What do you pay yourself?
If you have a basisverzekering (basic health insurance), you usually pay for routine adult dental care, ordinary glasses and adult physiotherapy for everyday complaints yourself. Covered care can still leave you with a deductible, a statutory contribution or a bill for a non-contracted provider. Ask your insurer to confirm your costs in writing before planned treatment. Seek urgent care first.
This guide applies to adults and families with Dutch basic health insurance. Rijksoverheid (Dutch government) (External site, opens in a new tab) sets the basic package.
Why can you get a healthcare bill?
Your bill can come from four sources: uncovered care, eigen risico (compulsory deductible), eigen bijdrage (statutory personal contribution), or a policy rule. The table separates them so you can ask your insurer which cost applies. The figures below apply in 2026.
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| Question | Cost type | What you may pay in 2026 |
|---|---|---|
| Is the care outside the statutory basic package? | Uncovered care | The full bill, unless supplementary insurance applies |
| Is it covered care subject to eigen risico? | Compulsory deductible | Up to the unused part of €385, plus any voluntary deductible; none under age 18 |
| Does covered care have an eigen bijdrage? | Statutory contribution | The set amount or percentage first. The remaining covered cost may then count toward the deductible. |
| Did you miss a referral, authorisation or provider rule? | Policy-related shortfall | Part or all of the bill, depending on your policy and the care |
Worked example for 2026: covered full removable dentures cost €1,200. You have the full €385 compulsory deductible left, no voluntary deductible and no other shortfall. You pay €300 as the 25% contribution, then €385 of the remaining €900. Your insurer pays €515; you pay €685 in total.
What conditions apply to covered care?
The table shows covered care and the conditions that can leave you with a bill. The age, medical reason and policy rules still matter.
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| Care | Basic-package rule | Your costs or limits |
|---|---|---|
| Huisarts (GP, family doctor) and huisartsenpost (out-of-hours GP service) | The consultation is covered without a referral | No compulsory deductible for the consultation. Ordered blood tests, medicines and care from other providers can count toward it. |
| Hospital and medisch specialist (medical specialist) | Qualifying treatment is covered. A referral is normally required, except for urgent specialist care. | Deductible applies. Provider contracts and prior-permission rules can affect reimbursement. |
| Prescription medicines | Pharmacy medicines usually need a GVS (medicine reimbursement system) listing. Medical conditions and preferred-brand rules can apply. | Deductible applies. Some medicines also have a statutory contribution, capped at €250 per calendar year in 2026. |
| Geneeskundige ggz (medical mental healthcare) | GP care includes support from a POH-ggz (GP practice mental-health worker). Medical ggz normally needs a referral and a qualifying disorder. | No deductible for GP or POH-ggz support. Medical ggz treatment is subject to the deductible. A GP-referred verkennend gesprek (exploratory mental-health discussion) is exempt. Policy rules can limit reimbursement. |
| Pregnancy and birth care | Verloskundige (midwife) care and medically indicated birth care are covered. | No deductible for this care or kraamzorg (maternity care). Separate blood tests, medicines and transport can use the deductible. Some birth choices have a contribution. |
| Medical devices | Coverage depends on the device category, medical reason and policy conditions. | Usually deductible from age 18. A contribution, contracted supplier, prescription, use period or prior permission may apply. |
A GP visit is exempt from the deductible. A laboratory, pharmacy or hospital used after that visit makes a separate claim.
For non-urgent specialist care, check which professionals your policy accepts as referrers and whether the provider is contracted. Urgent specialist care does not require a referral.
Which dental care and physiotherapy are covered?
Your age and diagnosis decide which dental care or physiotherapy the basic package covers. The table shows the 2026 rules.
