In the series of InsureToStudy articles Crescenzia Biemans will discuss the pros and cons, background and the legislation behind the private insurance company InsureToStudy in the Netherlands. This article aims to inform Aruban students about the law that categorises them as 'temporary inhabitants' and the options that come with it. The main issue that will be touched upon is that students with Arubalening are prompted to sign up for this insurance without receiving information about the different possibilities.
Version in Papiamento available here.
When I moved to the Netherlands in 2013 I was excited, nervous and extremely clueless. Like most people my age, who have lived blissfully unaware of the real world while living in the comfort of our parents’ homes, I was unaware of the registration process. I was especially dumbfounded when I heard the terms kwijtschelding or huur- en zorgtoeslag. To ease my cluelessness, I decided to sign up for Arubalening so that the local host committee (plaatselijke opvang commissie) could help me with this whole ordeal. They helped us get our bank accounts, register into the country and they explained that we needed to be insured because if not we could be fined by the Dutch government. We were told to take the health care scheme provided by ONVZ brokered by Boogaard Assurantiën N.V. and that we could not get a public health care insurance, unless we worked during our studies. It was all extremely confusing and so the other students in Amsterdam and myself agreed to take whatever insurance was being given alongside our Aruban student loan.
Like most countries, the Netherlands provides its citizens with a myriad of insurance options. Essentially anyone who lives or works in the Netherlands is mandated by the law to take out a basic health insurance scheme that covers some of the most basic and necessary medical costs, such as those costs that arise from going to your general practitioner or dentist. If you fulfill the requirements of being a working Dutch citizen (above the age of 18) then you must take out a public health care insurance that guarantees the basic health care scheme. If you are an international student who does not have a part-time job, for instance, then you are not obliged to do this and are able to take out a private insurance.
Since 2015, the private health care insurance created for Aruban students has been given to a company named InsureToStudy B.V. The experiences with with the previous insurance broker ONVZ and InsureToStudy have been similar, and in many cases quite negative. Many students, including myself, have complained about the unrecognizability of the insurance by medical institutions and the issues this brings along with it. For this reason I sought to find out why Aruban students are prompted to take on a private health care provider instead of a public one like all other Dutch citizens. It seemed especially odd to me that Aruban students who have a Dutch nationality are eligible for housing allowance (huurtoeslag), taxation remission (kwijtschelding) and a myriad of benefits given by the Dutch welfare state, but not when it comes to health care. Why are we seen as international students if we have Dutch nationality, citizenship and education?
First of all, Aruban students fall under article 20 of the “Besluit uitbreiding en beperking kring verzekerden volksverzekering 1999”. This article states that persons who are in the Netherlands for study purposes only are not insured on the basis of the national insurance. They specifically mention students who before they moved to the Netherlands for study reasons lived in Aruba, Curaçao, Bonaire, St. Maarten, St Eustatius and Saba. When we called the Sociale Verzekeringsbank (SVB) during the summer, the person on the phone explained that Aruban students are not mandated to take out a public health care insurance, unlike other Dutch citizens, because they are not seen as permanent residents. Aruban students are thusly seen as temporary residents who only migrate for study reasons.
This rule has a few exceptions. Firstly, Aruban students who have a part-time job are required to take out a Dutch public healthcare insurance. This is the only concrete exception where they are not just given this right, but are also required to do so. But does this mean that the only way to get a public health care provider is by working? Technically no. This essentially means that only those who can show that they are in the Netherlands for reasons beyond just studying have the right to sign up for a public health care insurance. During my call with SVB, it was explained that a student can argue for this by working or showing that they’re ‘planting roots’ and are staying indefinitely by having children who are born there, getting married with a Dutch resident, buying property, etc. However, in reality, the insurance companies could still deny their services based on whether or not they truly believe the student is planning on working and or staying in the Netherlands after they graduate. Yet the chances of them denying a student who has argued for this is are low and there are many competitors to whom a student can go if one denies him or her service.
