Frequently Asked Questions
You can visit the ZJCN desk for:
- Claiming medical expenses
- Changing general practitioners
- Changing your personal details
- Requesting proof of registration
- Extending policies and documents
- Filing a complaint
No, supplementary insurance with ZJCN is not possible.
Insured persons do not have to pay in advance for services provided by contracted care providers, such as your GP, local hospital or pharmacy. Services by care providers are reimbursed by ZJCN. However, you must have your sedula with you at all times for identification purposes. Note: keep an eye on the expiration date of your sedula. You are not entitled to free care if your sedula is expired.
People can only register with the ZJCN care administration office if they lawfully reside on one of the islands. This means that such people have a sedula / ID card, a Declaration of Admittance by Law (in Dutch: Verklaring van Rechtswege), or a temporary regular or a permanent residence permit.
People who have an employment contract with a local employer and who receive wages under this contract which are subject to the Wet Loonbelasting (BES Wage Tax Act) can register for the duration of the employment contract. You must provide an employer's statement to register with the ZJCN. The employment contract must have a duration of more than three months.
It is important that you first register with a general practitioner. You can subsequently register with the ZJCN with aforementioned documents (of proof).
Do not forget to cancel any other healthcare insurance.
Unless otherwise stated, entitlement to prescription glasses and contact lenses other than as referred to in Article 1.7.10 of the BES Health Insurance Claims Regulations, up to a maximum amount of $170 per three years for insured persons aged eighteen or older, and of up to $170 per year for insured under the age of eighteen.
See also: Changes in BES Healthcare Insurance claims as of January 1st, 2020
General practitioner services
It is possible to change general practitioners as per 1 April and 1 October. Your change must be registered in the system before that date. You must come to ZJCN for this or download the form here and return it to ZJCN.
Your companion himself/herself must arrange for time off from his/her employer to accompany you. Accompanying someone is done on a voluntary basis. It depends on the employer whether or not leave is granted for this.
This is not always possible. Should you wish to change your companion, we ask that you contact ZJCN.
Your referring physician submits a request to ZJCN. If this request is complete and has been received with the correct documentation, this will be assessed by the Medical Advice department. If the request is approved, ZJCN will contact you to make an appointment. During your appointment, you will receive all of the information about your medical referral.
If your follow-up appointment is the next day, you may remain at your destination. In that case, contact ZJCN. If your follow-up appointment is later, a new request shall be submitted for medical referral. This is done by your referring physician.
This depends on the arrangements that you have made with the attending physician. You may need to visit your referring physician for a checkup. After your medical referral, it is not necessary to visit ZJCN.
With medical broadcasts you are entitled to a daily allowance *. This allowance is intended as an contribution for the costs of eating and drinking.
If you spend a day in the hospital, the daily allowance for that day may be canceled because the hospital provides food and drinks for you. As a result, there may be a difference in the daily allowance for the insured and the companion.
* The amount of the reimbursement varies per destination. You will receive this information from ZJCN when you go on a medical broadcast.
If your medical referral is longer than expected, you will receive daily reimbursement payments for a longer period. This will be deposited into your account as soon as possible. If your medical referral is shorter than expected, you may choose to pay back the reimbursement or to have it settled with the following time that you go on medical referral. In both cases, contact ZJCN.
The healthcare insurance only reimburses care with serious illness or hospital admittance. These cases involve emergency assistance that cannot wait until your return to the island. With emergency assistance, contact must be made with ZJCN as quickly as possible. All other care abroad will not be reimbursed.
When abroad, you are only insured for emergency assistance and reimbursement is maximised at the price level of the Dutch Caribbean. ZJCN therefore recommends that everyone take out travel insurance prior to going abroad. Before you leave, request a proof of insurance. Come to ZJCN for this.
