The Belgian health care system

In Belgium, the social security system includes the public mandatory insurance for medical care and benefits, as well as pensions, unemployment benefits, etc. To benefit from the public insurance for medical care, residents in Belgium must register with a public health insurance fund of their choice (ziekenfonds or mutualiteit in Dutch).

Everyone over the age of 25 has to sign up with a public health insurance fund. This also applies to the under-25s if they are working or receiving benefits. Children do not have to pay membership fees.

The health insurance fund then (partly) reimburses your medical costs, for example the fee for a visit to your GP (general practitioner or family doctor) and the purchase of prescription medicines. (i.e. you pay the fee yourself up front and then you receive some, normally most, of the money back after making a claim with your health insurance fund.) Those reimbursements are regulated by law and are therefore the same for all public health insurance funds.

In addition, all public health insurance funds* offer their members a package of additional benefits, services and even supplemental insurance policies (hospitalisation and dental plans). Those extras are financed by membership fees, which vary per health insurance fund. All those who pay an annual membership fee are entitled to these extra benefits and services. For the more expensive options – such as hospitalisation insurance – you pay an extra premium in addition to your regular membership fee.

*There is one exception to the previous paragraph and that is the HIZIV, which only acts as the intermediary for the compulsory reimbursements without payment of additional contributions.  Obviously, there are no additional benefits or services either and HIZIV does not offer optional insurance such as hospitalisation or a dental plan. 

More information on the different public health insurance funds, what they cost and how to compare services in this article.

Action steps

  • Subscribe to a health insurance fund of your choice (ziekenfonds or mutualiteit) to get access to partial reimbursement of your medical costs. 
  • If applicable, take an additional insurance (for example: hospitalisation insurances) that reimburses costs which are not fully covered by the mandatory Belgian health insurance. Some employers cover additional insurances for their employees, check with your employer to find out exactly what is covered.
  • Be aware that for replacement income, only in the very specific case of illness-related work absence lasting more than one month, a waiting period of 6 months applies (full-time employment) from the date of subscription. During this period, you can check with your employer what to do (which insurance you can take) or during your stay in the hospital, you can ask the social service of the hospital for help.
  • If you are an employee with benefits in another EU country or Switzerland, you will be covered during this period. Make sure you have your EHIC-card (European Health Insurance card).
  • Check your insurance coverage before making appointments with specialists to know how much they cover and how much you will have to pay out of pocket.

Attention points

  • How do I have to pay the contributions?
    • If you are a salaried worker, contributions for the Belgian social security system are withheld from your income. Nevertheless, you still need to subscribe to a health insurance of your choice.
    • If you are self-employed you need to register with a social security fund of your choice and afterwards with a health insurance fund of your choice.
  • The mandatory Belgian insurance for medical care covers healthcare reimbursements for doctors, specialists, and hospital and medication costs. For more information, or a specific coverage question, contact your health insurance fund.
  • Whichever fund you have a membership with, you will always have to pay part of the medical costs yourself (remgeld in Dutch). The amount you will be reimbursed is the same for each fund as reimbursements are legally determined. The health funds merely act as ‘intermediaries’ between the national health care system and its members.
  • The content and fees for additional health, dental and hospitalization insurances vary between insurance companies. Check carefully what the terms and conditions are of the policy you want to purchase.
  • The European Health Insurance Card or EHIC-card is a free card that gives you access to medically necessary, state-provided, healthcare during a temporary stay in any of the EU countries as well as Iceland, Liechtenstein, Norway and Switzerland, under the same conditions and at the same cost as people insured in that country. It is not an alternative to travel insurance and does not guarantee free services.

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Last update: 10/08/2022


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