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  4. What is a country of residence factor?
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What is a country of residence factor?


The costs of healthcare abroad are often lower than they are in the Netherlands. One country may have a more extensive statutory healthcare package than another. In some cases that means that healthcare is more expensive in that country, but generally the healthcare in your country of residence is cheaper. We refer to the ratio between the costs in the two countries as the country of residence factor.
We use the country of residence factor to adjust the healthcare contribution according to the size and costs of healthcare in your country of residence (country of residence package). The Minister for Health, Welfare and Sport determines the country of residence factor annually for the treaty countries. If healthcare in your country of residence becomes more expensive, the country of residence factor also increases. You then have to pay a higher healthcare contribution for your family members.

How do we apply the country of residence factor?

We apply the country of residence factor annually to the total healthcare contribution you have to pay for your family members. The healthcare contribution consists of a nominal contribution Zvw per family member. Then we multiply the total amount by the country of residence factor.

Please note

The country of residence factors and the nominal contribution Zvw are re-determined each year.

Contributions Zvw and country of residence factors 2023

Nominal Zvw contribution

  • per month: EUR 138,08

Country Country of residence factor Monthly contribution (€)
Country of residence factors and nominal Zvw contributions
Belgium 0.7484 103.34
Bosnia and Herzegovina 0.0741 10.23
Bulgaria 0.0937 12.94
Cyprus 0.2155 29.76
Denmark 1.0000 138.08
Germany 0.8814 121.70
Estonia 0.2647 36.55
Finland 0.7069 97.61
France 0.8614 118.94
Greece 0.2269 31.33
Hungary 0.1564 21.60
Ireland 0.9267 127.96
Iceland 1.0000 138.08
Italy 0.5086 70.23
Cape Verde 0.0210 2.90
Croatia 0.2840 39.21
Latvia 0.1334 18.42
Liechtenstein 1.0000 138.08
Lithuania 0.2539 35.06
Luxemburg 0.7671 105.92
North Macedonia 0.0584 8.06
Malta 0.3957 54.64
Morocco 0.0226 3.12
Montenegro 0.0887 12.25
Norway 1.0000 138.08
Austria 0.7243 100.01
Poland 0.1643 22.69
Portugal 0.2790 38.52
Romania 0.1085 14.98
Serbia 0.0795 10.98
Slovenia 0.3510 48.47
Slovakia 0.2393 33.04
Spain 0.4051 55.94
Czech Republic 0.3003 41.47
Tunisia 0.0281 3.88
Turkey 0.0708 9.78
United Kingdom 0.7043 97.25
Sweden 0.8700 120.13
Switzerland 0.9711 134.09

Contributions Zvw and country of residence factors 2022

Nominal Zvw contribution
  • per month: EUR 126,83 (this amount serves as the basis for applying the country of residence factor)
Country Country of residence factor Monthly contribution (€)
Country of residence factors and nominal Zvw contributions
Belgium 0.7369 93.46
Bosnia and Herzegovina 0.0715 9.07
Bulgaria 0.0893 11.33
Cyprus 0.1504 19.08
Denmark 0.9836 124.75
Germany 0.8138 103.21
Estonia 0.2684 34.04
Finland 0.6716 85.18
France 0.8816 111.81
Greece 0.2271 28.80
Hungary 0.1521 19.29
Ireland 0.9185 116.49
Iceland 1.3388 169.80
Italy 0.5233 66.37
Cape Verde 0.0177 2.24
Croatia 0.1945 24.67
Latvia 0.1231 15.61
Liechtenstein 0.9172 116.33
Lithuania 0.2830 35.89
Luxemburg 0.7491 95.01
North Macedonia 0.0567 7.19
Malta 0.3956 50.17
Morocco 0.0253 3.21
Montenegro 0.0821 10.41
Norway 1.3213 167.58
Austria 0.6732 85.38
Poland 0.1829 23.20
Portugal 0.2727 34.59
Romania 0.1113 14.12
Serbia 0.0810 10.27
Slovenia 0.3645 46.23
Slovakia 0.2471 31.34
Spain 0.4019 50.97
Czech Republic 0.2917 37.00
Tunisia 0.0258 3.27
Turkey 0.0643 8.16
United Kingdom 0.6308 80.00
Sweden 0.7751 98.31
Switzerland 0.7145 90.62

Contributions Zvw and country of residence factors 2021

Nominal contribution for the Zvw

  • per month: € 123,17 (this amount serves as the basis for applying the country of residence factor).

