Eigen risico in 2026: what counts towards the €385 and what does not

This guide is for people with a Dutch basisverzekering (basic health insurance). Before planned care, ask your insurer about coverage, provider contracts, referrals, prior permission and your remaining deductible. Your insurer decides what your policy reimburses. This guide explains general 2026 billing rules; it does not decide which treatment is medically appropriate.

For the insurance obligation and enrolment deadline, use the Dutch health-insurance guide.

These five charges are separate. Only the compulsory deductible reduces your standard €385 balance for 2026.

The compulsory deductible belongs to you and one calendar year. It is lower if your basic insurance covers only part of the year. This includes the year you turn 18. Your insurer calculates the reduced amount. After you use the full compulsory amount, a voluntary deductible, co-payment or uncovered cost can still remain.

Your provider can send the claim to your insurer. The insurer pays the covered part and later bills you for your deductible. If you submit a bill yourself, the insurer can subtract the deductible from your reimbursement.

The care date determines the deductible year. Hospital treatment packages use their start date.

For example, in 2026 you have already paid €150 towards your compulsory deductible. You then receive €300 of covered specialist care. You have €235 left to pay: €385 − €150. Your insurer pays the remaining €65. This example assumes a full-year policy with no voluntary deductible, co-payment or contract shortfall. Zorginstituut Nederland (National Health Care Institute) (External site, opens in a new tab) gives this calculation.

Only care reimbursed from your basic insurance can use the deductible. You pay uncovered care yourself or claim it from supplementary insurance. Covered care can still have other charges and policy conditions. The guide to what Dutch health insurance does not cover explains common uninsured costs.

The table shows common services and the checks to make before planned care. Your policy may waive the compulsory deductible for selected services.

Your GP consultation is exempt, including at the huisartsenpost. A laboratory, pharmacy or specialist can bill separately for care your GP orders. Ask your GP which tests or medicines they will order. Check the likely reimbursement with your insurer.

For the choice between GP and hospital emergency care, use the emergency-care guide.

The following care is exempt from the compulsory deductible, according to the Rijksoverheid (Dutch government) deductible rules (External site, opens in a new tab):

• Basic-package care for children under 18
• Verloskundige zorg (pregnancy and birth care)
• Specified prenatale screening (prenatal screening)
• Kraamzorg (maternity nursing)
• Wijkverpleging (district nursing at home)

These covered programmes and services are also exempt from the compulsory deductible:

• Ketenzorg (coordinated chronic care)
• Gecombineerde leefstijlinterventie (GLI, combined lifestyle programme)
• Stoppen-met-rokenprogramma (stop-smoking programme)
• Verkennend gesprek (exploratory mental-health conversation)
• Follow-up checks and travel costs for organ donors

An insurer may also waive the compulsory deductible for selected providers, care programmes, medicines or devices. This waiver applies under that policy. Check your current policy and the insurer’s provider finder before relying on it.

A prescription alone does not guarantee coverage. Covered medicines and pharmacy service costs normally use the deductible. Under the preferentiebeleid (preferred-medicine policy), your insurer may cover only a preferred equivalent medicine. It can cover another medicine when that medicine is medically necessary and your doctor provides a statement. The official medicine-coverage rules (External site, opens in a new tab) explain this exception.

A medicine above its reimbursement limit can also have an eigen bijdrage. Medicine co-payments are capped at €250 per person for the 2026 calendar year. You pay the co-payment first. The remaining covered cost then uses your compulsory deductible, followed by any voluntary deductible. Medicines bought without a prescription and other uncovered medicines are paid outside the deductible.

Covered medical devices normally use the deductible. Your policy can require a prescription, prior permission or a contracted supplier. It can also specify whether you own or borrow the device. Some devices have a statutory co-payment or maximum reimbursement.

Ordinary everyday products are outside the basic package. You usually pay for replacement batteries or recharging yourself. You also pay for recurring maintenance of a device you own. Check the official medical-device coverage page (External site, opens in a new tab) and your policy before ordering. Uncovered costs do not reduce your deductible balance.

A covered ketenzorg programme is exempt from the compulsory deductible. Examples include programmes for type 2 diabetes, COPD (chronic obstructive pulmonary disease) and cardiovascular risk management. Your GP decides whether you qualify. Medicines, laboratory work and specialists outside the care group can still use the deductible. Ask whether each service is billed inside the programme.

