People living and working in the Netherlands are required to have a basic package (basispakket) of health insurance (zorgverzekering). The insurance covers the costs of basic medical care, including visits to a general practitioner, consultations with specialists, hospital treatment and medicines. You sometimes have to pay for some services out of your own pocket. You can also take out a more expensive extended insurance package (aanvullende zorgverzekering).
Obligation to have insurance
Since 2006, all people officially living and/or working in the Netherlands must have basic health insurance. Anyone who is not insured risks a fine and high medical costs in the event of a serious illness. Of course, this obligation does not apply to people who are only temporarily staying in the Netherlands, e.g. as tourists. Having health insurance in another country only exempts you from the obligation to have Dutch insurance in certain, not very frequent situations (more on this in the next point).
So if you live in the Netherlands, you are obliged to pay contributions for basic insurance. People who work for a Dutch employer (even if they are not registered in the Netherlands) and pay taxes here, as well as children under the age of 18 living in the Netherlands, are also obliged to have basic health insurance.
When is insurance not necessary in the Netherlands?
In some situations, a person residing or working in the Netherlands is not obliged to have health insurance here. This is the case for employees posted to the territory of the Netherlands from another EU country, e.g. Poles posted to work in the Netherlands by a Polish company. Also, people with a registered business activity, e.g. in Poland, who come to the Netherlands as part of running a company, and people running a business activity in Poland and the Netherlands, but permanently residing in Poland, do not have to be insured in the Netherlands. This also applies to people with paid employment in Poland and at the same time running a business activity in the Netherlands.
In all these cases, these people already pay health insurance contributions in another EU country (in the above examples, Poland) and do not have to do so in the Netherlands. However, in order to be exempt from insurance in the Netherlands, these people should apply to the Polish Social Insurance Institution (ZUS) for a so-called A1 certificate (“Certificate of social security legislation applicable to the entitled person”).
In addition, people who want to be exempt from health insurance in the Netherlands and are staying here temporarily should contact their health insurance institution (in Poland this is the National Health Fund) to issue a European Health Insurance Card (EHIC). This card should be presented to the healthcare provider (e.g. at a doctor’s office, hospital) if there is a need for medical assistance here during their stay in the Netherlands.
People living in the Netherlands and meeting the conditions for being exempt from health insurance here should contact their health insurance institution (in Poland, the National Health Fund) to request the issuance of an S1 document.
The S1 document must be registered in the Netherlands as soon as possible. This can be done on the website of the CZ insurance company.
The S1 document in the Netherlands is called Verdragsformulier (literally Treaty Form). Once registered in the Netherlands, you have access to Dutch healthcare as part of your basic health insurance. This “geographical extension” of your insurance (e.g. Polish to the Netherlands) is called “Verdragpolis” (literally Treaty Policy).
More information in Polish about EKUZ, A1 and S1 documents.
Children up to the age of 18
Children up to the age of eighteen must also be insured in the Netherlands. Health insurance for people up to the age of 18 is free, but children are not automatically insured after birth. It is the parent’s responsibility to arrange for free insurance for the child within four months of the child’s birth. For example, the parent can contact their insurer and add the child to their own insurance. The premium amount will not change and the child will already be insured.
4 months to get insurance
It is best to pay for insurance from the day you officially registered in the local municipality or started working for a Dutch employer. If you do not do this immediately, you must do it within 4 months of registering or starting work, the government website rijksoverheid.nl states .
A person who registers or starts working in the Netherlands is automatically insured – even if they have not yet taken out insurance themselves – for 4 months (provided that they take out insurance during that time). If someone takes out insurance after, for example, 2 months of stay, they will have to pay the outstanding contributions for those 2 months (because they were automatically insured during that time and were entitled to a basic medical care package).
If someone takes out insurance only after 4 months of official residence or work in the Netherlands, they will not have to pay any outstanding contributions, but it will mean that they were not insured during that time and cannot count on reimbursement of any medical costs incurred before taking out insurance.
