Acceptance of Supplementary Insurance in Leiden
The acceptance of supplementary health insurance is the decision by your health insurer to approve your application for additional coverage. Unlike the mandatory basic health insurance, which must always be accepted, insurers for supplementary policies in Leiden and surrounding areas have no general obligation to accept everyone. They may reject applications or impose restrictions, such as a health check or exclusion of pre-existing conditions. This article for Leiden residents explains how it works, your rights, and practical tips, including local advice from Het Juridisch Loket Leiden.
Legal Rules on Acceptance
The acceptance rules for supplementary health insurances are set out in the Health Insurance Act (Zvw). For basic insurance, there is an absolute acceptance obligation under Article 11, paragraph 1 Zvw: insurers in Leiden must accept everyone, regardless of health status or age. For supplementary coverage, such as dental or physiotherapy policies, this does not apply, as stated in Article 19 Zvw. This gives insurers freedom in their market choices.
Additional guidelines come from the Code for Insurance (CvdV) and Dutch Civil Code Book 7 (articles 7:911 et seq. BW), which require transparency and fairness. Insurers must clearly state their criteria and explain rejections. Medical selection is allowed, 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 | Possibly Required |
| Refusal Possible | Only in Case of Fraud | Based on Health, Age or Risk Profile |
| Exclusions | Not Possible | Yes, for Pre-Existing Conditions |
| Trial Period | N/A | Sometimes 30 Days |
As you can see, acceptance of supplementary insurance in Leiden involves more nuances than basic coverage.
Reasons for Rejecting an Application
Insurers assess risks. Typical grounds for rejection for Leiden residents include:
- Pre-Existing Conditions: Chronic issues such as diabetes or heart problems.
- Age: Stricter policies over 65.
- Prior Healthcare Costs: Significant expenses in the past.
- Incomplete Information: Failure to disclose health issues.
Leiden Case Example: Mr. Jansen (55, from Leiden-Noord) applies for dental coverage with rheumatism. The insurer requires an examination and excludes orthodontics due to his history. He accepts the policy with the exclusion.
Health Declaration and Examination
You usually complete a questionnaire with your application. If risks are identified, a medical examination follows. The ACM and CTR (Central Assessment of Risk Selection) oversee proportionality and prevent unfair practices.
Rights Upon Rejection for Leiden Residents
Rejected? Here are your options:
- Request Reasons: Demand written explanation (art. 7:941 BW).
- File a Complaint: First with the insurer, then with SKGZ.
- Seek Alternatives: Compare policies using online tools.
- Legal Assistance: Contact Het Juridisch Loket Leiden for free advice or involve the District Court of Leiden in disputes.
Always be honest: non-disclosure can lead to policy cancellation or premium repayment claim (art. 7:928 BW).
Case Examples from the Region
Example 1: Young Leiden mother with asthma gets physiotherapy coverage with a premium surcharge.
Example 2: Retiree from Leiden-Zuid with cancer in remission: rejection for extra hospital coverage; basic often suffices.
Example 3: Student at Leiden University without issues: quick acceptance.
Acceptance depends on your personal situation.
Frequently Asked Questions
Can an insurer just refuse in Leiden?
Yes, without an obligation, they can on risk grounds, provided it is motivated. Appeal via SKGZ or Het Juridisch Loket Leiden.
Possible with pre-existing condition?
Yes, but with exclusion or clause. Disclose everything honestly.
Examination mandatory?
Not always; CTR assesses necessity.
Switching period (1-31 Dec.)?
New insurers are more lenient; check local terms.
Tips for Leiden Residents
Improve your chances:
- Compare Providers: Via Independer or Poliswijzer; check acceptance criteria.
- Complete Fully: Be transparent about health.
- Local Advice: Visit Het Juridisch Loket Leiden or Municipality of Leiden for support.
- Apply Early: Especially outside switching period.