d-3598 summary of cover

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All he hg y

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Mre Care

Summary of health insurancereimbursements for 2011


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Avro Achmea

Postbus 1717

3800 BS Amersfoort

General telephone number: 0900 - 9590 (local rate)

Travel Line: 0900 - 23 02 340 ( 0.10 p/m)

Nursing articles line: 0900 - 20 08 010 ( 0.10 p/m)

Holiday doctor: +31 71 36 41 802

Emergency Centre: +31 71 36 41 850

www.averoachmea.nl/zorgverzekeringen

. . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . .

Table of contents

3 More Care. For you to make the most of4 Faster assistance thanks to care mediation!

4 The Seven Certainties of good care

5 The deductible excess

6 No deductible excess thanks to care mediation

7 On paying bills and their reimbursement

7 When permission is required for treatment

8 What happens when things change?

8 Awareness and healthy living!

9 Some useful information

10 A cheap way to get fit

15 Your health insurance

16 What can you find where in the summary of reim-

bursements?

18 Summary of reimbursements 2011

30 Summary of the health insurance policies

31 Privacy

31 Applicable law and complaints procedure

31 Information about Avro Achmea

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More Care

For you to make the most of

3

Avro Achmea offers excellent care, in every sense. We

help you make all the right arrangements to ensure

excellent cover for an attractive price. As far as we are

concerned, no-one should have to wait for care. We also

believe that good care should be a matter-of-course.

You can always be sure of our Seven Certainties of Good

Care:

1. Care and waiting time mediation for everyone.

2. A care guarantee for all insured parties.

3. No obligatory deductible excess in the case of certain

operations.

4. Recourse assistance.

5. GP and dentist mediation.

6. Help when on holiday abroad.

7. Health programme.

You can find out more about the benefits of Avro

Achmea on the following pages. They also contain

practical information on paying bills and submitting

claims. In the summary of reimbursements you can find

out exactly what is reimbursed via the various(supplementary) insurance policies.

We hope you live a long and healthy life, but if you need

more care, Avro Achmea will always be there to help.


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We believe that good care should be a matter of course.

After all, nothing is more important than your health. It is

for this reason that we have made a number of key

arrangements. You can always be sure of the following

Seven Certainties:

1. Care and waiting time mediation

If you have medical problems, you will want good quality

assistance at the earliest opportunity. It is our job to provide

it. All you have to do is call the Avro Achmea care mediation

department and you will soon have an appointment with a

doctor or specialist.

2. Care guarantee

Care guarantee means you are guaranteed follow-up assistan-

ce for 65 common forms of treatment within 10 working days.

3. No obligatory deductible excess in the case of certain

operations

You do not pay any obligatory deductible excess for a

number of common operations if you make the necessary

arrangements via our care mediation service. The great

thing about this is that we also ensure that you are provi-

ded with good quality care at the earliest opportunity.

Faster assistance thanks to care mediation!

The fastest referrals

If you have medical problems, you will want rapid and good quality assistance. Your GP will usually refer you to the ne-

arest hospital. You may then be added to a waiting list. Care mediation helps to ensure that you receive assistance more

quickly.

All you need to do is call the care mediation department and we will start looking for hospitals that are specialised in cer-

tain forms of medical treatment. The main focus is on the speed and quality of the care. Our care mediators are in contact

with all hospitals in the Netherlands and even some in Belgium and Germany. If you agree to the care advice they provide,

our care mediator will make all the necessary arrangements. Thanks to our guarantee agreements you can often get an

appointment within two weeks. The sooner your problem is dealt with, the sooner your life can get back to normal.

Call 0900 - 9590 (local rate) or surf to www.averoachmea.nl/zorgbemiddeling to arrange assistance.

The Seven Certainties of

good care

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4. Recourse assistance

If you have suffered bodily injury as a consequence of an

accident, or wish to make a claim for compensation as a

consequence of a medical activity, we will help you recover

the costs.

5. GP and dentist mediation

If you are going to move house, we will help you find a new

GP or dentist. We will find out which practices are able to

accept new patients and will make the necessary

arrangements so that your registration is completed within

two weeks.

6. Help when abroad

It is nice to know that, when you are abroad,

Avro Achmea is there for you 24 hours a day. All you have

to do is call our Emergency Centre or our Holiday Doctor.

7. Health-programme

Health is a unique service which helps you improve your

health and develop a healthy lifestyle. For example, it offers

you a discount on a Health Check, so that you can find out

exactly how healthy you are. You also get a discount at the

Achmea Health Centers, and you will be eligible for the

regular special offers which can be found at

www.averoachmea.nl/health. We even reimburse the

majority of the costs of, for example, a first aid course.

Everyone who has to pay a premium for the basic insurancepolicy also has an obligatory deductible excess. In 2011 this

is 170.00 per insured party per calendar year. This deducti-

ble excess is set by the government to keep care affordable.

This means you have to pay the first 170.00 of the medical

costs incurred yourself. The costs on top of this are then

eligible for reimbursement.

Avro Achmea allows you to opt for a voluntary deductible

excess in addition to the obligatory deductible excess. The

higher your voluntary deductible excess, the lower your

premium will be. There are several ways in which you can in-

crease your deductible excess. The details can be found on

the back of your policy document. From all reimbursements

of care expenses which we issue during the course of the

year, we first deduct the obligatory deductible excess of

170.00 and then any self-selected voluntary deductible ex-

cess. If you want to adjust your voluntary deductible excess,

you can do so every year by calling 0900 - 9590 (local rate).

The deductible excess does not apply to:

GP visits (with the exception of subcontracted labora-tory tests).

Care which is reimbursed via your supplementary (den-tal) insurance policy.

Care and dental care for children aged up to 18. Articles on loan (such as VDU spectacles). Maternity care and obstetrical assistance. Chain-based care and follow-up checks of the donor.

The deductible excess

What you have to pay and what not

Your bills are always set off against the obligatory

deductible excess and lastly the voluntary deductible

excess (if you have opted for one).

Sample calculation 1:

obligatory deductible excess alone

Mr Jones only has the deductible excess required by law

of 170.00. He pays a bill of 190.00 to the care provider

himself and then submits the invoice to us as a claim. The

first 170.00 of this invoice are charged to his deductible

excess as required by law. We then reimburse the rest

( 20.00). Mr Jones will then pay no more deductible

excess for the rest of the year. Any treatment he under-

goes in that year will, therefore, be reimbursed.

Sample calculation 2:

obligatory and voluntary deductible excess

Mrs Smith has opted for a voluntary deductible excess of

200.00 over and above the obligatory deductible excess.

Her hospital submits a claim directly to us for treatment

costing 700.00. We pay the hospital directly. We then

additionally charge Mrs Smith her obligatory deductible

excess ( 170.00), followed by her voluntary deductible

excess ( 200.00). Mrs Smith therefore has to pay a total

of 370.00. After that Mrs Smith will pay no more

deductible excess for the rest of the year. Any treatment

she undergoes in that year will, therefore, be reimbursed.

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No deductible excess thanks to care mediation

In the case of a number of forms of specialist medical treatment

We want to help you find the best possible care as quickly as possible. We want to do this on the basis of consultation

with you because the Dutch healthcare system really offers you a number of choices. One example is the useful informa-

tion which is available on the quality of various forms of specialist medical treatment. If you ask us for advice regarding

which hospital offers the best treatment you can, in a number of cases, even become eligible for exemption from the

obligatory deductible excess. All you have to do is contact us on 0900 - 9590 (local rate) or surf to www.averoachmea.nl/

zorgbemiddeling to find out which forms of treatment this exemption applies to.

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* In the case of medical expenses incurred abroad, travel expenses incurred using your own or public transport and visiting or accommodation costs, youhave to complete a claims form and submit it with the original bill. The forms can be downloaded via www.averoachmea.nl/zorgverzekeringen under

Meer informatie [More Information] and then Declareren [Claims].

As an insured party you often do not receive any bills at all.

In fact, most care providers submit bills to us directly. This

is handy and relieves you of the worry! If you do receive a

bill, this may be because we do not have agreements with

all care providers regarding direct payments. You have to

pay the bill yourself and then claim the costs from us.

Good to know

Please let us know if the bill you have submitted is the con-

sequence of an accident.

On paying bills and their reimbursement

How to submit bills

When permission is required for treatment

How to get authorisation?

Step 1

Find the original bill.

Step 2

Check whether your name, address, place of residence

and date of birth are referred to on the bill.

Step 3

Write down the client number of the person who has re-

ceived the treatment in the top right-hand corner of the

bill. You can find the client number of the care card.

Step 4

Make a copy of the bill for your own records.

