5 steps to getting healthcare in Belgium
Foreigners can typically access subsided Belgian healthcare — claiming back up to 75 percent of medical costs — provided they undertake several registrations with local authorities.
Foreigners in Belgium typically qualify under the local Belgian healthcare system, although certain registrations must be done before they can claim subsidised health services in Belgium.
Those who are residents and working in Belgium can access subsidised Belgian healthcare once they are paying social security contributions and have registered with a health insurance fund, as can their dependent family members.
European citizens staying temporarily in Belgium can access healthcare if they hold an EHIC (European Health Insurance Card), as can citizens from countries with a bi-lateral healthcare agreements with Belgium (check with your embassy for details). International insurance expert, Globality Health, provides the steps expats in Belgium need to take in order to access Belgian healthcare.
Belgium typically ranks in the top 10 healthcare systems in Europe in independent studies, and is praised for its accessibility and generally high quality of public services, which are funded by social security contributions and administered via state health insurance funds.
In an EU-commissioned study published in 2015, Belgium’s healthcare system ranked sixth overall and first for having the shortest waiting times in Europe, where in most cases patients could be seen by a doctor the same day and cancer treatment started on average within 21 days of diagnosis.
In recent years, Belgium has increasingly become a hotspot for medical tourism, largely from residents in the Netherlands followed by France, Luxembourg and the UK. However, if you want to claim back a reimbursement for any healthcare expenses in Belgium, you must follow the five steps below and ensure all your registrations are up-to-date.
1. Check whether you qualify to access the Belgian healthcare system
You can access subsidised healthcare in Belgium — where you pay upfront but are reimbursed a percentage of your medical costs — if you are a legal resident and are working or self-employed in Belgium and paying monthly social security contributions. Your dependant non-working family members, for example partners and children up to the age of 18, are also covered.
Citizens from the European Union (EU), European Economic Area (EEA) and Switzerland can also access Belgian healthcare under the same rights as Belgian locals using their EHIC (European Health Insurance Card) — until they take up official residence or employment. After that, they must also register with a health insurer like everyone else (see below).
Belgium has reciprocal social security arrangements with 25 non-EU countries, including Australia, Canada and the US. Under these arrangements, you can claim and be awarded many of the same benefits as Belgian citizens, provided you carry out the necessary paperwork (i.e. registering with your town hall or getting your residence visa, if applicable).
Other categories of non-working residents, such as students and pensioners, may also be able to access subsidised Belgian healthcare services under an agreement with their country of origin. However, as they must show proof of health insurance to be granted a residence permit, they should seek advice from the authorities in their country before submitting their application. If no agreement exists, it may be necessary to purchase private insurance.
2. Register your address with your local authorities
All foreigners who plan to live in Belgium longer than three months will be classed as Belgian residents. This means that within eight days after you arrive in Belgium, you are legally obliged to register on the Foreigner’s Register at your local municipal administration office/town hall (maison communale/gemeentehuis). This will initiate the proceedings for getting your e-ID (electronic identification) card, which also acts as your residence card and must be carried on you at all times. You can contact the commune where you are living to find the details of your local town hall.
The procedure differs slightly between communes, so ask before you go, but you will likely need to present your passport, proof of address, sufficient financial means (for example, a work permit, pension, scholarship or savings), health insurance and two to four passport photos. You will be issued with a Certificate of Registration and after several weeks you will be sent your Belgian e-ID. You will need to present this when seeking healthcare services.
You may find yourself in a catch-22 situation, where the town hall requests health insurance even though you can’t register with a Belgian health insurance fund until registered at the town hall. If you are unable to show an EHIC card, private insurance or other valid agreement, you should start both procedures at the same time and report one to the other about your progress.
3. Sign up with social security
Belgium has separate social security institutions and rules for the salaried, self-employed workers and civil servants.
If you are employed, your employer will typically register you with the national social security office (RSZ-ONSS). You will pay around 13 percent of your salary into a social security fund, while your employer will pay around an additional 25 percent or more on top of your salary. From this total, around 7.35 percent is paid towards to healthcare.
The self-employed must register themselves with the social security institution for self-employed workers (RSVZ-INASTI), and total contribution rates start around 22 percent and decrease the more you earn. The overall contribution is less than employees thus less sectors are covered by the fund. However, self-employed workers can opt to pay to include more coverage.
Rules for civil servants differ slightly, as social security can be claimed through the relevant governmental department.
