Annual Report 2022

With a market share of 3.1% (2021: 3.6%)1, a.s.r. is the sixth-largest provider of health insurance on the Dutch market in 2022, measured by numbers of customer. The number of policyholders at a.s.r. fell by 16.9% following two years of growth. This is partly due to a.s.r.'s value over volume principle and disciplined pricing. In 2022, a.s.r.’s health insurance policies were offered under the a.s.r. and Ditzo labels.

Combined ratio Health

(in %)

The COR of a.s.r. health deteriorated to 100.8% (2021: 96.2%).

In 2022, the COVID-19 pandemic was still putting pressure on the Dutch healthcare system. a.s.r., together with other health insurers, has taken measures to ensure continuity of care, duty of care and information to its policyholders. Through solidarity agreements, the additional costs due to COVID-19 have been shared equally between health insurers until April 2022. From April, the Authorithy for Consumers & Markets (ACM) no longer allowed these collective agreements between insurers. Only on rare occasions and in consultation between the Ministry of Health, Welfare and Sport and the ACM will this be allowed.


The Dutch health insurance market consists of two health product types: basic health insurance and supplementary insurances. The market is highly regulated; all Dutch citizens are obliged to take out basic insurance. Basic cover has a limited number of variations across all insurers since it is a statutory compulsory insurance and its conditions/content are prescribed by the government. Although supplementary insurance is not compulsory, 83.5% of the market opted for some form of supplementary health insurance in 2022. Health insurance contracts are concluded on an annual basis. In general, 6-7% of people insured in the Netherlands switch health insurers each calendar year; this has remained relatively stable over the past eight years. In 2022, the number of people switching was 1.2 million, or 6.7%.

Insurers are obliged to accept as policyholders anyone who is legally required to have basic insurance. This is made possible by a government-run system of risk equalisation, which reimburses insurers on a pro-rata basis for expected healthcare costs in their customer base.


The health insurance offerings of a.s.r. can be divided into the following categories:

  • Basic health insurance with a broad coverage of healthcare costs, the content of which is prescribed annually by the government. a.s.r. offers three types of basic health insurance:

    • Contracted care insurance (in-kind), under which the health insurer directly reimburses costs at contracted healthcare providers.

    • Restitution (non-contracted) care insurance, under which the customer is free to choose from hospitals and care providers.

    • Combination of contracted care and non-contracted care insurance.

  • Supplementary health insurance that covers specific risks not covered by basic insurance, such as the cost of dentistry, physiotherapy, orthodontics and medical support abroad.

The in-kind policy is the most common policy in the Dutch market: 76% of the insured population has contracted care insurance. 62% of a.s.r.'s healthcare customers had contracted care insurance.

Strategy and achievements

a.s.r. is ambitious in building on the transition to a healthcare system that supports customers in choosing a healthy and sustainable lifestyle. The range of different health services has increased further in the past year, with the aim of helping and motivating people to take care of their own health. a.s.r. wants to accelerate the sustainability transition, among other things, by seeking cooperation with suppliers, healthcare providers, customers and other health insurers.

Several features have been added to the health service offerings to make its policyholders aware of their health throughout the year, and to encourage them to make healthy choices. These healthy choices focus on exercise, sleep and mental health.

In 2022, a.s.r. contracted ZorgDomein. This further helps a.s.r. to advise customers on the best suitable care. ZorgDomein gives referrers and patients instant insight into whether the chosen care is insured. Policyholders are also directed to a dedicated a.s.r. page which provides them with relevant information. This contributes to a.s.r.’s aim of providing customers with a more proactive service.

Customer contact is an important part of the customer experience, which is why further improvements were pursued and achieved in 2022. One of the goals for 2022 was to make information easier to find so that customers do not have to contact the insurer for simple or self-referential questions. One development that takes this further is the online reimbursement finder, where customers can find out for themselves what the reimbursement is for each insurance policy. A further aim was to create proactive contact, with the customer getting a positive experience during this contact, e.g. notifying them in advance about when they have reached the maximum reimbursement on physiotherapy and dental care. As part of its duty of care, a.s.r is also actively pursuing care mediation, especially with a view to preventing catch-up care following COVID-19.

NPS-c Health

(score, -100 to 100)

With an NPS-c score of 49 (2021: 49), a.s.r. health’s customer satisfaction remained stable throughout 2022.

Outlook for 2023

In 2023, a.s.r. expects the health insurance market to be impacted by inflation and the abolition of the group discount, with low premiums being an even more decisive factor in consumers’ choice of health insurance. Moreover, the ability to contract healthcare providers is likely to be impacted by rising energy prices and wage costs. Combined with labour market shortages and high staff absenteeism in the healthcare sector, this is putting pressure on healthcare providers and insurers alike.

The first outcomes of the transfer season of the health insurance market at the end of 2022 indicate that a.s.r. will realise a significant growth in the number of insured for 2023. a.s.r. remains committed to a positive customer experience in 2023 and continues to encourage both new and existing customers to boost their health and vitality. In addition, a.s.r. will remain focused on cross-selling and branding, in order to increase the awareness of (new) customers on the added value of a.s.r. as an insurer.

Sustainability is another topic that will remain high on the agenda. Moreover, a.s.r. encourages appropriate care, i.e. care that demonstrably works, is smartly organised, and given in the right place or manner in close consultation with the patient. This ambition partly arises out of the Comprehensive Care Agreement, which sets out agreements to keep healthcare accessible and affordable in the next four years. The agreement was signed by health insurers in the Netherlands and the majority of industry players.

  • 1Source: IG&H performancemonitor Inkomen HY2022.