Rates

What is Generalist Basic GGZ and Specialized GGZ?

GGZ (Mental Health Care) is a system with a Generalist Basic GGZ (GB-GGZ) and a Specialized GGZ (S-GGZ).

A distinction is made between the degree of intensity of the problems and the required care.
The treatment of mild to moderate, non-complex psychological problems takes place by a (GZ) psychologist or therapist in the GB-GGZ. You can think of issues such as stress, burnout, depression, trauma, panic attacks, etc.

If the psychological problems are more serious and more complex, the treatment will take place in Specialized GGZ. The S-GGZ is characterized by a high degree of complexity of the treatment, which requires specialized knowledge. You can think of the deployment of a psychiatrist, EMDR therapist, etc.

When are you eligible for reimbursement?

To be eligible for insured care from the GB-GGZ or S-GGZ, you must meet a number of conditions:

• You need a referral from your doctor.
• There must be an appropriate diagnosis.
• The coordinating practitioner must be registered in the BIG register.
• Psychologen Amsterdam must have a quality statute and a practice ‘AGB’ code.

The quality statute of Psychologen Amsterdam can be found on the website and the AGB code is mentioned in the quality statute. An AGB code is a national (unique) code with which the care provider can be recognized.

You must bring your doctor’s referral with you to your first appointment with one of our healthcare professionals. After the intake, the practitioner will draw up a treatment plan and discuss it with you during the next consultation. An indication is also given of the required number of consultations (this number can be expanded during the interim evaluation if necessary). If you agree with the treatment plan, the treatment will be started.

There are certain symptoms that may have a psychological character, but the treatment of these symptoms are not covered by the basic insurance. This is the case if you do not have an ‘appropriate’ diagnosis, such as:

• psychological symptoms if you do not have (yet) a mental disorder;
• problems at work, such as burnout or stress;
• relationship problems;
• a parent-child relationship problem, abuse, mourning, study problem, identity problem, acculturation problem, religious problem or life phase problem;
• adjustment disorders;
• sleep disorder;
• a phobia, unless it is a situation that often occurs and guidance from the general practice does not help enough or if you are afraid of, for example, blood or injections;
• sexual dysfunctions, for example erection problems.

Ask your health insurer for the complete overview!

Reimbursement of this care is sometimes eligible via the additional health care insurance (alternative medicine or psychological care supplement). Ask your health insurer.

From 1 January 2022 you will no longer receive reimbursement per package, but for the care actually provided. Although GB-GGZ no longer has packages, profiles are still used when establishing the diagnosis and treatment plan:

Basic GGZ short
Basic GGZ medium
Basic GGZ intensive
Basic GGZ chronic

The applicable profile within GB-GGZ is stated on the invoice. Profiles are not used within S-GGZ.

The note also shows:

• the duration of the consultation;
• the type of consultation (diagnosis or treatment);
• the type of practitioner;
• the setting (monodisciplinary or multidisciplinary);
• the amount of the consultation.

Unfortunately, not all health insurers use the rates set by the Nederlandse Zorgautoriteit (NZa). Health insurers increasingly use the average rate for which they have purchased care from contracted care providers and call this the average contracted rate. The rates therefore differ per health insurer.

Restitution policy (‘restitutiepolis’) eliminated as of January 1, 2025
Choice between an In-Kind policy (‘naturapolis’) or a Combination policy (‘combinatiepolis’)

With an in-kind policy, healthcare is fully reimbursed, but only if the healthcare provider has a contract with your insurer. If you choose a provider that is not contracted by your insurer, you will need to pay a certain percentage of the bill yourself.

With a restitution policy, which will no longer be available after January 1, 2025, you had the freedom to choose any healthcare provider, also known as free choice of care. The insurer would fully reimburse the care, even if the provider did not have a contract with them.

A few years ago, the NZa tightened the regulations regarding the naming of policies. Policies could only be called a restitution policy if they offered 100% coverage for non-contracted care providers (unless the costs were exceptionally high).

As a result, each year, more insurers stopped offering restitution policies. As of January 1, 2025, no insurers will offer such policies anymore. This effectively marks the end of the restitution policy.

In recent years, a combination policy has been introduced, effectively replacing all restitution policies. This is a mix of an in-kind policy and a restitution policy. For certain types of care, a right to care applies (as with an in-kind policy), and for other types of care, you are entitled to reimbursement (as with a restitution policy).

The reimbursement rate for non-contracted care with a combination policy is generally higher than with an in-kind policy. For specific reimbursement details, it is best to contact your insurance company.

Deductible

The 2025 health insurance has (just like 2024) a compulsory deductible of € 385,– per calendar year. This deductible also applies to psychological care, regardless of whether or not the practitioner has contracts with health insurers.