Country Country of residence factor Monthly contribution (€)
Country of residence factors and nominal Zvw contributions
Belgium 0.7347 90.49
Bosnia and Herzegovina 0.0681 8.39
Bulgaria 0.0823 10.14
Cyprus 0.1434 17.66
Denmark 0.9982 122.95
Germany 0.8134 100.19
Estonia 0.2480 30.55
Finland 0.7023 86.50
France 0.8918 109.84
Greece 0.2446 30.13
Hungary 0.1493 18.39
Ireland 0.8981 110.62
Iceland 1.3453 165.70
Italy 0.5322 65.55
Cape Verde 0.0167 2.06
Croatia 0.1871 23.05
Latvia 0.1083 13.34
Liechtenstein 0.9923 122.22
Lithuania 0.2631 32.41
Luxembourg 0.7384 90.95
North Macedonia 0.0599 7.38
Malta 0.3987 49.11
Morocco 0.0222 2.73
Montenegro 0.0821 10.11
Norway 1.3064 160.91
Austria 0.6408 78.93
Poland 0.1601 19.72
Portugal 0.2600 32.02
Romania 0.0824 10.15
Serbia 0.0682 8.40
Slovenia 0.3344 41.19
Slovakia 0.2445 30.12
Spain 0.3855 47.48
Czech Republic 0.2341 28.83
Tunisia 0.0280 3.45
Turkey 0.0851 10.48
United Kingdom 0.6593 81.21
Sweden 0.7906 97.38
Switzerland 0.7536 92.82

Contributions Zvw and country of residence factors 2020

Nominal contribution for the Zvw

  • per month: € 117,92 (this amount serves as the basis for applying the country of residence factor).

Country Country of residence factor Monthly contribution (€)
Country of residence factors and nominal Zvw contributions
Belgium 0.7303 86.12
Bosnia and Herzegovina 0.0695 8.20
Bulgaria 0.0780 9.20
Cyprus 0.1410 16.63
Denmark 1.0095 119.04
Germany 0.8041 94.82
Estonia 0.2408 28.40
Finland 0.7340 86.55
France 0.9066 106.91
Greece 0.2589 30.53
Hungary 0.1445 17.04
Ireland 0.8972 105.80
Iceland 1.1637 137.22
Italy 0.5504 64.90
Cape Verde 0.0176 2.08
Croatia 0.1836 21.65
Latvia 0.1020 12.03
Liechtenstein 1.0584 124.81
Lithuania 0.2553 30.10
Luxembourg 0.7107 83.81
North Macedonia 0.0598 7.05
Malta 0.3783 44.61
Morocco 0.0229 2.70
Montenegro 0.0821 9.68
Norway 1.3678 161.29
Austria 0.6730 79.36
Poland 0.1709 20.15
Portugal 0.2736 32.26
Romania 0.0877 10.34
Serbia 0.0718 8.47
Slovenia 0.3520 41.51
Slovakia 0.2584 30.47
Spain 0.4065 47.93
Czech Republic 0.2464 29.06
Tunisia 0.0289 3.41
Turkey 0.0902 10.64
United Kingdom 0.7004 82.59
Sweden 0.8339 98.33
Switzerland 0.7933 93.55

Contributions Zvw and country of residence factors 2019

Nominal contribution for the Zvw

  • per month: € 115,42 (this amount serves as the basis for applying the country of residence factor).
Country Country of residence factor Monthly contribution (€)
Country of residence factors and nominal Zvw contributions
Belgium 0.7392 85.32
Bosnia and Herzegovina 0.0672 7.76
Bulgaria 0.0735 8.48
Cyprus 0.1363 15.73
Denmark 0.9951 114.85
Germany * 0.8701 100.43
Estonia 0.2262 26.11
Finland 0.7161 82.65
France 0.8316 95.98
Greece 0.2490 28.74
Hungary 0.1381 15.94
Ireland 0.8667 100.03
Iceland 0.9802 113.13
Italy 0.5470 63.13
Cape Verde 0.0177 2.04
Croatia 0.1674 19.32
Latvia 0.0672 7.76
Liechtenstein 0.9720 112.19
Lithuania 0.2399 27.69
Luxembourg 0.7358 84.93
North Macedonia 0.0565 6.52
Malta 0.3574 41.25
Morocco 0.0193 2.23
Montenegro 0.0821 9.48
Norway 1.3729 158.46
Austria 0.6632 76.55
Poland 0.1691 19.52
Portugal 0.2616 30.19
Romania 0.0814 9.40
Serbia 0.0714 8.24
Slovenia 0.3377 38.98
Slovakia 0.2405 27.76
Spain 0.4001 46.18
Czech Republic 0.2412 27.84
Tunisia 0.0292 3.37
Turkey 0.0874 10.09
United Kingdom 0.7741 89.35
Sweden 0.8213 94.79
Switzerland 0.8000 92.34

* The country of residence factor for Germany for 2017, 2018 and 2019 was adjusted downwards with effect from 25 October 2019. For 2019 it was adjusted to 0.7827 and the monthly contribution is EUR 90.34.

