Working while studying as an international student in the Netherlands

Working in the Netherlands: when health insurance becomes mandatory

For international students in the Netherlands, starting a job, even part-time, triggers one critical requirement: you must have Dutch basic health insurance.

This rule is mandatory from your first day of paid work. Failing to register can lead to significant fines from the CAK.

This guide explains the steps you have to take before you start working, how to avoid fines, and how to apply for the healthcare allowance (zorgtoeslag) to lower your costs.

Set up everything before your first workday

If you are employed in the Netherlands, even part-time, with a zero-hour contract, or with a student assistant role, you’re expected to have Dutch basic health insurance (basisverzekering) from your first working day. If you don’t, you risk a fine and retroactive premiums. Universities spell this out; Utrecht University is explicit, and UvA reiterates it for all working students.

If you are a paid intern, you are also required to take out Dutch health insurance.. Keep in mind that even an internship paying as little as € 150/month or € 1,500/year may qualify as a job (and Dutch insurance can be required). When in doubt: assume you are employed and need an insurance.

Step-by-step setup checklist

1. Register at the municipality (BRP) and get your citizen service number

(This is called, “BSN”, short for burgerservice nummer in the Netherlands) . It is a unique personal identification number issued to everyone who is registered in the Netherlands. You receive a BSN automatically when you register your address at your local municipality (gemeente). This registration is mandatory for international residents staying for more than four months. The BSN is issued once you are added to the Personal Records Database (Basisregistratie Personen or BRP). You need a BSN in order to work legally in the Netherlands and to apply for Dutch health insurance.

2. Open a Dutch bank account + set up DigiD.

This streamlines insurer applications and your zorgtoeslag (healthcare allowance).

3. Choose a basisverzekering (basic health insurance).

While the government mandates that all basic policies cover the same essential care (such as GP visits and hospital treatments), your monthly premium depends on the choices you make. The main choice is your policy type, which dictates your freedom in choosing healthcare providers. A budget policy (budgetpolis) is the cheapest but has the most limited network of approved hospitals and clinics. A natura policy (naturapolis) offers a wider network of contracted providers. A combination policy (combinatiepolis) provides the most freedom, offering full reimbursement for contracted providers and high (but not always 100%) reimbursement for non-contracted care.

Regardless of your policy, you have a deductible (eigen risico): the fixed amount (e.g., € 385,-) you must pay out-of-pocket for most care each year. You can opt to voluntarily increase this deductible to lower your monthly premium (up to € 885,-), but note that visits to your GP are always fully covered and do not count towards this deductible.

4. If you already have a EHIC/private student insurance

That’s fine for study-only, but once you work, it doesn’t meet the legal requirement. So you will have to switch to Dutch basic insurance.

5. Apply for Dutch health care allowance (zorgtoeslag) after you switch.

Many student workers and interns qualify. Health care allowance is a monthly payment (a subsidy) from the government, specifically from the Belastingdienst (the Dutch Tax and Customs Administration), to help you cover the costs of your mandatory Dutch basic health insurance. It’s designed to make health insurance affordable for everyone, especially those with lower incomes. Because most students have a low income, many international students who are required to have Dutch insurance are eligible to receive it. Universities flags this as a key step.

6. Keep proof for HR (policy confirmation PDF).

After taking out your Dutch basic health insurance, download or request the policy confirmation PDF from your insurer. This document serves as official proof of coverage and may be required by your employer or university’s HR department to verify that you’re properly insured.

7. Edge case?

If you believe you’re not obligated to take out Dutch insurance, you can request an official SVB Wlz insurance position assessment (this is the document CAK accepts when you’re exempt)

What to do if you receive a CAK letter or fine

Receiving a letter from the CAK (Centraal Administratie Kantoor) means the Dutch government believes you live or work in the Netherlands without valid Dutch health insurance (basisverzekering). From the moment the letter arrives, a three-month countdown starts. Within that time, you must either take out Dutch insurance or prove you’re exempt.

Option 1: Take a basiszorgverzekering immediately

Doing this within the three-month window stops the CAK process and prevents fines. Once you’re insured, your health insurer automatically notifies the CAK, and your case is closed.

If you don’t act, the CAK will continue the procedure, first issuing fines, and eventually assigning you to a health insurer under the Regeling Onverzekerden (Uninsured Persons Regulation).

Option 2: You think you are exempt

If you believe you’re not required to have Dutch health insurance (for example, if you’re only studying and not working), you can ask the SVB (Sociale Verzekeringsbank) to check your situation. You do this by submitting a Wlz insurance position assessment (Wlz-verzekeringstoets) on the SVB website.

