The Dutch VAT exemption for healthcare: when it applies and when it does not

Healthcare is VAT-exempt in the Netherlands, right? Usually, but not always. Freelance care workers who also coach, train or write reports quickly end up with a mixed practice: partly exempt, partly taxed. Here is where the line runs.

When care is exempt

The exemption covers medical care of individuals. In short: if you are BIG-registered (the Dutch register of healthcare professionals) and work within the scope of your BIG profession, that care is VAT-exempt. You charge no VAT and pay none. Care by non-BIG providers can also qualify if the quality is demonstrably at an equivalent level, but that assessment is strict; check with the Belastingdienst or an adviser rather than assuming.

When you do charge VAT

The exemption follows the type of work, not your title. Even as a BIG-registered professional you charge VAT (usually 21%) on services that are not medical care, such as:

• work outside your registered scope;
• coaching and training not aimed at treating a patient;
• reports and advisory work for insurers or legal proceedings;
• presentations and consultancy.

A mixed practice

Many freelancers combine both: exempt nursing shifts during the week, taxed team training on the side. That is fine, but you must keep the two apart in your records. Only the taxed part goes into your VAT return. If your taxed turnover stays small, the small business scheme (KOR) may be worth a look.

The downside of the exemption: VAT on costs for exempt work is not deductible. Costs purely for taxed work are; shared costs like a laptop are deducted proportionally.

How Finq handles it

In Finq you pick the VAT type per invoice: 21%, 9%, mixed, reverse charged or exempt. Invoice exempt care with the "Exempt" type and the VAT helper keeps it out of the VAT boxes; invoice taxed work with VAT, using the mixed type when 21% and 9% appear on one job so each line gets its own rate. Combine exempt and taxed work by using separate invoices, which keeps your records cleanly split. More on the healthcare page.

General information, not personal tax advice.