Like many other European countries, health insurance in Belgium is compulsory. Expats who also live and work in Belgium must have valid health insurance. Social contributions publicly fund most health insurance, but residents can also obtain private insurance to supplement their coverage. Self-employed expats must pay social contributions on their own, while for others, their employer usually calculates the social payments from their salary.
What Kind of Healthcare System Does Belgium Have?
The Belgium health system works under a “fee-for-service payment”, which means that you visit a healthcare centre, pay for the services, and then be reimbursed by your insurance provider. Here is where the insurance providers branch out— they can be either public insurance or private health insurance.
The tax system mostly funds the public health care system and its insurance distributors. A portion of your salary goes to the social security fund covering your health insurance. If you’re self-employed or a freelancer, you pay for the social security by yourself. On the other hand, you buy an insurance policy with your chosen provider for private coverage, and you can customise your plan according to your needs.
Who Needs Health Insurance in Belgium?
All residents over the age of 25 who have a registered address in Belgium must have valid health insurance, including expats living and working in the country. Health insurance is compulsory in Belgium, but there are a few gaps in the system where certain categories can remain uninsured, i.e., individuals without a registered address.
How Can Expats Get Health Insurance in Belgium?
If you’re an expat who lives and works in Belgium, you can obtain health insurance with one of the following options:
- Register for public health insurance. Public health insurance is funded partially by social contributions, which Belgian residents pay taxes. The National Institute for Health and Disability Insurance (NIHDI) regulates the public health insurance scheme. Public insurance is organised in the following ways:
- Auxiliary fund for sickness and invalidity insurance (Hulpkas voor Ziekte- en Invaliditeitsverzekering—HZIV). HZIV is a public organisation that covers compulsory insurance, and it’s usually free (depending on your income). This is the default insurance fund for most residents who have not chosen a mutuality (insurance fund) to join.
- Non-profit private insurance providers. These usually include five mutualities or insurance funds which residents can choose to join. Membership with the mutualities can be exclusive in some cases, i.e., specific mutualities accept only specific individuals of certain religions or political affiliations.
- Purchase private insurance. For private insurance, expats can purchase an international health plan or buy insurance from a private provider in Belgium. However, if you are employed in Belgium, you are automatically covered by the national healthcare insurance when your employer pays for your social contributions. Of course, you can still purchase private insurance to cover the areas not included in the public health scheme.
Important: Please note that it usually takes about six months to become eligible for state-funded health insurance, during which time you’re highly advised to purchase private insurance.
Health Insurance Companies in Belgium:
Depending on which insurance provider you choose, you can register with a public insurance fund in Belgium or with a private insurance company. However, you have to keep in mind that if you are automatically included in the health public scheme, you can only use private insurance to complement the national insurance plan.
Public Insurance Funds in Belgium
To benefit from the public health insurance scheme in Belgium, you need to register with one of the insurance funds, also known as mutualities—mutuelles (in French) or ziekenfonds (in Dutch). There are several mutualities you can choose from, which include the following:
- National Alliance of Christian Mutual Insurance Funds
- National Union of Non-denominational Mutual Insurance Funds
- National Union of Socialist Mutual Insurance Funds
- National Union of Liberal Mutual Insurance Funds
- National Union of Free Mutual Insurance Funds
You can find a list of the full mutualities here (only in French) along with their address and contact information. If you don’t join any of the funds mentioned above, you will automatically be included in the Auxiliary fund for sickness and invalidity insurance (Hulpkas voor Ziekte- en Invaliditeitsverzekering—HZIV). The difference is that the auxiliary fund offers only compulsory health insurance, while with the other mutualities, residents can obtain more extensive coverage with a membership fee— usually between €20 to €25.
Private Insurance Companies in Belgium
Most public insurers in Belgium cover around 70% of the medical services. So, to get full coverage, most residents opt for additional voluntary insurance. These additional insurance services are provided by public mutualities or by private insurers— most expats prefer to get an international health policy.
Here is a list of some of the best providers for expat health insurance in Belgium:
- Allianz Care.
- Cigna Global.
- P&V Verzekeringen.
- AG Insurance.
If you purchase private insurance, make sure to find a policy that will offer you benefits such as seeking an English-speaking doctor or translation benefits, since the language barrier in Belgium is a difficult one for expats when seeking medical care.
Visiting a Hospital/Doctor While in Belgium
Here is a general overview of how a medical visit in Belgium:
- You visit a medical healthcare centre. If you need to visit a healthcare centre in Belgium, you can choose any private or public hospital, no matter your insurance. You can use the website of the Belgian Federal Public Service Public Health here to find a hospital near you.
- You choose your doctor. Once you find your healthcare centre, you can look for a healthcare provider. Here, you have to check whether your doctor is contracted with one of the mutualities (insurance funds) and whether their services are reimbursable. Visiting a contracted doctor (fund doctor) means your insurance reimburses your medical costs. To make sure you find your doctor, you can use the locator from the NIHDI website here. Keep in mind that you don’t need e referral to visit a specialist in Belgium. Still, you’re always advised to visit a general practitioner (GP) first as they can help you navigate the healthcare system better.
