These changes apply to the basic health insurance ZEM Policy

• Exercise therapy for people with severe rheumatoid arthritis reimbursed

  If you are limited in daily life by severe rheumatoid arthritis, exercise therapy will be reimbursed under the basic health insurance policy from 2025 onwards. This is because research has shown that the therapy works well. Only people with a severe functional disability qualify for reimbursement. This care is paid out of the excess.
• Exercise therapy for COPD reimbursed, with no maximum number of treatments

  From 2025 onwards, there will no longer be a maximum to the number of exercise therapy treatments that are reimbursed for insured persons with COPD (stage ll or beyond). This will allow more suitable care to be provided in a better way. This care is paid out of the excess.
• Convalescent care following COVID-19 no longer reimbursed

  Paramedical convalescent care following COVID-19 will no longer be reimbursed under the basic health insurance policy. Studies have shown that the therapies have no proven positive effect on patients. Insured persons who are currently undergoing a course of treatment that started before 1 July 2024 will still receive a reimbursement to complete the treatment until 1 January 2025 at the latest.
• New: reimbursement for mental health care intake interview

  From 2025 onwards, people who are struggling with their mental health or related problems, such as debt or loneliness, will be reimbursed for an ‘intake interview’. If there is any doubt about the right approach to take concerning the mental health issues, the GP can use the outcome of the intake interview to call on the help of mental health care experts, social domain experts and experiential experts at an early stage. The aim is to help insured persons get the right kind of help earlier and to reduce waiting lists in mental health care. This interview is not paid out of the excess.
• Change to conditions for the reimbursement of rehabilitation care for the elderly

  From 2025 onwards, rehabilitation care for the elderly (geriatric rehabilitation) will be reimbursed more frequently under the basic health insurance policy. For example, the condition that you must have been hospitalised first will no longer apply. You will also be able to start rehabilitating at home from 2025 onwards. A geriatric care specialist will assess whether geriatric rehabilitation is the most appropriate care for you.
• Change to conditions for orthodontic treatment in the case of a severe developmental or growth disorder

  If you need to visit an orthodontist for treatment of a severe developmental or growth disorder in the tooth, jaw and mouth system, you may visit a dental surgeon instead from 2025 onwards.
• Support during prenatal screening reimbursed from the national budget

  Pregnant women may continue to avail themselves of support during prenatal screening, but from 2025 onwards this will be reimbursed from the national budget instead.
• Consent needed for dental treatment with a T or G code for patients aged up to 18

  If you need to take your child to the dentist for treatment with a T or G code (severe periodontitis and jaw defects), you will need our prior consent from 2025 onwards. Your dentist can apply to us for this consent.
• Reimbursement for fall prevention as part of a group

  From 2025 onwards, insured persons with an increased risk of experiencing a fall who qualify for a fall prevention movement intervention may use OTAGO and In Balans interventions as part of a group.

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• Health insurance
• Reimbursements