On 29 March 2016 the Dutch State Secretary of Finance published a new decree regarding the VAT exemption for the provision of medical care by medical practitioners taking the (recent) Dutch and European case law in consideration. Prior to the case law and the decree it was in principle only possible to apply the VAT exemption re the provision of medical care in the exercise of the medical and paramedical practise in case medical practitioners had been registered with the so-called "BIG register" which was only possible to the extend a specific (level of) education has been enjoyed.

The decree now provides clarity on when medical practitioners can also apply the VAT exemption in case they have not been registered with the "BIG register". This means that in case medical practitioners are able to proof that they have an equal level of education as medical practitioners who are registered with the "BIG register" for the provision of medical care in the exercise of the medical and paramedical practise. Note that, medical practitioners can under circumstances also apply the VAT exemption for alternative cure.

Further, modern days medical devices come with increasing functionality and due to the Internet of Things, these functions - and thus the use of medical devices, are expected to further increase. The increase of functionality (i.e. various types of services) of medical devices also comes with new indirect tax challenges.

The above is specifically interesting in light of the application of the VAT exemption for medical services provided by medical practitioners in case of online contact between the medical practitioner and the patient. The new Decree states that the medical practitioners have to be in direct contact with the patient. According to the new Decree the latter can (also) be established through email or chat. Please note that general information published on a website which is not aimed at the patient as such or  a online computer program offering medical information will not be subject to the VAT exemption.

Based on the above, it is recommendable to review the services which are currently rendered and to pro-actively assess new business initiatives that involve the use of online platforms, from a VAT perspective. The latter to determine any possibilities to further optimize the supply chain and to avoid VAT costs following from rendering services which are (could be) VAT exempt.