pediatric remedial therapist or psychosomatic remedial therapist.
3. Oedema therapy: an oedema therapist or oedema physiotherapist, or skin therapist.
4. Scar therapy: a skin therapist.
5. Hand or finger splint: a physiotherapist with a Hand Therapist Certificate (CHT-NL).

For physiotherapy, Cesar/Mensendieck remedial therapy and oedema therapy, we only have contracts with healthcare providers who meet the quality requirements of the profession. We also reimburse this care if you go to a healthcare provider abroad who provides similar care. In that case, we will reimburse a maximum of the rate stated in the 'List of maximum reimbursements abroad'. An overview of contracted healthcare providers is available from our website.

Please note

For physiotherapy in the context of Parkinson syndrome, we exclusively work with contracted specialist healthcare providers that are a member of ParkinsonNet. For more information on ParkinsonNet, please visit our website.

This is your cover

The cost of occupational therapy, with the goal of more or improved self-reliance. The healthcare policy covers 10 hours of occupational therapy per calendar year. Reimbursement from the supplementary insurance is additional to this cover.

This is not covered

A hand or finger splint for preventive use, such as for playing sports.

This is who to see

An occupational therapist.

A hand occupational therapist with a Hand Therapist Certificate (CHT-NL) for a hand or finger splint for temporary use.

This is your cover

Contraceptives for insured from age 21 that may be provided in accordance with the Healthcare Insurance Regulations. This includes: contraceptive pill, contraceptive rod, coil, ring or diaphragm.

This is where to go

To one of our contracted pharmacists or dispensing practitioners. If you have selected a non-contracted pharmacist or dispensing practitioner, Then we do not reimburse the cost. A list of contracted pharmacists and dispensing practitioners is available from our website. We also reimburse this care if you go to a pharmacy abroad. In that case, we will reimburse a maximum of the rate stated in the 'List of maximum reimbursements abroad'.

This is what you have to arrange yourself

The first prescription of a new or existing contraceptives. The relevant general practitioner, obstetrician or medical specialist issues the first prescription.

This is your cover

Sterilisation.

This is where to go

One of our contracted healthcare providers. Did you select a non-contracted healthcare provider? Then we do not reimburse the cost. In the case of a vasectomy (sterilisation of the male), a general practitioner.

An overview of contracted healthcare providers is available from our website.

This is covered

The cost of purchasing prescription glasses or prescription contact lenses from an optician. We also reimburse this care if you buy spectacles or lenses from an optician abroad.

The period of 3 calendar years includes the calendar year during which you purchased prescription glasses or contact lenses and the previous two calendar years. The costs for preparing the spectacles are covered only if these are part of the purchase price.

This is covered

Visits, necessary vaccinations (jabs) and/or prevention medication if you travel abroad.

This is where to go

To one of our contracted care providers. Did you select a healthcare provider that does not have a contract with us? Then we do not reimburse the cost. An overview of contracted healthcare providers is available from our website.

We also reimburse this care if you go to a care provider abroad who provides similar care. In that case, we will reimburse a maximum of the rate stated in the 'List of maximum reimbursements abroad'.

This is your cover

A supplement to the reimbursement of the cost of emergency care you receive pursuant to the healthcare policy. This is care that you need unexpectedly and that cannot be postponed until you are back in the Netherlands. Transport cost is only reimbursed if medically required in order to receive treatment as close as possible to the place where the insured person is staying or to the site of the accident.

This is not covered

1. Costs for non-urgent care or care that can be postponed until you return to the Netherlands
2. Costs of hospitalisation and/or costs of long-term medical treatment if you did not contact or arrange for prior contact with our Emergency Centre
3. Expenses that you would not be required to pay under the law or expenses that would not have been charged if there were no reimbursement under this policy
4. Costs of care that are not reasonable and necessary.

This is what you have to arrange independently

If you are hospitalised and/or you need long-term medical care, you need to involve Emergency Response. Please find the telephone number in the UMC Zorg app, on your healthcare card or on our website. Our Emergency Response Unit is operated by ANWB.

This is not covered

Was the repatriation reason foreseeable based on a pre-existing medical condition? Then we do not reimburse the cost.