Children under 18 have no compulsory deductible for basic-package care. They can still have co-payments or uncovered costs.

Verloskundige zorg, prenatal screening and kraamzorg are exempt from the compulsory deductible. Care directly connected to pregnancy or birth is also exempt. Separate costs that are not directly connected can use the deductible, including medicines, transport and some blood tests. Ask your insurer which rule applies to the service on your bill.

Home kraamzorg normally has an eigen bijdrage. Partusassistentie (birth assistance) has no co-payment. It covers delivery and up to two hours after the placenta is born.

A hospital birth without a medical indication can also have an eigen bijdrage. That birth co-payment falls away if a medical indication develops or you use nitrous oxide for pain relief. Check each service separately rather than treating all pregnancy costs as one charge.

Your insurer applies your policy’s rules for referrals, prior permission, providers and suppliers. A provider without a contract may be reimbursed only partly. The unpaid difference is separate from your deductible and does not reduce your €385 balance for 2026.

Providers must tell you before treatment whether they have a contract and whether you may have to pay. The Nederlandse Zorgautoriteit (NZa, Dutch Healthcare Authority) provider-information rules (External site, opens in a new tab) explain this duty. Your insurer confirms the exact reimbursement and your remaining deductible.

Your hospital invoice can arrive months after your first visit. A ziekenhuis (hospital) can bill a diagnose-behandelcombinatie (dbc, diagnosis-treatment package). A dbc groups consultations, tests and treatment for one diagnosis. It can run for up to 120 days. The hospital bills it after it closes. Longer treatment can create a follow-up dbc and another bill. Check your claim overview to see whether a late invoice covers a new package.

The start date of a dbc determines which year’s deductible applies. A first dbc starting in December 2025 can use your 2025 balance, even if care and billing continue in 2026. A follow-up dbc starting in 2026 can use your new 2026 balance. The SKGZ (health-insurance complaints and disputes body): hospital treatment packages (External site, opens in a new tab) gives this example.

Compare the start date, provider and diagnosis on the claim with your appointments. Ask your insurer to explain any mismatch.

If you are 18 or older, you can choose a voluntary deductible of €100, €200, €300, €400 or €500 for a lower monthly premium. You pay it after the compulsory €385. In 2026, the maximum combined deductible is €885.

Compare the yearly premium discount with the extra amount you could owe. Include expected medicines or hospital care and the money you have available.

Care exempt from the compulsory deductible usually stays exempt from the voluntary deductible. Check your policy.

Your voluntary deductible applies for a policy year. Check your insurer’s annual renewal terms to see when you can change it.

After a bill arrives, ask your insurer for a betalingsregeling (payment plan). Zorginstituut Nederland says deductible instalments carry no extra cost. Insurers can also offer advance payment or monthly payments alongside your premium. They return unused advance payments after the year ends. Conditions and enrolment dates differ, so ask your insurer when to apply.

Zorgtoeslag (healthcare benefit) can help eligible households pay insurance costs, including the deductible. It does not change your deductible balance. The toeslagen (allowances) overview explains which benefits to check.

If a bill looks wrong, check the claim before disputing it. Follow these steps:

1. Check the care and amounts in your insurer’s claim overview.
2. Ask your insurer for an itemised explanation of any unclear charge.
3. If the care was not yours, the year is wrong or your insurer applied the policy incorrectly, use its correction or complaint process.
4. If the complaint stays unresolved, check the SKGZ complaint conditions (External site, opens in a new tab).

For the claim check, compare the provider, care date or dbc start date, covered amount, and remaining compulsory and voluntary balances. Check any eigen bijdrage or contract shortfall too.

To submit a complaint to SKGZ, you need your insurer’s written reply. You must be at least 18. Your insurer must have handled the complaint in the last 12 months. SKGZ only considers cases that have not already been submitted to a court.

If the bill is correct but you cannot pay it at once, ask your insurer for a payment plan before the due date. If you need help with several debts, use the debt-help guide below.

Continue with these guides:

• Dutch health insurance: your duty and enrolment deadline
• Toeslagen: choose the right allowance
• Debt help in the Netherlands