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You can apply for an intervention of your insurance Medical care via our online form.

Continue to the form Refund of costs for medical care(New window)

Please note! You should notify us at all times of any change in your situation to stay insured properly. Please check the page Report any change in your personal or professional situation.

Access to the form

Log in with your eID, itsme, token or a unique code that allows you to use the secure version of the form. This code is generated by an app. A number of details will then be filled in for you in advance.

Are you using the non-secured version of the form? Then please have a scan of your identity document ready.

Preparing your application

In order to ensure optimal and fast processing of your application, please prepare the application in advance by following these instructions.

Please complete one form per person and per country.

Documents to be enclosed with the application

You receive care in Belgium

Please prepare the following documents:

  • Certificate of provided treatment supplied by the health care provider, if necessary accompanied by a medical prescription for the medicines (such as for physiotherapy),
  • The document “Payment in cash of the refundable pharmaceutical dispensations” (annex 30) for medicines purchased on medical prescription.

You receive care abroad

Please prepare the following documents:

  • The detailed invoices with proof of payment and, where appropriate, a medical prescription of the medicines and/or a report. The invoice must:
    • indicate exactly which treatments have been provided and the amount corresponding to which treatment,
    • be drawn up in one of the following languages: Dutch, French, German, English or Spanish. Otherwise, a translation into one of the three Belgian national languages must be added.
  • The detailed invoice from the pharmacist with the medical prescription of the medicines and proof of payment.

In case of a hospital admission abroad, please always add a medical report to your application for intervention.

Organise and check the documents

Before you send us the scanned version of your documents via the online form, you should take these points into account:

  • Arrange the certificates of provided treatment or the detailed invoices by person, country and date,
  • Make sure the invoice is complete with all pages in the right order,
  • Check that the proofs of payment are attached to the file,
  • Check the scanned document and photo before sending them, especially to make sure they are fully scanned and perfectly legible.

Any doubts, questions?

You can reach us through various media: our contact details can be found on the Contact page of this website.

When contacting our services, do not forget to indicate your registration number (this is shown on your certificate: it consists of the first six digits after the E-).

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