14 December 2017
Health insurance in Belgium: Taking steps to ensure the right plan
Most people who move to Belgium are only told about one option for enrolling in the health-care system. But there is more than one path, and it might be worth shopping around to find the one that’s right for you. From a free agency to a wealth of health insurance funds to private insurance, Belgium is a real buyer’s market when it comes to health care.
Belgium is considered one of the top countries in the world for health insurance. Not only is it easy to become insured, rates are low, and reimbursements are generous.
As a legal resident of the country, you are required to join a health insurance fund if you are older than 25 years of age or under 25, but working or receiving benefits. Children are covered by their parents’ insurance until they reach the age of 25, unless they are fiscally independent.
Health insurance funds are known as mutualities (mutuelle/mutualiteit). There are different mutualities to choose from, and many have names suggesting an affiliation to one of Belgium’s political parties, such as the Socialist Mutuality or the Liberal Mutuality. These are related to the mutuality’s origins and have no bearing on services. All mutualities are open to everyone.
The fee to join a mutuality for basic services is nominal and uniform. They are required to offer the same reimbursement packages for basic services, such as doctor visits. Reimbursement fees are set by the National Institute for Health and Disability Insurance (Inami/Riziv).
All mutualities also offer supplementary coverages, such as for optometry, medical devices and dental or clinical procedures not covered by the basic service. Fees related to supplementary coverage vary from mutuality to mutuality, and many now require clients to purchase one of the supplemental insurance plans in order to join. Inami/Riziv provides a list of mutualities.
Some mutualities impose a six-month waiting period before your insurance coverage becomes valid if you are becoming insured for the first time. If you can prove you had insurance coverage at the time of application, this period is usually waved.
An alternative to a mutuality is the Aid for Sickness and Disability Insurance (CAAMI/HZIV), which is a free health insurance fund. It only provides basic coverage, without any supplemental packages.
A stay in the hospital requires hospital insurance, which is separate from health insurance. Hospital insurance is also available from mutualities. There are different options related to hospital insurance, so fees vary.
Note that out-patient procedures performed at a hospital are generally covered by medical insurance and not by hospital insurance, which relates to overnight stays. The cost of overnight stays are less regulated and can differ from hospital to hospital and from region to region. Brussels hospitals tend to charge the highest fees in Belgium.
Many employers offer hospital insurance as part of a salary package. If employment is terminated, however, you will have to re-enrol as an individual. The older you are when you sign up for individual hospital insurance, the higher a premium you pay. It is therefore worth considering maintaining your own hospital insurance through a mutuality in case you retire or switch jobs.
A patient is free to choose any doctor, specialist or hospital in Belgium; there are no requirements set by the mutuality. The chip on your Belgian ID allows doctors access to your medical file and related insurance information, and you must provide the card to the health-care specialist when you visit for the first time.
A patient usually pays the full price of the visit and receives a form to submit to their mutuality for reimbursement. The time between the submission of a claim and reimbursement varies depending on the mutuality, but is usually one to two weeks.
Belgium’s public health ministry is currently working on a system that would see claims digitised and delivered directly from the doctor to the mutuality. The new system is expected to come online in 2018.
Fees charged by family doctors, dentists, for many hospital procedures and for prescriptions are set by law. Some specialists are not bound by this fee structure, so it’s important to ask before your visit if fees are set by Inami/Riziv.
Reimbursement rates vary depending on the procedure; all information is available on the Inami/Riziv website.
When picking up a prescription at the pharmacy, you will need to provide your Belgian ID card and the written prescription given to you by the doctor. The cost of prescription drugs is regulated, and all pharmacies must charge the same price. The pharmacist is legally obligated to record your prescription in a Pharmaceutical File, which is also connected to your ID card. You can give permission for the pharmacist to include non-prescription drugs on your Pharmaceutical File.
Aside from the legally required health insurance fund, you can choose to purchase additional health insurance from a private insurer. Depending on the treatment or specialist, you might find better coverage for your specific needs.
Private insurance will pay the difference between your costs and the reimbursement from the health insurance fund. This can be a particularly interesting option when looking at hospital costs in Brussels. Assuralia is the umbrella organisation for private firms that offer health care insurance.
Maternity and disability leave
The health insurance fund covers maternity leave and longer-term sick leave. Maternity leave is covered for a maximum of 15 weeks. In the first 30 days of maternity leave, mothers receive 100% of their salaries.
Longer-term sick leave is covered by the health insurance fund. If you are unable to work for several weeks or months because of an injury or illness, your mutuality pays part of your salary.