Belgium has one of the world’s most sophisticated and efficient health care services. Health insurance is obligatory in Belgium for both employed and self-employed workers. This forms an essential element of the country’s mandatory social security structure, which ensures the well-being of the entire population. In the case of employed workers, contributions are directly deducted from their salary by the employer, whereas self-employed workers are required to pay contributions into a social security fund.
In order to access the social security system every worker has to join a health insurance association ('Mutualité'-“Ziekenfonds”), which refunds a fixed percentage of medical care and costs. Workers are free to join any one they choose. The associations represent the different political and religious groups in Belgian society: they can be Christian, liberal, socialist or independent. All funds charge the same amount, as they act as intermediaries between the National Institute for Sickness and Invalidity (“INAMI”-“RIZIV”) and its members.
Membership of a 'mutualité' entitles you to a partial refund of medical and dental costs, hospital care, surgical operations, maternity costs, and prescribed medicines. The amount reimbursed is based on a precise scale for each service provided. Some mutual insurance associations have their own polyclinics where virtually all of the patient’s costs are refunded.
Refunds on prescribed medicines are made at the time of purchase. You simply present your electronic Belgian residence card to the chemist, who will then deduct a set percentage from the cost. In the case of medical and dental treatment, the refund is made by the 'mutualité' after the patient has submitted a green treatment certificate supplied by the doctor or dentist.
Members also are issued with stickers ('vignette') by their mutual insurance association. These should be attached to the green treatment certificates when you send them to your 'mutualité'.
As sickness insurance does not cover the full cost of treatment, you can sometimes find yourself incurring large medical bills in the event of hospitalisation. Some people therefore decide to take out additional hospital insurance.