Summary
Samenvatting Personenverzekeringen 1 - Ziekte
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Zelfgemaakte samenvatting adhv het boek 'ziekteverzekeringen' en notities uit de les.
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ZiekteverzekeringenInhoudsopgave
1 WETGEVING....................................................................................................................................6
1.1 WET VERWILGHEN.........................................................................................................................6
1.1.1 ACHTERGRONDINFORMATIE..................................................................................................................6
1.1.2 CIJFERS.............................................................................................................................................6
1.1.3 KRACHTLIJNEN VAN DE WET VERWILGHEN..............................................................................................6
1.1.4 BEGRIPPEN........................................................................................................................................6
1.1.5 LEVENSLANGE WAARBORG...................................................................................................................7
1.1.6 ONBETWISTBAARHEID.........................................................................................................................7
1.1.6.1 Termijn.......................................................................................................................................7
1.1.6.2 Informatieverplichting van de nemer.........................................................................................8
1.1.7 VOORWAARDEN TOT WIJZIGING VOORWAARDEN EN TARIEF........................................................................9
1.1.7.1 Medische index anno 2010.........................................................................................................9
1.1.7.2 Medische index anno 2017.........................................................................................................9
1.1.8 REGELING CHRONISCH ZIEKEN EN GEHANDICAPTEN....................................................................................9
1.1.8.1 Art. 206 Vwet..............................................................................................................................9
1.1.8.2 Bemiddelingscommissie ziektekostenverzekering......................................................................9
1.1.9 INDIVIDUELE VOORTZETTING...............................................................................................................10
1.1.9.1 Niet-beroepsgebonden overeenkomsten.................................................................................10
1.1.9.2 Beroepsgebonden overeenkomsten.........................................................................................10
1.2 ANTIDISCRIMINATIEWETGEVING.......................................................................................................12
1.2.1 ACHTERGRONDINFORMATIE................................................................................................................12
1.2.2 WEERSLAG OP ZIEKTEVERZEKERINGEN...................................................................................................13
1.2.2.1 Specifieke antidiscriminatieregel..............................................................................................13
1.2.2.2 Tarifering..................................................................................................................................13
1.2.2.3 Verzekerde risico’s....................................................................................................................14
1.3 BEGRIP WACHTTIJD – CARENSTIJD....................................................................................................14
1.3.1 WACHTTIJD.....................................................................................................................................14
1.3.2 CARENSTIJD.....................................................................................................................................14
1.3.2.1 Gewaarborgd inkomen.............................................................................................................14
1.3.2.2 Hospitalisatieverzekering..........................................................................................................14
1.4 RECHT OM VERGETEN TE WORDEN....................................................................................................15
2 UITSLUITINGEN.............................................................................................................................15
2.1 WETTELIJKE UITSLUITINGEN............................................................................................................15
2.1.1 OPZET............................................................................................................................................15
2.1.2 ZWARE FOUT...................................................................................................................................15
2.1.3 OORLOGSRISICO...............................................................................................................................15
2.1.4 TERRORISME....................................................................................................................................16
2.2 GEWOONLIJKE UITSLUITINGEN.........................................................................................................16
2.2.1 VOORAFBESTAANDE AANDOENINGEN...................................................................................................16
2.2.2 RISICOVOLLE SPORTEN, HOBBY’S EN BEROEPEN......................................................................................16
1
,2.2.3 PSYCHISCHE ONGESCHIKTHEDEN..........................................................................................................16
2.2.3.1 Gewaarborgd inkomen.............................................................................................................16
2.2.3.2 Hospitalisatieverzekering..........................................................................................................16
2.2.4 ZWANGERSCHAP OF BEVALLING...........................................................................................................16
2.2.4.1 Gewaarborgd inkomen.............................................................................................................16
2.2.4.2 Hospitalisatieverzekering..........................................................................................................16
3 FISCALITEIT...................................................................................................................................16
3.1 VERZEKERING GEWAARBORGD INKOMEN............................................................................................16
3.1.1 INDIVIDUELE POLIS............................................................................................................................16
3.1.1.1 Premietaks................................................................................................................................16
3.1.1.2 Fiscaal voordeel premie............................................................................................................16
3.1.1.3 Taxatie van de uitkering............................................................................................................16
3.1.2 BEROEPSGEBONDEN POLIS..................................................................................................................17
3.1.2.1 Premietaks................................................................................................................................17
