Key Benefits:
Law of 16 June 2005, providing for social insurance for medical care for the benefit of the entire population (ZorgInsurance Act)
We Beatrix, at the grace of God, Queen of the Netherlands, Princess of Orange-Nassau, etc. etc. etc.
All of them, who will see or hear these, saluut! do know:
In this regard, we considered that it would be desirable for the entire population to be insured, for each of the same social conditions, against the consequences of the need for medical care;
In this way, we, the Council of State, and with the mean consultations of the States-General, have been well-regarded and understood to be right and to be understood by the following:
For the purposes of this Act and the provisions based thereon, the following definitions shall apply:
a. Insurer: an insurance undertaking as referred to in the Solvency II Directive;
b. health insurer: an insurer, to the extent that such health insurance provides or carries out insurance;
c. policy-holder: a person who has a health insurance contract with a health insurance provider;
d. health insurance: a non-life insurance contract concluded between a health insurer and an insurance policyholder, meeting the requirements of or under this Act, and of which the insured person benefits from a non-life insurance contract; they do not exceed, in accordance with the provisions of this Act;
e. Insured person: the person who is the person who is responsible for the Article 2 be required to ensure or ensure that they are insured under a health insurance policy;
f. insured person: those whose risk of need of care or other services, as intended in Article 10 , covered by a health insurance policy;
g. obligated own risk: an amount of cost of care or other services referred to in or under Article 11 , which remains for the account of the insured person;
h. voluntarily own risk: an amount agreed by the policyholder with the health care insurer as part of the health insurance scheme to cover expenses of care or other services referred to in or under Article 11 , which the insured person will take for his account;
Health insurance policy: the instrument establishing the health insurance concluded between an policyholder and a health insurance provider;
j. model agreement: model of a health insurance scheme, giving an overview of the rights and obligations that the policyholder, the insured and the health insurance provider will have to each other if an agreement is in accordance with the relevant model is closed;
k. [ Red: expired;]
l. Withholding-like: the withholding agent in the sense of the Act on payroll tax 1964 or the employer in the sense of the Social insurance financing law ;
m. setting:
1 °. an institution within the meaning of the Health care institutions Act ;
2. an organisational link established outside the territory of the European part of the Netherlands and provides health care, as provided for in the legislation in force, as provided for by and under the law of the Article 11 ;
n. Our Minister: Our Minister of Health, Welfare and Sport;
o. care authority: the Dutch Zorgauthority, intended in the Health Organisation Act ;
p. Zorginstitute: the Zorginstitute Netherlands, named in Article 58, first paragraph ;
q. ZorgInsurance Fund: the fund, named in Article 39 ;
Directive Solvency II: Directive 2009 /138/EC of the European Parliament and of the Council of 25 November 2009 on the taking up and pursuit of the business of insurance and reinsurance (Solvency II) (PbEU 2009, L 335);
s. Wlz-exporter: the legal person, intended to Article 1.1.1 of the Act for long-term ;
t. wage period: the period of pay, specified in Article 25, 1st and 4th member, of the Law on Earnings Act 1964 ;
Inspector: the official of the State Revenue Service, designated as such under the arrangement of our Minister of Finance;
v. Civil Service Number: the number, intended to be used in: Article 1 (b) of the general provisions Act civil service number ;
w. premium: the premium provided for in Section 3.3.1 ;
(administrative bonus: the premium provided for in the Articles 18d and 18th ;
y. [ Red: expired by digestion;]
z. professional standard: guidelines, modules, standards, care standards or organizational descriptions related to the entire care process or part of a specific health care process and that commit what is necessary to get out of the the client's perspective to provide good care;
aa. measuring instrument: a means by which an indication can be obtained from the quality of care provided.
1 The person responsible for the Long-term care law and the regulation based on it is assured by law, is required to insure under a health insurance policy or to have insurance against it in Article 10 Such risk.
2 By way of derogation from the first paragraph, non-insurance shall be non-insurable:
a. the military official in actual service as intended in Article 1, first paragraph, part a in conjunction with subparagraph (b) of the Military Staff Regulations 1931 , as well as the military to whom special leave has been granted with the maintenance of military income;
b. The natural person who is based on Article 64, first paragraph, of the Social Insurance Financing Act is relieved of the obligations imposed on the basis of the Long-term care law .
3 The person exercising the authority over a minor under the age of 18 years, a trustee, a trustee or a mentor as intended for the purpose of the titles 16 , 19 or 20 of Book 1 of the Civil Code , ensure that the underage insured person, or the insurance provider under curatele, rule or mentorship is insured under a health insurance scheme.
1 A health insurer is obliged to, with or for the benefit of any insured person living in his area of insurance and with or for the benefit of any insured person living abroad, to enter into a care insurance policy.
2 If a health insurance insurer offers several variants of the health insurance in a province, it may be chosen from all variants for each insured person living in that province.
3 The health insurer proposes to provide all variants of the health insurance that it offers in a province to persons considering for the benefit of an insurable insurance company resident in that province care insurance with that insurer to close, as well as, if the health insurer adds or modifies variants, to the policyholders who have entered into a care insurance with him for the benefit of an insured person residing in that province.
4 By way of derogation from the first paragraph, a health insurer shall not be required to conclude a health insurance scheme with or for the benefit of an insurable insurance company:
a. which is already insured under a health insurance scheme; or
b. whose previous health insurance policy he or the policyholder has terminated or disbanded within a period of five years, situated immediately prior to the conclusion of the insurance, for:
1 °. deliberate deception by the policy holder or the insured person, or
2 °. the non-payment of the premium provided for in Article 17, fifth paragraph .
5 By way of derogation from the second paragraph, for the benefit of an insured person living abroad, it may be chosen among all the variations in the health insurance offered by a health insurer in the Netherlands.
6 By way of derogation from the third paragraph, the person who wishes to obtain a health insurance scheme for the benefit of an insured person living abroad shall be provided with all the model agreements used by the health insurer in the Netherlands; and where a care insurance is entered into, the policyholder shall be made available to the policyholder any variants or variants which have been added or changed that provided by that health insurer.
1 The person wishing to enter a health insurance shall indicate, upon request, the civil service number of the person to be insured, if this person has it.
2 The health insurer shall determine the identity of the person to be insured, to the extent that it is reasonably necessary for the performance of the health insurance and of this law.
3 The determination referred to in paragraph 2 shall be made on the basis of the documents referred to in the second paragraph. Article 1 of the Identification Light Act , which shall give the policy-holder or the person to be insured for inspection on request.
4 The health insurer shall record in its records the nature and number of the documents referred to in paragraph 3.
5 The health insurer requires of the foreigner, intended in the Aliens Act 2000 , for whom it is requested to close a care insurance policy, a copy of the document or the written statement, intended Article 9, first paragraph, of that Act , which is to be regarded as a product of a kind used in the Article 4:3, 2nd paragraph, of General Law governing the administrative law .
1 The person wishing to enter a health insurance shall state the address of the person to be insured if he so requests, and if he is not the person to be insured.
2 The health insurer does not exclude insurance as long as the given address of the person or persons referred to in the first paragraph does not exist in the basic registration or deviates from the address under which this person or persons in that person standing or being registered as resident.
3 By way of derogation from the second paragraph, the person to be insured shall be registered:
a. If the person seeking the care insurance has submitted a statement from the employer or a statement of salary, indicating that the person to be insured, including the effective date of the employment, is in the The Netherlands or on the continental shelf as intended in Article 1.1.1 of the Act for long-term , employment in employment is subject to the payroll tax, provided that the statement or the statement of salaries is not more than one month;
(b) if the person seeking to conclude the care insurance has provided a statement from the Social Insurance Bank certifying that the person to be insured is insured under the conditions of Long-term care law ; or
c. if the person or persons referred to in paragraph 2 of the derogation cannot reasonably be removed from the derogation.
1 The care insurance shall enter on the day on which the care insurer refers to the request, Article 3, first paragraph , and, if: second or fifth member of that Article is applicable, the indication of the variant to which the policy holder chooses, has been received.
2 If, on the basis of the request referred to in paragraph 1, the health insurer cannot establish whether he is required to provide health insurance for the person to be insured, he/she shall be the person seeking the insurance in connection with inviting, by way of derogation from paragraph 1, the information necessary for such a determination, on the day on which the latter has complied with this request.
3 The health insurer shall provide the person who makes the application referred to in paragraph 1 and, if it is a person other than the one for whose insurance the request was made, the latter without delay:
a. proof of the application referred to in paragraph 1, on which the date of receipt is indicated;
a proof of receipt of information referred to in paragraph 2, on which the date of the receipt is indicated.
4 If the person for whom the care insurance is concluded on the day on which the health insurer receives the request, referred to in the first member, is already insured under a health insurance scheme, and the policy holder indicates the the insurance of health insurance shall be based on a subsequent day other than the day referred to in the first or second paragraph, the insurance shall take effect on that later date.
5 The health insurance policy works, if necessary by derogation from Article 925, 1st paragraph, of Book 7 of the Civil Code , back to you.
(a) if it enters four months from the date of its creation, up to and including the day on which that obligation arose;
b. If it enters within one month of a prior health insurance policy with effect from 1 January of a calendar year, or by reason of the change in the conditions applying to Article 940, 4th paragraph, of Book 7 of the Civil Code has ended by denunciation, up to and including the day following that on which the previous care insurance has ended.
1 The health insurance policy shall cease to be effective from the day following the day on which:
a. The insurer is not authorised to offer health insurance due to amendment or withdrawal of its non-life insurance licence;
(b) the insured person shall reside outside the health insurer's work area as a result of changes in the area of work;
c. the insured person dies;
d. The insurance obligation of the insured ends.
2 The health insurance business ends automatically with effect from the first day of the second month following the day on which the insured person, without ending his obligation to insurance, comes to live outside a province in which his insured person is not health insurer offers or implements the variant of care insurance that is closed to him.
3 The health insurer shall notify the policy holder no later than two months before a health insurance insurance contract expires on the basis of paragraph 1 (a) or (b), indicating the reason and the date on which the insurance policy is based. ends.
4 The policyholder shall immediately inform the health insurer of all the facts and circumstances of the insured person who, under the first paragraph, part c or d, or the second member, have led to the end of the care insurance or can lead.
5 If, on the basis of the information referred to in paragraph 4, the health insurer concludes that the care insurance will end or be terminated, he shall, specifying the reason and the date on which the insurance is to end or terminate, shall be informed of such an insurance. shall be terminated without delay to the policyholder.
1 The policy holder shall be able to cancel the health insurance scheme by 31 December of each year, with effect from 1 January of the following calendar year.
2 The policyholder who has insured another person than himself may cancel the care insurance if the insured person is insured under any other health insurance.
3 By way of derogation from Article 940, 4th paragraph, of Book 7 of the Civil Code the policyholder cannot cancel if a change in the insured performance to the detriment of the policyholder or the insured is directly related to a change in the performance of the insured person or to the insured person. Articles 11 to 14a set rules.
4 The denunciation, referred to in paragraph 2, shall begin on the first day of the second calendar month following the day on which the policy-holder has denounced it.
5 By way of derogation from paragraph 4, from the day on which the insured person is insured under the other health insurance scheme, a denunciation referred to in paragraph 2 shall, if that termination is given prior to the date on which the insured person is insured by the person concerned, Health insurer has been received.
1 The termination or dissolution of the care insurance for the non-payment of the premium payable shall not be retroactive, nor shall it be subject to any obligation of unwinding or remuneration of any party have already been engaged in respect of care insurance against each other.
2 A health insurer may cover health care insurance during the period, intended Article 24 , don't cancel or decompose.
3 Article 934 of Book 7 of the Civil Code shall also apply in respect of the first premium that an insurance policy holder is owed for a health insurance.
1 After the health insurer has called the policyholder for payment of one or more instalments of the premium payable, the policyholder shall be entitled to the payment of the premium for the period of time when the premium, interest and debt charges payable are not satisfied; the health insurance does not cancel, unless the health insurer has suspended or suspended care insurance or its coverage.
2 The first member shall have the exception if the health insurer has given the policy-holder within a period of two weeks to confirm the termination.
1 The health insurer shall provide the policy-holder and, if they are different from the policyholder, the insured person as soon as possible after the insurance policy has been concluded, and thereafter a health policy prior to each calendar year.
