Deferred insurance medical care: detailed information on conditions and reimbursement
Please look into detailed conditions and reimbursement information regarding the deferred insurance policy for medical care.
Who can benefit?
All insured persons participating for at least 16 years
The age from which the benefits can be granted is set as follows:
|Duration of the contributions||Age at which the benefits can be granted:|
|16 years and below 18 years||57 years|
|18 years and below 20 years||56 years|
|20 years and below 22 years||55 years|
|22 years and below 24 years||54 years|
|24 years and below 26 years||53 years|
|26 years and below 28 years||52 years|
|28 years and below 30 years||51 years|
|30 years or more||50 years|
Insured persons recognized as unfit for work (disabled persons)
Insured persons recognized as being unfit for work (disabled) following the dispositions of the health and invalidity insurance scheme of the Overseas Social Security can benefit from the Deferred insurance for medical care.
Spouses part of the household and dependant children
Spouses belonging to the household of a insured person who is a beneficiary of the Deferred insurance for medical care, or children dependant to such a person can also benefit from the Deferred insurance for medical care.
To learn more about the conditions to be met to and the documents to attach, please consult the page Deferred insurance for medical care: who can be recognised as a dependant person?
Surviving spouse and orphans
A surviving spouse as well as orphans, when benefitting from the old age and death insurance following the Overseas Social Security scheme, can be beneficiaries of the Deferred insurance for medical care if:
- The insured has been participating to the insurance for at least 16 years or, if
- The insured has passed away while participating in the insurance, and thus for 12 months preceding the date of death. The latter is not valid when the deceased passed away due to an accident
The surviving spouse (of a disabled insured person) and the orphans benefitting allowances compliant with provisions stipulated in the sickness and invalidity insurance of the Overseas Social Security scheme can also benefit from the Deferred insurance for medical care.
For more information about the rights of separated spouses (who are not officially registered at the same address as the policyholder), please contact our services directly. You can find all contact data on the Contact page of this website.
Conditions the policyholder needs to meet
The following policyholders can choose their country of residence:
- Nationals of the European Economic Area (EEA)
- Nationals of the Swiss Confederation
- Stateless persons and refugees
- Nationals of countries with which a reciprocity agreement has been concluded
- The surviving spouse and the orphans (whatever their nationality) of a policyholder holding one of the nationalities mentioned above
Nationals of countries not mentioned above (this means mainly the non-European nationals) must reside officially in one of the member states of the European Union with the exception of Denmark and the United Kingdom.
Interdiction to cumulate insurances
The reimbursement of treatment is not granted to persons benefitting similar advantages (this means an insurance covering the reimbursement of medical care) deriving from other legal, contractual or regulatory provisions, Belgian or foreign, or deriving from a reciprocity agreement.
How are health care expenses reimbursed?
Health care expenses are reimbursed following scales and criteria set by Belgian legal provisions in regard to the obligatory sickness and invalidity insurance (RIZIV law). RIZIV is the National institute for sickness and disability insurance.
Health care expenses are reimbursed after aligning (assimilation) the given treatment with the Belgian nomenclature valid within the Belgian sickness and invalidity insurance (tariffs and criteria of the RIZIV).
The principle of assimilation with the Belgian nomenclature implies that the reimbursement provided is the same as if you would have received similar treatment in Belgium.
To clarify, some reimbursements valid in Belgium on 1 January 2020 are given:
- A medical consultation with a general physician: 10.31 €
- A medical consultation with a medical specialist: 9.96 €,
- A check-up consultation with a dentist: 17 €
Please bear in mind the reimbursed amount could be much lower than the amount you have paid to the medical practitioner, depending on the country where the medical cost was done.
If your specific situation changes…
From the moment you benefit from the right to be reimbursed for your health care via the Overseas Social Security, you must inform us when your personal, family or professional situation changes (change of address, additional Belgian or foreign pension, divorce, etc.)