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Are you an expat (employee, self-employed, a student, or unemployed)?
Belgian social security is based on both state subsidies and solidarity. Employees, the self-employed, and employers alike all chip in to keep it funded:
This funding provides benefits for the unemployed (unemployment payments), income for retirees (pensions), and family allowances, as well as compulsory healthcare insurance, entitling people to:
* A waiting period is required to qualify for benefits. However, this can be reduced or waived (using an E104 form) if you have already made contributions in another European country.
For each kind of medical service (consultations with doctors, physios, dentists, visits to specialists, surgeries, pregnancy follow-ups, medications, etc.), NIHDI (the National Institute for Health and Disability Insurance) sets a fixed reimbursement amount. It's this amount that's covered by compulsory health insurance.
These reimbursements, as well as benefits if unable to work or disabled, are paid to citizens by mutual health insurance companies. That's why anyone residing in Belgium must be enrolled with a mutual health insurance fund (mutualité) or scheme (mutuelle) if they want to be able to access to this system.
Unlike in other countries, where enrolment to a mutual health insurance scheme is completed automatically by the employer, in Belgium you have to undertake the process yourself. You have a choice of different organisations.
The reimbursement amounts covered by compulsory health insurance, also known as Compulsory Healthcare Insurance and Benefits, are the same for all citizens, regardless of their mutual health insurance scheme.
However, most mutual insurers offer additional reimbursements in various areas relating to health and well-being (for example, glasses, therapy, alternative therapies, children's courses, sports). These reimbursements (known here as Benefits) make up what is known as complementary insurance, and differ from one mutual health insurance scheme to another. To qualify, you need to be in good standing with your mutual health insurance scheme.
Good to know
Partenamut Business & Expats has over 20 years' expertise in international agreements and offers over 70 Benefits in addition to compulsory insurance reimbursements.
On top of reimbursements defined by NIHDI, there are also agreements about fees charged by healthcare providers.
In order to guarantee access to healthcare for as many people as possible, mutual health insurance funds and other healthcare players have drawn up an agreement known as the "Accord medicomut", which defines official rates for various services.
These pre-established rates are also known as "legal fees" (honoraires légaux). A large proportion of these legal fees are reimbursed by compulsory health insurance. Only part of the cost is left for the patient to cover, and this is known as the "ticket modérateur", or co-payment expenses. However, so-called "non-contract" ("non conventionné") healthcare providers may charge extra fees, which patients are responsible for paying.
When you pay a healthcare provider, the total is split up as follows:
Care providers can choose whether or not to join the Medicomut agreement (i.e. to be contracted or not). If they do, they are known as "contracted" ("conventionnés") doctors, and agree to respect the official rates. Otherwise, they are known as "non-contracted" ("non conventionnés") and are free to charge extra fees. These are never covered by compulsory insurance, and can vary from one provider to another, as each is free to set their own rates.
Don't hesitate to ask your doctor about if they're contracted or not, or to check by using NIHDI's online tool.
As shown above in example 2, some outpatient treatments can be costly when they're done by non-contracted providers. And when it comes to hospital visits, watch out. If you opt for a private room, you risk incurring significant additional fees and other charges. In Belgium, it's not uncommon to receive hospital bills amounting to several thousand euros.
That's why, in addition to basic coverage (compulsory healthcare insurance + supplementary insurance), mutual insurers often offer optional insurance. Partenamut, for example, offers dental cover (Dentalia Up) and 3 different types of hospitalisation insurance (the Hospitalia range) to suit your needs.
These plans can cover all or part of your extra fees, as well as other expenses (e.g. pre- and post-hospital care, transport, room surcharges), so you can rest easy when it comes to your healthcare budget.
If you're a foreign student in Belgium and you don't have an EHIC (European Health Insurance Card), you need to enrol with a Belgian mutual health insurance fund in order to be covered in the event of a health problem (e.g. illness, accident). If you have an EHIC, it's still highly recommended that you enrol. This doesn't happen automatically: you have to request it. Here's how to enrol:
You'll need to get in touch with your chosen mutual health insurance organisation and bring your European Health Insurance Card (EHIC) and identity card with you, so you can register free of charge for a renewable one-year period.
