What is the deductible (excess)?
The deductible is an obligatory amount that you must pay when you incur costs for care from your basic insurance. In 2020, this compulsory deductible for your health insurance was €385. The government sets this amount annually. In 2021 the deductible will remain at €385.
What is the voluntary deductible?
In addition to the compulsory deductible, there is also a voluntary deductible. If you choose for this option, the amount will be added to your deductible amount. You can increase your deductible voluntarily up to a maximum of €885. In exchange, you get a discount on your premium.
Beware: If you opt for a voluntary deductible, you ultimately will pay more if you use healthcare under the basic insurance. So consider this option with caution.
Why do I pay a deductible?
With the deductible, you pay the first part of your health care costs yourself. The purpose of the deductible is to prevent insurance premiums from rising further. In addition, the government wants everyone to be aware of the costs incurred relating to healthcare in the Netherlands. Paying the deductible serves this purpose.
Adjusting your deductible
You cannot adjust the excess of your health insurance during the calendar year. When you select your health insurance policy at the end of the year, your deductible is automatically set for the upcoming year. The only opportunity to change this is at the end of the year.
Which costs are deductible?
If you have incurred healthcare costs that fall under the compulsory deductible, you will be notified of this by your health insurer. If you would like to know in advance whether certain costs fall under the compulsory deductible, you can ask your health insurer or doctor for this information.
- Blood tests
- Ambulance transport
- Hospital admissions, treatments and operations
- Physiotherapy for a chronic disorder from the 21st treatment onwards
Exceptions to the deductible
There are a number of exceptions to the deductible. Some costs that are covered by the basic insurance do not fall under deductible costs. For example:
- The general practitioner (GP)
- Obstetric and maternity care
- Dental care for insured persons younger than 18
- Facilities on loan for home care
- Follow-up care for living organ donors (kidney or liver transplant)
- Integrated care (care in which different healthcare providers work together, for example in the case of diabetes treatment)
- Help to quit smoking. You are entitled to the reimbursement of one quitting program per year
- Community nursing
Good to know: The above exceptions are the same for every insurer. Some insurers include more exceptions than the ones that are mentioned here. The details can be found within the policy conditions of your health insurance.
General practitioner vs. hospital
The costs of general practitioner (GP) care is not included in the deductible. This means that you won’t have to pay for any visits to the GP. However, extra costs incurred via the GP are often deductible costs. If the GP prescribes medication or blood tests, these are costs are deductible. If the GP refers you for an X-ray at the hospital, you also will pay the deductible.
For example, if you have a bike accident and wound your knee, you may need medical attention. You have a few options:
- The GP
- The accident & emergency department
- The hospital (clinic)
- The after-hours GP clinic
In principle, all of these options are covered by the basic insurance and you therefore have to pay a deductible. However, if you visit the GP, then you don’t pay any deductible. If your GP is closed, you can go to the after-hours GP clinic. The costs you incur here are also not deductible, as with a ‘regular’ GP visit.
If you go to the accident & emergency department yourself, or are referred to the hospital by the GP, then you have to pay the deductible.
What if it's not my fault?
Are you in hospital due to the fault of another party? You still have to pay the deductible but you can later try to recover the costs from the other party. By claiming liability against the other party, you may be able to recover the cost of your excess.
Who does the deductible apply to?
Everyone who is 18 years of age or older and has a Dutch health insurance policy also has an compulsory deductible. This means that children under the age of 18 do not have a deductible. Therefore, if your child has to go to the accident and emergency department, you won’t have to pay the first €385 yourself.
Chronically ill people
The deductible is the same for everyone. So, even if you are chronically ill, your deductible will never be more than €385. Insurers are not allowed to charge a higher amount because someone may incur higher costs.
Are you an organ donor? In this case, in the first 13 weeks, the care you receive will be reimbursed by the basic insurance of the receiver. All medical checks within this period will be reimbursed and you will not be charged any deductible.
Do I also have a deductible on my supplementary insurance?
The deductible only applies to the basic insurance. Thus, reimbursements from the supplementary insurance do not count towards the deductible. Before you decide to take out supplementary health insurance, check the reimbursement overview to see what is covered and how much is reimbursed by the health insurer.
How often do you pay the deductible?
If you incur costs that fall under the deductible, you will receive an invoice from your health insurer. You only pay for the costs you have incurred. If this amount is higher than the deductible of €385 euros, the remaining costs will be reimbursed by your health insurer.
You only pay the deductible once per calendar year. This can be in one large payment, or several small ones. It depends totally on the kind of expenses you are incurring. In both cases, the balance of the deductible is reset again on 1 January of the following year.
There is one exception. For hospital care, a so-called DBC is opened. All the costs you incur relating to a diagnosis fall under the one DBC. For example, if at the end of the year you go to the hospital to treat a broken arm, but return to the hospital to have the cast removed only in the new year, all of the costs related to the broken arm will fall under the same DBC. Despite the fact that the second appointment takes place after 1 January, the costs are not considered deductible for the new year, but for the previous year.
The health insurance bill is sometimes delayed
You never pay directly at the hospital, but you receive the bill from your health insurer. In some situations this can take quite a long time. This is because your health insurance company depends on the speed of the health care provider you have been to. If, for example, the hospital takes a long time to send the bill to the insurer, it will also take a long time before the insurer sends the bill to you. This can sometimes take up to a year.
What if I can't pay the deductible?
You are obliged to pay the deductible if you incur costs which fall under this.There is no way to annul this payment. If you have trouble paying the deductible, you can ask your health insurer for a payment plan. With some health insurers it is possible to agree on a payment schedule in advance. This can be useful, for example, if you are on medication and are already sure that your costs incurred will exceed the deductible. Unfortunately, it is not possible to buy off or insure the deductible.
The difference between deductible and personal contribution
The deductible is the amount you pay when you receive care by the basic insurance. The personal contribution is the part of the bill that you always pay yourself.
If I pay a personal contribution do I also have to pay a deductible?
One does not exclude the other. It is therefore possible that you will have to pay both a deductible and a personal contribution. An example is the reimbursement for a hearing aid where you have to pay both a personal contribution (25% of the total amount) plus the deductible (to a maximum of €385). The remaining cost will be reimbursed by the health insurer.
Does the excess also apply abroad?
Medical costs abroad are reimbursed by the basic insurance up to the rate applicable in the Netherlands. That means you'll have to pay the deductible on that, too. In this case it doesn’t matter that the costs were incurred abroad.
How can I see how much deductible is left?
If you want to know more about your deductible, it’s best to ask your health insurer. Also, to find out how much excess you have already paid, you can easily see this in the online environment of your health insurer.