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| Care | What the basic package covers | What it usually leaves out |
|---|---|---|
| Dental care under 18 | Most preventive care and treatment, without deductible or statutory contribution | Braces, crowns, bridges and implants usually need supplementary cover. Narrow basic-package exceptions apply; see below. |
| Dental care from 18 | Certain special dental care, full removable dentures and limited oral-surgery care | Routine check-ups, cleaning, fillings, crowns, root-canal care and routine tandarts (dentist) X-rays |
| Physiotherapy from 18 | Specific medical conditions; chronic-list care generally from treatment 21 | Ordinary complaints and the first 20 sessions per chronic-list condition |
| Physiotherapy under 18 | 9 treatments within 12 months from the first treatment; up to 9 extra if results are insufficient. Chronic-list care starts at treatment 1, subject to any time limit. | Care beyond the applicable limit when no other entitlement applies |
For children, braces qualify only under special dental-care rules. Crowns, bridges and implants can qualify for front teeth that never developed or were completely lost in an accident. Ask the insurer to check the exact treatment.
For adults, covered dental X-rays must be taken by, or requested by, a kaakchirurg (oral surgeon) for covered surgical dental care. Treatment by a kaakchirurg that a regular tandarts could perform is excluded from the basic package.
In 2026, full removable dentures have a 25% contribution. Implant-retained full dentures have a 10% contribution for the lower jaw or 8% for the upper jaw. Covered adult dental care also uses the deductible.
When does adult physiotherapy cover start?
Some adult physiotherapy and exercise-therapy treatments are covered from treatment 1. Chronic-list care generally starts with treatment 21. For the 2026 rules, see Zorginstituut Nederland (National Health Care Institute) (External site, opens in a new tab).
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| Condition | Basic-package cover starts | Treatment limit and conditions |
|---|---|---|
| Official chronic-list condition | Treatment 21 | Adults pay the first 20 treatments per condition unless supplementary cover pays them. Some conditions have a time limit. |
| Hip or knee artrose (osteoarthritis) | Treatment 1 | Supervised exercise therapy: up to 12 treatments within 12 months from the first treatment. |
| Claudicatio intermittens (leg pain caused by narrowed arteries) | Treatment 1 | Supervised exercise therapy: up to 37 treatments within 12 months from the first treatment. |
| Urine-incontinentie (loss of bladder control) | Treatment 1 | Pelvic physiotherapy: up to 9 treatments within 12 months from the first treatment. |
| COPD (chronic obstructive pulmonary disease), phase 2 or higher | Treatment 1 | Supervised exercise therapy: no statutory session maximum. Only medically needed care qualifies. |
| Severe limits on daily activities from reumatoïde artritis (rheumatoid arthritis) or axiale spondyloartritis (axial spondyloarthritis) | Treatment 1 | Personalised supervised exercise therapy: no statutory session maximum when the strict medical criteria are met. |
The diagnosis, severity, provider and any referral must meet the rule for that condition. Supplementary insurance may cover ordinary sessions or the first 20 chronic-list treatments. Check its annual limit and provider conditions.
Which medicines and mental healthcare are covered?
Medicine cover depends on the product and your medical reason for using it. Mental-health cover depends on the care route. Check these coverage rules before planned treatment.
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| Area | Coverage test | Action before care |
|---|---|---|
| Medicine | Check the GVS listing, medical conditions and preferred brand. Pharmacy service costs form part of the claim. | Ask your arts (doctor), apotheker (pharmacist) or insurer for a covered equivalent. A statement from your arts about medical necessity can allow a different brand. |
| Mental healthcare | GP and POH-ggz support differs from medical ggz treatment. Adult medical ggz needs the right referral, a qualifying disorder and an effective treatment. | Check the referral, diagnosis, provider contract and any prior permission before treatment starts at a private or independent clinic. |
The official medicine coverage rules (External site, opens in a new tab) also allow narrow exceptions for certain unregistered medicines and pharmacy preparations. Medicines given during hospital treatment can follow the hospital-care route.
A GP-referred verkennend gesprek has no deductible. Medical ggz treatment under basic insurance is for adults from 18. Children’s mental-health treatment normally follows the Jeugdwet (Youth Act). Municipal social support follows a separate system.
What do you pay for birth care, devices and birth control?
Find your planned care or product in the table and check the costs you pay yourself. Birth care comes first, followed by glasses, lenses and other devices. The figures below apply in 2026.