Step 5

Send the original bill without* any accompanying letter or

claims form* to:

Avro Achmea

Afdeling Declaratieservice

Postbus 59005

1040 KA Amsterdam

The bill will be processed within 10 days.

In some cases you will need

permission beforehand in order fortreatment, medicines or travel costs

to be reimbursed. We refer to this

approval as an authorisation. Dental

implants and an insulin pump are

examples of treatment or a nursing

article for which you need

authorisation.

You can find details of the types of

treatment for which you need an

authorisation in our summary of

reimbursements and policy

conditions. You or your care provider

can apply for authorisation using the

special form which can be found at

www.averoachmea.nl/zorgverzeke-ringen. You can also telephone our

Customer Services on: 0900 - 9590

(local rate).

Travel costs

Insured parties who have to undergo

certain forms of treatment or who are

wheelchair-dependent can receive a

reimbursement of (part of) the travel

costs from and to the hospital. For this

you need an authorisation for travel

costs. You can apply for this via the

special Travel Line: 0900 - 23 02 340

( 0.10 p/m).

Nursing articles without authorisation

For some nursing articles, for examplehearing aids, incontinence materials

and ortheses, you can simply contact

the supplier we have contracted using

the referral from your GP or specialist

without any authorisation. Details on

all our contracted suppliers can be

found at Find your care provider at

www.averoachmea.nl/zorgverzekerin-

gen. Alternatively you can call our

nursing articles line: 0900 - 20 08 010

( 0.10 p/m).

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When things change

How do you change your personal details?

Our health client benefit product is ideal for all our health-

conscious policyholders. It is a unique service which helps

you improve your health and develop a healthy lifestyle. It

includes things like the Health Check and various discounts.

For example you get a discount on participation in a first aid

course or a course on coping with heart problems. Informa-

tion on the special offers with which you can get even more

out of your health insurance can be found further on in this

booklet. We can make a real difference to your state of

health.

Awareness and healthy living!

The Avro Achmea Health programme

Sometimes things in life change. The

same applies to the details we have

on you. If you want to change your

policy and opt for another health

insurance, please contact your insu-

rance adviser. You can also use the

change form at www.averoachmea.

nl/zorgverzekeringen

We receive notification about you

moving house within the Netherlands,

a change in initial(s), additional name

details or surname, a marriage or

registered partnership, a divorce

(except in the event of a policyholder

change) or death via the municipal

records database. There is therefore

no need for you to inform us of these

changes yourself. Neither do you need

to inform us of any change in dentist,

GP or pharmacy.

For administrative changes relating to

a birth, moving house abroad (in that

case you should check whether you

retain your right to basic insurance in

the Netherlands), a different

telephone number, e-mail address,

account number or payment method,

you can simply call our Customer

Services on 0900 - 9590 (local rate) or

use the change form at www.avero-

achmea.nl/zorgverzekeringen.

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Care allowance

The care allowance is a financial contribution by the Tax

Authorities intended to keep the basic insurance afforda-

ble for everyone. Whether you are eligible depends on your

personal situation. The Tax Authorities determine the

amount of the care allowance on the basis of your income

and that of your partner if you have one.

If you have received care allowance this year and your

situation has not changed, you do not need to apply for it

again for next year. If you have not received any care

allowance this calendar year and you think you are entitled

to it in the coming year, you can submit an appropriate ap-

plication to the Tax Authorities. Surf to www.toeslagen.nl

or call the BelastingTelefoon on 0800 - 0543.

Complaints

We do our level best to resolve any problems you may

encounter. Nevertheless, you may still be unhappy about

some aspect of the services we provide. You should then

contact your insurance adviser. If you wish to submit a

complaint, please do so via www.averoachmea.nl/zorg-

verzekeringen or by post: Avro Achmea, Centrale Klach-

tencordinatie Achmea Zorg, Antwoordnummer 93200,

2200 XA Noordwijk.

The Care Regulator

The Algemene Wet Bijzondere Ziektekosten [Exceptional

Medical Expenses Act] (AWBZ) is a national medical expen-

ses scheme, for example for long-term home care and care

for handicapped people. It is an obligatory insurance for

everyone who lives and works in the Netherlands. If your

own health insurance does not reimburse your care

expenses you can, in some cases, claim via the AWBZ.

The Wet maatschappelijke ondersteuning [Social Support

Act] (Wmo) offers local authority assistance if you need

help and are unable to fall back on volunteer carers in your

community (family, friends, neighbours, volunteers).

For care issues related to the AWBZ and Wmo, you or your

carer can use our Care Regulator. Via the supplementary

health insurance we reimburse a number of hours of

support relating to complex care issues relating to the

AWBZ and the Wmo and the accompanying regulatory

tasks in the field of care, work, welfare, living and finances.

If you would like to be eligible for this support, please

contact our Customer Services on 0900 - 9590 (local rate).

A carefree holiday

Start your trip in a stress-free way. After all, you can always

turn to us for advice or assistance if you have a medical

query or in the event of an emergency. Make sure you have

the following numbers in your mobile telephone:

Some useful information

Useful addresses and numbers

The holiday doctor: +31 71 36 41 802For medical queries, not emergencies.

The Achmea Emergency Centre:+31 71 36 41 850The Achmea Emergency Centre can be contacted

in emergencies 24 hours a day.

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A cheap way to get fit

Get more out of your health insurance with Avro Achmeas Health programme

Getting fit makes you feel better. Its something we all want. That is why we are making it as attractive as possible. We

offer all kinds of offers and discounts. For example, there is a discount on a Health Check, help losing weight, a reimburse-ment for a first aid course and a discount on eye laser treatment. More information can be found on our website

www.averoachmea.nl/health

First Aid

First aid coursesIt can be very handy to know how to provide first aid in the

event of accidents. If you have supplementary insurance

the costs will be partially reimbursed, or even totally

reimbursed in the case of the Excellent variant.


Sleeping

Sleeping courseSleeping better makes people healthier and fitter. If you

have supplementary insurance the costs will be partially

reimbursed, or even totally reimbursed in the case of the

Excellent variant. www.averoachmea.nl/health

First Aid

First aid for accidents involving childrenAccidents and injuries can happen at any time, especially

where children are concerned. Doing a first-aid course

helps you to know what you should do. You can attend a

course in first aid for childrens accidents at a home care

institution or the local First Aid association. Alternatively

you can do the Internet course on first aid for children

offered by Iedereen EHBO. If you have supplementary

insurance the costs will be partially reimbursed, or even

totally reimbursed in the case of the Excellent variant.


Instructive

Diabetes courseThe Diabetesvereniging Nederland [Netherlands Diabetes

Association] (DVN) organises basic and follow-up courses

for patients with type 2 diabetes or people associated with

them. If you have supplementary insurance the costs will

be partially reimbursed, or even totally reimbursed in the

case of the Excellent variant. www.averoachmea.nl/health

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Well seen

Eye laser treatmentWouldnt it be great, if you are short or long sighted, to

wake up in the morning and immediately see everything

clearly, without first having to put on your glasses or put

in your lenses? Having your eyes lasered can make this a

reality. If you have supplementary insurance, you will be

eligible for an attractive discount if you have your eyes la-

sered at Vision- Clinics. No reimbursement for eye laser

treatment is available in the case of the Start supplemen-

tary insurance policy. The Extra and Royaal variants provi-de a reimbursement of up to 500.00 for eye laser treat-

ment over the entire term of your insurance policy. The

Excellent variant provides a reimbursement of up to

750.00 for eye laser treatment over the entire term of

your insurance policy. www.averoachmea.nl/health

Instructive

Coping with heart problemsA preventive course designed to help patients learn to cope

with heart problems. You can do this course at a home care

institution. If you have supplementary insurance the costs

will be partially reimbursed, or even totally reimbursed in

the case of the Excellent variant.


Sauna

A discount on visits to the saunaGoing to the sauna is a great way to give your body and

mind a little break. As an Avro Achmea insured party you

are eligible for a discount on visits to the sauna. Details

on the special offer can be found at


Welfare

Stopping smokingIf your basic insurance does not grant you eligibility for a stop-

ping smoking programme, you can always do a course. You

can choose between Stop smoking with Allen Carr, I Quit

Smoking at a home care institution, or laser therapy. If you

have supplementary insurance the costs will be partially

reimbursed, or even totally reimbursed in the case of the Ex-

cellent variant. www.averoachmea.nl/health

now

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Exercise

Achmea Health Centers: 20% discountAt the Achmea Health Centers, a personal plan and good

quality supervision will help you train.


now

20%disCount

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Nutrition

A healthy weight in 15 weeks

Help losing weight might be just the boost you need. Depen-ding on your supplementary insurance policy, the reimburse-

ment may be as much as 100%. You can do a course at a home

care institution, or a correspondence or online Happy Weight

course, or complete the Sportief afslanken [Sports weight loss]

programme at one of the Achmea Health Centers.


