Acceptance of Supplementary Insurance in Amsterdam
The acceptance of supplementary insurance is the decision by a health insurer to approve your application for additional coverage. Unlike the mandatory basic health insurance, which must always be accepted, insurers in Amsterdam have no general obligation to accept supplementary policies. They may reject applications or impose restrictions, such as a medical examination or exclusion of pre-existing conditions. This article for Amsterdam residents explains how it works, your rights, and practical tips, including local advice from the Juridisch Loket Amsterdam.
Legal Rules on Acceptance
The acceptance rules are laid down in the Health Insurance Act (Zvw). For basic insurance, Article 11, paragraph 1 Zvw requires insurers to accept all applicants regardless of health status or age. This does not apply to supplementary insurance – whether individual or collective – as stated in Article 19 Zvw, which safeguards insurers' free market position.
Additional guidelines are provided by the Code for Insurance (CvdV) and Dutch Civil Code Book 7 (Articles 7:911 et seq. BW), focusing on transparency and fairness. Insurers in Amsterdam must clearly disclose their criteria and explain decisions. Medical underwriting is permitted, but discrimination on grounds of gender, ethnicity, or other factors is prohibited under the 2013 Amendment Act on Equal Treatment in Insurance.
Difference Between Basic and Supplementary Insurance
Here's an overview for clarity:
| Aspect | Basic Insurance | Supplementary Insurance |
|---|---|---|
| Obligation to Accept | Yes (Art. 11 Zvw) | No |
| Medical Examination | Not Permitted | May Be Required |
| Rejection Possible | Only for Fraud | Based on Health, Age or Risk Profile |
| Exclusions | Not Possible | Yes, for Pre-Existing Conditions |
| Trial Period | N/A | Sometimes 30 Days |
This illustrates why acceptance of supplementary coverage in Amsterdam is more complex.
Reasons for Rejecting an Application
Insurers weigh the risks. Common grounds for rejection in practice:
- Pre-Existing Conditions: Chronic conditions such as diabetes or heart issues.
- Age: Stricter from age 65.
- Prior Healthcare Costs: Significant past expenses.
- Incomplete Information: Failure to disclose conditions.
Amsterdam Practice: Mr. De Vries (55, from De Pijp) with rheumatism applies for dental coverage. After examination, the insurer excludes orthodontics; he accepts the policy.
Health Declaration and Examination
You typically complete a questionnaire; if risks are flagged, a medical exam follows. The ACM and CTR oversee proportionality and prevent unfair practices.
Your Rights if Rejected in Amsterdam
Application rejected? Your options:
- Request Reasons: In writing, under Art. 7:941 BW.
- File a Complaint: First with the insurer, then SKGZ.
- Explore Alternatives: Compare via tools for supplementary health insurance.
- Seek Assistance: Free advice from Juridisch Loket Amsterdam or court proceedings at Amsterdam District Court.
Be transparent: Non-disclosure may result in policy cancellation or premium repayment (Art. 7:928 BW).
Amsterdam Case Examples
Example 1: Young mother from Amsterdam-Noord with asthma receives physiotherapy coverage with a premium surcharge.
Example 2: Retiree from Oud-Zuid with cancer in remission: rejected for extra hospital coverage; basic insurance suffices.
Example 3: Student from the UvA neighborhood without issues: quickly accepted.
Acceptance depends on your personal circumstances in Amsterdam.
Frequently Asked Questions
Can an insurer simply refuse in Amsterdam?
Yes, without obligation to accept, but must provide reasons. Appeal via SKGZ or Juridisch Loket Amsterdam.
What about pre-existing conditions?
Exclusion or clause possible. Always disclose on application.
Is a medical exam mandatory?
Not always; CTR assesses necessity.
Switching period (1-31 December)?
Often more lenient, but check local conditions.
Tips for Amsterdam Residents
Boost your chances:
- Compare Providers: Via Independer or Poliswijzer; review acceptance criteria.
- Complete Fully: Provide honest health declaration.
- Local Advice: Call Juridisch Loket Amsterdam or visit the Municipality of Amsterdam for information.
- Start Early: Especially when switching.