This is where to go

Our Emergency Response Unit. Our Emergency Response Unit is operated by ANWB. If repatriation is not arranged by our Emergency Response Unit, Then we do not reimburse the cost. Please find the telephone number in the UMC Zorg app, on your healthcare card or on our website.

You will receive a personal health budget that you can use for courses, healthcare and advice as set out below in Articles 18.1. Courses through 18.5. Consults and advice for women.

This is covered

If you are pregnant or trying to get pregnant, we will reimburse the cost of:

1. the self-help programme Smarter Pregnant;
2. online or on-site courses:
   • preparing you for childbirth;
   • helping you optimise your health and fitness during your pregnancy;
   • accelerating your physical post-partum recovery (maximum 6 months after childbirth);
   • focusing on bonding with your baby (maximum 6 months after childbirth).

This is where to go

The healthcare provider must be registered with the Chamber of Commerce and have a website listing the course.

You can seek advice from your obstetrician when choosing a course.

The name of the course, the provider's website and the Chamber of Commerce number must be listed on the invoice.

This is your cover

A maternity package we compile in consultation with the obstetricians. If you are pregnant, you can apply for this package through our website.

This is your cover

The cost of a visit with a lactation consultant if you have nursing issues.

This is where to go

With a lactation expert who is a member of the Dutch Association of Lactation Experts (NVL) or the Association of Breastfeeding and Baby Guidance Specialists (VSBB).

This is your cover

The cost of:

• additional aftercare when you could not or not sufficiently use your indicated hours of maternity care from healthcare insurance due to hospitalisation of yourself or your baby.
• necessary support and advice regarding the care of your adopted baby if younger than 3 months.

In both cases, the maternity organisation determines the number of necessary care hours.

This is where to go

A qualified maternity assistant or a nurse.

This is your cover

The cost of renting or buying an electrical or mechanical breast pump.

This is your cover

The statutory personal contribution for maternity care. This personal contribution applies pursuant to the healthcare insurance policy.

This is covered

Reversal operation sterilisation.

This is where to go

One of our contracted healthcare providers. Did you select a non-contracted healthcare provider? Then we do not reimburse the cost. An overview of contracted healthcare providers is available from our website.

This is covered

Reimbursement of the cost of a fourth IVF (In-Vitro Fertilisation) attempt for each pregnancy to be realised in addition to the reimbursement of the first, second and third attempts that were reimbursed, provided that the insured woman is age 42 or younger. We will only reimburse the costs of the actual 4th attempt, i.e. the attempt that directly follows on from the 1st, 2nd and 3rd attempts made under the health insurance policy.

The medication required for treatment will be reimbursed as part of specialist medical care in connection with IVF treatment.

This is not covered

The costs of the 5th and subsequent in vitro fertilisation (IVF) attempts per pregnancy to be achieved. This also applies if you have already completed the 4th attempt, but have not claimed reimbursement from us because, for example, you were not insured with us at the time of the 4th attempt.

This is where to go

Gynaecologist in an institution licensed for this specialist field. An overview of contracted healthcare providers is available from our website.

This is what you have to arrange yourself

A referral letter from a gynaecologist or urologist.

You will receive a budget that you can use for acne treatment, camouflage therapy and depilation as set out below in Articles 27.1. Acne treatment, 27.2. Camouflage therapy and 27.3. Hair removal for insured age 16 and older.

You will receive a budget that you can use for medical aids as set out below in Articles 28.1. Batteries hearing aids through 28.8. Personal contribution visual aids.

This is covered

The cost of renting or buying crutches, walker or three- or four-pronged walking stick for personal use.

This is where to go

Any supplier of these aids.

This is covered

The cost of support or compression stockings pressure class 1.

This is what you have to arrange yourself

A recent referral letter from a general practitioner or medical specialist. This should be attached when sending us the bill.

This is your cover

Correction protruding ears for insured up to age 18.

This is where to go

One of our contracted healthcare providers. Did you select a non-contracted healthcare provider? Then we do not reimburse the cost.

An overview of contracted healthcare providers is available from our website.

The actions you need to take

A referral letter from a general practitioner or medical specialist.

This is where to go

One of our contracted healthcare providers. Did you select a non-contracted healthcare provider? Then we do not reimburse the cost. An overview of contracted healthcare providers is available from our website.

