OHRA Zorgverzekering 2014

Arranging it yourself is so easy!

3Arranging it yourself is so easy! 4

The OHRA Zorgverzekering 5

Which supplementary insurance can

you choose? 8

Dental insurance 9

What is covered? 10

OHRA Coverage Guide 11

Mijn OHRA Zorgverzekering 14

Extra Advantages 16

What will it cost you? 17

Arranging your healthcare insurance

immediately? 18

Contents

When it comes to healthcare insurance, you know what

you want and what you dont want. Thats why you want to

choose your own insurance coverage. Only then will you have

an insurance policy that really benefits you. This brochure

contains everything you need to know about our healthcare

insurance. The OHRA Zorgverzekering offers excellent service,

easy conditions and a competitive premium. Simply arrange

your insurance by phone or online.

Arranging it yourself is so easy! You can arrange much more online with OHRA, such as Mijn

OHRA Zorgverzekering; your own online policy folder. You

will always have a clear overview of your insurance, your

healthcare costs, your coverage and more. Together with the

Coverage Guide, you will see exactly what is covered

and whether an excess applies.

New: declarations via your mobile phone In most cases, your healthcare provider will send your invoice

directly to OHRA. Have you received an invoice? You can

declare it the easy way via your mobile with the OHRA app.

Our healthcare insurance

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5 With OHRA, your healthcare insurance is arranged well. With

the OHRA Zorgverzekering, you have basic insurance with

which you are insured, for example, for your general

practitioner, the hospital, medication and maternity care.

Additionally, you can choose from

various types of supplementary insurance, including sup-

plementary dental insurance. The OHRA Zorgverzekering is

a non-contracted care policy. This means that you yourself

choose which doctor, which hospital or which

physical therapist you want to treat you. In most cases, your

healthcare provider will send your invoice directly to OHRA.

Basic insurance The basic insurance is the same for all healthcare insurers.

The government has decided what basic insurance must

cover. Below are the costs that we cover if you choose OHRA

Zorgverzekering:

General practitioner.

Hospital.

Physiotherapy for complaints that are included on a list drawn

up by the government.

Visit www.ohra.nl/vergoedingenwijzer

Medication. The rules on the reimbursement of medication

can be found in our policy conditions.

Maternity care. You must pay a personal contribution.

Medical aids, for example hearing aids. You must pay a

personal contribution for some medical aids.

What costs are not paid under basic insurance?

The OHRA Zorgverzekering

6 Physiotherapy for complaints that are not included on the list

drawn up by the government.

Personal contribution for maternity care.

Spectacles, contact lenses and eye laser treatment for persons

aged 18 and above.

Alternative therapies, such as acupuncture.

The costs of dental treatment for persons aged 18 and above.

Orthodontics.

Better cover for costs made outside the Netherlands.

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

Courses and exercise programmes (e.g. first aid, weight

management in the event of obesity, etc)

Excess Everyone from the age of 18 has a mandatory excess of 360 per

year. This amount is determined by the government. This means

that you must pay the first 360 yourself. The excess only applies

to those costs covered under the basic health insurance scheme.

The excess does not apply to the following care:

7 Care provided by a general practitioner.

Obstetric care.

Maternity care.

Healthcare costs and dental treatment costs for children up to

the age of 18.

Integrated care (a concept where various care providers work

together to agree on the best care for you).

A check-up for kidney or liver donors.

Medical aids on loan.

The excess does not apply to supplementary insurance

policies. You can also choose to increase your excess. Your

premium will then be reduced. You can increase your excess

by 100, 200, 300, 400 or 500. Visit

www.ohra.nl/zorg and calculate how much your premium

will be with a higher excess.

Paying your excess in instalments Are you expecting healthcare costs and would you rather not

pay this amount all at once? OHRA offers you the opportunity

to pay the statutory excess of 360 in ten monthly instalments

of 36 in advance. If you have not used all your excess during

a calendar year, we will refund the amount overpaid.

Visit www.ohra.nl/zorg for further information.

