Your Health Insurance Card
According to the Dutch Health Insurance Act, your health insurer automatically provides worldwide coverage. This means that you can claim medical care anywhere in the world. However, if you use this claim, you will be insured exactly the same way as you would be in the Netherlands. In other words: you are only entitled to the medical care which falls under the Dutch health care package, against the same rates and conditions.
Insurance reimbursement for medical expenses abroad
What reimbursements you receive abroad, depends partially on the type of insurance you have. For example, if you have a refund policy, you can also choose your own healthcare provider(s) abroad. As usual with a refund policy, you should pay for the medical expenses in advance. You can claim these expenses from your health insurer in the Netherlands.
However, your insurer will only reimburse the expenses that match the Dutch rate. Any costs above this rate that will be for your own account. It is therefore advisable to thoroughly check if the rates of medical care abroad are consistent with the current rates in the Netherlands before going abroad. This prevents unpleasant surprises, like being confronted with high costs that you have to pay by yourself.
In-kind insurance with medical care abroad
Do you have an in-kind insurance policy? In that case, you should go to a healthcare provider that has a contract with your insurer. All medical expenses will then be settled directly with your Dutch insurer (so you don’t have to pay in advance), regardless of high expenses compared to current Dutch prices. Should you still like to use a healthcare provider who is not contracted to your insurance company, you are not forbidden to do so. In this case you do have to pay in advance and your in-kind insurance will cover the medical expenses up to the maximum of the Dutch rate. All costs exceeding this rate, are for your own account.
In case you are using a foreign healthcare provider who is not contracted with your insurance company, then your insurer is allowed to apply a discount to the amount of your reimbursement. This discount will be applied while taking the circumstances and the type of healthcare into account, since there is no uniform standard for this discount. For example: your insurer will reimburse half of the costs of a consultation with a foreign family doctor up to € 50, – but 95% of € 50,000, – on the costs of an operation. The only established rule in this is that the application of this discount may not result in a (financial) barrier for invoking necessary medical care abroad.
Medical expenses abroad and deductibles
When you use your health insurance card for medical care abroad, then the medical expenses also count for your own risk in the Netherlands. Your insurer might choose to deduct these expenses from the reimbursed costs. If not, then your insurer will send you an invoice afterwards.
Be smart and contact your healthcare insurance provider!
It is good to remember that your healthcare insurer is not required to reimburse expenses that are not covered by your health care insurance. This applies to both the Netherlands and other countries. If you need medical care abroad, or if you specifically go abroad for special medical treatments, it is always advisable to contact your insurer. Be well informed about which expenses will or will not be reimbursed. This is very important, since medical expenses abroad may be considerably higher than in the Netherlands. For example: costs for medical care are much higher in countries like Japan and the United States.
When you are in a country where the rates for medical care are much higher than in the Netherlands, it could be an (sometimes urgent) option to travel back to the Netherlands for the necessary medical care. Repatriation costs (costs for a possible return to the Netherlands) are not automatically covered by your health insurance. Therefore it is advisable to take out a travel insurance.
You should also get informed about the way medical expenses will be reimbursed. It may be the case that you have to pay all expenses in advance. Your insurer is able to advise you about the best ways to deal with this, if this is the case.
Do you have supplementary health insurance? Then it may happen that medical expenses which you would normally pay for still get reimbursed.
The European Health Insurance Card (EHIC)
Within the EU Member States, as well as Iceland, Norway, Switzerland, Lichtenstein and Australia you can use the European Health Insurance Card for reimbursement of medical expenses.
This card is internationally called the European Health Insurance Card (EHIC). This way, your medical expenses can be reimbursed, even if they are higher than the rates applicable in the Netherlands. If there is a personal contribution applicable in the country where you get your treatment, then you must pay for this yourself.
You can compare the EHIC card with a credit card. It allows you to prove to an external provider that all medical expenses are covered. The EHIC is thus a valuable document which you need to handle with care. You can apply for an EHIC with your insurer. In some cases you will receive a pass which combine the EHIC and your regular health insurance card. Keep in mind that there are countries where you have to pay for medical expenses yourself in advance if you cannot show your EHIC prior to the treatment.
If you are going abroad and your insurance company has not provided the EHIC yet, then you can request one. In many cases you can request one through the website of your insurance company. Please note that the EHIC card only gives access to healthcare that applies to the rules and regulations of the particular country. These rules may therefore vary per country.