List of reimbursements 2016

List of reimbursements 2016OZF Zorgpolis, Supplementary insurance policies & Dental insurance policies

OZF. Your health insurer.

These conditions apply from 1 January 2016 and replace all previous versions.They only apply if the cover in question is stated on your policy certificate.

70418/20

15-11

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3List of Reimbursements 2016OZF ZorgpolisAV Compact and AV Royaal supplementary insuranceTand Compact and Tand Royaal dental insurance

Health insurance policies of OZF

We call our basic insurance OZF Zorgpolis. This is an arranged care

policy. This means that you are entitled to care arranged by us.

But you are also entitled to reimbursement of healthcare costs.

You can supplement the cover provided by the OZF Zorgpolis with

1 or more other supplementary (dental) insurance policies:

• AV Compact or AV Royaal.

• Tand Compact or Tand Royaal.

The government determines the contents of the basic

insurance

The government stipulates the conditions of the basic insurance.

These are laid down in the Dutch Health Insurance Act (Zorg ver

zekeringswet (Zvw)) and the corresponding legislation. Every

health insurer must comply with these conditions.

What expenses are covered by the basic insurance?

The following is a brief summary of what is covered by the basic

health insurance package:

• General practitioner care.

• Specialist medical care, and stay.

• Mental health care (18 years or older).

• Medical devices.

• Medication (medicines) and dietary preparations.

• Maternity care and obstetric or midwifery care.

• Transport by ambulance and seated patient transport.

• Paramedic care (occupational therapy, speech therapy and a

certain amount of physiotherapy and/or remedial therapy).

• Oral health care (up to 18 years).

• Oral health care in exceptional cases (18 years or older).

What expenses are reimbursed by our supplementary

(dental) insurance policies?

Our supplementary (dental) insurance policy covers medical care

that is not, or only partially, reimbursed by the basic health insur

ance package. For example physiotherapy, alternative forms of

treatment and spectacles and/or contact lenses. This includes

regular oral health care for insured persons aged 18 or older.

This is because this oral care is not included in the basic health

insurance package.

Please note! We may also reimburse your care under your basic

insurance and/or your supplementary (dental) insurance (policies).

The reimbursement of medical expenses is subject to con-

ditions and exclusions

These conditions and exclusions are not always reproduced in full

in this List of Reimbursements, which is no more than a brief

summary of our policy conditions. You can find all our conditions

and exclusions in the policy conditions. Our policy conditions

always take precedence. For instance, this is where to find out

whether a referral is needed, which medical indication(s) will be

reimbursed, and whether reimbursement requires our permission

in advance. Our policy conditions can be found on our website,

www.ozf.nl/vergoedingen, or we can send you a copy on request.

Contracted and non-contracted care

We have entered into contracts with a large number of care

providers and healthcare institutions. Contracted care providers

invoice us directly. If you are entitled to full reimbursement under

the policy conditions, the bill is (usually) paid in full. But that does

not apply to the (mandatory and/or voluntarily chosen) excess and

any (statutory) personal contribution. We collect these payments

from you.

What medical expenses are covered by the basic health insurance? And what expenses are reimbursed by our

supplementary (dental) insurance (policies)? Do different reimbursements apply, depending on whether

treatment is provided by contracted or non-contracted care providers? How are mandatory and/or voluntarily

chosen excess and personal contributions deducted? We are happy to explain.

4List of Reimbursements 2016 (cont'd)OZF ZorgpolisAV Compact and AV Royaal supplementary insuranceTand Compact and Tand Royaal dental insurance

Are you going to a noncontracted care provider or health care

insti tution? In that case you are usually entitled to reimbur se ment

of 75% of our average contracted tariff.

Please note! Sometimes we only reimburse contracted care.

If this is the case, it will say so next to the reimbursement.

Do you want to know with which care providers and health care

institutions we have a contract? In that case use the Medical

Provider Search Tool on our website www.ozf.nl/zorgzoeker,

or contact us.

A list of the reimbursement tariffs that apply to care provided

by noncontracted care providers or healthcare institutions can

also be found on our website or obtained from us.

Mandatory excess

Basic insurance for everyone aged 18 years and older involves

a mandatory excess. Each year the government determines the

amount of the mandatory excess. In 2016 this is €385.00. This

means that you yourself have to pay the first €385.00 towards

medical expenses covered by the basic health insurance. How

ever, you are not required to pay an excess for:

• The costs of care or other services incurred in 2016 but

for which the invoices are not received until after

31 December 2017.

• The costs of care provided by general practitioners. The costs

of tests or examinations performed as part of this care, which

are performed elsewhere and charged for separately, are an

exception in this respect.

• The direct costs of maternity care or obstetric or midwifery

care.

• The costs of registering with a general practitioner or an insti

tution that provides general practitioner care.

• The costs of followup examinations of a donor after the period

of caring for that donor has expired. This period of care is a

maximum of 13 weeks, or, in the event of a liver transplant,

6 months.

• The donor’s transport costs if these costs are reimbursed

by the donor’s own basic insurance.

• The costs of integrated care claimed in accordance with

the Policy Regulation on Performancerelated funding of

the pro vision of multidisciplinary care for chronic disorders.

This policy regulation was established on the basis of the

Dutch Healthcare Market Regulation Act (Wet markt orde

ning gezondheidszorg (Wmg)).

• The costs of nursing and care provided by nurses (in accor

dance with article 30 of ‘OZF Zorgpolis Entitlements and

Reimbursements’).

Voluntarily chosen excess

In addition to the mandatory excess you can opt for a voluntarily

chosen excess. You can increase your mandatory excess by

€100.00, €200.00, €300.00, €400.00 or €500.00. The premium

for your basic insurance will then be lower. We reduce your

annual premium by €44.40 for every €100.00 of your voluntarily

chosen excess. More information can be found on our website

www.ozf.nl/premieoverzicht.