Explanation of country of residence factors for 2019

The country of residence factors for 2019 were calculated in a different way. Below you can read about why this change was made and how the calculation is performed.

What is the country of residence factor?

A treaty contribution is adjusted using a country of residence factor, as in each country the costs of medical care are different. Is the statutory healthcare in your country of residence cheaper per person than it is in the Netherlands? If so, your treaty contribution will be lower. If the statutory healthcare in your country of residence is more expensive, your treaty contribution will be higher.

How is the country of residence factor calculated?

We divide the average healthcare costs per person in your country of residence by the average healthcare costs per person in the Netherlands. We always use the healthcare costs from the same year. If we take the healthcare costs in your country of residence in 2014 as a basis for the calculation, we will also use the healthcare costs in the Netherlands in 2014. If these costs are exactly the same, the country of residence factor is 1. The treaty contribution is multiplied by the country of residence factor. Are the costs in your country of residence 10% lower than in the Netherlands, for example? In that case the country of residence factor is 0.9 and your treaty contribution is therefore 10% lower.

Why have you changed the calculation for 2019?

To calculate the country of residence factor, we rely on information from your country of residence about healthcare costs. However, for more and more countries it is becoming difficult to obtain the correct information. For 2019 we therefore used a different source: the World Health Organization (WHO).

What is different in the calculation for 2019?

The WHO figures* are calculated in a slightly different way compared with those we received from your country of residence in previous years. Should we use the WHO figures to recalculate the country of residence factor? This could then result in a significant increase in this factor, which is not desirable. For that reason we are only using the WHO figures to adjust (i.e. index) the country of residence factor. If, according to the WHO, the healthcare costs in your country of residence are rising more than those in the Netherlands, the country of residence factor will increase. Conversely, if healthcare costs in the Netherlands are rising more quickly than those in your country of residence, the country of residence factor will decrease.

* For Liechtenstein we used the Eurostat figures

Country of residence factor for 2017 as a basis for the 2019 factor

Since the end of 2014, certain healthcare costs in the Netherlands are no londer part of the statutory health insurance. As of 2015 these costs have been paid under the Social Support Act (Wmo). This means that the average healthcare costs used to calculate the country of residence factor have decreased in the Netherlands. Consequently, the country of residence factor for certain countries rose significantly in 2018. For those countries we are calculating the 2019 country of residence factor on the basis of the factor for 2017.

Country of residence factor for 2018 as a basis for the 2019 factor

For all other countries healthcare costs for 2014 or earlier were still being used to calculate the country of residence factor for 2018. This is because the healthcare costs in those countries for 2015 were not yet known. For those countries we are calculating the 2019 country of residence factor on the basis of the factor for 2018.

Same starting point for all countries

We are therefore performing the calculation for all countries using average healthcare costs that pre-date the change made in 2015. In this way we are keeping the new calculation as fair as possible for everyone.

Contributions Zvw and country of residence factors 2018

Nominal contribution for the Zvw

  • per month: € 109,33 (this amount serves as the basis for applying the country of residence factor).
Country Country of residence factor Monthly contribution (€)
Country of residence factors and nominal Zvw contributions
Belgium 0.7193 78.64
Bosnia and Herzegovina 0.1006 11.00
Bulgaria 0.0909 9.94
Cyprus 0.1384 15.13
Denmark 1.0830 118.40
Germany * 0.9559 104.51
Estonia 0.2491 27.23
Finland 0.7120 77.84
France 0.9262 101.26
Greece 0.1573 17.20
Hungary 0.1501 16.41
Ireland 0.8326 91.03
Iceland 1.0826 118.36
Italy 0.5569 60.89
Cape Verde 0.0175 1.91
Croatia 0.1834 20.05
Latvia 0.1096 11.98
Liechtenstein 1.1866 129.73
Lithuania 0.2650 28.97
Luxembourg 0.7497 81.96
Macedonia ** 0.0595 6.51
Malta 0.3269 35.74
Morocco 0.0125 1.37
Montenegro 0.0829 9.06
Norway 1.4015 153.23
Austria 0.7330 80.14
Poland 0.1606 17.56
Portugal 0.2521 27.56
Romania 0.0903 9.87
Serbia 0.0734 8.02
Slovenia 0.3696 40.41
Slovakia 0.2587 28.28
Spain 0.4365 47.72
Czech Republic 0.2806 30.68
Tunisia 0.0216 2.36
Turkey 0.0894 9.77
United Kingdom 0.6789 74.22
Sweden 0.8104 88.60
Switserland 0.8948 97.83

