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Contracted care; what is that?

Every health insurer makes agreements with health care providers every year. For example, they negotiate the prices of treatments. These agreements directly affect the premium of your health insurance. But what exactly does contracted care mean?

What is contracted care?

Contracted care is care from providers with whom your health insurer has a contract. At a health insurer with contracted care, you can be sure that the bill will be paid by the health insurer. However, you are not obliged to seek care from contracted providers. If you choose a provider who has no contract with the health insurer, you will be charged part of the costs.

Benefits of contracted care

When you choose health insurance with contracted care, you enjoy a number of benefits:

  • You will be reimbursed in full, provided you are entitled to it under the policy terms.
  • The treatments of the contracted care providers meet the quality requirements of the insurer
  • You never have to advance the bill. The health care provider declares the bill directly to the health insurance company.
  • Agreements on quality, accessibility and maximum waiting times.

What is non-contracted care?

Not all health care providers agree with the arrangements made by health insurers. For that reason, healthcare providers may choose not to enter into contracts with the healthcare insurers. For you, this means that there is a good chance that part of the bill will have to be paid by you if you go to a non-contracted healthcare provider.

How much you have to pay depends on the type of policy you have. Is it a restitution policy? Then all costs will be reimbursed, regardless of whether there is a contract between healthcare provider and healthcare insurance. With an in-kind policy or a budget policy, you will have to pay between 20% and 30% of the costs yourself. The rest will be reimbursed by your health insurance. With a combination policy, it depends on whether contracts have been concluded for that specific type of care, or whether that is covered by the 'restitution part' of the policy.

What do I need to consider in case of non-contracted care?

For non-contracted care, there are a number of things that are different from contracted care. Please note the following points:

  • In some cases, you first pay the bill to the health care provider yourself. Then you can submit the bill to the health insurance company. It is also possible that the health care provider submits the bill directly to the insurer, after which the insurer deposits the non-reimbursed portion of the bill with you.
  • Level of reimbursement varies by type of basic insurance.
  • When using devices, you should ask for prior approval if the supplier complies with the health insurer's rules.
  • Nothing comes out of your deductible from the portion of the bill you have to pay yourself.

Contracted care: When are the contracts known?

Every year, health insurers must announce their premiums by November 12 at the latest. Often at that time the contracts are also known. This means that you can check whether your current health insurer has a contract with your trusted health care provider next year. If this is not the case, only ongoing treatment will be reimbursed. You can then choose to switch to another health insurer. Are you planning to switch health insurance anyway? Keep in mind the care providers contracted by the insurer in your comparison.

It is possible that not all contracts have yet been finalized with all health care providers. If you definitely want to switch health insurance, but do not yet know which health insurer you want, you can already cancel your current policy. If you do this by December 31, you still have until January 31 to take out a new insurance policy. All contracts will probably be known by then. Read more about when you can switch here .


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