Whether the mental health cao and the PFZW pension fund apply to your practice depends on two things: your legal form and the type of care. The mental health cao defines the employer as a legal entity, such as a private limited company (bv) or foundation. PFZW excludes employers that only provide general basic mental health care without a medical specialist.
A cao is a collective labour agreement: arrangements on pay and conditions for a whole sector. PFZW is Pensioenfonds Zorg en Welzijn, the mandatory pension fund for large parts of the care sector.
In short
- The mental health cao applies to a legal entity providing mental health care. A sole proprietorship or partnership is not a legal entity. The cao ran until 31 July 2026 and was only generally binding from 15 to 31 July 2026.
- PFZW is not mandatory for an employer that only provides general basic mental health care without a medical specialist. If you also provide specialist mental health care or a psychiatrist is involved, you do fall under it.
- In 2026 the PFZW premium is 25.9% of the pensionable salary minus € 17,283. Under the mental health cao, employer and employee each pay half.
In this article
Does the mental health cao apply to your practice?
The mental health cao applies to a legal entity that maintains organisations for care, support and services in mental health care or addiction care. A bv or foundation is a legal entity. A sole proprietorship, partnership (maatschap) or general partnership (vof) is not (Mental Health Cao 2025-2026, chapter 11 article 1).
Members of the employers' association de Nederlandse ggz must apply the cao. Other employers only if the cao has been declared generally binding. It then applies to all employers within its defined scope (Mental Health Cao 2025-2026, chapter 10 article 6). An employer outside the scope can ask the cao parties for permission to apply the cao (article 3).
Declaring a cao generally binding (avv) means that the Minister of Social Affairs makes it apply to employers who are not members as well. The minister did so for the mental health cao by a decision of 9 July 2026. That decision took effect on the day after publication in the Government Gazette of 14 July 2026 and lapsed on 1 August 2026 (Government Gazette 2026, 21825).
The cao itself ran from 1 January 2025 to 31 July 2026. As at 1 November 2026 there is no new cao yet. If one is agreed and declared generally binding again, it will again apply to every bv or foundation within the scope, even if you are not a member.
Does your practice fall under the mandatory PFZW pension fund?
That depends on the type of care. PFZW is mandatory for employers in care with or without accommodation who provide treatment and whose income comes to some extent directly or indirectly from the government. But there is an exception for an employer that exclusively provides general basic mental health care without the involvement of a medical specialist (Government Gazette 2024, 27714, PFZW mandatory participation).
That exception no longer applies as soon as you also provide specialist mental health care or medical specialist treatment "in any form". So a practice with a psychiatrist, or with treatments in specialist mental health care, does fall under PFZW (Government Gazette 2024, 27714).
The mandatory participation decree uses the terms general basic mental health care and specialist mental health care. If you are unsure which group your care falls into, ask PFZW. With the application form you will hear within 10 working days whether your staff must or may build up pension with the fund (PFZW, Must or may I join (in Dutch)).
Do not leave this too long. If you fall under a mandatory pension fund and do not register, you may later be told to join. You then pay all unpaid premiums retroactively (Ondernemersplein, Offering a pension scheme to your employees (in Dutch)).
What applies if you have a sole proprietorship with staff?
For the mental health cao a sole proprietorship is not an employer, because the cao refers to a legal entity. For PFZW it is less certain. The text for care with or without accommodation names the legal entity, the partnership (maatschap), the general partnership and the limited partnership. The sole proprietorship is not listed (Government Gazette 2024, 27714).
Whether a sole proprietorship therefore falls outside PFZW has not been confirmed. The mandatory participation decree does not say so in so many words. So always have it checked by PFZW before you hire your first employee.
If you do not fall under a cao or a mandatory pension fund, you decide yourself whether to offer a pension scheme and what it looks like (Ondernemersplein). You must then still follow the statutory rules, such as the minimum wage and statutory holidays.
What do the mental health cao and PFZW cost you as an employer?
In 2026 the PFZW premium is 25.9% of the premium base. The base is the pensionable salary minus a franchise of € 17,283. The pensionable salary is the annual salary including holiday pay and the structural end-of-year payment, up to € 137,800 (PFZW, pension rules 2026, articles 5.1, 5.4 and 5.6). The franchise is the part of the salary on which no pension is built up.
Under the mental health cao, employer and employee each pay half of the PFZW premium (Mental Health Cao 2025-2026, article 21). The cao also provides holiday pay of 8.33% and an end-of-year payment of 8.33% of the annual salary (article 17). You can work out what an employee under the mental health cao costs in total with the calculator for the cost of an employee under the mental health cao.
Pension is not a cost you recover through lower pay. A British study using panel data found no evidence that employees with a pension scheme received lower pay than employees without one (Haynes and Sessions, 2013). That is one country and not proof for the Netherlands, but do count pension as an extra cost on top of pay.
What should you watch for if you grow or set up a company?
With a bv you become a legal entity. You then fall within the scope of the mental health cao as soon as it is generally binding again, or if you join de Nederlandse ggz. For PFZW the legal form matters less: what mainly decides is whether you provide specialist mental health care or work with a medical specialist.
A bv with staff providing care under the Health Insurance Act also needs a licence under the Healthcare Providers (Admission) Act (Wtza). If your Chamber of Commerce number changes, the CIBG regards you as a new provider and you may need to apply for a new licence (Toetreding zorgaanbieders, Licensing (in Dutch)).
- Determine which type of care you provide: basic mental health care only, or specialist care as well.
- Have PFZW check whether your staff must participate, before you hire anyone.
- Watch whether a new mental health cao is agreed and whether it is declared generally binding.
- Also compare sole proprietorship and bv on tax, with the sole proprietorship or company calculator.
Sources
- Mental Health Care Cao 2025-2026, 1 January 2025 to 31 July 2026, version 11 June 2026, chapter 3 articles 17 and 21, chapter 10 articles 3 and 6, chapter 11 article 1 (in Dutch). fnv.nl
- Decision of the Minister of Social Affairs of 9 July 2026 declaring provisions of the Mental Health Care cao generally binding, Government Gazette 2026, 21825 (in Dutch). officielebekendmakingen.nl
- Decision amending mandatory participation in the Care and Welfare industry-wide pension fund, Government Gazette 2024, 27714, 27 August 2024 (in Dutch). pfzw.nl
- PFZW, Must or may I join (in Dutch), accessed 1 November 2026. pfzw.nl
- PFZW, Articles of association and pension rules 2026, articles 5.1, 5.4 and 5.6 (in Dutch). pfzw.nl
- Ondernemersplein (RVO), Offering a pension scheme to your employees (in Dutch), accessed 1 November 2026. ondernemersplein.overheid.nl
- CIBG, Healthcare provider admission, Licensing (in Dutch), accessed 1 November 2026. toetredingzorgaanbieders.nl
- Haynes, J. & Sessions, J. G. (2013). Work now, pay later? An empirical analysis of the pension-pay trade off. Economic Modelling, 30, 835-843. doi.org