Penalties for lack of insurance
Uninsured people, who are also obliged to do so, face fines. Such a person should first receive an official warning letter. If, 3 months after receiving the letter, the warned person still does not have health insurance, the CAK office, which deals with, among other things, uninsured people, will fine them €496.74 (as of 2024). If, despite the warning and fine, the person still does not insure themselves within the next 3 months, they will receive another fine of the same amount. If this does not work and the person still does not insure themselves, then the CAK office will conclude an insurance contract on their behalf with the selected company.
Such a person will therefore be insured (they should receive a policy by post from the insurance company), and the CAK will collect insurance costs from that person for a maximum of 12 months, e.g. by seizing part of the income or benefits (the CAK has the right to do this).
Insurance through CAK is more expensive than the standard premium for basic insurance and in 2024 amounts to 165.58 euros. CAK will not require a previously uninsured person to pay premiums for the period in which they did not have insurance. This means that such a person will also not be able to count on reimbursement of any medical costs incurred during the period of not having insurance. After 12 months of paying premiums through CAK, such a person will already pay premiums directly to the insurance company.
The CAK is therefore an intermediate body, somehow forcing the uninsured to enter the compulsory health insurance system. Once a person is insured, the role of the CAK – which has the right to impose fines or seize part of the income – ends.
Obligation to accept
Insurers are required to accept anyone who applies for basic health insurance with a given company. This means that the basic package is available to everyone, regardless of age or health.
It should be emphasized that this order only applies to the mandatory basic package (basispakket). In the case of voluntary extended insurance (aanvullende zorgverzekering), insurers may impose additional conditions.
The insurer is also obliged to issue the insured person with a zorgpas card, which is proof of insurance (a small plastic card resembling a payment card, for example). The insurance company is also legally obliged to inform customers about their policies, additional costs, refund rules or waiting times for a given procedure or service.
What does the basic package guarantee?
The basic package includes, as the name suggests, basic medical services, such as access to a general practitioner, consultations with a specialist, hospital stay, medicines, tests, etc. In the case of some of these services, the so-called own risk “eigen risico” applies (more on this in a separate point) or a statutory own contribution (“wettelijke eigen bijdrage”, the patient bears part of the costs from his own pocket)
The basic package includes:
– a visit to a general practitioner, also called a family doctor (huisarts) or family doctor (always free of charge, no own risk or contribution)
– a visit to a specialist, e.g. a cardiologist, internist, allergist, etc.
– hospital stay, operations, first aid in hospital, ambulance transport
– most medications (sometimes partial reimbursement, only up to a certain amount)
– blood tests (at a general practitioner, specialist, in hospital, etc.)
– for children and adolescents up to 18 years of age, extended dental care (check-ups, procedures, treatment), for adults – limited dental care (e.g. some necessary procedures related to specialist surgical treatment), adults have to pay for check-ups and most basic procedures out of their own pocket, unless they have additional extended insurance, then (part of) the costs are covered by the insurer
– psychological and psychiatric help: basic for people with less serious mental problems (e.g. visit to a psychologist, e-health internet consultations) and specialist help for patients with serious disorders (e.g. stay in a clinic – first three years)
– physiotherapy: up to 18 years of age in a broader scope, in the case of adults in a very limited scope (details in a separate point below)
– obstetric care
– speech therapy (for medical purposes)
– ergotherapy (maximum 10 hours per year)
– dietitian (maximum 3 hours of consultation per year)
– nursing care
– some medical aids necessary to perform the procedure, care, rehabilitation or treatment of a specific condition, e.g. hearing aids or orthopedic shoes. However, the basic package does not include, for example, the “rollator” type walkers often used by Dutch seniors
– care for disabled people who are blind or deaf
– help for people who are seriously overweight and obese as part of a series of individual consultations and group meetings (GLI programme)
– rehabilitation care for seniors
– a maximum of three in vitro procedures for women up to 43 years of age
It is worth emphasizing once again that in the case of many of these benefits, the so-called eigen risico applies (see below), and in the case of some, an own contribution also applies (insurance covers only part of the costs).
It is worth checking every year, e.g. on the website of your insurer or on the official government website ( rijksoverheid.nl ), which benefits are included in the basic package and whether your own risk and own contribution apply to them.
