You pay monthly for the basic health insurance (these costs depend on the insurance package you chose). Next to that, if you as an adult, receive special care, it may be that you have to pay for ‘own risk’ (eigen risico). That means the first 385 euro of special care costs, you have to pay yourself.
Most insurances offer to insure also this amount or pay it in advance in smaller parts per month. In this way you prevent unexpected high bills.
The basic health insurance pays for the basic costs, and all visits to the family doctor (huisarts) are covered. Also, the costs for care for children. However, when you as an adult receive special care (for example if you go to the hospital, a therapist or when you need medicines) you will have to pay for the first 385 euro of costs yourself. This is called own risk (in Dutch: eigen risico).
This own risk, is ...
⇒ per individual 18+;
⇒ counts per calendar year; so, every year after January 1st, the insurance starts counting again.
The own risk, does NOT count for ...
⇒ kids, their basic care costs are always covered by the basic insurance
⇒ the costs to go to the family doctor (huisarts) are also covered by the basic insurance
⇒ the care costs which are covered by your extra health insurance (aanvullende zorgverzekering). If you have it
How do you pay for Own Risk?
In most cases, the insurance first pays the bills directly to the pharmacy or hospital. Later you pay the first € 385 (or a part of it if the bills are not that high) back to your health insurance. You will receive bills for that. If you need more than € 385,- worth of care, then the insurance will pay the extra costs. Note: sometimes it can take long before you have to pay these bills, after the full year.
Spread Own Risk Costs! You can ask your insurance to pay your own risk in parts, before or after something happens, spread over a several months. Ask for this option at your insurance company BEFORE January 1st. In this way you prevent to have to pay the own risk all at once. Spreading payments prevents financial problems.
Why is there ‘Own Risk’?
⇒ People will be more aware of the care costs if they have to pay themselves in the start. So, everyone has to assess if the care they receive is really necessary.
⇒ The care costs are payed partly by the people that need care. In this way the basic health insurance stays affordable for everyone.
Always check if your family doctor prescribes medicines, contraceptives and/or further research, if you have to pay for them later. Or if you reached the maximum coverage for that year. Sometimes waiting or clustering care treatments can be smart.