The co-payment

The co-payment is the possibility for some patients to refrain from paying the full amount of certain services that are too expensive for them. They will then co-pay them (the personal share is about 25% for regular insured people and 10-15% for beneficiaries whose an increased intervention has been granted; the difference is then paid by the health care insurance directly to the provider.

The general principle relies on the prohibition of co-payment for advises, consultations and visits to the doctor, psychotherapeutic treatment, medical care and dental radiography.

However, the following people can benefit from co-payments:

• beneficiaries of a guaranteed income for elderly,

• beneficiaries of the integration income (ex-minimex),

• beneficiaries of the increased intervention),

• beneficiaries of a disability allowance,

• the fully unemployed for more than 6 consecutive months (single or head of household),

• holders, fully entitled unemployed for at least one year and aged 50 years or older and their dependents,

• holders aged 65 years or more holders and their dependents,

• children benefiting from increased family allowances, whether they holders or dependents,

• persons receiving medical care in a medical care centre,

• persons receiving medical or dental care in a mental health centre, family planning, medical care centre applying the package, centres for drug addicts and institutions for the care of children, the disabled or elderly, child care organized by circles of GPs,

• people in coma or having died during treatment.

Warning:

these holders and their dependents must apply themselves to their health care insurer to benefit from a claim exemption from the prohibition of co-payment. They then receive a document to present to the medical care provider. For hospitals, the co-payment is mandatory for everyone. On the other hand, other health care providers are free to implement or not this system. In pharmacies, the system is applicable to all prescription drugs from a doctor.

Good to know:

Since May, 1st, 2009, children under 18 years get free health care for all dentistry included in the nomenclature of health benefits, with the exception of orthodontics. Covered treatments include: consultation, oral examination, scaling, some extractions (permanent teeth and deciduous molars), fillings, restorations, root canal treatment and placement and treatment of dentures.

http://www.mutsoc.be/Mutsoc/MaSituation/Argent/soins-remboursements/Soins-dentaires/Remboursement/remboursement-moins12.htm

For additional information, please get in contact with your health care insurer.

Legislation:

Article 53 de la loi coordonnée le 14/07/1994

Arrêté Royal du 10/10/1986 portant exécution de l'article 53, alinéa 8 de la loi relative à l'assurance obligatoire soins de santé et indemnités coordonnée le 14/07/1994, modifié par l'arrêté royal du 27 avril 2007 paru au MB du 15/05/2007

Article 53 of the Law dated 14/07/1994

Royal Decree dated 10/10/1986 on the implementation of Article 53, paragraph 8 of the law on compulsory insurance and health care benefits coordinated on July 14th, 1994, amended by Royal Decree dated April 27, 2007 published in the MB of May 15th, 2007.