An example of how the excess is calculated and deducted

In addition to the mandatory excess, you opt for a voluntarily

chosen excess of €500.00. This means your total excess in 2016

is €885.00 (€385.00 + €500.00). Has your care provider received

€950.00 from us for care you received in 2016? And have you yet

used any of your excess in 2016? Then we will subsequently send

you (the policyholder) a summary of the claim. The summary

informs you of the care that will be deducted from your manda

tory and voluntarily chosen excess, in this example €885.00.

As well as about how and when you will pay the sum of the

excess to us. This depends on the agreed method of payment.

When does a (statutory) personal contribution apply?

Sometimes, in addition to the mandatory excess, you also have

to pay a statutory personal contribution for healthcare. The

amount of the statutory personal contribution is determined

by the government. Seated patient transport, certain medical

devices, some medicines and some forms of maternity care

are all exam ples of care for which you have to pay a personal

contribution. You pay the personal contribution yourself. The

remaining amount is then paid from your mandatory and/or

voluntarily chosen excess.

Please note! We sometimes reimburse you a (statutory) perso

nal contribution under your supplementary (dental) insurance

(policies).

What should you do if a care provider or healthcare institution

sends you an invoice?

There are two ways in which you can send the invoice to us:

• Online: www.ozf.nl/declareren

• By post: OZF, Claims Service Department, Postbus 94,

7550 AB Hengelo NL.

5

A number of abbreviations and phrases are used in the List

of Reimbursements

These abbreviations and phrases are explained below.

• Art: article.

• Tr: treatment(s).

• P: page.

• GVS: Medicinal Products Reimbursement System (Genees

middelenvergoedingssysteem).

• GVS limit: a medicine is reimbursed up to a limit specified

by the GVS.

• Cy: calendar year (from 1 January to 31 December incl.).

• Km: kilometre(s).

• Max: maximum.

• After receiving our permission in advance: before you are

entitled to a reimbursement, we must give you permission in

advance.

• For the duration of the insurance: a reimbursement that ap

plies for as long as the insurance policy in question is still valid.

• Wlz: Dutch Longterm Care Act (Wlz)

• ZBC: Independent Treatment Centre (Zelfstandig Behandel

centrum ).

Please note! The reimbursements specified in this List of

Reimbursements apply per person, unless otherwise indicated.

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7ContentsWhere can you find what you are looking for in this List of Reimbursements?

Alternative therapies 10

Alternative medicines

Alternative forms of treatment and therapy

Bones, muscles and joints 10

Remedial therapy in a hot water pool for rheumatoid arthritis

Chiropractic treatment

Occupational therapy

Osteopathy

Pedicure care for rheumatoid foot conditions

Pedicure care for diabetic foot conditions, Care Profile 1 (Zorgprofiel 1)

Pedicure care for medical foot conditions

Podiatry/podology/podopost therapy

Sports doctor

Sports medical examination

(Sport) arch supports and/or orthoses (or their repair)

Foot care in the case of diabetes mellitus

Abroad 11

Overnight stay and transport costs of family members following healthcare mediation if care is provided in Belgium or Germany

Transport costs following healthcare mediation if care is provided in Belgium or Germany

Transport of the insured person and mortal remains to the Netherlands (repatriation)

Medical treatment abroad, nonurgent

Medical treatment abroad, urgent

Physiotherapy and remedial therapy 12

Pelvic physiotherapy 18 years or older

Exercise programmes (for certain indications)

Physiotherapy and remedial therapy 18 years or older

Physiotherapy and remedial therapy up to 18 years

Postcare physiotherapy

Skin 13

Acne treatment

Camouflage therapy

Hair removal treatment

Medical devices 13

Hand splint

Headwear (for oncology)

Medical devices

Personal alert system required for medical reasons

Adhesive strips for breast prosthesis

Bedwetting alarm

Wigs Personal contribution

Support pessary

Incontinence therapy

Selfhelp programme IncoCure

How do you find a reimbursement in this List of Reimbursements? First look for the general heading in this table of contents.

The page number for this general heading tells you where to find details of the reimbursement we provide for the care in

question in the List of Reimbursements. Under the general heading you will see the types of medical care that come under

that heading. In the List of Reimbursements you will see whether we reimburse the care under (in this sequence) the OZF

Zorgpolis and/or under the supplementary (dental) insurance AV Compact, AV Royaal, Tand Compact or Tand Royaal. Are

you unable to find the medical care you are looking for? Then you should visit our website, www.ozf.nl, or call our Customer

Service Department.

How do you find a reimbursement in this List of Reimbursements? First look for the general heading in this table of contents.

The page number for this general heading tells you where to find details of the reimbursement we provide for the care in

question in the List of Reimbursements. Under the general heading you will see the types of medical care that come under

that heading. In the List of Reimbursements you will see whether we reimburse the care under (in this sequence) the OZF

Zorgpolis and/or under the supplementary (dental) insurance AV Compact, AV Royaal, Tand Compact or Tand Royaal. Are

you unable to find the medical care you are looking for? Then you should visit our website, www.ozf.nl, or call our Customer

Service Department.

8Contents (cont'd)

Medicines and dietary preparations 14

Contraceptives

Medicines and dietary preparations

Melatonin

Statutory personal contribution (upperlimit GVS price)

Oral health care and dentistry 14

Implants

Orthodontics (braces) in exceptional cases

Regular dental care and oral hygiene 18 years or older

Regular dental care under the age of 18

Dental care 18 years or older dental surgery

Dental care 18 years or older full set of removable dentures (false teeth) Personal contribution

Dental care in exceptional cases

Dental care crowns, bridges, inlays and implants

Dental care orthodontics (braces) for insured persons up to 22 years

Dental care full set of removable implantretained dentures

Dental care for insured persons with a handicap

Eyes and ears 15

Audiology centre

Spectacles and/or contact lenses

Hearing aid Personal contribution

Refractive eye surgery or lens implants

Sensory impairment care

Preventive 16

Consultations, vaccinations and medication required for foreign travel

Flu vaccinations

Coping with heart problems

Lymphoedema, awareness and/or selfmanagement course

Coping with rheumatoid arthritis, osteoarthritis or ankylosing spondylitis (Bechterew's disease)