Aruban students who are not working and have a public health insurance cannot apply for ‘Zorgtoeslag’, which is a grant from the government to help pay for the high insurance cost (the costs range from 90 to 105 euros per month). Zorgtoeslag grants Dutch nationals (or those with a valid residence permit, who have Dutch public health insurance, relatively low capital and are above the age of 18) a maximum of 998 euros per year in 2016 and 1066 euros per year in 2017 to cover their insurance costs. Although most Aruban students meet all of these requirements, due the law mentioned above they cannot apply for this without risking a fine unless they are also working.
However, because the Dutch system is set up in this way, the Aruban government has created a private health care insurance for their students for more than 20 years already. Before 2015 this task was given to the Dutch health care provider ONVZ brokered by Boogaard Assurantiën N.V. Students were covered under the Basisfit Internationaal, Extrafit Internationaal and Tandfit B packages. The cost for this was 279,24 euros per quarter, which is 93,08 euros per month. This was paid indirectly by Arubalening, meaning that students would ultimately pay this back when they finished their studies at a 6% interest rate. This price (without calculating the additional interest rate) is comparable to that of the public health care providers, however, students cannot claim any Zorgtoeslag on it. There was no “eigen-risico” involved, but it was not always recognized by medical providers such as family doctors and hospitals. This inconsistency in recognizability was an issue since some students had no problems with coverage, while many other students had to pay the sum themselves and then claim it back from the insurance company.
With the introduction of InsureToStudy in 2015 the same issues remained, however, the monthly cost went down to 54,50 euros. This saves students 462,96 euros per year in comparison to ONVZ. For Aruban students who had a part-time job or internship, InsureToStudy offered a basic health insurance (basiszorgverzekering) through Turien & Co. that cost 75,80 euros in 2015 and 84,50 in 2016.
As of 2017 Turien & Co. is not the health care provider for these students. The new provider is HollandZorg. With the announcement of this change it could be seen that there is a severe lack in information given to students who are confused on how this insurance company is set up. Sharrity Oduber, a student living and working in Rotterdam, explained that she has not had a negative experience with InsureToStudy, but she believes there was a lack in transparency with this transition. She explained that when she asked for the policy conditions she was denied this information. She was told that firstly she would have to sign the contract and that HollandZorg did not want to disclose this information publicly so that other persons do not attempt to get this attractive ‘deal’ seeing that the deductible is bought off. She believes that it is her right as a client to know what her policy conditions will be before she signs in order to ensure that she will be receiving the same coverage. According to article 17 lid 6 of the Zorgverzekeringswet the health care provider must give a model agreement where the rights and duties of the customer are stated and the basis of the premium is derived from the health care policy. She has already signed and is yet to receive the model agreement and health care policy granted by HollandZorg. According to article 9 lid 1 of the same law, the health care policy must be sent as soon as possible after a client has signed for their insurance.
Before we get into the issues surrounding InsureToStudy, we need to take a look at the benefits as well. Firstly, InsureToStudy is cheaper than a Dutch public health care insurance and covers additional costs that are usually not covered, such as a 150 euros for eyeglasses and contact lenses. This is 50 euros more than most of the public health care providers in the Netherlands. They also cover the expenses of flying when parents, siblings, registered partners, grandparents and children have passed away. The coverage of such expenses are important for foreign students because they are then guaranteed to be able to go home if they are faced with the loss of a family member. Furthermore, InsureToStudy has no “eigen-risico”, which translates to deductible rate, for the medical procedures they cover. The government mandated eigen-risico is a maximum of 385 euros per year and can only be charged to people who have a basic package at their Dutch health care provider. This isn’t charged when you go to your family doctor, but it may be charged if you go to a specialist or to the hospital. If you come into a situation where the whole 385 euros has to be charged, the sum is divided by the amount of months left and is charged monthly to lessen the payment burden.