2 If care insurance ends, the health insurance provider shall provide the policy-holder and, if different from the policy holder, the insured person with proof of the end of the care insurance, to which shall be registered:
a. Name, address, place of residence and civil service number of the insured person;
(b) the name, address and place of residence of the policy holder;
(c) name, address and address of the health insurer;
d. the day on which the care insurance ends;
e. or to the insured person on that day a voluntary own risk and, if so, the effective date, the amount and the discount granted in relation to that date.
3 If care insurance ends to cover the Article 6, first paragraph, part d That reason shall be recorded on the proof referred to in paragraph 2.
1 The Institute of Care is based on comparison of the files to be indicated by ministerial arrangement, after which insurance companies are not insured under a health insurance scheme in spite of their insurance obligation.
2 The Institute of Health shall send a written notice of formal notice to an insured person referred to in paragraph 1, within three months of the date of dispatch of the formal notice, on the basis of such insurance. ensure or ensure that they are insured.
3 The notice of formal notice shall contain an overview of the consequences if the person concerned will not be insured within the period specified in the second paragraph.
1 If an insurance agent to whom a formal notice is to be given in Article 9a was not insured within three months of its dispatch, the Zorginstitute shall, if the underwriting underage is underage, impose an administrative penalty on the person exercising the authority over him.
2 The amount of the fine shall be equal to three times the standard premium, redefined to a monthly amount, specified in the Health care allowance law .
3 Article 5:53, 2nd and 3rd member, of the General Law governing law shall not apply to the imposition of the fine referred to in the first paragraph.
4 The Institute of Care can claim the fine in the case of a warrant.
5 At the same time as the imposition of the fine, the Zorginstitute informs what the consequences will be if the insurance party does not, within a period of three months from the date on which the decision was sent, to impose the Fine, will be insured.
(1) If an insurance party to whom the fine is intended to Article 9b If the fifth paragraph of Article 9b is not provided for, the Zorginstitute shall, if he is a minor, again impose an administrative penalty on the person exercising the authority over him.
2 Article 9b, second to fourth paragraphs , apply.
3 The penalty of the penalty provided for in paragraph 1 shall be accompanied by a charge that the insured person must be insured under a health insurance scheme within three months of the date of dispatch of the charge, in the absence of any such guarantee. Care Institute Article 9d will apply.
4 The articles in this article and in Article 9b The fines provided for shall be paid into the cashier's cashier.
1 If an insurable person to whom the administrative fine and the burden, is intended to Article 9c , if it is imposed, not within three months of the date of dispatch of the decision until it is lodged, the Zorginstitute shall, on its behalf, conclude a care insurance scheme in which he shall ensure that he is insured.
2 The Care Institute chooses the health insurance provider to close a health insurance plan referred to in the first member, subject to a distribution of health insurance as referred to in that paragraph on all health insurance providers, to proportionality of the number of insured persons with each health insurer.
3 If a health insurer offers several variants of health insurance, the Zorginstitute excludes health insurance according to the variant with the lowest premium, but without collectivity discount as intended. Article 18 and without voluntarily own risk.
4 On the load, intended in Article 9c, third paragraph , and on carrying out the burden referred to in the first member, is Section 5.3.1 of the General Administrative Law Act , except the Articles 5:25 and 5:27 to 5:30 of that law , mutatis mutandis.
5 The person insured under the first paragraph by the Zorginstitute shall be entitled to destroy the insurance in question for a period of two weeks from the date on which the institution has notified him of that assurance, if he and the health insurer in whom that health insurance has been concluded demonstrates that, in the period referred to in that paragraph, he has already been insured under another health insurance scheme.
6 By way of derogation from Article 931 of Book 7 of the Civil Code a health insurer has jurisdiction to annul an insurance contract concluded with him on account of error, if it is found subsequently that the person who insured the ZorgInstitute at the time of his insured person was not insured at that time.
7 If appropriate, by way of derogation from Article 7 , unless the fourth member of that Article applies, a policy-holder shall not cancel a health insurance scheme referred to in paragraph 1 during the first 12 months of which it is to run.
The risk to be insured under the health insurance system is the need for:
a. Medical care, including integral first-line care, as it is customary for general practitioners and midwives;
b. mouthcare;
c. Pharmaceutical care;
d. auxiliary resource care;
e. nursing;
f. grooming, including maternity care;
g. Stay in connection with medical care;
h. transport in connection with the provision of care or services referred to in parts a to g, or in connection with a right of care based on the Long-term care law .
1 The health insurer has a duty of care to its insured persons, which is designed in such a way that the insured person in whom the risk arises is entitled to benefits under the health insurance scheme consisting of:
a. the care or other services to which he needs; or
(b) reimbursement of the costs of such care or other services and, if requested, activities aimed at obtaining such care or services.
2 In care insurance, any combinations of insured benefits referred to in paragraph 1 (a) or (b) may be included.
3 In the case of a general measure of management, the content and extent of the benefits referred to in paragraph 1 shall be specified and may, for the purpose of designating a measure of concern or of other services, provide for a part of the cost to be provided for: account of the insured person is coming.
4 In the general measure of management, it may be determined by ministerial arrangement:
a. forms of care or other services may be exempted from performance specified in the first paragraph or specified in the measure;
b. the content and extent of the performance consisting of care as referred to in Article 10, parts a, c and d , be settled in more detail;
c. More detailed rules may be made on the part of the costs to be borne by the insured person.
5 A health insurance provider may offer model agreements in which, by way of derogation from the provisions of, or under the first and third paragraphs, certain ethical or philosophical reasons which are controversial outside the coverage of the health care provider, care insurance remaining.
1 In the case of a general measure of management, provision may be made to protect the public interest or to designate other services which the health insurer only provides or reimburses if between him and the provider of the care concerned or a contract on the care or service to be provided and the price to be charged for that provision has been concluded, or if the provider is employed with him.
2 In this general measure of management, also forms of care or other services may be designated for which the health insurer with any institution situated within its area of work or of which insured persons are expected to be regularly insured use, at its request, an agreement as referred to in the first paragraph.
3 An institution as referred to in Article 1 (m), below 1 ° , having concluded an agreement with a health insurer for a care or service referred to in the second paragraph, it is required to conclude an equal agreement with another health insurance provider on request.
4 The second and third members shall not apply where the health insurer or the institution has serious reservations, respectively, against the conclusion of an agreement with the institution or health insurer requesting that agreement.
1 If, under his health insurance, an insured person is required to obtain a given form of care or another service from a provider with whom his health insurer has an agreement on such care or service and the charge to be charged for that has closed, or from a provider employed by its health insurer, and he nevertheless engats such care or other service from another provider, he is entitled to a fee to be determined by the health insurance provider of the fee for such care or Service incurred.
2 The health insurer shall record the manner in which it calculates the fee in the model contract.
3 Where, in the case of or under the general measure of management, Article 11 , is determined that part of the cost of a particular form of care or of a particular other service is borne by the insured person, the care insurer processes this in the manner in which he provides the compensation for the relevant form of care or Calculates service.
4 The method of calculating the allowance shall be the same for all insured persons referred to in the first paragraph, who in the same situation need the same form of care or service.
5 If an agreement between a health insurer and a provider as referred to in paragraph 1 is terminated, an insured person who receives care from this provider at the time of termination of the contract shall be entitled to care by that provider for the account of this health insurer.
This part has not (yet) entered into force; see the summary of changes
1 The question of whether an insured person needs a particular form of care or a certain other service is answered only on the basis of substantive criteria.
2 The health insurer, in its model agreement, assumes that medical care, such as medical specialists, to offer, except for acute care, is accessible only after reference by categories designated in that agreement healthcare providers, including at least the general practitioner.
3 The health insurer is responsible for ensuring that its model agreement is in line with the agreements referred to in Article 2.7, fourth paragraph, of the Youth Act .
4 The health insurer agrees to the manner in which it carries out its responsibilities under this Act with the colleges of mayor and aldermen with a view to the legal responsibilities of those latter.
5 In so far as an insured person is required by his health insurance insurance provider, or a referral or a prescription from an expert is required to obtain the insured benefits, and the insured person is in possession of this permission, this reference or recipe, applies that consent, that referral or that recipe as a title for obtaining the insured performance during the period for which the consent is granted or the reference or recipe valid is, and does not require a new insurer to be requested again or that a Referral or prescription shall be submitted.
1 The health insurer ensures that its model agreement is in line with the agreements reached, intended to Article 5.4.1 of the Social Support Act .
2 The health insurer votes the way in which he carries out his duties under this law with the colleges of mayor and aldermen, with a view to the statutory duties of those latter on the basis of the Social support law .
1 The Articles 941, first paragraph , and 957 of Book 7 of the Civil Code are not applicable.
2 If appropriate, by way of derogation from Article 952 of Book 7 of the Civil Code the health insurer is not empowered to withhold an insured performance in whole or in part if the insured person's risk is attributable to the insured person.
1 Under the care insurance policy, the policyholder is liable to the premium.
2 By way of derogation from Article 925 of Book 7 of the Civil Code and of the first paragraph:
a. does not pay any premium up to the first day of the calendar month following the calendar month in which an insured person reaches the age of 18 years;
b. is not a premium payable over the period, intended in Article 18d or 18th .
1 The health insurer shall fix and record the basis of the premium and the premium or premium for each variant of the health insurance scheme which it offers and take it into the model contract.
2 The basis of the premium is the same for variants which, as far as the performance is to be insured, is Article 11, first paragraph The differences do not differ from the options between providers of care or of other services referred to in that paragraph.
3 If the health insurer makes use of its privileges, intended Article 11, fifth paragraph , is the basis of premium equal to the basis he has or would have established for a model agreement with full coverage.
4 The basis of the premium is the premium if not a premium discount as intended Article 18 (4) , or Article 20 or would apply.
5 The premium payable is equal to the premium benefit of the variant of the insurance policy chosen by the policy holder, less the premium discounts, intended for the benefit of the premium. Article 18, fourth paragraph , or 20 , if applicable.
6 The health insurer gives the method of deducting the due premium from the premium base in the model contract, and takes the manner in which the premium payable by the policyholder is from the premium basis. derived from the health care policy.
7 A change to the basis of the premium shall not take effect earlier than six weeks after the day on which it is communicated to the policy holder.
1 The health insurer may agree with an employer that it provides a monetary advantage if its employees, former employees or members of their families are insured on the basis of a model contract to be established in that agreement.
2 The advantage is not more than 10% of the basis of the premium for the relevant model agreement, per person covered by the relevant model agreement.
3 The Agreement, referred to in paragraph 1, shall at least determine:
a. The height of the benefit, where that height may vary according to the number of persons insured under the relevant model contract;
b. The distribution of the benefit to the employer and the persons insured under the relevant model contract.
4 If the benefit or part of the benefit is provided to the policyholder, it shall be in the form of a discount on the basis of the premium.
5 The first to fourth members shall also apply in respect of a legal person, other than an employer, in respect of the insurance of natural persons whose interests represent that legal person.
6 In the case of a general measure of administration, in order to avoid undermining the social character of the insurance, it may be necessary to lay down detailed rules and, if necessary, to derogate from the rules.
1 At the latest 10 working days after a period of payment of the premium for the premium for two monthly contributions has been found in respect of a health insurance scheme, the care insurer shall make an offer to the policyholder for the benefit of the insurance policy. a payment scheme.
2 The payment scheme shall consist of at least the following elements:
a. An authorisation from the policyholder to the health insurer until monthly direct debits of newly reversionated instalments of the premium or a contract to a third party from whom the policyholder receives periodic payments, to pay him, and under deduction of the corresponding amounts on these payments, directly to the health insurer the amount of newly-covered instalments of the premium,
b. arrangements for the settlement of the policyholder's debts arising out of the care insurance to the health insurer, including interest and debt collection costs, and the time limits within which payment is to take place; and
c. a commitment from the health insurance provider, adding that he will not terminate, suspend or terminate the health insurance or cover thereof during the term of the payment scheme for reason of the existence of the debts referred to in subparagraph (b). suspend, as long as the policy holder fails to withdraw the authorisation or the contract referred to in subparagraph (a) and to comply with the arrangements provided for in subparagraph (b).
3 If the policy holder has insured another and, to the effect of his insurance, a backlog as referred to in paragraph 1 has been incurred, the offer referred to in paragraph 1 shall also include a declaration of withdrawal of that contract from the holder. to accept insurance as from the day on which the payment scheme becomes effective, provided that:
a. The insured person has insured himself at the latest with effect from the same day under any other health insurance; and
If this health insurance has been entered into by the same health insurer, it shall have provided the premium for that insurance with a power of attorney or order referred to in paragraph 2 (a).
