The Netherlands has nine big health insurance concerns in the Netherlands, each with multiple brands. There are 39 health insurance brands. In 2018, Dutch health insurance concern Zilveren Kruis had a market share of approximately 30 percent. These brands can offer up to four types of health insurance products, or policies (in Dutch: polissen), which all offer the same healthcare as required by the government but with varying price ranges. This matters, as it is allowed to cancel one's basic health insurance and change insurance companies every year until the 31st of December. When individuals end their contract before the end of December, their contract will expire on January 1st. They can then choose a new health insurance company before February 1st. In the "insurance season" of 2017/2018, the share of individuals who switched health insurance companies amounted to approximately 6.3 percent.
The funding of Dutch health insurance has two important characteristics. First, there is the so-called "principle of social solidarity": the overall costs of health care are paid by everybody. This is coordinated in two ways. On the one hand, all insured persons aged 18 years and over pay a "nominal" premium to their health insurer. By 2018, the average nominal annual premium reached 1,378 euros per person. On the other hand, there is an income-dependent contribution which is paid by the employer. This income-dependent contribution ends up in a Health Insurance Fund (in Dutch: Zorgverzekeringsfonds), together with the central government contribution for children and adolescents under the age of 18. Health insurers, therefore, are paid both through nominal premiums and from resources in the Health Insurance Fund. Because of this construction, inhabitants of the Netherlands on average pay a high health insurance premium per capita when compared to the other Benelux-countries or even the European average.
Second, all individuals aged 18 and older also pay a mandatory policy excess (in Dutch: verplicht eigen risico) before the basic insurance reimburses medical costs. This is meant to increase cost awareness among the general public. In 2018, the total mandatory excess reaches 385 euros. This mandatory excess can be increased with either 100, 200, 300, 400 or 500 euros as a so-called additional voluntary excess (in Dutch: vrijwillig eigen risico), in exchange for a lower premium. In 2017, the share of individuals without voluntary excess was approximately 88 percent, but approximately 72 percent of Dutch people aged 18 years and older who did pick a voluntary excess in 2017 decided to increase it with 500 euros.
