package comparer ohra

8/11/2019 Package Comparer OHRA

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Package Comparer OHRA Zorgverzekering 2014

Basic insurance

OHRAZorgverzekering(Health insurance)

ExcessPersonalcontribution

OHRAStrong

OHRASupplementary

OHRAExtraSupplementary

OHRAComprehensive

Alternative healing and remedies

Total compensation alternative healing and remedies 250 500 750

Alternative healing 45 per day 45 per day 45 per day

Alternative remedies (registered as homeopathic or anthroposophic medication) full cover full cover full cover

Delivery and maternity care

Hospital delivery on medical grounds

Hospital delivery or maternity care without medical grounds yes, personal contribution

formaternity care

Use of delivery room

Obstetric care by a midwife, general practitioner or specialist

Statutory personal contribution for hospital delivery full cover

Maternity care

Tip: request maternity care at the latest five months before the expected delivery date throughMijn OHRA orgverzekering

Maternity care in maternity centre or hospital without medical grounds

16.50 per day. If your care provider

declares more than 116.50 perday, the excess amount is paid by

you as personal contribution.

Maternity care at home. You must apply by the 4th month of pregnancy at the latest. maximum of 10 days 4.10 per hour

Birth kit service

Personal contribution for maternity care full cover

Incubator aftercare 15 hours

Breastfeeding advice 200

Maternity care following hospitalisation 15 hours

Additional maternity care (only on medical grounds) Prior consent required. 5 x 3 hours

Maternity care for adopted child younger than 6 months. Prior consent required. 3 x 3 hours

Fertility treatments

IVF/ICSI for women up to the age of 43 (at a government-improved institution) and associated hormonalpreparations

attempts 1, 2 and 3 yes

Other fertility treatments yes

Prenatal screening

Prenatal screening on medical grounds

Prenatal screening without medical grounds for women older than the age of 36

Prenatal screening without medical grounds for women younger than the age of 36

Other

Monitoring equipment to prevent cot death. Prior consent required.

Courses on childbirth 200

GeboorteTENS (equipment to combat pain). Prior consent required.

Spectacles/contact lenses/eye laser treatment

Spectacles/contact lenses/eye laser treatment, per 2 calendar years 50 50 75

Abroad

Area of cover world world world world

Non-emergency assistance abroad. Prior consent required for hospitalisation.100% according to standard rates

in the Netherlandsyes

Emergency assistance abroad100% according to standard rates in

the Netherlandsyes full cover full cover full cover full cover

Helpline:

- Travel physician service service service service

- Repatriat ion of pat ients/injured persons service service service service

- Repatriation of deceased service service service service

- Sending medicines service service service service

- Telecommunication costs 350 350 350

Emergency dental treatment from the age of 18 250 250 250 250

Travel inoculations 250 250 250

This package comparer enables you tosee at a glance which coverage is inclu-

ded under which insurance package. Itis an easy way to compare the different

types of health insurance provided byOHRA. Eligibility for compensation is sub-

ject to a number of conditions, which you

will find in the General Terms & Conditionsand in the compensation overview pertai-

ning to your insurance.

Basic insuranceThe government determines the compensation under the basic insu-

rance. These amounts, which are included in this overview, are validper insured person per calendar year, unless otherwise stated. Under

the excess column you can see whether a compensation falls underthe excess. The excess is only applicable to insured persons aged 18

and older. Under the personal contribution column you will see the

amount that all insured persons must pay. The personal contributionhas been established by the government and is a separate matter

from your excess.

Supplementary & dental insuranceWould you like more coverage than your basic insurance

allows? Supplementary insurance, including dentalcoverage, is available. All amounts in this package com-

parer are maximum amounts and are valid per insuredperson per calendar year, unless stated otherwise. In all

cases, the care provider and/or institution must be appro-

ved and recognised by OHRA. The maximum compensa-tion is based on the standard market rates.

Standard market ratesWhen you see the symbol in the package com-

parer, it means that this type of care is insured.OHRA usually agrees on the rates with care

providers in advance. In those cases, OHRA willapply the agreed rates. If you visit a care provider

with whom OHRA does not have an agreement,

you will receive the maximum compensationbased on the standard market rates in the

Netherlands.


