If you are an expat in Belgium, and chronically ill, your treatment options and healthcare expenses will depend on your level of health insurance. As an expat, you will be able to sign up for the national system as long as you are paying contributions into it, which will be deducted from your salary if you are working in the country. It is mandatory to sign up for national health insurance.Once you have registered with the social security system, you will be eligible to sign up with a mutuelle/ziekenfonds, which will cover both you and your family. You can then register with a doctor and obtain a Global Medical Dossier (Dossier Médical Global/Het Globaal Medisch Dossier), which will contain your medical history.
As a chronic illness sufferer, your care options will also depend on whether your condition has obliged you to give up work or not. If you are still working and paying into the system, you will be able to access the full range of benefits available to Belgian citizens, including routine, specialist and hospital treatment. If your illness has meant that you have had to give up work, however, you should still be covered by national insurance if you have been making contributions.
How does the Belgian healthcare system work?
Once you have signed up with an insurance provider, you will be able to choose your own GP. Belgian health insurance cover operates on a co-pay, reimbursement basis, so you will need to pay for any treatment up front but then submit a claim to your insurance company. The amount you will be able to claim back will depend on the nature of the treatment, the status of the doctor or hospital, and your income: you may, for example, be entitled to higher reimbursements or a lump sum payment for those suffering from chronic illnesses.
You can see a specialist without a doctor’s referral but most people choose to go through their GP. If you see a specialist without a referral from your family doctor, you will pay more.
You will also be entitled to visit an emergency room, but you might have to pay a small fee which is non-refundable. Make sure you take your EHIC card or your eID with you, or you won’t be eligible for reimbursements.
You should be able to claim back around 70% of your medical fees, for example, for a doctor’s visit. If you are hospitalized, you will need to pay a fixed sum for your accommodation, but your actual treatment fees will be covered by your insurer. You will also need to pay more if you opt for a single-occupancy room. However, if your condition has rendered you unemployed, then you are likely to be charged less.
The fees charged by your healthcare provider will depend on whether they are ‘conventioned’ or ‘unconventioned’ (conventionné/geconventioneerd):
• ‘Conventioned’ healthcare providers respect the official price set by the ‘Medicomut agreement’: an agreement between doctors and health insurance companies setting the official fees
• ‘Non-conventioned’ healthcare providers charge supplements on top of the official price. These supplements will not be covered by compulsory insurance
The Belgian healthcare system and chronic illnesses
The Belgian healthcare system is no stranger to chronic illness. A government report showed that in 2012, over one quarter of the population (27.2%) were said to be suffering from a chronic condition, with back pain, allergies, joint diseases, high blood pressure, neck pain, headaches and respiratory disorders at the top of the list.
The government has sought to address the issue of chronic illness by making it a priority within the healthcare system, for example by organizing high-quality outpatient care, designing individual care plans, early detection, and support of informal care givers.
Overall, if you have a chronic illness, your national insurance policy will cover:
• ordinary medical treatment (consultations and treatment from doctors and specialists)
• medication (preparations, proprietary medicinal products, generic medication, certain prostheses, certain bandages and implants)
• medical treatment in hospital
You also have the option of taking out private health insurance, but note that this may not cover some chronic conditions, particularly pre-existing ones. You should check this with any potential health insurance provider. If you are entitled to take out private cover, then you might consider using it as top-up insurance to cover any payment gap: the discrepancy caused between the amount your healthcare provider charges and the amount reimbursed by your mutuelle.
If you are disabled, then you may consider applying for an integration allowance (e.g. to adjust your living space to your new needs). An integration allowance may be awarded to you if:
• your disability is certified by an approved medical doctor
• your income and that of your partner do not exceed certain limits
• you are at least 21 years of age and under 65
• you are included in the population register
• you are domiciled in Belgium and reside there
You may also be entitled to an allowance for assistance to the elderly if you are over 65.
If you suffer from a chronic illness and your healthcare costs are likely to be high, you can apply for a lump sum allowance in order to increase your reimbursement level. You will need to discuss this with your health care fund, who will make the decision on your behalf.
Applying for disability/sickness benefit
You may also be eligible for sickness benefit if your condition has meant that you have had to give up work. To be eligible you must:
• be registered as primary policy holder with a mutual insurance fund
• demonstrate a minimum volume of work or payment of a minimum level of contributions for a period of at least 12 months
• not have had a period of interruption of more than 30 days between the start of the incapacity and the last working day
• have worked for a total of at least 180 days
• have stopped all work activity
• be acknowledged as unable to work by the doctor of your mutual insurance fund
If you are self-employed:
• you must demonstrate payment of contributions for a minimum of 6 months
• you must be able to demonstrate that you have paid sufficient contributions in a period preceding your incapacity for work
• there must not have been a period of interruption of more than 30 days between the date of your incapacity for work and the last quarter of social security contributions
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