8Which supplementary insurance canyou choose?

Basic insurance covers a large percentage of care, but not everything.

That is why OHRA has various types of supplementary insurance.

There is always a supplementary insurance to suit your situation.

OHRA has four supplementary insurance packages:

OHRA Sterk (OHRA Strong)

OHRA Aanvullend (OHRA Supplementary)

OHRA Extra aanvullend (OHRA Extra Supplementary)

OHRA Uitgebreid (OHRA Comprehensive)

All these supplementary insurance packages include cover for

physiotherapy, spectacles and contact lenses, alternative medicines,

care abroad, maternity care and orthodontics. You will receive

supplementary insurance coverage on top of your basic insurance.

For a complete summary of all supplementary insurance coverage,

see our package comparer on www.ohra.nl/zorg.

OHRA Growth Service As your lifestyle changes, you may want to adapt your insurance

to your needs. OHRA takes this into account. Our growth service

enables you to adapt your supplementary insurance once a year, for

example if you and your partner decide to live together or if you are

having a baby. There are no additional conditions for this service.

Choose the right package You will always make the right choice with OHRA when it comes to

healthcare insurance.

Visit www.ohra.nl/zorg for the OHRA Selection Guide. Here you can

specify which coverage is important for you. Based on your input,

you will immediately see which supplementary package the majority

of people chose. You will immediately know where you stand.

9 A large percentage of dental costs is covered for children

and adolescents up to 18 years of age. This is included in the

basic insurance package. Would you like dental coverage for

people above the age of 18? Choose OHRA TandenGaaf or

Tand Sterk supplementary dental insurance.

OHRA TandenGaaf dental insurance OHRA TandenGaaf insurance covers all kinds of treatments

by the dentist, dental hygienist and prosthodontist. This

includes crowns, bridges, implants and technical costs. Teeth

whitening treatments and subscription fees for the dentist are

not covered by this insurance.

OHRA TandenGaaf enables you to set the maximum

coverage that we pay for your dental costs each year yourself.

You can choose a coverage of 250 or 500. A higher

coverage means a higher premium. We cover your dental

expenses until your maximum coverage has been reached.

OHRA Tand Sterk OHRA Tand Sterk covers 75% to a maximum amount of 250.

The coverage applies to the following treatments by a dentist

and/or dental hygienist:

Consultations

Fillings

Teeth cleaning

X-rays

Root canal treatment

Anaesthetic

No coverage for, among other things, teeth whitening,

orthodontics, crowns and bridges.

Dental insurance

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What treatments do we pay for you? It is good to know which dental treatments are covered.

Would you like to know which treatments we pay for you

under OHRA TandenGaaf and OHRA Tand Sterk? Use the

OHRA Coverage Guide on the internet. Enter a search term,

such as teeth extraction or plaque removal.

You will quickly receive answers to questions such as:

What exactly does OHRA cover and what not?

Where can I go?

Do I need prior permission from OHRA?

You will then know where you stand and will be able to

prevent unexpected surprises. The OHRA Coverage Guide

can be found on www.ohra.nl/vergoedingenwijzer.

What treatments do we not pay for you? OHRA TandenGaaf and OHRA Tand Sterk do not cover

treatments by an orthodontist. Would you like us to pay

treatments by an orthodontist for you? If so, you will need

supplementary insurance. For more information, please visit

www.ohra.nl/zorg.

No excess OHRA TandenGaaf and OHRA Tand Sterk do not have an

excess. This means that we always fully reimburse the dental

costs for which you are insured up to the annual amount that

you choose.

What is covered?

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Would you like to know what OHRA Zorgverzekering covers?

The OHRA Coverage Guide gives you quick and clear

answers to important questions, such as:

What exactly is covered and what not?

Do I have to pay a personal contribution?

Do the costs count for the statutory excess?

Which care provider can I go to?

Do I need permission from OHRA prior to treatment?

