The Health Insurance System in Belgium

Understand which medical costs are covered by insurers and patients, how to pay for medical care and how to submit a claim to a health insurance company…

Anyone working in Belgium pays mandatory social security contributions and, in addition, is usually required to join a health insurance scheme (mutuelle/mutualiteits) run by one of the private or mutual insurers (this may be linked to a union). Individuals may choose which insurance scheme they join, although their employer usually enrols them in one automatically.

The cost of care is partially or fully refunded, depending on certain criteria fixed by law.

Self-employed workers and freelancers

Self-employed people are only insured for major risks, for example hospital surgery and radiography, but can take out additional cover for minor risks. This extra cover then entitles them to partial reimbursement for consultations, certain dental care, physiotherapy, prostheses and medication when not in hospital.

The 'personal share'

When medical costs are incurred, the individual is asked to pay a portion of the costs. This is known as the personal share. This amount can be subject to a fixed maximum (a concept referred to as maximum billing) calculated with reference to income. For minor medical treatment, the individual usually pays the healthcare provider in full and submits a certificate detailing the treatment and cost to their health insurance scheme for reimbursement. The rate at which an individual is reimbursed depends on the type of care, the provider used and their own personal status, for example if a person is disabled, widowed, retired or employed.

For hospital stays and for medication from a pharmacy, the individual pays only their personal share. The hospital or pharmacy reads the SIS card to determine the type of cover given, then collects the balance directly from the health insurance fund.

Some people choose to take out additional healthcare insurance to cover them for any amounts not refunded by their health insurance scheme.

Paying for medical treatment

Receiving medical treatment in Belgium usually works on a pay-per-service basis, in which the patient is billed and pays for each individual consultation, treatment or procedure they receive, and then submits a claim to the appropriate insurance company in order to reclaim part or all of the cost. It is rarely the case that all of the cost of medical treatment is reimbursed through the insurance policy system. Commonly, up to 75 percent will be returned, with the remainder covered by the patient.