Questions about public health insurance in Belgium

2POSTS

12 years ago

Hello all,

I am hoping that someone can answer a few basic questions about public health insurance in Belgium. I currently live in the US and work for a multinational company with offices in Brussels. Recently, the possibility has been raised that I might be transferred there. The discussions are at a very early stage, and the transfer itself is still far from certain; however, if it occurs, it will be a permanent transfer rather than an "expat" temporary relocation. Thus, I would be on a local contract, paying local taxes and social security, and using the Belgian public healthcare system.

My main question involves my wife, who has a health condition which is considered "pre-existing" for the purposes of most private insurance. Does the Belgian public health insurance cover such pre-existing conditions? Naturally, before we commit to relocating we must make sure that she will have access to health care. Does anyone have any links to documentation to confirm this one way or the other? My research has turned up plenty of private insurances that deny coverage for pre-existing conditions, but I can't find a concrete answer regarding the public insurance.

I also have a few other general questions:

1. Would my wife would be covered under the public insurance through my employment contract/payment of social security, even if she doesn't work?

2. Is it true that under the public insurance plan you can choose any doctor? Do all doctors participate?

3. Is it difficult to obtain brand-name prescription medicine under the public insurance plan? We are generally fine with generics, but there is one medication my wife takes where she didn't respond to the generic forumulation, so her doctor in the US specifies the brand name when writing a prescription.

If it makes any difference, my wife is an EU citizen (I am a US citizen).

Thank you so much for any insight anyone can offer.

S

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aneesh Belgium Expert

2002POSTS

12 years ago

1. Would my wife would be covered under the public insurance through my employment contract/payment of social security, even if she doesn't work?聽聽聽聽聽---> YES. Your spouse (and kids if any) will be covered in the mutuality (that is what public medical insurance is called here

) .

2. Is it true that under the public insurance plan you can choose any doctor? Do all doctors participate?聽 ---> Almost all doctors participate. You can choose the doctor.

3. Is it difficult to obtain brand-name prescription medicine under the public insurance plan? We are generally fine with generics, but there is one medication my wife takes where she didn't respond to the generic forumulation, so her doctor in the US specifies the brand name when writing a prescription.
--> Doctors can give you brandname prescriptions. But mutuality does not cover the ones that are not tested and proved (for example herbal formulas, etc).
If it makes any difference, my wife is an EU citizen (I am a US citizen).

Another thing to note is, public mutuality re-imburses (on average) 80% of the costs. Most employers subscribe the employee to an additional private insurance to cover the rest 20%.

聽聽can give you some more info.

SeanStrickland Member

2POSTS

12 years ago

Thank you, pamelascot and aneeshks.聽 Pamelascot, that's a good idea regarding keeping our BCBS coverage, though I guess it would be a challenge to submit out of network claims from Europe.聽 Aneeshks, thank you for the link and your detailed responses.聽 I will check out the link.聽

My main question remains:聽 would the mutuality (mutuelle?) public insurance cover costs for my wife's pre-existing medical condition?聽 I know that many private insurances do NOT, or will cover it only at great cost.聽 We need to make sure that she would not be denied coverage for the health condition she had before arriving in Belgium.聽 Is there a government agency we could call to get a definitive answer to this question?

Again, thank you very much!聽 I really appreciate your help!

Kind regards,

Sean

aneesh Belgium Expert

2002POSTS

12 years ago

It may be worth posting a question here:

tervurener Serial expat

552POSTS

12 years ago

You must ask the question about per existing medical conditions to a potential mutuelle. Short of staying the conditions here and someone having the same condition and responding. Unlikely anyone can give an accurate answer

tervurener Serial expat

552POSTS

12 years ago

Top up insurance doesn't always cover remaining 20 per cent, usually only hospital and outpatients and you would need to check coverage of the top up policy

deepak.ranganathan Member

17POSTS

8 years ago

Hi Aneesh,

Thank you for you detailed resposes and simply the heart go out of your way to answer all expats noobs.

I opted for the "Mandatory Insurance" at BePartenaMut so do we have to pay for this insurance or is it taken care by the taxes/social security?

When we go to a hospital should we show them some kind of card stating that I have an insurance?

Deepak

aneesh Belgium Expert

2002POSTS

8 years ago

Thanks Deepak !

Normally your employer deals with this contribution. The best way is to check with your HR or benefits team.

deepak.ranganathan Member

17POSTS

8 years ago

#10

My employer pays for a complimentary insurance called DKV.

This is a mandatory insurance, but still I am the one paying for it. That is why I had a doubt about it.

Could you please explain what are the insurances an expat must normally take?
I think that would help me gain some clarity.

Thanks

Deepak

aneesh Belgium Expert

2002POSTS

8 years ago

#11

Yes. You are right. In my firm too, employees pay themselves the premium for mutuality and the extra coverage (like DKV) is paid by the employer.

In terms of what you should get - I use Partenamut +advantages. They have several plans and their website lists the coverage details for all plans. Based on your medical needs you may pick the best.

deepak.ranganathan Member

17POSTS

8 years ago

#12

Thanks Aneesh. This clarifies things. I have the same insurance Partenamut + Advantages too and I pay the premium for it.

Thanks and Regards,
Deepak

satpalsharma Member

14POSTS

7 years ago

#13

Hey guys, wanted your feedback on Partenamut:

- Do you think it covers its cost of 鈧�125/测别补谤 through reimbursements or other services it offers? How was your experience.
- If it's mainly for the 'mandatory insurance' part or doctor's visit reimbursement, did you explore CAAMI for which the subscription is free and it reimburses your doctor visits.

What I learned is that the basic mandatory insurance (which reimburses your medical visit to doctors) is always free. If mutualities (Partena etc.) have to charge for the subscription they should offer some services. Whether you use those services or not, is another thing to see. So if you just need basic mandatory insurance (with reimbursement to your visits) you can get it for FREE from CAAMI. Is that correct?

Rate of Refund:
Membership:

Currylover Serial expat

272POSTS

7 years ago

#14

Indeed you can just join CAAMI, if all you want is INAMI reimbursements and you don't mind that it is very small.

For my own situation, the extra reimbursements have added up to over 500 euro every single single year, so paying for a mutuelle pays for itself and makes me money too.

phipiemar VIP Member

4733POSTS

7 years ago

#15

Joining CAAMI can seem financially interesting. But if you read well, they cover only the legal minimum with many conditions of execution.

If that's all you need, but if you ever have a medical problem that does not fit into their system, you're going to have a bad surprise.

In addition, the number of office is reduced to its most impeccable expression. This can lead to serious delays in the management of health records.

For my post, I prefer to deal with a private mutual and pay an additional contribution to have a better service.

Making a comparison between different mutuals is not really realistic because each has its strengths and weaknesses. At one moment in life, one will be more interesting than the other.

But let's never forget that health is priceless.

1 member reacted to this post

satpalsharma Member

14POSTS

7 years ago

#16

Great. Thanks for all the info.

Rohit45 Active member

91POSTS

6 years ago

#17

Regarding Mutual, I have certain doubts for which I could not find any information,

I and my family are registered with CM,
Now, whenever I visit any hospital, I am asked to pay the full amount for the consultation (CHU saint pierre, hopital erasme, St Luc, Brugmann..etc). Some part of the changes are reimbursed say around 65 to 70%.

But I have seen some other people who visit the same doctors and are registered with CM pay only 3.60 to 4.80 euros for consultation.

What am I missing here, I checked with CM but did not get a satisfactory answer.

TIA ..!!