Physiotherapy in the basic package
Physiotherapy in the basic package is included only to a limited extent, especially in the case of adults.
People under 18 are entitled to 9 physiotherapy treatments under basic health insurance. If the treatments do not bring the desired effect, the insurer may reimburse another 9 visits. Minors with chronic problems are entitled to reimbursement of all treatments, even if their number exceeds 18. The Health Insurance Act contains a list of chronic diseases; you can also ask your insurer or physiotherapist whether a given disease is on this list and whether it will be reimbursed.
Physiotherapy for adults is mostly paid for. Only for a few specific conditions does insurance cover physiotherapy, but only up to a certain limit. For example, people who need pelvic physiotherapy due to urinary incontinence problems are entitled to 9 reimbursed visits. For most chronic conditions, the rule is that the first 20 visits are paid for, and subsequent visits may be reimbursed.
In the Netherlands, you do not need a referral from your family doctor to make an appointment with a physiotherapist. If you are unsure whether a particular service is or is not reimbursed in a given situation, you can ask your insurer. They are obliged to provide such information.
Physiotherapy costs
Currently, the prices of physiotherapy services are not set centrally by the government (as is the case with many other medical or dental services). Each clinic has its own price list, which is worth checking before visiting. In 2024, a standard visit to a physiotherapist in the Netherlands usually costs around 45-60 euros.
Dentist and the basic package
Minors receive reimbursement for most standard dental treatments, such as periodic check-ups, tartar removal, anesthesia and fillings.
For people over 18, dental care in the basic package is very limited in scope and mainly concerns certain rare, complicated procedures, e.g. medically necessary specialist surgery. Adults have to pay for check-ups and most basic procedures out of pocket, unless they have additional extended insurance, in which case (part of) the costs are covered by the insurer.
Insurers often offer additional dental insurance policies at different prices and with different levels of reimbursement. However, there is often a maximum annual amount that the insurer will pay.
In the case of really high expenses (e.g. for implants), a large part of the costs will be covered by the patient himself, despite having additional dental insurance.
Patient transportation
Patient transport in some situations (patient in a wheelchair, travel to kidney dialysis, visually impaired person, cancer patient going to chemo- or radiotherapy) is reimbursed from the basic package, but often part of the costs is covered by the patient himself. Reimbursed transport can take place, for example, by (own) car, taxi or public transport.
Individual insurers may have their own rules here, so if in doubt, it is always worth contacting your insurance company.
Ambulance transport that is necessary from a medical point of view (e.g. transporting a patient in a lying position) is reimbursed in full and does not apply to the co-payment (but is covered by eigen risico).
Medicines
Essential medicines and medical aids are included in the basic package. If the medicine is prescribed by a family doctor or specialist, it will often be (at least partially) reimbursed. However, medicines are covered by the so-called eigen risico, so reimbursement only applies if the total out-of-pocket expenses for treatment and medicines in a given year exceed the eigen risico amount.
Currently, many medications on the market have numerous variants at different prices. Insurers usually only reimburse the cheapest option. If a patient buys a more expensive equivalent of a given medication, the patient pays the difference in these prices. The list of medications, preparations and medical instruments reimbursed under the basic package is available from the insurer.
As of 2019, the total amount of patient co-payments for reimbursed medicines is 250 euros per year. This limit only applies to (partially) reimbursed medicines. Furthermore, this rule does not invalidate the eigen risico principle. To clarify this, let’s look at two examples: it is 2024 and eigen risico is 385 euros.
Example 1
Mrs. Anna has already spent on treatment this year the amount of eigen risico. In December, she had to pay 340 euros for partially refunded medicines. According to this rule, Mrs. Anna will pay only 250 euros.
Example 2
In the same year, Mr. Jan enjoyed good health, did not go to the doctor and did not spend a cent on treatment from his own pocket. His eigen risico is still 385 euros. Also, in December, Mr. Jan was prescribed medication by his doctor that is partially reimbursed and Mr. Jan has to pay 340 euros. And he will actually pay that much (not 250 euros), because this amount is within the framework of his previously unaffected eigen risico.
