Anyone who needs more than the usual care, help or guidance due to a disability, condition or disorder can make use of a personal budget.
Think of:
1. Vulnerable elderly
2. Chronically ill
3. People with a physical, mental or sensory disability.
4. Young people with a disorder, disorder, disability or psychological problem
But what is a pgb actually, what forms are there and how can you apply for a pgb?
More on that in this dossier.
What is a pgb?
The personal budget (pgb) is a subsidy (budget) from the government with which people can purchase the care they need themselves.
Examples of PGB care:
1. Intensive care & guidance
2. Personal care and nursing
3. Tools and facilities
Someone with a pgb is in principle free to select and hire his/her own care providers.
Which pgb forms are there?
A pgb can have different goals/forms:
Pgb via the Long-Term Care Act (Wlz)
The pgb-wlz is intended for people who need intensive, long-term (24 x 7) care, such as:
1. Chronically ill
2. Vulnerable elderly
3. People with a severe mental or physical disability or condition
Pgb via the Social Support Act (Wmo)
The pgb-wmo is intended for people who are insufficiently self-reliant or cannot participate well in society.
A pgb can be used for:
1. Guidance and support (individually or in groups)
2. Daytime activities or certain facilities and aids
3. Domestic help
Pgb via the Health Insurance Act (Zvw)
A pgb-zwv is for people who:
1. Need personal nursing and/or care
2. Children in need of intensive care, for example with autism
Pgb via the Youth Act
The PGB Youth Act is intended for children and young people who need care, help and/or support, such as:
1. Personal care
2. Accompaniment
3. Short-term stay
How can you apply for a pgb?
Apply for a pgb in five steps:
1. Find out which care desk you need to be at to apply for a pgb
2. Contact the appropriate care desk by e-mail or telephone
3. The care desk looks at your personal situation and assesses the demand for care
4. It is mapped out to which care you are entitled
5. The insurer, the care office or the municipality decides whether a PGB is granted and what conditions are associated with it.
There are three care desks where you can go, depending on your care demand:
1. The municipality
2. The health insurer
3. The CIZ
During the application, it is often necessary to explain your pgb application, for example why pgb is suitable for you.
Applying for a pgb differs per form of the pgb.
PGB-WLZ
A Pgb-Wlz indication is requested from the CIZ. In the first instance, a WLZ application is simply made. The CIZ looks at your personal situation and care needs. It is mapped out to which care you are entitled: personal care, nursing, guidance with activities and / or stay in a care institution.
The indication is sent to a care office in the region. At this care office you can then apply for care in kind or a personal budget.
Conditions:
1. A budget plan describes which care you purchase from which care providers.
2. A contract is concluded with these care providers. Each care contract also includes a description of the care that is provided. The Social Insurance Bank (SVB) approves the PGB contract.
3. Treatments are not paid from the pgb.
4. Sometimes it is mandatory that someone manages the pgb for you.
PGB-WMO
As a citizen, you can go to the care desk of the municipality if you need help in the household, for guidance of activities or for facilities and adjustments in your home (wheelchair, stairlift). During the conversation with the municipality, we look at how much help and support you are entitled to and then you choose a PGB or care in kind.
Sometimes the self-purchased care is more expensive than care that is provided via care in kind. In that case, a PGB may not be refused. The municipality may decide that you only get the amount that care in kind would cost. The difference will be paid by the client himself. For help with applying for pgb, a free client supporter can be called in at the municipality.
Conditions:
1. It must be clearly indicated why a pgb is desirable for you.
2. The municipality assesses the quality of the purchased services and tools.
3. There may be additional rules for the help you get from family, friends and acquaintances.
PGB-ZVW
As of 1 January 2015, a number of reforms have been implemented around the personal budget. For example, health insurers are now responsible for organizing personal care and district nursing. In short, this means that the pgb is anchored in the Zwv.
