Step-by-step guide to starting as a care zzp'er via an intermediary

  • Willeke Leensma
  • Step-by-step plan
  • 12 September 2021
  • Edited 31 August 2023
  • 7 min
  • Starting

You want to work as a self-employed professional without staff in nursing, care, or home care via an intermediary. Bear in mind that you cannot just start up. You will have to deal with rules and professional requirements. Thirteen steps will help you prepare for your start in healthcare. In addition, Loe van Erp of sector organisation Solopartners explains what to look out for when choosing an intermediary.

Solopartners figures show that in 2021, more than 118,000 self-employed professionals without staff will be working through an intermediary as self-employed professionals in healthcare. Do you also want to work in care via a mediator? Then you need to arrange a number of things with different organisations. The mediation agency you will work for will check your diplomas, work experience, VOG and other important documents. Mediators in the care sector do not all work in the same way. Check with your intermediary which matters you need to arrange. Usually, you need to take the following steps:

1. Register at KVK

Do you want to work as a zzp'er (self-employed professional without staff) via an intermediary and do you comply with the rules for registering with KVK? Fill out the digital registration form (in Dutch). Next, make an appointment to finalise your registration at a KVK office. Most zzp’ers register as an eenmanszaak (sole proprietorship).

2. Apply for eHerkenning 

As a care zzp’er, you must report to the Healthcare and Youth Inspectorate (IGJ). To do this, you need eHerkenning. This is a kind of DigiD for entrepreneurs. You can apply for eHerkenning as soon as you are registered with the KVK. Applying for eHerkenning may take a few days.

3. Report to the Health Care and Youth Inspectorate IGJ

The Wet toetreding zorgaanbieders (Care providers entry Act, Wtza, in Dutch) sets out the requirements you must meet before you are allowed to provide care. One of these requirements is that you report to theZorgaanbiedersportaal (in Dutch). This allows the IGJ to check whether you know enough about the legislation and quality requirements for healthcare. You can register up to three months before you start.
Watch the ​​​​​​video (in Dutch) explaining the obligation to report to the IGJ here.

4. Register in the BIG-register

Do you work as a nurse at level 4 or 5? If so, you must register in the BIG register. This register shows what healthcare providers can and may do, such as certain surgical procedures or giving injections.
Do you work at level 2 or 3? Then skip this step.

5. Apply for a Certificate of Good Conduct (VOG)

With a Certificate of Good Conduct (VOG) you show that your past behaviour is in order. You can apply for a VOG online at the municipality where you live.

6. Appoint a complaints officer

The government wants everyone to receive good care. This is laid down in the Wet kwaliteit, klachten en geschillen zorg (Care quality, complaints, and disputes Act, Wkkgz). The Wkkgz applies to all healthcare providers. Your clients must be able to file a complaint about the care you provide. To arrange this, you work with a complaints officer and must join a recognised disputes committee (in Dutch). Clients can submit a complaint to the complaints officer. This will help the client and mediate between you and your client. The complaints officer is independent.

Complaints officers who comply with the Wkkgz (all websites in Dutch):

7. Choose an intermediary agency

There are many intermediaries active in healthcare. The quality of intermediaries varies. Loe van Erp gives tips: "Check reviews and ask other self-employed people about their experiences with this intermediary. Also check whether the agency works with a non-solicitation clause. This is a kind of non-compete clause that states, for example, that you are not allowed to take clients with you. Or that you are not allowed to work for a client through another agency. Ideally, as a self-employed person, you want an agreement without a non-solicitation clause. Is that not possible? Then refuse the contract and look for a mediator where it is possible."

According to van Erp, the big advantage of working through an intermediary is that you do not have to look for clients yourself. You take on services at times that are most convenient for you and at an hourly rate that you decide. In addition, an intermediary often takes some of the administration out of your hands. They arrange the care agreement, your invoices and keep you informed of laws and regulations. There are also disadvantages. You often work alone and at a different workplace each time. Your income may also vary from month to month.  Plus, you have to provide for your own income if you fall ill. And you do not build up a supplementary pension.  

