With a contract you agree your rate with the health insurer. With a written contract this may be up to 10% above the maximum rate set by the Dutch Healthcare Authority (NZa): the max-max rate. Without a contract you may not charge more than the maximum rate. Your client then receives a reimbursement the insurer sets itself, and pays the difference.
The NZa is the Dutch Healthcare Authority. In mental health care (ggz) it sets a maximum rate for each service.
In short
- The max-max rate is up to 10% above the maximum rate and is only possible with a written agreement with the health insurer (NZa, mental health rate decision 2026).
- Without a contract the insurer sets your client's reimbursement. The Supreme Court ruled it may not be so low as to form a practical obstacle. A fixed 25% reduction is not always too low.
- Rates for independent healthcare psychologists, clinical psychologists and psychotherapists were under pressure from litigation in 2025 and 2026. From 2027 the NZa will use a new labour cost standard for them.
In this article
- What is the difference between working with and without a contract?
- What is the max-max rate?
- What may you charge if you have no contract?
- How low may the reimbursement without a contract be?
- What do we know about rates for independent psychologists in 2026 and 2027?
- What does the choice mean for your turnover and your cash?
What is the difference between working with and without a contract?
With a contract you invoice the health insurer at the rate in the contract. Without a contract you usually send the bill to the client. The client submits it to the insurer and receives a reimbursement.
The law states that an insured person with a benefits-in-kind policy (naturapolis) who goes to a provider without a contract is entitled to a reimbursement to be set by the health insurer. The insurer states in the policy how it calculates this, and the calculation is the same for all insured persons in the same situation (Health Insurance Act, article 13(1), (2) and (4)).
A naturapolis is a health insurance policy under which the insurer buys care from contracted providers. Under a restitution policy (restitutiepolis) the insured person chooses freely and is reimbursed, up to a limit set in the policy.
What is the max-max rate?
The max-max rate is a rate of up to 10% above the applicable maximum rate. The NZa offers this room to providers who have a written agreement with the health insurer (NZa, Rate Decision Mental Health Care and Forensic Care, TB/REG-26628-05, adopted 9 June 2026, valid for 2026).
The max-max rate is a ceiling, not a right. The NZa writes that health insurers "as a rule apply discounts" to the maximum rates when buying care (NZa, Q&A on new maximum rates for mental health and forensic care (in Dutch), 14 July 2025).
Research on Dutch mental health care shows how this works. After the maximum rates rose by about 10% in 2014, insurers and providers agreed most prices below the new maximum. Providers with more market power obtained higher prices. Some insurers paid clearly less than others (Brouns, Douven and Kemp, 2021).
What may you charge if you have no contract?
Without a contract you may not charge more than the maximum rate. The max-max rate only applies with a written agreement with the insurer. A healthcare provider may not charge a rate outside the range set by the NZa (Healthcare Market Regulation Act, article 35(1)).
You may charge less than the maximum. If you charge the maximum rate and the reimbursement is lower, the client pays the difference. That makes you dependent on the client as payer. Anyone who does not pay is your debtor, not the insurer.
Explain to your client in advance what they will pay themselves. The reimbursement differs by insurer and by policy. The calculation is set out in the policy conditions (Health Insurance Act, article 13(2)).
How low may the reimbursement without a contract be?
The reimbursement may not be so low that it forms a practical obstacle for the insured person to go to a provider without a contract. This is known as the obstacle criterion (hinderpaalcriterium). The Supreme Court confirmed it in 2014 in a case about a mental health provider, after an insurer had limited reimbursement for non-contracted specialist mental health care to 50% (Supreme Court, 11 July 2014, ECLI:NL:HR:2014:1646).
A fixed reduction is not always too much. In 2019 the Supreme Court ruled that the law does not in general preclude a generic reduction of 25%. Whether a reduction is an obstacle depends on the specific facts (Supreme Court, 7 June 2019, ECLI:NL:HR:2019:853).
In 2024 the government wanted to lower reimbursement for non-contracted care, first in district nursing and parts of mental health care (Government of the Netherlands, 17 May 2024). That bill, the Promotion of Care Contracting Act, was withdrawn on 18 December 2024 (Senate, bill 36.561). So the obstacle criterion from case law still applies.
What do we know about rates for independent psychologists in 2026 and 2027?
Rates for three professions in independent practices were delayed. After summary proceedings brought by the LVVP, the association of independent psychologists and psychotherapists, the NZa did not yet set 2026 rates in July 2025 for healthcare psychologists, clinical (neuro)psychologists and psychotherapists in setting 1 (NZa, 14 July 2025).
On 9 June 2026 the NZa adopted a new rate decision for 2026, replacing the previous one. It comes with a decision on objection of the same day about the 2026 mental health rates (NZa, TB/REG-26628-05). The amounts per service are in the annex to that decision. Check the rates for your profession there.
From 2027 the NZa will base the standard labour costs for these three professions on reports by Berenschot, as for psychiatrists (NZa, Policy Rule BR/REG-27113, Government Gazette 2026, 24582). The standard labour costs are the amount for the provider's income that the NZa uses to build up the rate. How high the 2027 rates will be cannot yet be read in this source as at 1 November 2026.
What does the choice mean for your turnover and your cash?
With a contract you know in advance what you will receive per session, and the insurer pays. Without a contract you can charge the maximum rate, but payment depends on your client. You also have to collect the difference between rate and reimbursement from the client.
- Work out per insurer what a contract brings you per session, after the discount.
- If you work without a contract, have the client sign for the costs in advance and ask for monthly payment.
- Track outstanding client bills separately and include them in your forecast. How to make a reliable forecast is explained in how reliable is a cash flow forecast.
Sources
- Health Insurance Act (Zorgverzekeringswet), article 13, version 1 January 2026. wetten.overheid.nl
- Healthcare Market Regulation Act (Wet marktordening gezondheidszorg), article 35, version 1 September 2026. wetten.overheid.nl
- NZa, Rate Decision Mental Health Care and Forensic Care, TB/REG-26628-05, adopted 9 June 2026 (in Dutch). puc.overheid.nl
- NZa, Q&A on new maximum rates for mental health and forensic care, PUC_796488_22, 14 July 2025 (in Dutch). puc.overheid.nl
- NZa, Policy Rule on rate structure for mental health and forensic care, BR/REG-27113, Government Gazette 2026, 24582 (in Dutch). officielebekendmakingen.nl
- Supreme Court of the Netherlands 11 July 2014, ECLI:NL:HR:2014:1646. uitspraken.rechtspraak.nl
- Supreme Court of the Netherlands 7 June 2019, ECLI:NL:HR:2019:853. uitspraken.rechtspraak.nl
- Government of the Netherlands, Bill to encourage contracting of care (in Dutch), 17 May 2024. rijksoverheid.nl
- Senate of the Netherlands, Promotion of Care Contracting Act (36.561), status: withdrawn, accessed 1 November 2026. eerstekamer.nl
- Brouns, C., Douven, R. & Kemp, R. (2021). Prices and market power in mental health care: Evidence from a major policy change in the Netherlands. Health Economics, 30(4), 803-819. doi.org