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Health Insurance Subsidy Application Form

Please fill out the form below to apply for a health insurance subsidy

Basic Information
Detailed Information
Additional Information
Have you previously applied for a health insurance subsidy?
Do you have an account registered with Belastingdienst?
Do you have a person with whom you file a joint tax return and wish to apply for an insurance subsidy (toeslagpartner)?

If 'Yes' – partner's details and documents confirming income.

Does your tax partner have a SoFi/BSN number?

Required information about your tax partner:

Does your tax partner earn income?
Select currency

If you were uninsured for even one day in a month, you are not entitled to a subsidy for that month.

Did you earn any other income?

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