What is the difference between a deductible and a copayment?
- Deductible The deductible is the amount you must pay out of pocket each year for care covered by basic health insurance. In 2025, the mandatory deductible is €385. Only after you’ve paid that amount will the health insurer reimburse the rest. You can choose to increase your voluntary deductible. In exchange, you’ll pay a lower monthly health insurance premium. For people who regularly need specialized eye care or checkups (such as those with an ocular prosthesis), it’s unwise to increase the deductible. There’s a good chance you’ll have to pay the full deductible every year anyway.
Example: Your ocular prosthesis needs to be polished, and this is covered by basic insurance. The bill is €160. If you haven’t yet reached your deductible through healthcare costs, you’ll have to pay this €160 yourself. - Copayment A copayment is something different: it’s a portion of the costs that you always pay yourself, even if you’ve already reached your deductible. The amount of the copayment depends on the type of care or medical devices.
What are the exceptions to the deductible?
Not all healthcare costs are subject to the deductible. In the Netherlands, there are a few important exceptions. This means that you will always be reimbursed for these healthcare costs under your basic insurance plan, without the deductible being applied.
Healthcare costs not covered by the deductible:
- Primary Care
- Obstetric Care and Postpartum Care
- Child Care for Children Up to Age 18
- Eyeglasses and contact lenses are covered only if there is a severe vision problem that cannot be corrected with a standard product. Many parents choose supplemental insurance when they know their child will need eyeglasses or contact lenses.
- Follow-up Examinations and Population Screening Programs
- Assistive Devices on Loan
- Community Nursing, if Medically Necessary
What types of ocular prosthesis care are covered by basic health insurance?
Basic health insurance covers:
- Fitting and making the first ocular prosthesis following eye surgery or an accident.
- Periodic replacement of the prosthesis (usually once every 2 to 3 years, depending on your situation).
- Medical checkups with a doctor or specialist.
- Necessary adjustments to the prosthesis, such as those required due to changes in the eye socket.
Please note: Polishing or minor repairs are also covered under basic insurance, but this may vary by insurer. The deductible also applies to these costs.
Which costs are not covered?
- Faster Replacement: Sometimes you may want a new prosthesis sooner, for example, because your eye socket has changed and a different prosthesis would look better. The ocularist can contact the insurance company about this.
- Special dentures: These include special colors, extra finishes, or a spare set for vacations.
Do the same conditions apply to plastic prosthetic eyes as to glass prosthetic eyes?
The ocularists in the Netherlands who specialize in plastic prostheses (Axel Franken, Frédérique Bak, Rob Roeleveld, and Jelmer Remmers) have contracts with all health insurers. In principle, the eye prostheses they create are covered 100 percent by basic health insurance. The situation is different for the ocularist who specializes in glass prostheses (Benjamin Flettner). He does not yet have contracts with all health insurers. These insurers usually want to receive a quote from Benjamin first, after which they determine the reimbursement percentage. So check with Benjamin to see if your health insurance plan has a contract with him; otherwise, you’ll have to pay for the consultation with Benjamin out of pocket, after which you can submit a claim to your health insurer. In the case of non-contracted care, insurers typically reimburse 75% to, in some cases, 100% of the cost of a glass prosthesis. The reimbursement amount depends heavily on your policy. Therefore, always contact your health insurer before your first appointment.
Is there one health insurance provider that’s best for people with an ocular prosthesis?
Not really. For contracted care, all health insurers reimburse 100% of the costs, with no copayment, but it does count toward your deductible. The reimbursement for a glass prosthesis may be different. When choosing health insurance, it’s also always important to clearly understand what other types of care you expect to need and to determine which health insurer and policy best suits those needs. It’s always a good idea to research this thoroughly. For example, you can check out zorgverzekering.nl
