Coverage & financing
Non-contracted mental health care: what does it mean?
Non-contracted does not mean uninsured. In most cases your health insurer covers a substantial part of the treatment.
Basic explanation
A healthcare provider can choose not to hold a contract with health insurers. AvondFocus has deliberately chosen this model. This means:
- You pay the invoice yourself to AvondFocus first.
- You submit the invoice to your own health insurer.
- Your insurer reimburses a portion — depending on your policy.
This differs from contracted care, where you pay nothing upfront and the invoice goes directly to the insurer.
Policy types
The reimbursement depends on the type of policy you hold. Check your policy conditions or call your health insurer.
80–100% covered
You are entitled to reimbursement up to the full NZa rate. The most favourable policy for non-contracted care.
60–80% covered
You receive a lower percentage. The remaining portion (the "free choice of provider" reduction) is at your own expense.
Varies per component
Some types of care fall under restitution, others under in-kind. Check your policy document carefully.
Claims process
- 1
Treatment completed
After completing a treatment period or at the end of a calendar year, you will receive an invoice from AvondFocus.
- 2
Invoice received
The invoice states the care provided, the DBC code used and the NZa rate. Keep this invoice safe.
- 3
Pay AvondFocus
You pay the full invoice amount to AvondFocus within the payment term.
- 4
Submit to your insurer
Submit the invoice via your health insurer's app or website (usually under "submit invoice" or "claim"). You may need to attach proof of payment.
- 5
Receive reimbursement
Your insurer assesses the claim and transfers the covered amount to you — typically within two to four weeks.
Frequently asked questions
Do I have to pay upfront?
Yes. You pay the invoice directly to AvondFocus first. You then submit the invoice to your health insurer, who reimburses the covered portion back to you. This is called the restitution mechanism.
How do I find out how much I will be reimbursed?
The reimbursement amount depends on your policy type and your insurer. Call your insurer before starting treatment and ask specifically about reimbursement for 'non-contracted specialised mental health care'. You can also check your policy conditions on your insurer's website.
Can I go to another practice if the costs are too high?
Yes, that is always your right. If the out-of-pocket costs are too high for you, you may choose a contracted mental health provider. Keep in mind that contracted providers often have longer waiting lists due to contract caps.
Does my deductible also apply here?
Yes. The statutory deductible (€385 in 2026) applies to all insured mental health care, regardless of whether the provider is contracted or not. Once your deductible is met, it applies to all further care that year.
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