Are you studying abroad? Then you are entitled to reimbursement of the medical expenses. The reimbursement is capped at the price level of the region or the Netherlands. It is possible that the price level in the country in which you are studying is higher than that which we reimburse. It is your own responsibility to take out supplementary insurance for this. ZJCN does not play any role in this.
The care provider can bill ZJCN directly. Both the bill and the 'proof of students' healthcare insurance' must be mailed to: firstname.lastname@example.org. It may be that you must pay for the expenses for medical care yourself. You can then submit a claim for the expenses incurred to ZJCN. For more information about claims, click here.
Choice of healthcare provider - Article 10 paragraph 4
The underlying principle is that care (in kind) must be received from healthcare providers that have established a contract with ZJCN (article 10 paragraph 2 of the BES Health Insurance Decree). Click here for a list of contracted healthcare providers.
The Decree also stipulates that it is possible for insured persons to visit a healthcare provider of their choice, both on and away from the islands. This is possible based on article 10 paragraph 4 of the Decree.
If prior consent has been received from ZJCN, insured persons can visit the healthcare provider of their choice and will be entitled to claim full or partial reimbursement of medical expenses incurred during this care.
You can request consent to consult the healthcare provider of your choice. If you do so, you will be exercising your right under article 10 paragraph 4 of the BES Health Insurance Decree. However, you must have a legitimate reason for visiting a healthcare provider of your choice, and this legitimate reason must be explained in the referral letter from your local GP.
Even if you opt for a different contracted healthcare provider than the one you would have been referred to by ZJCN, you must still request consent via the arrangement stipulated in article 10 paragraph 4. You will need prior consent from ZJCN if you want to use this arrangement. The date of consent must be before the date of treatment. You can only make appointments with your preferred healthcare provider, and start planning your trip, once ZJCN has provided consent for treatment based on article 10 paragraph 4.
The reimbursement you receive for your treatment will be capped so it does not exceed the price of treatment within our region or in the Netherlands. Your treatment will thus not be classed as a medical referral. You will be responsible for all travel and accommodation costs.
Requests pursuant to article 10 paragraph 4 must be submitted to a general practitioner or specialist. This must be done by submitting the following documents:
- medical statement from referrer (general practitioner or specialist)
- quote from healthcare provider, featuring a precise description of the treatment and its total cost
- statement of approval signed by the insured person
It is important for you to know what is expected of you, as an insured person, and what you can expect of ZJCN. So please carefully read the conditions for article 10 paragraph 4 and make sure that you understand everything before you sign the statement of approval.
Incomplete applications will not be processed.
Depending on the medical expenses mentioned in the quote, these expenses will be fully or partially reimbursed. This means that not all medical expenses may be reimbursed. Please take this into account. Amounts that deviate from the submitted and pre-approved quote will not be reimbursed. This also applies to costs associated with care that differs from that mentioned on the referral letter and approved by ZJCN.
You will be responsible for travel and accommodation costs; they cannot be reimbursed afterwards. You will also not receive a daily allowance or a transport allowance.
Treatments under article 10 paragraph 4 cannot be changed to a medical referral during the course of the treatment process. You will be personally responsible for costs associated with extended stays, re-booking plane tickets and other unexpected costs.
Applications or quotes submitted after the fact will not be reimbursed.
In order to claim medical expenses for treatments approved under article 10 paragraph 4, you must first pay invoices from the doctor or medical institution yourself, as stated in the conditions for consent under article 10 paragraph 4. You must then submit invoices and proofs of payment together with the claim form.
Expenses can be declared in three steps:
Step 1: Download the claim form and fill it in
Step 2: Scan invoices that accompany the claim form
Step 3: E-mail the claim form and appendix to: email@example.com
Make sure that your claim form is fully completed and signed, otherwise it will not be processed.
Submit your claim form to ZJCN as soon as possible.
Invoices older than 12 months will no longer be processed.
If you have a complaint about ZJCN then you can fill in the complaint form or send a letter. The complaints officer will respond in detail to your complaint in writing. They will explain what the rules are. There is a statutory time limit for handling a complaint. It is set at 6 weeks.
