The future of top-up health insurance policies could be in doubt according to a new report by the Dutch central bank DNB.
The top up policies, which cover dental care, physiotherapy and alternative medicine, are commercial products and insurance companies are free to set their own prices and conditions.
When the new health insurance system was introduced in 2006, 93% of policy holders took out additional insurance but that figure has now fallen to 84%, the central bank said.
Insurance companies are now keeping the prices artificially low and some are already making a loss on their supplementary policies, the central bank said.
Research by the Dutch consumers authority ACM and national health council NZ shows that consumers can save up to €100 a year on their health insurance costs by shopping around for a better deal.
There are savings averaging €100 per year per person to be made for policies which are virtually identical, the organisations say. Every year, some 6% of the population changes policy in the year-end window.
‘Switching health insurer ensures a dynamic market and keeps insurance companies on their toes,’ ACM director Chris Fonteijn said.
Consumers have until the end of December to cancel their current policy and up to the end of January to choose a new one.
Some Dutch health insurance companies are cloning their basic policies and offering them for different prices under different labels, according to the Dutch consumers association Consumentenbond.
The 50 different insurance companies in the Netherlands are creating a policy jungle by offering around 1,000 different healthcare policies.
‘All these identical policies with different names make the supply side unnecessarily confusing for consumers,’ said organisation director Bart Combée. ‘Consumers can choose from 57 different basic insurance packages but a third of them can be scrapped because they are identical to others.’
CZ, one of the big four big insurance companies, offers a standard policy costing €122.60. But the same policy, issued by CZ subsidiary Ohra, costs just €107.95 a month.
Three quarters of health insurance polices taken out by the Dutch only cover patients completely if they visit a healthcare practitioner who has a contract with the insurer, new figures show.
Just under 20% have opted to have complete freedom to decide where to get treatment and the rest have opted for a combination policy, according to research by care information platform Vektis.
This year, insurance companies had 58 different policies on offer and 67% of people were covered by a collective policy, often via their jobs, Vektis said. In addition, 84% of people have taken out top up policies to cover services not covered in the basic state-determined policy. These include items such as extra physiotherapy, homeopathy and dental treatment.
Just over half of patients spend less than the €385 compulsory excess on their health bills last year.
Of those who opted to increase the excess charge by €500 – which results in lower monthly premiums – just 8% ended up having to pay the first €885 of their medical bills themselves.
The four parties in talks on forming a new Dutch government do not want the planned rise in the health insurance own-risk element to go up to €400.
Chief negotiator Gerrit Zalm has written to health minister Edith Schippers to say the four parties oppose the increase. He has taken the unusual step because any change has to be made formal in law by October 1.
The size of the own-risk payment – currently €385 – is important for health insurance companies when they determine what premiums to charge patients next year. Patients have to first spend €385 on healthcare themselves before they can claim on their health insurance for treatment.
Caretaker health minister Edith Schippers says the decision not to increase the own risk means that all adults will have to pay an extra €10 a year in premiums. She had earlier indicated that premiums would go up by an average of €6 a month. The government determines what is covered in the basic healthcare insurance package but insurers are free to set their own fees.
Expats and internationals may complain about Dutch healthcare, but in global terms we are pretty lucky – at least that is how the Netherlands appears in various healthcare rankings.
In May 2017, the Lancet Magazine put the Netherlands in ninth place in a ranking of almost 200 countries. The ranking was compiled by looking at how likely you are to survive diseases, including tuberculosis, whooping cough and measles – 32 different ailments in total.
In early 2015, Sweden’s Health Consumer Powerhouse put the Dutch health service at the top of a ranking of 36 different European countries for the second year running. Why did the Dutch do well? Accessibility and the lack of government interference.
Then again, research by the Commonwealth Fund think-tank in America put the Netherlands at the top of a list of 11 western countries in terms of its healthcare system. That research was published at the end of 2016.
There is a two-month window at the end of every year during which you can switch health insurance company.
You’ll notice when it starts by all the adverts for health insurance companies appearing everywhere.
Every year around 5% of policy holders make the switch. Is it worth it? If you’ve had crappy service or can save a significant amount of money, it probably is.
Visits to your doctor are free but that’s about it. Prescriptions, specialists, hospital treatments – all of that will cost you. But you probably won’t be aware of it because the pharmacy and the hospital will send their bills to your insurance company and your insurance company will pay them – without ever checking with you.
However, if you have not yet paid your full own risk or excess charge (€385 to €885 a year) your insurance company will send you its own bill and you will be expected to pay it.
This is where you need to take care. If you have any doubts about the size of the bill at all, you need to question it. Hospitals and health insurance companies get it wrong all the time.
Hospital bills are drawn up according to a complicated system of codes known as a DBC. The DBC (Diagnose Behandel Combinatie) involves giving each potential step in a course of treatment (there are over 30,000) an average price. This means you pay the average price of whatever treatment you’ve had… which gives rise to some crazy situations.
We’ve know someone who was charged €470 to have a plaster put on a profusely bleeding cut knee because it was classified as ‘a small surgical operation’.
So check, and make a fuss if you have any doubts at all.
If you have a low income, are single, and earn less than € 27.500 a year you will probably be able to claim healthcare benefits (zorgtoeslag) – about €6 a month if you are at the top of the scale but rising to €88 a month if you earn less than €19,000. Couples qualify for more.
In other words, if you are very crafty, you can get more in benefits than your insurance costs you.
If you think you might qualify, you can calculate out how much you will get on the Dutch Belastingdienst website. However, the calulcator isn’t there on their English website, but you might find some other useful information there.
Be aware that if your earnings turn out to be more than you thought, you will be required to pay back the money you should not have had.
Reckon on around €100 a month for the basic package – and the fact that you will have to pay the first €385 of your treatment (not visits to the doctors).
You can slash this by around €20 a month by agreeing that you will pay the first €885 of your treatment. If you are generally healthy, this is well worth doing – well, you can do the sums. If you don’t make any claims, you’ve saved about €360 a year.
The lowest health insurance premium (for 2017) we’ve come across is around €62.25 a month. This is so cheap because you are only allowed to go to doctors, hospitals and other health care pros that the health insurance company dictates. In case you are wondering, it is from Anderszorg – which is part of the giant Menzis group. This sort of policy is known as a natura policy.
If you have a natura policy and you insist on going to the doctor of your choice, you will have to pay part of the bill yourself.
If you want free choice, you need to make sure you take out a restitutie policy. These are more expensive.
Note: If you are an employee, your boss is also paying towards your basic healthcare. If you are self-employed you will have to pay this yourself because you count as your own employer. This will cost you up to 7.5% of the first € 51,414 of your income as a freelancer or one-man company. The exact percentage depends on whether you are officially self-employed, an employer or on a freelance contract.