Type 2 diabetic patients course

Weight loss course

Basic resuscitation/AED course

First aid course

Baby and child first aid course

Online sleep course

Stop smoking course

Stop smoking programme

Intestinal cancer screening selftest

Psychological care 17

General Basic GGZ 18 years or older

Nonclinical specialist GGZ (secondline GGZ) 18 years or older

Stay in a psychiatric hospital 18 years or older

Speech and reading 18

Speech therapy

Stutter therapy by a speech therapist

Stutter therapy method taught at the Del Ferro or Hausdörfer Institute, the BOMA method or the McGuire programme

Transport 18

Transport by ambulance

Hospital visit costs

Overnight guest house accommodation during an outpatient treatment cycle

Overnight guest house accommodation and transport of family members in the event of hospitalisation in the Netherlands, Belgium or Germany

Seated patient transport

9

Hospital, treatment and nursing 19

Asthma Centre in Davos (Switzerland)

Circumcision (male)

Genetic research and advice

MammaPrint diagnostic breast cancer test

Mechanical respiration

Specialist medical care and stay

Plastic surgery

Plastic and cosmetic surgery

Rehabilitation (specialist medical rehabilitation and geriatric rehabilitation)

Second opinion

Sterilisation

Home dialysis

Transplantation of organs and tissues

Nursing and care in your own surroundings (extramural)

Pregnancy/baby/child 20

Maternity care or medical screening related to adoption

Delivery and obstetric or midwifery care that is medically necessary

Delivery and obstetric or midwifery care that is not medically necessary Personal contribution

Oocyte vitrification

Personal contribution for assistance during childbirth

IVF (in vitro fertilisation)

Maternity package

Maternity care at a hospital with a medical indication

Maternity care at a hospital without a medical indication Personal contribution

Maternity care at home or at a birth or maternity centre Personal contribution

Lactation care

Oncological examination of children (by SKION)

Assistance during childbirth Personal contribution

Prenatal screening: combined test, counselling, Structural Echoscopic Examination (SEO), NonInvasive Prenatal Testing (NIPT), Invasive diagnostics

Sperm cryopreservation

TENS during delivery

Maternity care postponed due to medical necessity

Maternity care extended due to medical necessity

Fertilityenhancing treatments (other than IVF)

Slimmer Zwanger pregnancy selfhelp programme

Antenatal classes

Other medical care 22

Dietetic therapy

Convalescent home or care hotel

Hospice (in the Netherlands)

General practitioner care

Integrated care for diabetes mellitus type 2, COPD, asthma and/or vascular risk management (VRM)

Patient association membership

Therapeutic holiday camp for handicapped persons

Therapeutic holiday camp for children

Thrombosis service

Contents (cont'd)

10List of reimbursements 2016

Alternative therapiesBasic insurance OZF Zorgpolis

Supplementary insurance AV Compact

Supplementary insurance AV Royaal

Alternative medicines (registered in the Gstandard of the Zindex as homeopathic or anthroposophic medicines)

Max €100.00 per cy (with a doctor's prescription)

100% (with a doctor's prescription)

Alternative forms of treatment and therapy(for conditions and what we do not reimburse: see art. 2 on p. 46 of the policy conditions)

Max €40.00 per day, max €20.00 per cy (healthcare provider is affiliated with a professional association recognised by us: see our website)

Max €50.00 per day, max €500.00 per cy (healthcare provider is affiliated with a professional association recognised by us: see our website)

Bones, muscles and jointsBasic insurance OZF Zorgpolis



Remedial therapy in a hot water pool for rheumatoid arthritis

Max €200.00 per cy

Chiropractic treatment (chiropractor is a member of the NCA, DCF, CCA or SCN)

Max €40.00 per day, max 24 tr per cy

Occupational therapy(advice, instruction, training or treatment by an occupational therapist)

Max 10 hours per cyContracted: 100% Noncontracted: max 75% of our average contracted tariff

Osteopathy (osteopath is a member of the NOF or the NRO)

Max €50.00 per day, max 10 tr per cy

Pedicure care for rheumatoid foot conditions (for conditions and what we do not reimburse: see art. 6.1 on p. 47 of the policy conditions)

Max €25.00 per tr, max €150.00 per cy (for pedicure care for rheumatoid foot conditions, diabetic and medical foot conditions together)

Pedicure care for diabetic foot conditions, Care Profile 1 (Zorgprofiel 1) (for conditions and what we do not reimburse: see art. 6.2 on p. 47 of the policy conditions)


Pedicure care for medical foot conditions (for conditions and what we do not reimburse: see art. 6.3 on p. 47 and 48 of the policy conditions)


Podiatry/podology/podopostural therapy(for conditions and what we do not reimburse: see art. 7 on p. 48 of the policy conditions)


11Bones, muscles and joints (cont'd)

Basic insurance OZF Zorgpolis



Sports doctor (in a SCAS accredited Sports Medical Insitution: www.sportzorg.nl/zoekeensportzorgprofessional)

Max €130.00 per cy for injury and/or followup consultations

Max €130.00 per cy for injury and/or followup consultations

Sports medical examination (in a SCAS accredited Sports Medical Insitution: www.sportzorg.nl/zoekeensportzorgprofessional)

Max €100.00 per 2 cy Max €100.00 per 2 cy

(Sport) arch supports and/or orthoses. Or their repair. (a recognised supplier who manufactures/supplies/repairs: see art. 10 on p. 49 of the policy conditions)


Foot care in the case of diabetes mellitus(for conditions and what we do not reimburse: see art. 2 on p. 20 of the policy conditions)

Foot examination and treatment by a podiatrist (Care Profile 1 (Zorgprofiel 1) and higher)Contracted: 100%Noncontracted: max 75% of our average contracted tariff

AbroadBasic insurance OZF Zorgpolis



Overnight stay and transport costs of family members following healthcare mediation if care is provided in Belgium or Germany(your family members have our AV Compact or AV Royaal)