How does it work? Go to www.ohra.nl/vergoedingenwijzer. Then select the

Coverage Guide. Enter a search term, such as acupuncture,

or search in alphabetical order. You will then see the

amount that we cover. You will also see whether you need

to ask OHRA for prior permission. This is how you can avoid

unexpected surprises.

What should a treatment cost? How do we determine what a medical examination or

treatment should cost? Or what the cost of transport should

be? There are three possibilities:

The government has established the cost. This applies to

most situations.

We have agreements with care providers.

We have determined ourselves what a reasonable amount

is for a treatment, a medical examination or transport. These

are what are known as market rates.

OHRA Coverage Guide

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In all cases the person providing treatment and/or the care

institution must comply with the conditions of OHRA.

Sometimes exceptional rules apply where it concerns

reimbursements. Below are the main rules:

Do we pay for your physiotherapy? Are you receiving physiotherapy or remedial therapy? If so,

you must pay the first 20 treatments yourself. We will pay the

21st treatment and any subsequent treatments. However,

your complaint must be included on the list drawn up by the

government. In that case, the costs will be covered under the

basic insurance package. You can find the list on

www.ohra.nl/zorg. Is your complaint not included on the list

drawn up by the government? In that case we will only pay

the costs if you have taken out supplementary insurance.

For children up to the age of 18 we will pay the first nine

treatments. This is included in the basic insurance package.

If the complaints have not subsided after treatment, we will

pay a maximum of nine further treatments. If the complaints

are included on the list drawn up by the government, OHRA

will reimburse all the costs. Would you like more coverage

for physiotherapy and remedial therapy? You can take out

supplementary insurance that is tailored to your needs.

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Do we pay for your medication? This is often the case. For some medication you will have

to pay a personal contribution, or you will have to ask

prior permission from OHRA. Sometimes we only pay for

medication from certain manufacturers. For example, this

applies to medication to reduce cholesterol. OHRA has

established some rules in this regard.

The government has liberalised the price of all medication.

This means that pharmacists may determine what rates to

ask for medicine or for personal advice themselves. If you go

to a pharmacist with whom we have an agreement, OHRA

will reimburse the amount that the pharmacist charges. If you

go to another pharmacist, we will reimburse the market rate.

Will we reimburse you for care abroad? Do you need care abroad? If so, we will pay the maximum

amount of care that it would have cost in the Netherlands.

Do you know in advance that you will be admitted to a

hospital abroad? For example because you are planning to

have treatment abroad? In that case you will need our prior

permission or you will not receive any reimbursement.

Do you wish to be insured for emergency assistance abroad?

Then it would be wise to take out supplementary insurance.

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Mijn OHRA Zorgverzekering

OHRA Zorgverzekering administration is easily arranged via

Mijn OHRA Zorgverzekering. This is an online policy where

your details are conveniently organised. You can submit

changes, declare invoices from your care provider electro-

nically, track the status of your claims and see what is reim-

bursed at a single glance, wherever and whenever you wish.

You can even order your medication from the pharmacist

online.

Electronic declarations OHRA enables you to submit your declarations online. Simply

fill in a declaration form on Mijn OHRA Zorgverzekering, make

a copy or scan your invoice and send everything to OHRA

online. No more hassle with receipts and postage stamps

and no more paperwork.

Status of your declaration Mijn OHRA Zorgverzekering gives you immediate access

to the status of your declaration. Has OHRA received your

declaration? Will the declaration be reimbursed? Mijn OHRA

Zorgverzekering gives you an answer immediately.

Wherever and whenever you wish!

Status of maximum reimbursements Do you wish to know how many reimbursements you still

have? You can check the status of your maximum reimbur-

sements in Mijn OHRA Zorgverzekering. You will find a sum-

mary of your reimbursements for physiotherapy, spectacles

and contact lenses, alternative care, orthodontic and dental

treatment.

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Submitting changes You can quickly and easily change your personal details and

those of your family. Do you wish to co-insure a member of

your family? Will you be moving house shortly? Or do you

wish to submit another bank account number? Changes can

be submitted via Mijn OHRA Zorgverzekering, even outside

office hours.