3.1.2.2 Fiscaal voordeel premie............................................................................................................17
3.1.2.3 Taxatie van de uitkering............................................................................................................17
3.2 HOSPITALISATIEVERZEKERING..........................................................................................................18
3.2.1 INDIVIDUELE POLIS............................................................................................................................18
3.2.1.1 Premietaks................................................................................................................................18
3.2.1.2 Fiscaal voordeel premie............................................................................................................18
3.2.1.3 Taxatie van de uitkering............................................................................................................18
3.2.2 BEROEPSGEBONDEN POLIS..................................................................................................................18
3.2.2.1 Premietaks................................................................................................................................18
3.2.2.2 Fiscaal voordeel premie............................................................................................................18
3.2.2.3 Taxatie van de uitkering............................................................................................................18
1 EERSTE PIJLER...............................................................................................................................18
1.1 WERKNEMERS.............................................................................................................................18
1.1.1 ZIEKTE EN PRIVÉ-ONGEVALLEN............................................................................................................18
1.1.1.1 Primaire arbeidsongeschiktheid...............................................................................................18
1.1.1.2 Invaliditeit.................................................................................................................................19
1.1.2 ARBEIDSONGEVALLEN........................................................................................................................19
1.1.2.1 Tijdelijke ongeschiktheid..........................................................................................................19
1.1.2.2 Blijvende ongeschiktheid..........................................................................................................19
1.2 AMBTENAREN..............................................................................................................................19
1.2.1 ZIEKTE EN PRIVÉ-ONGEVALLEN............................................................................................................19
1.2.1.1 Ziekteverlof...............................................................................................................................19
1.2.1.2 Disponibiliteit...........................................................................................................................20
1.2.2 ARBEIDSONGEVALLEN........................................................................................................................20
1.2.2.1 Tijdelijke ongeschiktheid..........................................................................................................20
1.2.2.2 Blijvende ongeschiktheid..........................................................................................................20
1.3 ZELFSTANDIGEN...........................................................................................................................20
2 WAARBORGEN VAN DE AANVULLENDE VERZEKERINGEN.............................................................20
2
,2.1 BEGRIPPEN.................................................................................................................................20
2.1.1 FYSIOLOGISCHE INVALIDITEIT...............................................................................................................20
2.1.2 ECONOMISCHE ONGESCHIKTHEID.........................................................................................................21
2.1.3 POLISVOORBEELD.............................................................................................................................21
2.2 SCHADEVERGOEDING.....................................................................................................................21
2.2.1 INVALIDITEITSPERCENTAGE.................................................................................................................21
2.2.2 UITKERINGEN...................................................................................................................................21
2.2.2.1 Rente........................................................................................................................................21
2.2.2.2 Terugbetaling premie...............................................................................................................21
2.2.2.3 Overzicht...................................................................................................................................21
2.3 FORMULES..................................................................................................................................22
2.3.1 WAARBORG ZIEKTE EN/OF ONGEVAL....................................................................................................22
2.3.1.1 Begrip ziekte.............................................................................................................................22
2.3.1.2 Begrip ongeval..........................................................................................................................22
2.3.1.3 Waarborg ziekte en/of ongeval................................................................................................22
2.3.2 SOORTEN RENTES.............................................................................................................................22
2.3.2.1 Polisvoorbeeld..........................................................................................................................22
2.3.2.2 Soorten rentes..........................................................................................................................22
2.3.3 VOORBEELDEN.................................................................................................................................23
3 DUUR VAN HET CONTRACT...........................................................................................................23
3.1 TOT STAND KOMEN VAN DE OVEREENKOMST......................................................................................23
3.1.1 AANVAARDINGSVOORWAARDEN..........................................................................................................23
3.1.1.1 Normaal risico...........................................................................................................................23
3.1.1.2 Bedrijfsinkomen........................................................................................................................23
3.1.1.3 Woonplaats in België................................................................................................................23
3.1.1.4 Medische formaliteiten............................................................................................................23