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| Care or product | 2026 basic-package position | Own cost |
|---|---|---|
| Verloskundige care, home birth or medically indicated hospital birth | Covered | No deductible or statutory contribution for the birth care itself |
| Hospital or birth-centre birth without medical indication | Covered up to the statutory reimbursement limit | At least €22.50 per day for the mother and €22.50 per baby in 2026. Charges above the reimbursement limit can add more. |
| Kraamzorg | Covered | In 2026, you pay €5.70 per hour at home or in a chosen maternity or birth centre without medical need. At the centre, you also pay accommodation and possibly other costs, such as supplies. Hospital kraamzorg has no contribution. |
| Ordinary glasses | Ordinary lenses and frames are outside the basic package. Some children and specialised aids have medical exceptions. | You pay the full cost of ordinary glasses. Even for children with qualifying medical conditions, frames remain self-paid. |
| Medically indicated contact lenses | Covered when the medical conditions are met | In 2026: €66 per lens lasting over a year. For shorter-use lenses: €66 per lens per calendar year, up to €132. The deductible can apply afterwards. |
| Other medical devices | Only covered categories and medical conditions. Simple walking aids such as rollators are excluded. | The deductible and contribution depend on the device. In 2026, adults pay a 25% contribution for hearing aids. |
For a hospital or birth-centre birth, the contribution ends if a medical indication develops during labour or if laughing gas is used for pain relief. Birth assistance by a maternity-care worker also has no contribution. Ask the provider to separate birth costs from care after the birth.
Anticonceptiemiddelen (birth-control products) are covered before age 21, subject to product rules. From age 18, a covered product is subject to the deductible. Hormonal products can also have a contribution. GP insertion or removal of a coil or implant has no deductible.
From age 21, you generally pay for birth control yourself. Narrow medical exceptions include endometriose (endometriosis) and bloedarmoede (anaemia) caused by heavy menstrual bleeding. Ask your insurer about the exact product and medical reason.
What does your insurance pay abroad?
During a temporary trip, Dutch basic insurance can cover suddenly needed care up to the Dutch reimbursement rate. The deductible can still apply. Call the assistance number on your health or travel policy as soon as you can. Higher foreign charges and repatriëring (transport home) may need travel or supplementary insurance.
An EHIC (European Health Insurance Card) (External site, opens in a new tab) gives access to necessary public care under local conditions during a temporary stay. It applies in the EU (European Union), Iceland, Liechtenstein, Norway, Switzerland and the United Kingdom. It excludes planned treatment, private clinics, cruise-ship care and transport home.
If you have a CAK EHIC, it covers basic-package care in the Netherlands and necessary care in the other covered European countries. In your country of residence, use the local insurer’s card and local rules. CAK-insured residents outside these countries receive no EHIC. They have no care entitlement in the Netherlands or Europe under this scheme, except for Dutch basic care for residents of North Macedonia.
CAK-insured residents of North Macedonia can claim reimbursement for Dutch basic care. Pay the bill first, then submit it to Zilveren Kruis, Groep Buitenlands Recht (health insurer’s Foreign Law Group) (External site, opens in a new tab).
How do provider and policy rules affect your bill?
A naturapolis (in-kind policy) can pay less at a non-contracted provider. A restrictive policy may have fewer contracted providers or lower reimbursement. A combinatiepolis (combination policy) applies different rules by care type.
Your policy can require a named supplier, referral, prescription or prior permission. Check the insurer’s provider finder and current policy terms for your exact treatment. A provider saying it works with insurers is not enough. Get permission before treatment when your policy requires it.
The NZa (Nederlandse Zorgautoriteit, Dutch Healthcare Authority) (External site, opens in a new tab) supervises insurers’ duty to help you obtain timely covered care. Ask for help if you face a long wait.
What can supplementary insurance pay?
Supplementary insurance can pay for care outside the basic package or some costs you would otherwise pay yourself. Compare its limits with the care you expect.
