Risicoverevening Policy Updates: Key Amendments for 2022-2025 Explained
On December 9, 2025, the Board of Directors of Zorginstituut Nederland (decision reference 2025027072) approved amendments to the Beleidsregels risicoverevening for 2022, 2023, 2024, and 2025. These changes, published in Staatscourant 2026 nr. 967 on January 19, 2026, correct textual inaccuracies and one technical error in risk equalization rules under the Zorgverzekeringswet (articles 32(5) and 34(4)).
The amendments restore original formulations for gross-net factors, detention factors in own-risk revenue calculations, and reference files for Diagnosis Treatment Combinations (DKG). All changes are non-substantive, with no impact on prior equalization contributions. They received ministerial approval from the Minister of Health, Welfare and Sport (letter dated January 8, 2026, reference 4331086-1092590-Z) and apply retroactively to ensure accuracy.
Summary of Amendments
| Article | Year Affected | Key Change | Effective Date |
|---|---|---|---|
| I | 2022 | Article 7.2: Restores reference to normative own-risk revenue (art. 2.30(4) & 2.29(5)) | Retroactive to Oct 15, 2021 |
| II | 2023 | Art. 4.27: Adds detention factor based on realized lost income (art. 24); Art. 7.2 restored | Retroactive to Oct 15, 2022 |
| III | 2024 | Art. 4.25: Adds detention factor; Art. 7.2 restored; Bijlage 4 DKG_C text corrected | Retroactive to Oct 15, 2023 |
| IV | 2025 | Bijlage 5 DKG_G: Corrects uplift factors for group consults GC0073–GC0144 | Retroactive to Oct 15, 2024 |
Detailed Changes
Gross-Net Factor (Articles 7.2, Years 2022–2024)
Unintended omissions during annual updates removed references to normative own-risk revenues. Restored phrasing matches unchanged calculation methods:
- 2022: References art. 2.30(4) and art. 2.29(5)
- 2023: References art. 2.31(4) and art. 2.30(5)
- 2024: References art. 2.30(4) and art. 2.29(5)
Detention Factor for Own-Risk Revenue (Articles 4.27 & 4.25, Years 2023–2024)
For ex-post products, the detention factor now explicitly bases on realized lost income for insured persons aged 18+ subject to Zorgverzekeringswet art. 24 (no nominal premiums due to detention). This per-insurer calculation replaces a deleted description, aligning with established practice. The result is the “provisional recalculated normative own-risk revenue.”
DKG Reference Files
| Year | File | Specific Change | Publication Date |
|---|---|---|---|
| 2024 | Bijlage 4: DKG_C (arts. 2.8 & 4.5) | Tab “Toelichting,” step 2a: Removes outdated labels “(DKG 23)” after DX 981056 and “(DKG 26)” after DX 991056 | November 18, 2025 |
| 2025 | Bijlage 5: DKG_G (arts. 2.9 & 4.6) | Corrects ophoogfactor (uplift factor) for group consults GC0073–GC0144 (rows 875–946, column L). Changes from per-person minutes to per-consult minutes to align ZPM direct time with DBC total (direct + indirect) minutes | August 7, 2025 |
Corrected files will publish on zorginstituutnederland.nl. No impact on 2025 ex-ante allocations or spring recalculations; first use in September 2026 provisional settlement.
Background and Rationale
Risicoverevening balances risks among health insurers based on insured population characteristics. These textual fixes address errors from iterative policy updates:
- Gross-net factor: Ensures inclusion of normative own-risk in net payable calculations.
- Detention factor: Ex-ante uses national estimates; ex-post uses verified insurer data.
- DKG files: 2024 fixes post-maintenance classification errors; 2025 aligns mental health group therapy (ZPM) with legacy DBC system.
Retroactive effect to October 15 each prior year is unproblematic, as changes are purely corrective with no financial consequences.
Implications for Insurers
- Maintains calculation stability and insurer solvency.
- Supports fair risk-sharing without payment adjustments.
- Improves GGZ data accuracy under Zorgprestatiemodel (ZPM).
FAQ
- Do these amendments change past equalization payments?
- No—purely textual and technical corrections with no recalculation impact.
- What is the detention factor?
- Adjusts own-risk revenue for lost nominal premiums from detained adults (18+), using ex-post realized data per insurer.
- Why correct DKG_G uplift factors?
- ZPM registers only direct time; uplift ensures equivalence to DBC’s direct + indirect minutes for 15+ min group consults introduced in 2024.
Full Text and References
- Full decision: Wijziging van de Beleidsregels risicoverevening 2022-2025 (Staatscourant 2026 nr. 967)
- M.J. Janssen, Chairman, Zorginstituut Nederland Board
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