3.1.2 HET VERZEKERINGSVOORSTEL..............................................................................................................23
3.2 DUURTIJD VAN DE OVEREENKOMST..................................................................................................23
3.2.1 NIET BEROEPSGEBONDEN OVEREENKOMST............................................................................................23
3.2.2 BEROEPSGEBONDEN OVEREENKOMST...................................................................................................23
4 PREMIE.........................................................................................................................................23
4.1 ELEMENTEN DIE DE PREMIE BEÏNVLOEDEN..........................................................................................23
4.2 WIJZIGINGEN IN DE LOOP VAN DE OVEREENKOMST...............................................................................24
5 RIZIV-POLIS...................................................................................................................................24
5.1 WAT?.......................................................................................................................................24
5.2 VOORWAARDEN...........................................................................................................................24
5.2.1 APOTHEKERS...................................................................................................................................24
5.2.2 ARTSEN..........................................................................................................................................24
5.3 BEDRAG.....................................................................................................................................25
3
, 1 EERSTE PIJLER...............................................................................................................................25
1.1 ZIEKTE- OF PRIVÉONGEVAL..............................................................................................................25
1.1.1 ZIEKENHUISOPNAME.........................................................................................................................25
1.1.1.1 Opnameformulier.....................................................................................................................25
1.1.1.2 Erelonen...................................................................................................................................25
1.1.1.3 Verblijfkosten...........................................................................................................................26
1.1.1.4 Forfaits......................................................................................................................................26
1.1.1.5 Farmaceutische kosten.............................................................................................................26
1.1.1.6 Andere kosten..........................................................................................................................26
1.1.1.7 Transportkosten.......................................................................................................................26
1.1.2 DAGHOSPITALISATIE..........................................................................................................................27
1.1.3 ZIEKENHUISFACTUUR.........................................................................................................................27
1.2 AMBULANTE KOSTEN.....................................................................................................................27
1.2.1 ERELONEN.......................................................................................................................................27
1.2.2 MEDICIJNEN....................................................................................................................................28
1.2.2.1 Magistrale bereidingen.............................................................................................................28
1.2.2.2 Farmaceutische specialiteiten..................................................................................................28
1.3 SYSTEEM DERDEBETALER................................................................................................................29
1.3.1 EERSTE PIJLER..................................................................................................................................29
1.3.2 ASSURCARD EN MEDICARD.................................................................................................................29
1.3.3 ASSURPHARMA................................................................................................................................29
1.4 ARBEIDSONGEVAL.........................................................................................................................29
1.4.1 ZIEKENHUISOPNAME.........................................................................................................................29
1.4.2 AMBULANTE KOSTEN.........................................................................................................................29
1.4.2.1 Erelonen...................................................................................................................................29
1.4.2.2 Medicijnen................................................................................................................................29
2 FORMULES....................................................................................................................................29
2.1 SYSTEEM DAGVERGOEDING.............................................................................................................29
2.2 TERUGBETALING VAN DE WERKELIJKE KOSTEN.....................................................................................30
2.2.1 ONBEPERKTE TUSSENKOMST...............................................................................................................30
2.2.2 BEPERKTE TUSSENKOMST...................................................................................................................30
3 WAARBORGEN..............................................................................................................................30
3.1 HOSPITALISATIE...........................................................................................................................30
3.1.1 DEFINITIES......................................................................................................................................30
3.1.1.1 Verpleeginstelling.....................................................................................................................30
3.1.1.2 Ziekenhuisopname...................................................................................................................30
3.1.2 ONE DAY CLINIC (DAGKLINIEK)............................................................................................................30
3.2 PRE- EN POST..............................................................................................................................30
3.3 ZWARE ZIEKTEN...........................................................................................................................30
3.4 AMBULANTE KOSTEN.....................................................................................................................30
3.5 PALLIATIEVE ZORGEN.....................................................................................................................31
3.6 KOSTEN DIE EVENTUEEL NIET WORDEN VERGOED.................................................................................31
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