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| Expected need | What to compare | Cost to check |
|---|---|---|
| Dental care | Annual premium, reimbursement percentage, annual maximum and excluded treatment codes | A high headline maximum can still reimburse only part of each bill |
| Physiotherapy | Number of sessions, contracted-provider rules and whether the first 20 chronic-list sessions count | Cover stops when the annual session budget is used |
| Glasses, lenses or statutory contributions | Amount, frequency, approved supplier and whether the contribution is included | An allowance every 2 or 3 years may be worth less than one year of premiums |
| Already planned treatment | Acceptance, medical questions, start date, waiting period and existing-treatment exclusion | Buying a policy does not prove that this treatment is payable |
Supplementary insurance is voluntary. Insurers can refuse applicants, although this rarely happens. They can also assess your health or set a waiting period. Obtain acceptance before cancelling your existing supplementary cover.
For example, Zilveren Kruis (health insurer) (External site, opens in a new tab) can assess health when adding dental cover in 2026. Its 3-star and 4-star supplementary packages have a 1-year wait for children’s braces if you had no orthodontic cover with it throughout 2025. Costs incurred during that wait stay excluded afterwards. These are this insurer’s rules.
How do you compare supplementary insurance?
Compare the amount you can use with the annual premium. Work through these steps in order:
- List the care you expect next calendar year, including treatment codes or the number of sessions.
- Estimate what the basic package pays after the deductible, statutory contribution and any shortfall for non-contracted care.
- Calculate each supplementary package’s annual premium and expected reimbursement, using its percentage, frequency and annual limits.
- Check acceptance, waiting periods, provider contracts and the start date before choosing a package.
- Decide whether the expected reimbursement and protection against larger bills justify the premium. Otherwise, set money aside to pay yourself.
How do you solve coverage and care problems?
The complaint route depends on whether the problem concerns your insurer, provider or access to care. SKGZ (health-insurance complaints and disputes foundation) (External site, opens in a new tab) handles insurance complaints. The table shows the complaint routes and time limits.
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| Problem | First route | If unresolved |
|---|---|---|
| Insurer refuses or underpays reimbursement | Ask for the decision, policy clause and reconsideration in writing. | If you disagree with the reply or receive none within 4 weeks, contact SKGZ. Mediation is free; its disputes committee charges €37 in 2026. |
| Care provider’s quality, conduct or bill | Raise the problem with the provider. Its independent complaints officer can help. | Use the provider’s recognised disputes body if unresolved. Landelijk Meldpunt Zorg (National Healthcare Reporting Centre) (External site, opens in a new tab) can advise on quality complaints. |
| Incorrect billing, misleading information or continued long waits | Contact the provider or insurer first and keep the documents. | Report the issue to the NZa. It uses reports for supervision; it does not resolve individual disputes. |
SKGZ must receive your complaint within 1 year after your insurer’s decision on it. If the insurer gives no answer to the points in your complaint, SKGZ must receive it within 1 year after you submitted it to the insurer. If the insurer failed to tell you properly about SKGZ, you get 90 extra days. SKGZ cannot handle a complaint already before a court.
You can take the complaint directly to court or do so after unsuccessful mediation. If you agree in advance to a binding decision, both you and the insurer must follow it. You cannot appeal the binding decision. If it contains a serious error, you can ask a court for a limited review. You must ask the court to cancel the binding decision within 1 year after SKGZ sent it. The court reviews the decision rather than your original complaint.
For a provider complaint, the complaints officer is independent and free. You can use this officer if talking to the provider does not resolve the problem, or if you prefer not to talk directly. The provider’s recognised disputes body gives a decision that binds both parties.
Landelijk Meldpunt Zorg gives information and advice. It does not resolve the complaint for you.
What should you do before planned or urgent care?
For planned care, request the written coverage answer before treatment starts. A referral alone does not guarantee full reimbursement. Keep your policy open when you contact the insurer.
Call 112 for a life-threatening situation. For other urgent problems, contact your huisarts or huisartsenpost first. Seek urgent care before checking costs. Use the emergency-care guide to check which service to call.
Use these guides for your next decision:
Official Sources
- Rijksoverheid: Basic package in 2026 (External site, opens in a new tab) - National entitlement, 2026 deductible and major conditions.
- Rijksoverheid: Compulsory deductible (External site, opens in a new tab) - The €385 amount and care exempt from the deductible.
- Rijksoverheid: Statutory contributions (External site, opens in a new tab) - 2026 contributions and the order before the deductible.