EU/EEA/Swiss nationals can seek information from the Overseas Social Security Office (DOSZ-OSSOM) about their social security situation. Typically, European citizens must make social security payments once they start working in Belgium.
4. Sign up with a health insurance fund
Once you are registered with social security, before you can access subsidised healthcare it is mandatory to sign up with one of Belgium’s health insurance funds (mutuelle / ziekenfonds). The funds are responsible for administering healthcare reimbursements on behalf of the social security system.
Once you are registered, you will receive a social identification number, which is now carried in your e-resident card. Your card is required when visiting a doctor, hospital or pharmacy, and your insurance association will be responsible for refunding your fixed percentage of medical care and costs. In many cases, you will typically be reimbursed up to 75 percent of your medical expenses.
You are free to join any health insurer of your choice. Each mutuelle is usually linked to a political or religious group, such as Christian, socialist or liberal groups, although you may find some that offer useful services, such as English-language information. Regardless of which mutuelle you choose, however, the reimbursement amount doesn’t change and medical coverage will be more or less the same, although the process and time taken to pay out claims can be one variation. In some cases your employer might enrol you automatically with a fund, hence you should tell your employer as soon as possible if you want to choose your own. You can find a list of insurers (in French or Dutch).
To register with a mutuelle, you will typically be required to present a copy of your passport or ID card.
Each mutuelle covers most medical treatments, including specialists, hospitals, prescriptions, pregnancy and childbirth. However, you typically cannot claim a reimbursement within the first six months, although this period can be waived if you have been covered by a state health care plan for six months in another EU country.
5. Going to the doctor, local specialist, hospital or dentist in Belgium
Under the state mutuelle/mutualiteit scheme, patients are allowed to choose their healthcare provider, as long as they confirm the provider is registered with one of the insurance companies.
Thus there are no restrictions on which doctors you can see in Belgium, and you have the freedom to consult or register with whomever you choose. Similarly, you are also free to choose any specialist consultant although reimbursement is more guaranteed if you have a doctor’s referral.
Medical records are not centralized in Belgium, however, so if you opt to see several different doctors it is your responsibility to mention if you hold medical records elsewhere. To encourage patients to keep their medical records with one doctor, the government introduced the comprehensive medical record system, known as the Dossier Médical Global (DMG) or Het Globaal Medisch Dossier. To apply, patients register with a main doctor and pay a registration fee (which is reimbursable by your insurance fund), in exchange for a larger proportion of their medical fees reimbursed.
For recommendations, besides asking friends or colleagues, you can also check expat forums or your embassy, which typically keeps a list of doctors who work in your language, although most doctors in Belgium speak English. The National Institute for Health and Disability Insurance (INAMI) also maintains a list of medical professionals (in French and Dutch), as does the Yellow Pages (in French and Dutch).
General practitioners (GP) or family doctors (médecin/huisarts) can be found in private practices or attached to clinics and hospitals. It’s always worth checking whether a doctor is registered in the national health service (conventionné/ geconventioneerd) or private. Some doctors do both, so make sure it’s clear which you want.
You’ll need to take along your Belgian card for the consultation and potentially cash to pay fees, as some doctors do not offer card payments. Some mutuals have arrangements with GPs and hospitals that allow you to pay a reduced fee upfront that already includes your refund, so it pays to check if your insurer has any contacts. Otherwise, you’ll generally pay the full amount upfront and send your receipt or doctor’s treatment certificate to your health insurer to claim a reimbursement.
For hospital and pharmacy costs, you pay only your ‘personal share’ and the hospital or pharmacy claims the balance from the insurer. For inpatient stays at a hospital, you will typically pay a daily fee and should take along some amenities such as soap and a towel. It costs extra to stay in a single room, unless you have private insurance that covers this.
In a hospital, you can also use ‘emergency outpatients’ for immediate treatment, though similar to elsewhere, this shouldn't be a GP substitute and you may be charged a small fee if you go without a referral.
Basic dental work is also reimbursed but to qualify, it is required to visit a dentist at least once per year. Social security has set the levels of reimbursement for dentists in Belgium, so no matter the fee the dentist charges, you can only claim up to a certain amount. Most dentists (dentistes/tandartsen) in Belgium are private, however, you may find those who accept part-payment on state insurance. For out-of-hours dental emergencies in Brussels, you can dial an on-call dentist at +32 (0)2 426 1026.
Globality Health / Expatica
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