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Basic insurance



OHRAStrong

OHRASupplementary


OHRAComprehensive

Pharmaceutical care

Dietary preparation (for certain medical conditions) yes

Medicines such as antibiotics

according to drug

compensation systemyes

possible (in the drug compensationsystem you will find the maximum

compensation and exceptionalpersonal contribution)

Contraceptives (pill/coil/pessary) up to the age of 21according to drug

compensation systemyes

possible (in the drug compensationsystem you will find the maximum

compensation and exceptionalpersonal contribution)

Contraceptives (pill/coil/pessary) from the age of 21 200 200 200

Compensation of statutory personal contribution drug compensation system 25 50 150

Compensation of statutory personal contribution for contraception up to the age of 21 full cover full cover full cover

Recovery, accommodation and aftercare

Convalescent homes. Prior consent required. 250 500 1,000

Recovery and Balance programme for ex-cancer patients (per treatment programme) 250 500

Therapeutic (holiday) camp for children (for certain indications) 200

Childcare during hospitalisation 200

Accommodation costs for 1 room at the guest house rate (e.g. Ronald McDonald house) 200

Health resor ts ( for cer ta in ind icat ions) P rior consent required. 500 1,000

Trauma processing

Assistance with recovery service

Hospice

Personal contribution hospice 500 1,000

Skin therapy (prescribed by a physician)

Acne treatment 50 100 150

Camouflage therapy 50 100 150

Depilation or laser treatment (facial/neck hair removal) for female insured persons 250 500 1,000

UV-B light therapy equipment (purchase or rental costs). Prior consent required. yes 500 1,000

General practitioner

Care provided by general practitioner

Preventive foot care for diabetic patients

Medical care aids

Medical aids (such as wigs, hearing aids)

see OHRAs Medical Aids

Regulations yes, except when on loan

possible (in the Medical AidsRegulations you will find the maxi-

mum compensation and exceptionalpersonal contribution per aid)

Personal contribution medical aids basic insurance 500 1,000

Head cover other than a wig 75 75

Personal alarms 150

Epilepsy alarms

Bed-wetting alarm for insured persons aged 7-18(purchase cost or rental cost for a maximum of 90 days for insured persons aged between 7 and 18)

Cranial helmets (for certain indications)

Support soles 100 150

Therapeutic sports braces 150 150 150

Medical specialist care

Hospital care maximum of 365 days yes

D ay -c ar e n ur si ng, h os pi tal is at io n a nd c are s eve ral da ys ma xi mu m c las s 3 ye s

Specialist costs during hospitalisation. The following treatments are excluded: sterilisation, reversal of sterilisation,circumcision, snoring treatment, upper eyelid correction when the eyelid covers at least half of the pupil causingsevere visual impairment, correction of the ear position and breast prosthesis unless a mastectomy has been car-ried out. Look under the heading other for compensation of these medical conditions.

yes

Additional costs (costs during hospitalisation):

- use of operating theatre yes

- medicines and dressings, X-rays, laboratory, physiotherapy in the hospital yes

Outpatient specialist care

Specialist costs during hospitalisation. The following treatments are excluded: sterilisation, reversal of sterilisation,circumcision, snoring treatment, upper eyelid correction when the eyelid covers at least half of the pupil causingsevere visual impairment, correction of the ear position and breast prosthesis unless a mastectomy has been car-ried out. Look under the heading other for compensation of these medical conditions.

yes

Use of operating theatre yes

X-rays, laboratory tests and medicine and dressings yes

Radiotherapy yes

Kidney dialysis in hospital (outpatient) or at home yes

Thrombosis service yes

S pe rm f re ez in g o r s to ra ge i n t he e ve nt o f i mp en di ng f er ti li ty r ed uc ti on a s a r esul t o f o ncol og ical t re at me nt s. y es

Obesity, outpatient (once for the entire insurance period) 500

Admission and/or treatment in connection with transplantation of specified organs

Heart, bone, kidney, liver, skin, c ornea, bone marrow, lung, heart /lung and kidney/pancreas yes, except for check-ups after a

kidney/liver donation.

Tissue type tests. Prior consent required. yes

Aftercare cos ts if you have received a donor organ (t ransport, operation and donor care) 13 weeks yes


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Basic insurance



OHRAStrong

OHRASupplementary


OHRAComprehensive

Other

Costs of Independent Treatment Centre. The following t reatments are excluded: sterilisation, reversal of sterilisation,circumcision, snoring treatment, eyelid correction, correction of the ear position and breast prosthesis unless amastectomy has been carried out. Look below for the amount of reimbursement of these medical conditions.

yes

Audiological care (by an approved audiological centre) yes

Genetic testing (by an approved centre) yes

Medically necessary cosmetic surgery (excluding the number of treatmentsnot covered under the policy conditions). Prior consent required.

yes

Cosmetic surgery (breast prosthesis replacement other than after a mastectomy,correction of protruding ears and upper eyelids when the eyelid covers at leasthalf of the pupil causing severe visual impairment). Prior consent required.

N on -m ed ical ly n ecessa ry c ir cu mc is io n f or i nsur ed m al e p er so ns 25 0 25 0

Medically necessary circumcision for insured male persons

Male sterilisation 400

Female sterilisation 1,250Reversal of sterilisation (m/f).

Second opinion by a physician (not a dentist or an oral surgeon) yes

Revalidation yes

Surgical treatment for snoring

Artificial respiration yes

Help during the treatment of children with cancer (SKION)

Sports medical consultations

Courses and exercise programmes (incl. First Aid, diet and weight management in the event of overweight,how to stop drinking alcohol and reanimation)

100 150 200

Sports medical examination 100 100 100

Dental care

Dental care up to the age of 18

Check-ups (as indicated by the dentist, several times a year possible) 1x per year

Fluoride treatment 2x per year

Other dental care (excluding crowns, bridges, inlays, dental bleaching and orthodontics).