Simply ordering medication online As an extra service, OHRA Zorgverzekering enables you to

order your medication online. You no longer need to leave the

house to go to the pharmacist. Neither do you need to stay at

home to await delivery of your medicines, because most of

them fit through the letter box and are packaged as

childproof and pet-friendly. The medicines are delivered to

any address in the Netherlands. Do you need a prescription

for your medicines? Your general practitioner or specialist can

send this by e-mail. If that is not possible, you can send the

prescription by post. Your order will then be delivered to your

home free of charge.

Would you already like to experience the online convenience

of Mijn OHRA Zorgverzekering yourself?

Visit www.ohra.nl/zorg for a demonstration.

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OHRA Zorgverzekering offers you a discount on products

and services that help you remain healthy and fit. All care

advantages are offered directly by our partners. Therefore,

they have no influence on the amount of your premium. The full

customer benefits programme can be found on

www.ohra.nl/korting.

Mobility

Discount at almost 500 fitness centres in the Netherlands.

Discount on Tulp bicycles.

Free running schedule.

Discount on sports clothes at Aktiesport.

Prevention

25% discount on Euro - Codicil lifesaving card.

20% discount on UV-resistant childrens clothing.

Treatments and medical aids

Discount on spectacles and contact lenses at Het Huis Eyewish

Opticians and Specsavers.

Discount on travel vaccinations.

Relaxation

Discount at saunas.

Discount on a floating session.

Discount on various magazines.

Extra Advantages

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The amount of your premium depends on the type of insurance

that you choose. Calculate your premium on www.ohra.nl/zorg.

OHRA Zorgverzekering does not charge administration or policy

costs. Additionally, you can receive discounts on your premium in

various ways. How? Read all about it below.

Group discount We have agreements with many employers, associations, senior

citizens associations, housing corporations, retailers and other

organisations. As a result, you will receive a discount on your

OHRA Zorgverzekering. For more information, please visit

www.ohracollectief.nl.

Discount when you pay per quarter or per year As a rule, the premium for your healthcare insurance is paid

each month. Would you rather pay per quarter? If so, you will

receive a discount of 0.75%. Do you wish to pay per year? You

will receive a discount of 3%.

Take advantage of the OHRA Package Discount On our already low premiums, you can in addition get a

package discount. The principle is simple: the more insurance

you take out, the higher your discount. If you take out three

insurance policies, you will receive a discount of 3%, four

insurance policies 4% discount, and so on. The discount can run

up to no less than 10%. OHRA does not give package discounts

on life insurance policies, temporary travel and cancellation

insurances or the OHRA Zorgverzekering basic package. Does

your employer or association have a group contract with OHRA?

In that case other discount percentages may apply.

What will it cost you?

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Do you wish to take out healthcare insurance immediately?

Visit www.ohra.nl/zorg. You can also immediately calculate

your premium and take out your OHRA Zorgverzekering.

Arranging your healthcare insurance immediately?

This brochure has been compiled with the utmost care. However,

the text in the brochure does not give you any rights. Neither can

you derive any rights from the OHRA Coverage Guide: the policy

conditions and regulations shall prevail. The policy conditions state

precisely what your and our rights and obligations are. At the time of

printing of this brochure, the changes were not final. These changes

are the changes proposed by the government. Until such time as

the government makes a final decision on these changes, the policy

conditions may still be subject to change. For the most recent version

of the reimbursements, please read the policy conditions at

www.ohra.nl/zorg.

OHRA Schadeverzekeringen is a trade name of Delta Lloyd

Schadeverzekering N.V. in Amsterdam - CoC 33052073, PO Box

40000 - 6803 GA Arnhem - the Netherlands - Rijksweg West 2 -

www.ohra.nl - Tel +31 (0)26 400 40 40

OHRA Schadeverzekeringen is the intermediary for OHRA

Zorgverzekeringen N.V. and OHRA Ziektekostenverzekeringen N.V.,

both part of CZ.

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For more information please visit www.ohra.nl/zorg

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