The SVB determines whether you fall under the Dutch long-term care insurance law (Wlz), the key factor that decides if you must have Dutch health insurance (basisverzekering). Once you submit your request, the SVB automatically notifies the CAK that your assessment is in progress.

If the SVB confirms you are not insured under the Wlz

This means you are not obligated to take out Dutch basic health insurance. Once the SVB issues this decision, you should forward it to the CAK. The CAK will then close your case, cancel any pending fines, and you won’t need to pay or take further action.

If the SVB confirms you are insured under the Wlz

This means you are required to take out Dutch basic health insurance. In this case, you must arrange a basisverzekering immediately with any Dutch health insurer.

If you don’t take out insurance within the three-month window after receiving the CAK letter, the CAK will continue its process and you’ll:

1. Receive a first fine,
2. Then a second fine if you still don’t act
3. And eventually be automatically assigned to a health insurer and charged an administrative premium for 12 months.

Option 3: You do nothing

If the government’s systems detect that you live or work in the Netherlands without valid Dutch basic health insurance (basisverzekering), the CAK (Centraal Administratie Kantoor) will send you a letter.

From that date, a three-month countdown begins. Within those three months, you must either take out Dutch health insurance or prove that you’re exempt (for example, through an SVB Wlz insurance position assessment).

If you do nothing, you’ll receive a fine. This rule and timeline are clearly stated on both Rijksoverheid and CAK’s official pages.

If you keep ignoring the CAK letters and fines

If you still don’t act after the first fine, you’ll receive a second fine. Keep ignoring it, and the CAK can assign you to a Dutch health insurer under the Regeling Onverzekerden (Uninsured Persons Regulation).

Once this happens, you’ll be automatically enrolled in a basic health insurance plan and charged an administrative premium for 12 months.  This premium is usually deducted directly from your salary or benefits, and during this 12-month period, you cannot change insurers.
The earliest you can switch again is January 1, after the 12-month period ends.

If you don’t pay your CAK fines

Ignoring your fines triggers a series of escalating steps.

1. Payment reminder and late fee
   If you miss the payment deadline, the CAK will send you a reminder and may add administrative costs or interest. You can still pay voluntarily at this point.
2. Transfer to a collection agency or CJIB
   If you continue to ignore reminders and fines, your case may be transferred to a collection agency (incassobureau) to recover the debt. In some cases, especially those involving unpaid health premiums, the CAK may transfer your case to the CJIB, which is legally authorized to collect public debts on behalf of government bodies.
3. Enforcement through a bailiff (deurwaarder)
   If you still refuse to pay, the case can escalate to a bailiff (deurwaarder). The bailiff can obtain legal authorization to enforce payment by:
   Withholding part of your income (loonbeslag), or freezing part of your bank account (bankbeslag) to recover the amount owed. Any frozen funds will reduce your available balance, indirectly limiting your ability to make payments until the debt is settled.

Health insurance options if you don’t work in the Netherlands

If you’re not working or doing a paid internship in the Netherlands, you’re not required to take out Dutch basic health insurance (basiszorgverzekering). However, you are still expected to have adequate health coverage for medical costs during your stay, Dutch hospitals and clinics require proof of insurance before treatment, except in emergencies. Below are the most common ways to stay insured without a Dutch policy.

1. International health insurance

Many international students, interns, and visitors choose international health insurance, which offers worldwide or regional coverage, including the Netherlands. These plans are usually flexible in duration and can be tailored to your stay.

Some insurers offer specific student packages that include coverage for general practitioners, hospital care, and sometimes dental treatment or repatriation. Your educational institution can often recommend trusted providers or even have partnerships with certain insurers. Before purchasing, always confirm that your policy:

• Covers medical care in the Netherlands (some global plans exclude certain countries);
• Includes emergency care and hospitalisation; and provides coverage for the entire length of your stay.
• Examples of common international insurers include AON Student Insurance, Allianz Care, Cigna Global, and ISO Student Health Insurance (for U.S. students abroad).

2. European or Global Health Insurance Card

If you’re from an EU or EEA country, you can use your European Health Insurance Card (EHIC). If you’re from the United Kingdom, you can use the Global Health Insurance Card (GHIC) instead. These cards provide access to medically necessary healthcare in the Netherlands at the same cost as Dutch residents, for example, if you need to visit a general practitioner, receive hospital treatment, or require emergency care.