Dutch health insurance: choosing a zorgverzekering

Dutch health insurance trips people up in two opposite ways. Some leave it for months, because the four-month deadline sounds like free time. Others panic in week one and buy the first policy an app suggests. The rules are simpler than they look, and most of the real choice comes down to one question: how much you care about picking your own doctors.

Our guide to moving to Amsterdam covers insurance in a few paragraphs, in the order it fits into your first weeks. This is the long version. Who actually has to insure, how the four-month clock really works and what happens if you miss it. Then how to choose a zorgverzekering you won't regret when the November letter arrives.

Two quick notes before we start. This is friendly guidance from people who've been through it, not insurance, tax or medical advice. And several figures here reset every January, so we say where a number is current and where a change has already been announced. Almost all of it is national, so it holds outside Amsterdam too.

Who has to take out Dutch health insurance

The legal hook is the Wlz, the Dutch long-term care act. If you're insured under it, the law says you must also take out a zorgverzekering, the basic health policy, with a Dutch insurer. Most people who live or work here are Wlz-insured, which is why you'll hear the short version: everyone who lives or works in the Netherlands.

Living here means more than having an address. The SVB, the social insurance bank that decides who's covered, looks at how long you're staying and why you came. Registering with the gemeente doesn't settle it on its own. Coming to study or to stay with family usually doesn't make you insured, but taking a job here usually does.

Working here counts too, even if you live across the border. The conditions are that your work is actually done in the Netherlands, you don't also work in another country, and you weren't posted here by a foreign employer. If you're not an EU, EEA or Swiss national, you also need to be here on the right permits.

The exceptions are narrower than most people hope:

• Your employer is based abroad. The government describes this as the only case where your insurance from home can be enough, and the SVB has its own rules on it.
• You work only for an EU institution. You're covered by the EU's own sickness scheme and can't take out a Dutch policy. Take on any other paid work here and that changes.
• You're an international student who doesn't work. It depends on where you're from. Any paid job alongside your studies, even a few hours a week or a zero-hours contract, makes Dutch cover compulsory.

If you can't tell which side of the line you're on, ask the SVB for a Wlz assessment, an onderzoek Wlz. The outcome is your proof either way, and it's what the authorities go on if you think you're exempt.

The four-month deadline, and why it isn't a free trial

You have four months from the day the obligation starts to take out a policy. For most people that's the day they arrive to live here, or the day they start work.

Here's the part people miss. Take out a policy inside those four months and it's backdated to day one, and so is the premium. You pay for the months you waited, and in return any care you had in that time is covered. The four months is a window for the paperwork, not a holiday from paying.

Miss the window and the rule flips. You're not insured retroactively, you only pay premium from the day you sign, and every bill from the gap is yours. A broken wrist in month three is a nuisance. In month five, it's a hospital invoice in your own name.

Waiting on a residence permit? While the IND, the immigration service, hasn't decided your application, you generally can't take out a Dutch policy at all. Once the permit is granted, your cover has to start from the date it comes into force, and the premium is backdated to that date. If a letter about being uninsured arrives while you're still waiting, ask the SVB for a Wlz assessment straight away.

In practice, sort it out in your first few weeks, once the gemeente has given you your BSN, the citizen service number everything here runs on. When the sign-up form asks for a start date, use the day your obligation began, usually your arrival or first working day, rather than today. There's no prize for leaving it to month four.

If you miss it: what the CAK does

The CAK is the government office that makes sure everyone who should be insured is. Once you're registered with a gemeente and no insurer has you on its books, the CAK writes to you. From there it runs in a fixed order:

1. A letter. You get three months to take out a policy, or to show you don't need one with an SVB Wlz assessment.
2. A first fine if you do neither. It's set at roughly three months of what an average adult spends on cover and excess, which is a little over €500 right now. You can pay it in three instalments.
3. A second fine of the same size if you're still uninsured three months after the first.
4. Insurance on your behalf. After the second fine, the CAK takes out a policy in your name and withholds the premium from your salary or benefit for twelve months.

Keep two things in mind. A fine doesn't replace the insurance, so you still have to take out a policy. And asking for an assessment or objecting doesn't pause the fine. You pay it, and it's refunded if the SVB decides you never needed Dutch cover.

On the money side, the government is clear that you don't owe backdated premium for the months you were uninsured. Any medical bills from that period, though, stay with you.

The basic package is the same everywhere. The policy isn't.

The government decides what goes into the basisverzekering, the basic package. It covers care from your GP, hospital and specialists, most medicines, mental health care and maternity care. Every insurer covers that same list, and none of them can turn you down for it, whatever your age or health.

What you're actually choosing comes down to three things:

• The price. Insurers set their own premiums for the same package.
• The network. Which doctors, hospitals and therapists the insurer has contracts with.
• What you get back outside it. How much of the bill is paid if you see someone without a contract.

Service matters too, and for most of us so does how easy the insurer is to deal with in English. Ask before you sign, not when you have a claim. It's also worth asking your employer whether there's a collective scheme. It's the same basic policy, sometimes with a discount or extras agreed for the group.