Although the responses of students’ experiences with this company are mixed, there were a few who reported to be very pleased with the company due to these reasons. Daniella Arends, a fellow Fuentera, explained that her experience with InsureToStudy has always been positive. They have covered multiple lab tests, physiotherapy and even medical care in Aruba. When it came to paying these institutions, all she had to do is scan the receipt, email it to them and then they would pay the institution directly for her. This positive experience was also showcased by Kiara Van Trikt, a student in Amsterdam. She explained that they covered the costs of her eyeglasses and her fysiotherapy therapy. Furthermore, she likes the speediness with which they reimburse her the costs.
Our fellow Fuentero, Haischel Dabian, explained that his experience with InsureToStudy was quite the opposite. “InsureToStudy was a bad experience for me because each time I went to a medical institution my insurance would not be recognized. I decided to leave InsureToStudy after I had a severe accident, where my hand had to be operated on after a car hit me while I was biking to school. I got picked up by the ambulance and when they took me to the hospital they told me that there were issues with my insurance and if this could not be resolved, I would have to pay everything myself. InsureToStudy was unreachable and I had to go through Arubahuis in order to resolve my insurance problems. You can imagine that that was the last thing I wanted to be doing at that moment. To this day, which is more than a year later, I have received multiple invoices valued at 2334,68 euros (the last invoice arriving on the 10th of December 2016) for the hospital costs of this accident. Each time I received an invoice I have emailed or called to ensure that they will pay, but they still have not done this.”
So, now let’s look at the cons of having InsureToStudy. The company is not recognized by most medical institutions, such as hospital, dentists, family doctors and specialists. Students have to either send the receipt via email to the company or they have to pay the sums themselves and claim it afterwards. It lasts approximately 3 work days for the payment to be reimbursed. If someone lands in the hospital, for example, and cannot pay the sum themselves at that moment, they then need to call the insurance provider and ask them to contact the hospital to see if they can arrange the payment directly. In the weekends they are not open, so if it’s an emergency, they are unreachable. This is time consuming, inefficient and, to some, an overall hassle. The company does not cover for instance vaccinations, profilax, contraception, HIV/aids, pre-existing conditions or essential cosmetic surgeries.
If a student is able to get zorgtoeslag, it is then more expensive to stay with InsureToStudy than with a public health care provider. If someone is paying a 104,50 euros for Friese Boeren en Tuinders Onderlinge (FBTO) for example and received 88,83 euros per month back from the government, they are only paying 15,67 euros each month. This is 38,83 euros less each month. Even if for some reason the student has to pay part of or the whole eigen risico back, their monthly cost would still be lower than taking InsureToStudy.
Another issue that many students have complained about is the difficulty of unsubscribing from this insurance company. Some have explained that they were told by InsureToStudy that the insurance cannot be removed after the 1st of January of each year and others, including myself, have been told that it is required for students who have Arubalening. Viviana Lopez, who is currently pursuing a masters in the Netherlands, explained that when she canceled her contract with InsureToStudy, they still charged her for about three months, regardless of her efforts to prove that her insurance had been canceled. A few days ago they charged her and other students who had canceled their contract again when they automatically signed them up after the switch had been made to HollandZorg.
The biggest issue lies within the lack of information given by InsureToStudy and the Aruban institutions that prompt us to take this insurance, while not thoroughly explaining the different options that students have. Student should know that InsureToStudy is not their only option seeing that there are many other private insurances that have created policies that cater to international students. Furthermore, this distinction of Aruban students that is made in the Dutch law is an important topic that will be discussed in a further article.
The decision of whether to stick to InsureToStudy or to choose a public health care provider, such as FBTO or Unive, lies on what each student believes to be more important - extensive recognition or extra coverage without eigen-risico. A Dutch public health care provider is universally recognized and has many competitors with differing prices, but can be expensive if the student is not eligible for zorgtoeslag or if the student needs medical attention that requires them to pay an eigen-risico sum. While InsureToStudy, on the other hand, has no eigen-risico and covers students thoroughly, it is not recognized by most medical institutions and requires additional effort of the student themselves. In the following article we will explore the rocky origins of InsureToStudy and the controversies surrounding the public procurement.
Would you like to share your experience with InsureToStudy? Comment bellow.
Contributors: Thalia Malmberg.
Translation to Papiamento: George Thiel.