4 At the same time as the offer, the care insurer informs the policyholder in writing that it has a four-week period to accept it, with the insurer in addition indicating the consequences if the offer is not made accepted and the premium debt, interest and collection costs are not taken into account, will have accrued to six months or more of the monthly premium, he shall assign the policy holder the possibility of granting the aid, including providing information on the forms and ways in which it may be requested.
5 If the third paragraph is applicable, the health insurer shall send the insured person, at the same time as the insured person, with the transmission of the documents referred to in paragraphs 1 to 4, to the policy-holder, copies of those documents.
1 In the case of or under general management measure, it may be specified that, in so doing, a care supplement to be paid to the policyholder or his partner is to be charged to the policyholder or his partner as referred to in the Health care allowance law or an advance on it, by way of derogation from Article 25, first paragraph, of the General Law on Income-dependent schemes , as a contribution to the premium and, in so far as the care supplement or advance is still sufficient, the own risk is paid, in whole or in part, directly or through the intermediary of the Institute of Health, to the health insurer, if (i) the payment of the premium in respect of a care insurance, interest rate and debt collection costs of the premium for the premium of three monthly premiums has been incurred.
2 Under ministerial arrangements, rules may be laid down in respect of the first paragraph.
1 As soon as possible after a care insurance, interest and collection costs are disregarded, a delay in payment of the premium due to four monthly premiums is established, the health insurer shares the insurance policy holder and, if different from the policy holder, the insured person that he intends to enter the notification, intended to Article 18c , as soon as the premium debt will have reached the height provided there, unless the policyholder or the insured person has informed him of the existence of the debt or the height of the debt no later than four weeks after receipt of the notice.
2 In the event of a timely challenge as referred to in paragraph 1, the health insurer shall, if it maintains its position after examination, shall inform the policy-holder and, if different from the policy-holder, that he is intending to on the notification to be notified as soon as the premium debt is paid into Article 18c, first paragraph , shall have reached the level referred to, unless the policyholder or the insured person has referred to an independent body within a period of four weeks of receipt of the notice referred to in this paragraph to an independent body referred to in this paragraph. Article 114 or to the civil court.
3 If a payment scheme as referred to in Article 18a where the care insurance, interest and collection costs are disregarded, a delay in the payment of the premium due to four months of the month has been incurred, leave the health insurer in the first paragraph. the said notification shall be omitted as long as the newly redeemed period of the premium is met.
1 Where a care insurance, interest and incalant costs are disregarded, a premium debt of six or more monthly premiums has been incurred, the care insurer shall report this, indicating the charge for the charge of the insurance Administrative premium and for the execution of Article 34a the necessary personal data of the policyholder and the insured person, to the Zorginstitute, the policyholder and, if the insured person is different from the policy holder, to the insured person.
2 The notification shall not be made:
a. in the event of a timely challenge as referred to in Article 18b, first paragraph , as long as the health insurer has disclosed its position to the insured person and, if it is a non-policyholder, to the insured person;
b. during the period mentioned in Article 18b, second paragraph ;
c. in the event of a timely submission of the dispute to an independent body or to the civil court as referred to in Article 18b, second paragraph , as long as the dispute has not been irrevocably decided;
d. in case the policyholder has signed on to a debt aid worker as referred to in Article 48 of the Consumer Credit Act and demonstrates that he has entered into a written agreement for the stabilisation of its debts in writing;
e. in the case of the address of the policyholder and, if this is different from the policyholder, the insured person, not in the basic registration persons or the address as included in the administration of the health insurer deviating from the insurance policy holder's address under which this person or persons in the basic registration persons as a resident is or are registered, unless that deviation is due to a circumstance as referred to in Article 4a (a) (a) (a) to (c) .
3 Part of the notification constitutes a statement by the health insurer, which states that Article 18b and the second member has taken heed.
1 The policyholder shall be from the first day of the month following the month in which the Zorginstitute refers to the notification. Article 18c , has received from the ZorgInstitute a minimum of 110% and a maximum of 130% of the average premium, to be laid down by ministerial arrangement.
2 The premium provided for in paragraph 1 shall not be payable from the first day of the month following the month of the following month:
a. The debts arising out of the health insurance are, or will be, redeemed or cancelled;
b. The debt restructuring scheme, natural persons, intended in the Bankruptcy Act , to apply to the policy holder,
c. through the intervention of a debt aid provider as specified in Article 48 of the Consumer Credit Act an agreement as referred to in Article 18c, second paragraph, part d , is closed, through its intervention, an out-of-court debt arrangement which, in addition to the policy holder, is at least a health insurer, or the health insurer is a payment scheme with the policyholder agreed to, or
d. The policy holder fulfils conditions to be determined by ministerial arrangement.
3 For the purposes of applying the second paragraph, the care insurer shall inform the Zorginstitute, the policyholder and, if any other than the policyholder, the insured person, without delay, of the date on which a situation as referred to in Article 1 was established. Section a, b or c of that paragraph shall apply.
4 By way of derogation from the first and second paragraphs, the policyholder shall again owe to the ZorgInstitution an administrative premium from the first day of the month following the month:
a. In which the application of the debt restructuring scheme to natural persons under Article 350, third paragraph, part c, d, e, f, or g, of the Faillissementwet , has been terminated,
(b) in which he has taken, as is apparent from a notification from his health insurer, to participation in an agreement or arrangement referred to in paragraph 2 (c) under the relevant agreement or arrangement as referred to in paragraph 2 (c) of the said the arrangements laid down in respect of its health insurer have been fully complied with or
(c) where he no longer fulfils the conditions to be determined by the ministerial arrangement referred to in the second paragraph.
5 If, in the case referred to in paragraph 4 (b), a contract or arrangement concluded through a debt aid provider as referred to in paragraph 2 (c), the notification referred to in that part shall be was signed by a debt aid provider.
6 In the case of a ministerial arrangement, the average premium referred to in paragraph 1 shall be calculated.
1 During the first 12 months for which an insurance is referred to in Article 9d The policy holder shall, from the first day of the calendar month following the month in which he reaches the Zorginstitute the Zorginstitute, shall become responsible for the payment of a fee.
2 The level of the administrative premium shall be fixed by a ministerial arrangement at a percentage of the average premium.
3 Article 18d, sixth paragraph , is applicable.
1 The Institute of Care raises and collects the administrative premium.
2 Under the order of the Zorginstitute, the withholding agent shall, as a result of the wage or salary or for any part of the institution to be determined by that institution, shall keep the payment as referred to in the first paragraph of this Article for the purposes of the Act on payroll tax 1964 , after which he will pay the retained amount to the institute.
3 The deduction shall be made immediately after the obligation to hold taxes, premiums or other contributions required under any other legal requirement or contract of employment, subject to the provisions of a ministerial order. Deductions may be made on social security benefits or be subject to a different order of business.
4 A withholding agent which has not, or has not, retained the amount to be given by the Centre Institute shall be obliged to pay the entire amount to that institution, without the amount withheld from being withheld from the policy holder. That's right
5 In the event of retention on earnings of an administrative premium, the amount which the withholding agent pays at least to the policyholder shall be equal to the attachment of the attachment of the same kind as the same as the order of the asset. Article 475d of the Code of Civil Procedure , minus the amount withheld under the instructions of the Zorginstitute.
6 In order of the Zorginstitute, a care allowance to be paid to the policyholder or his partner is as intended in the Health care allowance law or an advance on it, by way of derogation from Article 25, first paragraph, of the General Law on Income-dependent schemes , as a concession paid to the ZorgInstitute by the administrative premium.
7 The health institute may, in the fourth paragraph, recover the amount of the administrative premium or the amount to be borne by the employer in the case of a compulsory order.
8 The Institute of Care has a privilege on all goods of the policy-holder, which is a privilege for all goods of the policy-holder, which is the prerogative immediately after the privilege, of the nature of which it is not. Article 21 of the Act of Invorting , can be exercised.
(9) If the Zorginstitute is responsible for collecting the administrative premium under a third party which makes periodic payments to the policy-holder, other than periodic payments in respect of the maintenance of the child's subsistence, As long as the Institute so requires, the third party shall be obliged to determine the overdue amount indicated by the Institute and the new limitation periods of the administrative premium or the institute's new limitation periods. parts of it, which has been the subject of the seizure, of the institute, to pay, unless he was allowed to be placed under him for claims of higher or equal rank.
10 If a herd as referred to in the ninth paragraph has been placed on a claim for a periodic payment as referred to in Article 475c of the Code of Civil Procedure , the impound foot is intended to be used in Article 475d of that Act In addition to paragraph 5 (a) of the latter article, on the sole purpose of the Zorginstitute's claim for the purpose of which the seizure was made, the difference between the administrative premium and the amount already applied Amount withheld from that premium.
11 The third person who paid more to the ZorgInstitute than is entitled to that right shall be freed from the policyholder in so far as it is derived from Article 34 of Book 6 of the Civil Code .
1 The Care Institute uses the civil service number of the in articles 18c, first paragraph , and 18th Persons referred to, with the aim of ensuring that the persons involved in the implementation of this section and Article 34a personal data to be processed in respect of those persons.
2 In the case of data exchange between the Zorginstitute and the in Articles 18f , 88 and 89 Persons and bodies referred to shall, for the purposes of this Section and in so far as they are empowered to use that number, shall be used as a civil service number.
3 The Institute of Care is responsible for debts of the administrative premium which have not yet been satisfied. Article 18d or 18th is no longer applicable to the policy holder, to be lost.
4 In the case of ministerial arrangements, detailed rules are laid down on how the Zorginstitute collects the administrative premium and determines which part of the administrative premium to be deposited by that college in the State treasury.
1 Each insured person of 18 years of age or older has a mandatory own risk of € 385 per calendar year.
2 The amount, referred to in paragraph 1, shall be indexed annually in accordance with the difference in estimated expenditure on the care and other services referred to in the Article 11 , between the calendar year to which it is committed to own risk and comparable expenditure for the year preceding that calendar year.
3 If the indexed amount is less than € 5 or a multiple of that amount differs from the amount specified in paragraph 1, this amount shall be changed by ministerial arrangement and shall then replace the amount referred to in that scheme. of the amount referred to in the first paragraph.
4 Accounts for costs of care or other services are only deducted from the required own risk, if they are received by the health insurer for a day of the calendar year to be determined by general management measure following the calendar year to which it relates to own risk.
5 In the case of a general measure of management, it shall determine the manner in which the deduction of own risk is deducted.
1 The health insurer offers from each health care insurance with a certain combination of to ensure performance as intended in Article 11, first paragraph , a variant of no voluntary own risk.
2 The health insurer can offer for the insurance of a person of eighteen years or older of health insurance variants with a voluntary own risk of € 100, € 200, € 300, € 400 or € 500 per calendar year, with which he offers a discount on grants the basis of the premium.
3 The discount may depend on:
a. The extent of the voluntary own risk chosen for the insured person;
(b) the number of calendar years for which a voluntary own risk for the insured person has been at risk.
4 The health insurer shall specify in its model contract what premium discount applies to any voluntary own risk for which calendar years.
5 If the health insurer leaves one or more of the voluntary own risks offered by it, the care insurer gives the policyholders who have a health insurance contract with such voluntary own risk, the option to opt for a health insurance with a lower or without voluntary own risk.
1 The percentage of the cost of care or other services which is charged to the compulsory own risk shall be determined by a general measure of management.
2 By way of derogation from the first paragraph, a general measure of management may designate forms of care or other services for which the costs are entirely, in part or in part, not covered by the obligation of own risk.
3 By way of derogation from the first paragraph, in the case of general measures of management, care or other services of which the health insurer, under conditions to be determined by that measure, may determine that the costs are wholly or partly outside the obligation of own risk.
4 The health insurer may designate forms of care or other services the costs of which do not fall under the voluntary own risk, with the exception that a general measure of management may designate forms of care or other services of which the costs are wholly or partly outside the voluntary own risk.
1 If care insurance does not enter or end on 1 January of a calendar year, it shall be the amount of mandatory own risk applicable to that agreement in that calendar year, and if applicable, voluntarily own risk equal to the amount applicable for the whole calendar year, multiplied by a rupture whose numerator is equal to the number of days in that calendar year over which the health insurance will run or has run, and the denominator in the number of days in the relevant calendar year.