Accommodation expenses: max €35.00 per day for all family members combined Own transport, public transport (lowest class) or transport by taxi: €0.30 per km up to max 700 km per admission

Accommodation expenses: max €35.00 per day for all family members combined Own transport, public transport (lowest class) or transport by taxi: €0.30 per km up to max 700 km per admission

Transport costs following care mediation if care is provided in Belgium or GermanyCall our Transport Telephone Line (Vervoerslijn) for permission in advance: +31 71 365 4 154

Contracted transport by taxi: 100% Noncontracted transport by taxi: no reimbursementOwn transport: €0.30 per km Public transport: 100% (lowest class) Max €1,000.00 per cy

Contracted transport by taxi: 100% Noncontracted transport by taxi: no reimbursementOwn transport: €0.30 per km Public transport: 100% (lowest class) Max €1,000.00 per cy

Transport of the insured person and mortal remains to the Netherlands (repatriation)

100% if approved in advance by emergency response centre Eurocross Assistance

100% if approved in advance by emergency response centre Eurocross Assistance

Medical treatment abroad, nonurgent

Contracted: 100%Noncontracted: according to the reimbursement that applies in the Netherlands, subject to conditions and exclusions, up to max 75% of the average contracted tariff in the Netherlands

Medical treatment abroad, urgent 100% up to max Dutch tariffs Supplement to basic insurance up to cost price (with a max stay of 365 days)

Supplement to basic insurance up to cost price (with a max stay of 365 days)

12Physiotherapy and remedial therapy




Pelvic physiotherapy 18 years or older (for urinary incontinence)

9 tr per cy Contracted: 100%Noncontracted: max 75% of our average contracted tariff

Max 12 tr per cy Contracted: 100%Noncontracted: max 75% of our average contracted tariff

Max 27 tr per cyContracted: 100%Noncontracted: max 75% of our average contracted tariff

Exercise programmes for: • Obesity (BMI > 30)• Earlier heart failure• Rheumatoid arthritis

(as defined by the Dutch Reumafonds (Arthritis Foundation))

• Diabetes type 2• COPD with a lung function of

FEV1/VC < 0.7, a breathlessness score of > 2 on the MRC scale and a health score of > 1 to 1.7 on the CCQ scale

• Suffering or recovering from an oncological condition

Contracted: max €175.00 per disorder for the duration of the supplementary insuranceNoncontracted: no reimbursement

Contracted: max €350.00 per disorder for the duration of the supplementary insuranceNoncontracted: no reimbursement

Physiotherapy and remedial therapy 18 years or older with a chronic disorder (you will find the list of chronic disorders on our website) For severe lymphoedema, manual lymphatic drainage may also be performed by a skin therapist

Tr 21 and next Contracted: 100%Noncontracted: max 75% of our average contracted tariff

Max 12 tr per cy (tr 13 to 20 you pay yourself) Contracted: 100%Noncontracted: max 75% of our average contracted tariff

Max 27 tr per cy Contracted: 100%Noncontracted: max 75% of our average contracted tariff

Physiotherapy and remedial therapy 18 years or older with a nonchronic disorder (you will find the list of chronic disorders on our website)



Please note!

Is a maximum number of physiotherapy and remedial therapy treatments specified under AV Compact and/or AV Royaal?Then the specified maximum number of treatments applies per calendar year, even if the insured person suffers from several disorders. The maximum number of treatments also applies regardless of whether the disorder(s) is/are on the list established by the Dutch Minister of Health, Welfare and Sport (VWS).

More information about physiotherapy and/or remedial therapy can be found on our website.

Physiotherapy and remedial therapy up to 18 years with a chronic disorder (you will find the list of chronic disorders on our website) For severe lymphoedema, manual lymphatic drainage may also be performed by a skin therapist

Unlimited number of trContracted: 100%Noncontracted: max 75% of our average contracted tariff

Physiotherapy and remedial therapy up to 18 years with a nonchronic disorder (you will find the list of chronic disorders on our website)

Max 9 tr per cy per disorder, with the possible addition of 9 further tr (for a medical necessity)Contracted: 100%Noncontracted: max 75% of our average contracted tariff

Contracted: unlimited number of tr per cy 100% NonContracted: max 12 tr per cy, max 75% of our average contracted tariff

Contracted: unlimited number of tr per cy 100% NonContracted: max 27 tr per cy, max 75% of our average contracted tariff

Postcare physiotherapy (oncology, CVA, cardiovascular diseases)

Contracted: 100%Noncontracted: no reimbursement


13Skin




Acne treatment(for conditions and what we do not reimburse: see art. 16 on p. 52 of the policy conditions)

Max €350.00 per cy (we reimburse either camouflage therapy or acne treatment for the same indication)

Camouflage therapy(for conditions and what we do not reimburse: see art. 17 on p. 52 of the policy conditions)

Max €350.00 per cy (we reimburse either camouflage therapy or acne treatment for the same indication)

Hair removal treatment (for conditions and what we do not reimburse: see art. 18 on p. 52 of the policy conditions)

Max €545.00 for the duration of the supplementary insurance(for female insured persons if there is unsightlyfacial hair)

Medical devicesBasic insurance OZF Zorgpolis



Hand splint (for postcare physiotherapy in the case of hand problems that require specialist treatment for delivery conditions: see art. 19.2 on p. 52 of the policy conditions)

Maximum of €40.00 per cy for a finger or small thumb splint Maximum of €60.00 per cy for a wrist, hand or large thumb splintMaximum of €90.00 per cy for a dynamic or static splint

Maximum of €40.00 per cy for a finger or small thumb splint Maximum of €60.00 per cy for a wrist, hand or large thumb splintMaximum of €90.00 per cy for a dynamic or static splint

Headwear for oncology(scarf, hat, peaked cap, bandana or Toupim (headband wig))

Max €150.00 per cy (purchased from a specialist supplier recognised by us and chosen in preference to a wig)

