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How does health insurance work in Belgium? Our guick guide to mutuelles
It’s a buyers’ market when setting up with a Belgian health insurance fund, known as a mutuality (mutuelle/ mutualiteit). While many funds were originally affiliated to political parties, they are open to everyone and offer similar basic services. Children are covered by their parents’ insurance up to the age of 25 or when they start working or receiving benefits. In working-class areas, the Socialist Mutuality may be the largest provider, while in more upmarket suburbs, the Liberal Mutuality will dominate.
Additional cover is offered for nonurgent care, as well as separate hospital insurance. The extra cover includes physiotherapy, speech therapy, nursing care, optometry and psychology, and you need a prescription from a doctor to qualify for partial reimbursement. Alternative treatment covers homeopathy, acupuncture, osteopathy and chiropractic and in many cases you can claim up to €150 a year for complementary therapies.
While your mutuality will pick up the majority of the cost of hospital treatment, a lengthy stay can prove expensive. Fees vary from one hospital and one region to another, with Brussels clinics charging the most. If your employer doesn’t offer hospital insurance, you can add it to your basic cover or take out a policy with a private insurer.
The general advice is that if you can afford private health insurance, go for it. You’ll benefit from greater peace of mind. Private health insurance will pay the difference between the hospital bill and the reimbursement. Again, it pays to shop around to find the best deal for your situation. The umbrella organisation for private firms offering health care insurance is Assuralia. assuralia.be
For a first visit to the pharmacy, you provide your Belgian ID card and the written prescription given to you by the doctor. That’s one reason why it’s easier to use the same chemist each time. The cost of prescription drugs is regulated, so they all charge the same price. There is a legal obligation to record your prescription in a file connected to your ID card. You can give permission for the pharmacist to include non-prescription drugs on this file.
Maternity & sick pay
Your health insurance fund covers maternity leave and longer-term sick leave. Maternity leave is covered for a maximum of 15 weeks. For the first 30 days, mothers receive 100% of their salaries. If you are unable to work for several weeks or months because of an injury or illness, your mutuality pays part of your salary. The mutuality is also responsible for disability benefits if you have previously worked.
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 ID card allows doctors access to your medical file and related insurance information, and you must provide the card to a 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. A new online system enables claims to be digitised and delivered directly from the doctor to the mutuality. Fees charged by family doctors, dentists, for many hospital procedures and for prescriptions are set by law. Some doctors are not bound by this fee structure, so ask before your visit if fees are set by Inami/Riziv.
Mutualities provide some health cover for emergencies (excluding adventure sports) if you’re holidaying in the EU countries, plus a number of other countries, principally Mediterranean. Pick up a European blue card from your mutuality, particularly useful if visiting France. If you travel more regularly and further afield, it’s advisable to take out private travel insurance, which includes medical and repatriation costs. One word of warning: even private insurance only covers you for an absence of three months. For a longer period, consult your insurer.
This article first appeared in The Bulletin autumn 2018