How does the health insurance excess work?
Everyone with basic health insurance and over the age of 18 has to deal with a deductible. This means that the first healthcare costs you incur are for your own account. This applies to almost all healthcare costs covered by the basic health insurance. But how exactly does the deductible work? We explain.
What is the excess?
If you receive care from the basic insurance, you pay part of the healthcare costs yourself. We call this the compulsory excess. The deductible applies to every basic insurance policy, regardless of what type of health insurance you have. The amount of the legal compulsory excess is determined annually by the government. In 2024, the legal compulsory excess is €385 per insured person. The compulsory excess applies to everyone aged 18 and older. Children have no excess.
- The deductible applies for an entire calendar year (January 1 to December 31).
- You pay the deductible in addition to your premium.
- You use up the deductible first, then you can get reimbursement from your basic insurance.
- With supplementary insurance, there is never any excess.
- There is no deductible for certain basic insurance care, such as the family doctor.
Why do I pay an excess?
There are two reasons why a deductible should be paid. First, the government thus wants to make everyone more aware of the healthcare costs they incur. Along with that, the mandatory deductible also means that the premium can remain as low as possible for everyone.
What care is not covered by the excess?
Some health care expenses are not covered by the deductible. For example, you pay no deductible for:
- The family doctor (note: prescribed medication and blood tests are not excluded from the excess)
- Care for children under 18.
- Obstetric care and maternity care (here, however, a personal contribution may be payable for maternity care and hospital births without medical necessity)
- Aids on loan.
- Care that is reimbursed under the Long-Term Care Act (Wlz) or the Social Support Act (Wmo).
- Care from the supplementary insurance such as dental care.
What is the voluntary excess?
In addition to the mandatory deductible, there is also a voluntary deductible. You can voluntarily supplement your mandatory deductible up to € 485, € 585, € 685, € 785 or up to € 885. The higher the deductible, the lower your premium becomes. Just as with the obligatory deductible excess, you pay the voluntary deductible excess yourself before you get reimbursed from the basic insurance. This amount also applies for an entire calendar year (January 1 to December 31).
Examples own risk
To clarify the deductible, the following are two practical examples:
Linda has a deductible of €385 in 2023. After an accident while playing sports, she hurts her head badly and goes to the emergency room. There the wound is stitched. The hospital sends the bill of € 185 to her health insurer. The health insurance company will deduct this amount from Linda's deductible. In 2023, Linda goes to the family doctor once more (no deductible) and receives medication for € 35.
Her deductible costs for 2023 come to: €185 + €35 = €220. Thus, the health insurance company does not yet reimburse health care costs.
The costs for the family doctor are not covered by the deductible, therefore these costs are not charged. In 2024, the deductible counter starts back at zero.
Wouter has a deductible of € 485. He has voluntarily increased his deductible by € 100. In the spring, Wouter goes to the hospital with complaints on the referral of his family doctor. At the hospital, Wouter has to undergo some examinations. He is given some medication for the complaints.
The calculation is then as follows:
- GP consultation: € 40/ no excess
- Hospital examination: € 200/ do deductible
- Medication: € 50/ do own risk
The consultation with the family doctor is fully reimbursed by the health insurance company, since the deductible does not apply to it. For the hospital examination and medication, however, a deductible does apply. Calculation of the deductible is then:
The costs for the deductible amount to € 200 + € 50 = € 250. Since Wouter has opted for a deductible of € 485, the health insurance company will not reimburse any costs yet. Wouter is left with € 485 - € 250 = € 235 for the rest of the year.
Wouter's symptoms persist and he still needs to undergo minor surgery later in the year. The cost is €350. Wouter had an outstanding deductible of € 235. The calculation now becomes: € 235 - € 350= -€ 115. This means that Wouter still has to pay € 235. The health insurance company will pay the remaining € 115.
What is the difference with an own contribution?
As mentioned above, every Dutch person aged 18 and older pays a deductible for care from the basic insurance. You first pay this amount yourself if you need care. After that, your health insurer will reimburse the remaining costs.
The co-payment is an amount you pay for certain types of care, such as maternity care, hearing aids and medications. The amount of the co-payment varies by type of care.
Example of own contribution and excess
Jan goes to the audiologist for a hearing aid. For hearing aids, both the co-payment and the deductible are charged. For hearing aids, there is a mandatory deductible of 25% of the cost. In this example, we assume that Jan has not yet had to pay a deductible in that year.
Cost of hearing aid € 1,200
Own contribution: 25% of €1,200 = €300
Cost after deducting own contribution: € 1,200 - € 300 = € 900
Excess is € 385
Left over after deductible € 900 - € 385 = € 515.
Jan pays a personal contribution of € 300 + excess of € 385. This is a total of € 685. The remaining costs of € 515 are paid by the health insurance company.
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