Medical devices (certain medical devices must be approved by us in advance, and are subject to a max reimbursement or statutory personal contribution)

Contracted: 100%Noncontracted: max 75% of our average contracted tariff

Personal alarm system(with a medical indication)

According to Medical Devices Regulations (Reglement Hulpmiddelen) (see our website)

Personal alarm system (subscription fees)Contracted: 100% Noncontracted: max €35.00 per cy, after receiving our permission in advance

Personal alarm system (subscription fees)Contracted: 100% Noncontracted: max €35.00 per cy, after receiving our permission in advance

Adhesive strips for breast prosthesis (after mastectomy)

100% 100%

Bedwetting alarm, purchase or rental costs (for bedwetting problems)

Max €100.00 for the duration of the supplementary insurance


Wig Personal contribution According to Medical Devices Regulations (Reglement Hulpmiddelen) (see our website): max €418.50 per wig

Personal contribution for wig: Max €200.00 per cy (in addition to the reimbursement covered by your basic insurance)

Support pessary(supplied by your general practitioner)

100% (for preventing/relieving prolapse of the bladder or womb)

Incontinence therapy, rental of apparatus (for tr of incontinence)



Selfhelp programme IncoCure (for female insured persons who suffer from incontinence)

The IncoCure online physiotherapy treatment: max €15.00 per cy (www.incocure.com)

The IncoCure online physiotherapy treatment: max €15.00 per cy (www.incocure.com)

14Medicines and dietary preparations




Contraceptives• Up to 21 years

• 21 years or older

Contracted: 100% up to the GVS limitNoncontracted: max 75% of our average contracted tariff

Only upon medical indication endometriosis or menorrhagia (abnormally heavy menstrual periods)Contracted: 100% up to the GVS limitNoncontracted: max 75% of our average contracted tariff

Contracted: 100% up to the GVS limitNoncontracted: no reimbursement

Contracted: 100% up to the GVS limitNoncontracted: no reimbursement

Medicines and dietary preparations According to Pharmaceutical Care Reguations (Reglement Farmaceutische Zorg) (see our website)Contracted: 100% Noncontracted: max 75% of our average contracted tariff

Melatonin(prescribed by a (child) psychiatrist, paediatrician or (paediatric) neurologist and on the condition it is prescribed by general practitioner)

Via online pharmacy eFarma: 100% or Via another contracted pharmacy: max €100.00 per cy Noncontracted: no reimbursement

Statutory personal contribution (GVS upperlimit price)


Oral health care and dentistry (dental care)


Supplementary insurance Tand Compact

Supplementary insurance Tand Royaal

Implants (for reimbursement conditions: see art. 11.1 on p. 26 of the policy conditions)

100%For noncontracted dental surgeon: max 75% of our average contracted tariff

Orthodontics (brace) in exceptional cases (for conditions and what we do not reimburse: see art. 7 on p. 24 and 25 of the policy conditions)

100%

Regular dental care and oral hygiene 18 years or older (for conditions and what we do not reimburse: see art. 47 on p. 63 of the policy conditions)

Consultations (C codes), oral hygiene (M codes), fillings (V codes), extractions (H codes) and a second opinion: 100%

Other dental treatments: 75%

Max reimbursement: €250.00 per cy

Consultations (C codes), oral hygiene (M codes), fillings (V codes), extractions (H codes) and a second opinion: 100%

Other dental treatments: 80%

No max reimbursement per cy

Regular dental care younger than 18 years (for conditions and which treatments we do and do not reimburse: see art. 8 on p. 25 of the policy conditions)

100%For noncontracted dental surgeon: max 75% of our average contracted tariff

15Oral health care and dentistry (dental care) (cont’d)


Supplementary insurance Tand Compact

Supplementary insurance Tand Royaal

Dental care 18 years or older Dental surgery (for conditions and what we do not reimburse: see art. 9 on p. 25 and 26 of the policy conditions)

100% For noncontracted dental surgeon: max 75% of our average contracted tariff

Dental care 18 years or older Full set of removable dentures (false teeth) (for conditions and what we do not reimburse: see art. 10 on p. 26 of the policy conditions)

75% (a statutory personal contribution of 25% applies)

Repair or rebasing: 100%

100% of the statutory personal contribution payable under the basic insurance

Dental care in exceptional cases (for reimbursement conditions: see art. 13 on p. 27 of the policy conditions)

100% For noncontracted dental surgeon: max 75% of our average contracted tariff (in some cases a statutory personal contribution applies for persons 18 years or older)

Dental care Crowns, bridges, inlays and implants (for conditions and what we do not reimburse: see art. 48 on p. 63 of the policy conditions)

80% up to max €750.00 per cy

Dental care Orthodontics (braces) for insured persons up to 22 years(for conditions and what we do not reimburse: see art. 49 on p. 63 of the policy conditions)

80% up to max €2,000.00 for the duration of the supplementary insurance up to 22 years

Dental care Full set of removable implantretained dentures (for reimbursement conditions: see art. 11.2 on p. 26 of the policy conditions)

100%, not including the statutory €125.00 personal contribution payable per upper or lower jaw (therefore max €250.00)

Dental care for insured persons with a handicap (for reimbursement conditions : see art. 12 on p. 27 of the policy conditions)

100% unless they have a right toreimbursement under the Dutch Longterm Care Act (Wlz)For noncontracted dental surgeon: max 75% of our average contracted tariff

Eyes and earsBasic insurance OZF Zorgpolis



Audiology centre Hearing problemsContracted: 100%Noncontracted: max 75% of our average contracted tariff Speech and language disorders in childrenContracted: 100%Noncontracted: max 75% of our average contracted tariff

Spectacles and/or contact lenses(prescription and supplied by an optician or optical retailer)

Only for specific medical disorders according to Medical Devices Regulations (Reglement Hulpmiddelen) (see our website)

Max €100.00 per 2 cy Max €200.00 per 2cy

16Eyes and ears (cont'd)




