Reimbursement of Breast Prostheses and Aids After Breast Cancer

When you have gone through breast cancer, a lot comes at you. Besides medical treatments and recovery, you may also need aids that help you feel comfortable and confident again. Think of breast prostheses, a prosthesis bra, or adapted swimwear. But what about the reimbursement of these products by your health insurance? We have laid it out clearly for you.

Basic Insurance

Most medical aids needed after breast cancer fall under the basic insurance. This means your health insurer reimburses them, provided there is a medical necessity and you have a referral from a doctor.

• Breast prostheses: Fully reimbursed under the basic insurance when your breast has been amputated or when there is another medical necessity.
  
• Referral: You always need a referral from your doctor to qualify for reimbursement.
  
• Specialized supplier: The prosthesis must be fitted by a recognized supplier who has a contract with your health insurer. Only then can you count on full reimbursement.
  
• Deductible: Keep in mind that reimbursement from the basic insurance does count towards your deductible.
  
• 
  Reimbursement period: In most cases, a breast prosthesis is reimbursed once every two years.
  

Supplementary Insurance

Not all products that contribute to your recovery and comfort fall under the basic insurance. Fortunately, many health insurers offer supplementary packages that provide (partial) reimbursement for these.

• Prosthesis bras and lingerie: Often (partially) reimbursed through supplementary insurance, usually once every two years.
  
• Swim prostheses and adapted swimwear: Sometimes reimbursed once or partially from a supplementary package.
  

Important to Know

Although reimbursements are usually available only once every two years, we understand that you may need a new prosthesis or extra products in the meantime. A prosthesis can be lost, your body can change, or you may simply have a different preference. Additionally, it is nice to have multiple prosthesis bras and swimwear in which the prosthesis can be worn. This way, you can alternate, move more freely, and not feel further restricted.

Practical Tips

• Contact your health insurer: Each insurer has its own rules and reimbursement amounts. It is therefore wise to contact them in advance and discuss the options for your personal situation.
  
• Check your policy conditions: Your basic and supplementary insurance conditions state exactly which aids are reimbursed and which are not.
  
• Get advice: Feel free to Contact us if you have questions about the range.
  

Summary

• Basic insurance: Reimburses breast prostheses for medical necessity, after referral from a doctor (usually once every two years).
  
• Supplementary insurance: Can provide (partial) coverage for prosthesis bras, swim prostheses, and adapted swimwear.
  
• Extra purchase: It is very understandable that you want a new prosthesis in between or need multiple bras and swimwear to alternate.
  

At Mamma Nova, we understand how important comfort and confidence are in this phase of your life. That is why we are happy to help you make the right choice from our range and how to use it.

At VGZ, a breast prosthesis is covered by the basic insurance when there is a medical necessity, for example after breast surgery. You need a referral from a doctor for this. Delivery is done through a contracted and SEMH-recognized supplier.

• Contracted: full reimbursement according to the policy.
• Non-contracted: up to 75% of the average contracted rate. For some budget policies, such as VGZ Bewuzt, this may be lower (50–70%).
• For certain policies, VGZ works with a select number of suppliers.
• In some cases, prior approval is required, for example for replacement within the two-year period.
• The reimbursement is subject to the deductible.

Zilveren Kruis reimburses an external breast prosthesis through the basic insurance if it is medically necessary. A referral from the treating physician is also required here.

• Contracted: full reimbursement.
• Non-contracted: for most natural policies about 75% of the average contracted rate. For budget policies, this may be lower (around 60%).
• Prior approval is sometimes required, for example, for replacement within two years.
• Accessories such as prosthesis bras and swimwear are usually not covered by the basic insurance but may be partially reimbursed through supplementary insurance.

Menzis reimburses breast prostheses (both ready-made and custom-made) when a doctor has provided a medical indication. Prior approval is often required for custom-made prostheses. The supplier must be contracted or SEMH-certified.

• Contracted: full reimbursement.
• Non-contracted: up to 75% of the market rate. This may be lower with budget policies.
• Accessories such as prosthesis bras, adhesive strips, and swimwear are generally not covered by the basic insurance.
• The reimbursement counts towards the deductible.

At CZ, breast prostheses are covered by the basic insurance when there is a medical necessity and you have a referral from your doctor. Delivery preferably takes place through a contracted supplier.

• Contracted: full reimbursement.
• Non-contracted: usually 75% of the average contracted rate, sometimes 60–65% for budget options.
• Supplementary insurances often offer extra coverage for prosthesis bras or adapted lingerie.
• The reimbursement from the basic insurance is subject to the deductible.

ONVZ offers a reimbursement policy. This means you have a lot of freedom in choosing your supplier with ONVZ. An external breast prosthesis is covered by the basic insurance in case of medical necessity, for example after removal of the breast gland.

• Contracted: 100% reimbursement.
• Non-contracted: also 100% of the market rate, because ONVZ offers a reimbursement policy.
• The prosthesis generally has a minimum usage period of one year.
• Accessories such as prosthesis bras or swimwear are usually not covered by the basic insurance but can be reimbursed through supplementary insurance.

Zorg & Zekerheid reimburses breast prostheses under the basic insurance for medical necessity and with a referral from a doctor. The 2025 Medical Devices Regulation includes conditions per device, such as usage period and prescriber.

• Contracted: full reimbursement.
• Non-contracted: up to 75% of the market rate.
• Permission may be required for replacement within two years.
• Accessories and lingerie are usually not covered by the basic insurance, but supplementary packages may offer (partial) reimbursement for these.

At HollandZorg, a breast prosthesis is covered by the basic insurance, provided there is a medical necessity and you have a referral from your doctor.

• Contracted provider: full reimbursement.
• Non-contracted provider: up to 75% of the costs, both for purchase and repair.
• The costs count towards your deductible.
• There is no separate statutory personal contribution on top of the deductible.