The actions you need to take

1. A referral letter from a general practitioner or medical specialist.
2. You require our prior approval. We need the request to be accompanied by a substantiation from your medical specialist about the nature and extent of the defect.

This is your cover

Correction of the abdominal wall if you have an overhanging abdominal skin fold that is likely to cause blemishes. To be eligible, the overhanging abdominal skin fold should have an inner side depth measurement of 6 cm or more. Additionally, it is important to have a reasonable weight/height ratio. Your BMI is no more than 30. For abdominal wall correction after bariatric surgery, your BMI may not exceed 35 (≤35).

This is where to go

One of our contracted healthcare providers. Did you select a non-contracted healthcare provider? Then we do not reimburse the cost. An overview of contracted healthcare providers is available from our website.

The actions you need to take

1. A referral letter from a general practitioner or medical specialist.
2. You require our prior approval. The application must be accompanied by an explanation from your specialist, setting out the nature and extent of the anomaly.

This is covered

1. Surgical insertion and replacement of a breast prosthesis other than after a full or partial breast amputation, if you are not entitled to reimbursement from your healthcare insurance policy.
2. Surgical removal of a breast prosthesis without medical necessity. Reimbursement
   • of the costs: of reshaping intervention after mutilation due to injury or disease;
   • of reshaping intervention to correct a severe anomaly present and detected at birth; or
   • of resolving objectively impaired functionality.

This is where to go

One of our contracted healthcare providers. An overview of contracted healthcare providers is available from our website. Did you select a non-contracted healthcare provider? then we do not reimburse the cost.

This is what you have to arrange yourself

You require our prior approval. The application must be accompanied by a medical statement and an explanation from your medical specialist, setting out the nature and size of the anomaly and the treatment to be applied.

This is covered

A contribution towards the cost of an 8-week training Mindfulness Based Cognitive Therapy (MBCT) or Mindfulness Based Stress Reduction (MBSR). You are entitled to this training if you are age 18 or older and have burnout symptoms.

This is where to go

A mindfulness trainer who is a member of VMBN (Association Mindfulness-Based Trainers Netherlands) with category 1 membership. A mindfulness trainer certified by MBCT/MBSR who is a member of VMBN (Association Mindfulness-Based Netherlands).

You can find the trainers on the website of these associations www.vmbn.nl and www.verenigingvoormindfulness.nl.

Your claim on us for mindfulness for burn-out complaints cannot be transferred to healthcare providers or other parties without a contract for this type of healthcare. This is a clause as referred to in Section 3:83 paragraph 2 of the Dutch Civil Code. Any reimbursement for expenses relating to healthcare provided by a healthcare provider that we have not concluded a contract with will be remitted to the policy holder’s account number.

The actions you need to take

A referral letter from a general practitioner or company doctor.

This is your cover

The cost of sex therapy. This care includes help with problems with intimacy, eroticism, sexual functions and relationship and partner therapy.

This is where to go

A sex therapist registered with the Nederlandse Vereniging voor Seksuologie (NVVS or Netherlands Association for Sex Therapy).

Your claim on us for sex therapy cannot be transferred to healthcare providers or other parties without a contract for this type of healthcare. This is a clause as referred to in Section 3:83 paragraph 2 of the Dutch Civil Code. Any reimbursement for expenses relating to healthcare provided by a healthcare provider that we have not concluded a contract with will be remitted to the policy holder’s account number.

The actions you need to take

A referral letter from a general practitioner or company doctor.

You will receive a budget for foot treatments and podiatry as set out below in Articles 37.1. Foot treatments for rheumatic and diabetic foot and 37.2. Podiatry.

This is covered

Taking the measurements and the cost of arch supports and therapy soles supporting the joints, ligaments and capsules of the feet. You are also entitled to a contribution towards the costs of repair and adjustment of the soles.

This is where to go

Podotherapist, orthopaedic shoe manufacturer (SEMH-OSB) or shoe shop (SEMH-OIM). SEMH stands for Stichting Erkenningsregeling Medische Hulpmiddelen (Foundation Accreditation Scheme Medical Aids), OSB stands for Orthopedisch Schoentechnische Bedrijven (Orthopaedic Technical Shoe Companies) and OIM stands for Orthopedische Instrument Makerijen (Orthopaedic Instrument Manufacturers). We also reimburse this care if you go to a care provider abroad who provides similar care.