Hearing aid Personal contribution Up to 18 yearsContracted: 100%Noncontracted: max 75% of our average contracted tariff

18 years or older: subject to a statutory personal contribution of 25%Contracted: 100%Noncontracted: max 75% of our average contracted tariff

Up to 18 years: no reimbursement

18 years or older:Contracted: 100% of the statutory personal contribution payable under the basic insurance Noncontracted: per hearing aid max €100.00 of the statutory personal contribution payable under the basic insurance

Tip! Want to get a hearing aid faster and pay less for it? Here’s how

If you go to one of our contracted hearing aid specialists, you do not have to visit your general practitioner or an ear, nose and throat doctor (ENT doctor) first. This hearing aid specialist is qualified to assess your hearing. The hearing aid specialist will refer you to an ENT doctor or an Audiology Centre if it is really necessary. Our contracted hearing aid specialists always supply high quality hearing aids. The hearing aid specialists we have contracted in 2016 are Beter Horen and Hans Anders.

Use the Medical Provider Search Tool on our website, www.ozf.nl/zorgzoeker, to find a contracted hearing aid specialist in your neighbourhood.

Refractive eye surgery or lens implants (for reimbursement conditions: see art. 22 on p. 55 of the policy conditions)

Please note! Newly insured persons are put on a 12month waiting list

Refractive surgery: no reimbursementLens implantation: for monofocal lens, after receiving our permission in advance:Contracted: 100%Noncontracted: max 75% of our average contracted tariff

Refractive eye surgery or lens implants: max €500.00 per eye for the duration of the supplementary insurance (for lens implants we reimburse the additional costs of a lens other than a monofocal (standard) intraocular lens)

Sensory impairment care(for which impairments and the reimbursement conditions: see art. 15 on p. 28 of the policy conditions)

Contracted: 100%Noncontracted: max 75%of our average contracted tariff

PreventiveBasic insurance OZF Zorgpolis



Consultations, vaccinations and medication required for foreign travel(if necessary according to the advice of the National Coordination Centre for Travel Health Advice (Landelijk Coördinatiecentrum Reizigersadvisering (LCR)): see www.lcr.nl/landen)

Contracted: 100% or Noncontracted: max €75.00 per cy

Contracted: 100% orNoncontracted: max €100.00 per cy

Flu vaccinations 100% (not provided by the national vaccination programme)

Coping with heart problems Max €100.00 per course, per cy(for where the course must take place: see art. 26 on p. 56 of the policy conditions)

Max €100.00 per course, per cy(for where the course must take place: see art. 26 on p. 56 of the policy conditions)

Lymphoedema, awareness and/or selfmanagement course



Coping with rheumatoid arthritis, osteoarthritis or ankylosing spondylitis (Bechterew's disease)



17Preventive (cont’d)




Type 2 diabetics, basic or followup educational course



Weight loss course Max €100.00 per course, per cy(for where the course must take place: see art. 26 on p. 56 of the policy conditions)


Basic resuscitation/AED course Max €100.00 per course, per cy(for where the course must take place: see art. 26 on p. 56 of the policy conditions)


First aid course Max €100.00 per course, per cy(for where the course must take place: see art. 26 on p. 56 of the policy conditions)


Baby and child first aid course Max €100.00 per course, per cy(for where the course must take place: see art. 26 on p. 56 of the policy conditions)


Online sleep course Max €100.00 per course, per cy(for where the course must take place: see art. 26 on p. 56 of the policy conditions)


Stop smoking course Max €100.00 per course, per cy(for where the course must take place: see art. 26 on p. 56 of the policy conditions)


Stop smoking programme(max 1x per cy)


Intestinal cancer screening selftest (50 years or older)

Max €15.00 per cy for the iFOBT test

Psychological careBasic insurance OZF Zorgpolis



General Basic GGZ 18 years or older (for conditions and what we do not reimburse: see art. 16 on p. 28 and 29 of the policy conditions)


Nonclinical specialised GGZ (secondline GGZ) 18 years or older (for conditions and what we do not reimburse: see art. 17 on p. 29 of the policy conditions)


Stay in a psychiatric hospital18 years or older (for conditions and what we do not reimburse: see art. 18 on p. 29 and 30 of the policy conditions)

Max 1095 daysContracted: 100%Noncontracted: max 75% of our average contracted tariff

18Speech and reading




Speech therapy(for conditions and what we do not reimburse: see art. 19 on p. 30 of the policy conditions)


Stutter therapy by a speech therapist


Stutter therapy method taught at the Del Ferro or Hausdörfer Institute, the BOMA method or the McGuire programme



TransportBasic insurance OZF Zorgpolis



Transport by ambulance(for entitlements and reimbursement conditions see art. 20.1 on p. 31 of the policy conditions)

100%

Hospital visit costs to see an OZFinsured family member(transport costs in the case of a hospital or rehabilitation centre stay in the Netherlands; does not apply for a stay in a psychiatric hospital)

€0.30 per km, irrespective of the method of transport and max of 3 visits per calendar week for all family members combined First 80 km per visit date at own expense (family member has our AV Royaal insurance)

Overnight guest house accommodation during an outpatient treatment cycle

Max €35.00 per day (excludes the overnight stay prior to the first tr day)

Max €35.00 per day (excludes the overnight stay prior to the first tr day)

Overnight guest house accommodation and transport of family members(in the event of hospitalisation in the Netherlands with min distance of 50 km from home or in Belgium or Germany with max 55 km across the border; reimbursement excludes hospitalisation in a psychiatric hospital)

Accommodation expenses: max €35.00 per day up to max €500.00 per cy for all family members combinedTransport: €0.30 per km, irrespective of the method of transport

Accommodation expenses: max €35.00 per day for all family members combinedTransport: €0.30 per km, irrespective of the method of transport

Patient transport by public transport, own transport or (multiperson) taxi transport (up to 200 km one way)