2 By way of derogation from paragraph 1, the amount of the voluntary own risk in force in the calendar year if it changes during the calendar year and the policyholder immediately prior to the change shall already have a health insurance with the health insurer had closed, calculated as follows:
(a) any amount of voluntary own risk which has been or will have been applied in the calendar year in question shall be multiplied by the number of days in which that risk was or will be applied in that year;
b. The amounts calculated on the basis of subparagraph a shall be added together;
c. the amount calculated on the basis of subparagraph (b) shall be divided by the number of days in the calendar year.
3 The amount calculated on the basis of the first or second paragraph shall be rounded up to the whole of the euro.
1 Cost of care or another service shall be allocated to the calendar year in which the care or service was received, except that the cost of care or any other service that was received in two consecutive calendar years and by the a care provider or other service provider has been charged in a single sum shall be allocated to the calendar year in which the care or service is caught.
2 Amounts as referred to in Article 11, third or fourth member , to be borne by the insured person, or costs as referred to in Article 13, first paragraph In so far as they remain on behalf of the insured person, the answer to the question of whether a compulsory or optional own risk is exceeded shall not be taken into account.
3 A health insurer shall bear the cost of care or other services which may be incurred as a charge of voluntary self-risk, first of all, of the obligation to be borne by the health insurance company.
1 The rights and duties of the care insurance are suspended by law during the period under which our Minister of Justice is responsible for the provision of a judicial ruling in the context of the execution of a judicial ruling. medical care to an insured person.
2 The rights and duties of the care insurance are also suspended by law during the period during which an insured person has, according to a statement by the Minister for Foreign Affairs or a statement by Reclassification Netherlands, published in the Netherlands Detention has been taken.
3 The policyholder, the insured person, or the agent of the policyholder or an insured person shall notify the care insurer the day of the commencement of the period referred to in the first or second paragraph, where the second member is applicable, the there is a statement to the health insurer referred to therein.
1 An insurer reports the intention to offer and execute health insurance policies in writing to the healthcare authority, stating the day with effect from which he will offer health insurance.
2 The insurer shall attach to the notification all the model agreements according to which he wishes to offer health insurance.
3 A health insurer submits amendments to its model agreements or new model agreements before they enter into the care authority.
1 The care authority shall sign the date of receipt of the notice by which the notification is intended to Article 25, first paragraph , has been made, as well as to the model agreements or amendments thereto, as referred to in Article 25, second and third paragraphs .
2 The health authority shall immediately send to the insurer a proof of receipt stating that date.
3 The health authority shall without delay send the Zorginstitute a copy of the notification, the model agreements or the amendments to the model agreements, indicating the date of receipt of the notification.
4 The healthcare authority shall send the administrator of the health insurers ' register referred to in Article 14 of the Act uses civil service number in care , a copy of the notification without delay, stating the date of receipt of the notification.
An insurer who incorrectly provides or carries out insurance as a health insurance shall be liable to make good any damage to an insured person or to the person who has insured him.
1 The statutes of a health insurer:
(a) supervise the policy of the management and general management of the legal person and the related undertaking;
b. provide safeguards for a reasonable degree of influence of the insured person on the policy; and
(c) exclude any obligation of policy holders, insured persons, former policyholders or former insured persons to make a contribution in the legal person's deficits.
2 In the case of a general measure of management, rules may be laid down on the degree of influence that insured persons must have at least on the policy of a health insurer.
1 The work area of a health insurer is the Netherlands.
2 By way of derogation from the first paragraph, a health insurer may limit its working area to one or more of the whole of the provinces of the Netherlands for as long as less than 850 000 insured persons are insured on the basis of a health insurance.
3 For the purpose of determining the number of insured persons referred to in paragraph 2, the average number of insured persons in the second year preceding the year in respect of which the provision is made shall be based.
4 By ministerial arrangement rules may be laid down on how the number of insured persons is to be determined if the health insurer has been a legal successor in the second or first year preceding the year for which the provision is made has been merged with, or has been spun off from, another health insurer or if that insurer has taken over health insurance from another health insurer.
1 A health insurance provider who does not wish to offer or execute any health insurance services shall notify the healthcare authority in writing, indicating the day from which he will not perform any more health insurance.
2 Article 26 shall apply mutatis mutandis.
1 If the emergency rule is given to a health insurer or a former health insurer under Section 3.5.5 of the Financial Supervision Act whether a former health insurer has been declared bankrupt, the ZorgInstitute meets the insured persons vis-a-vis that health insurer or former health insurer, existing claims in respect of a right to compensation as referred to in Article 4 (1) of the Treaty. Article 11, first paragraph, part b , or Article 13 .
2 The claims referred to in paragraph 1 shall, by way of subrogation at the Zorginstitute, be carried out in so far as that institution has complied with it.
3 The Kingdom shall be liable to the Zorginstitute for the payments provided for in paragraph 1.
1 The Care Institute is aware of a health insurer that has fulfilled its obligations, and is intended to Article 25 , for each calendar year in which he offers health insurance and carries out an equation contribution.
2 In the case of a general measure of management, rules on the calculation of the settlement contributions shall be laid down.
3 The rules referred to in the second paragraph shall at least determine that the amount of the contribution contribution shall be calculated on the basis of the same criteria for all health insurers, including, in any case, the number of insured persons in the event of a change in the amount of the contribution to the pension scheme. a health insurer and a number of insurance features.
4 By ministerial arrangement:
a. For 1 October of each year, the total amount for the health insurance insurers for the following calendar year shall be determined;
(b) may be determined that, in addition to the criteria referred to in the third paragraph, the calculation of the amount of the contribution contributions shall be taken into account once a time as to determine, for all health insurers, a single account to be determined under that scheme Criterion;
c. is subject to statistical justification of any criterion referred to in the third paragraph or to a criterion referred to in subparagraph b;
d. lay down detailed rules on the calculation of the contribution contributions and determine how the compensation payments granted under the first paragraph are paid by the Zorginstitute.
5 The Institute of Health provides policy rules for each year before 15 October, specifying how the rules referred to in paragraph 4 are to be applied.
6 The award referred to in paragraph 1 shall be granted before 1 November of the year preceding the year for which the contribution is to be made.
7 The rules of policy, referred to in paragraph 5, require the approval of our Minister.
1 For the purposes of this Article:
a. Catastrophe: a natural disaster, a pandemic, a nuclear explosion, or other exceptional occurrence to be established under a ministerial arrangement;
b. catastrophic year: the calendar year in which a catastrophe occurs;
c. Average contribution contribution: the amount of compensation granted per insured person, calculated by the sum of the amount of the compensation awarded on the basis of the Article 32 share the total number of insurance contributions granted to all health insurers by the total number of insured persons expected at the time of the granting of those contributions in that year.
2 If the cost of care or other services insured under the health insurance is expected to occur jointly by the Zorginstitute in the catastrophic year and the following calendar year, The health insurer will be higher than 4% of the product of the average settlement contribution and the number of insured persons expected to be insured with that insurer at the time of granting the contribution to the event in the event of the catastrophe. Care institute the insurer that requests it in addition to the one awarded for the catastrophic year the contribution contribution shall be an additional contribution.
3 A health insurer to whom an additional contribution referred to in paragraph 2 has been granted shall keep separate records of the costs of catastrophe occurring in the year and the following calendar year. Insured care and other services.
4 In the case of ministerial arrangements, rules shall be laid down concerning the calculation of the contributions and rules on the records referred to in paragraph 3 and the manner in which the contributions granted are paid by the Institute.
5 Article 32, fifth and seventh paragraphs , with the exception of the obligation set out in that fifth paragraph, the policy rules shall be adopted annually before 15 October, mutatis mutandis.
1 Not later than 1 April of the fourth year following the calendar year for which the contributions referred to in Article 32 and 33 , have been awarded, the Zorginstitute shall determine the contributions.
2 The determination of an equation contribution as referred to in Article 32 , in any event, involves recalculation of the settlement contribution based on the actual number of insured persons that the health insurer had in the year in question and the actual distribution of the insurance features as referred to in Article 3 (1) of the Treaty. Article 32, third paragraph , on those insured persons, to the extent that the data required for this purpose have been delivered to the Zorginstitute in good time.
3 In the case of, or under general management, detailed rules on the calculation of contributions shall be laid down.
4 The Care Institute shall establish policy rules specifying how to apply the rules referred to in paragraph 3 and to which compensation for interest costs is granted, respectively, to be charged.
5 If the contribution found exceeds the contribution granted, the Zorginstitute shall pay the health insurer or its legal successor the difference, plus the interest costs, and if the contribution found is less than the amount of the contribution granted the Zorginstitute shall recover the difference, plus interest costs, from the health insurer or its legal successor.
6 The Institute of Care is empowered to pay the amount which is to be paid to the health insurance provider after application of the first and fifth member, respectively, to be recovered from the health insurer, to be charged with an award of a contribution referred to in Article 32 or 33 About a year later.
1 The Care Institute shall make a contribution to a health insurer if he insured persons for whose health insurance the administrative premium is due, without prejudice to the coverage of health insurance.
2 The contribution shall be granted for the insurance of defaulters only if the health insurer:
a. committed to its obligations, intended to Article 18a , 18b and 18c, second and third members ,
b. Prior to the notification, specified in Article 18c , also in addition to the efforts focused on direct debit, intended in the Articles 18a and 18b , sufficient efforts to collect the premium have been put in place; and
c. adheres to its obligation, intended to Article 18d, third paragraph , and, upon request, sufficiently cooperate with the policy holder or third parties, with a view to the repayment of the debt arising out of the health insurance provider.
3 The period for which the contribution is to be made and the amount thereof, and the manner in which it is made available, shall be determined by ministerial arrangement.
4 The Institute of Care shall be empowered to convert amounts to be recovered from the health insurer in the amount of the contribution to the care provider.
1 The Institute of Care shall ensure the setting up and maintaining of an administration, which shall include every insured person:
a. The civil service number;
b. the health insurance provider in which the insured person is insured;
c. Personal data, including personal data relating to health as intended in the Personal data protection law , which are necessary for the calculation of contributions to the care insurer as referred to in the Articles 32 to 34 .
2 The health insurer shall report to the Zorginstitute, indicating its effective date, any health insurance concluded by him, as well as, if the care insurance has ended, the date on which it ended.
3 If the Zorginstitute finds that an insured person is insured with two or more health insurers, he shall inform the health insurers concerned thereof, indicating the names of all health insurers in which the insured person is insured. To the altitude.
4 By ministerial arrangement:
a. Rules shall be drawn up on personal data to be included in the administration of the ZorgInstitute as referred to in subparagraph (c) of the first paragraph;
(b) Rules shall be drawn up on the establishment of the administration of the Zorginstitute referred to in the first paragraph.
Rights or obligations arising out of what is regulated in this paragraph shall be Title 4.2 of the General Administrative Law Not applicable.
1 The health insurer shall send two copies of its financial statements and of its annual report to the care authority within six months of the end of the accounting year.
2 A health insurer Article 403 of Book 2 of the Civil Code apply the annual accounts, annual report and consolidated accounts without delay after the deposit of the annual report and the consolidated financial statements at the registered office of the trade register, in duplicate to the care authority.
3 The health insurer shall add two copies of the certificate of account to the documents referred to in the first or second paragraph, which he/she shall give under the Civil Code or the Law on financial supervision have to be drawn up on these documents.
4 The care authority shall without delay send the Zorginstitute one copy of the documents referred to in paragraphs 1 to 3.
1 The health insurer shall send a two-year implementation report to the care authority in duplicate before 1 July, in which:
a. Reports on the implementation of this Act in the previous calendar year; and
a summary of its intentions regarding the implementation of this Act in the current calendar year and the following calendar year.
2 In the case of ministerial arrangements, detailed rules may be laid down on the content of the implementation report.
3 The rules referred to in paragraph 2 may, in particular, relate to compliance with a code of conduct to be referred to in the scheme.
4 The health insurer adds two copies of a report with auditors ' findings as intended in the implementation report. Article 393 of Book 2 of the Civil Code about whether:
(a) the implementing report has been drawn up in accordance with the rules in force;
(b) execution has been carried out in accordance with the obligations of the health insurer in the preceding calendar year or by virtue of this Act.
