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 package (‘restitutiepolis’) or in-kind package (‘naturapolis’)

With a restitution package, the reimbursement is usually higher than with an in-kind package. The premium for a restitution package is usually slightly higher, but you can choose a care provider yourself, the so-called free choice of care. With an in-kind package , the premium is generally somewhat lower, but you will only receive full reimbursement for care provided by contracted care providers.

In addition, there is a combination package , which is a combination between an in-kind package and a restitution package . For some types of care, a right to care applies (such as with an in-kind package ) and for other types of care, a right to reimbursement (such as with a restitution package).

A few years ago, the NZa tightened up the regulations regarding the names of packages. Packages may only be called a restitution package if they also fully reimburse the care provided by non-contracted care providers (unless the costs are very high). As a result, some packages that were previously restitution packages are now combination packages.

For the exact reimbursement it is best to contact your insurance company.

Deductible

The 2023 health insurance has (just like 2022) 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.