Call our Transport Telephone Line (Vervoerslijn) for permission: (071) 365 4 154

For the following medical indications:• Kidney dialysis• Oncology tr with radiotherapy

or chemotherapy• Visual handicap (and inability to

travel unescorted)• Wheelchair dependence• Intensive childcare and under

the age of 18 years

Own transport: €0.30 per km Public transport: 100% (lowest class) Contracted transport by taxi: 100% Noncontracted transport by taxi: max 75% of our average contracted tariff

Statutory personal contributions €98.00 per cy

Other medical indications:• Admission to, or discharge

from, a hospital or maternity centre

• Admission to an institution covered by the Ducth Longterm Care Act (Wlz)

• Visits to an orthopaedic device manufacturer for prosthesis adjustment

Own transport: €0.30 per km Contracted transport by taxi: 100%Noncontracted transport by taxi: max 75% of our average contracted tariff

Personal contribution €98.00 per cy (only payable if the statutorypersonal contribution payable under the basic insurance has not yet been reached)

Max reimbursement €1,000.00 per cy

19Hospital, treatment and nursing




Asthma Centre in Davos (Switzerland)

100%, after receiving our written permission in advance

Circumcision (male, not on religious grounds)

With a medical indication and after referralContracted: 100%Noncontracted: no reimbursement

With a medical indication and after referralContracted: 100%Noncontracted: no reimbursement

Genetic research and advice Contracted: 100%Noncontracted: max 75% of our average contracted tariff

MammaPrint diagnostic breast cancer test

100% if the test is performed by the Agendia laboratory

100% if the test is performed by the Agendia laboratory

Mechanical respiration Contracted: 100%Noncontracted: max 75% of our average contracted tariff

Specialist medical care and stay(for conditions and what we do not reimburse: see art. 24 on p. 32 and 33 of the policy conditions)

Max 1095 daysContracted: 100%Noncontracted: max 75% of our average contracted tariff

Plastic surgery (for which treatments we reimburse, for conditions and what we do not reimburse: see art. 25 on p. 33 of the policy conditions)

Contracted: 100% Noncontracted: max 75% of our average contracted tariff

Plastic and cosmetic surgery

Correction of upper eyelids if field of vision is severely impaired and no claim can be made under the basic insuranceContracted: 100%Noncontracted: no reimbursement

Correction of prominent ears(younger than 18 years)Contracted: 100%Noncontracted: no reimbursement

Correction of upper eyelids if field of vision is severely impaired and a claim can be made under the basic insuranceContracted: 100%Noncontracted: no reimbursement

Correction of prominent ears(younger than 18 years) Contracted: 100%Noncontracted: no reimbursement

Rehabilitation(for reimbursement conditions: see art. 26.1 for specialist medical rehabilitation and art. 26.2 for geriatric rehabilitation, both on p. 34 of the policy conditions)

Specialist medical rehabilitiation (max 1095 days)Contracted: 100%Noncontracted: max 75% of our average contracted tariff

Geriatric rehabilitation (max 6 months)Contracted: 100%Noncontracted: max 75% of our average contracted tariff

Second opinion(for conditions and what we do not reimburse: see art. 27 on p. 34 of the policy conditions)


Sterilisation (reversal surgery is not reimbursed)

100% if performed on a male insured person by an authorised general practitioner100% if performed by a contracted medical specialist at a hospital or independent treatment centre (ZBC)Noncontracted: no reimbursement

Home dialysis 100% if approved in advance by us

20Hospital, treatment and nursing (cont'd)




Transplantation of organs and tissues

At a hospital or ZBCContracted: 100%Noncontracted: max 75% of our average contracted tariff, if approved by us in advance

Donor care: max 13 weeksLiver transplant: max 6 months

Nursing and care in your own surroundings (extramural)(for reimbursement conditions (also PGB) and what we do not reimburse: see art. 30 on p. 35 and 36 of the policy conditions)


Pregnancy/baby/childBasic insurance OZF Zorgpolis



Maternity care related to adoption (for children up to 12 months), or Medical screening for adoption

Max 10 hours, orMax €300.00 per adopted child

Max 10 hours,or €300.00 per adopted child

Delivery and obstetric or midwifery care that is medically necessary

Clinical and outpatient Contracted: 100%Noncontracted: max 75% of our average contracted tariff

Delivery and obstetric or midwifery care that is not medically necessary Personal contribution

• At home Contracted: 100%

Noncontracted: max 75% of our average contracted tariff

• At a hospital or birth centre Contracted: 100% Noncontracted: max 75% of our

average contracted tariffStatutory personal contribution €16.50 per day of hospitalisation plus the fee charged by the hospital insofar as it exceeds €119.00

• Use of a delivery room at a hospital or birth centre: 100% of the statutory personal contribution payable under the basic insurance

• Use of a delivery room at a hospital or birth centre: 100% of the statutory personal contribution payable under the basic insurance

Oocyte vitrification (for which medical indications, reimbursement conditions and what we do not reimburse: see art. 32.4 on p. 37 and 38 of the policy conditions)

In an authorised hospitalContracted: 100%Noncontracted: max 75% of our average contracted tariff

IVF up to 43 years(for reimbursement conditions , reimbursement of medicines and what we do not reimburse: see art. 32.1 on p. 36 and 37 of the policy conditions)

First 3 attempts per potential pregnancy Contracted: 100%Noncontracted: max 75% of our average contracted tariff

Maternity package(for female insured persons)

100%, applications via our website 100%, applications via our website

Maternity care at a hospital with a medical indication


Maternity care at a hospitalwithout a medical indication

Max 10 days Contracted: 100%Noncontracted: max 75% of our average contracted tariffStatutory personal contribution €16.50 per day of hospitalisation plus the fee charged by the hospital insofar as it exceeds €119.00

21Pregnancy/baby/child (cont’d)




Maternity care at home or at a birth or maternity centre Personal contribution (number of hours of maternity care according to the National Indication Protocol on Maternity Care (Landelijk Indicatieprotocol Kraamzorg), to be found on our website)

Max 10 days Contracted: 100% Noncontracted: max 75% of our average contracted tariffStatutory personal contribution €4.20 per hour