5 Article 37, fourth paragraph , shall apply mutatis mutandis.
1 There is a ZorgInsurance Fund.
2 In favour of the ZorgInsurance Fund:
a. the income dependent contributions, specified in Section 5.2 and the contribution replacement tax, specified in Article 57, second paragraph ;
b. the driver's contribution, specified in Article 54 ;
Bb. the driver's contribution, intended to Article 54a ;
c. a driver's contribution as specified in the Articles 55 or 56 ;
d. an amount of each account, for the purpose of Article 70 , equal to:
1 °. for each household as a household Article 70, second paragraph , self-assured peace of mind: the balance of the account divided by the number of household values of the household;
2 °. if the account with application of Article 70, seventh paragraph , the balance of the account shall be lifted;
e. amounts paid to the ZorgInstitute for the payment of claims as a whole or in part of claims as referred to in Article 31, second paragraph ;
f. the contributions and administrative penalties provided for in Article 69 ;
g. excluding the part provided for in Article 18g, fourth paragraph , the administrative premiums referred to in the Articles 18d and 18th ;
h. the income arising in connection with this Act from international agreements;
i. the health insurance authority of insurers on the basis of Article 83 of the Health Organisation Act the periodic penalty payments and the administrative penalties provided for in the Articles 86 to 89 of that Act ;
j. the contribution, intended in Article 87a of the Social Insurance Financing Act ;
k. by healthcare providers pursuant to a rule of the care authority on the basis of Article 37, first paragraph, introductory wording and point (d) of the Health Organisation Act Or at the appointment of the care authority on the basis of Article 76, second paragraph, of that Act paid amounts and by the healthcare authority of healthcare providers on the basis of Article 81, first paragraph, point (c) of that Act Amounts recovered, provided that such amounts are not paid to the long-term care fund or to third parties.
3 To be charged to the Zorginsurance Fund:
a. The contributions, intended in the Articles 32 , 33 , 34 and 34a ;
b. [ Red: Expiring;]
c. Claims carried out by the Zorginstitute in accordance with Article 31, first paragraph ;
d. expenses related to molest as intended in Article 55 , including fees referred to in the third paragraph of that Article;
(e) expenditure arising in connection with this Act from international agreements;
f. amounts as referred to in Article 56a of the Health Organisation Act ;
g. The allocation amounts established by the Zorginstitute under a ministerial arrangement, being the parts of the amounts referred to in part k of the second paragraph, allocated to the relevant health insurance insurers.
4 From the Zorginsurance Fund, according to rules to be laid down by ministerial rules, funds may be used for the purpose of forming and maintaining a reserve necessary for the purpose of the Fund.
1 The Health Institute manages and administered separately the ZorgInsurance Fund.
2 The Care Institute holds the financial resources that are part of the Zorginsurance Fund, in current account with our Minister of Finance.
3 The Care Institute may, in order to carry out its statutory tasks, have the financial resources that he holds in charge of our Minister for Finance.
4 By way of derogation from the second paragraph, the Zorginstitute may keep a part of the financial resources referred to in that paragraph outside the current account.
5 Our Minister, in agreement with our Minister of Finance, after consultation with the Zorginstitute, shall determine the extent of the part of the financial resources referred to in paragraph 4.
6 In the case of a financial shortfall, the Zorginstitute only uses the credit facilities provided by our Minister of Finance.
7 Our Minister of Finance informs daily the Zorginstitute on the current account of the current account, in any case with regard to:
a. The closing positions per day;
b. All daily booked mutations or transactions in the current account.
8 The Care Institute informs our Minister of Finance regarding the current account in any case regarding the projections of the current account balances.
9 Our Minister of Finance does not charge costs for the management of the current account.
10 Our Minister, in agreement with our Minister of Finance, after consultation with the Zorginstitute, shall lay down rules on the interest payable on the balances of the current account in the second paragraph. shall be taken
11 Our Minister may, in agreement with our Minister of Finance, after consultation with the Zorginstitute, lay down rules on the second, seventh and eighth members.
The withholding agent and the insured person owe an income-dependent contribution.
1 The withholding agent owes an income dependent on the wage he gave in accordance with the provisions of the Act on payroll tax 1964 from:
a. present service as defined in the Act on payroll tax 1964 of the insured person or of the person referred to in Article 2, second paragraph, part b , of this Act, with the exception of:
1 °. the final components of the levy, Article 31, first paragraph, parts b to h, of the Wet op de payroll 1964 ;
2 °. Article 13a of the Law on payroll 1964 in so far as this benefit has been taken into account by means of a post-charging attack imposed on the worker;
3 °. the salary of the person intended for the purpose of Article 4 (f) of the Law on payroll 1964 ;
4. the salary of the managing director-major shareholder, referred to in Article 6, first paragraph, part d, of the Health Act ;
b. Former labor as intended for use in the Act on payroll tax 1964 of the insured person or of the person referred to in Article 2, second paragraph, part b , up to a date to be determined by ministerial order, with the exception of items of remuneration to be indicated by ministerial arrangement.
2 The salary on which the income-dependent contribution is levied pursuant to paragraph 1 shall be at least nil and shall not be taken into account by the same withholding agent to the same amount as that of our Minister, in accordance with the provisions of the agree to our Ministers of Social Affairs and Employment and Finance, with respect to the amount fixed in a calendar year.
3 The amount referred to in paragraph 2 shall be fixed for periods of pay in respect of which the salary referred to in the first paragraph is enjoyed by our Minister, in agreement with our Minister for Social Affairs and Employment, that it considers it necessary.
4 For the redirection of another pay period of the amount referred to in the third paragraph, Article 25, 1st and 4th member, of the Law on Earnings Act 1964 applicable mutatis mutandis.
5 The income-dependent contribution shall be calculated per wage period on the difference between the salary enjoyed by the employee in the calendar year up to that period of pay and the salary which the worker has enjoyed in that calendar year up to and including the salary during that period of pay prior to that period of pay, on the understanding that the amount paid out by the same withholding tax is more than that which exceeds the amount fixed by application of the third or fourth paragraph of this Article. pay period, multiplied by the number of pay periods of the calendar year.
6 The second, third and fourth paragraphs do not apply in the cases, intended in Article 26b, first sentence, of the Law on Earnings Act 1964 .
7 The withholding agent shall not cover the income-related contribution which it is liable to pay to the insured person or the person intended for payment in respect of Article 2, second paragraph, part b . Any clause that derogates from the first sentence shall be null and void.
8 The State tax administration shall pay the income dependent on the salary of the person referred to in the Article 2, second paragraph, part b , of this bill on the account, intended in Article 70, first or second paragraph .
1 The insured person owes an income dependent contribution over the contribution income enjoyed in a calendar year.
2 The contribution income is the joint amount of what was enjoyed by the insurance-like:
a. wage according to the Act on payroll tax 1964 , reduced by:
1 °. Article 42 is applicable;
2 °. the final components of the levy, Article 31, first paragraph, parts b to h, of the Wet op de payroll 1964 ;
plus wages plus pay, determined according to the rules of Article 3.82 of the Income Tax Act 2001 ;
b. taxable profits from an undertaking, determined by the rules of Section 3.2 of the Income Tax Act 2001 ;
c. taxable result from other activities, determined by the rules of Section 3.4 of the Income Tax Act 2001 , except the in Article 3.91, first paragraph, points (a) and (b) , and Article 3.92 of the Income Tax Act 2001 intended work;
d. taxable periodic benefits and benefits in kind, determined by the rules of Section 3.5 of the Income Tax Act 2001 .
3 The contribution income shall be at least zero and shall not be taken into account at any rate higher than that of the arrangement of our Minister, in agreement with Our Ministers for Social Affairs and Employment and Finance, with relating to a calendar year fixed.
4. In the case of income dependent contribution under Article 49, second paragraph , if an inaction is levied, Article 42, second to sixth paragraphs , mutatis mutandis.
5 In the case of income dependent contribution under Article 49, third paragraph Where an attack is carried out, the amount of the contribution shall be equal to a sum equal to the amount referred to in paragraph 3, less the wage or salary referred to in the second paragraph. Article 42 , of the insured person and the salary enjoyed by the insured person of a withholding agent referred to in paragraph 2 (a) of the second paragraph.
1 The amount of income dependent on which the withholding tax is payable is a percentage of the wage or salary referred to in the Article 42, first paragraph .
2 The income dependent income payable by the insured person amounts to a percentage of the contribution income.
3 The percentages of the contribution referred to in paragraphs 1 and 2 shall be determined by way of a regulation by our Minister, in agreement with Our Ministers for Social Affairs and Employment and Finance, with the result that they are to be indicated. The salary or the contribution-income may be determined by a different percentage.
4 The rates of contribution are determined in such a way that the sum of the income dependent contributions is equal to 50% of the sum of the sum of the fees to be determined by ministerial arrangement, to the benefit of the Zorginsurance Fund or to the health insurers income.
5 After the end of the calendar year, differences between the amounts of income taken into account in the ministerial arrangement referred to in the fourth paragraph and the actual amounts of that income shall be offset by the amounts of the income, establishment of the rate of contribution in the following year.
6 If an amendment to the contribution rate goes into effect at a time other than 1 January, the determination shall be made in accordance with the Minister of Finance and may be subject to rules on the method of calculation of the contribution to the budget. contribution for the whole calendar year.
Our Minister's arrangement, in agreement with our Minister of Finance and Our Minister of Social Affairs and Employment, may be subject to detailed rules regarding this paragraph.
The State tax authority makes the income dependent contribution.
1 The amount of income dependent on deduction of the withholding tax shall be charged by the corresponding application of the rules applicable to the levying of payroll tax.
2 To the extent that the contribution-income consists of pay as referred to in Article 43, second paragraph, part a In the case of a withholding agent, the income-related contribution shall be levied by way of deduction by corresponding application of the rules applicable to the charging of payroll tax.
3 In so far as the contribution income consists of items other than those referred to in paragraph 2, the income-dependent contribution shall be levied by way of an attack by corresponding application of the income tax. rules in force, with the exception of Article 3 154 of the Income Tax Act 2001 .
4 Article 13a, fifteenth and nineteenth member, of the Law on payroll 1964 shall apply mutatis mutandis.
1 The inspector shall, by way of an objection, provide the insured person with a refund of the income dependent on the earnings, in so far as the salary of the insured person's income dependent on a income dependent on earnings is subject to a statement of the right to pay. is higher than it is in Article 43, third paragraph , amount referred to.
2 A refund shall not be granted if the amount calculated in application of the first paragraph does not exceed the amount set out in the Annex. Article 9.4, fifth paragraph, of the Income Tax Act 2001 said amount.
3 By ministerial arrangement, rules shall be laid down on the granting of an advance on the amount to be fixed by the decision referred to in paragraph 1.
(4) Where a refund or an advance has been granted unduly or on an overpayment, the inspector may recover the amount overpaid by a decision which is liable to be contested. The right of recovery shall lapse by five years after the end of the calendar year to which the refund or advance referred to in the first sentence relates. Where the amount to be recovered pursuant to the first sentence is recovered, the rules applicable to the application of income tax shall be applied mutatis mutandis.
5 By way of derogation from the Articles 30h and 30ha of the General Law on State Taxation shall be remunerated at the contested decision referred to in paragraph 1 and the contested decision referred to in paragraph 4 shall be subject to reimbursement of tax interest only, if the service of the person concerned is to be paid on the basis of the decision. After the expiry of a period of six months from the end of the calendar year to which the contribution relates. The tax rate shall be calculated on a single basis for the period starting on the day after the end of a period of six months after the end of the calendar year to which the contribution relates and ends 14 days after the day of the day on the day of the day of the day's day. the order.
1 The State tax authorities are seeking to contribute to the income-related contribution.
2 In the case of recovery of the contribution, as appropriate Article 49, first or second, or third , where applicable, the rules applicable to the recovery of payroll tax, subject to the income tax, shall apply mutatis mutandis.
Under the terms of our Minister and our Minister of Finance, rules are laid down regarding the transfer of income dependent contributions as well as the related administrative fines and interest by the tax authorities. the ZorgInsurance Fund.
Our Minister's arrangement, in agreement with our Minister of Finance and Our Minister of Social Affairs and Employment, may be subject to detailed rules regarding this paragraph.
1 Our Minister grants to the ZorgInsurance Fund each year a contribution to the financing of health insurance for insured persons under the age of 18.
2 The contribution shall be equal to the amount allowed for that purpose in the Act for the adoption of the budget of the Ministry for that year.