Health products

Health ShopDiscounts are available on the entire range of health

products from our Health Shop Internet store.


Health Check

Check your health via the Health CheckThe Health Check is a quick and easy way for people to

get a good indication of their state of health. By determi-

ning the cholesterol and glucose levels in your blood, ta-

king your blood pressure, and measuring the length/body

mass ratio and lung function, the Health Check ensures

that any increased risk of heart and vascular diseases is

detected in good time. Avro Achmea offers an attractive

discount on the Health Check. In fact, the Excellent sup-

plementary insurance policy even offers a 100% reimbur-

sement of the Health Check. www.averoachmea.nl/health

A clear view of things

Reimbursements and discounts for glasses andcontact lensesNo-one wants their eyesight to deteriorate and no-one

wants to spend a fortune on glasses or lenses. Via the Start

supplementary insurance policy we reimburse, per person

per 3 calendar years, the costs of glasses and contact lensesup to an amount of 100.00. The reimbursement via the

Extra variant is 150.00. Via the Royaal variant, Avro

Achmea reimburses, per person per 3 calendar years, 1 set of

spectacles (including frame) or a pair of contact lenses for

long-term use up to an amount of 250.00. This means new

glasses or contact lenses on average once every 3 years! The

reimbursement for daily, weekly, monthly, six monthly and

yearly lenses is up to 65.00 per calendar year. The amounts

reimbursed via the Excellent variant are 350.00 and

75.00 per calendar year respectively. In addition, each

supplementary insurance policy offers a discount at Pearle

and Eye Wish stores. www.averoachmea.nl/health

now

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Summary of reimbursements 2011

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15/3215

Your health insurance

For which types of care are we insured in the Netherlands? What is the difference between the basic insurance and the

supplementary insurance policies? Our care system in a nutshell.

The Dutch care system

The government introduced our current care system on

1 January 2006. It consists of a basic insurance policy

with an obligatory deductible excess. Everyone in the

Netherlands is obliged to be insured for medical expenses

and everyone aged 18 or over pays a premium. You may

be eligible for a premium costs subsidy. This subsidy is

called the care allowance. More information is available

at www.toeslagen.nl.

What is basic insurance?

Basic insurance is for everyone in the Netherlands. The

government sets the basic insurance reimbursements every

year.

Zorg Plan [Care Plan]

Zorg Plan means you receive care from care providers with

whom we have made agreements. As a result you pay a

slightly lower premium. If you use other care providers, the

reimbursement will be lower and you may have to pay an

additional charge. We pay bills directly (less the statutory

personal contributions).

Keuze Zorg [Options Care] Plan

The Keuze Zorg Plan gives you complete freedom to choose

whichever care provider you want. It does not matter

whether the care provider has a contract with us or not. You

always receive a full reimbursement to the maximum of the

statutory amount, or to the maximum of the rate (applica-

ble on the market) in the Netherlands (less the statutory

personal contributions).

What cover does the (Keuze) Zorg Plan provide?

Medical care provided by GPs, hospitals, specialists and

midwives.

Hospital admissions.

Nursing articles.

Medicines.

Maternity care.

Patient transport.

Paramedic assistance (limited physiotherapy/remedial

therapy, speech and language therapy, occupational thera-

py and dietary advice).

Dental care (up to the age of 18).

What cover does a supplementary insurance policy

provide?

You can take out supplementary insurance in addition to basic

insurance. For example for a reimbursement of the statutory

personal contributions, or for more comprehensive cover for

physiotherapy, dental costs or emergency help when abroad.

Avro Achmea allows you to choose from different supplemen-

tary insurance policies and separate dental insurance policies.

The higher the supplementary insurance policy, the more

extensive the cover and the higher the reimbursements.


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Alternative18 Alternative remedies and

therapies.

18 Homeopathic and anthropo-

sophic medicines

Bones, muscles and joints19 Exercise programmes

19 Exercising in extra heated wa-

ter for rheumatism sufferers

19 Occupational therapy

19 Orthopaedic medicine

19 Chiropodist care in the case of

rheumatism or diabetes

When abroad19 Repatriation

19 Emergency care

19 Non-emergency care

19 Vaccinations and

consultations

Skin20 Skin care

20 Psoriasis treatment

Physiotherapy and remedialtherapy (18 and older)20 Chronic disorder

20 Non-chronic disorder

20 Pelvic physiotherapy

Physiotherapy and remedialtherapy (younger than 18)20 Chronic disorder

20 Non-chronic disorder

Nursing articles21 Nursing articles via the basic

insurance

21 Equipment for negative

pressure therapy

21 CPM invalid buggy

21 Walking aids

21 Personal alarms

21 Breast prosthesis adhesive

strips

21 Incontinence alarm

21 Wig

21 Support pessary

21 Support soles

21 Transtherapy to alleviate in-

continence

Medicines22 Contraception

22 Medicines via the basic

insurance

22 Flu vaccination

22 Melatonin

Mouth and teeth (18 andolder with supplementary

dental insurance)22 Dentist, dental hygienist and

dental prosthetician

22 Other forms of treatment

22 Treatment which we do not

reimburse

Mouth and teeth (18 andolder)22 Dentures (prosthesis)

23 Orthodontics (brace)

23 Orthodontics (brace) 18 - 22

years old

23 Orthodontics (brace) from age

22 onwards

23 Dental costs as a consequence

of an accident from age 18

onwards

23 Care for handicapped people

23 Exceptional cases

Mouth and teeth (youngerthan 18)23 Any treatment by a dentist,

dental hygienist, dental

surgeon and dental

prosthetician

23 Crowns, bridges, inlays and

implants

23 Orthodontics (brace)

Eyes and ears23 Audiological centre

23 Prescription glasses and lenses23 Correction of upper eyelids

23 Correction of ear position

24 Hearing aid

24 Eye laser treatment

Psychological care24 Primary psychological care

24 Second-line mental health

care (GGZ)

24 Admission to a psychiatric

hospital

What can you find where in the summary of

reimbursements?

To find out what is reimbursed, choose the theme in the overview below and then look to see which page it is on. This is a

quick way of finding the care you are looking for. Each reimbursement is accompanied by information on what exactly is

reimbursed via the (Keuze) Zorg Plan (basic insurance) and via any of the supplementary insurance policies. If you cannotfind the care you are looking for, surf to our website www.averoachmea.nl/zorgverzekeringen or call our Customer Services

on 0900 - 9590 (local rate).


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Talking and reading24 Dyslexia-related care

24 Speech and language therapy

24 Stutter therapy

(Patient) transport25 Ambulance

25 Travel costs after care

mediation abroad

25 Accommodation and travel

costs incurred by family

members after care mediation

abroad

25 Patient transport

Hospital, treatment andnursing25 Asthma Centre in Davos

25 Treatment, examination and

operation in hospital

25 Cosmetic and plastic surgery

25 Dialysis

25 Hereditary research and con-

sultancy

26 Guest house

26 Dental surgery

26 Mechanical respiration26 Obesity change in behaviour

programme

26 Organ transplants

26 Preventive examinations

26 Second opinion

26 Sterilisation

26 Telemonitoring in the event of

chronic heart failure

26 Nursing outside hospital

26 Nursing in hospital

26 Independent treatment centre

(Becoming) pregnant / baby /child27 Maternity care for adopted

children or medical screening

in the event of adoption

27 Circumcision

27 Childbirth

27 Monitoring equipment to

prevent cot death

27 GeboorteTENS

27 IVF

27 Maternity pack

27 Maternity care

27 Breastfeeding assistance

27 Oncology examination for

children

28 Prenatal screening

28 Therapeutic holiday camps

28 Obstetrical care

28 Fertility-enhancing treatment

Other28 Dietary advice and nutritional

information

28 Health Check

28 Herstel en Balans [Recovery

and Balance]28 Convalescence home

28 Hospice

28 GP

28 Chain-based care for diabetes

and COPD

28 Childcare for children aged up

to 12 while their parent(s) is/

are admitted to hospital

28 Lifestyle training sessions

28 Substitute volunteer care

28 Menopause consultant

28 Patient associations

29 (Preventive) courses

29 Rehabilitation

29 Sports doctor

29 Sport-medical examination

29 Stopping smoking programme

29 Therapeutic holiday camps for

handicapped people

29 Thrombosis service

29 Payment in the event of a

functional loss

29 Holiday hotels or sailing

holidays

29 Care Regulator

Extra insurance policies29 Ziekenhuis Extra [Hospital

Extra] Insurance Policies


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Alternative(Keuze) Zorg Plan(basic insurance)

Start Extra Royaal Excellent

A. Alternative remedies andtherapiesBy a practitioner at a professionalassociation recognised by us, for

example: acupuncture, homeo-pathy, chiropractic treatment,osteopathy and manual therapyand other forms of treatment.