Medical specialist
To see a specialist under basic health insurance, a referral from a primary care physician (family doctor, home doctor) is required. Theoretically, you can also try to make an appointment with a specialist without a referral from your family doctor, but then you have to pay for the entire visit out of pocket. If a patient believes that their primary care physician is wrongly refusing to write a referral to a specialist, they can contact their insurer directly for help in resolving the conflict or obtaining a referral.
Additional insurance, with extended package (aanvullende zorgverzekering)
In addition to the basic insurance, it is also possible to take out additional insurance with an extended package (aanvullende zorgverzekering, supplementary insurance). This can be taken out with the company where the basic insurance premiums are paid or with another insurance company.
The extended package insurance is aimed at people who want to receive (partial) reimbursement of medical services that are not included in the basic package. This can include, for example, the purchase of glasses or additional visits to a physiotherapist. Many insurance companies also offer additional dental insurance (tandartsverzekering, dental insurance).
In the case of an extended package, insurers are not legally obliged to accept every person. Insurers may set additional conditions, and in the event of their failure to meet, refuse to provide extended insurance.
Additional insurance is not mandatory, and there are many such policies available on the market, at different prices and with different scope. The choice depends on the personal situation of the interested party. In
There are many websites on the Internet where you can compare different policies and choose the one that best suits your specific needs.
A dozen or so percent of Dutch residents, especially those with lower incomes and the youngest, do not pay for any additional insurance. In 2018, the percentage of people with additional insurance was around 84% (in 2010 it was still 93%). In the vast majority (over three quarters of cases), this was about additional dental insurance.
Own risk (eigen risico)
The so-called own risk is a very important element of the Dutch health insurance system. Eigen risico means that the first part of the health care costs in a given year, an adult patient pays from his own pocket. In 2024, the own risk is 385 euros.
Every insured person over the age of 18 is covered by an own risk. You can also voluntarily increase the amount of your own eigen risico, which will lower your monthly premium for basic health insurance.
An increase in eigen risico is associated with – as the name suggests – a greater risk. If someone increased their eigen risico in 2024 by 500 euros (to a total of 885 euros) and used medical care little or nothing, they saved on lower premiums. However, if the same person became seriously ill and used expensive medical care very often, they had to cover the first 885 euros of costs themselves.
It should be noted that the own risk does not cover all services. For example, visits to a general practitioner, nursing and obstetric care, organ donor check-ups and treatment of certain chronic diseases that require the involvement of multiple specialists (e.g. chronic obstructive pulmonary disease, type 2 diabetes) are exempt from this rule. Eigen risico also does not apply to children and young people under 18.
People who have trouble paying for treatment under eigen risico at once can ask their insurer to spread the payment over several installments. The government explains that if eigen risico had not been introduced, health insurance premiums would have had to be higher. In addition, thanks to eigen risico, patients “are more aware of the costs of medical care.”
Change of policy, transfer to another insurer
At the end of the year, you can change your policy and switch to another insurer. To do this, you must cancel your current insurance by December 31st and sign a contract with another insurer by January 31st of the new year. You can do this online or by phone. The new insurance is then valid from January 1st and premiums are charged from that moment.
You can also immediately sign a contract with a new insurer, without cancelling your current insurance. It is important to do this before 31 December, we read on the government website rijksoverheid.nl. If you do this before 31 December, the new insurer will inform the old insurer and cancel the old policy on behalf of the patient.
It is therefore worth taking a look at your insurance policy at the end of the year and considering whether it meets your needs. Around mid-November, insurance companies announce the amount of premiums for the coming year. On the Internet, you will find many websites with a comparison of individual policies and search engines that allow you to find the best offer, tailored to your individual needs. Such websites include:
www.independer.nl
www.consumentenbond.nl
www.pricewise.nl
www.zorgwijzer.nl
Who determines the amount of contributions?
Every adult pays a monthly fixed premium for basic insurance. Its amount does not depend on the health of the insured person, their income or age. Insurers themselves set the premium amount. They have until about mid-November to do so. In 2020, they had to announce the premium amount for 2021 by November 12.
Despite the competition between insurers, the differences in premiums can be high. This is because insurance companies offer different insurance options.
