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Beneficiary

The medical insurance covers the freelances as well as the employees or the civil servents, unemployed people, pensioners, disabled, students, etc and all the dependents: partners, next of kin, children, grandchildren, great grandchildren, etc.

Two conditions give rights to the medical insurance benefits:

1. All beneficiary of the medical insurance must register with an insurance of his choice (mutual fund, medical institution, medical insurance of the SNCB).
2. The right to heatlthcare starts only when contributions have been payed and reach a minimum value (an additional contribution can be paid if the minimum amount is not reached).

Medical benefits

Health benefits include:

1. the usual medical care including: visits and acts from general practioners and specialists, physiotherapists;
2. dental care;
3. pregnancy;
4. hospital;
5. all the care needed for functional reeducation.

The rate of the refunds

If you go to visit your GP, you need usually to pay the full price of the visit. Then you contact the insurance with your prescription and you get the refund. Most of the time you won't get the full refund and you will have to pay for a share called the "ticket modérateur" (25%).

For some people (widows, disabled, pensioners,...) there is a higher refund system (called préférentiel).

At the pharmacy, with a prescription of a GP, you won't have to pay the full amount, the refund rates are always applied directly (system of tiers payant). Depending on their efficiency and needs the specific medecines are grouped into 5 categories: personal share of 10% to 25% depending on the generic kind of drug and the status of the patient.

Beside the medecines, in thecase of hospital care, the share of the patient is a fixed amount..