Maximum to Bill (MTB)

Definition

The Maximum to Bill (MTB) aims to increase the financial accessibility to health care.

General principle: when co-payments for some health care to a household exceed a maximum specified amount during a calendar year (variable depending on the type of applicable MTB), the household members are reimbursed for their MTB personal share health care they receive during the remainder of this calendar year.

The MTB aims to ensure a better protection of patients and, in particular, chronically ill individual whose medical costs are particularly high. In this way, each household should not spend more than a specified amount of health care costs covered by the compulsory medical care insurance. This amount (minimum 450 €) is linked to the family income and depends on the composition of household.

Since the year 2008, if you've reached the maximum limit corresponding to your benefits and if you need to be hospitalized, your health care insurance notifies the institution. This allows the hospital to bill your different personal interventions, that are taken into account in the MTB counter, directly to the insurer.

There are two types of MTB:

1. Social MTB: the maximum to bill is determined by the social class of its beneficiaries.

2. Income MTB: it is determined according to the household income of the beneficiary. The incomes taken into consideration are the last three years of incomes preceding the MTB.

Beneficiaries of the MTB

Two conditions are to be met so as the social MTB is granted to all members of a household (beneficiary, spouse or partner and dependents).

The household must have actually incurred € 450 user fees.

The household must include among its members at least one beneficiary of the increased intervention following:

• widowed, disabled pensioner or orphan;

• beneficiary of an integration income or equivalent assistance by the CPAS;

• beneficiary of a guaranteed income for elderly;

• unemployed over 50 years and full-time unemployed for at least a year;

• persons of 65 years or older registered within his health care insurer as "resident";

• person registered within his health care insurer as disabled holder on the basis of medical recognition;

• person who receives a disability allowance, unless the beneficiaries of an integration allowance and whose spouse or partner has income, however modest they may be.

Children who benefit from increased family allowances are not included in the list of beneficiaries of social MTB.

MTB income and children

The persons entitled to refunds of tickets modérateurs as soon as these amounts (proportional to their income) have been achieved in the considered year.

Amounts for 2012

Beneficiaries

Social MTB : € 450

MTB Income and children

• Household with incomes between 0 and € 17.039,73 : € 450
  

• Households with incomes between € 17.039,74 and 26.195,40 : € 650

• Children under 19 years (individual) : € 650

• Households with incomes between € 26.195,41 and 35.351,10 : € 1000

• Households with incomes between € 35.351,11 and 44.125,29 € : € 1.400

• Households with incomes superior to € 44.125,30 : € 1.800