The Dutch health service is also financed from other sources. In addition to revenue from the mandatory basic health insurance, it is also financed from contributions automatically deducted from income (Zzw) and paid by the employer to the Tax Office.
How much does it cost? Contributions in 2024
In 2024, the average premium for basic health insurance (basisverzekering) with the lowest own risk (385 euros) is 146 euros per month. In the four largest insurance companies ( CZ , VGZ , Menzis , Zilveren Kruis ), which have around 86% of the Dutch health insurance market, the premium for 2024 varies depending on the type of policy and is 143 euros, 139.95 euros, 140.25 euros, 140.45 euros (when choosing the cheapest option).
The price difference between the most expensive and cheapest basic health insurance policies is significant in 2024 and amounts to almost 40 euros per month. After all, we are talking about basic insurance, with a package of reimbursed benefits set by the government, so more or less the same for all policies. The premium for 2024 in asr Eigen Keuze is 170.95 euros per month, and in FBTO Basis it is 131.95 euros.
Group insurance (collectieve zorgverzekering, collective insurance)
Dutch law allows a large group of people, such as employees of the same company or chronically ill people associated in a patient association, to enter into a collective agreement with an insurer. In such a situation, these people receive a discount on the monthly premium. Hence the great popularity of this form of insurance.
There is also a so-called municipal health insurance policy (gemeenteverzekering, gemeentepolis). This is a type of group insurance for people with the lowest income, offered by individual local governments. It looks different in each municipality. Insurance companies sometimes offer discounts to municipalities, and local governments themselves often pay for this form of insurance, so the premiums are relatively low.
Group insurance for employment agency employees
Employment agencies also often provide group health insurance for employees. Many Poles in the Netherlands work through this type of agency. It is worth checking carefully whether the agency offers this type of insurance and whether, for example, it deducts contributions from earnings. Before the agency insures an employee, the employee should agree to it and authorize the agency to do so.
The employer should provide the employee with a copy of the policy and the insurance card.
Greater and smaller possibilities of choosing a doctor (restitutie- and naturapolis)
There are three main types of policies: resitutie-, natura- and combinatiepolis. They differ in the level of freedom of the patient in choosing the type of treatment, doctors and specialists. The amount of premiums and the methods of declaring costs are also different.
In the case of restitutiepolis, the insured person has greater freedom to choose a doctor, clinic or hospital (so-called “vrije zorgkeuze”, or “freedom of choice of medical care”). Sometimes, however, the patient must first pay for the service out of pocket and then ask the insurer for reimbursement. The premium for restitutiepolis is higher than for naturapolis, reports the portal geld.nl.
Naturapolis insurance is cheaper, but gives the patient less freedom of choice. The insurer has signed contracts with specific clinics, hospitals, clinics and doctors, and the patient can count on the insurer to cover the costs completely only when they use the services of these providers. If, for example, the patient goes to a specialist with whom their insurer does not have a contract, then part of the costs (e.g. 20%-50%) will be paid out of pocket. However, most insurers sign contracts with many providers, so this should not happen often.
Combinatiepolis combines elements of both types of policies. In the case of some services, e.g. physiotherapy, the patient has freedom of choice, while in the case of other medical services, only visits to service providers contracted by the insurer are fully reimbursed.
Health insurance supplement (zorgtoeslag)
People with low incomes and without great assets can receive partial compensation for the costs of basic health insurance. The zorgtoeslag supplement should be applied for at the Tax Office (Belastingdienst).
The amount of the allowance depends on the income: the lower the income, the higher the allowance. In 2024, the allowance is available to people with annual gross incomes of up to 37,000 euros (one person) or up to 47,000 euros for a couple.
People with the lowest incomes could count on the supplement being in the amount close to their monthly contribution. In 2024, the maximum amount of zorgtoeslag is 123 euros per month. It is due in 2024 to people with an income of up to 26,500 euros gross per year (one person).
People with incomes just slightly below the threshold for this supplement receive a much lower zorgtoeslag. In 2024, a person with a gross income of 37,000 euros per year, for example, will receive only 7 euros per month of this supplement.