Belgian health insurance providers refund part of the (Belgian) medical costs. The medical insurance covers, on average, about 75% of the total costs.
You will usually need to pay the costs up front, and these will then be refunded. The full amount is not refunded in most cases. Often you have to pay a personal contribution; this is known as the co-payment. Generally, the personal share or co-payment is 25% but it may be higher depending on the type of treatment. Some (essential) medical costs are reimbursed in full.
Ambulatory care with doctors, specialists and dentists
You are free to choose your health care provider in Belgium. Doctors are located in private practices or affiliated with a hospital. Always take cash with you when you go to the doctor. After the consultation you pay the doctor’s fee immediately. Few doctors accept credit card payments.
In principal, if you go to a doctor or receive other medical care, you must first pay the total amount in exchange for a doctor’s note or certificate. Reimbursement from the statutory health insurance system is done retrospectively on the basis of the certificate you receive. Affix your identification sticker to it and send this document to your health insurance provider or to the HZIV.
Caution: some health care providers negotiate fixed-tariff agreements with the health insurance providers = doctors that follow the convention). They commit themselves to respecting the negotiated rates unless you, as a patient, make specific demands, e.g. a consultation by appointment. There are also doctors who do not sign these agreements (= doctors that don't follow the convention) These care providers can determine their fees freely. In most cases these are higher than the official rates. In addition, doctors and dentists can also be partially contracted, that is, they are only contracted for certain hours, days and/or sites. To avoid any surprises when receiving your invoice, try your best find out in advance what the status of your health care provider is.
At a pharmacy, a different procedure applies than at the doctor’s. In a pharmacy you do not have to pay the full amount for a prescription from a licensed physician because the reimbursement rates are applied directly (direct settlement system). In this way, you only pay the co-payment. A number of drugs are reimbursed by the statutory health insurance system. Ask your doctor for more information. For these medicines and their reimbursement, you will need a prescription from a doctor and an identification sticker.
Your personal contribution to the cost of hospitalisation is mainly affected by your choice of hospital and the type of room. Accommodation in a single room costs significantly more than a shared room. Do some research in advance and always take your identification stickers with you when being admitted to hospital. This way, the intervention costs may be settled directly with the statutory health insurance system and you will only have to pay your personal contribution.