Is the information not clear? Then the complaints officer will speak with you. ZJCN is always looking at how it can further improve its services. For instance, ZJCN is always working on improving the website. So that every insured person can find good information.
The complaints officer at ZJCN takes every complaint seriously and explains the legislation and the rules to the best of their ability. They make every effort to resolve a complaint.
A medical referral entails quite a lot of logistics. ZJCN arranges the best possible accommodation. Nevertheless, occasionally the complaints officer of ZJCN receives complaints about the accommodation. For example, because there is no lift, whilst the insured is wheelchair-bound. Or because there is no kitchen, even though the insured needs one for medical reasons. There are also occasional complaints about the room. For example, because the room is not properly cleaned. The complaints officer discusses with the insured what the problem is. ZJCN then contacts the accommodation to look for a good solution. So that the stay of the insured is as pleasant as possible.
Sometimes an insured person complains because they need to sleep in 1 bed with their companion during a medical referral. ZJCN arranges accommodation for the insured and the companion according to set procedures. You and your companion may be given a standard double room. ARe you going on a medical referral and do you need to bring a companion with you? It is therefore important to think carefully about who is going with you.
The complaints officer tries to explain this as best they can when complaints are received about this. They handle every complaint meticulously.
The complaints officer of ZJCN occasionally receives complaints about the hospital. For example, about long waiting lists. Or because the insured has a different medical specialist every three months. Unfortunately, not all physicians can be at the hospital all year round. Do you have complaints about the hospital? Then the ZJCN complaints officer will refer you to the complaints department of the hospital. The complaints officer at the hospital will handle the complaint further.
The complaints officer at ZJCN occasionally receives complaints about transport during a medical referral. For example, about the flight. Sometimes insured parties fly on a small plane. They may find this an uncomfortable way of travelling. Or they had expected a larger plane. But especially from the Windward Islands, it is usually not possible to go on a medical referral with a large aircraft. Arrangements are in place on which days medical flights are operated. And with what type of aircraft.
Sometimes you may be required to make stopovers on other islands during the flight. To pick up or drop off other insured people. This is something that is occasionally find annoying. ZJCN has set procedures for flights. So that care is arranged as efficiently as possible. Hence, you cannot pick on what day and via what route you fly.
Complaints are also received about transport at the destination. ZJCN only arranges transport between the airport, hotel, and hospital. If the insured requires transport to, for instance, a shop, then they need to arrange and pay for this themselves.
The complaints officer tries to explain as best they can what the legal rules are. ZJCN must comply with these rules.
Sometimes insured want to choose where they receive treatment. For example, in the Netherlands. Or in Colombia. The complaints officer of ZJCN occasionally receives complaints about this. If the care can be given in Bonaire, Aruba or Curaçao, for example, you cannot go to the Netherlands. These are the legal rules that ZJCN must adhere to. The closer to home, the more convenient it often is for the insured too. They have to travel less.
Occasionally, people also want to be on referral for longer than medically necessary. For example, to be able to also go on a holiday. Unfortunately, this is not possible. You can only be reimbursed for the days when you need medical treatment.
The complaints officer does what they can, but must always comply with the RAZ BES legislation. The Regeling Aanspraken Zorgverzekering BES (Healthcare Insurance Claims Regulations BES).
The complaints officer at ZJCN occasionally receives complaints about the per diem allowance. For example, if it takes a little longer for the per diem allowance to be transferred. In the case of an unexpected medical referral, the insured sometimes has to leave the very next day. ZJCN then transfers the per diem allowance to the bank account of the insured as soon as possible. But sometimes it takes a few days before the per diem allowance is credited to the account. This depends on the bank account, for instance.
Complaints are occasionally received about this. The complaints officer then tries to explain why it can sometimes take a while for the per diem allowance to be transferred. So always make sure that ZJCN has the correct (bank) details for you!