Is rehabilitation in a clinic covered by your health insurance?

If you are seeking help for an addiction and considering treatment in a rehab clinic, it is important to know what reimbursement options are available. In the Netherlands, these costs are often fully covered by the basic insurance, but there are some exceptions and conditions.

This article discusses coverage through your health insurance, including the deductible, and highlights specific clinics. Additionally, we cover additional insurance, the WMO, Youth Care, and special assistance. Finally, we address reimbursement options for treatments abroad, such as in Scotland and South Africa.

Reimbursement of costs from your health insurance

If you seek help for an addiction, the costs for treatment in the Netherlands are fully covered by the basic insurance. You do not need additional insurance for this. This also applies if clinical admission is necessary.

These addiction treatment costs are directly billed by the clinic to your health insurer. However, to qualify for reimbursement, it is important to have a referral from a recognized healthcare provider, such as your general practitioner.

Castle Craig and Jellinek

At the Castle Craig rehab clinic, every Dutch person receives treatment fully reimbursed. However, there are exceptions: if you are insured with ENO, the costs for a treatment at Castle Craig are not covered. All other health insurers do provide coverage.

If you are insured with VGZ or Menzis, you can only be treated at the Castle Craig clinic in Scotland after getting approval from your health insurer. For CZ-insured individuals, treatment is only possible at the Dutch branch of Castle Craig.

Treatments at Jellinek (Arkin) are reimbursed by all Dutch health insurers.

Deductible

Note your deductible, which is mandatory at € 385 in 2024. If you haven’t used up your deductible, you must pay the first € 385 yourself before your health insurer reimburses the remaining costs (source: Fundamentum).

How does the deductible work exactly? In the Netherlands, every adult (18+) with health insurance is required to pay an annual deductible of € 385 unless you have opted for a higher amount. This deductible applies to costs that fall under the basic package of health insurance. When receiving medical care, you contribute to part of the costs, depending on your deductible.

The amount you actually pay is reduced by the costs you have already incurred for medical care throughout the year. Visits to the GP and district nursing are excluded from the deductible. The deductible mainly applies to specialized care, including treatments at rehab clinics.

The costs for admission to a rehab clinic, therefore, vary per person but will never exceed the deductible of at least € 385. This means that regardless of the specific costs of treatment, you pay a maximum of this amount out of pocket.

Contact your health insurer

Healthcare financing can be complex. For questions about reimbursements and your deductible, you can contact your health insurer.

You can also use the handy tool from GGZinterventie, where you easily select your health insurer and immediately see the extent to which treatment (in the Netherlands or Portugal) is reimbursed.

If you experience problems with your health insurer, such as disputes over reimbursements, you can seek help from the Healthcare Complaints and Disputes Foundation (SKGZ).

Other possibilities

There are also other options to receive reimbursement or assistance for the care you need.

Additional insurances

In addition to the basic insurance, there are additional insurances that sometimes offer extra coverage for addiction care. These insurances can reimburse, for example, luxury facilities or alternative treatment methods that fall outside the basic insurance.

WMO

Another option is to receive a contribution from the municipality through the Social Support Act (WMO). The WMO can support the costs of addiction care, especially when there is a combination of care needs, such as guidance and residential care. This law is aimed at promoting independent living and participation in society. Often, a personal contribution applies, depending on your income and wealth (source: National Government).

Youth Care

For young people under 18, addiction care falls under the Youth Act. Municipalities are responsible for organizing and financing youth care, including treatments in a rehab clinic (source: National Government).

Special assistance

In special circumstances, where care costs are not fully covered by insurance or the WMO, special assistance may be requested from the municipality for additional financial support (source: National Government).

For personal advice and to check which reimbursements specifically apply to your situation, it is wise to contact your health insurer, municipality, or a care advisor. You can also contact the Consumers’ Association for useful information and guides on health insurance and reimbursements abroad.

Rehabilitation reimbursement abroad

Many health insurers also reimburse the costs of clinical treatments abroad. During the intake interview, it is carefully assessed which treatment best suits your situation, which may lead to advice for clinical treatment abroad. The foreign clinic will then submit an authorization request to your health insurer, who will then decide whether the treatment will be reimbursed.

Planned care

When a Dutch insured chooses to go abroad for care, this falls under planned care. The reimbursement options depend on the country where the care is received. The Health Insurance Act (Zvw) offers worldwide coverage. This can relate to an EU or EEA country, or a country with which the Netherlands has a bilateral agreement. However, there are also countries, such as the United States or Russia, with which the Netherlands does not have agreements on healthcare reimbursements. If you wish to receive care abroad that is also available in the Netherlands, it is advisable to request permission from your health insurer in advance.

Not always complete coverage

When undergoing treatment abroad, consider the costs for plane tickets and possibly transport to the clinic. Some clinics also offer aftercare programs, for which extra costs often apply, usually ranging from € 500 to € 1,500 per month.

Although most health insurers reimburse the costs of clinical treatments abroad, in some cases only part of the costs is covered, particularly if it concerns non-contracted clinics.

Scotland and South Africa

As you have read above, you can be helped at Castle Craig at their location in Scotland if you are insured with VGZ (Univé, IZA, IZZ, UMC, Zekur, Bewuzt, MVJP, and Zorgzaam Verzekerd) or MENZIS (AnderZorg, HEMA, and PMZ). However, you must first obtain approval from your health insurer.

At Recovery Mental Healthcare, a recognized mental health institution, the costs of treatment in South Africa can also be reimbursed.

It is advisable to consult your health insurer’s website for information about reimbursements for care abroad. Check the policy conditions and coverage options for foreign care. Zorginstituut Nederland also provides information about international treaties.

Conclusion

Obtaining the right care for addiction is largely covered by the basic insurance, but there are important nuances, such as the deductible and specific conditions with certain health insurers and clinics. In addition to the basic insurance, additional options like the WMO, Youth Care, and special assistance can provide extra support.

If you are considering treatment abroad, it is essential to thoroughly research the conditions and limitations and seek prior approval from your health insurer.

While the financial aspect can be complex, there are often suitable solutions available to receive the necessary care without unexpected costs. Make sure you are well-informed to make your recovery as smooth as possible.