The care performance model ‘Zorgprestatiemodel’
Charging for mental healthcare
In ‘het zorgprestatiemodel’, mental health treatments are paid for as separate care services.
The system for calculating and reimbursing healthcare costs regulates what the treatment may cost and how your care provider must charge for it. It is not about the type of treatment you get or how you get it.
Rate: The healthcare provider bases the rate on the time that was set aside for you in the agenda, even if the consultation actually was a little longer or shorter.
If you are in touch with your healthcare provider several times in one day by email or a chat session, then this may be invoiced as one consultation.

‘Het zorgprestatiemodel’
Your treatment in mental healthcare consists of ‘care services’. The care services are listed on the invoice that the healthcare provider sends to you or your healthcare insurer.
This way, it is clear which treatment you or your health insurance company will pay for.
The treatment that you get will not change. But it will be easier for you to check the bill. You can see exactly who you spoke to during a consultation and how much time was charged. The bill will also be sent sooner, for instance in a month’s time.

Type of healthcare required ‘Zorgvraagtypering’
In the old system, it was the diagnosis that often determined the costs of treatment. This is no longer the case in the new way of charging. Your healthcare provider records the type of care required in ‘het zorgprestatiemodel’. The type of care provides information about the care you require. Your healthcare provider can use it when drawing up a treatment plan, for instance.
The type of care does not determine the price of the treatment.
Instead it is the care services that you are given that determine the price.
During your treatment, your healthcare provider may redefine the type of care required to make the change clear. The type of care required is stated on the bill.
There are 8 types of healthcare. Type 1 to 4 (and sometimes 5) are equal to generalist basic mental health (gb-ggz). Types 5-8 are equal to specialized mental health care.

Referral letter
To receive reimbursement of costs from your insurance company, you will need a referral letter from your general practitioner.
Insurance companies want the referrals to meet certain requirements.
You can check whether your referral meets the requirements, by studying the information mentioned below.
The following needs to be mentioned in your referral letter:
• Is there a reference to either BG-GGZ or S-GGZ?
• What is the hypothesis about the diagnosis or which is the disorder suspected by the general practitioner that is registered in DSM 5 and that meets the requirements for eligibility for reimbursement?
• Is the date of referral mentioned?
• Is there an official stamp and signature of the general practitioner?
You will find some examples of a referral letter of either B-GGZ or S-GGZ down below:
• example referral letter ‘generalistische basis GGZ
• example referral letter ‘specialistische GGZ’

Reimbursement basic insurance
In 2025, there will be no health insurance policies that offer a 100% restitutie/reimbursement policy.
With a restitutie policy 100% of the NZa rate was reimbursed.
The NZa rate must be stated on the invoice by the healthcare provider.
For policies of health insurance companies with which our practice has not a contract, our practice accepts policies that reimburse a percentage of 70% or more of the rates set by the NZa for diagnosis and treatment by the basic psychologist, general health psychologist, psychotherapist and clinical psychologist.
For the remaining percentage that is not reimbursed, the practice will offer a leniency arrangement in 2025, whereby you do not have to pay these costs yourself
If you register in 2025 and you do not have a policy that reimburses this percentage, we can discuss this with you
If you have chosen a budgetpolicy than, in 2025, you can’t come to our practice for treatment. You can study the website of your health insurance company where you can go for treatment.

Ask for the reimbursement % of the NZa tarive. The health insurance company gives the percentage of ‘het gemiddeld gecontracteerd tarief’. It is unclear how high that rate is and how high it is compared to the formally established NZa tarive.
This is important if you have to pay extra.

Health care not reimbursed by the ‘Zorgverzekeringswet’ (Zvw; health care Insurance company)
Additional care product ‘overig zorgproduct ‘(OZP) S-GGZ
Treatment of certain problems will not be reimbursed according to the healthcare insurance agreements and thus are not eligible for reimbursement.
Partner – relationship therapy will not be reimbursed. The exception to this is when an underlying psychological problem is the cause of relationship problems. In this case your general practitioner can write you a referral letter.
Relationship therapy sec, work problems and adjustment disorders will not be reimbursed.
Treatment of problems that are not reimbursed under the ‘Zorgverzekeringswet'(Zvw; Health Insurance Act) is not offered in our practice.

The bill
The healthcare provider does or does not have a contract with your health insurance company.
2.1. When there is a contract with the health insurance company, the costs will be reimbursed by the health insurer.
When there is a contract with the health insurance company, the declaration takes place via Vecozo.
There is a contract with: DSW, Stad Holland.
2.2. When there is not a contract with the health insurance company
You will receive a bill each month.

Responsibility:
You are responsible for the choice of the health insurance company and the insured package of your policy and therefore for the extent to which the healthcare is reimbursed by the health insurance company. If you have any questions about reimbursements, please contact your health insurer. We also like to think along with you.

Terms of payment
The terms of payment apply to all parts and arrangements.
You are responsible for the payments.
www.zorgwijzer.nl/vergoeding/psychologie

Cancelling
In case of foreclosure or change in appointment, you are required to give notice of this
24 hours prior to the appointment, either by phone (voice mail) or email. If you do not cancel an appointment 24 hours beforehand the associated costs will be charged.

Conditions and rate no-show:
The rate for no-show is equal to the rate for the missed appointment.

ZPM rates NZa
The prices can be found on the Dutch page about reimbursement of costs.