Changes to BES health insurance claims as of 1 July 2021

A number of elements of the BES Healthcare Insurance Claims Regulation [Regeling aanspraken zorgverzekering BES] (Raz BES) are going to change on 1 July 2021. The changes relate to the clarification of a number of claims, while additional text and requirements have been added to a number of stipulations.

Specifying a number of articles also makes the reimbursements less arbitrary and instead makes it completely clear what is reimbursed and what not.

The following is a selection of the amended articles.

For the detailed description of all amendments please refer to: https://www.officielebekendmakingen.nl/stcrt-2021-33699.html

 

Treatment that is eligible for reimbursement

Dental treatment

Insured parties are entitled to a mouth disinfection procedure if this is essential for medical treatment. You need to get permission for this in advance.

Contribution by pensioners to long-term care

The current amendment means that the entire pension amount is no longer paid to the care institution. Instead, the insured party can retain part of the amount (to be used as pocket money and clothing money).

Contraception

The reimbursement of contraceptive devices has been broadened to include reimbursement for vaginal hormonal rings.

 

Clarification and additional requirements

Second Opinion

If an insured party has any doubts about treatment provided by a care provider, a second opinion can be requested from another care provider in consultation with the care provider in question and the BES Healthcare Insurance Office. The second opinion must be provided in the Caribbean part of the Kingdom and is a one-off consultation exclusively on the basis of the details contained in the medical file provided by the insured party. A second opinion can be requested via the referrer.

Primary psychological care

In order to be eligible for reimbursement of primary psychological care, a clear diagnosis (disorder) must have been made in accordance with the Diagnostic and Statistical Manual of Mental Disorders (DSM–5). Serious symptoms which are expected to require more than nine treatment sessions do not fall under primary psychological care, but under medical-specialist care instead.

IVF treatment

The definition of IVF treatment has been brought into line with the definition in the Dutch Health Insurance Decree [Besluit Zorgverzekering]. Consequently, it is now clear that the reversal of sterilization is not part of IVF treatment and therefore not eligible for reimbursement.

Eye laser treatment

Eye laser treatment to correct long-sightedness or short-sightedness, so that the insured party no longer needs glasses or lenses, is not reimbursed.

Medical pedicures

Applications for medical pedicures will have to be accompanied by a substantiated diabetic foot risk classification, as referred to in the Diabetic Foot Guidelines [Richtlijn Diabetische Voet] of the Federation of Medical Specialists [Federatie Medisch Specialisten].

Physiotherapy and remedial therapy

The reimbursements for physiotherapy and remedial therapy have been amended on the basis of reimbursements in the European Netherlands.

Speech therapy

Applications must fulfill certain requirements. This element of the Raz BES has been clarified. The Raz BES now also states that speech therapy care does not include care needs relating to language problems that can be resolved in regular education, such as bilingualism or language delays.

Wigs

Wigs will only be reimbursed if a medical disorder or medical treatment is the cause of permanent or long-term full or partial baldness.

Raz BES

For more information about the BES Healthcare Insurance Claims Regulation [Regeling aanspraken zorgverzekering BES] (Raz BES) 2021 please click the following link: https://wetten.overheid.nl/BWBR0029442/

Legal validity

The texts referred to and presented here are intended to be general information for the populations of Bonaire, Saba, and Sint Eustatius and no rights can be derived from them.

RCN

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