People who currently already have a PGB for the indication personal nursing and / or care, or intensive child care (if all goes well) have automatically received a PGB from their health insurer at the beginning of 2015.
A new PGB or re-indication can be requested by entering into a conversation with the district nurse contracted by the health insurer. He/she investigates the request for help/care need and personal situation and investigates what solutions there are for the client. Then it is examined which care is granted and the client can indicate that he wants to opt for a personal budget.
Conditions:
1. You write a budget plan that states which care is purchased.
2. There is a clear justification for why a PGB is desirable.
3. The health insurer examines whether a PGB is suitable and assesses the quality of purchased care.
4. Each health insurer has its own regulations for a PGB. This is described in the policy conditions of the health insurance. For example, the regulations state which criteria you must meet for a PGB.
PGB Youth Act
A PGB for your child can be requested via the municipality. However, the municipality will often first offer an individual facility (via care in kind). As a parent or carer, you look at and discuss whether this facility is suitable or whether a personal budget is really necessary in the child’s situation.
Which and the amount of care that is needed is determined by an indication maker of the municipality or a youth doctor. Sometimes the self-purchased care is more expensive than care that is provided via care in kind. In that case, a PGB may not be refused.
The municipality may decide that you only get the amount that care in kind would cost. The majority will be paid by the client himself. For help with applying for pgb, a free client supporter can be called in at the municipality.
Conditions:
1. You write a budget plan that states which care is purchased.
2. There is a clear justification for why a PGB is desirable.
3. The health insurer examines whether a PGB is suitable and assesses the quality of purchased care.
4. Each health insurer has its own regulations for a PGB. This is described in the policy conditions of the health insurance. For example, the regulations state which criteria you must meet for a PGB.
PGB Youth Act
A PGB for your child can be requested via the municipality. However, the municipality will often first offer an individual facility (via care in kind). As a parent or carer, you look at and discuss whether this facility is suitable or whether a personal budget is really necessary in the child’s situation.
Which and the amount of care that is needed is determined by an indication maker of the municipality or a youth doctor. Sometimes the self-purchased care is more expensive than care that is provided via care in kind. In that case, a PGB may not be refused.
The municipality may decide that you only get the amount that care in kind would cost. The majority will be paid by the client himself. For help with applying for pgb, a free client supporter can be called in at the municipality.
Conditions:
1. There must be a clear justification why a PGB is desirable for your child and care in kind does not fit.
2. The municipality assesses the quality of the purchased care, services, tools and facilities.
3. There may be additional rules for the help your child receives from family, friends and acquaintances.
Costs and payment pgb
The SVB may only make payments to care providers who have approval on the basis of a care agreement with the municipality or the care office. The SVB will register these care agreements of budget holders itself.
The PGB is no longer deposited into a client’s bank account. Instead, the SVB pays the care providers themselves on your behalf. This also means that the SVB takes over part of the financial administration.
The SVB takes care of the payments from your budget and carries out any employer tasks for you. The drawing right has been introduced to prevent fraud, so that the PGB can continue to exist in the future. It is important to send the signed care agreements to the SVB in a timely manner. In this way, as a client, you account for the spending of the money.
Declarations can be submitted relatively easily to the SVB via ‘My Pgb’.
Administratie at Pgb-Zvw
For people who have a personal budget through the health insurance act, for example clients with an indication for personal care and nursing, they can choose whether they want to use the services of the SVB or whether they arrange their own administration. Bills are paid by the client and can be declared to the health insurer afterwards.
Personal contribution
The income or assets are not important whether or not someone is eligible for a PGB. The financial situation does affect the amount of the personal contribution that must be paid in most cases.
1. The PGB may be used for a maximum of thirteen weeks per year for the purchase of care abroad (for terminal care, a maximum of one year).
With a personal budget, everything is slightly different. You then decide for yourself which care providers will support you and how exactly you will receive the care. With your personal budget, you will contract, pay and keep the corresponding administrations yourself. Furthermore, you must be accountable to the care office.