What eigen risico amount applies to you in 2026?
For 2026, the verplicht eigen risico is €385 for each person, and it applies to most care that basic health insurance covers. It begins the month after your 18th birthday. On 1 January, your balance starts again. Huisarts care does not count, but tests and medicines provided outside that setting may count. A voluntary deductible or other costs can raise the total you owe.
This guide addresses people who hold a Dutch basisverzekering (basic health insurance). If you are planning care, ask your insurer about coverage, contracts with providers, referrals, prior permission and how much deductible you have left. The insurer determines what your policy reimburses. The guide covers general billing rules for 2026; it does not determine whether a treatment is medically suitable.
Use the Dutch health-insurance guide for the insurance obligation and the enrolment deadline.
Tell apart the charges on your healthcare bill
These five charges are distinct. For 2026, only the compulsory deductible lowers your standard €385 balance.
Wide tables can be scrolled sideways.
| Charge | When you pay it | Reduces the €385 balance? |
|---|---|---|
| Monthly premium | For your policy, whether or not you use care | No |
| Compulsory deductible | Most covered basic-package care; €385 in 2026 | Yes |
| Vrijwillig eigen risico | An optional extra €100–€500 after the compulsory amount, for a premium discount | No; an extra balance |
| Eigen bijdrage (statutory co-payment) | A legally set share for particular care, medicines or devices | No; you pay it first |
| Uncovered cost or contract shortfall | Care outside the package or policy conditions, or a reimbursement gap for a provider without a contract | No |
The compulsory deductible is tied to you and to one calendar year. If your basic insurance covers only part of the year, the amount is lower. That includes the year in which you turn 18. Your insurer works out the reduced amount. Once you have used the full compulsory amount, a voluntary deductible, a co-payment or an uncovered cost may still be left.
A provider may send the claim to your insurer. The insurer pays the covered portion and later sends you a bill for your deductible. If you send in a bill yourself, the insurer may take the deductible out of your reimbursement.
The date of care decides which deductible year applies. For hospital treatment packages, the start date is used.
Take an example for 2026: you have already paid €150 toward your compulsory deductible. You then receive €300 in covered specialist care. You still owe €235: €385 minus €150. Your insurer pays the other €65. This example assumes a full-year policy and no voluntary deductible, co-payment or contract shortfall. The Zorginstituut Nederland (National Health Care Institute) provides this calculation.
Find out which care counts toward your deductible
The deductible can apply only to care that your basic insurance reimburses. For care that is not covered, you pay yourself or claim it from supplementary insurance. Even covered care may come with other charges and policy conditions. The guide to what Dutch health insurance does not cover describes common costs that are not insured.
The table lists common services and the checks to carry out before planned care. For certain services, your policy may waive the compulsory deductible.
You can move wide tables sideways by scrolling.
| Care | Compulsory deductible | Check separately |
|---|---|---|
| GP or huisartsenpost (out-of-hours GP service) | Exempt for GP care itself | External tests, medicines and referred care can count |
| Hospital, specialist or emergency department | Usually applies | Referral, prior permission, contract and treatment-package year |
| Covered prescription medicine | Usually applies | Preferred brand, pharmacy service charge, reimbursement limit and co-payment |
| Covered medical device | Usually applies | Prescription, prior permission, contracted supplier and co-payment |
A consultation with your GP is exempt, and this also applies at the huisartsenpost. A laboratory, pharmacy or specialist may bill separately for care that your GP orders. Ask your GP what tests or medicines they will order. Ask your insurer what reimbursement is likely.
Use the emergency-care guide when deciding between GP care and hospital emergency care.
According to the Rijksoverheid (Dutch government) deductible rules, the care listed below is exempt from the compulsory deductible:
- Care from the basic package for children younger than 18
- Verloskundige zorg (care during pregnancy and birth)
- Specified prenatale screening (prenatal screening)
- Kraamzorg (maternity nursing care)
- Wijkverpleging (district nursing provided at home)
The covered programmes and services below are also exempt from the compulsory deductible:
- Ketenzorg (coordinated care for chronic conditions)
- Gecombineerde leefstijlinterventie (GLI, a combined lifestyle programme)
- Stoppen-met-rokenprogramma (a stop-smoking programme)
- Verkennend gesprek (exploratory conversation about mental health)
- Checks after donation and travel costs for organ donors
An insurer may also waive the compulsory deductible for particular providers, care programmes, medicines or devices. That waiver applies under the policy in question. Before you rely on it, check your current policy and the insurer’s provider finder.