3 The contribution shall be paid in equal monthly volumes.
1 Our Minister grants from the calendar years 2015 to 2018 to the ZorgInsurance Fund a contribution in the financing of insurance coverage of care provided until 1 January 2015 on the basis of General Law Specific Health Costs was insured.
2 The contribution for the year 2015 is equal to the amount allowed for that purpose in the law establishing the budget of his ministry for that year, and contributions for the years 2016, 2017 and 2018 amount to 75, 50 and 25% respectively of the contribution for the year 2015.
3 The contribution shall be paid in equal monthly volumes.
4 This Article and Article 39, second paragraph, part bb , due to expire from 1 January 2019.
1 Our Minister, in agreement with our Minister of Finance, may grant a contribution to the ZorgInsurance Fund for payment of whole or partial payment of care or other services as referred to in Article 10 , in case the need for that care or services has been caused by or arising out of armed conflict, civil war, rebellion, domestic unrest, insurgency, mutiny, or terrorism.
2 The following shall be determined by ministerial arrangement:
a. which forms of care or other services are paid for which part of the contribution;
b. for the benefit of the persons to whom the contribution is paid;
c. under what conditions and in what way such care or other services are paid by the Zorginstitute.
3 In a scheme referred to in paragraph 2, health insurers may provide the ZorgInstitute with assistance in the implementation of the ministerial arrangement referred to in paragraph 2 and the remuneration for the health insurers. against state.
If the situation is: Article 31, first paragraph , has occurred, our Minister shall make a contribution to the ZorgInsurance Fund to the difference between the amount of the claims committed, as referred to in Article 4 (2). Article 31, first paragraph , and the amount specified by the ZorgInstitution in respect of the claims, Article 31, second paragraph -I've received it.
1 Person on the basis of Article 2, second paragraph, part b , if it is not insurable, the contribution tax is levied up to the amount of the tax. Article 43, second paragraph , intended income-related contribution that this person would be owed if he were an insurance party.
2 By way of derogation from Article 43 becomes the person to whom with application of Article 64 of the Social Insurance Financing Act a derogation has been granted under one or more public insurance policies other than those according to the Long-term care law , no income dependent contribution but a contribution substitute tax, up to the amount of income dependent contribution, meant in Article 43, second paragraph .
3 The levy of the contribution replacement tax shall be applied by corresponding application of: Article 49, second, third and fourth members .
4 The State tax authority shall pay the tax referred to in paragraph 1 on the account, as referred to in Article 4 (1). Article 70, first or second paragraph .
1 There is a Zorginstitute Netherlands, which has legal personality.
2 The Institute of Care is established in a place to be determined by our Minister.
3 The Institute of Care shall be entrusted with the tasks assigned to it by or under the law or international agreement.
4 The Institute of Care shall be represented in and out of law by the Chair.
5 The Framework Law on self-employed administrative bodies is applicable to the ZorgInstitute.
1 The Institute of Care shall be composed of a maximum of three members, including the Chair.
2 Appointment shall take place on the basis of the expertise necessary for the performance of the tasks of the Zorginstitute as well as on the basis of social knowledge and experience.
3 Members shall be appointed for a maximum period of four years. Reappointment may take place twice and each time for a maximum of four years.
1 The Care Institute has a commission that reports or signals as intended. Article 66 preparing.
2 The Committee shall consist of an odd number of up to nine members, including the members of the Zorginstitute. Our Minister appoints, suspends and dismisses the members of the committee. Membership ends in the interim term, dismissal on their own request, or dismissal for serious reasons by our Minister.
3 Article 59, second and third paragraphs , the members of the committee who are not members of the ZorgInstitute shall apply mutatis mutandis, subject to the knowledge that they shall be appointed on the basis of the expertise necessary for the exercise of the tasks of the institution of the institution of the Sea. Commission and on the basis of social knowledge and experience.
4 By ministerial arrangement, the reimbursement of travel and subsistence expenses and further allowances to members of the committee who are not also members of the Zorginstitute shall be established.
1 The Institute of Care has an Advisory Committee on Quality.
2 The Quality Advisory Board shall consist of an odd number of not more than 15 members appointed, suspended and dismissed by the Institute for Zorging.
3 Members shall be included in the Advisory Committee on a personal basis as part of the Advisory Committee on Quality.
4 The appointment of the members of the Advisory Committee on Quality takes place on the basis of the expertise necessary for the performance of the tasks of the Advisory Committee on Quality and on the basis of social knowledge and experience.
5 The Articles 59, third paragraph , and 59a, fourth member , shall apply mutatis mutandis.
6 Membership ends in the interim term, dismissal on their own request, or dismissal for serious reasons by the Zorginstitute.
7 The membership of the Advisory Committee Quality is incompatible with the membership of the Zorginstitute and the commission, referred to in Article 59a .
1 The Institute of Care shall establish a Board of Procedure.
2 Meetings of the Zorginstitute shall not be public, except where otherwise provided for in the rules of administration.
3 In any case, the ZorgInstitute shall, in any case, lay down the conditions of compliance with the obligation under the rules of management. Article 3: 2 of the General Administrative Law Act .
1 The Care Institute promotes unambiguous explanation of the nature, content and extent of performance, intended in Article 11 .
2 The Care Institute may provide guidance to the health insurers with a view to this.
The Care Institute gives to health insurers, to healthcare providers and to citizens information about the nature, content and extent of performance, intended Article 11 .
1 The Institute of Health reports our Minister on the proposed policy on the nature, content and extent of performance, intended to be considered by the Minister of Health. Article 11 .
2 The Care Institute identifies and unsolicits to our Minister factual developments that may give rise to changes in the nature, content and extent of performance, intended to Article 11 .
Under care in the Articles 66b to 66e '
1 °. care or service as defined by or under this Act or Special Sickness Benefits Act;
2 °. health care operations as referred to in Article 2 (2). Article 1 of the Act on Professions in Individual Health Care , which are not included under 1 °, even if such operations are of a different nature from the promotion or monitoring of the health of the client.
1 The Institute of Care shall maintain a public register in which, on a proposal from client organisations, healthcare providers and health insurance providers, a professional standard or a measuring instrument is shared or shared by the Advisory Committee on Quality Included.
2 The Care Institute establishes a policy rule that assesses whether a professional standard can be considered a responsible description of the quality of a specific care process and a measurement tool can be used. be considered as a responsible means of measuring or good care.
3 The Care Institute shall not enter a professional standard or measuring instrument proposed in accordance with paragraph 1 if it does not comply with the policy rule referred to in the second paragraph.
1 The Care Institute determines which forms of care require a professional standard or a measuring instrument or a corresponding standard of care. Article 66b professional standard or measuring instrument included in the public register need to be amended. In doing so, the Zorginstitute is promoting the dissemination of good examples in the field of patient safety.
2 The Institute of Care shall determine the time at which the professional standard or measuring instrument referred to in paragraph 1 must be adjusted for each one of the institutions.
3 If no professional standard or measuring instrument has been drawn up on the basis of the date referred to in paragraph 2, the ZorgInstitute may request the Quality Advisory Committee within a time limit to be determined for this purpose. to carry out appropriate professional standard consultations with relevant clients ' organisations, health care providers and health insurance companies on the professionally adjusted standard.
1 The Care Institute carries out care to collect, merge and make available information about the quality of care provided:
a. For the right of the client to be able to make an informed choice between different health care providers; and
b. For the purpose of supervision by State Supervision officials of public health.
2 Care providers are required to report the information, referred to in the first member, based on the corresponding Article 66b measuring instruments included in the public register.
3 The agency shall designate the authority where health care providers provide the information referred to in the second paragraph.
1 The Advisory Committee Quality sets out a request from the Zorginstitute as intended Article 66c, third paragraph , a professional standard or a measuring instrument on.
2 The Quality Advisory Committee shall be responsible for advising the Institute on matters relating to the quality of care, including:
a. the multiannual agenda and the work programme of the Institute for the Zorginstitute,
b. the consistency between professional standards and the funding of care, and
c. making informed information about the quality of care.
3 The Quality Advisory Board may, for the purpose of carrying out its activities, enable one or more experts in the field of a specific form of care.
1 The Care Institute reports to our Minister on the feasibility, effectiveness and effectiveness of proposed policies related to innovations and improvements in the structure of occupations and training in the health care.
2 The Care Institute has called for and unsolicits to our Minister to de facto develop innovations and improvements in the structure of professions and training in the health care sector.
The Zorginstitute promotes the reconciliation of implementation:
a. of and between health insurance and insurance long-term care, and
b. of these insurances with the implementation of policies in other areas of public health and in other areas of social security.
1 Persons living abroad who are affected by the application of a Regulation of the Council of the European Communities or of a regulation of the European Economic Area or of a Treaty on European Economic Area residing in the European Communities social security in the event of need of care are entitled to care or reimbursement of the costs thereof, as provided for in the legislation on insurance for care of their residential country, report itself, unless under this Act they are insured under this law He's at the Zorginstitute.
2 The persons referred to in paragraphs 1, 2 and 13 shall be liable to a contribution to be determined by ministerial order, which shall be the subject of a section to be determined by that scheme, for the purposes of applying the Health care allowance law is considered to be a premium for health insurance.
3 In so far as a pension or interest-raising institution is subject to a person referred to in the first paragraph Article 42 This institution shall be responsible for that institution's contribution to be determined by a ministerial arrangement.
4 The Institute of Health is responsible for the administration resulting from the first, 12th and 13th members and the international rules mentioned therein, as well as the taking of decisions on the levy and collection of contributions intended to Second and third members.
5 If an objection is raised against a decision taken by the Institute under this Article, it shall, by way of derogation from Article 7:10, 1st paragraph, of General Law governing law , counted within 13 weeks from the day following that on which the deadline for the submission of the notice of objection has expired.
6 The Care Institute shall use the civil service number of the persons referred to in paragraph 1 for the implementation of this Article.
7 By ministerial arrangement:
a. may be determined that institutions which are liable for retirement or interest, or employers, on behalf of the Zorginstitute, work in the preparation or execution of decisions as referred to in the fourth paragraph, which may be determined that those bodies or employers shall contribute to a pension or interest or, where the first member applies to members of the family of an insured person, to the wage or salary, the contributions payable by the persons referred to in the first paragraph, or the pension or interest of that insurance-like insurance;
b. may be subject to rules on the way the Zorginstitute exercises its mission as referred to in the fourth paragraph, or the bodies or employers referred to in subparagraph (a) carry out the work referred to in that subparagraph.
8 Article 18f, third paragraph , shall apply mutatis mutandis.
9 If the notification referred to in paragraph 1 has not been made within four months of the date of the entry into force of the right referred to in paragraph 1, the Zorginstitute shall, to the person who should have notified it, impose an administrative fine of three of the three months of the notification. up to a monthly amount of the standard premium, referred to in the Health care allowance law .
10 The Care Institute may recover the contribution referred to in the second or third member, or a fine as referred to in the ninth member on a compulsory order.
11 Article 5:53, 2nd and 3rd member, of the General Law governing law shall not apply to the imposition of the fine referred to in the ninth paragraph.
12 For the purposes of Regulation (EC) No 883/2004 of the European Parliament and of the Council of 29 April 2004 on the coordination of social security systems (Pb EU 2004, L 166), the person referred to in the first paragraph shall be those who are on the last day of the day. from the month preceding that in which he reaches the age of 65 a pension or benefits equivalent to pensions due under Netherlands legislation under the provisions of Annex XI to that Regulation, up to the end of the month of that month. retirement age as referred to in the Article 7a of the General old-age law Qualified as an applicant for a pension.
13 For the purposes of applying a Convention referred to in paragraph 1, the person referred to in paragraph 1 shall receive a pension on the last day of the month prior to that in which he reaches the age of 65 years of age. of the Treaty is equivalent to pensions due under Dutch law, up to retirement age as referred to in Article 4 (1) of the Treaty. Article 7a of the General old-age law Qualified as a pensioner in a pension.
1 The Care Institute opens up to any peace of mind, intended in Article 2, second paragraph, part b , an account, to which the charged contribution tax is to be charged Article 57, first paragraph It's going to fall.
2 By way of derogation from the first paragraph, the Zorginstitute shall open up one account if two or more of the senses of mind are referred to in: Article 2, second paragraph, part b , conduct a common household, and shall pay into that account the taxes of each of these senses of mind.
