A dental emergency post does not charge VAT on treating the patient. That care is exempt. But does the emergency post also receive a fixed fee from the affiliated practices for being available? Then 21% VAT is due on that fee, the Arnhem-Leeuwarden Court of Appeal ruled on 21 January 2025.
For the practices, that VAT is an extra cost. A dental practice mainly provides exempt care, so it usually cannot deduct the VAT on the emergency post's invoice.
In short
- Treating the patient at the emergency post remains exempt from VAT. The fixed fee per dentist that the practices pay for availability is a separate service to the practices and is subject to 21%.
- The court saw no cover for a colleague, because the service to the practices contains no care. Relying on the tax authority's website did not succeed.
- Whether the Supreme Court will rule on this case is not known as at 1 November 2026. So record the fee and the invoice properly now.
In this article
- What did the court decide about the emergency cover fee?
- Why are the treatment and the fee two separate services?
- Is being available for emergency cover not cover for a colleague?
- Who charges the VAT, and what does it cost the practice?
- Can you rely on the tax authority's wording?
- What should you arrange now as an emergency post or an affiliated practice?
What did the court decide about the emergency cover fee?
The court decided that the fixed fee for a dental emergency post being available is not exempt from VAT. The emergency post had to pay VAT on that fee for 2019 and 2020. The court thereby upheld the judgment of the Gelderland District Court (Arnhem-Leeuwarden Court of Appeal, 21 January 2025, ECLI:NL:GHARL:2025:327).
The emergency post was a partnership (maatschap) of five dental practices. A maatschap is a cooperation of independent entrepreneurs who run a business together. The partnership had its own premises, its own equipment and its own support staff. Dentists on the payroll, self-employed dentists and dentists from the partners' own practices worked there.
The dental practices in the region signed a contract for services with the emergency post. It set a fee of € 1,000 per dentist per year for the period in which the emergency post was available. The emergency post sent the practices an invoice for this, without VAT. Patients paid for their emergency treatment directly to the emergency post straight afterwards, at the rates set by the Dutch Healthcare Authority (NZa).
Why are the treatment and the fee two separate services?
The treatment and the fee each have their own customer. The patient enters into a treatment agreement with the emergency post and pays for the treatment. The practice enters into a contract for services with the emergency post and pays for availability. That is why, for VAT purposes, they are two services.
The court pointed out that the fee bore no relation to the nature or number of treatments of the practice's patients. The amount depended only on the number of dentists in the practice. The fee could therefore not be an ancillary part of the treatment either (ECLI:NL:GHARL:2025:327, paras 4.4 and 4.5).
The Supreme Court took the same line in a case about a GP. The GP worked for a fee for a partnership providing integrated primary care. Those services to the partnership were not exempt. According to the Supreme Court, services to different customers under different agreements may not be treated together as one service (Supreme Court, 3 October 2025, ECLI:NL:HR:2025:1326).
Is being available for emergency cover not cover for a colleague?
No, not according to the court. Cover for a colleague is exempt if you provide care yourself while doing it. Being available for a fixed amount contains no care. The court held that cover must in any case have a care component (ECLI:NL:GHARL:2025:327, para 4.7).
The tax authority's website gives two examples that seem close to this. The medical service is also exempt if you perform it "while covering for a colleague". And evening, night and weekend shifts at a GP out-of-hours post are on the list of exempt services (Belastingdienst, Examples of exempt medical services (in Dutch), accessed 1 November 2026). In both cases it concerns the care itself, not a fee for availability.
The exemption for dentists applies to "services of dentists and dental technicians" and to the supply of dental prostheses, such as crowns, bridges and braces (Belastingdienst, Exemption for dentists and dental technicians (in Dutch)). The law itself refers to services in the field of human healthcare (Turnover Tax Act 1968, article 11(1)(g)).
The court's strict approach fits European case law. A review of the European VAT rules for healthcare shows that the Court of Justice of the EU interprets the healthcare exemptions strictly, because they are exceptions to the main rule that every service is taxed. Medical care in this context is care with a therapeutic purpose: diagnosis, treatment and, where possible, cure (Påhlsson, 2015).
Who charges the VAT, and what does it cost the practice?
The emergency post charges the VAT. It provides the taxable service and adds 21% VAT to the invoice to the affiliated practices. The practice pays that VAT and usually cannot reclaim it.
Anyone supplying only exempt services may not deduct the VAT on costs and purchases. Anyone with both exempt and taxable turnover may partly do so (Belastingdienst, What to do if you supply exempt goods or services (in Dutch)). For the emergency post this means: alongside the exempt treatments it also has taxable turnover. It can then deduct part of the VAT on its own costs, for example on equipment and rent.
The emergency post files ordinary VAT returns for the taxable turnover and keeps taxable and exempt turnover separate in its records. How the return works is explained in filing a VAT return: how, when and what to enter.
Can you rely on the tax authority's wording?
Not in this case. The emergency post argued that it was entitled to rely on the fee being exempt, because the tax authority listed "cover for a colleague" as an exempt service. The court rejected this, because the service to the practices is not cover.
There was a further reason. Before the emergency post started, its adviser had asked the inspector for a view. In 2018 the inspector wrote, also after reading the agreement, that the fee was taxable. According to the court, the emergency post's decision to follow different advice afterwards was at its own risk (ECLI:NL:GHARL:2025:327, para 4.9).
An appeal to equal treatment with GP partnerships also failed. In those partnerships the GP provides the care and the payment comes from one source. In the emergency post case, the emergency post itself entered into the treatment agreement with the patient (para 4.10).
What should you arrange now as an emergency post or an affiliated practice?
First check exactly what the practices are paying for. A fixed fee per dentist or per practice for availability, separate from the treatments, resembles the fee in this ruling. Then 21% VAT is the safe starting point.
- Emergency post: put VAT on the invoice for availability, file VAT returns and keep taxable and exempt turnover separate.
- Emergency post: check what part of the VAT on your own costs you can now deduct.
- Practice: include the VAT as a cost in your budget. You usually cannot deduct it.
- Both: if no VAT was charged in earlier years, discuss putting this right. The tax authority can issue additional assessments for earlier years, as in this case for 2019 and 2020.
- Both: if in doubt, submit your agreement to the inspector in advance and keep the reply.
The ruling is from a court of appeal, not from the Supreme Court. As at 1 November 2026, rechtspraak.nl shows no Supreme Court ruling in this case. Whether one will follow is not known. Until then, this is the clearest judgment on the emergency cover fee between dentists.
Sources
- Arnhem-Leeuwarden Court of Appeal 21 January 2025, ECLI:NL:GHARL:2025:327. uitspraken.rechtspraak.nl
- Supreme Court of the Netherlands 3 October 2025, ECLI:NL:HR:2025:1326. uitspraken.rechtspraak.nl
- Turnover Tax Act 1968 (Wet op de omzetbelasting 1968), article 11, version 1 January 2026. wetten.overheid.nl
- Belastingdienst, Examples of exempt medical services (in Dutch), accessed 1 November 2026. belastingdienst.nl
- Belastingdienst, Exemption for dentists and dental technicians (in Dutch), accessed 1 November 2026. belastingdienst.nl
- Belastingdienst, What to do if you supply exempt goods or services (in Dutch), accessed 1 November 2026. belastingdienst.nl
- Påhlsson, R. (2015). The VAT exemption for health care: EU law and its impact on Swedish law. Nordic Tax Journal, 2015(2), 18-35. doi.org