100% of the statutory personal contribution payable under the basic insurance, max 24 hours per pregnancy


Lactation care (help and advice for breast feeding problems)


Oncological examination of children (by SKION)

100%

Assistance during childbirth Personal contribution (number of hours of midwife assistance during delivery)

Contracted maternity centre: 100%Noncontracted maternity centre: max 75% of our average contracted tariffStatutory personal contribution €4.20 per hour



Prenatal screening• Combined test: (after referral)

• Counselling

• Structural Echoscopic Examination (SEO)

• NonInvasive Prenatal Testing (NIPT) (with a medical indication or positive combined test)

• Invasive diagnostics (with a medical indication, positive combined test or positive noninvasive prenatal test)Prenatal screening






Sperm cryopreservation(for reimbursement conditions: see art. 32.3 on p. 37 of the policy conditions)


TENS during delivery(for female insured persons)

Contracted: 1x for the duration of the supplementary insuranceNoncontracted: no reimbursement

Contracted: 1x for the duration of the supplementary insuranceNoncontracted: no reimbursement

Maternity care postponed due to medical necessity

Contracted: max €300.00Noncontracted: no reimbursement

Maternity care extended due to medical necessity (10th day onwards)

Contracted: max €200.00 per day, max 5 daysNoncontracted: no reimbursement

Fertilityenhancing treatments, other than IVF, up to 43 years(for reimbursement conditions, reimbursement of medicines and what we do not reimburse: see art. 32.2 on p. 37 of the policy conditions)

Contracted: 100% Noncontracted: max 75% of our average contracted tariffReimbursement of medicines according to GVS

22Pregnancy/baby/child (cont'd)




Slimmer Zwanger pregnancy selfhelp programme

1 subscription lasting 26 weeks for the duration of the supplementary insurance

1 subscription lasting 26 weeks for the duration of the supplementary insurance

Antenatal classes, yoga or gymnastics(for reimbursement conditions: see art. 41 on p. 61 of the policy conditions)

Max €50.00 per pregnancy (for female insured persons)

Max €75.00 per pregnancy (for female insured persons)

Other medical careBasic insurance OZF Zorgpolis



Dietetic therapy Dietary advice by a dietitian: max 3 hours per cyContracted: 100%Noncontracted: max 75% of our average contracted tariff

Dietetic therapy by a dietitian: max 2 hours, as supplement to basic insuranceContracted: 100%Noncontracted: max 75% of our average contracted tariff

Convalescent home or care hotel (does not apply for psychosomatic healthcare and personal contri bution payable under the Dutch Long term Care Act (Wet langdurige zorg (Wlz)) or the Dutch Social Support Act (Wet maatschappelijke ondersteuning (Wmo))

Max €80.00 per day, max 40 days per cy (after receiving our permission in advance)

Hospice(in the Netherlands, does not apply for the personal contribution payable under the Dutch Longterm Care Act (Wet langdurige zorg (Wlz))

Maximum of €40.00 per day up to a maximum of €1,200.00

General practitioner care Contracted: 100% Noncontracted: max 75% of our average contracted tariff

Integrated care(for diabetes mellitus type 2 (18 years or older), COPD, asthma and/or VRM)

100%, as long as we have entered into appropriate agreements with a care group: see our website

Membership of patient association Max €25.00 per cy (for the patient associations for which we provide reimbursement: see art. 45 on p. 62 of the policy conditions)

Therapeutic holiday camp for handicapped persons


Therapeutic holiday camp for children:(for the holiday camps for which we provide reimbursement: see art. 46.1 on p. 62 of the policy conditions)

Max €150.00 per cy (younger than 18 years)

Thrombosis service Contracted: 100%Noncontracted: max 75% of our average contracted tariff

23Healthcare ServicesEmergency response centre Eurocross Assistance

Service provided by Eurocross Assistance. Available 24 hours a day if

you need emergency medical assistance abroad.

Telephone number +31 71 364 1 282.

Holiday doctor

Free advice on nonurgent medical issues before and/or during holidays.

Telephone number +31 71 364 1 802.

Care mediation

We gladly provide you with the best care advice in order to ensure that

you receive high quality care quickly. We will also help you find a general

practitioner, dentist or physiotherapist if you move home. Telephone

number (074) 789 0 789 or look at our website.

We offer attractive discounts

This applies to cosmetic surgery, a number of medical devices, spectacles

and contact lenses or refractive eye surgery/lens implantation. For more

information and a complete overview, please visit our website.

Visit www.ozf.nl

For details of our contracted care providers, maximum reimbursements for noncontracted care, the Medical Devices Regulations (Reglement

Hulpmiddelen), the Pharmaceutical Care Regulations (Reglement Farmaceutische Zorg), the List of Reimbursements for Basic Paramedic Care,

professional associations for alternative therapists who meet our quality criteria, conditions, brochures, forms and other information about our

health insurance policies.

OZF. Your health insurer.

Visit our websitewww.ozf.nl/aviva

Call usCustomer Service +31 74 789 0 789 Lines are open from 08.00 to 17.00 on working days

Email us [email protected]

Write to usZorgverzekeraar OZFCustomer Service DepartmentPostbus 94 7550 AB Hengelo

Submit your claims• Online:

www.ozf.nl/declareren• By post:

Zorgverzekeraar OZF Claims Service Department Postbus 94 7550 AB Hengelo - NL

We are a relatively small health insurer. Our team of 30 staff provide dedicated

and caring assistance for our customers. We make personal attention and

customer friendliness a priority. We are a non-profit organisation. As well as

providing personal insurance, we also provide group health insurance for a

large number of companies. We are based in Hengelo in the Netherlands and

operate nationally.

If you would prefer not to receive information about our products or services, please let us know by writing to us at: Zorgverzekeraar OZF, Customer Privacy Department, Postbus 94, 7550 AB Hengelo - NL. No rights can be derived from this brochure.

Documents

List of reimbursements 2016