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A mutualité (sometimes also called « mutuelle ») is a non-profit making insurer. The main aim of a mutuality is to manage the reimbursement of healthcare costs for its members and the payment of indemnities in the case of inability to work. It offers you benefits and reimbursements in addition to the compulsory insurance, as well as several other services (rental of equipment, social support, hospitalisation and dental insurance).

Compulsory insurance

It is linked to Social Security and allows for your healthcare costs to be reimbursed in accordance with the amounts laid down by the INAMI (National Institute for Sickness-Invalidity Insurance) or for you to receive indemnities in case of illness or inability to work. It is financed by the social security contributions withheld from your salary or your social laws, and State subsidies.

Complementary Insurance

Since Social Security does not cover all health risks, the complementary insurance intervenes, as its name indicates, as a complement to the compulsory insurance. Its benefits and services are specific to the mutuelle. It is finished by the fees paid by the members.

Waiting period

The waiting period is a period of several months during which you pay your membership fee but you are not covered or only partially covered by the guarantees of your mutuelle.

Social laws

Social laws are the contributions due by self-employed persons to the social security offices in order to be covered for social security.

Member

The member opens the right to healthcare reimbursements based on his or her work or based on the fact that he or she benefits from a social allowance.

Dependent

Each person, not the holder, living under your roof and who is registered in your « household » in the commune. The dependent can be entitled to healthcare based on the cohabitation with a member and/or on a family relationship.

EHIC

The European Health Insurance Card (EHIC) is a document which allows a European citizen to benefit from healthcare in a member State other than his or her own. It allows you to prove when you are abroad that you are covered by Belgian social security. It is necessary if you want to be reimbursed while abroad for your healthcare and in case you are hospitalised.

Co-payment (part at your expense)

The Social Security reimburses you a part of what you have paid to your doctor. The co-payment is the part that is not reimbursed to you (i.e. the difference between what the Social Security reimburses and the legal fee of your doctor). If your doctor charges fees higher than the legal fee, the supplement is at your expense.

Advisory Doctor

The role of the advisory doctors assigned to the mutuelles is to verify the correct application of the rules set out by the INAMI (National Institute for Sickness-Invalidity Insurance) for specific services (ex. prostheses, specific medications, specific types of treatment...). An advisory doctor is independent from the mutuelle to which he is assigned, which means that the mutuelles have no influence on his decisions.

Primary incapacity/invalidity

When you are unable to work for a long period of time because of a health problem, we talk about primary incapacity for the first 12 months and invalidity thereafter.

The third-party payment scheme

This is the system via which the health insurance organisation pays the amount due from the compulsory sickness insurance directly to the care provider, service or body. Patients therefore do not have to ‘advance’ the total amount and then wait for a reimbursement. They only pay the payments for their own account (their personal share) and possible fee supplements. This procedure is mandatory for payments during a hospital admission.

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