Yes, a gynaecologist is covered by basic insurance, but only with a referral and only after you have paid your mandatory deductible. That deductible is 385 euros in 2026 and has not risen since 2016. Without a referral, basic insurance covers nothing.
That is the whole rule. Yet this is the question that causes the most confusion, and usually only once the invoice has arrived.
What does basic insurance cover?
Specialist medical care is in the basic package. That means a consultation, an ultrasound, a smear test on indication and a gynaecological procedure are reimbursed, provided there is a referral from a GP, midwife or other authorised referrer.
What is not in it: care without a medical indication. A preventive check-up because you would like to be looked over falls outside it, however sensible that feels. That is not a judgement about the care, it is how the package is drawn.
How exactly does the deductible work?
Your deductible is a threshold amount. You pay the first 385 euros of reimbursed care in a calendar year yourself, after which your insurer takes over. It applies per calendar year and is not recalculated per treatment.
An important detail: hospital care is billed in a care pathway that can run for months. A pathway starting in December can fall under that year's deductible even if most appointments happen in January. Ask about it if you want to plan around that.
| Situation | Reimbursed | What you pay |
|---|---|---|
| Gynaecologist with referral | Yes, basic insurance | Your remaining deductible, max 385 euros |
| Gynaecologist without referral | No | The clinic's full invoice |
| GP | Yes | Nothing, GP care sits outside the deductible |
| Lab work ordered by your GP | Yes | Usually does fall under your deductible |
| Blood test you arrange yourself | No | The test price, your deductible stays untouched |
What does it cost without a referral?
Then you pay the clinic's rate. Private clinics in the Netherlands generally charge a few hundred euros for a gynaecological check-up, depending on whether an ultrasound is included. Always ask for a quote first, because those amounts vary widely.
The flip side is that your deductible stays untouched. If you have not used it this year and expect no other care costs, the difference is smaller than it looks. If your deductible is already full, the referral route is nearly always cheaper.
And blood tests you arrange yourself?
A test you request yourself falls outside basic insurance, so you pay for it. In exchange your deductible stays intact and you need neither a referral nor a waiting time.
For hormone questions that is often the shortest route to an answer. A hormone test for women measures your oestradiol, progesterone, FSH, LH and thyroid values without a specialist in between. Which values are useful when is covered in the pillar on hormone testing in women. If you are unsure about the route itself, read gynaecologist without a referral.
Does supplementary insurance help?
For the gynaecologist itself, usually not. Specialist care with a referral is already in the basic package, so a supplementary policy adds nothing there. Supplementary insurance also does not lower your deductible, because that amount is set in law.
Where supplementary packages sometimes do something is for care outside the basic package. Think of certain fertility treatments, contraception above the age of 21, or part of the cost of a private clinic. That differs a great deal per insurer and per policy, so read the terms before counting on it.
How do you read the invoice?
Hospitals do not bill per individual action but per care pathway. On your statement you therefore often see one amount covering a period of weeks or months, rather than a line per appointment. That explains why a single consultation can look surprisingly expensive.
Check two things. Whether the pathway period is right, and whether the amount was offset against your deductible rather than charged on top of it. If something looks wrong, call your insurer first, because they can review the claim on its merits. If you doubt whether the pathway should have been opened at all, a second opinion is an option.
Frequently asked questions
Do I pay a deductible at the GP?
No. GP care is exempt from the mandatory deductible. Testing the GP orders from a laboratory or hospital can fall under it.
Can I pay my deductible in instalments?
With most insurers yes. Ask your own insurer, because the terms and periods differ per policy.
Is a smear test reimbursed?
The smear within the national RIVM cervical cancer screening programme costs you nothing and does not touch your deductible. A smear on medical indication runs through regular care and therefore through your deductible.
References
- Zorginstituut Nederland, Deductible under the Health Insurance Act, 2026
- RIVM, Cervical cancer screening programme, 2026
- Thuisarts.nl, I want to see a specialist, 2026
- NHG, NHG guidelines and gynaecology referral indications, 2026
Every blood test result through Lunara includes a professional assessment by a BIG-registered doctor. For questions about your own policy and reimbursement, contact your health insurer.
Author
Lunarahealth
Dr. Naimi, BIG-registered physician, oversees the medical standards behind our content and assessments. Read our medical policy