Contact our advisors if you'd like some help with the formalities, to make your enrolment quick and easy!
In Belgium, it's standard practice to have a "family" doctor, who's a general practitioner you visit when you're ill or need a medical prescription. This is the doctor who will open a Global Medical Record and can refer you to specialist doctors.
You're free to choose your own general practitioner. Municipalities and embassies are sometimes able to provide you with more information on the doctors in your area.
GPs normally work on an appointment basis and also offer walk-in consultations without an appointment. If you need to see a doctor outside consulting hours, there is generally an on-call doctor available in your region.
Don't forget to get your GP to open a Global Medical Record (DMG) for you, which will contain all your medical data (operations, chronic illnesses, current treatments, etc.). You'll also get a slightly higher reimbursement amount from the doctor responsible for your DMG.
You can contact the number 1733 (which is also accessible via +32 2 524 98 89). Please note that while this number is active in a large part of Belgium, it's not yet available country-wide. For more information, visit the FPS Public Health website.
Some areas still use their own number. In this case, check the website for the on-call post in your area, or ask your GP for the right number to use, in case you ever need it in the future. If you dial 1733 and it's not available in your area yet, the telephone system will tell you.
Need emergency medical assistance? Call 112.
In Belgium, in addition to general practitioners, there's a network of specialist doctors available to the population. These include dermatologists, endocrinologists, cardiologists, gynaecologists, neurologists, ENT (ears, nose, throat) doctors, and even psychiatrists and pulmonologists.
If you think you need to talk to a specialist, don't hesitate to talk to your GP about it beforehand. They should be able to tell you what to do based on your situation, and if necessary, as explained by NIHDI, provide you with a prescription (letter of transmittal +
"Referral to a specialist" form). In some cases, you can use this to pay less for your consultation.
Note that you'll only be able to see certain specialists with a prescription. But direct access remains available in emergencies.
Preventive and corrective dental treatments (consultation, oral examination, pit and fissure sealing, tartar removal, periodontics, and X-rays) are partially covered by compulsory insurance. For increased reimbursements, you'll need to see a dentist at least once a year. You don't need a prescription from your GP to do so.
The same goes for orthodontic treatments, too: you don't need a prescription from your GP to see a specialist. However, it's important to note that to be considered eligible for reimbursement under compulsory health insurance, the orthodontic treatment must begin before the age of 9 for initial treatments, and before the age of 15 for regular treatments.
As some dental care costs can be expensive, we offer optional insurance (Dentalia Up) to make your cover even better.
Dentalia Up
Are you looking for affordable dental care that includes preventive and curative care, dentures and dental implants, and orthodontics, as well as cancer and accident coverage? Dentalia Up offers just that, and more.
In Belgium, you'll be fully or partially reimbursed for your medication, provided it's prescribed by a doctor and is included on the list of reimbursed medications.
Pharmaceutical specialities (medicines) are classified into different reimbursement categories, depending on their medical and therapeutic significance and necessity. These categories define what proportion of a drug's cost is covered by compulsory health insurance.
Some drugs aren't reimbursed by social security at all. These are sometimes known as "category D" drugs. To find out whether you can get reimbursed for the drug you need, you can use the NIHDI search engine, or check the list of reimbursed pharmaceutical specialities.
There are certain drugs known as "generics", which are copies of standard drugs. These copies are generally cheaper, since they have lower research costs involved in making them.
Despite having a lower price tag, generic drugs contain the same active ingredients, are subject to the same quality controls, and meet the same efficacy criteria as standard drugs. That makes them just as reliable as the drugs they've been copied from.
If you'd like access to these generic drugs, ask your doctor to take this into account when they're prescribing you something. They can write you an INN (international non-proprietary name) prescription, which specifies the scientific name of the active ingredient, and other instructions that will help the pharmacist choose the most appropriate product, medically and financially.