- You pay for the service. At the end of your medical visit, you pay for the services. Then, your insurance provider will reimburse you for up to 70% of the costs. Please note that if you visit a non-contracted doctor or partially contracted, some of the services may not be covered, and you have to pay for the costs on your own.
Is Healthcare Free in Belgium?
Healthcare in Belgium is partially free—what this means is that when you require medical attention, you pay for the service first and then you are reimbursed by your insurance (either from the national fund or private insurance). Not all services are reimbursed by national insurance, so you may still pay for some medical costs on your own. On average, public health insurance in Belgium reimburses 70% of your medical costs; the rest you have to pay out of pocket.
How Much Does Health Insurance in Belgium Cost?
If you’re employed in Belgium, around 13% of your income goes to social contributions, which fund your health insurance. While if you’re self-employed, prepare to pay up to 20% of your income for public health insurance. These social contributions cover only compulsory health insurance, and if you want additional (voluntary health insurance), you have to pay a membership fee between €20 to €25, depending on your mutuality.
On the other hand, private health insurance costs vary based on what level of coverage you want, the duration of your policy, age, and medical condition.
What Does Expat Health Insurance Cover in Belgium?
In Belgium, public health insurance covers between 60% to 75% (the total cost of reimbursement depends on your medical situation and in which region of Belgium you live) of your medical expenses, including emergency treatment, hospitalisation, long-term care, and medication, maternity and child care. However, according to a European health report, mental health care and dental are two of the least covered areas in Belgium. If you want to extend your coverage area, you can pay for voluntary health insurance— either with one of the mutualities or with a private insurer.
Similarly, with private insurance, you can adjust the level of your insurance coverage. Usually, this means you have to pay more for your premium.
Here is a basic summary of what public and private health insurance covers in Belgium:
|Coverage Area||Public Health Insurance||Private Health Insurance|
|Pregnancy and maternity care||Yes||Not with a basic plan|
|Physiotherapy||Yes||Not with a basic plan|
|Mental health care||Partially||Not with a basic plan|
|Dental care||Partially||Not with a basic plan|
How Can International Students Get Health Insurance in Belgium?
Non-EU/EEA students need to register in the Belgian Registry of Foreign Nationals and pay an obligatory contribution fee to get coverage from national health insurance. Depending on your residence status as a student in Belgium, you have two options when it comes to joining the public healthcare scheme:
- Register in the ‘student’ category— you can get an insurance registration as a student, which you have to pay quarterly for € 66,56 (as of 2022). This type of insurance coverage is usually suitable for students studying in Belgium for short periods, i.e., less than 90 days.
- Register as a resident— if you plan to study for longer than 90 days after entering Belgium with your Schengen visa, you have to register as a temporary resident. Afterwards, you can join the national healthcare scheme under the ‘resident’ category and contribute €0 to €785,10 per quarter, depending on your income.
For both of these options, you may also be required to pay an additional membership fee to join your chosen mutuality. If you don’t want to pay a membership fee, you can register the Auxiliary fund for sickness and invalidity insurance (Hulpkas voor Ziekte- en Invaliditeitsverzekering—HZIV) for free. But, keep in mind that with the HZIV, you can only get reimbursement for statutory health insurance.
Health Insurance for Employed Expats in Belgium
If you are working in Belgium, registration for health insurance depends on how you are employed:
- If a Belgian employer employs you— anyone working (office worker, company employee, etc.) in Belgium must pay social contributions to qualify for the public health insurance scheme. These social contributions are deducted from your salary— around 13% go to health insurance— which your employer pays for you. However, you can choose your mutuality (insurance fund).
- If you are a self-employed/freelancer in Belgium— you want to join the public insurance plan, you have to declare your earnings and pay your social security contributions which depend on your income— around 20% or 22%. The National Institute for the Social Security of the Self-employed (NISSE) is in charge of your social security contributions, health insurance, and pension in Belgium.
Health Insurance in Belgium for Retired Expats
If you’re a retired expat in Belgium, the same health insurance options apply as well. So, you can choose a mutuality for your insurance or buy an insurance policy from a private provider. If you are over the age of 80, you can purchase a policy tailored to seniors that include coverage for your pre-existing conditions.
Do EU/EEA Citizens Need Health Insurance in Belgium?
EU/EEA citizens are eligible for any medical services while in Belgium, and if they provide their EHIC (European Health Insurance Card), they can get reimbursements from their country of origin. However, this is suitable for EU/EEA nationals living in Belgium short term. If you are an EU national planning to move to Belgium long-term, you should register with the country’s health insurance scheme. Even though the EHIC enables you to benefit from medical services in the EU, it’s not a substitution for health insurance. The same rules apply to EU/EEA students moving to study in Belgium.
Benefits and Drawbacks of the Belgian Healthcare System
The Belgian healthcare system is known as one of the best systems in Europe. Yet, it comes with some disadvantages:
|The public health system allows patients to choose doctors, hospitals, and specialists regardless of whether they have public or private insurance.||Only 70% of costs are covered; residents have to pay extra for additional coverage.|
|Because not every medical cost is reimbursed, it discourages people from visiting healthcare centres often, which does not allow the system to get overcrowded and underfunded.||The organisation of the system and insurance distributors can be overly complicated and bureaucratic.|
|Patients are not obligated to visit a general practitioner before going to a specialist.|