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Insurance policy for Medical care
You can also rest assured that your medical care will be reimbursed overseas – as though you were still in Belgium. This is what our supplementary insurance policy for Medical care is for. It intervenes in your costs all over the world, and it has no annual limit.
What is included?
Our insurance policy for medical care covers all costs that are also covered by the Belgian compulsory sickness and disability insurance. It also includes:
- hospitalisation, childbirth and physiotherapy,
- orthodontics (if the advisory doctor of the Overseas Social Security agrees in advance),
- anti-malarial medicines,
- vaccines,
- transport in an ambulance: for a maximum amount of €100 in the event of a transfer to a hospital or hospital centre. The patient must have been declared medically unable to travel independently or by public transport.
The following costs are not covered:
- homeopathy,
- acupuncture,
- osteopathy,
- dental crowns, bridges and implants, and
- repatriation.
Please check the general conditions for more information.
What is the amount of the contribution?
Please note: you must have the basic package in order to take out this contract.
There are two types of contributions:
| Type of contribution | Type of agreement | Amount |
|---|---|---|
| AC | Individual or collective (via an employer) | euro/month (according to the index of ) |
| BC | Collective (via an employer) | euro/month (according to the index of ) |
| Type of contribution | Amount |
|---|---|
| Contribution AC | |
| Individual or collective (via an employer) | euro/month (according to the index of ) |
| Contribution BC | |
| Collective (via an employer) | euro/month (according to the index of ) |
What is the amount of the reimbursement?
In Belgium
If the costs are incurred in Belgium, we reimburse them according to the scales of the National Institute for Health and Disability Insurance (NIHDI). You therefore receive reimbursement which is identical to that of a Belgian health insurance fund.
Has your employer taken out a BC contract for you? Then you are reimbursed twice as much as provided for in the NIHDI reimbursement scales (but not more than the costs actually paid).
Outside Belgium
If the costs are incurred outside Belgium, we pay 75% of the costs actually paid. Please note that these must be costs that can be reimbursed according to NIHDI reimbursement scales. Here there is no difference between an AC or a BC contract.
Who is entitled to this supplementary insurance policy?
You as the insured person, and all your family members whom we acknowledge as being dependants. For individual contracts there is a waiting time of six months, except for the following cases:
- you were already covered by another health insurance policy of the Overseas Social Security,
- up until that point, you were subject to the social security system of a country of the EEA(New window), Switzerland or the United Kingdom, or
- you have just completed your studies.
Proof of dependants
The insurance policy for medical care also covers your dependants. As such, you need to provide us with the necessary documents to prove exactly who your dependants are.
For a spouse, you need to provide us with:
- A declaration from the last health insurance fund or similar Belgian or non-Belgian institution, stating the date of the end of the previous insurance policy. You do not have to issue this certificate if your spouse is on career break, with benefits from the NEO (National Employment Office).
- In the event of a career break: form C62 from the NEO.
- A sworn declaration that your income is low enough for you to be recognised as a dependant (NSSO form – in French)(.pdf-New window).
- An extract from your marriage certificate. If you were not married in Belgium, this document must be validated by the Belgian authorities.
For a cohabiting partner, you need to provide us with:
- A declaration from the last health insurance fund or similar Belgian or non-Belgian institution, stating the date of the end of the previous insurance policy. You do not have to issue this certificate if your cohabiting partner is on career break, with benefits from the NEO (National Employment Office).
- In the event of a career break: form C62 from the NEO.
- A sworn declaration that your income is low enough for you to be recognised as a dependant (NSSO form – in French)(.pdf-New window).
- A declaration from the local authorities that you have been cohabiting for more than 6 months. This declaration is not necessary if you have been officially registered as cohabiting in Belgium for 6 months.
For children and grandchildren, you need to provide us with:
- A birth certificate. If the child was born abroad, this document must have been validated by the Belgian authorities.
- If the children or grandchildren are over 18 and under 25 years of age: an annual school certificate or a certificate of an apprenticeship contract.
- For grandchildren: a declaration from the local authorities that the grandchildren are actually living with you, and any document proving that they are actually dependants.
Waiting time
The 6 month period waiting time required for Medical Care insurance (see also Article 9 of the general conditions of the private affiliation contract ‘Medical care’) could be withdrawn or limited in time in case you can provide one or more of the following declarations to the Overseas Social Security Service of the NSSO in regard to the 6 month period preceding your affiliation to the Overseas Social Security Service of the NSSO:
- In case you were an employee, you need to provide a declaration from your former employer stating social contributions have been paid for you in a member state of the EEA, Switzerland or the United Kingdom,
- In case you were self-employed, you need to provide a declaration issued by your social insurance fund for the self-employed, stating social contributions have been paid in your regard within the EEA, Switzerland or the United Kingdom,
- In case you were unemployed, you need to provide a declaration from the National Employment Office stating you were registered as a beneficiary,
- In case you were on a waiting period for unemployment benefits, a certificate from the organization where you were registered as a jobseeker,
- In case you were a student, you need to provide a declaration issued by the educational institute stating you have been following a full curriculum daytime course.
How are you reimbursed?
You must submit an application for reimbursement with the Overseas Social Security within 36 months following the medical intervention. For this, use the form Overview of medical costs for reimbursement(.pdf-New window). Do not forget to fill in your payment address and contact address.
You can find all the information about submitting an application for intervention on the page Make an insurance claim for Medical care.
For medical expenses in Belgium
To have your costs reimbursed, you must provide us with the following evidence:
- For care provided: the official certificate - a form that meets the requirements of the NIHDI.
- For medicines: the ‘Bijlage 30/Annexe 30’ form delivered by the pharmacist.
In case of hospitalisation in Belgium, the Overseas Social Security can intervene directly at the hospital for its part of the costs. This is the third-party payment system. The hospital will then only send you an invoice for your part of the costs, supplements included. How much you have to pay yourself depends on the hospital and the type of room (private or communal) you have taken, and whether or not the doctor or healthcare provider is approved.
Please contact us prior to your admission in order to obtain proof of cover. Our contact details can be found on the Contact page of our website.
Do you have a BC contract? In that case, the Overseas Social Security will also reimburse part of the costs that you have to bear yourself. This compensation can amount to twice the reimbursement of the NIHDI.
For medical expenses outside Belgium
For medical care, you need to present the certificate of care or the original invoice. This certificate must:
- contain the name and first name of the beneficiary of the care, date of the care given, identification and type of the healthcare provider,
- describe the precise nature of the care provided, taking into account the amount paid for each intervention,
- be drawn up in one of the following languages: Dutch, French, German, or English. If the document is drawn up in any other language, you must provide us with a translation in one of the three Belgian national languages, and
- be paid in full and accompanied with proof of payment (on the certificate or on an accompanying document).
For pharmaceutical costs, send us a medical prescription for the medicines, as well as the pharmacy bill. The name and the cost of each medicine must be indicated on the bill.