40.00 per day.

B. Medicines (anthroposophic andhomeopathic)The medicines have to be registeredand supplied by a pharmacy.

See www.averoachmea.nl/ zorg-

verzekeringen or call 0900 - 9590(local rate).

100% 100%

A + B added up together 440.00per person per year.

640.00per person per year.

Medicines (anthroposophic andhomeopathic)The medicines have to be registeredand supplied by a pharmacy.

See www.averoachmea.nl/ zorg-


100% 100%

Alternative remedies and therapiesSee www.averoachmea.nl/ zorg-


Specifically referredto doctors (2) 75 per

day; specificallyreferred to non-doctors (3) 40 perday; together 20consultations.

Doctors who prac-tise alternative me-

dicine 75 per day;specifically referredto non-doctors (3)

50 per day;together 24 consul-

tations.

8

Summary of reimbursements 2011

This overview details the reimbursements via both the (Keuze) Zorg Plan and the

supplementary insurance policies.

The reimbursements via the Keuze Zorg Plan and Zorg Plan are described in asingle column. These reimbursements can be found under the heading (Keuze)

Zorg Plan (basic insurance).

Surf to www.averoachmea.nl/zorgverzekeringen for an overview of contracted

care providers, the Achmea Reglement Hulpmiddelen [Achmea Nursing Articles

Regulations], the Achmea Reglement Farmaceutische Zorg [Achmea Pharmaceuti-

cal Care Regulations], our terms and conditions, brochures, forms and information

about our insurance policies.

No rights can be derived from the summary of reimbursements. A detailed

description of the terms and conditions and entitlements can be found in the

policy conditions. You should always consult these first before you contact a care

provider. You can download the policy terms and conditions from our website or

we will send it to you on request.

What does it

mean?

Year

A calendar year, which runs from1 January to 31 December.

One-off

A reimbursement for the term of

the insurance policy.

Permission from us

You need our permission before

you can claim a reimbursement.

You can request this permission

by telephoning our Customer

Services on 0900 - 9590 (local

rate).

(2) Alternative doctors are: an acupuncturist doctor, homeopathic doctor, naturalmedicines doctor, anthroposophic doctor, doctor-enzyme therapist, Sickeszdoctor, manual doctor or Moerman doctor established in the Netherlands.

(3) Alternative non-doctors are: an acupuncturist, physiotherapist acupuncturist,classic homeopath, manual therapist, chiropractor, hapto therapist or naturalmedicine therapist established in the Netherlands.


19/3219

Bones, muscles and joints (Keuze)Zorg Plan (basic insurance)

(Keuze) Zorg Plan(basic insurance)


Exercise programmesFor people with:

obesity BMI > 30

previous heart failure

type 2 diabetes

COPD in Gold 1 and 2 stages witha lung value of FEV1/VC > 60%.



Exercising in extra heated waterRemedial therapy for rheumatismsufferers.


100% reimburse-ment ( 1), togetherwith other costs up to 500.00.

100%per person per year.

Occupational therapy Via (Keuze) Zorg Plan 100% up to 10 hours per person per year.

Orthopaedic medicineVia the Vereniging van Artsen voorOrthopedische Geneeskunde[Association of OrthopaedicDoctors] (VAOG).



100% reimburse-ment (1), together withother costs up to 500.00.


Chiropodist care

For insured parties with diabetes orrheumatism.

21.00 per appoint-ment up to 126.00

per person per year.

100% reimbursement (1), together with

other costs up to 500.00.


For insured parties with acerebral infarction (CVA).


Podotherapie/podologie/podoposturale therapie(Stichting LOOP of Omni PodoGenootschap).Foot treatment and the measuring,manufacturing and delivering of po-

diatric soles and nursing articles, noshoes or shoe adaptations.

100,-per person per year.

100% reimburse-ment (1), together withother costs up to 500.00.

100%


When abroad(Keuze) Zorg Plan(basic insurance) Start Extra Royaal Excellent

Repatriation of insured party andtransport of human remains to theNetherlands

100% after permission from Eurocross Assistance.

Urgent careCare which cannot wait until youare back in the Netherlands.Call Eurocross Assistance foremergency assistance abroad on+31 71 36 41 850. This telephone

number can also be found on yourcare card.

100% of the rate inthe Netherlands viathe (Keuze) Zorg Plan.

100% of the rate in the Netherlands via the (Keuze) Zorg Plan.

Via Start, Extra, Royaal and Excellent.Supplement to 100% of the cost price for an uninterrupted stay of up to 12 months.Cost price = usual rate in the country in question.

Non-emergency careReimbursement in accordance withthe terms and conditions and

reimbursements

100% of the rate inthe Netherlands via

the (Keuze) Zorg Plan.See the policyconditions.

100% of the rate in the Netherlands via the (Keuze) Zorg Plan, see the policy conditions.

Via Start, Extra, Royaal and Excellent.In accordance with the reimbursement in the Netherlands with due regard for the conditionsand exclusions.

Vaccinations and consultationsDTP, yellow fever, typhoid, cholera,

rabies, Lyme disease and hepatitisA/B or medicines against malaria inconnection with a trip abroad.

Via Meditel and Achmea Vitale Travel Clinics 100%.Via the eFarma Internet pharmacy 100%.

Or via another care provider 150.00 per person per year.More information about a location close to where you live can befound at www.meditel.nl and www.achmeavitale.nl.

Via Meditel andAchmea Vitale Travel

Clinics 100%, via theeFarma Internetpharmacy 100%, orvia another care pro-vider 100% per person

per year.More informationabout a location closeto where you live canbe found at

www.meditel.nl andwww.achmeavitale.nl.

(1) ) For these care activities, insured via Royaal, a total of max. 500 is reimbursed per insured party per calendar year.


20/320

Skin(Keuze) Zorg Plan(basic insurance)


Skin care By a beautician (ANBOS) or derma-

tologist:

acne treatment

camouflage therapy

facial depilation for women

300.00


600.00


100%

per person per year.For epilation you needpermission from us.

PsoriasisHire costs relating to UV B lighttherapy at home.

Via the (Keuze) Zorg Plan 100% after permission from us.

Treatment in a day treatment centre(skin).

750.00per persoon per year.

1.000.00per person per year.

18 and older

Physiotherapy and remedialtherapy



Chronic disorder

Your doctor and/or physiotherapist

diagnoses the disorder.

You pay for appoint-

ments 1 to 12 yourself.









(Manual lymph drainage inconnection with seriouslymphoedema may also beperformed by a dermatologist

rather than a physiotherapist or re-medial therapist.)

Via the (Keuze) ZorgPlan as from appoint-ment 13, 100%.


+Via Start 12 appoint-ments per year.


+Via Extra 12 appoint-ments per year.

Via the (Keuze) ZorgPlan as from appoint-

ment 13, 100%.+Via Royaal 12 appoint-ments per year.

Via the (Keuze) ZorgPlan as from appoint-

ment 13, 100%.+Via Excellent 12 ap-pointments per year.

Non-chronic disorderYour doctor and/or physiotherapist

diagnoses the disorder.

Manual lymph drainage i n connec-tion with serious lymphoedemamay also be performed by a

dermatologist rather than a phy-siotherapist or remedial therapist.

12 appointments peryear.



All appointments.

Pelvic physiotherapy Via the (Keuze) ZorgPlan appointments 1to 9.

Via the (Keuze) ZorgPlan appointments 1to 9.

+Via Start 12 appoint-ments per year.

Via the (Keuze) ZorgPlan appointments 1to 9.

+Via Extra 27 appoint-ments per year.

Via the (Keuze) ZorgPlan appointments 1

to 9.+Via Royaal 27 appoint-ments per year.

Via the (Keuze) ZorgPlan appointments 1

to 9.+Via Excellent allappointments.

A number of chronic and non-chronic disorders or pelvic physiotherapyIf you have a number of disorders, you should always contact our Customer Services on 0900 - 9590 (local rate). Our staff would be only too pleased to explain whatreimbursements you can expect.

Younger than 18

Physiotherapy and remedialtherapy (Keuze) Zorg Plan(basic insurance) Start Extra Royaal Excellent

Chronic disorderYour doctor and/or physiotherapist

diagnoses the disorder.Manual lymph drainage in conne c-tion with serious lymphoedema mayalso be performed by a dermato-logist rather than a physiotherapist

or remedial therapist.

