Epidermolysis Bullosa Home Care Standard care plan Financing benefits

When a provision is needed, the question arises which provisions are available under which conditions and what regulation and procedure applies to them. This module explores these questions.

Provisions and allowances

Provisions are aids, adaptations and measures for people who are restricted as the result of a chronic disease or handicap. There are several kind of provisions, which each have a separate regulation for reimbursement:

• Provisions for housing and transport

For these an appeal should be made to the council that may grant provisions under the terms of the Health Care Provisions Act (WVG).

• Provisions for work and schooling, such as commuter

transport or adaptations to the workplace.

The industrial insurance board may offer help for these by granting provisions under the terms of the General Disablement Act (AAW). Civil servants can go to their pension fund for work provisions.

• Care provisions (all sorts of aids)

For care provisions people can apply to their health insurer.

• Supplementary benefit

When the extra costs, as a result of a chronic disease or handicap, are not reimbursed under the terms of benefits mentioned above, people may apply to the General Social Security Act (ABW) in their local council.

• Tax-deductible unusual charges

In certain cases, when large expenditure caused by illness or handicap is not reimbursed, it might be deducted from the tax return as unusual charges

Principle

Guiding principle for the allowance of a provision is that the provision has been requested by an individual patient. That means that people might apply for a contribution towards the costs for, for example, the broadening of a front door but not for the alteration of a communal (outside) door of a block of flats.

A provision will only be granted when the applicant has to rely on it for a longer period of time. When, for example, someone temporarily needs a wheelchair, an application may be submitted but the allowance will not be granted. In this situation, an appeal should be made to the home care organisation or home nursing service (kruisvereniging) who will lend the aids for a specific period of time (usually up to six months). When it is not clear how long the handicap will be present, the council makes agreements with these organisations.

The provision must not be communal either. An example of a communal provision is: a phone, central heating, a cooking ring or a bicycle. These provisions are generally not reimbursed. Allowance for adaptation of these provisions, however, may be granted to enable the applicant to use them optimally.

Decision time limit

When a specific provision has been applied for, the councils, industrial insurance boards or health insurers are generally obliged to make a decision within two months. When the council, industrial insurance board or health insurer need more time to attend to the application, the person involved will be so informed. A new term, in which the decision will eventually be taken, will also be set.

Procedure of objection

If the person involved does not agree to the decision taken by the council or industrial insurance board or when the decision is not taken within the term that was agreed, a notice of objection should be submitted. The notice of objection should be, after the decision has been made known or after the term has elapsed, submitted within six weeks to the executive body that has taken the decision or is going to do so. The notice of objection should include why the person involved does not agree with the decision (a copy of the decision should be sent along) and how the executive body should decide on the application involved. In most cases an opportunity will be granted to give a verbal explanation of the objections during a hearing of the executive body.

The description of the different benefits includes how a procedure of objection can be started.

For care provisions which have to be reimbursed by the health insurer different rules apply.

If the health insurer refuses the provision, advice must be asked first from the Medical Insurance Board about the lawfulness of the rejection, before the person involved can start a procedure of objection.

Appeal

If the objections are overruled, the person involved may lodge an appeal with the court within six weeks (administrative law department). If the person involved disagrees with the judge, again an appeal may be lodged with the Central Court of Appeal within six weeks. If the person involved appeals or demands a temporary provision, legal charges must be paid.

It is important to know that the appeal will not be dealt with until legal charges have been paid. If the person involved is partially or fully put in the right, the legal charges will be reimbursed by the executive body that took the incorrect decision about the application.