Belgium runs a two-tier system, with both state-funded and private providers. The state system is run by the federal government, but there are ministers for health in both the federal and the regional governments.

You have to pay contributions to the health system, or make sure that your employer pays them for you. A close watch is kept on this and companies are taken to court in Belgium for failing to make contributions for their employees: it is taken very seriously by the government.

The Belgian health insurance system works on a reimbursement scheme, rather than being free at the point of delivery.

Doctors work both privately and in the public sector: most work in the public sector, with some dividing their working time between the two systems. Hospitals, however, are almost all private and are governed by universities, religious institutions or the state insurance sector itself.

The Belgian healthcare system is currently undergoing an overhaul, in order to reduce the tax burden on employees. VAT has been added to cosmetic surgery that is undertaken from patient choice rather than as a result of accidents and emergencies.

Whether you are employed in Belgium by a company, or are self-employed, you will be eligible for state health insurance. It is mandatory to be registered with the health system, and your employer is also legally obliged to make contributions.

Belgium has healthcare agreements with over 20 non-EU nations, including the USA, Canada, Australia and Japan. If you are from these countries and making contributions, you will have the same healthcare rights as Belgian citizens.

If you are employed by a company, then they must arrange this for you. You must arrange it yourself if you are self-employed. In either case, you will have to sign up with the social security office first, either in person or through your workplace. This will cover both you and your dependents, and you can choose your own provider. Most providers are open to everyone, although a few are restricted to members of particular professional, political and religious groups.

You can also choose which medical practice to go to. Check if your doctor works in the state or the private sector, or both; there is usually a notice in the waiting room. If your doctor is a state medic – a ‘fund’ doctor – then their fees will be set by the state and they are not legally allowed to charge more.

Once you have signed up, you will be sent a health insurance card, which used to be known as the Carte SIS but is now the eID, and you will need to take this to a clinic or hospital to claim your costs back.

It is possible to see a specialist without a doctor’s referral, but most people choose to go through their GP. You will also be entitled to visit an emergency room, but you might have to pay a small fee which is non-refundable. You must take your EHIC card, if you have one, or your eID with you, otherwise you won’t be eligible for reimbursements.

Under state medical insurance, you will be eligible to claim back:

• a proportion of your medical fees
• a proportion of your dental fees
• prescriptions
• hospital care and treatment
• maternity costs

Some alternative treatments are covered, but not all. They will be eligible for a private top-up on your insurance.

You should be able to claim back around 70% of your medical fees 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. If you are unemployed, the accommodation cost will be a lot less and the cost overall decreases after your first night. You will need to pay more if you opt for a single-occupancy room.

The hospital will provide a breakdown of any costs in advance. Check with your provider, since coverage might just be for major health problems (for instance cancer, surgery, mental illness) and not for anything else.

If you go to the pharmacy (pharmacie or apotheek), you will have to pay for non-prescription medication, but some of your prescription costs will be refunded. This might only be up to 20%: it depends what sort of medication you need.

If you are pregnant, and in a Flemish-speaking region, consult the Kind en Gezin, which is the local childcare and welfare agency. They will be able to give you free advice and support if you are pregnant or have any children under the age of three. In French-speaking areas, the Office de la Naissance de l’Enfance will carry out a similar function, but you can also consult your GP.

There are around 18 tiers of treatment and coverage in Belgium, each with their own reimbursements. Costs may also depend on your status: if you are a widow, or classed as vulnerable, then you may find that you are eligible for a higher rate of reimbursement. Some insurers have existing arrangements with clinics that will allow full reimbursement, and sometimes the reimbursement will be deducted from your initial payment.

Check with your provider as to when your coverage starts: some expats in Belgium have had problems because the mutuelle/ziekenfonds may not be applied until six months after signing up. Unless you can prove that you have paid sufficient social security contributions in your own country, or if you have previously been covered by Belgian state insurance as someone else’s dependent, you may not be able to reclaim these costs.

If you are a retired expat, the Belgian state health insurance scheme will cover you if you are in receipt of a pension and you pay into the social security system.

If you are a student from within the EU, you will be able to pay into the state system and will be eligible for access to healthcare. You will need to pay a membership fee called a lidgeld (€49 – €180 per annum). There is a six-month waiting period before you can claim under the state scheme, but your EHIC will cover you for emergencies.

If you are an international student from outside the EU, and you plan to be in the country for under 90 days, you will need to apply for a Schengen visa and must show proof of private cover. For more than 90 days, you will need a long-stay visa and must also show that you have private health insurance.

Your family – including your spouse and children under 18 – will automatically be covered by your state insurance if they live in the same property as you.

Your state insurance will cover some dental fees, but it is compulsory to have an annual checkup in order to maintain your insurance coverage. You can claim back the fees for any dental treatment for your children up to the age of 22. Check that you are registered with a state dentist, rather than a private one.

You will pay 7.35% of your gross salary for healthcare. 3.55% is deducted at source; 3.8% will be paid by your employer. If you are self-employed, then you must manage your social security contributions yourself. In this case, you will need to pay the full 7.35%.

People take out private health insurance in Belgium in order to top up existing state coverage, or to secure quicker access to treatments. Some expats take out private insurance to cover the gap between state premiums and the level of reimbursements.

Private insurance covers treatments such as:

• complementary treatment
• more advanced dental treatment
• elective cosmetic surgery

Procedures covered by private health insurance can often be accessed quicker than those offered by the state.

Numerous variables can have an impact on the cost of private health insurance in Belgium.

The most important variables are:

• Age (the higher the more expensive)
• Area of cover (i.e. just Belgium or other areas too? If those other areas include any of the US, the Caribbean, Singapore, China, Hong Kong or Dubai this can significantly increase the overall price)
• Product choice (higher end insurance products are more expensive)

Other variables include:

• Deductibles
• Co-insurance
• Payment frequency
• Gender
• Nationality
• Country of residence

As so many variables have an effect on the cost of private medical insurance in Belgium it becomes very difficult to give accurate estimates without knowing the full details of the coverage required. However, as a very rough guide, using a standard profile of a 40 year old British male with no deductibles, no co-insurance, a middle tier plan/product, all modules included and worldwide coverage excluding the US, a ballpark price of around £4,000/$5,000 might be expected. Were coverage to be expanded to include the US then the premium could increase to almost double that amount.

The big international health insurance companies offer private health cover in Belgium:

• Aetna Global
• Bupa Global
• Cigna Global
• Pacific Prime

Always request quotes from as many insurance providers as possible.

FOD Volksgezondheid en Sociale Zekerheid / SPF Santé Publique et Securité Sociale - Public Administration for Public Health and Social Security

Il me faut un médécin/Ik heb een doctor nodig- I need a doctor

J\'ai une carte EHIC - I have an EHIC card

La sécurité sociale belge/De Belgische sociale zekerheid - Belgian Social Security Office

mutuelle /ziekenfonds - state insurance system