Review medicines and medical devices
A prescription by itself does not guarantee that something is covered. Medicines that are covered and pharmacy service costs usually count toward the deductible. Under the preferentiebeleid (preferred-medicine policy), your insurer may cover only a preferred equivalent medicine. It may cover a different medicine if that medicine is medically necessary and your doctor supplies a statement. The official medicine-coverage rules explain this exception.
A medicine that costs more than its reimbursement limit can also carry an eigen bijdrage. For the 2026 calendar year, medicine co-payments are capped at €250 per person. You pay the co-payment first. After that, the remaining covered cost counts toward your compulsory deductible, and then toward any voluntary deductible. Medicines bought without a prescription and other medicines that are not covered are paid outside the deductible.
Medical devices that are covered usually count toward the deductible. Your policy may require a prescription, prior permission or a supplier with a contract. It may also state whether you own or borrow the device. For some devices, a statutory co-payment or maximum reimbursement applies.
Standard everyday products fall outside the basic package. You normally pay yourself for replacement batteries or for recharging. You also pay for ongoing maintenance of a device that you own. Before ordering, check the official medical-device coverage page and your policy. Costs that are not covered do not lower your deductible balance.
Review costs for chronic care and pregnancy
A ketenzorg programme that is covered is exempt from the compulsory deductible. Examples are programmes for type 2 diabetes, COPD (chronic obstructive pulmonary disease) and cardiovascular risk management. Your GP determines whether you qualify. Medicines, laboratory work and specialists outside the care group may still count toward the deductible. Ask whether each service is billed as part of the programme.
For children younger than 18, there is no compulsory deductible for care from the basic package. They may still face co-payments or costs that are not covered.
Verloskundige zorg, prenatal screening and kraamzorg are exempt from the compulsory deductible. Care that is directly connected to pregnancy or birth is exempt as well. Separate costs that are not directly connected may count toward the deductible, such as medicines, transport and some blood tests. Ask your insurer which rule applies to the service on your bill.
Kraamzorg at home usually has an eigen bijdrage. Partusassistentie (birth assistance) has no co-payment. It covers the delivery and up to two hours after the placenta is born.
A hospital birth without a medical indication can also carry an eigen bijdrage. That birth co-payment no longer applies if a medical indication develops or if you use nitrous oxide for pain relief. Check each service separately instead of treating all pregnancy costs as a single charge.
Check the contract status and price of your provider
Your insurer follows your policy’s rules on referrals, prior permission, providers and suppliers. If a provider has no contract, you may be reimbursed only in part. The amount left unpaid is separate from your deductible and does not lower your €385 balance for 2026.
Before treatment, providers must tell you whether they have a contract and whether you may need to pay. The Nederlandse Zorgautoriteit (NZa, Dutch Healthcare Authority) provider-information rules explain this duty. Your insurer confirms the exact reimbursement and how much deductible you have left.
Questions to ask your insurer before planned care
Ask four questions: Is this service covered for my medical need? Does this provider or supplier have a contract? Do I need a referral or prior permission? What deductible, co-payment or other costs should I expect? Keep the reply together with your appointment details.
Check which year a hospital bill belongs to
Expect that a hospital bill may arrive late
A hospital invoice may reach you months after your first visit. A ziekenhuis (hospital) can bill a diagnose-behandelcombinatie (dbc, diagnosis-treatment package). A dbc combines consultations, tests and treatment for a single diagnosis. It may last up to 120 days. The hospital bills it once it closes. If treatment continues longer, this can lead to a follow-up dbc and another bill. Look at your claim overview to see whether a late invoice relates to a new package.
Use the start date of the treatment package
Which year’s deductible applies is determined by the start date of a dbc. A first dbc that starts in December 2025 can use your 2025 balance, even if care and billing continue into 2026. A follow-up dbc that starts in 2026 can use your new 2026 balance. The SKGZ (health-insurance complaints and disputes body): hospital treatment packages gives this example.
Compare the start date, provider and diagnosis shown on the claim with your appointments. If something does not match, ask your insurer to explain it.
Decide on your voluntary deductible
If you are 18 or older, you may choose a voluntary deductible of €100, €200, €300, €400 or €500 in exchange for a lower monthly premium. You pay this after the compulsory €385. For 2026, the maximum combined deductible is €885.
Compare the discount on your yearly premium with the extra amount you might owe. Take into account expected medicines or hospital care and the money you have available.
Care that is exempt from the compulsory deductible usually remains exempt from the voluntary deductible. Check your policy.
