What does my health insurance cover?

The GP is your first point of contact for health problems. They keep an eye on the overview of your general health and refer you, if so required. All insured persons are entitled to medical and surgical care by a GP. Laboratory, radiological, function and pathological-anatomical research referred by the GP is reimbursed. Alternative medicine and medical examinations are not covered by the GP care and are not reimbursed.

Anyone who is insured with ZJCN is entitled to reimbursement of patient transport. This covers:

• Medically necessary transport by ambulance, from or to a care institution or from or to your home
• Transport reimbursement (not by ambulance) for insured persons who must undergo kidney dialysis, chemotherapy or radiotherapy and who can only move around by wheelchair or who has limited vision as a result of which they cannot move around individually.
• 'Air ambulance' if, as a result of illness or an emergency situation, a medical referral becomes necessary.
• Transport during medical referrals: from and to the airport and from the place of residence to the place of destination and vice versa.

The reimbursement of patient transport requires the prior consent of ZJCN, unless there is question of an emergency situation. The reimbursement of patient transport can differ per destination.

The first-line psychological care focuses on the treatment of light to moderately serious issues.

The treatment is often of short duration. Your GP, specialist or nursing- home physician can prescribe you treatment by a psychologist. If the psychologist makes a diagnosis then you are entitled to a maximum of nine treatment sessions per indication. This includes the intake meeting. In this regard, you are not entitled to assistance with work and/or relationship issues.

If you need to be hospitalised then this is covered by the health insurance.

Mother and child are entitled to hospitalisation for obstetric care. Where applicable, hospitalisation in a higher class is reimbursed in case of a medical necessity. This is determined by the treating physician.

Paramedical care focuses on making you function better in case of a certain illness of condition. Paramedical care comprises the below. Chiropractic treatment and electrolysis are not covered by paramedical care.

Physiotherapy and Cesar and Mensendieck exercise therapy

Physiotherapy and exercise therapy are aimed at healing, alleviation of pain, or maintenance of the best possible physical condition. You need a referral from a GP or specialist for physiotherapy and exercise therapy.

For children up to the age of 17, the first nine treatments per calendar year are reimbursed. If this is not sufficient, the referring doctor can submit a follow-up application for a further nine treatments in the same year. The total per year is therefore a maximum of 18 treatments.

For insured persons aged 18 or older, physiotherapy is reimbursed for conditions included in the exhaustive list. The first 20 treatments are not eligible for reimbursement. You can find the list in the Health Insurance Entitlements Regulations BES, paragraph 4, Section 1.4.2. A maximum period has been set for a number of conditions. Your treating physician can inform you of this.

For reimbursement of physiotherapy and exercise therapy, your healthcare provider must request prior consent from ZJCN.

Speech therapy

Insured persons can claim speech therapy with the medical aim of restoring or improving the speech function or speech ability. This requires a referral from a GP, specialist or dentist. Speech therapy for non-medical purposes (e.g. dyslexia, public speaking or singing lessons) is not covered.

Prior consent from ZJCN is required for reimbursement of speech therapy.

Occupational therapy

Occupational therapy promotes or restores self-care and self-reliance by teaching people to perform daily activities more effectively. The occupational therapist provides advice, instruction, training or treatment in their treatment room or at your home. A referral from a GP, specialist or nursing-home physician is required for occupational therapy. You are then entitled to a maximum of ten treatment hours per year.

Dietary advice

Information and advice on nutrition and eating habits for medical purposes are provided by a dietician. This requires a prescription from a physician or dentist. You are then entitled to a maximum of three treatment hours per year.

Podiatry

Podiatry and podiatric insoles are intended to reduce or eliminate foot problems. This requires a prescription from a GP or medical specialist.

Medical pedicures

A medical pedicurist provides (specialist) foot care and treats skin and nail conditions. Only insured persons with diabetes are eligible for medical pedicures. Your healthcare provider must request prior consent from ZJCN.

Stop smoking programme

Insured persons can participate in a stop-smoking programme prescribed by a GP or specialist. This concerns medical and, if necessary, pharmaceutical assistance that is included in the Stop Smoking Quality Register. A stop-smoking programme can be followed a maximum of once per calendar year. This requires prior consent from ZJCN.

Combined lifestyle intervention

For insured persons aged 18 or older, care for combined lifestyle intervention (CLI) prescribed by a GP or specialist can be reimbursed. CLI is a two-year programme focused on healthier eating (lower energy intake), increased physical activity, and psychological support for behavioural change. A CLI programme can be followed a maximum of once every 24 months. If the programme is not followed in its entirety, only part of it is reimbursed.

Prior consent from ZJCN is required for reimbursement of participation in a CLI programme.

Dental care involves the maintenance and repair of your teeth. Insured persons up to the age of 18 are entitled to the full package of dental and oral care.

The following is reimbursed for insured persons aged 18 and over: removable prostheses, partially removable prostheses (i.e. not bridges or crowns), medically necessary treatments and surgical dental care, including the associated X-ray examinations. Gum surgery, simple extractions and implants are not covered.

