Health & Care Access

How the Belgian healthcare system works

In Belgium, health care is financed by the social security system which is characterized by solidarity. The health care system is based upon a mandatory medical insurance. In concrete terms, this means that a deal of the price of your visit at the doctor’s and of your medications will be refunded, as well as some medical materials. In some circumstances (glasses, wheelchairs, …). Moreover, if your state of health does not allow you to work, you are entitled to a replacement revenue.

Belgian workers and employers are financing health care expenses refund through contributions. The Belgian State also intervenes in the social security’s total budget. But how does it work and who is entitled to it ?

Practically, two principal actors are concerned by the refunding of health care expenses. The first one is a public organization named the National Institute for Health & Disability Insurance (English acronym NIHID. French acronym, INAMI for Institut National d’Assurance Maladie-Invalidité. Dutch acronym, RIZIV for RijksInstituut voor Ziekte en InvaliditeitsVerzekering), which is competent for health and invalidity insurances. It takes decisions concerning the amounts of health care expenses to be refunded in case of work incapacity or invalidity. The second ones are the mutual insurance companies. These are private organizations which act as intermediaries between citizens and NIHID. They propose insurances for services and complementary care (for instance, dental care, psychological care, etc.) in exchange of an annual financial contribution added to the basic mandatory insurance. You are free to choose your mutual . The Auxiliary health Insurance Disability Fund (French acronym CAAMI, for Caisse Auxiliaire d’Assurance Maladie-Invalidité. Dutch acronym HZIV, for Hulpkas voor Ziekte en InvaliditeitsVerzekering) only offers the mandatory insurance and is, therefore, totally free of charge.

How to get your health care expenses refunded ?

To benefit from health care expenses refunding, you must imperatively be affiliated to a mutual or with the CAAMI. Then, the first step it to have an appointment with your general practitioner. After having paid the health care fee in full, he/she can remit you up to three documents :

A certificate of care: This document must be transmitted to your mutual or to the CAAMI, which will refund a part of the sum you have paid to your doctor.
A medical prescription: This document must be given to your pharmacist who will give you access to some medications which are not accessible over the counter.
A medical certificate: This document must be handed over to your employer. It enables you to take a sick leave, also called work incapacity.

Be careful to choose you mutual insurance company in accordance with a complementary insurance or other advantages proposed in relation with your own specific situation. It is indeed preferable to choose a mutual which is active in a domain for which you feel you will have health care expenses..

CAAMI (Free)

Mandatory refund

According to amounts fixed by NIHID/INAMI/RIZIV

MUTUALS (Payable)

Mandatory refund

According to amounts fixed by NIHID/INAMI/RIZIV

Complementary Insurance

(Better refunds in certain health care domains)

Doctors : Generalists, Specialists

You are free to choose your doctor..

The General Practitioner : deals with all aspects of the patient’s health. He/She does preventive medicine. He/She can work in a private office or in a Medical House (i.e. a center where many professionals work) : generalists, physiotherapists, social workers, mental health professionals etc.)
The Specialist Doctor : before consulting a specialist (often more expensive), it is advised to see a generalist. This to avoid unnecessary exams and costs.

Some tips :

If your complementary health insurance allows you to increase refunds in certain health domains, there are also other ways to increase refunds or reduce health care costs.

1 Give preference to contracted physicians : Contracted physicians charge consultation fees listed by INAMI whereas an uncontracted physician will himself/herself fix his/her fees. Contracted physicians are more affordable. Please note that physicians who are working in Medical Houses are all contracted. This is also the case in hospitals of the IRIS network.

Give preference to generic medications: These are medications sold under a common denomination, without a brand name. They are far cheaper. Medications sold in both cases are identical in composition. Only the package and sell price differ. Next time you visit your pharmacist, make sure you ask for generic medication.
Open a Global Medical File (GMF) with your family doctor : This is a file destined to contain all relevant medical information which concern you. This will allow your generalist practitioner to ensure an easier monitoring of your health. The opening of a GMF will also allow you to decrease by 30% your contribution in the fee of the medical visit. Be careful though to consult the same practitioner who opened your GMF. Otherwise, you’ll have to pay the whole of the consultation fee.

Requesting the BEI (Beneficiary of the Enhanced Intervention, French acronym BIM, for Bénéficiaire de l’Intervention Majorée): This status is automatically allowed to every person receiving a financial aid from the CPAS. It is also accessible upon request and after an enquiry on your revenues, in the case your annual revenues do not exceed a certain amount, i.e. 20 763.88 Euros (+ 3 843.96 Euros per dependent person). BIM status offers many advantages :