Changes in BES Healthcare Insurance claims
Care and Youth Caribbean Netherlands (ZJCN) announces that, as of 1 January 2025, the health insurance entitlements package for residents of Bonaire, St. Eustatius, and Saba will be amended. The BES Health Insurance Entitlements Regulation (RazBES) outlines which healthcare services are covered for ZJCN policyholders and is specifically designed to make healthcare in the Caribbean Netherlands more accessible and better aligned with the needs of the populations of Bonaire, St. Eustatius, and Saba.
Overview of Changes to the Entitlements Package
- Exercise therapy for COPD covered with no limit on sessions
Starting in 2025, exercise therapy for patients with COPD will be covered without a cap on the number of sessions. Coverage begins immediately from the first treatment. Prior approval from ZJCN is required for both exercise therapy and physiotherapy.
- Coverage for exercise therapy in cases of severe rheumatoid arthritis
From 1 January 2025, individuals diagnosed with significant functional limitations caused by rheumatoid arthritis will receive full coverage for exercise therapy. Prior approval from ZJCN is also required for this benefit.
- Geriatric rehabilitation care covered
Geriatric rehabilitation care will be specifically included as an entitlement from 1 January 2025. A specialist in geriatric medicine will assess whether this form of rehabilitation is the most appropriate care.
- Right to a second companion for medical transfers
Policyholders aged 18 and older in terminal or acute life-threatening situations may, with prior approval from ZJCN, be entitled to a second companion during medical transfers. This additional support acknowledges the vulnerability and physical and emotional burden associated with such situations.
- Suitability assessment for companion during medical transfers
From 2025, a suitability assessment will be introduced to ensure that companions are well-prepared for their role. Companions will need to be capable of assisting with daily activities and providing emotional support during critical decision-making moments.
- Abolition of the 'best ear' criterion
Until the end of 2024, coverage for hearing loss depends on the hearing capacity of the "better ear." If the hearing in the better ear exceeds the reimbursement threshold, no claim can be made. From 1 January 2025, this condition will be removed, meaning coverage will no longer depend on the hearing ability of the better ear.
Important Information for Employers
To support employers in the Caribbean Netherlands with increased labour costs due to the 2024 minimum wage rise, the premium rate will be reduced from 11.7% to 9.3% as of 1 January 2025. This reduction provides financial relief and is part of the adjustments to the BES Employee and Employer Premium Rate Determination Regulation.