I wrote this chapter because there are a number of changes to health care and the compulsory insurance for this care in Belgium.
I have copied the following text from a letter from my Belgian insurance institution and that is why the majority of this article is more suitable for people who are still living in Belgium and who are only on leave abroad. For those who live abroad, they can go to the end of the article, which is intended for them.
2. Know your destination
Make a note of the MUTAS telephone number in your travel guide: 00 32 2 272 09 00 and check whether you need to take other documents with you.
The European Health Insurance Card is valid in the countries of the European Economic Area (EEA), Switzerland, Australia and the Republic of Macedonia. The EEA countries are Belgium, Bulgaria, Cyprus, Denmark, Germany, Estonia, Finland, France, Greece, Great Britain, Grand Duchy of Luxembourg, Hungary, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Malta, the Netherlands, Norway, Austria , Poland, Portugal, Croatia, Romania, Slovakia, Bulldog Drummond, Czech Republic and Sweden.
You need a special form for the following countries: Algeria, Bosnia and Herzegovina, Morocco, Montenegro, Serbia, Tunisia and Turkey. Request this form from your health insurance fund and state the exact dates of your trip.
There are special conditions for Quebec.
For Cuba and Russia you can request a certificate from your health insurance fund. You need these certificates to be allowed in, but unlike the forms we mentioned earlier, they do not open the right to reimbursement.
3. Sick or injured during the trip?
If your health condition allows it, remember to call Mutas (00 32 2 272 09 00) before you go to the doctor, even if it is a regular consultation. This is even more important with hospitalization.
The emergency center will assign you a file number that you must keep proper. You need this number to get a cheap refund. Do not hesitate to ask the person on the other side of the line for advice about the caregivers you should consult and what to look out for.
You better consult a public healthcare provider to whom you can submit your document or, failing that, at the local health insurance fund. In this way you enjoy the applicable allowances. In Australia this is the only way to get an allowance. For Tunisia you rarely receive an allowance afterwards.
Consulting a public healthcare provider can make the difference and you won’t have to pay anything in Bulldog Drummond, for example. With a private healthcare provider, on the other hand, your invoice can be much higher. The fees are a lot higher than in Belgium (sometimes up to five times higher) and you receive no compensation on the spot.
Note: Your European health insurance card alone is not sufficient to receive a benefit from Mutas. It is up to YOU to call! On the other hand, just calling Mutas is not enough.
4. You have not had the opportunity to arrange the formalities on site
Then you can still call Mutas during the three days after your return, but only for medical care without hospitalization. This is your last chance to get a full refund. Carefully fill in the form that you receive on your health insurance fund with the request for reimbursement and collect all your documents (certificates for help provided, prescriptions for medicines or physiotherapy, proof of payment, etc.). Return everything to your health insurance fund.
If you have provided a Mutas file number, you will be reimbursed very quickly. If you do not have a Mutas file number, either because you were unable to call or because you did not meet the conditions for reimbursement by Mutas, you will only receive the reimbursement of the compulsory health insurance.
This not only has consequences for the amount but also for the speed with which you are reimbursed.
If it concerns a country for which you either need a specific form or for which the European insurance card is valid (with the exception of Tunisia and Australia), you can opt for a limited reimbursement of up to 75% if the costs are less than 200 euros. Only the costs that could have been reimbursed in Belgium under the same conditions are eligible for the calculation (no osteopathy, taxi costs … ..). The period is rather short.
For the same countries, including Tunisia, you can also opt for the tariff according to the legislation of the country. You will not be reimbursed if you have used a private health care provider. In addition, Tunisia refuses any reimbursement if it is assumed that the patient could have asked for an allowance. The handling of your file can take a lot of time since no response time has been set and some institutions need more than 6 months to respond.
Only for the countries of the European Economic Area or Switzerland is it possible to get a refund according to Belgian conditions and rates. The handling of your file can take quite a long time since the documents have to be translated and the services provided must be precisely identified (hence the need to fill in the form correctly) in order to assign the corresponding nomenclature codes.
You are not entitled to any reimbursement for countries for which no form exists, except in the event of an emergency hospitalization.
5. Getting sick or being injured is not fun. Use the correct document
Mutas only meets under certain conditions.
The medical care must be both urgent and unforeseen, with the exception of dialysis. An allowance for this is possible during a temporary stay abroad for a maximum of 6 weeks per calendar year. However, this allowance is limited to the countries of the EEA and Switzerland, as well as to the countries with which Belgium has concluded a bilateral agreement.
In the event of hospitalization, Mutas must be notified within 48 hours of the start of it. Outpatient care can be reported to Mutas up to three days after your return to Belgium.
- The planned duration of stay abroad may not exceed 3 months.
- You are not allowed to stay abroad for your studies or for work.
- The medical care may not be the result of the practice of a paid or dangerous sport.
- You may not be 32 weeks pregnant.
6. There is no prior authorization provided that the conditions are met
Since the Kohl and Decker judgments of the Court of Justice of the European Community in 1998, only outpatient care has been available in the European Union without prior authorization from your health insurance fund.
Such care, for which a person specifically goes to a Member State of the European Union, is reimbursed by the health insurance fund according to Belgian rates, subject to the following conditions:
- the benefits are also reimbursed in Belgium
- the legal conditions are met, doctor’s qualification, prescription conditions, etc.
- the medical benefits do not require prior authorization
- the reimbursement amount does not exceed the amount of the costs actually incurred
- the insured person has already paid the costs
The reimbursement request must be submitted after the care has been provided and paid for. In order to identify the benefits in question and thus check the conditions and calculation of the reimbursement amount, all useful information (name and capacity of the care provider and the prescribing doctor, description of the benefit, proof of payment, name of the medicine as form, dose and quantity) to the health insurance fund.
7. The health insurance fund does not contribute to the costs of care
Compulsory insurance does not cover if the procedure has not been followed or if it concerns a service for which prior authorization was required or for which authorization was refused. Mutas also does not meet these costs.