This is your cover

The cost of education with a medical purpose about food and eating habits The healthcare policy covers 3 hours of dietetics treatment hours per calendar year. Reimbursement from the supplementary insurance is additional to this cover.

This is where to go

A dietician.

This is your cover

The cost of nutrition advice and exercise information for healthy people with weight issues.

This is where to go

To a weight consultant who is a member of the Beroepsvereniging Gewichtsconsulenten Nederland (BGN - Professional Association Weight Consultants Netherlands).

Please visit www.gewichtsconsulenten.nl to find a weight consultant near you.

This is your cover

The cost of:

1. staying in a hospital residence or family guest house associated with a hospital in the Netherlands if your under-age child or your partner is hospitalised. Examples of family houses especially for children are the Ronald McDonald houses and the Kiwanis houses. If your under-age child or your partner is admitted to Antwerp University Hospital, you can go to the Onthaaltehuis Ter Weijde;
2. staying in a hospital residence if you are required to complete two day sessions in a hospital located more than 40 kilometres from your home address. The day treatment must take place on consecutive days.

The hospital usually determines whether you are eligible to stay in a family residence or guest house.

This is covered

The cost of staying in the guest house of the Antoni van Leeuwenhoek Hospital or the Daniël den Hoed Family Residence if you are under outpatient treatment at Antoni van Leeuwenhoek Hospital or Erasmus MC Cancer Institute.

This is your cover

The cost of a stay in a hospice/Almost Home accommodation is reimbursed if you are terminally ill and can no longer be adequately taken care of at home. The hospice cares for you until your death.

This is not covered

You will not receive reimbursement for accommodation expenses pursuant to the supplementary insurance if you are receiving Primary Care Home (ELV). Accommodation costs for ELV are reimbursed pursuant to basic insurance.

This is where to go:

A hospice/Bijna-Thuis-Huis (Almost Home) accommodation we accredited. If you selected a non-accredited hospice/Almost Home accommodation, Then we do not reimburse the cost. Find an affiliated hospice or Almost Home on the Palliative Care Network website.

This is covered

Stay in a convalescence home or assisted accommodation if:

1. immediately following discharge from a hospital or treatment in an independent treatment centre after completion of the treatments;
2. your family care provider is overburdened or temporarily not available and no other care is possible at home;
3. you want to recover from (mental) overload or burn-out.

This is where to go

Please submit the application for such a stay to our Healthcare Advice and Mediation department. The telephone number is available from our website. Our healtcare advisor discusses with you to determine if you are eligible for first-line stay based on the Healthcare Insurance Act, the Wet maatschappelijke ondersteuning (Wmo or Social Support Act) or Wet langdurige zorg (Wlz or Long-Term Healthcare Act) and may refer you to a contracted convalescence home or assisted accommodation. If you have selected a non-contracted convalescence home or assisted accommodation, then we do not reimburse the cost. An overview of contracted convalescence homes and assisted accommodation is available from our website.

The actions you need to take

A referral from a general practitioner or medical specialist in the event of recovery from mental or physical overextension or burn-out (as set out under This is your cover, item 3).

This is covered

The cost of treatment in a health spa resort for the following referrals: Bechterew’s disease (Ankylosing spondylitis), rheumatoid arthritis, arthritis psoriatica or morbus Forestier. If treated in a health spa resort in the Netherlands, the minimum stay in the health spa resort is 2 weeks. We do not reimburse the cost of your stay in the health spa resort.

This is where to go

One of our preferred health spa resorts. An overview of our preferred health spa resorts is available from our website.

This is what you have to arrange yourself

1. A referral letter from a rheumatologist.
2. You need our approval prior to treatment.

This is your cover

A family care broker temporarily provides professional support to the family care provider. A family care broker supports and guides the family care provider in organisation tasks related to care, welfare or finances to prevent the family care provider from becoming overburdened. You can use the family care broker if you are a family care provider. The family care broker determines the number of hours needed for family care support.

The reimbursement is issued to you as the family care provider. Only one family care provider per care recipient (care situation) can claim the allowance.

