Acceptance of Supplementary Insurance in Utrecht
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 Utrecht 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 informs Utrecht residents about how it works, your rights, and practical tips, including local support through Het Juridisch Loket Utrecht.
Legal Rules on Acceptance
The acceptance rules for supplementary health insurances are set out in the Health Insurance Act (Zvw). The basic insurance is subject to an absolute acceptance obligation under Article 11, paragraph 1 Zvw: every application must be accepted, regardless of your health status or age. This does not apply to supplementary coverage, such as dental or physiotherapy policies, as stated in Article 19 Zvw. This provides insurers with market freedom.
Additional guidelines come from the Code for Insurance (CvdV) and Civil Code Book 7 (Articles 7:911 et seq. BW), which require transparency and fairness. Insurers must disclose criteria in advance and explain rejections. Medical underwriting is permitted, but discrimination based on gender, ethnicity, or other protected grounds is prohibited (Amendment Act on Equal Treatment in Insurance 2013).
Difference Between Basic and Supplementary Insurance
Here is an overview of the key differences:
| Aspect | Basic Insurance | Supplementary Insurance |
|---|---|---|
| Acceptance Obligation | 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 table highlights why acceptance of supplementary insurances in Utrecht is more complex than for basic coverage.
Reasons for Rejecting an Application
Insurers assess risk factors. Common grounds for rejection include:
- Pre-existing conditions: Chronic issues such as diabetes or heart problems.
- Age: Stricter policies over 65.
- Prior healthcare costs: High expenses in the past.
- Incomplete information: Undeclared health issues.
Utrecht Case Example: Mr. Jansen (55) from the Lombok neighborhood in Utrecht applies for dental supplementary insurance despite having rheumatism. The insurer requires an examination and excludes orthodontics. He agrees and receives the policy with that condition.
Health Declaration and Examination
You usually complete a questionnaire with your application. If risks are identified, a medical exam follows. The ACM and CTR (Central Risk Selection Testing) oversee proportionality. CTR prevents unfair practices through registration.
Rights for Utrecht Residents in Case of Rejection
Received a rejection? Here are your options:
- Request motivation: Demand a written explanation (Art. 7:941 BW).
- Complaints procedure: First with the insurer, then SKGZ.
- Alternative provider: Compare via online tools for supplementary health insurances.
- Legal assistance: Contact Het Juridisch Loket Utrecht or the Utrecht District Court for free advice.
Your obligations: Always be honest. Non-disclosure can lead to policy cancellation or premium repayment claim (Art. 7:928 BW).
Utrecht Case Examples
Example 1: Young mother from Utrecht-Noord with asthma gets physiotherapy coverage with a premium surcharge.
Example 2: Retiree from Kanaleneiland with cancer in remission: rejection for extra hospital coverage; basic often suffices.
Example 3: Student from Utrecht city center with no issues: quickly accepted without examination.
These cases show that acceptance depends on personal factors.
Frequently Asked Questions
Can an insurer just refuse in Utrecht?
Yes, without an obligation, they can on risk grounds, provided it is motivated. Appeal via SKGZ or Het Juridisch Loket Utrecht.
With a pre-existing condition in Utrecht?
Exclusion or clause possible. Disclose everything; non-disclosure is risky.
Do I have to undergo an examination?
Not standard, but for high-risk coverage. CTR checks necessity.
Switching period (Dec 1-31)?
New insurers often more lenient, but check Utrecht-specific terms.
Tips for Utrecht Residents
Improve your chances of acceptance of supplementary insurance:
- Compare providers: Via Independer or Poliswijzer; check acceptance conditions.
- Complete fully: Be honest about health.
- Local advice: Het Juridisch Loket Utrecht offers free help with applications.
- Consider group policies: Via employer or Municipality of Utrecht, sometimes more favorable.