How are you insured for healthcare?
Everyone is insured for care in the Netherlands
With a referral from your general practitioner, medical specialist care in the Netherlands is always covered by the compulsory basic health insurance. Reimbursement depends on the policy conditions of the insurance you have chosen. Each year you can choose the health insurance that suits you best (switch in January).
Karmenta has a contract with your health insurer
100% reimbursement, no co-payment.
That's nice for you, because in this contract we agree on rates with your health insurer and then you get Karmenta's care fully reimbursed. Reimbursement is the same as in the hospital. The mandatory deductible always applies.
Budget (turnover ceiling) can lead to waiting list.
A disadvantage of a contract is that your health insurer agrees a maximum number of treatments (budget, turnover ceiling) with Karmenta. If that turnover ceiling is reached, we have to stop treating you. In that case, we put you on a waiting list until the budget is available again. If you still want to be helped more quickly, please contact the waiting list mediation department of your health insurance company.
Your insurance is a Natura policy
There is a co-payment, you can apply for coulance discounts.
Most Dutch people have a Natura policy. The premium is often cheaper than with a combination policy or restitution policy. With a Natura policy, you are insured for 100% reimbursement of care from contracted healthcare providers, such as most hospitals.
Karmenta has no contract with your health insurer!
Because your health insurer has no contract with Karmenta, a substantial part of Karmenta's care bill is covered by your health insurance, but not all: you have to pay the “own contribution”. Reimbursement is usually (it varies by health insurance) 75% of the average contracted rate (which varies by health insurance company). So not of the amount on Karmenta's care bill, which is called the pass-through rate and is similar to the pass-through rates of the hospitals in our region, but this rate is usually higher than the average contracted rate of your health insurance company.
The unreimbursed portion of Karmenta's bill is called the co-payment and is usually about 40% of the amount on Karmenta's healthcare bill. For this, you can apply to Karmenta for coulance. The coulance (discount) is up to 20% of Karmenta's bill amount. The other 20% will be for your own account. You can apply for the discount using the online form. On the basis of your application form and the claim summary sent with it, we will check whether your health insurance company will reimburse correctly.
Your insurance is a Refund policy
Almost always 100% reimbursement, sometimes small co-payment.
The premium for a restitution policy is slightly higher than for an in-kind policy, but with a restitution policy you will get 100% of Karmenta's care bill reimbursed by your health insurance, because with a restitution policy you are also insured for (100% reimbursement of) care at a non-contracted care provider, such as Karmenta. This freedom of choice is a considerable advantage, especially if you expect that waiting times at contracted healthcare providers will not decrease in the coming years.
Please note that the policy conditions of some restitution policies state that they do not reimburse 100% of the bill after all, but a little less, for example, the market rate set by the health insurer. This still results in a small co-payment, which is usually no more than a few percent of Karmenta's care bill.
Health insurers have increasingly stopped offering restitution policies in recent years; they have become mostly combination policies.
Your insurance is a Combination policy
Good reimbursement, sometimes small co-payment.
Many health insurers have changed their reimbursement policies to combination policies. Usually with a combination policy for medical specialty care, like Karmenta's, you get a restitution reimbursement, which means 100% reimbursement, but nowadays it is usually 100% reimbursement of the market-based rate set by the health insurer. So this can be lower than the amount on Karmenta's bill (pass-through rate), however, the co-payment rarely becomes more than about 5 a 10% Karmenta's pass-through rate. This varies by policy, so read your policy conditions carefully.
Your insurance is a Budget or Select policy
Please note! There is a hefty co-payment!
Warning: you have a policy that requires you to pay relatively high co-payments!
You have a policy with very low reimbursement if you go to an uncontracted clinic, such as Karmenta. For you as the insured, the advantage of this choice is that you pay a very low premium, but you also really have less freedom of choice with this policy. You are actually only properly insured for care at a hospital with which your health insurer has made agreements (contract) and often then only a subset of those hospitals (Select). This can be a good option for you if you expect to incur little or no health care costs.
At Karmenta you will have to pay a considerable part of the treatment yourself, count on about 60% of our bill! A good advice is to go for treatment to a hospital that has a contract with your insurance company. Please contact your health insurer or check the health insurance website.
Of course you are still welcome at Karmenta, but you have to agree to a relatively high co-payment. You can indicate that agreement on this form below.
Those insured with a Budget or Select policy are NOT eligible for Karmenta's leniency scheme.
No basic insurance (uninsured)
Not being insured for medical expenses is unusual in the Netherlands because basic health insurance is a legally required insurance.
If you are not insured for medical expenses, you will receive a bill with the rate for uninsured care. You must pay that amount in full to Karmenta. Pinning at the counter is our preference.
See here the rates uninsured care.
Foreign health insurance
If you are insured for medical expenses abroad, you will receive a bill for the expenses incurred from Karmenta. This will show the rate of uninsured care for your treatment. You must pay that amount in full to Karmenta. Pinning at the counter is our preference.
You can submit Karmenta's care note for reimbursement to your foreign health insurance and you will probably receive reimbursement in accordance with your policy conditions. Of course, your foreign health insurance is entirely your responsibility.
See here the rates uninsured care.
Arrangement Medical Necessary Care Displaced Persons from Ukraine.
Karmenta has an agreement with the Dutch government to provide medically necessary care to displaced persons from Ukraine. Please inform the healthcare administration about this.
Medical Care Arrangement for Asylum Seekers.
Karmenta has an agreement with the Dutch government to provide medically necessary care to asylum seekers. Please inquire about this with the healthcare administration.
