KNM: Health Insurance and Eigen Risico Explained Simply

Healthcare is one of the most important KNM topics. The Dutch system is based on mandatory private insurance, and understanding how it works — especially the eigen risico — is essential for both the exam and daily life.

The Zorgverzekeringswet (Health Insurance Act)

The Zorgverzekeringswet (Zvw) requires every person who lives or works in the Netherlands to take out a basisverzekering (basic health insurance) from a private insurance company. This law has been in effect since 2006. You choose your own insurer — companies such as Zilveren Kruis, CZ, Menzis, or VGZ — but the basic coverage package is determined by the government and is the same regardless of which insurer you choose.

Basisverzekering (Basic Insurance)

The basisverzekering covers essential medical care: visits to the huisarts (GP), hospital treatment, specialist care, most prescription medications, maternity care, mental healthcare, and ambulance transport. You pay a monthly premium (premie), which varies between insurers but is typically between 120 and 170 euros per month. Children under 18 are insured for free under a parent’s policy. Insurers cannot refuse anyone for the basic package, regardless of health status.

Eigen Risico (Mandatory Deductible)

The eigen risico is the amount you must pay out of pocket each year before your insurance starts covering costs for certain treatments. In 2025, the eigen risico is 385 euros per year for adults aged 18 and older. Children under 18 have no eigen risico.

What is exempt from eigen risico: Visits to the huisarts (GP), maternity care and obstetric support, and healthcare for children under 18 do not count toward the deductible. You pay nothing extra for these.

When you do pay eigen risico: Specialist care (e.g., a referral to a cardiologist or dermatologist), hospital admissions, most prescription medications, mental healthcare beyond the GP, and medical devices are all subject to the deductible. You pay the first 385 euros of these costs yourself per calendar year.

You can choose to raise your eigen risico voluntarily (up to 885 euros) in exchange for a lower monthly premium, but this means more out-of-pocket risk if you need care.

Aanvullende Verzekering (Supplementary Insurance)

Beyond the basisverzekering, you can buy aanvullende verzekering (supplementary insurance) to cover things not included in the basic package, such as dental care for adults, physiotherapy sessions beyond a limited number, glasses or contact lenses, and alternative medicine. Supplementary insurance is optional, and insurers can refuse applicants for these packages.

Zorgtoeslag (Healthcare Allowance)

If your income is below a certain threshold, you may qualify for zorgtoeslag — a monthly subsidy from the Belastingdienst/Toeslagen to help pay your health insurance premium. You apply via the Toeslagen portal using your DigiD. In 2025, the maximum zorgtoeslag was approximately 154 euros per month for single individuals.

Switching Insurers

Every year, you can switch health insurance companies. The deadline is January 1: if you want to change, you must cancel your old policy and sign up with a new insurer before the end of the year. The new policy starts on January 1. November and December are the period when insurers publish their new premiums and packages.

Related Guides

• KNM Healthcare Practice Questions
• KNM Complete Guide