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If you intend to start up as a freelancer/self-employed professional (zzp-er) in the Dutch health care sector, you must comply with various government rules and regulations. You can use this checklist to determine which obligations you must fulfil. This checklist covers rules for freelance/self-employed health care practitioners who want to set up a health care in-home business, and for health care practitioners who set up their own practice, such as dentists and physiotherapists.
This checklist is merely a guideline. Several steps can be carried out at the same time. Depending on your specific health care profession, you may also be subject to other obligations.
1. Check whether you fulfil the conditions for staying in the Netherlands
To start a business and settle in the Netherlands, you may need a residence permit. Our interactive tool Coming to the Netherlands as an entrepreneur can help you find out quickly if this is true for you, and what other obligations you have to fulfil.
If you plan to start doing business in the Netherlands, you may also want to apply for a business bank account (IBAN). The Dutch Banking Association has created a Quick Scan to help you find out if you are eligible. Read how it works.
2. Register with the Dutch Commercial Register and Dutch Tax Administration
New businesses must register with the Netherlands Chamber of Commerce (KVK) Commercial Register.
Sole proprietors: VAT number procedure changes as of 1 January 2020
Do you want to start as a sole proprietor (eenmanszaak)? In that case, from 1 January 2020 onwards, the Tax and Customs Administration will issue your VAT number when you register at the Chamber of Commerce. When you register with the Commercial Register, the Chamber of Commerce will forward your registration to the Tax Administration, and they will process this to provide you with your VAT number. This may take up to five days. Before 1 January 2020, the Chamber of Commerce issued you with your VAT number directly when you registered your business. The change in procedure is necessary to protect sole proprietors' privacy; prior to the change, the VAT number was linked to the private citizen service number (BSN). Personal data were freely available in the Commercial Register. The Data Protection Authority (Autoriteit Persoonsbescherming) has ruled that this is a violation of the GDPR. If you were already registered as a sole proprietor with your citizen service number before 1 January 2020, the Tax Administration will issue you with a new VAT number. You don't have to undertake any action.
3. Fill in the Dutch Health Care Inspectorate's questionnaire
After registration with the Dutch Commercial Register, the Dutch Health Care Inspectorate (Inspectie voor de Gezondheidszorg, IGZ) will ask you to fill in a questionnaire (in Dutch). They use this questionnaire to determine if your care institution falls under their supervision.
4. Have your qualifications evaluated and recognisedTo work as a self-employed care professional, you need to be qualified. If you have foreign qualifications or diplomas, you need to have these validated. You can find out if your diploma is valid in the Netherlands and how to get it evaluated on the Nuffic website.
5. Register with the BIG Register
Certain health care professions have a protected title. You must be entered in the BIG register to be allowed to practice these professions, provide health care services, and use their legally protected professional title in the Netherlands.
6. Apply for an AGB code
You need an AGB code to claim the costs for the care you provide from insurance companies. You can only apply for an AGB code if you have a valid BIG registration or registration from a professional or quality register. The organisation managing the AGB register is Vektis. You can find all the relevant information on registering for AGB on starterindezorg.nl (in Dutch).
7. Prove you are self-employed with a model agreement
As a self-employed professional or freelancer, you may be in the situation that you work in someone else's practice for a while, or for a number of hours per week. Or you can officiate as a health expert (arbo-arts) for one or more companies. The person or company that gives you the assignment is then your business client (N.B.: not to be confused with private individuals, who receive care). The question may arise: are you really self-employed, or is there an employer-employee relationship? Your client does not have to pay wage contributions or payroll taxes for you if the Tax and Customs Administration has proof that you are self-employed. To prove that you are independent, you can use a model agreement between you and your client.
8. Provide insured health care
As a freelancer/self-employed professional, you can provide your clients with long-term insured care in several ways: via a care provider or a care administration office, or directly, using the client's Personal Care Budget. Insured care means that your clients will be insured under the Chronic Care Act (Wet langdurige zorg, Wlz) or the Social Support Act (Wet maatschappelijke ondersteuning, Wmo) and they can reclaim your fees from the insurance company - or the insurance company pays your fees directly.
9. Meet the quality requirements
The care you provide, must meet the care quality requirements set by law.
10. Set your hourly rates
The Dutch Health Care Authority sets maximum rates for certain independent health care professions. Many health care services are exempt from VAT. Freelancers/self-employed professionals, partners in a company and care agencies use the 21% rate.
11. Draw up general terms and conditions
General terms and conditions include rules about payment, delivery times, guarantees and disputes. You can use the specimen terms and conditions drawn up by the Chamber of Commerce (KvK).
12. Take out the insurances you need
You are obliged to take out health insurance in the Netherlands. You also have the option of taking out insurance against a number of other business-related risks, for instance professional indemnity insurance.
13. Report your home business
If you plan to run a business from your home, you are normally obliged to report this plan to your local municipality. You must also bear in mind various tax issues.
14. Create a patient file
Health care practitioners are required to keep records for each patient. These records contain various details including the patient’s health and the treatment prescribed by the health care practitioner. Please note: medical data are special personal data, and you need to take measures to keep them safe. Read what to do to comply with the GDPR.
15. Report child abuse and domestic violence
If you are suspecting child abuse or domestic violence, you have to use a reporting code.
Statistics: self-employment in human health activities
Number of self-employed persons in human health activities.