Dutch Health Insurance for Expats: The 4-Month Rule and How to Choose

This guide is for internationals who have just registered in a Dutch municipality and now need to arrange health insurance. After reading it you will understand the four-month rule, the difference between the basic and additional packages, what you pay, whether you qualify for healthcare benefit, and how switching works later in the year.

• The four-month rule: why you must act now
• Basisverzekering: the standard package
• Aanvullend: optional additional insurance
• What you pay: premium, contribution and eigen risico
• Zorgtoeslag: help with the cost
• Switching in November
• FAQ

The four-month rule: why you must act now

Everyone who lives or works in the Netherlands is legally obliged to take out standard health insurance, which covers costs such as consulting a general practitioner, hospital treatment and prescription medication. This is set out on the Dutch government page for standard health insurance. Because the obligation begins as soon as you start living or working here, you should arrange your policy as soon as you have registered, not months later.

The official page states one clear four-month deadline: parents must register a child with an insurance company within four months of its birth. For adults who have just arrived and registered, this page does not set out a separate deadline in days or months. If you are unsure exactly how long you have in your own situation, confirm the timeline with your chosen insurer or the relevant agency rather than relying on a guess, because they decide case by case.

You do not have to arrange everything alone. You can take out health insurance without permission for your children under 18 and for anyone placed under your guardianship or tutorship. In other cases you need a written declaration from the person you want to insure, and if that person cannot give permission you can sign the application as their attorney.

Basisverzekering: the standard package

The basisverzekering, or standard package, is the insurance every resident is obliged to hold. The government decides what the standard package covers, and all insurers offer exactly the same standard package. This means the cover itself does not differ from one company to another, so you are comparing service and price rather than what is included.

Two rules protect you as a newcomer. Insurers are obliged to accept anyone who applies for the standard package, and they must charge all policyholders the same premium regardless of age or state of health. The system is built on social solidarity, meaning everyone contributes together to the overall cost of care, including maternity care and geriatric care. You also have a right to essential medical care even if a condition is caused by an unhealthy or reckless lifestyle.

Children under 18 must have health insurance but do not pay premiums for the standard package, so once you register your child within the four-month window their basic cover is free.

Aanvullend: optional additional insurance

Not all health care is covered by the standard package. You can choose to take out additional insurance, known as aanvullend, to cover things such as physiotherapy or dental care. This is optional and you are never required to have it.

There are two differences that matter when you compare. First, you do not have to take out the standard package and the additional insurance with the same company, so you can mix providers if that suits you. Second, insurers are not obliged to accept everyone for additional insurance. A company can refuse you or ask about your health before accepting you, which is the opposite of the guaranteed acceptance that applies to the basic package. If you know you will need specific extra care, it is worth checking the additional terms before you commit.

What you pay: premium, contribution and eigen risico

For the standard package you pay a fixed, nominal premium directly to your insurance company. On top of that you pay an income-related contribution, laid down in the Healthcare Insurance Act and known as the ZVW contribution. This contribution is a percentage of your income, and if you are employed your employer remits it directly to the Health Insurance Fund, so you usually do not arrange it yourself.

You will also hear about the eigen risico, the amount you pay towards certain care yourself before the insurer starts to reimburse. The official government page used for this guide does not state the eigen risico figure or the exact premium amount. Because these amounts are set nationally and can change each year, check the current figures with your insurer or on official sources rather than trusting a number from an unofficial site.

Zorgtoeslag: help with the cost

People on a low income may be eligible for healthcare benefit, known in Dutch as zorgtoeslag, to help pay for health insurance. This is a real form of support built into the system, so it is worth checking whether you qualify soon after you take out your policy.

The government page does not list the income thresholds or the amount you can receive. Whether you are eligible and how much you would get depends on your circumstances and is decided by the responsible tax and benefits authority on a case-by-case basis. Apply through the official benefits channel and use their calculation tool rather than assuming an amount, because the figures change over time.

Switching in November

Because every insurer offers the same standard package, switching is mainly about finding a better price or better service, or choosing different additional cover. Insurers review their offers for the coming year toward the end of the year, so late in the calendar, around November, is when people compare policies and decide whether to change.

The official page used here does not set out the switching deadlines or the steps to cancel and re-enrol. Confirm the exact annual switching window and cancellation dates with your current insurer or on official sources before you rely on them. Remember that even if you switch your standard package freely, an insurer is not obliged to accept you for additional insurance, so check the additional terms before you cancel a policy you still need.

FAQ

Do I really have to take out Dutch insurance if I already have cover from home?

Everyone who lives or works in the Netherlands is legally obliged to take out standard Dutch health insurance, so foreign cover does not remove that obligation in general. If you are unsure whether your specific situation is an exception, confirm it with your insurer or the relevant agency rather than assuming, because these cases are assessed individually.

Can an insurer refuse me because of my age or health?

No, not for the standard package. Insurers are obliged to accept anyone who applies for the standard insurance and must charge all policyholders the same premium regardless of age or state of health. This guaranteed acceptance does not apply to additional insurance, where an insurer can refuse you or ask about your health first.

How do I insure my children?

Children under 18 must have health insurance but do not pay premiums for the standard package. You can take out insurance for your children under 18 without their permission, and if you have a newborn you must register the child with an insurance company within four months of birth.

What is the difference between the nominal premium and the ZVW contribution?

The nominal premium is the fixed amount you pay directly to your insurance company for the standard package. The ZVW contribution is an additional income-related payment, a percentage of your income laid down in the Healthcare Insurance Act, and if you are employed your employer remits it directly to the Health Insurance Fund.

Official sources: government.nl

Last verified: 2 September 2026 against the official pages linked above. Rules and fees change; the official page always wins. General information, not legal or tax advice.