If insured persons do not follow the instructions of their dentist or seriously neglect their oral hygiene, dental treatment is not reimbursed.

Pharmaceutical care involves the supply and administration of medicines.

The health insurance covers medicines prescribed by a physician, dentist, or obstetrician. Pharmaceutical care also includes advice and counselling from pharmacists, dietary preparations in certain medical cases, and flu vaccinations. In principle, medicines are prescribed by substance name.

Female insured persons are entitled to reimbursement of the following contraceptives: (hormone) coil, hormone rod and pessary. As well as emergency contraception; the morning-after pill.

Medicines that are freely available (“over the counter”) are not reimbursed, even if you have a prescription. 

Medical aid care involves the provision of medical aids. In summary, this includes:

• Prostheses
• Contraceptive aids
• Dressing materials
• Injection syringes
• Aids for sight, hearing, mobility or breathing
• Aids for diabetes
• Care products
• Aids for long-term compensation of functional loss in blood and lymph vessels or in arms, hands and fingers
• Aids against chronic pain
• Communication and signalling aids
• Aids for the administration of nutrition or infusions
• Furnishing elements for the adaptation of homes
• Resources and costs for home dialysis

You can find a detailed overview of the aids you are entitled to in the Health Insurance Entitlements Regulations BES, paragraph 7, Sections 1.7.5-1.7.31.

For certain aids, e.g. the purchase of a wheelchair, prior consent of ZJCN is required. Your treating physician or the medical aid supplier knows which medical aids this applies to. A personal contribution is also requested for some medical aids. Modification, replacement or repair of aids is included, unless there is question of careless use. The ZJCN determines whether aids are provided on a permanent or temporary basis.

Obstetric care consists of counselling during childbirth and pre- and postnatal care provided by an obstetrician, GP or medical specialist.

Obstetric care and delivery care in the hospital are reimbursed in full. The reimbursement of hospitalisation is limited to a maximum of three days, unless a longer period is medically necessary. Gynaecological care is reimbursed on medical indication.

The reimbursement of obstetric care includes the use of the delivery room, medical and nursing supplies, and laboratory costs.

Also see: Medical Referral in case of pregnancy

Maternity care is the care and assistance provided to mothers and babies after childbirth.

You are entitled to maternity care at home for a minimum of 24 hours up to a maximum of 49 hours, spread over a maximum of six weeks. Maternity care in a maternity facility is reimbursed for a maximum period of eight days. The care is provided by a maternity nurse or a maternity care organisation.

The reimbursement of maternity care also includes a maternity package, medical and nursing supplies, and assistance from a lactation consultant – the latter upon referral from the obstetrician or the consultation office.

If an insured person dies during a medical referral or emergency transport by air ambulance, ZJCN, together with its partners, arranges repatriation. ZJCN is responsible for the repatriation up to the landing on the residential island.

Long-term care covers:

• Personal care, nursing or support at an insured person's home
• Hospitalisation and further stay in a care home, nursing home or institution for disabled persons
• Heel prick screening and any necessary treatments

For reimbursement of long-term care, the healthcare provider must request prior consent from ZJCN. In urgent cases, consent can be requested afterwards.

Home care

Care at an insured person's home is provided by a home care organisation, care home, nursing home or institution for disabled persons designated by ZJCN.

Stay at an institution

Hospitalisation and further stay at an institution is intended for insured persons who require a protective living environment, a therapeutic living environment or permanent supervision.

Sign language interpreting services

Sign language interpreting services are provided by a sign language interpreter when conducting a conversation in the living environment. The duration of these services is limited to a maximum of 30 hours per calendar year. For insured persons who are deafblind, the duration of sign language interpreting services is limited to a maximum of 168 hours per calendar year. The services are only reimbursed if there is a sign language interpreter working on your island and the services last at least 30 minutes.

Palliative terminal care

Palliative care is aimed at persons who can no longer be cured. The aim is to maintain and, where possible, improve the quality of life. For insured persons who require palliative terminal care, the health insurance covers accommodation, nursing and care in a hospice. For reimbursement of palliative terminal care, the healthcare provider must request prior consent of ZJCN.

Tailored provisions

Residents of Bonaire who live independently at home but are unable to participate in general provisions due to illness or mental health conditions can contact the Lokèt Aksesibel at Sentro Akseso for their tailored provision. Tailored provisions include services such as day care, home help, meal delivery, or medical aids.

Social Network First

Not everyone with a condition living at home automatically qualifies. Consideration is given to the individual’s social network. If managing the household independently is not feasible, it is expected that the social network will lend a hand. Only if this is insufficient or if the individual lacks a social network, does a tailored provision become available.

You can find more information about this in the Tailored Provisions FAQ.

How to Apply?

From 2025, residents can submit applications via the Lokét Aksesibel at Sentro Akseso. This can be done by phone, online, or in person. Staff will assist with completing the application. Sentro Akseso and ZJCN will evaluate the application. Applicants will receive a decision within an agreed timeframe.