Wft Zorg Samenvatting: zeer professionele en uitgebreide samenvatting van het gehele boek WFT zorgverzekering. De samenvatting is geschreven naar aanleiding van het meest recente studiemateriaal van NIBE-SVV.
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,Wft Zorgverzekeringen
SAMENVATTING (Versie: geldig tot 1 april 2022)
Inhoudsopgave
Deel 1: Wet- en regelgeving
1. Recht op gezondheidszorg ....................................................................................................................................... 3
2. Regelgeving ............................................................................................................................................................. 3
3. Bestuursorganen ..................................................................................................................................................... 4
4. Soorten zorgverzekeringen ...................................................................................................................................... 4
5. Zorg en welzijn ........................................................................................................................................................ 6
6. Sociale zekerheid..................................................................................................................................................... 7
Deel 2: Toezicht en betrokken organisaties
1. Algemeen wettelijk toezicht .................................................................................................................................... 8
2. Specifiek wettelijk toezicht .....................................................................................................................................10
3. Zorginstituut Nederland (ZiNL) en CAK ....................................................................................................................11
4. Brancheorganisaties ...............................................................................................................................................12
5. Klachten en geschillen ............................................................................................................................................13
Deel 3: Kenmerken zorgverzekering
1. De verzekeringsovereenkomst ................................................................................................................................15
2. Bijzondere kenmerken zorgverzekering ..................................................................................................................16
3. Dekkingsvorm zorgverzekering ...............................................................................................................................17
4. Beperkingen in dekking Zvw ...................................................................................................................................18
5. Prijs van de zorgverzekering ...................................................................................................................................19
6. Eigen risico zorgverzekering....................................................................................................................................21
7. Collectieve verzekering ...........................................................................................................................................22
8. Contractduur zorgverzekering ................................................................................................................................23
9. Provinciale zorgpolis ...............................................................................................................................................23
10. Aanvullende verzekering.......................................................................................................................................23
Deel 4: Zorgtaken
1. Zorginkoop en zorgbemiddeling..............................................................................................................................25
Deel 7: Financiële afhandeling
1. Aanleveren van declaraties .....................................................................................................................................51
2. Controles notaverwerking ......................................................................................................................................52
3. Financiële afhandeling zorgkosten ..........................................................................................................................52
4. Nota’s en declaraties buitenland.............................................................................................................................55
5. Verdeling van kosten over verzekeringen................................................................................................................56
6. Verhaal van verzekeringsuitkering ..........................................................................................................................57
Deel 8: Beëindiging van de verzekering
1. Opzeggen door verzekeringnemer ..........................................................................................................................58
2. Beëindigen verzekering door zorgverzekeraar.........................................................................................................59
3. Beëindiging verzekering van rechtswege.................................................................................................................60
4. Beëindigingsbewijs .................................................................................................................................................60
5. Regels en afspraken aanpak wanbetaling ................................................................................................................61
6. Beëindiging aanvullende verzekering ......................................................................................................................63
Deel 9: Algemene verzekeringskennis
1. Fraude en fraudebestrijding....................................................................................................................................63
2. Overeenkomsten ....................................................................................................................................................65
3. De verzekeraar als risicodrager ...............................................................................................................................67
4. Distributiemodellen................................................................................................................................................69
5. De verzekeringsovereenkomst en de daarbij betrokken partijen .............................................................................71
6. Aanvraag en acceptatie van de verzekering.............................................................................................................72
7. Verzekeringspremie en premiebetaling...................................................................................................................74
8. Schade en uitkering ................................................................................................................................................74
9. Bescherming consument ........................................................................................................................................76
Deze samenvatting is geschreven op basis van het Tekstboek Wft Zorgverzekeringen van NIBESVV.
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