3 To the account is none other favored than the Zorginstitute.
4 The balance is used by the Zorginstitute to do:
a. Benefits for the reimbursement of expenses of care or other services referred to in Article 11 , in so far as they have been given to a peace of mind for whom the account is maintained, or to a child of his household, less than 18 years of age;
b. Benefits as referred to in Article 39 (d) (d) .
5 Benefits referred to in paragraph 4 (a) shall be made only at the request of a peace of mind for whom the account is maintained.
6 The cost of care or other services shall not be reimbursed to the extent that it is provided for an insured person under the rules, established by or under the general measure of management, as referred to in Article 2 (1). Article 11, third or fourth member -Stay on your own account.
7 The Institute of Care raises an account if all the peace of mind for whom the account was maintained have become insurable, or have passed away.
8 If a compromise of peace is to constitute a common household with a different spirit of peace, the Zorginstitute shall charge one of the two accounts, with the balance being transferred to the remaining account.
9 The Institute of Care provides for an orderly administration of the payments and benefits of the account per mind or household, referred to in the second paragraph.
10 The rules and implementing rules may be laid down in respect of the provisions of the provisions of the first to the ninth paragraph of the Ministerial Regulation.
11 The Institute of Care shall be responsible for outsourcing to one or more health insurers the activities provided for in or under the first to tenth members, under reimbursement of the costs associated therewith.
12 The Care Institute used for the implementation of this article the civil service number of the mind encumin.
This part has not (yet) entered into force; see the summary of changes
This part has not (yet) entered into force; see the summary of changes
1 The Health Institute shall send a programme of work for the following calendar year to our Minister, together with the budget, for the following calendar year, describing the activities which the Institute intends to undertake in order to carry out its tasks. to perform.
2 At the same time as the budget referred to in paragraph 1, the Zorginstitute shall also send to our Minister a multiannual agenda for the following four calendar years for the performance of the quality of care tasks.
3 Without prejudice Article 27 of the Framework Law on independent administrative bodies the budget shall contain a multi-annual estimate of the management costs for the four calendar years following the financial year.
4 In the work programme referred to in paragraph 1, a distinction shall be made in relation to the performance of tasks in the field of quality of care and of the tasks specified in the work programme. Article 66f -or for other tasks of the Zorginstitute.
1 The budget for the management costs of the Zorginstitute shall be fixed annually by 1 December of each year for the following calendar year.
2 Our Minister may decide to change the budget for the management costs of the Zorginstitute.
3 The Care Institute does not commit to and does not incur expenditure resulting in overrun of the established budget for administrative costs in relation to management costs.
4 If the budget for administrative costs has not been fixed for 1 January of the calendar year to which the budget relates, the Zorginstitute shall have the power to hold its activities up to a maximum of one third of the period of the budget. part of the budget that was last established for an entire year.
5 Our Minister may decide that, in a case as referred to in paragraph 4, the Zorginstitute may have more than one third of the budget which was last fixed for an entire year.
6 The budget allocated by Our Minister for the management costs of the Zorginstitute is covered from the Rijks ' greenhouse.
1 The in Article 26 of the Framework Law on independent administrative bodies The budget referred to relates to the management costs of the Zorginstitute.
2 The in Article 34 of the Framework Law on independent administrative bodies The financial statements of the Zorginstitute concerned the management costs of the Zorginstitute.
3 In Article 18 of the Framework Law on independent administrative bodies The Zorginstitute's annual report on the implementation of the Article 122a exclusively applicable to the business operations.
4 Without prejudice Article 35 (4) of the Framework Law on independent administrative bodies The auditor shall also report on his or her findings as to whether the management and organisation of the Zorginstitute complies with the requirements of legality, ordability and controllability.
1 The Institute of Care sends to our Minister every year before 15 April:
a. As much as possible with corresponding application of Title 9 of Book 2 of the Civil Code provide for a financial report of implementation tasks over the past calendar year, including financial accountability of the amounts of money flows related to the implementation tasks, as well as the report on findings, in which the findings are indicated by money flow;
b. a justification for the determination of the contribution, Article 34 , for the purposes of the fourth calendar year preceding the year in which the accounts are held, together with an assurance report.
2 The implementation tasks of the financial report shall be accompanied by a statement of the fidelity.
3 The report of findings and assurance report indicate whether management and organisation meet requirements of lawfulness, ordability, controllability and efficiency.
4 The statement of fidelity, the report of findings and the assurance report are drawn up by an accountant as intended Article 393 of Book 2 of the Civil Code He is prepared to give our Minister, upon request, an insight into his audit work.
1 The Institute of Health shall send to our Minister for the ZorgInsurance Fund annual accounts for the previous calendar year for 31 December of each year and the report of findings as referred to in the fifth paragraph.
2 The Institute of Health submits in the financial statements, which shall apply as much as possible with corresponding application of Title 9 of Book 2 of the Civil Code shall be set up, taken into account and held responsible for:
a. The income and expenses of the Zorginsurance Fund;
b. Money flows specified in: Article 73a (a) (a) ,
(c) the lawfulness and efficiency of the management of the Zorginsurance Fund;
d. The state of the Zorginsurance Fund as at 31 December of the previous calendar year.
3 The annual accounts are accompanied by a statement of the fidelity issued by an auditor as referred to in Article 393 of Book 2 of the Civil Code He is prepared to give our Minister, upon request, an insight into his audit work.
4 The declaration also relates to the lawful acquisition and use of the funds of the Zorginsurance Fund.
5 The auditor adds to the statement a report of his findings on whether the management and the organisation meet requirements of legality, ordability, controllability and efficiency.
1 The work programme referred to in Article 71 , the implementation tasks and the accountability of the financial report, Article 73a, first paragraph, parts a and b , the annual accounts referred to in Article 74 , and the budget referred to in Article 122a, seventh paragraph We need the approval of our Minister.
2 By way of derogation from the first paragraph and of Article 29 (1) of the Framework Law on independent administrative bodies , amendments to an approved budget do not have to approve our Minister, provided that:
a. the total size of the budget does not undergo any change; and
b. the change by group of cost categories and benefits, counted in respect of the relevant financial year, a 5% share of the Article 72 That budget does not exceed the budget.
3 Under ministerial arrangements, rules may be laid down on:
a. the content and establishment of the work programme referred to in Article 71, first paragraph , and the multiannual agenda, as referred to in Article 71, second paragraph;
b. the content and the establishment of the budgets specified in Article 122a, seventh paragraph , as well as in Article 26 of the Framework Law on independent administrative bodies ;
(c) the content and establishment of the financial report, and the responsibility, for the purpose of Article 73a, first paragraph, part a ;
d. The content and establishment of the accountability, intended in Article 73a, first paragraph, part b , and of the assurance report referred to in that section;
e. the content and establishment of the financial statements intended in Article 74 , as well as in Article 34 of the Framework Law on independent administrative bodies ;
Audit of the audit of the financial report, intended to be carried out in accordance with Article 73a, first paragraph, part a , and of the annual accounts, as referred to in Article 74 and Article 34 of the Framework Law on independent administrative bodies , and of the responsibility referred to in Article 73a, first paragraph, part a, of the Zorginstitute;
g. the tasks of implementation of the financial report referred to in Article 73a, first paragraph, part a , and the annual accounts referred to in Article 74 and Article 34 of the Framework Law on independent administrative bodies , corresponding report of findings and the assurance report referred to in Article 73a, first paragraph, part b;
h. the content and establishment of the annual reports provided for in Article 122a, 10th paragraph , as well as in Article 18 of the Framework Law on independent administrative bodies ;
i. the size of the equalization reserve, specified in: Article 33 of the Framework Law on independent administrative bodies .
4 By ministerial arrangement rules are laid down on the manner and conditions under which the budget, referred to in Article 72 , it shall be established.
After the approval, as specified in point Article 75, first paragraph , and the approval, as specified in the Article 29, first paragraph , and 34, second member, of the framework law on self-governing bodies , the Zorginstitute shall make the documents listed in Article 75 (3) (a), (b), (c), (e) and (h) generally available.
1 Unless the insured person does not have it, the health insurer shall, for the purposes of the performance of the care insurance and of this Act, take the civil service number of his insured person and, for seven years from the end of the insurance, from his A former insured person in his administration.
2 The health insurer shall, at the time of the initial admission to its administration and, where appropriate, the civil service number of the insured person, with corresponding application of Article 7 of the Act uses civil service number in care .
3 The health insurer shall use the civil service number of the insured with the purpose of ensuring that the personal data to be processed in the context of the insurance cover relates to that insured person.
4 In the case of data exchange between health insurers and the Articles 88 and 89 the persons and bodies mentioned shall be the civil service number or, in the absence thereof, the social security number, to the extent that such persons and bodies are empowered to use that number.
5 The fourth member shall apply mutatis mutandis to the data exchange between health insurers and healthcare providers, indicatoryand health insurers within the meaning of the Law use civil service number in care which is not in the Articles 88 and 89 have been named.
6 In the case of a general measure of management, detailed rules may be laid down for the first and second paragraphs.
7 In the case of a ministerial arrangement, the security requirements for the processing of the data referred to in the first, fourth and fifth paragraphs of this Article may be laid down.
8 In the case of, or under general management, rules may be laid down on the facts or information to be processed in the data exchange referred to in the fourth and fifth paragraphs, in respect of insured persons whose determination of the rules of administration is Civil service number impossible or a disproportionate effort costs. The security requirements for the processing of those facts or data may be determined by the measure or by virtue of that measure.
9 In the case of a general measure of administration, forms of care or other services as referred to in Article 11 , as well as categories of health insurers and from in Articles 88 and 89 the persons and bodies mentioned shall be exempted from the application of the provisions of the provisions of the provisions of the first to the eighth paragraph.
1 A healthcare provider provided to an insured care or other services, intended in Article 11 , has granted, and has the cost thereof, under an agreement entered into by him with the care insurer, directly to that health insurance provider, provides that health insurer or a person designated by that health insurance provider the personal data of the insured person, including personal data relating to health as referred to in the Personal data protection law , which are necessary for the performance of the health insurance or of this law, or, for this purpose, shall make it available for inspection or the taking of copies.
2 A healthcare provider provided to an insured care or other services, intended in Article 11 , has granted and charged costs to the insured person, shall provide him with the personal data, including personal data relating to his health as intended in the Personal data protection law , which are necessary for the care insurance or of this law for his health insurer.
3 The care provider, referred to in the first or second member, shall provide a person designated by Our Minister, free of charge, by ministerial arrangement, for the implementation of this law necessary personal data, including personal data on health as referred to in the Personal data protection law .
4 Persons employed for the benefit of a healthcare provider as referred to in the first or second members shall provide that healthcare provider with the personal data he needs to be able to comply with his obligations referred to in the first, second and third paragraphs.
5 Persons employed by the health insurer, by a person designated by the care insurer as referred to in the first member, or by the person designated by Our Minister as referred to in paragraph 3, for whom not under the office or profession an obligation of secrecy shall be subject to the confidentiality of the information referred to in the first, second or third paragraphs, except in so far as any provision of law allows them to be communicated.
6 By ministerial arrangement, the following may be determined:
a. what information is required under the first or second paragraph of this Article;
b. to which data referred to in the first or second paragraph are processed;
c. according to which technical standards data processing takes place;
d. the security requirements for data processing;
e. in which cases data referred to in the first or second member are further processed for the purpose of implementing health insurance or supplementary health insurance insofar as these data are not used for the assessment and accept an aspiring insured person for an additional insurance and, in addition, it is necessary for:
1. the payment to a healthcare provider or the reimbursement of care expenses to an insured person;
2. the fixing of own contributions, whether compulsory or voluntary, of own risk;
3 °. the exercise of the law of redress; or
4 °. to carry out checks or fraud investigations.
1 Each provided upon request to the health insurers, the Zorginstitute, the care authority, Our Minister, the State Tax Office, the Execution Institute Employees ' Insurance, the Social Insurance Bank, the College of Mayor and Aldermen, or to any person designated for that purpose by or because of any of these health insurers or bodies, free of charge, all information and data, including personal data as referred to in the Personal data protection law , which are necessary for the performance of the health insurance or of this law.
2 The information and information referred to in paragraph 1 shall be submitted on request in written form or in any other form which may be reasonably required, within a period drawn up in writing at the time referred to in paragraph 1. Request.
3 Any person shall, at the request of a legal person referred to in paragraph 1, give access to all documents and other data media, shall make it available, on request, for a copy of the copy and shall provide the relevant cooperation, provided that this is necessary for the implementation of this Act by the relevant health insurers or bodies.