This is who to see

An independently employed family care broker who is registered in the Central Quality Register of Family Care Brokers of the Professional Association for Family Care Brokers (BMZM). You can request a family care broker from our Healthcare Advice and Mediation department through our website. Our healthcare advisors will assess your eligibility.

This is covered

Temporary transfer of a family care provider's care so that you, the family caregiver, can have some time off. You can use replacement family care if you are a family care provider. Only one family care provider per care recipient (care situation) can claim the allowance. You can apply for replacement family care for a minimum of one day. Even if you purchase less than 24 hours in 1 day, we will charge for a full day, regardless of the number of hours you receive.

This is who to see

A contracted organisation. Replacement family care can be requested from our Healthcare Advice and Mediation department through our website. Our healthcare advisors will assess your eligibility before you purchase care and refer you to a contracted organisation. Do you not have a referral from our healthcare advisors to an organisation that provides replacement family care? Then we do not reimburse the cost. A list of our contracted care providers and the number of hours of replacement family care that is reimbursed per day is available from our website.

This is your cover

The cost of transport by taxi or by private car, between your place of permanent or temporary residence and the institution where you are receiving care relating to an organ transplant. You get this reimbursement only if the cost of this transportation is not covered by healthcare insurance. This concerns the following care: pre-transplantation examination, admissions and follow-up checks. The distance is calculated based on the quickest route as provided by the ANWB route planner. The journey there and the journey back are calculated separately.

This is who to see

One of our contracted transportation firms. If you have selected a non-contracted transport provider, you are not entitled to reimbursement. An overview of our contracted transportation firms is available from our website.

The actions you need to take

1. You require a prescription from a general practitioner or medical specialist and
2. You require our prior approval. Visit our website for more information.

This is covered

The statutory personal contributions due for medications covered by the healthcare insurance policy in accordance with GVS (Medication Reimbursement System)

This is your cover

The cost of laser eye surgery or lens implantation. The reimbursement also applies for the supplementary cost of a multi-focal or toric lens for cataract operations (glaucoma surgery).

This is where to go

To an ophthalmologist. We also reimburse this care if you go to an ophthalmologist abroad.

This is covered

The cost of orthodontic care.

This is where to go

A dentist or orthodontist.

Your dentist or orthodontist specifies the treatments performed on the invoice in accordance with the description and code in the list of rates for orthodontic care of the Nza (Netherlands Healthcare Authority). We reimburse only the A codes in the supplementary insurance policy. We also reimburse this care if you go to a dentist or orthodontist abroad.

This is your cover

The cost for unforeseen dental care in order to repair damage to your dentures due to an accident. The cost of technology and materials is also covered. We only reimburse care necessary to restore your dental condition in the status immediately preceding the accident.

If you wore braces during the accident, they became damaged or unusable as a result of the accident and you still need them after the accident, the costs of removing and repairing these braces or, if this is not possible, the purchase of new equivalent braces will be reimbursed. These costs will only be reimbursed if this is necessary to continue the ongoing treatment.

An accident is a sudden, unexpected external force on your body, directly causing physical injury that can be established by a medical professional. The reimbursement only applies if the accident and treatment take place during the term of the supplementary insurance policy UMC Extra Zorg Instap, UMC Extra Zorg 1, UMC Extra Zorg 2 or UMC Extra Zorg 3. And if the treatment takes place within 1 year of the accident, unless it is necessary to delay (definitive) treatment. Our consulting dentist will assess whether or not your situation constitutes a necessary delay.

This is where to go

A dentist, dental surgeon or orthodontist in the Netherlands.

This is what you have to arrange yourself

You need our prior approval. We ​must receive the first request before the repair treatment and within 3 months after the accident.

Our consulting dentist will assess whether you are dependent on the care and whether the care is not unnecessarily expensive. This request must include at least the following information: a report from the emergency room or (dental) doctor where you have been for emergency care, X-rays of the damage to your teeth, colour photographs of the dental situation just after the accident and a treatment plan with a cost estimate. If the consulting dentist deems it necessary, he/she can request additional information from your care provider. More information about applying for permission can be found in article 1.7. Referral, prescription or approval of these terms and conditions.