There are two types of insurance policies:
- Natura polis (in-kind policy), with care providers billing directly to the insurance company;
- Restitutie polis (restitution policy), which allows you to choose your own health care supplier, who will bill you directly, with the insurer reimbursing you afterwards. Many insurance companies will reimburse the care provider directly, presuming they have a contract with your insurance provider.
The type of policy will affect the premium; the restitution policy is more expensive.
Some providers offer a combination policy ('combinatie polis'), which is a combination of an in-kind and restitution policy. This definition is in use since the regulator stipulated that a restitution policy should always fully cover the cost of care that is delivered by a non-contracted healthcare provider, except when the charges are clearly excessive. A combination policy may promise tocover the 'full cost' of a non-contracted healthcare provider, but the reimbursement may be limited to what the insurance provider considers to be the 'average market price'.
With the in-kind policy you will have to visit a care provider that is contracted by your insurance provider. You will find however that all GP’s and most Secondary/Tertiary Healthcare Providers are contracted. Check with your insurance provider which health care providers are contracted in your area.
A special in-kind policy is the so-called Budget Policy, where only a limited number of health care providers have been contracted. When you compare policy options, it should be indicated which are budget policies, having limited choice of provider.
You still have by law the freedom to go to a non-contracted provider, but you may not receive a full reimbursement of the costs. The level of reimbursement typically is 75%, but other percentages are also used. Beware that the insurance provider applies the reimbursement percentage to what it considers to be a reasonable market price, which may be lower than what you were charged by the non-contracted healthcare provider.
With the restitution policy you are free to choose your health care provider, but even here it may occur in rare situations (mostly with non-contracted private clinics) that the insurance provider does not reimburse the full amount if they consider this to be far above what is ‘regular’. In doubt, always check with your insurance provider.