With some types of care, your care provider will first have to apply for permission (authorisation) from ZEM. Below is an overview of the types of care concerned, and of the application procedure.

Your care provider submits the application

Your care provider knows for which types of care an authorisation is required. This may depend on our agreements with that particular care provider. It is the care provider who submits the application to us.

What types of care require prior permission?

The types of care for which you need prior permission (before the start of treatment) include the following:

• specific medicines

• care aids

• seated patient transport

• scheduled treatments abroad

• surgery (incl. plastic surgery)

• special oral care

• district nursing for more than 12 hours

• speech therapy

If an authorisation is required, the Policy Conditions will say so.

The authorisation procedure

1. Your care provider arranges the authorisation form, completes it and sends it to ZEM. He or she will provide the authorisation form, so there is no need for you to do anything.
2. We will respond to the application within 15 working days, by sending a letter to you and to your care provider. Sometimes we need additional information from the care provider so as to properly assess the application. We may also decide to submit the application to our medical adviser. In both cases, we may need more than 15 days to inform you and your care provider about the application.
3. If we decide to grant permission, you and your care provider will receive a letter from us specifying the care to which the permission applies. The authorisation may come with restrictions in terms of time, money and quantities and may differ between one type of care and another.
4. We will also write you a letter to inform you in the event we have decided not to grant permission. In that letter we will explain our reasons for rejecting the application.

Read more

• View Reimbursement Overview