- Rijksoverheid: GP costs (External site, opens in a new tab) - GP exemption and separate laboratory and medicine claims.
- Zorginstituut Nederland: Medical specialist care (External site, opens in a new tab) - Referral exception for urgency, deductible and provider conditions.
- Rijksoverheid: Policy types and contracted care (External site, opens in a new tab) - Network-policy differences and lower non-contracted reimbursement.
- Zorginstituut Nederland: Dental and oral care (External site, opens in a new tab) - Age limits, adult exceptions, dentures and oral surgery.
- Zorginstituut Nederland: Physiotherapy and exercise therapy (External site, opens in a new tab) - Diagnosis-specific entitlements and first-treatment exceptions.
- Zorginstituut Nederland: Chronic-condition list (External site, opens in a new tab) - First 20 adult treatments and condition-specific time limits.
- Zorginstituut Nederland: Prescription medicines (External site, opens in a new tab) - GVS, indication limits, preferred medicines and €250 cap.
- Zorginstituut Nederland: Medical mental healthcare (External site, opens in a new tab) - GP/POH-GGZ distinction, referral and deductible.
- Zorginstituut Nederland: Maternity and birth care (External site, opens in a new tab) - Medical indication, non-medical birth contribution and deductible exceptions.
- Zorginstituut Nederland: Visual aids (External site, opens in a new tab) - Glasses exclusions, medical lenses and 2026 contributions.
- Zorginstituut Nederland: Medical devices (External site, opens in a new tab) - Indications, supplier rules, permission and use periods.
- Zorginstituut Nederland: Contraception (External site, opens in a new tab) - Age rule, product contributions and medical exceptions.
- Rijksoverheid: Care while abroad (External site, opens in a new tab) - Dutch-tariff limit, EHIC limits and repatriation exclusion.
- CAK: CAK EHIC reimbursement (External site, opens in a new tab) - CAK EHIC coverage, residence-country rules and North Macedonia’s Dutch-care reimbursement exception.
- Rijksoverheid: Supplementary insurance (External site, opens in a new tab) - Voluntary cover, acceptance, premium and possible waiting periods.
- Zilveren Kruis: 2026 policy conditions (External site, opens in a new tab) - 2026 dental medical assessment, orthodontic waiting conditions and chronic-list treatment counting.
- Zorginstituut Nederland: Reimbursement complaints (External site, opens in a new tab) - Insurer reconsideration, SKGZ mediation and disputes committee.
- Rijksoverheid: Provider complaints (External site, opens in a new tab) - Provider, complaints officer and recognised disputes body.
- Nederlandse Zorgautoriteit: NZa reporting point (External site, opens in a new tab) - Signals about billing, information and access after first contacting the responsible party.
- Rijksoverheid: Contribution before deductible (External site, opens in a new tab) - Payment order and the worked denture calculation.
- Zorginstituut Nederland: Kraamzorg (External site, opens in a new tab) - 2026 hourly contribution at home and chosen centres, mandatory centre accommodation costs, and hospital and birth-assistance exemptions.
- NederlandWereldwijd (Dutch government information service): EHIC coverage (External site, opens in a new tab) - Covered countries, necessary public care and exclusions including cruise ships.
- NZa: Insurers’ duty of care (External site, opens in a new tab) - Timely covered care and the regulator’s role.
- NZa: Long waits and care mediation (External site, opens in a new tab) - Care mediation and reimbursement of a non-contracted alternative.
- Rijksoverheid: Urgent medical help (External site, opens in a new tab) - 112 for life-threatening situations and GP services for other urgent problems.
- SKGZ: Complaint procedure (External site, opens in a new tab) - 4-week response period, filing deadline and exception, €37 fee and binding decisions.
- Landelijk Meldpunt Zorg: Advice about care complaints (External site, opens in a new tab) - Advice and reporting for care-quality complaints.
- Zilveren Kruis: claim care received in the Netherlands (External site, opens in a new tab) - Official destination linked by CAK for submitting Dutch-care bills, including North Macedonia’s exception.
- SKGZ: Complaint and disputes regulations (External site, opens in a new tab) - Articles 2, 15 and 17: complaint deadlines, advance consent and the court cancellation deadline.