Via the (Keuze) Zorg Plan 100%.

Non-chronic disorderYour doctor and/or physiotherapistdiagnoses the disorder.Manual lymph drainage i n connec-

tion with serious lymphoedema

may also be performed by a der-matologist rather than a physio-therapist or remedial therapist.

Via the (Keuze) ZorgPlan 18 appointmentsper diagnosis.


+Via Start 12 appoint-

ments per year.


+Via Extra 27 appoint-

ments per year.

Via the (Keuze) ZorgPlan 18 appointments

per diagnosis.+Via Royaal 27 appoint-

ments per year.

Via the (Keuze) ZorgPlan 18 appoint-

ments per diagnosis.+Via Excellent all

appointments.


21/3221

Nursing articles(Keuze) Zorg Plan(basic insurance)


Nursing articles via the basicinsuranceReimbursement in accordance withthe terms and conditions in theAchmea Reglement Hulpmiddelen(Keuze) Zorg Plan [Achmea (Options)

Care Plan Nursing Articles Regulati-

ons]. See www.averoachmea.nl/zorg-verzekeringen or call 0900 - 9590 (localrate). Call 0900 - 20 08 010 ( 0.10 p/m)for personal alarms, workchairs, chairs

adapted for people with disabilities(not stand-up chairs) and nursing beds.


Certain nursing articles are subject to prior permission from us, a max.reimbursement or statutory personal contribution.

250.00 statutorypersonal contributionfor other nursingarticles, no wig,hearing aid, ortho-

paedic shoes andallergy-free shoes.

100% statutorypersonal contributionfor other nursingarticles, no wig, hearing

aid, orthopaedic shoesand allergy-free shoes.

In addition to the above reimbursement, all insured parties with a supplementary insurance

policy are eligible, upon production of their care pass at Vegro and Harting-Bank/Ligtvoet, fora discount for rollators, stand-up chairs and ADL nursing articles.

Equipment for negative pressuretherapyE.g. for the removal of wounddischarge. Call the nursing articles

line: 0900 - 20 08 010 ( 0.10 p/m)


CPM invalid buggyNursing article used after knee orankle joint operations.


Walking aidsElbow crutches, walking aids and 3or 4 leg sticks and walking frames.

Only via suppliers we have selected 100%.

Personal alarms

On medical grounds

Call the nursing articles line:0900 - 20 08 010 ( 0.10 p/m)

Via the (Keuze) ZorgPlan, requested via thenursing articles line100% for personalalarm unit. See also the

Achmea Reglement(Restitutie) Hulpmid-

delen [Achmea NursingArticles (Restitution)Regulations].

Via the (Keuze) Zorg Plan, requested via the nursing articles line 100% for personal alarmunit Eurocross Assistance alarm system.

Via Start, Extra, Royaal and Excellent 100% for alarm system subscription costs Action Line

via Eurocross Assistance.

Or via an other alarm system provider 35.00 per year for subscription costs after permis-

sion from us.

On social grounds. Via Excellent 100% foralarm system subscrip-tion costs Action Linevia Eurocross Assistan-ce or via an other alarm

system provider 35.00 per year afterpermission from us.

Breast prosthesis adhesive strips 100%

Incontinence alarmIn the event of bedwetting

problems.

One-off 100.00 perperson.

100% reimburse-ment (1), together with

other costs up to 500.00.

100%

Wig Via the (Keuze) Zorg Plan 386.50 per wi g.

See also the Achmea Reglement (Restitutie)Hulpmiddelen [Achmea Nursing Articles(Restitution) Regulations].

462.00 per wig with

386.50 via the(Keuze) Zorg Plan 75.50 via Extra.

486.50 per wig with 386.50 via the(Keuze) Zorg Planmax. 100.00 viaRoyaal.

486.50 per wig with 386.50 via the(Keuze) Zorg Plan.Extra reimbursementis possible.

Support pessaryIn the event of a prolapse of the womb.

100%

Support solesNo podotherapeutic or podologicalsupport soles.

35,-per person per year.

100% reimburse-ment (1), 1 pair, toge-ther with other costs

up to 500.00.

100%.

Transtherapy to alleviate incontinenceHire of neuromodulator (BioStim). 100%

Hire of bio feedback equipment(FemiScan).

100%

(1) For these care activities, insured via Royaal, a total of max. 500 is reimbursed per insured party per calendar year.


22/32

Medicines(Keuze) Zorg Plan(basic insurance)


Contraception

Up to age 21,

for example the pill or coil.

Via the (Keuze) Zorg Plan in accordance with Achmea Reglement Far-

maceutische Zorg [Achmea Pharmaceutical Care Regulations] (Keuze)Zorg Plan.You yourself pay the statutory personal contribution, the Geneesmid-delen Vergoedingen Systeem [Medicine Reimbursements Scheme](GVS), which differs per medicine.

See www.averoachmea.nl/zorgverzekeringen for detailed informati-on.

Via the (Keuze) Zorg Plan in accordance wi thAchmea Reglement Farmaceutische Zorg[Achmea Pharmaceutical Care Regulations](Keuze) Zorg Plan.+

Via Royaal and Excellent 100% reimbursement

of statutory personal contribution (the GVSupper limit price).

From age 21,

for example the pill or coil.

100%. No reimbursement personal contributi-

on (GVS upper limit price).

100%

+Via Royaal and Excellent 100% reimbursementof statutory personal contribution (the GVSupper limit price).

Medicines via the basic insurance Via the (Keuze) Zorg Plan in accordance with Achmea Reglement Farmaceu-tische Zorg [Achmea Pharmaceutical Care Regulations] (Keuze) Zorg. You

yourself pay the statutory personal contribution, the Geneesmiddelen Ver-goedingen Systeem [Medicine Reimbursements Scheme] (GVS), which dif-fers per medicine. See www.averoachmea.nl/zorgverzekeringen for de-tailed information.

Via the (Keuze) Zorg Plan in accordance wi thAchmea Reglement Farmaceutische Zorg

[Achmea Pharmaceutical Care Regulations]. +Via Royaal and Excellent 100% reimbursementof statutory personal contribution (the GVSupper limit price).

Flu vaccination 100%

MelatoninMedication for, among other things,insomnia.

Via the eFarma Inter-net pharmacy 100%or via another phar-macy 100.00 after

permission from us.

Via the eFarma Inter-net pharmacy 100%or via another phar-macy 150.00 after

permission from us.

100% afterpermission from us.

18 and older with supplementary dental insurance

Mouth and teeth(Keuze) Zorg Plan(basic insurance)

T Start T Extra T Royaal T Excellent

A. Dentist, dental hygienist anddental prosthetician:

consultations (C codes) andsecond opinion

oral hygiene (M codes)

fillings (V codes) extraction of teeth/molars

(H codes).

100%

B. Other forms of treatment 75% 100%

A + B added up together 225.00 per personper year.

450.00 per personper year.


1.150.00 per personper year.

C. Treatment which we do notreimburse:

inspection report (C70 and C75)

missed appointments (C90)

orthodontics (D codes)

subscriptions (Z codes)

external bleaching of teeth and

molars (E97, E98 and E00)

mandibular advancement devices(MRA G71, G72 and G73).

18 and older

Mouth and teeth(Keuze) Zorg Plan(basic insurance)


Dentures (prosthesis) Via the (Keuze) Zorg Plan 75%.Statutory personal contribution 25%.Costs higher than 600.00 per jaw after permission from us.

Replacement within 5 years after permission from us.

The purchase of fully removabledentures made by a dentist ordental prosthetician.

Repair or refitting (rebasing) of fully

removable dentures made by adentist or dental prosthetician.


Implants for removable dentures, inthe case of serious dental, jaw ormouth development or growth dis-

orders, made by a dentist, dentalsurgeon or centre for special dentaltreatment.


2


23/3223

18 and older

Mond en tanden(Keuze) Zorg Plan(basic insurance)


Dentures (prosthesis)Fully removable complete prosthe-sis on implants, in the case of seri-ous dental, jaw or mouth develop-ment or growth disorders, made bya dentist, dental prosthetician or

centre for special d ental treatment.

Via the (Keuze) Zorg Plan 100% after permission from us.Statutory personal contribution 125.00 per upper or lower jaw.

Orthodontics (brace)In the case of serious dental, jaw ormouth development or growth dis-orders.


Orthodontics (brace) 18 - 22 years oldBy dentist/orthodontist. With theexception of repair/replacementafter damage/loss due to your own

fault/negligence.

One-off 90%reimbursement up to 2,500.00 per person.

100% per person.

