In contrast to the UK, Belgium does not have a free national health service.

Everyone is required by law to belong to a health insurance fund.

The system will be roughly familiar to those coming from North America or some other countries.

Basically you’re required to pay the doctor, dentist or pharmacy at the point of use.  Part of this fee is then reimbursed by your health insurance fund.

The standard of provision is very high. You get to enjoy direct access to medical services at most levels without having to first rely on referrals from a GP or house doctor and without any waiting lists.

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You can visit and register with any doctor or doctors of your choice. In these aspects the system is superior to that of the Netherlands, where medical provision is more tightly controlled.

The EHIC gives you temporary free health insurance cover

For people coming from other EU countries the EHIC or European Health Insurance Card system is available.  If you’re arriving in Belgium from another EU country – and only staying for a period of less than six months, then you can obtain initial temporary free health coverage without having to join a health fund for that period.

To do this you first need to obtain a European Health Insurance Card or EHIC in your home country. This replaces the old paper E111 form which used to be required. In the UK you can order your EHIC online from the Department of Health at http://www.dh.gov.uk.

Note that even with the EHIC you will still be liable to pay the residue medical charges that insured Belgians pay.

Officially the EHIC is only to be used if you are not planning to stay in the country beyond six months from your time of arrival.  Thus if you’ve signed a contract of employment lasting longer than this period then an EHIC will not be valid. In this case you will have to obtain Belgian health insurance.

If you don’t have an EHIC and not yet any Belgian health fund insurance fixed up you can still visit a doctor or dentist, but you’ll be liable to pay the higher pre-reimbursement standard charges.

For stays in Belgium longer than six months you must join a health fund

If you’re going to be staying in Belgium for longer than six months then you will have to join a health insurance fund, known as a ziekenfonds or mutaliteit/mutualité. There are many different funds in existence, originally set up to cater for members of specific religious, political or professional groups.

Nowadays you can mostly join any fund you wish and there are no differences in the level of reimbursement as this is fixed nationally by the government.  You may need to make a personal visit to the office of the health insurance fund you wish to enrol at to complete the formalities.

The funds all impose a six-month waiting period before you are entitled to any reimbursements of fees. This waiting period will be waived if you were previously insured for at least six months in another EU country, or in another person’s health fund insurance (eg. as a dependant) prior your becoming insured in Belgium.

You’ll be sent a SIS or Social Insurance Card

The SIS card is a chip card which contains basic information about your age, date of birth, level of insurance etc. You show this to the doctor and pharmacy.  You can register with a specific pharmacy using your SIS card. In this case you will only have to pay the remaining non-reimbursable part of the prescription fee, thus saving you having to send the prescription receipt on to your health fund.

You can also take out supplementary health insurance to cover the non-reimbursed remainder of the cost as well. Some employers offer supplementary health insurance as a fringe benefit to their staff. Alternatively you can seek out a supplementary policy yourself.

You pay the doctor, dentist or pharmacy direct according to a fee scale laid down by the government. For example every visit to the doctor will cost around 21 Euros, for which the doctor will give you a receipt.

You’ll need to have ready cash with you as doctors dont often have electronic payment devices.  You also have to pay for prescriptions and any other medical services, eg specialist examinations, X-rays, blood tests and other consultations.

Precisely what prices are charged and what level of reimbursement applies depends on how the treatment is classified by the government. A distinction is made between “small risks” and “large risks”. There are also basic daily fees for hospitalization. The other large charges for hospital treatment are billed directly to your health fund.

You need to retain the receipts in order to send them on to your health fund.  You have to send the original receipts – for safety you can take photocopies first. Your health fund will provide you with a set of stamp-like stickers printed with your insurance number and name. You stick one of these on each receipt before sending it to the fund.  The idea is that the SIS card system will eventually replace this outdated procedure but for the moment it’s still a requirement.

The health fund will then credit the reimbursements directly to your bank account. If you have also taken out supplementary health insurance, then the health fund will also notify the insurer who will make the necessary remaining reimbursement.

Tip: low cost health insurance is available from the government run HZIV/CAAMI

You can obtain a basic level of cover at low cost from the national social security system under the HZIV Hulpkas voor Ziekte- en Invaliditeitsverzekering / CAAMI Caisse Auxiliaire d’Assurance Maladie-Invalidité.

Unfortunately the HZIV/CAAMI site is only available in Dutch, French and German but not English.

The HVIC/CAAMI is at:  http://www.caami-hziv.fgov.be/Model4-10-N.htm

On the whole the Belgian health insurance system works well. It’s a bit of a nuisance having to make sure you have cash on you if you need to visit a doctor, but it ensures that in Belgium, and in contrast to say the Netherlands or UK, the customer (or patient) is king.

Another good thing about most Belgian doctors is that they don’t have receptionists. You simply walk into the waiting room and wait your turn. No receptionist to turn you away or tell you to come back another day.

Finally, one oddity of Belgian pharmacies is that they often tend to be closed on Saturdays. However, there’s usually a list on display for Saturdays (and Sundays, as well as evenings) showing which pharmacy is open at that time and where.

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Image courtesy of mrmystery

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