As for cost, the government's working figure for the average premium is in the region of €160 to €170 a month per adult, and insurers price around it. A couple pays it twice. Our guide to what it really costs to live in Amsterdam shows how it sits next to rent and everything else.

Natura or combinatie: the choice that decides your doctors

This is the decision that matters most if you want care in English, and it's easy to skim past on a comparison site.

With a naturapolis, the insurer picks providers and signs contracts with them. Go to one of those and the care is simply paid. Go to someone outside the network and the insurer may pay a lower amount, and how much lower is written in the policy. A budget policy is a natura policy with a smaller network or lower payouts, which is why it's cheaper.

A combinatiepolis mixes the two models. For some types of care you need a contracted provider to be fully covered. For others you can choose freely and still get a full or near-full reimbursement. Which care falls on which side differs per insurer, so read the table in the policy conditions rather than the headline.

You'll still read about restitutiepolissen in older guides. These let you go to any provider and claim the bill back. They've disappeared from the market, and existing ones were moved onto combinatie policies. If an article tells you to buy one, it's out of date.

For newcomers, this is where it gets personal. Plenty of us want a GP, a psychologist or a physio we can talk to properly in English. That provider may or may not have a contract with your insurer. On a natura policy, going outside the network can leave you paying a real share of every bill. Before you choose, check these:

• The specific practice. Search the insurer's provider list for the exact practice you want to use, not just the type of care.
• The percentage for non-contracted care. It's in the policy conditions, and it varies more than the premium does.
• Mental health care separately. The Dutch call it ggz, and combinatie policies often treat it differently from the rest of the package.
• Contract ceilings. Some contracts cap how much care a provider can deliver in a year. Late in the year, that can mean a wait or a bill.

If you're looking for an English-speaking psychologist in Amsterdam, ask them which insurers they have contracts with before your first session. It's a normal question, and they'll be used to it.

Eigen risico: the excess you pay first

The eigen risico is the compulsory excess. Every adult pays for their own basic-package care each year up to that amount, and only then does the insurer start paying. The government sets it nationally and reviews it every year. It's €385 right now, and it has been announced at €400 for the next policy year. Children under eighteen pay none.

What doesn't count towards it is as useful to know as the amount:

• Outside the excess: GP care, including the out-of-hours GP service. Also midwife and maternity care, district nursing, and certain structured care for diabetes, chronic lung disease and cardiovascular risk.
• Counts towards the excess: specialists, hospital care including A&E, most prescription medicines, ambulance transport, and blood tests, even when your GP is the one who ordered them.

That last point catches people. A GP visit is free at the point of use, but the blood test that comes out of it isn't, until you've used up the excess for the year.

You can also raise the excess voluntarily, in steps of €100 up to €500 extra, in return for a lower monthly premium. At the current rate that means up to €885 out of pocket in a bad year. It's a bet. It can make sense if you're healthy and have savings to cover the full amount. It usually doesn't if you have an ongoing condition, regular prescriptions or a baby on the way. If the excess lands all at once, ask your insurer for a payment arrangement.

Aanvullende verzekering: the optional extras

The basic package leaves some everyday things out. For adults that means routine dental care, ordinary glasses and contact lenses, and most physiotherapy. For a condition on the government's chronic list, physio is covered from the twenty-first treatment, so you usually pay the first twenty yourself. Children are better covered: dental care until eighteen, and a set number of physio treatments.

The aanvullende verzekering is the top-up policy that pays towards those, usually up to a set amount a year. It's optional, and it works differently from basic cover:

• An insurer can refuse you for a top-up, though very few still ask medical questions.
• There can be waiting periods. A crown, for example, might only be covered once you've been insured for six months.
• You can buy the top-up from a different insurer than your basic policy, though a standalone one can cost more.
• It doesn't touch your eigen risico, which only applies to the basic package.

Do the sums before you add one. Compare what the top-up costs over a year with what you'd realistically claim. If you already know you'll need regular treatment, find an English-speaking dentist or physiotherapist in Amsterdam first. Ask what a typical year costs, then choose the cover to match.

Zorgtoeslag: the allowance worth checking

Zorgtoeslag is a government contribution towards your premium for people on lower incomes, and it also helps with the excess. It's paid by the benefits arm of the tax office, and a lot of newcomers never check whether they qualify.

You need to be eighteen or over, have a Dutch health policy and be lawfully resident. Your income and savings also have to sit under the limits. Right now the income limit is about €41,000 a year on your own, or about €51,000 together with a toeslagpartner, the partner the tax office counts with you. There's a separate ceiling on savings. All of these are reset every January.

The income that counts is your taxable income for the whole year, not your gross salary. That matters if part of your pay is tax-free under the 30% ruling. It also means you give a full-year figure even if you only arrived in September.

A few practical points:

• Residence status. EU, EEA and Swiss citizens need a valid residence status, which the gemeente passes on. Everyone else needs a residence permit that gives a right to allowances.
• A partner abroad. If your partner has no Dutch policy, you get half the allowance, but their income still counts.
• Timing. It can start from the date you became obliged to insure. You apply once your policy is in place, online through Mijn toeslagen with your DigiD.
• It's an advance. You get it based on the income you expect. If you earn more than you estimated, you'll pay some back, so keep the figure honest.
• Late claims. You can still claim a year's allowance until the end of the following year.