Orthodontics (brace) from age 22onwardsBy dentist/orthodontist. With the ex-ception of repair/replacement after

damage/loss due to your own fault/negligence.

One-off 70% up to 1,000.00 per person,no score 1 and 2 of

the Index for Ortho-

dontic TreatmentNeed (IOTN).

One-off 70% up to 500.00 per person,no score 1 and 2 of

the Index for Ortho-

dontic TreatmentNeed (IOTN).

Dental costs as a consequence of anaccident from age 18 onwards

75% up to 200.00 per element and up to 2,500.00 per accident per person per year.

Care for handicapped peopleYour dentist will know whether

you are eligible for the reimburse-ment.

Via the (Keuze) Zorg Plan 100% in the absence of an entitlement to reimbursement via the AWBZ and after permissionfrom us.

Exceptional casesUw tandarts weet of u in aan-merking komt voor de vergoeding.

Your dentist will know whether you are eligible for the reimbursement.Via the (Keuze) Zorg Plan 100% after permission from us.In some cases a statutory personal contribution applies.

Younger than 18

Mouth and teeth (Keuze) Zorg Plan(basic insurance)


Any treatment by a dentist, dentalhygienist, dental surgeon anddental prostheticianWith the exception of cast fillings,crowns, bridges, inlays and implants.


Crowns, bridges, inlays andimplantsBy dentist/dental surgeon.

225.00


450.00


100%


100%


Orthodontics (brace)By dentist/orthodontist. With theexception of repair/replacement af-

ter damage/loss due to your own

fault/negligence.

One-off 90%,reimbursement up to 1,500.00 per person.

One-off 90%,reimbursement up to 2,000.00 per person.

One-off 90%,reimbursement up to

2,500.00 per person.

100% per person.


24/324

Eyes and ears(Keuze) Zorg Plan(basic insurance)


Audiological centre Via the (Keuze) Zorg Plan 100%.

Prescription glasses and lenses 100.00 per personfor glasses and lenses

together once every 3years.

150.00 per personfor glasses and lenses

together once every 3years.

Glasses or contactlenses for long-term

use: 1 pair of glassesor 1 pair of lenses upto 250.00 per 3

years or contact len-ses for shor t-term

use, such as daily,weekly, monthly, sixmonthly and yearlylenses is up to 65.00 per year.

Glasses or contact

lenses for long-termuse: 1 pair of glassesor 1 pair of lenses upto 350.00 per 3

years or contact len-

ses for short-termuse, such as daily,weekly, monthly, sixmonthly and yearlylenses is up to

75.00 per year.

In addition to the above reimbursement, all insured parties with a supplementary insurancepolicy are eligible for a discount upon production of their care pass at Pearle Opticiens - Neder-land, Eye Wish or Specsavers.

Correction of upper eyelidsOn medical grounds.

100% per person per year only via care provi-der selected by us.

100% per person per year.

Correction of ear position 100% per person aged up to 18 per year onlyvia care provider selected by us.

100% per person per year.

Eyes and ears(Keuze) Zorg Plan(basic insurance)


Hearing aid

From age 16 onwards.

From age 16.

683.00 per aid.CROS, BiCROS or bone anchored hearing aids included in a glasses

frame: 65.00 extra. See also the Achmea Reglement Hulpmiddelen[Achmea Nursing Articles Regulations].

800.00 per hearingaid with an amount

being reimbursed viathe (Keuze) Zorg Planand a supplement toa maximum of 250.00 via Royaal.

800.00 per hearing

aid with an amountbeing reimbursed viathe (Keuze) Zorg Planand the rest viaExcellent after

permission from us.Via the (Keuze) Zorg Plan.Initial purchase: 501.50.

Replacement within 5 years: 501.50.Replacement after 6 to 7 years: 592.00.Replacement after 7 years: 683.00.

CROS, BiCROS or bone anchored hearing aids included in a glassesframe: 65.00 extra. See also the Achmea Reglement Hulpmiddelen

[Achmea Nursing Articles Regulations].

With remote control on medicalgrounds.

185.00 extra per de-vice after permissionfrom us.

Eye laser treatment One-off 500.00 perperson.

One-off 500.00 per

person.

One-off 750.00 per

person.

In addition to the above reimbursement, all insured parties with a supplementary insurancepolicy are eligible for a discount upon production of their care pass at VisionClinics.

Psychological care(Keuze) Zorg Plan(basic insurance)


Primary psychological carePrimary psychologist, clinicalpsychologist, primary health carepsychologist or general remedial

educationalist (generalist).

Via the (Keuze) ZorgPlan 8 sessions perperson per year. A

statutory personalcontribution of 10.00 applies persession.

Via the (Keuze) ZorgPlan 8 sessions perperson per year. A sta-

tutory personal con-tribution of 10.00applies per session.+Via Start 4 extra

sessions per personper year.

Via the (Keuze) ZorgPlan 8 sessions per

person per year. A sta-tutory personal con-tribution of 10.00applies per session.+

Via Extra 6 extrasessions per personper year.

Via the (Keuze) Zorg

Plan 8 sessions perperson per year. A sta-tutory personal con-tribution of 10.00applies per session.

+Via Royaal 8 extrasessions per personper year.

Via the (Keuze) ZorgPlan 8 sessions perperson per year. A sta-tutory personal con-tribution of 10.00

applies per session.+Via Excellent 8 extrasessions per personper year.

Reimbursement of the statutorypersonal contribution for primarypsychological care.

Reimbursement of the statutory personal contribution of 10.00 persession up to 80.00 per person per year.

Second-line mental health care (GGZ)

Psychiatrist, neurologist, mentalhealth institution, clinical psychologistor psychotherapist.


Psychiatric hospital admissionsAdmission to a mental healthinstitution (psychiatric hospital orpsychiatric ward of a hospital).



25/3225

Talking and reading(Keuze) Zorg Plan(basic insurance)


Dyslexia careDiagnosis and treatment of seriousdyslexia for 7 to 10 year old children.


Speech and language therapyNo dyslexia and language develop-ment disorders.


Stutter therapy

In v arious s tu tter centres . Via the (Keuze) Zorg Plan 10 0%.

According to the Del Ferro, Hausdr-fer and BOMA methods.



One-off 1,000.00per person.

One-off 1,250.00per person.

(Patient) transport(Keuze) Zorg Plan(basic insurance)


Ambulance Via the (Keuze) Zorg Plan 100%.

Travel costs in the context of care me-diation abroadIn Belgium and Germany in theevent of care mediation.

Call the Travel Line for permission on0900 - 23 02 340 ( 0.10 p/m).

Via taxi company 100%.

Own car 0.27 per kilometre.Public transport (second class) 100%.

Accommodation and travel costs in-curred by family members after caremediation abroadIn Belgium and Germany in the event

of care mediation as from the 15thday of admission.

Accommodation costs: 35.00 per day for the whole of the family.Own vehicle 0.27 per kilometre for max. 700 kilometres per admission.

Patient transport

By public transport, own car, hire car

or taxi in the event of kidney dialysis,oncological care with radio/chemo-therapy, visual handicap and if you

are unable to travel or are wheel-chair-dependent.


Via the (Keuze) Zorg Plan.

Up to 200 kilometres one way:Own car 0.27 per kilometre.

Public transport (second class) 100%.By taxi 100%.

You pay a statutory personal contribution of 92.00 per person after permission from us.

By own vehicle or taxi in the event ofother medical grounds which mean

you cannot use public transport.


Up to 200 kilometresone way and, if you

cross a border, up to55 kilometres acrossthe border: ownvehicle 0.27 per kilo-metre, by taxi 100%.

You pay 92.00 peryear, total maximumreimbursement 1,000.00 per personper year after permis-

sion from us.

If you cross a border

up to 55 kilometresacross the border:own vehicle 0.27 perkilometre, by taxi100% per person per

year after permissionfrom us.

If you cross a borderup to 55 kilometresacross the border:own vehicle 0.27 perkilometre, by taxi

100% per person peryear after permissionfrom us.

Statutory personal contribution forpatient transport.

100%

Hospital, treatment and nursing(Keuze) Zorg Plan(basic insurance)


Asthma Centre in Davos Via the (Keuze) Zorg Plan 100% after permission from us.

Treatment, examination and opera-tion in hospital


Cosmetic and plastic surgery

Cosmetic surgery, not Botox, fillers,(autologous) lip augmentation,peeling, laser or refraction surgery.

500.00 per personper calendar year.


26/326

Plastic surgery on medical groundssuch as a breast prosthesis after abreast amputation (not a breastenhancement, an operation to re-

move a breast prosthesis withoutany medical necessity, liposuctionof the abdomen, correction of up-per eyelids and ear position).

