What is the Health Insurance Act (Zorgverzekeringswet)?

Health insurers in the Netherlands are responsible for implementing the Health Insurance Act (Zorgverzekeringswet or Zvw), which replaced the old health insurance law in 2006. The Dutch Healthcare Authority oversees whether insurers comply with the regulations set out in the Zvw.

The Health Insurance Act is funded by income-based contributions from all citizens, a portion of health insurance premiums, the mandatory deductible (own risk), and a general health fund. But what exactly does the Health Insurance Act cover? We’ve summarized the key points below. 

Who is required to have health insurance?

The most important rule in the Zvw is that everyone who lives or works in the Netherlands is required to take out a basic health insurance plan. Children under 18 are automatically covered under their parents' policy. There are three exceptions to this insurance requirement: military personnel, conscientious objectors, and prisoners.

What healthcare is covered by the basic health insurance package (basisverzekering)?

The basic health insurance package in the Netherlands covers essential and necessary healthcare, including:

• General practitioner care: consultations and minor treatments.
• Specialist care: Visits to medical specialists and hospital treatments.
• Hospitalization: costs for hospital stays, treatments, and surgeries.
• Medications: Many prescribed drugs (some with an additional personal contribution).
• Mental healthcare (GGZ): Basic and specialized mental healthcare after referral.
• Physical therapy: Fully covered for those under 18; for adults, coverage is only for specific chronic conditions (from the 21st session onwards).
• Maternity care and midwifery: Support during pregnancy and childbirth.
• Emergency care: Emergency room visits and ambulance transport.
• Dental dare: Only for children up to 18 years old.
• Medical devices: Such as hearing aids, braces, etc. (only in certain situations, with conditions).
• Smoking Cessation Programs
• Nursing and care: community nursing for care at home.
• Sensory disability care
• Medical transportation
• Dietary supplements

Note: Adults are required to pay a mandatory deductible (set at € 385,- in 2024).

Voluntary additional insurance package

Not all healthcare services are covered by the basic insurance package (basisverzekering). For services not included, such as adult physical therapy or dental care, you can opt for additional insurance (aanvullende verzekering). The content of additional insurance policies and the conditions under which they can be taken out are determined by the insurer. Keep in mind that insurers can deny you coverage for supplemental insurance. 

What is the acceptance requirement for health insurers?

All health insurers must accept anyone for basic insurance coverage. However, this is not the case for the additional insurance, where waiting periods or medical evaluations may apply. The basic insurance coverage is the same across all insurers.

Note: Premiums for basic insurance can vary by up to € 300,- per year, depending on the insurer and the type of policy offered. The estimated annual premium for 2025 is € 1,872,-. Insurers will announce their exact 2025 premiums on November 12, 2024. Be sure to compare different health insurance plans carefully at the end of the year, as you may be able to save on your premium. You can easily compare all health care plans with ZorgKiezer.nl

What types of health insurance policies are available?

In the Netherlands, you can choose from three types of policies:

In-Kind Policy (Naturapolis):You can only visit healthcare providers contracted by your insurer. Treatments from non-contracted providers are only partially reimbursed. This option offers less freedom of choice but often comes with a lower premium.

Restitution Policy: 
You have full freedom to choose any healthcare provider. Costs are fully reimbursed, even for non-contracted providers, as long as the charges are reasonable. This policy usually has a higher premium but offers more freedom. In 2024, only three insurers offered a restitution policy.

Combination Policy: 
A mix of the in-kind and restitution policies. For certain types of care, it operates like an in-kind policy (full reimbursement only with contracted providers), while for other services, you have the flexibility of a restitution policy.

What is the mandatory deductible regarding health insurance?

The Zvw includes a mandatory deductible. In 2025, this will be € 385,-. This is the amount you must pay out of pocket before your health insurance begins to cover costs from the basic package. Services covered by additional insurance do not count toward this deductible. Children under 18 do not have to pay the deductible. 

What is a personal contribution regarding health insurance?

A personal contribution is different from the deductible. It is a one-time payment required for certain types of care from the basic package, such as maternity care. This is also outlined in the Zvw. In some cases, you can get additional insurance to cover this contribution. 

What is healthcare allowance (zorgtoeslag)?

The Zvw takes into account people with lower incomes, who can receive a healthcare allowance to help make health insurance more affordable for them. This is a monthly allowance depending on your income. 

How are health insurers compensated?

Insurers who cover numerous of high-risk individuals incur higher costs. These insurers are compensated through financial contributions, as set out in the Zvw. The compensation varies by insurer, depending on the average risk profile of their insured clients. Factors used to assess risk include:

- Chronic conditions
- Pharmacy costs
- Age

How is the financial compensation funded?

The compensation comes from a special health insurance fund. Insurers with clients who have lower-than-average health risks, such as younger people who require less healthcare, contribute to this fund annually.

Compare health insurance in The Netherlands

Are you looking to apply for health insurance in the Netherlands, but unsure where to start? ZorgKiezer.nl makes it easy to find the best insurance policy for you. We compare premiums, coverage, extras, and more to help you make the right choice. If you have any questions or need assistance, our experts are ready to help. Feel free to reach out to us at 020 2611 600.