A voluntary deductible applies for one policy year. Look at your insurer’s annual renewal terms to find out when you can change it.
Set up payment before the due date
Once a bill arrives, ask your insurer about a betalingsregeling (payment plan). Zorginstituut Nederland says that instalments for the deductible have no extra cost. Insurers may also offer advance payment or monthly payments together with your premium. They return any unused advance payments after the year ends. Conditions and enrolment dates vary, so ask your insurer when to apply.
Zorgtoeslag (healthcare benefit) can help households that qualify pay insurance costs, including the deductible. It does not alter your deductible balance. The toeslagen (allowances) overview explains which benefits to check.
Sort out common billing problems
If a bill appears incorrect, check the claim before you dispute it. Take these steps:
- Look at the care and amounts in your insurer’s claim overview.
- Ask your insurer for an itemised explanation of any charge that is unclear.
- Should the care not belong to you, the year be incorrect, or your insurer have used the policy in the wrong way, follow that insurer’s correction or complaint procedure.
- When the complaint remains unresolved, consult SKGZ complaint conditions.
When reviewing the claim, check the provider, the care date or dbc start date, the covered amount, and what is left in the compulsory and voluntary balances. Also look at any eigen bijdrage or contract shortfall.
To file a complaint with SKGZ, your insurer’s written response is required. You have to be 18 or older. The complaint must have been handled by your insurer within the past 12 months. SKGZ will only look at cases that have not already gone to a court.
If the bill is accurate but you are unable to pay it all at once, request a payment plan from your insurer before the due date. If several debts are causing you trouble, turn to the debt-help guide below.
Go on to these guides:
- Dutch health insurance: your duty and enrolment deadline
- Toeslagen: choose the right allowance
- Debt help in the Netherlands
Official Sources
- Rijksoverheid: When do I pay an eigen risico? - the compulsory €385 amount for 2026, exempt care, children, insurer-specific exclusions, voluntary excess and instalments
- Zorginstituut Nederland: Eigen risico - 2026 amount, calendar-year and age rules, payment methods, exemptions, voluntary deductible, and worked calculations
- Rijksoverheid: Do I pay GP costs myself? - GP and out-of-hours GP care are exempt, while externally performed tests and prescribed medicines can use the deductible
- Zorginstituut Nederland: Eigen bijdrage - 2026 statutory co-payments and the order: co-payment first, then compulsory and voluntary deductible
- Zorginstituut Nederland: Medicines - Basic-package conditions, preferred-medicine policy, medicine deductible and the €250 co-payment cap; pharmacy service costs are sourced separately below.
- Zorginstituut Nederland: Medical devices - prescription, prior approval and supplier conditions, deductible and co-payments for covered medical devices
- Zorginstituut Nederland: Coordinated chronic care - the care programme is exempt, but medicines, laboratory work and providers outside the care group can use the deductible
- Zorginstituut Nederland: Maternity care - Exempt pregnancy, birth and prenatal care; costs not directly connected to pregnancy or birth; hospital-birth co-payments and their exceptions
- Rijksoverheid: Tips for controlling healthcare costs - checking provider contracts, reimbursement, policy conditions, bills and spread-payment options
- Nederlandse Zorgautoriteit: Provider information duties - providers must disclose contract status and possible patient payments before treatment
- SKGZ: Hospital treatment packages - 120-day hospital billing packages, follow-up packages, delayed bills and the start-date rule for the deductible year
- Zorgverzekeringswet (Health Insurance Act): 2026 legal text - the statutory compulsory deductible and reduction when insurance covers only part of the calendar year
- Besluit zorgverzekering (Health Insurance Decree): Deductible exemptions - Legal exemptions and insurer-specific waivers under Article 2.17.
- Zorginstituut Nederland: Medical mental healthcare - The verkennend gesprek is exempt from the compulsory deductible; this is a specific exploratory conversation, not every first mental-health appointment.
- Zorginstituut Nederland: Kraamzorg - Kraamzorg is exempt from the compulsory deductible; home care normally has a statutory co-payment, while birth assistance has none.
- SKGZ: Submit a health-insurance complaint - First complain to the insurer and obtain its written reply; SKGZ eligibility, 12-month limit and court-case exclusion.
- Rijksoverheid: What do I pay for prescription medicines? - Separate pharmacy service charges and prescription-medicine reimbursement conditions.
- Government parliamentary letter: Pharmacy services and the deductible (PDF, 53 KB) - Covered pharmacy services use the deductible. This 2015 explanation is read with the current medicine and insurer-waiver rules.