How can I object to a decision concerning my personal budget?
You can object to a decision on the size of your personal budget (PGB), or if your application for a personal budget is rejected. You must submit your objection within 6 weeks of receiving the decision from the care administration office or your municipality. If the PGB comes from your health insurer, you have 12 months to send a complaint to an independent complaints body.
Objecting to the size of your personal budget
You can submit an objection as follows:
Objection concerning a PGB for care under the Chronic Care Act
If you disagree with the size of your personal budget for care under the Chronic Care Act (WLZ) you can send a written objection to your care administration office. The letter notifying you of the care administration office’s decision will explain how to submit an objection. The addresses of care administration offices (Zorgkantoren) can be found on the Zorgverzekeraars Nederland website (in Dutch).
Objection concerning a PGB for care under the Social Support Act or Youth Act
If you disagree with the size of your personal budget for care under the Social Support Act (WMO 2015) or the Youth Act you can send a written objection to your municipality. The letter notifying you of the municipality’s decision will explain how to do this.
Review by a court of the decision on your PGB objection
If you do not agree with the decision on your objection you can apply to a court for judicial review. For legal advice, contact a lawyer, the Legal Aid and Advice Centre or a social legal adviser.
Complaint or dispute concerning a PGB from your health insurer
If you disagree with the size of the personal budget awarded to you by your health insurer for care under the Healthcare Insurance Act (ZVW), you can submit a written complaint to the health insurer. The terms and conditions of your health insurance policy will explain how to do this. The insurer must then reconsider its decision.
If you do not agree with the insurer’s decision in response to your complaint, you have 12 months to take your case to SKGZ. This is a special organisation that deals with health insurance complaints and disputes. The SKGZ’s Ombudsman will deal with your complaint, and see whether the matter can be settled through mediation. If this is not successful, you may present your complaint to the Health Insurance Disputes Committee. The committee’s ruling is binding and both parties must abide by it.