Also, some over-the-counter medicines (notably painkillers) are also available as generics. Don't hesitate to ask your pharmacist for them.
In healthcare, the amount of the cost of a drug that the patient is responsible for paying is known as the "ticket modérateur" (co-payment). It varies according to the category of drug and where it was dispensed (public pharmacy or hospital).
In order to fight misuse and improper use, certain drugs are only available by prescription. In Belgium, only doctors, dentists, and midwives can prescribe medicines.
If you have an electronic ID card (i.e. with a chip), your healthcare provider can record your prescription directly on it, without needing to give you a paper version.
Got a Belgian identity card or diplomatic ID? Go to any pharmacy and give them your medical prescription.
Here are the documents you'll need, depending on your situation:
The mutual health insurance scheme is directly involved in paying the amount due to the pharmacy because of the third-party payer system. This means you'll only need to cover the amount that's left for you to pay, which is known as the "ticket modérateur" or co-payment.
Go to any pharmacy and give them your medical prescription.
The pharmacist will ask you to pay for the medication in full, and you'll then need to claim the reimbursement from your mutual health insurance company.
To do so, ask your pharmacist for an "Appendix 30". You'll then need to send the original version of this document to your mutual insurance company:
Our country has a vast network of pharmacies. You can easily find one using the pharmacie.be search engine.
Pharmacies aren't open 24/7, but some remain available "on-call" outside opening hours. It's important to check which pharmacy is on call when you need one. Note that the on-call pharmacy can apply additional charges if you don't have a prescription.
Our hospital system comprises several types of establishments: public hospitals, private hospitals, and university clinics. Each offers a range of services, from basic care to specialised treatments. Hospitals are equipped to meet a variety of medical needs, including emergencies, specialised consultations, and short- or long-term stays.
Patients can receive hospital care, either through direct admission or referral from a GP or specialist. Hospital services are available to all, regardless of your coverage, but costs can vary depending on the facility's status and required care.
In Belgium, mutual health insurance funds cover part of the costs of hospitalisation, depending on the amounts determined by NIHDI, but patients will often have to cover part of these costs themselves. Hospitalisation costs may include room and supplementary charges, medication costs, and costs for other kinds of care received during the stay.
The amount a health insurance fund will reimburse depends on a number of factors, including the hospital, the type of room (single or shared), the type of treatment received, etcetera.
The final bill varies depending on your doctor's status (contracted or non-contracted, i.e. conventionné or non conventionné), and your chosen room type:
When you're admitted to hospital, present your identity card (Belgian identity card, residency card, or diplomatic card). That way, the hospital can send the costs covered by the compulsory insurance (Belgian social security) directly to your mutual health insurance fund.
For costs that aren't covered by social security, the hospital will send you an invoice. You can then apply for these out-of-pocket expenses to be reimbursed through hospitalisation insurance.
We highly recommend getting optional hospitalisation insurance in order to cover any costs that aren't covered by compulsory insurance (i.e. mutual health insurance). This not only keeps any out-of-pocket costs as low as possible, but also ensures you have the best access to quality care and comfort during your hospital stay.
Good to know
In Belgium, employers do not enrol their workers in a mutual health insurance scheme. However, some employment contracts do include hospitalisation insurance. It's important to understand that these two aren't the same: if you have hospitalisation insurance through your employer, that doesn't mean you're enrolled in a mutual health insurance fund. It's a private insurance scheme, and is an entirely separate thing from mutual insurance companies.
Don't have hospitalisation coverage? We offer a range of insurance packages that include various types of coverage. Our advisors are ready and waiting to show you our full range of Hospitalia insurance plans, and help you decide which one is right for you.
Whether you're an HR manager, an employer, or even a foreign student, our advisors are on hand to help you with the formalities. They're specialists in international agreements and the expat community, and they can answer your questions in several different languages.