What will I be required to pay for my medical expenses? What will my personal contribution be? How much will be refunded to me by my healthcare insurance? Is it possible to pay less for my healthcare costs? If my financial situation changes, will I still have to pay as much for my medical expenses?
This section will give you a number of answers to these questions.
Mandatory healthcare and indemnity insurance
To benefit from cover under mandatory healthcare and indemnity insurance, you need to be a member of an insuring organisation (i.e. a healthcare fund, the Auxiliary Illness and Disability Insurance Fund or the Healthcare Fund of the SNCB Holding Company), either as a policyholder or a dependant.
You will then be able to receive various allowances, including:
- refunds for consultations with a doctor
- fixed allowances for hospitalisation
- the payment of allowances in the event of being unable to work or pregnancy/maternity
Mandatory healthcare cover entitles the policyholder to a basic refund, i.e. to a refund for certain types of medication, and an allowance for numerous healthcare services given by healthcare providers, such as:
What is the difference between a general practitioner and a specialist? Why do they charge different fees? Is it normal for the price of a consultation to differ from one doctor to another, whereas they practise the same area of specialisation?
The fees charged by doctors may differ, depending on:
- the category to which they belong (qualified, in training, etc.)
- the area of specialisation (dermatology, gynaecology, paediatrics, general medicine, etc)
- the place of the consultation (at the doctor’s practice, at home, etc.)
- the time of the consultation (evening, weekend, etc.)
What is a 'fund doctor'?
Agreements between the medical profession and health insurance funds set the official rates for basic fees for reimbursement by the mandatory healthcare insurance cover. If your doctor belongs to these agreements, he or she is what is known as a ‘fund doctor’. This means your doctor is not at liberty to charge the fees of his or her choice.
Whether the doctor is a fund doctor or not, the amount of the refund by the healthcare insurance cover is identical. This means that the fee overrun (‘gap’) generally charged by non-fund doctors is required to be paid entirely by the patient.
Some doctors are fund doctors in everything they do. Others are only partly so: they abide by the rates sets by INAMI on certain days, at certain times (e.g. for consultations at the hospital), whereas they are free to decide on what to charge in terms of fees at other times (e.g. for consultations at home).
All doctors are required to inform their patients about whether they are fund doctors or not. This can be done in particular by posting a notice in the waiting room.