8. Get a quality mark

Most mediators require you to meet a quality mark. You also need a quality mark to apply for an AGB code (see step 9). You can choose between two quality marks.

  1. KIWA is a quality mark for freelancers in home care. It shows that you meet the professional and entrepreneurial requirements and that you provide good care. The KIWA quality mark (in Dutch) costs 110 euros per year, excluding VAT. The quality mark is valid for one year.
  2. HKZ stands for Harmonisation Quality Assessment in the Healthcare Sector. The HKZ quality mark (in Dutch) is a quality mark that demonstrates that you provide high-quality care. Applying for an HKZ quality mark costs 510 euro excluding VAT. The quality mark is valid for 3 years.

For these levels, a quality mark is compulsory anyway when applying for an AGB code:

  • Caregivers with qualification 9111 and a Caregiver diploma.
  • Nurse level 5 with qualification 9110.

Ask your intermediary whether you need an AGB code, if so go to step 9, if not go to step 10.

9. Apply for an AGB code

Do you want clients to be able to claim your care from health insurers, healthcare offices or the municipality? If so, you may need an Algemene Gegevens Beheercode (General Data Management Code, AGB code). It varies per intermediary whether you need an AGB code. So check this when you start working through an intermediary. Everyone with an AGB code is listed in a database. With this code, insurers, healthcare offices and municipalities recognise you as a healthcare provider. You can apply for the code from Vektis (in Dutch). You need:

  • a diploma for the work you will be doing
  • a VOG (see step 5)
  • a KVK number (see step 1)
  • a KIWA or HKZ quality mark (see step 8)
  • for nursing levels 4 and 5: membership of professional association or BIG quality register (see step 4)

10. Determine your hourly rate  

You determine your own hourly rate. You indicate this to the mediation agency. The intermediary offers assignments at different rates. The higher your rate, the fewer assignments they will offer you. Your hourly rate will be much higher than if you were an employee, because a lot of costs and taxes will be deducted.

With the Hourly Rate Calculator tool, you can calculate what your minimum hourly rate should be to make sure you have enough money left over for your fixed expenses, groceries and taxes. Watch the video for an example of how to calculate your hourly rate.

Video: How to calculate your hourly rate

11. Prevent false self-employment

The Wet Beoordeling Arbeidsrelatie (Employment Relationship Assessment Act, DBA) deals with the independence of zzp'ers. The act is intended to provide clarity to zzp’ers and their clients about whether their relationship is one of an entrepreneur with his client, or one of false self-employment. y are in an employer-employee relationship or not. If you are pseudo self-employed, you do not meet the conditions of being an entrepreneur. That means you are actually employed and not self-employed. Are you pseudo self-employed? If so, you are not allowed to use the entrepreneur allowance and you may receive an additional VAT assessment. Find out whether there is no false self-employment and work according to a model agreement if you are in doubt (in Dutch). 

12. Take out insurance

you perform all kinds of activities in which something can go wrong. A small mistake can have major consequences. Has someone suffered injury or damage because of a mistake you made? Then you have to pay for it. That is why many intermediaries require you to take out business liability insurance. 

KVK Insurance check

Some insurances are compulsory, others are convenient. Which ones do you need? The KVK Insurance Check helps you choose your insurances.

13. Pay taxes

After registration at the KVK, you will usually automatically receive a letter with your VAT number. As health care professions are exempt from VAT, you may not receive a VAT number. Do you still need a VAT number? Then fill in the form Opgaaf Startende onderneming (in Dutch). Put the comment ‘btw-belastbare diensten via een bemiddelingsbureau (VAT taxable services via an intermediary agency)’. If you have a VAT number, you have to file a quarterly VAT return.

Income tax

As an entrepreneur, you have to pay income tax on your profits every year. Is the profit your main income or do you work more than 1225 hours per year on your business? Then you may be able to reduce your profit with deductions, such as the tax relief for new companies and the private business owner's allowance. You will pay less tax.  

Income-related healthcare contribution

As an entrepreneur, in addition to your income tax return, you will also have to pay the income-related healthcare insurance premium. This is a separate assessment.

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