Switching insurer: November to 31 December

Health policies run per calendar year, and so does your chance to change. Before 12 November, insurers publish next year's premiums and conditions, and you'll get a letter with yours.

You then have two ways to switch. Take out a new policy by 31 December and the new insurer cancels the old one for you. Or cancel your current policy yourself by 31 December and take out the new one before 1 February. It's then backdated to 1 January, so there's no gap. That's the one-month grace period people talk about.

If you'd rather stay with the same insurer but move to a different policy, for example from natura to combinatie, do that by 31 December too. Outside that window you're normally locked in for the year.

Switching mid-treatment is less risky than it sounds. The bill goes to the insurer you had when the treatment started, and any approvals from your old insurer carry over to the new one.

If you've just arrived, the four-month rule applies whenever you land. You don't wait for January to get covered, and you can still switch in your first November if your first choice turns out wrong.

Your huisarts is a separate step

A health insurance policy doesn't come with a GP. You register with a huisarts, a family doctor, yourself, normally at a practice close to where you live. Do it early. A practice can turn you down if its list is full or you live too far away, and you don't want to be ringing round with a fever.

The huisarts is the gatekeeper to the rest of the system. For a specialist or hospital appointment you generally need their referral, and without one you may end up paying yourself. A GP only refuses a referral when they don't think it's medically useful, and they have to explain why. Some care needs no referral at all, including physiotherapy, dietitians and the dental hygienist, unless your policy says otherwise.

If you can't find a practice with space, call your insurer. They have a legal duty to make sure you can get the care you're insured for, and they can help you find a practice through zorgbemiddeling, their care-mediation service. Our moving guide puts the GP step in order with the rest of your first weeks.

A newcomer's checklist

In the order that works:

1. Week one. Register at the gemeente and get your BSN. Most of what follows waits on it.
2. If you're not sure you're covered by the obligation. A foreign employer, a posting, study without a job or a pending permit all count. Ask the SVB for a Wlz assessment now, not after a CAK letter.
3. Weeks one to four. Decide between natura and combinatie, check the providers you care about, and choose your excess.
4. Well inside four months. Take out the policy. Expect the first bill to include the backdated months.
5. The same day. Add your children. It costs nothing, but it isn't automatic.
6. Once you're insured. Check zorgtoeslag if your income is anywhere near the limit.
7. Straight after. Register with a huisarts near home.
8. If your employer offered the 30% ruling. It runs on its own four-month clock from your first working day, so don't let it slide either.
9. Every November. Read the letter from your insurer, compare, and switch or adjust by 31 December.

How Locallista helps

Most of this you can do yourself in an evening. What makes it heavy is the Dutch small print, the official letters, and doing it all in the same month as a flat hunt and a new job. Some of the vetted English-speaking bureaucratic services in Amsterdam on Locallista list healthcare registration among their services, covering the insurer, the huisarts and the zorgtoeslag application.

Locallista is a directory of English-speaking local service providers in Amsterdam. Every business is screened before it's listed and reviews are phone-verified, so the ranking reflects real expat experience rather than who paid the most. It's free to browse and free to get in touch.

Frequently asked questions

Do I need Dutch health insurance if I'm still insured in my home country?

Almost always, yes. The obligation follows where you live and work, not your passport, so cover from home doesn't replace it once the Netherlands is where you live or work. The main exception is an employer based outside the Netherlands, and staff of EU institutions have their own scheme. If you're unsure, the social insurance bank can assess your position, and its decision is your proof either way.

What happens if I take out insurance after the four months?

Your cover starts on the day you sign, not the day you arrived. You don't owe premium for the gap, but any care you had in that period is yours to pay. If you're registered with the gemeente, the government office that checks insurance will also write to you, and ignoring that letter leads to fines.

Can I see an English-speaking doctor or therapist on a natura policy?

Yes, but check the contract first. If the provider has a contract with your insurer, the care is paid as normal. If they don't, a natura policy may only reimburse part of the bill, and the percentage is in the policy conditions. Ask the practice which insurers they work with before your first appointment, especially for mental health care.

Do I pay the eigen risico when I see my GP?

No. Visits to your huisarts, including the out-of-hours GP service, sit outside the excess. The catch is what the GP sends you on to. Blood tests, most prescription medicines and anything at the hospital do count towards it, even when your GP ordered them.

Do my children need their own health insurance policy?

They need to be insured, but it costs you nothing. Children under eighteen pay no premium and no excess, and you add them to your own policy with your insurer. It isn't automatic, so register them when you take out your own cover. At eighteen they take out a policy of their own.

When can I switch to a different health insurer?

Once a year. Insurers announce next year's premiums and conditions in November, and you switch by taking out a new policy by 31 December, which cancels the old one for you. If you cancel yourself by 31 December, you have until the end of January to take out the new one, backdated to the first of the month.