Via the (Keuze) Zorg Plan 100% after permission from us. 100% of other formsof treatment withmedical necessityafter permission

from us.

Dialysis Via the (Keuze) Zorg Plan 100%.

Hereditary research andconsultancy


Hospital, treatment and nursing(Keuze) Zorg Plan(basic insurance)


Guest house

Accommodation in a guest house inthe event of a cycle of outpatient

treatment.

35.00 per person per year. 35.00 per personper day (1), togetherwith other costs up to

500.00.


Accommodation or travel expensesof you or your family members in

the event of a hospital admission,not being a psychiatric hospital.

As from 15th day of admission travelbetween home and hospital is at least 50

kilometres 35.00 per day up to 500.00per year for all family members together.Own car 0.27 per kilometre or publictransport (second class) 100%.

As from 15th day ofadmission 100%(1) per

year for all familymembers together.Own car 0.27 perkilometre, togetherwith other costs up to 500.00.

As from 15th day ofadmission 100% per

year for all familymembers together.Own car 0.27 perkilometre.

Dental surgery Via the (Keuze) Zorg Plan 100%.

Mechanical respiration Via the (Keuze) Zorg Plan 100%.

Obesity change in behaviourprogrammeBMI greater than 40.

Via NOK: one-off

750.00 per person af-ter permission from us.

Via NOK: one-off 1,000.00 per person after

permission from us.

Organ transplants Via the (Keuze) Zorg Plan 100% in hospital or independent treatment centre.

Nursing of person who has donatedthe organ (donor). Via the (Keuze) Zorg Plan 3 months, 6 months in the case of liver transplant.

Preventive examinations:

cervicalcancer(smear)breastcancer

heartandvasculardiseasesprostatecancer.Not a population screening (isreimbursed via the AWBZ).

100%

A periodic general check-up. 1x per 2 years per person.Rate major general GP che ck-up.

Second opinionFor care via the basic insurance bymedical specialist.


SterilisationNot a reversal operation.

100%

TelemonitoringIn the event of chronic heart failure

hire and supervision.


Nursing (extramural)Outside the hospital at home, notartificial respiration at home or alle-

viating care for terminal patients(palliative care).


Nursing in hospitalCare provided by a specialist medicaland dental surgeon.


Independent treatment centreA clinic certified by the governmentfor specialist medical care at whichexaminations and outpatient treat-

ment takes place.

Via the (Keuze) Zorg Plan 100%.In the case of plastic surgery and dental surgery after we have granted permission.



27/3227

(Becoming) pregnant / baby /child



Maternity care for adopted babies(younger than 12 months)or

Medical screening in the event ofadoption

3 days up to 3 hours a dayor

300.00 per adopted child.

CircumcisionOn religious grounds.

Only by care providers we have selected 250.00.

Childbirth

Giving birth at home. Via the (Keuze) Zorg Plan 100%.

Outpatient childbirth in hospital atown request (without medicalgrounds).

Via the (Keuze) ZorgPlan 192.00 for use

of delivery room,remaining amount isstatutory personalcontribution.

Via the (Keuze) Zorg Plan 192.00 for use ofdelivery room, remaining amount is statutory

personal contribution.+Via Start and Extra 50% reimbursement ofstatutory personal contribution.

100% via the (Keuze) Zorg Plan 192.00 foruse of delivery room, remaining amount is

statutory personal contribution.+Via Royaal and Excellent 100% reimbursementof statutory personal contribution.

Childbirth in birth centre in hospital

at own request (without medicalgrounds).

Via the Keuze Zorg

Plan 192.00 for useof delivery room,remaining amount isstatutory personal

contribution.

Via the (Keuze) Zorg Plan 192.00 for use of delivery room, remaining amount is statutory per-

sonal contribution.+Via Start, Extra, Royaal and Excellent 100% reimbursement of statutory personal contribution.

Outpatient childbirth with medicalgrounds.


Childbirth in hospital (stay inhospital for several days).


Monitoring equipment to preventcot death

Monitoring equipment (hire). 100% for 12 months after permission from us.

Nanny Care sensor mat (purchase). 100% after referral by doctor.

GeboorteTENSOn loan.

100%, you arrange this via your midwife.

In Vitro Fertilisation (IVF)Fertility-enhancing treatment.

Via the (Keuze) Zorg Plan first 3 attempts for each attempted pregnancy. Medicines, in accordance with GVS for first 3attempts. In Vitro Fertilisation (IVF) abroad after permission from us.

Maternity packOrder your maternity pack via www.

averoachmea.nl/ zorgverzekeringenor call 0900 - 9590 (local rate).

100% (request before the 7th month of the pregnancy).

Maternity care

At home o r in a birth centre. Via the (Keuze) Zorg

Plan 10 days,statutory personalcontribution of 3.90per hour.

Via the (Keuze) Zorg Plan 10 days, statutory

personal contribution of 3.90 per hour.+Via Start and Extra, statutory personalcontribution for 24 hours.

Via the (Keuze) Zorg Plan 10 days, statutorypersonal contribution of 3.90 per hour.+Via Royaal and Excellent 100% reimburse-ment, statutory personal contribution of

3.90 per hour.

In hospital on medical grounds. Via the (Keuze) Zorg Plan 100%.

In hospital without medicalgrounds.

Via the (Keuze) Zorg Plan 10 days.+Statutory personal contribution 15.50 per day of admission and

hospital rate amount above 111.50.

100% via the (Keuze) Zorg Plan 10 daysstatutory personal contribution 15.50 perday of admission and hospital rate amount

above 111.50.+Via Royaal and Excellent 100% reimbursementof statutory personal contribution.

Postponed on medical grounds (for

example in the event of a caesareansection or premature birth).

15 hours, personalpayment 3.90 perhour.

15 hours, personal payment 100%.

Breastfeeding assistanceHelp and advice during

breastfeeding.

75% up to 115. 00 per per son per year. 115.0 0per person per year.

Oncology examinationOncology examination for children.

Via the (Keuze) Zorg Plan 100% via Stichting Kinderoncologie Nederland (Skion).


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(Becoming) pregnant / baby /child



Prenatal screening

Counselling. Via the (Keuze) Zorg Plan 100%.

Structural Echoscopic Examination(20 week scan).


Combination test (neck fold measu-

rement in combination with a bloodtest) up to the age of 36 on medicalgrounds.


Combination test (neck fold measure-ment in combination with a bloodtest) 36 years or older.


Therapeutic holiday camps forchildren Via Stichting Gezond Ge-wicht, Stichting de Luchtballon, Di-abetes Jeugdvereniging Nederland,

Stichting Kinderoncologische Va-kantiekampen, Stichting de Ster,Nederlandse Hartstichting.


250.00 (1) per personper year, togetherwith other costs up to 500.00.


Obstetrical care Via the (Keuze) Zorg Plan 100%.

Fertility-enhancing treatment andfreezing sperm Not IVF.

Via the (Keuze) Zorg Plan 100%.Or abroad after permission from us.

Other(Keuze) Zorg Plan(basic insurance)


Dietary advice and nutritionalinformation

Dietary advice via a dietician

(on medical grounds).


Up to 4 hours per person per year.

Via (Keuze) Zorg Plan 100% up to 4 hours per person per year.

+ Via Extra, Royaal and Excellent 115.00 per person per year.

Nutritional information via dieticianor weight consultant.

115,- per person per year.

Health Check 1x 100% per person

per year.

Herstel en Balans [Recovery andBalance] Aftercare training ex-can-cer patients.


1,000.00 per personper year.



Convalescence homeNot psychosomatic care.

50.00 per day up to28 days per person per

year after permissionfrom us.

48 days per personper year after permis-sion from us.

Hospice 40.00 per day up to 3,600.0 0. 50.00 per day up to 4,500.00.

General Practitioner Via the (Keuze) Zorg Plan 100%.

Chain-based care for type 2

diabetes mellitus and COPD

Via the (Keuze) Zorg Plan 100% only via contracted care groups.

Childcare for children aged up to 12while their parent(s) is/are admittedto hospital. Not admissions to a psy-chiatric hospital.

50 hours per week after we permission from us.

Lifestyle training sessionsBasic training for heart patients, whip-lash patients and people with stressand burn-out related problems.

Via Leefstijl Training & Coaching (LTC) in Dalf-sen 1,000.00 per person per year.

Via Leefstijl Training& Coaching (LTC) inDalfsen 1,500.00per person per year.

Substitute volunteer careCare for handicapped and chronical-ly ill people in the absence of carevia family/friends (volunteer care).

Via stichting Handen-in-huis 21 days per per-son per year.

Via stichting Handen-in-huis 100% per per-son per year.