* The country of residence factor for Germany for 2017, 2018 and 2019 was adjusted downwards with effect from 25 October 2019. For 2018 it was adjusted to 0.8595 and the monthly contribution is € 93.97.
** From 12 February 2019: North Macedonia

Contributions Zvw and country of residence factors 2017

Nominal contribution for the Zvw

  • per month: € 107,50 (this amount serves as the basis for applying the country of residence factor).
Country Country of residence factor Monthly contribution (€)
Country of residence factors and nominal Zvw contributions
Belgium 0.7029 75.56
Bosnia and Herzegovina 0.0645 6.93
Bulgaria 0.0743 7.99
Cyprus 0.1384 14.88
Denmark 0.9715 104.44
Germany * 0.8372 90.00
Estonia 0.2109 22.67
Finland 0.6463 69.48
France 0.8245 88.63
Greece 0.3590 38.59
Hungary 0.1310 14.08
Ireland 0.8226 88.43
Iceland 0.8594 92.39
Italy 0.5569 59.87
Cape Verde 0.0175 1.88
Croatia 0.1674 18.00
Latvia 0.0915 9.84
Liechtenstein 0.9473 101.83
Lithuania 0.2235 24.03
Luxembourg 0.7497 80.59
Macedonia ** 0.0529 5.69
Malta 0.3269 35.14
Morocco 0.0125 1.34
Montenegro 0.0763 8.20
Norway 1.5288 164.35
Austria 0.6476 69.62
Poland 0.1606 17.26
Portugal 0.2510 26.98
Romania 0.0630 6.77
Serbia 0.0750 8.06
Slovenia 0.3243 34.86
Slovakia 0.2352 25.28
Spain 0.3767 40.50
Czech Republic 0.2386 25.65
Tunisia 0.0216 2.32
Turkey 0.0913 9.81
United Kingdom 0.6269 67.39
Sweden 0.8263 88.83
Switzerland 0.6824 73.36

* The country of residence factor for Germany for 2017, 2018 and 2019 was adjusted downwards with effect from 25 October 2019. For 2017 it was adjusted to 0.7532 and the monthly contribution is € 80.97.

** From 12 February 2019: North Macedonia.

Adjustment to country of residence factor for Germany for 2017, 2018 en 2019

From 2017 to 2019 the country of residence factor set for Germany was too high. Are you a treaty-entitled person and did you live in Germany during that period? If so, the amount of the healthcare contribution that was deducted or that you paid was too high.

Why has the country of residence factor for Germany been adjusted?

We use the country of residence factor to adjust your healthcare contribution according to the level of healthcare in your country of residence. Each year the Minister for Health, Welfare and Sport determines the country of residence factor for the treaty countries. For the calculation of this we depend on data from the respective country of residence.

When calculating the country of residence factor for Germany, we took healthcare costs into account which are not part of the calculation afterwards. For the years 2017, 2018 and 2019, the residence factor set for Germany has therefore been too high.

Treaty-entitled persons who lived in Germany during that period therefore overpaid their healthcare contribution or the level of the healthcare contribution deducted was too high. The country of residence factor has now been recalculated and adjusted downwards.

To which period does the adjustment apply?

The adjustment of the country of residence factor for Germany applies only to the years 2017 to 2019. In previous years the country of residence factor had been calculated correctly.

What are the new country of residence factors for Germany for 2017, 2018 and 2019?

Country of residence factor for Germany and nominal contributions under the Healthcare Insurance Act (Zvw)

Year Old country of residence factor Old monthly contribution (€) New country of residence factor Nominal Zvw contribution (€) New monthly contribution (€)
new country of residence factors for Germany
2017 0.8372 90.00 0.7532 107.50 80.97
2018 0.9559 104.51 0.8595 109.33 93.97
2019 0.8701 100.43 0.7827 115.42 90.34

How do I calculate the new monthly contribution?

You calculate the new monthly contribution as follows:

Multiply the new country of residence factorby the nominal Zvw contributionfor the same year. The result is the new monthly contribution.

Example 2019: 0.7827 x 115.42 = 90.34

I am a treaty-entitled person and lived in Germany in 2017, 2018 and/or 2019. What do I need to do?

You do not need to take any action. At the end of 2019 you received a letter from us containing more information.

If it becomes clear that you paid too much healthcare contribution or the level of the healthcare contribution deducted was too high, you will receive a refund from us.

I am a treaty-entitled person, but do not live in Germany. Does this adjustment also affect the country of residence factor in my treaty country?

The adjustment of the country of residence factor for Germany does not affect the country of residence factor in other treaty countries. That means that the country of residence factor for 2017 to 2019 will remain the same for all other treaty countries.



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