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How do the reimbursements work?

 

The 'status' of a doctor

The fee that a doctor asks depends on his or her status: committed or not committed. A committed  doctor respects the rates of the 'medicomut agreement': an agreement between doctors and health insurance organisations that sets the official fees.

Some doctors are partially committed: they apply the official rates at certain times and/or places. Such a doctor can ask for more in private practice than during the consulting hour in a hospital.

Doctors must display whether and when they are committed in the waiting room or on the reception desk. If you do not see this information displayed, don't hesitate to ask your doctor about it.

Reimbursements are only possible for care from care providers who are recognised by the RIZIV/INAMI. A recognised doctor is not necessarily an committed doctor by definition! 

Care institutions must also be recognised.

Qualified for reimbursement are: care institutions, psychiatric agencies, rest homes, rehabilitation centres, laboratories, outpatients' clinics, hospitals, etc.

What is the Global Medical File (GMF)?

In Belgium, any person can ask their general practitioner (GP) to open a Global Medical File (GMF). It will contain your medical history including a list of medical examinations, information about your use of medicines and the care provided by other medical providers and specialists.

What is the Maximum Invoice (MAF)?

Once the personal remainder fees paid by a family within a calendar year for health care in Belgium exceed a certain ceiling, the personal remainder fees above this ceiling are reimbursed. The ‘ceiling for health care expenses’, better known as ‘Maximum Invoice’, is determined according to the household income or social status.  For families that have not yet reached the MAF ceiling, a personal ceiling per year for children under 19 applies.

 

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