In order to keep your health insurance costs low in Belgium, you have two main options: either signing up with Belgian’s national health insurance scheme, or by shopping around for the best private health insurance plan from international coverage for your own treatment needs.Belgium’s healthcare system is based on a two-tier insurance model, consisting of both national and private health insurance. As an expat, you’ll be able to sign up for the national system as long as you are paying contributions into it, which your employer will deduct from your salary. Registering with the national health insurance scheme is mandatory. You may, however, choose to take out private insurance to cover any gap in reimbursement costs, or for additional peace of mind during your stay in the country.
Personalising Your Health Insurance Cover
Belgium operates on a reimbursement policy under state medical insurance, and if you are registered, you will be eligible to claim back:
• a proportion of your medical fees
• a proportion of your dental fees
• prescriptions
• hospital care and treatment
• maternity costs
Once you have made your claim, you should be reimbursed for around 70% of your medical fees, for example, for a doctor’s visit. If you are hospitalized, you will need to pay a fixed sum for your accommodation, but your actual treatment fees will be covered by your insurer. You will also need to pay more if you opt for a single-occupancy room.
You will have to pay for non-prescription medication, but some of your prescription costs will be refunded (again, you will need to pay upfront and claim them back). This might only be 20%, however: it depends what sort of medication you need.
Since there is likely to be a gap between the amount actually paid by you for your healthcare and the amount reimbursed by your insurance company, you may wish to opt for private insurance to cover the disparity.
Moreover, the national scheme does not cover all medical treatment: for example, annual dental check-ups are compulsory but the scheme does not cover all dental care, and it won’t cover elective cosmetic surgery or alternative treatments. So you may prefer to take out a private policy as well in order to top up your medical insurance options, depending on your budget.
We’re going to suggest some options for you to consider in order for you to keep your private premiums as low as possible.
Selectable Options
Check the small print of any private policy to see whether it covers treatments that you may want to access, such as specialist treatment or more advanced dental care, for example crowns or dental implants.
Remember to check if your potential policy covers pre-existing conditions: the definition of this varies between insurers. Usually the term applies to any conditions which present symptoms or for which you’ve been treated in the last five years. This normally includes any conditions you were diagnosed with over five years ago, but some insurers have different time limits for diagnosis.
You may also want to check out whether your policy has a ‘hospitalisation’ clause covering you for occasional hospital visits. You may need to discuss this directly with your insurer.
Take a good look at any potential policy for any cover relating to healthcare which does not apply to you: some policies have provision for maternity care, for instance, and if you are not intending to become pregnant (or prefer to rely on the cover provided by the Belgian maternity system), then you may wish to reduce your policy costs by having such options removed.
Cost Sharing
You may also be able to reduce the cost of your premium through cost sharing: this means that you and your insurer will share the costs of any treatment. You will pay up to an agreed limit, and your provider will cover the rest. Different insurers will have different ways of arranging cost sharing, as detailed below.
Co-pay: where you pay a fixed sum for your treatment and your insurer covers the rest. For instance, if the total cost of your treatment is €85, and your co-pay amount is set at €40, then you will pay €40 and your insurer will pay €45.
Co-insurance: where you pay a fixed percentage of the total cost and your insurer covers the rest. For instance, if your co-insurance is set at 20%, you will pay 20% of €85 and your insurer will cover the remaining 80%.
Deductibles: where you pay the entire amount allowed for all services provided until the deductible is met. For instance, if your policy has a €1,000 annual deductible, you would pay €85 for each visit to your GP. However, you would then have to pay the entire amount for 11 such visits (€1000/€85 = 11.8) before your insurance began to pay out to the doctor directly.
You may also need to take a look at whether there is an out-of-pocket maximum that you would be expected to pay after your deductible has been met.
Let’s say that your plan above, with a €1000 deductible, also has a co-insurance option of 20% and an out-of-pocket maximum of €1500. You will thus pay €85 for 11 visits to the doctor under your deductible until it is met. You will then pay €17 for each visit as your 20% coinsurance, until you reach the co-insurance ceiling of €500 (€1,500 minus the deductible of €1,000), or about 29 more visits (€500€17 = 29.4). At that point (40 total visits in a year), you would pay nothing more for the remainder of the plan year.
It’s worth doing the maths, especially if you don’t think that you’ll need to make more than a couple of visits to your GP in Belgium in any one policy period. For example, if you just want dental check-ups with an occasional filling, it might be worth working out whether one or two out-of-pocket costs might be cheaper than full dental cover.
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