What is the excess?

If an employee receives care that is covered by the basic healthcare insurance policy, they must pay a certain amount, their ‘excess', towards the costs of the care. The amount of the compulsory excess is set by the government: €385. The compulsory excess applies to all individuals from age 18.

Excess included under AV-ZEM supplementary insurance

The AV-ZEM policy also covers the compulsory excess of €385. This means that your employee will not have to pay any invoices for their excess. In other words, no uncertainty, no hidden costs. This supplementary insurance is only available for employees who participate in group insurance via employment agencies that have a contract with ZEM.

What costs are subject to excess?

Most of the healthcare costs that are reimbursed under the basic healthcare insurance policy count towards the excess. However, there are a number of exceptions.

• Healthcare costs subject to excess

  • Ambulance

  • Mental healthcare

  • Medicines including pharmacy costs that are not on the list of preferred medicines.

  • Costs incurred by organ recipient (see also the list below)

  • Oral care

  • Nicotine replacement substances and medication to help you quit smoking. The smoking cessation programme does not count towards the excess.

  • Laboratory costs

  • Paramedical care (such as physiotherapy, speech therapy, remedial therapy)

  • Thrombosis service

  • Hospital care

  • Care for persons with a sensory disability

  • Seated patient transport

• Healthcare costs not subject to excess

  • General practitioner care and care claimed via the GP as part of multidisciplinary care

  • Contraceptives for persons aged between 18 and 20

  • Behavioural support to help you quit smoking

  • Combined Lifestyle Intervention (CLI)

  • Medicines on the list of preferred medicines (NB. Pharmacy costs do count towards your excess)

  • Borrowed aids (however, your excess applies once you become the owner of the aid concerned)

  • Maternity care

  • Medication check by a contracted pharmacist

  • The necessary specialist medical care following organ donation, until 3 years after the intervention (see also the list above)

  • Donor's travel expenses for organ donation (see also the list above)

  • Obstetric care

  • Nursing and care

  • Foot care for diabetes types 1 and 2 (Care Profile 2 or higher)

What is a personal contribution and what types of care does it apply to?

For some healthcare costs under the basic insurance employees need to pay a personal contribution. The government decides the amount of the personal contribution and the types of healthcare that it applies to. The personal contribution is not the same as the excess.

• Care for which you employees need to pay a personal contribution

  content invoegen

Check the personal contribution rates in the Policy Conditions.