Menopause consultantIn the event of menopause-related pro-blems Care for Women or the VVOC.

In the event of menopause-related problems Care for Women or theVVOC.

Patient associations 25.00 (1) per mem-bership, together

with other costs up to 500.00.

100%


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Other(Keuze) Zorg Plan(basic insurance)


(Preventieve) cursussen:

coping with heart problems

lymphoedema awareness and/orself-management course

coping with rheumatoid arthritis,

arthrosis or Bechterews disease

type 2 diabetes patients, basic or

follow-up losing weight

stopping smoking

Vrij van alcohol [Alcohol Free]training course

basic resuscitation course

First Aid

first aid for accidents involving

children

sleep therapy

75% to 115.00

per course per person per year.

75% up to 115.00

per course (1) per per-

son per year togetherwith other costs up to 500.00.

100% per course per

person per year.

course and/or training in preven-

ting falls

exercise programmes for the elderly

memory training.

100% per course perperson per year.

Rehabilitation Via the (Keuze) Zorg Plan 100%.

Sports doctorInjury or repeat consultation.

Via a sports medical institution 2 x per person per year.Check www.sportgeneeskunde.com/fsmi for a location close to your home.

Sport-medical examinationNot an obligatory sports

examination.

Via a sports medical institution 1 x per person per 2 years.Basic Examination 85.00.

Basic Examination Plus 100.00.Major Examination 135.00.Check www.sportgeneeskunde.com/fsmi for a location close to yourhome.

Via a sports medicalinstitution 1 x per

person per 2 years Ba-sic Examination, BasicExamination Plus,Major Examination.Check ww w.sportge-

neeskunde.com/fsmifor a location close to

your home.

Stopping smoking programme

Therapeutic holiday camps forhandicapped people

150.00 per person

per year.

250.00 (1) per person

per year, togetherwith other costs up to 500.00.


Thrombosis service Via the (Keuze) Zorg Plan 100%.

Payment in the event of the functio-nal loss of any part, capacity or or-gan of the body, due to an accident

250.00 per accident.

Holiday hotels (Red Cross) or sailingholidays (Red Cross or Zonnebloemorganisation) For handicappedpeople and the chronically ill.

25%

Care Regulator (also for insured carer)Telephone number: 0900 - 9590(local rate).

3 hours per personper year. 6 hours per person per year. 9 hours per personper year.

Supplementary Ziekenhuis Extra [Hospital Extra] Insurance Policies

Extra comfort cover

Contracted care. 100%

Non-contracted care. 150.00 per day.

Daily monetary payment 70.00 per day up to 4,900.00 * per person per year.

When abroad: room supplement class room / fee surcharge

Contracted care. 100%

Non-contracted care. 70.00 per day up to 4,900.00 per person per year, no reimbursement of the fee surcharge.

* Reimbursement in the Netherlands and abroad together.



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Keuze Zorg Plan(basic insurance)

This reimbursement policy givesyou the freedom to choose your

own care providers.

Zorg Plan(basic insurance)

With this combination of non-monetary and reimbursement you

receive care from our contractedcare providers.

The basic insurance

Should you become ill, our health insurance policies offer

you the right care without any nasty financial surprises.

However, even if you are in good health, you want to

know you can rely on us to be there whenever you need

help. You can opt for one of our basic insurance policies.

If you have the Avro Achmea basic insurance you are

already assured of the Seven Certainties of good care,

irrespective of which basic insurance you choose.

Supplementary insurance

In addition to the basic insurance policies we also offer four supplementary insurance policies - Start, Extra, Royaal and

Excellent. They range from a very competitively priced insurance policy to insurance with very comprehensive cover. The fol-

lowing is a brief overview of the supplementary insurance policies you can choose for.

Dental insurance

The basic insurance does not cover regular dental care from the age of 18.

For that reason it is a good idea to supplement your basic insurance with a dental insurance, for family members aged over 18.

Disclaimer:

In the event of contrariety between the English and Dutch versions of this document, the Dutch version will prevail.

Types of care Start Extra Royaal Excellent

1 Alternative therapies 440.00 per year 640.00 per year 1.500.00 per year 1.800.00 per year

2 Contracep tion 100% 100% 100% 100%

3 Glasses and lenses 100.00per 3 calendar years

150.00per 3 calendar years



4 Eye laser treatment none 500.00 500.00 750.00

5 Primary psychology 4 extraappointments

A reimbursement of the

personal contribution 80.00 + 6 extraappointments.





6 Physiotherapy and remedial therapy 12 times 27 times 27 times 100%

7 Help when abroad includingvaccinations

100% 100% 100% 100%

8 Or thodontics Up to 18 years of age 90%

and max. 1,500.00

Up to 18 years of age 90%

and max. 2,000.00

Up to 22 years of age 90%

to max. 2,500.00, fromage 22 onwards 70% tomax. 1,000.00

Up to 22 years of age

100%, from age 22 70% tomax. 1,500.00

Type of care T Start T Extra T Royaal T Excellent

9 Dental care A maximum reimburse-ment of 225.00 per year

A maximum reimburse-ment of 450.00 per year

A maximum reimburse-ment of 900.00 per year

A maximum reimburse-ment of 1,150.00 per year

Summary of the health insurance policies


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Disclaimer

Privacy

We need personal data to process applications for an insu-

rance policy or a financial service. This data is used within the

Achmea Group to enter into and implement insurance agree-

ments, to inform you about relevant products and/or services,

to guarantee the security and integrity of the financial sector,

for statistical analyses, customer relationship managementand in order to comply with statutory obligations. The use of

your personal details is subject to the Gedragscode Verwerking

Persoonsgegevens Financile Instellingen [Code of Conduct

for the Processing of Personal Data by Financial Institutions].

Health insurers also have to comply with the Gedragscode

Verwerking Persoonsgegevens Zorgverzekeraars [Code of

Conduct for the Processing of Personal Data by Health Care

Insurers].

If you do not wish to receive information about our products

and/or services, or if you wish to withdraw your permission

for the use of your e-mail address, please write to us at Avro

Achmea, Postbus 1717, 3800 BS Amersfoort. With a view to

maintaining a sound acceptance policy, we are allowed, as

the Achmea Group, to consult details kept at the StichtingCentraal Informatie Systeem [Central Information System

Board] (CIS) in Zeist. Within that framework, those affiliated

to the Stichting CIS are also allowed to exchange data among

themselves. The aim is to manage the risks and combat fraud.

This is subject to the privacy regulations of the Stichting CIS.

More information can be found at www.stichtingcis.nl.

Applicable law and complaints procedure

The insurance policies are exclusively subject to Dutch law. It

goes without saying that we do our very best to provide you

with an optimal service at all times. Nevertheless, you may still

be unhappy about some aspect of the services we provide. In

such instances, you should first contact your adviser or contact

person. If you still feel it is necessary to submit a complaint,

you can do so by e-mail via our website www.averoachmea.nl(under the klacht doorgeven [submit complaint] section) or in

writing to Avro Achmea, Centrale Klachtencordinatie,

Antwoordnummer 93200, 2200 XA Noordwijk. If, in your

opinion, we do not manage to solve the problem satisfactorily

and if you are a natural person that is not involved in running

a business or engaged in a profession, you can submit your

complaint to the authorised complaints board to which we are

affiliated, namely: Stichting Klachten en Geschillen Zorgver-

zekering [Health Care Insurance Complaints and Disputes

Foundation] (SKGZ), Postbus 291, 3700 AG Zeist, tel. +31 (0)30

69 88 360, www.skgz.nl.

Information about Avro Achmea

Avro Achmea is a provider of insurance products and uses

independent brokers and advisers. Avro Achmea is a trade nameof Achmea Zorgverzekeringen N.V., which is located in Noordwijk

and registered with the AFM under number 12000647, and

of Avro Achmea Zorgverzekeringen N.V., which is located in

Utrecht and registered with the AFM under number 12001023.

The office of Avro Achmea is located on the Van Asch van Wijck-

straat 55, 3811 LP Amersfoort, the Netherlands.


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Avr Achmea ha acqre he Klagerch Verzekere [Cmer-ree irace] qaly mark.

Confidence and certainty are essential for the quality of services provided in the insurance sector. The Klant-

gericht Verzekeren quality mark is issued by the independent Stichting toetsing verzekeraars [Insurers Assess

Basic insurance policies (Keuze) Zorg [(Options) Care] Plan

Supplementary insurance policies Start, Extra, Royaal, Excellent

Dental insurance policies T Start, T Extra, T Royaal, T Excellent

Comfort nursing Ziekenhuis Extra [Hospital Extra]

d-3598 summary of cover

Documents