4 In the case of ministerial arrangements, detailed rules may be laid down in respect of the first, second or third members.
1 The in Article 88, first paragraph Health insurers and agencies, as well as the Wlz-exporters, shall be empowered to exercise their own movement and, upon request, within a time limit specified in that request, from the administration, to each other, under their responsibility, to one another. to that end by or because of them designated person or to a person designated by Our Minister, free of charge, the data, including personal data as intended in the Personal data protection law , to be provided that are necessary for the execution of the health insurance or of this law, or for the approximation of health insurance insured care and care insured on the basis of the Long-term care law .
2 A health insurer shall, at the request of the Centre Institute or the care authority, give access to all documents and other data media to persons designated by the relevant administrative body, shall make available to them on request. the taking of copies and the cooperation requested in respect of the exercise of his duties, provided that the relevant administrative body deems it necessary.
3 All officials responsible for the issue of extracts from registers of civil status shall be required to comply with: Article 88, first paragraph , the health insurer or authority referred to, to send the extracts from the registers free of charge, free of charge.
4 Colleges of colleges, wholly or partly with jurisdiction, shall, upon request, provide, free of charge, to a health insurer, to the CAK, to the Zorginstitute or to the care authority all information, information and extracts from or copies of statements, registers and other documents necessary for the implementation of this law by the health insurer or the relevant administrative body.
5 In the case of a general measure of management, detailed rules on the provision of data by the State Tax Administration to the health insurance companies shall be laid down.
6 In the case of ministerial arrangements, detailed rules may be laid down in respect of the first or second members.
1 The care authority, the Zorginstitute, can determine, after consultation with the Zorginstitute, the health care authority, which provides information and information regularly to be provided by health insurers.
2 The rules may include the time and manner in which the data and intelligence is to be provided, as well as that an auditor referred to in Article 393 of Book 2 of the Civil Code to confirm the accuracy of the information and information provided.
3 In the case of Ministerial Regulations, the statistical information collected by the health insurers in respect of forms of care and other services may be determined.
1 The Care Institute and the care authority inform our Minister of its own movement of information about developments that result or may lead to the failure of insured persons to be freely chosen between health insurers and those who are insured with care. offered variants of the health insurance scheme, or which could endanger the lawful and complete performance of healthcare insurance against policyholders or insured persons.
2 The Health Institute and the care authority provide the College Building or the College remediation on request, intended in the Health care institutions Act , the information and data required for the performance of their tasks.
3 The Care Institute and the care authority shall provide access to, and access to, business data and documents by a governing body referred to in the second paragraph, to the extent that it is reasonably necessary for the performance of their task.
1 A health insurer makes provision or receipt of data to or from individuals, to be indicated by the Zorginstitute, use of an electronic infrastructure.
2 The Institute of Care may lay down rules on the following rules:
a. the nature and extent of the data and the requirements to be met by the provision or receipt;
b. the manner in which the provision or receipt of data is carried out, including the connection of health insurers to the infrastructure;
c. the manner in which the use of the infrastructure is organised and managed, including the establishment and maintenance of a common database;
d. the financing of the use of the infrastructure and the way in which its costs are distributed.
1 It shall be prohibited any person who, by virtue of the application of this Law or of acts adopted by virtue of this Law, has performed or has completed any duties, prohibitions on any confidential information or information under that law or any information under that law. Title 5.2 of the General Administrative Law have been provided or obtained or received from De Nederlandsche Bank N.V. or the Foundation Financial Markets, to use, further, or otherwise to make use of, or otherwise known, than for the performance of his or her task, or are required under this law.
2 By way of derogation from paragraph 1, the care authority and the Zorginstitute may, using confidential information or information obtained in the performance of their tasks under this law, make communications, if they cannot shall be retraced to individual persons or undertakings.
3 By way of derogation from the first paragraph and in accordance with Article 1:89 of the Financial Supervision Act The care authority, the Zorginstitute, De Nederlandsche Bank N.V. and the Foundation for Financial Markets, where necessary for their duties, shall be entitled to each other and to our Minister confidential information or intelligence. provide separate insurers.
4. The first paragraph shall be without prejudice to the person to whom that paragraph applies:
a. the applicability of the provisions of the Code of Criminal Procedure which relate to a declaration of information or information obtained in the performance of the task assigned to it as a witness or expert in criminal matters;
b. the applicability of the provisions of the Law of Civil Procedure and from Article 66 of the Bankruptcy Law which relate to a declaration of information or information obtained in the performance of its position as a witness or party to a party or party in civil matters or as an expert in civil matters. the task assigned to it, in so far as it relates to information or intelligence on an insurer which has been declared bankrupt or has been decomposed on the basis of a court ruling;
c. the powers of the Court of Auditors pursuant to Article 91 of the Comptability Act 2001 , in so far as they are not Article 121 are limited.
5 The fourth paragraph, part b, does not apply to data or information relating to insurers involved in or having been involved in an effort to enable the insurer concerned to continue its business.
6 The Court of Auditors is the General Court of Auditors in the field of communications as referred to in Article 91, twelfth to fifteenth paragraph, of the Comptability Act 2001 , obliged to keep confidential, in so far as it relates to information and information which has become known to it under the fourth paragraph of point (c).
Any person who is responsible for the application of Article 45 of the Health Organisation Act receive information or intelligence for the purpose of providing timely alerts on risks for the purpose of meeting the obligation to comply with the obligation to comply with the obligations of the Article 11, first paragraph, part a This information shall be subject to the confidentiality of such information, except in so far as any provision of law requires it to be communicated to it.
1 The health insurer shall ensure that its policyholders and insured persons can submit disputes concerning the performance of the care insurance to an independent body.
2 The independent body takes a dispute only after the policyholder or the insured has asked the health insurer to reconsider his decision, and not to receive it within a reasonable period or not to the satisfaction of the policy holder or insured person has responded.
3 The independent authority shall seek advice from the Zorginstitute if the dispute relates to the care or other services referred to in Article 3 (2). Article 11 -or the reimbursement of such care or services.
4 The Care Institute shall send its opinion to the independent body within four weeks of receipt of the application for an opinion.
1 An insured person who, on behalf of his health care insurance, to designate in accordance with ministerial arrangement, or other services as referred to in Article 11 wishes to enjoy, provide to the person or institution that provides that care or service for inspection an identity document as intended Article 1, first paragraph, of the Law on identification of the identification , or any other document to be identified by ministerial arrangement, to determine its identity.
2 If the identity document cannot be provided immediately for inspection, the person or institution may allow the fulfilment of that requirement within a period of 14 days at the latest.
3 The person or institution shall, on the basis of the document provided for inspection, establish the identity of the person to whom the care or service referred to in the first paragraph is granted, and shall take it into account: Article 7 of the Act uses civil service number in care established civilian service number of the insured person in his administration.
4 [ Red: This member has not yet entered into force.]
1 An agreement with regard to the insurance of medical care or the cost thereof, concluded for an insured person with or for the benefit of who is also a health insurance policy, shall lapse from the day of the day on which the insurance Article 11 ensure that benefits are extended to the extent that the contract is derived from rights equivalent to those resulting from the care insurance scheme from that point in time.
2 The amount of the premium paid in advance for the contract, which has been cancelled wholly or in part by virtue of the first paragraph, shall be refunded by the insurer in accordance with the expired part of the contract, less than or equal to 25% of the amount of the contract. the amount to be recovered.
A clause of an insurer providing health insurance to supplement health insurance, bearing that health insurance ends or may be terminated by the insurer if with or for the benefit of the insured person, health insurance with another health insurer is closed, is void.
The powers that Article 91 of the Comptability Act 2001 the General Court of Auditors provides for legal persons referred to in paragraph 1 (d) of that Article in respect of the manner in which health insurers are subject to the proceeds of levies imposed by or under this Law to use.
A health insurer, in so far as it cannot be regarded as an undertaking within the meaning of Article 81 of the Treaty establishing the European Community, shall apply for the purposes of the Competition law Classified as an undertaking within the meaning of Article 1 of that Act .
1 The Care Institute provides contributions to healthcare providers who have revenue losses due to the provision of medically necessary care to:
a. Aliens as intended in Article 8 (f) or (h) of the Aliens Act 2000 , in so far as it concerns aliens pending a decision on an application for residence permit as intended. Article 14 of that Act Or aliens who are awaiting a decision on a statement of objection or a notice of appeal as a result of a decision to that effect and that procedure under the Aliens Act 2000 whether, on the basis of a judicial decision, in the Netherlands, and
b. Aliens as intended in Article 10 of the Aliens Act 2000 .
2 Under medically necessary care means care or other services as referred to in Article 11 of this law or in Article 3.1.1 of the Act on long-term care , with the exception of forms of provision of care or services to be indicated by or under general management, and only to the extent that the healthcare provider provides, given the nature of the performance and the expected duration of the stay of the service Stranger, medically necessary eight.
3 No contribution shall be granted to the extent that the cost of the care provided:
a. to the stranger or an insurer of the foreigner can be recovered,
(b) may be reimbursed on the basis of another legal provision; or
c. Higher than in Dutch market conditions reasonably appropriate.
4 If care is provided which are usually without reference, prescription or no indication as intended by the insured person General Law Specific Health Costs The contribution shall be as follows:
a. 100% of the costs associated with pregnancy and childbirth; and
b. 80% of the costs in other cases;
to the extent that those costs are not, or may not be, paid or excluded on the basis of the third paragraph.
5 In contributions referred to in the first paragraph for other care than the care provided for in paragraph 4, provision shall be made for the provision of such care between the Care Institute and care providers.
6 If a healthcare provider may provide for both care and care under the fourth paragraph as referred to in paragraph 5, an agreement as referred to in paragraph 5 may also extend to the care provided for in paragraph 4 and may, in the case of a healthcare provider, be covered by an agreement as referred to in the fifth paragraph. the agreement of the fourth paragraph shall be subject to different agreements.
7 The Health Institute shall send to our Minister annually before 1 October a budget of the costs of the contributions referred to in paragraph 1 for the following calendar year. If, during the year, there have been or are likely to arise from significant differences between the real and the significant income and expenses, the Zorginstitute shall forthwith inform our Minister, indicating the cause of the differences.
8 The amount available for contributions in a calendar year shall be fixed by Our Minister before 1 December of the year preceding that year.
9 The amount, referred to in paragraph 8, shall be covered from the national treasury and shall be administered and administered separately by the Centre Institute.
10 At the same time as the financial report on implementation tasks, Article 73a, first paragraph, part a , the Zorginstitute shall send to our Minister an annual report on the policy it has pursued in providing the contributions referred to in paragraph 1, the effectiveness of that policy and the implementation of the programme of work in this field. last calendar year.
11 The Articles 40, 2nd to 11 members , 72, second to fifth members , and 75, fourth member , shall apply mutatis mutandis.
12 The care provider who wishes to qualify for a contribution as referred to in this Article, provides the Zorginstitute or designated by that institute, in the execution of this article, to determine by ministerial arrangement information necessary for the determination of the right to and the extent of a contribution, or it shall make such information available for the purpose of inspection or for the taking of copies.
1 The nomination for a under Articles 11, third or 4th Member , 18aa, 1st Member 19, fourth and fifth members , 21 and 32, second paragraph , the general measure of management to be adopted shall not be more than four weeks after presentation to the two Chambers of the States-General.
2 The design for a under Article 18aa, first or second paragraph , or Article 18d, second paragraph, part d A ministerial arrangement to be adopted shall be submitted to both Chambers of the States-General. The ministerial arrangement shall be set not earlier than four weeks after the presentation of the draft.
Within five years of the entry into force of this Act, our Minister shall send to the States-General a report on the effectiveness and effects of this law in practice.
For the implementation of this law, detailed rules may be laid down in the context of a general measure of administration.
The articles of this Law shall enter into force on a date to be determined by royal decree, which may be determined differently for the various articles or parts of such articles.
This law is cited as: Zorginsurance law.
Burdens and orders that it will be placed in the Official Gazette, and that all ministries, authorities, colleges and officials who so concern will keep their hands on the precise execution.
Given at The Hague, 16 June 2005
Beatrix
The Minister for Health, Welfare and Sport,
J. F. Hoogervorst
Issued the fourteenth of July 2005The Minister of Justice,
J. P. H. Donner
