October 23, 2020

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Health insurer sedan must not reject “excessive grade” by default | Money

Health insurer sedan must not reject "excessive grade" by default | Money

This was established by the Dutch Health Authority (NZa) at the request of stichting Zorghuis. The health insurers Silver Cross, FBTO and Avéro were given the designation to stop this policy.

The health insurance companies appealed against this decision, but the Board of Appeal now ruled that nZa was right. Avéro has stopped offering refund policies in 2020, so the case is no longer so relevant to that party.

Price

Both Silver Cross and FBTO used price lists with maximum prices. They were rejected. Insurers set their maximum rates by an average of 25%. As a result, about 5% of the notes submitted were automatically marked as too high and rejected.

The Board of Appeal also considers that this cannot be automatically rejected. Finally, it is by no means certain that the 5% highest prices are, by definition, too high.

Refund policy

Customers who have a refund policy (with a free choice of doctor) should be compensated for their full care notes. A non-market-based care letter can be (partially) rejected, but it is then up to the health insurance company to prove that a price is extremely much higher than is usual on the market. This should not be done automatically.

Silver Cross and FBTO said they feared a sliding scale in which health insurers would have to accept ever higher rates if they were no longer allowed to reject the level. The college didn’t do that. The judgment is final.