Crowns and bridges 500 500 500

Dental care from the age of 18

Complete dentures (upper and/or lower) 75%, 1 x 5 years yes 25%

Repairs and rebasing (filling) complete dentures (upper and/or lower) yes

Compensation personal contribution complete dentures (upper and/or lower) 200

Dental care in exceptional cases

For certain indications/disability. Prior consent required. yes

Orthodontics

Orthodont ics up to the age of 18 (once for the ent ire insurance per iod) 1,000 2,000

Orthodontics from the age of 18 (once for the entire insurance period) 250 250

Orthodontist in exceptional cases (for certain indications). Prior consent required. yes

Implants (for certain indications). Prior consent required.

Compensation dentist and oral surgeon yes

Polyclinic and clinical additional costs (hospital) yes

Suprastructure yes

Upper or lower dentures on implant yes 125

Upper and lower dentures on implant yes 250

Therapies

Physiotherapy up to the age of 18

Physiotherapy and Cesar/Mensendieck exercise therapy, per indication. Prior consent required if you visit a careprovider with whom OHRA does not have an agreement.

max 9 treatments (if unsatisfactoryresult a further

9 treatments at maximum)

Physiotherapy for indications that are included on the list of disorders, as determined by thegovernment. See www.ohra.nl. Prior consent required.

Physiotherapy from the age of 18

From the 21st treatment for indications that are included on the list of disorders, asdetermined by the government. See www.ohra.nl. Prior consent required.

yes

Physiotherapy for all ages

Physiotherapy and Cesar/Mensendieck exercise therapy9

treatments4

treatments9

treatments18

treatments

Screening physiotherapy

Ergotherapy 10 hours yes

E rgo th era py up t o 1 8 y ear s o f ag e, i n add it io n t o t he ba si c i ns ura nc e c over ag e 2 h ou rs 2 h ou rs 2 ho urs

Instruction and supervision care providers of the insured persons receiving ergotherapy 2 hours 2 hours 2 hours

Other

Pelvic therapy through urinary incontinence 9 treatments yes

Speech therapy yes

Dyslexia: diagnosis and treatment of severe dyslexia for 7-year-olds to 12-year-olds.

Phototherapy (rental/purchase price of the unit) 100 150 250

Foot treatment and counselling for medical indication rheumatoid arthritis or severe vascular problems in the legs.Prior consent required.

50 100 150

Foot treatment other situations (by chiropodist or podiatrist, prescribed by a physician) 50 100 150

Stutter therapy. Prior consent required.

Dietary advice 3 hours yes 100 150


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www.ohra.nl/vergoedingenwijzer

ZV0704

1113

Basic insurance



OHRAStrong

OHRASupplementary


OHRAComprehensive

Preventive care

Stop Smoking programme (combined with medicines), dealing with depressive symptoms and alcohol abuse yes

Influenza immunisation 1 x per year

General preventive and work-related examinations, 1 x per year 50 100 150

Psychological care

Primary psychological care

Primary psychological care (including internet treatment process) yes

Secondary psychological care

Psychiatric help with admission 365 days yes

Psychiatric help without admission yes

Psychotherapy (for personality disorders per indication and other disorders) yes

Other

Consultations and counselling for women (including menopause counsellors, carefree pregnancy advice and

cancer prevention advice) 200

Transport

Ambulance transport service (one way) maximum of 200 kilometres yes

Seated patient transport (one way) in the following situations: maximum of 200 kilometres 96 per year

- Own car. Prior consent required. 0.31 per kilometre yes

- Taxi. Prior consent required. yes

Seated patient transport is only reimbursed in the following instances:- For renal dialysis treatments- For radiotherapy or chemotherapy treatments- If you are blind or visually impaired- If you are wheelchair dependent- In the case of long-term illness or a disorder and you have a certificate from your physician that you have to rely

on transport long-term.

Travel expenses of parents (0.19 per kilometre) 200

Transport of the patient by own car (per kilometre). Prior consent required. 0.19 0.19

Transport of the patient by taxi. Prior consent required. 100% for contracted care, maximum rate per kilometre fornon-contracted care.

Waiting list mediation service

Dental insurance for insured persons of 18 and above

Tand Sterk TandenGaaf 250 TandenGaaf 500

Dental treatment by a dentist or oral hygienist for maintenance of the teeth:- consultations- fillings- teeth cleaning- dental extractions- X-ray- root canal treatment- anaesthetics

75% up to 250 100% up to 250 100% up to 500

C ro wn s, b ridges , imp lant s, den tu res and inlays. 1 00 % u p t o 25 0 1 00 % u p t o 50 0

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