This chapter tells you what you need to know in order to benefit from the health insurance system in Belgium.

For persons travelling or living in the European Union outside Belgium, the European health insurance card allows you to benefit from public health care at reduced cost or even free.

If you have worked and paid social insurance contributions in another European Union country, your period of work and the contributions you have paid can be taken into account as part of the benefit calculation.

In what situation can I claim?

 The health insurance system covers practically the whole population: employees and persons treated as such, self-employed workers and persons treated as such, other categories (students, disabled persons, beneficiaries of integration income, etc.) as well as dependants of the aforementioned persons.

To be recognised as a dependant, you must reside in the family of the beneficiary of the insurance, with the exception of the separated spouse (de facto or living apart) and children under age 25. You must not have an income (pension, annuity, etc.) greater than € 2,892.47 gross per quarter (amount in force in the 4^thquarter of 2022).

What conditions do I need to meet?

 To be able to obtain benefits:

• you must be registered with a health insurance body, which in turn must itself be affiliated to a national union of authorised mutual insurance funds, or register with CAAMI;
• your contributions may not be lower than a fixed minimum amount. If this is not the case, an additional contribution has to be paid to maintain the right to healthcare;
• Your affiliation to the insurance body remains valid until the end of the second year following the last year during which you were insured, at the latest.

What am I entitled to and how can I claim?

The benefits in relation to preventive and curative care are reimbursed according to the scales laid down in agreements established between practitioners and the health insurance system.

Medical and dental care

• You are free to choose your doctor or your dentist;
• you are free to consult a specialist;
• In principle, the health insurance fund will reimburse 60-75% of the fees charged for healthcare services.
• Co-payment of € 6 (€ 1.50 for those on the preferential scheme) for consultations with general practitioners; € 4 (€ 1) if you have a “dossier medical global”.
• Co-payment of € 12 (€ 3 for those on the preferential scheme) for consultations with specialist physicians; physiotherapy is reimbursed only if prescribed by a doctor;
• the dental care which will be reimbursed includes preventive and conservative treatment, extractions, dental prosthesis and orthodontic treatment (depending on the age limit: 9 years for a first-line treatment and end of the intervention at the latest at the age of 22);
• you pay the fees directly to the doctor or dentist and you are then reimbursed by your insurance fund.

More information about reimbursement of medical costs is available on https://socialsecurity.belgium.be/en.

Pharmaceutical products

• You are free to choose the pharmacy where you get the medication prescribed by the doctor or dentist;
• you pay the amount of the cost directly to the pharmacist, who will give you a receipt for the medication provided;
• the amount reimbursed by the health insurance varies depending on the social and therapeutic usefulness of the prescribed medication;
• the prescription of an outpatient medication is done electronically (except in exceptional circumstances)
• you will only have to pay the pharmacist the portion of the price not covered by your health insurance fund.

Hospitalisation

• The cost of care is shared between you and your health insurance fund. The hospital will invoice your health insurance fund directly for the costs covered by your insurance;
• on admission to hospital, you make a flat-rate prepayment. The amount varies depending on your status (those benefiting from the preferential scheme, the unemployed, dependent children);
• the cost of the daily care is a flat-rate amount which covers the costs of your stay and your care in hospital. A large proportion of this amount is paid by your health insurance fund. The amount which you have to pay yourself varies according to your status;
• you will also be charged a flat-rate daily amount for the reimbursed medications used during your hospital stay.

More information about hospitalisation at https://www.socialsecurity.be/.

Jargon busters

• Prescription document by which an authorised health professional sets out the treatment recommendations for a patient.
• CAAMI: Auxiliary Fund for Sickness & Invalidity Insurance. Public institution which carries out the same tasks as the mutual insurance funds. Unlike the latter, the auxiliary fund is required to register any beneficiary who applies without them needing a subscription to additional insurance. http://www.caami-hziv.fgov.be/Model4-10-F.htm.
• Preferential scheme: in certain circumstances certain categories of patient benefit from an improved level of reimbursement for their medical costs. This is referred to as the preferential scheme. The personal share that these patients pay for their medical care is therefore lower. More information about the status of beneficiary of the preferential scheme can be found at https://www.socialsecurity.be.
• Personal share or co-payment the amount which you have to pay yourself, after deducting the insurance element.
• INAMI: National Institute for Sickness and Invalidity Insurance. A public body which administers the sickness, maternity and invalidity sector and distributes the financial resources between the different insurance organisations (mutual insurance funds). http://www.inami.fgov.be/FR/Pages/default.aspx.

Know your rights

The links below allow you to find out more about your rights. These sites are not dependent upon the European Commission and so do not represent the viewpoints of the latter:

• https://www.socialsecurity.be;
• www.socialsecurity.belgium.be.

More information about the European health insurance card can be found on the information and services portal of the federal authorities and on the dedicated page of the European Commission.

Who do you need to contact?

  National Institute for Sickness and Invalidity Insurance (INAMI)

• Address: Avenue de Tervueren 211 - 1150 Brussels
• Telephone: +32 27397111
• Email: communication@inami.fgov.be
• Website: http://www.inami.fgov.be/fr/Pages/default.aspx

Auxiliary Fund for Sickness & Invalidity Insurance (CAAMI)

• CAAMI web page to find your nearest regional office.

To contact the mutual insurance funds:

• National Alliance of Christian Mutual Insurance Funds
• National Union of Non-denominational Mutual Insurance Funds
• National Union of Socialist Mutual Insurance Funds
• National Union of Liberal Mutual Insurance Funds
• National Union of Free Mutual Insurance Funds
• Auxiliary Fund for Sickness and Invalidity Insurance
• The SNCB Holding health insurance fund

In the event of any problems with your rights as a European citizen: EU helpdesks