social security - FOD Sociale Zekerheid

Medical careWhat exactly is medical care? What is reimbursed and how much for whom? We will try to provideanswers to all these questions.A. The entitledThe compulsory insurance for medical care is not only destined to salaried or self-employedpersons and civil servants, but also to the unemployed, the retired, the persons who areentitled to the integration wage, the disabled, students, orphans, non-accompanied under-agedforeigners, etc. as well as to their dependants who qualify to be dependants: spouses, couplesliving together, children, grandchildren, great-grandchildren, etc.These are the conditions to be considered a dependant:- the gross income should not exceed 2,221.08 EUR per quarter (for the second quarterof 2011);- the person belongs to the family of the entitled to health insurance, with the exceptionof divorced or separated spouses (living apart or judicially separated), of children under25 years and spouses who have another main place of residence because the spouse orthe entitled person is obliged to have his main place of residence at a specific place byvirtue of a regulatory provision.In fact, we could say that the entire Belgian population is entitled to medical care, with a fewexceptions. However, an entitled person should meet a number of conditions to open the rightto health insurance benefits.a) All the persons entitled to the compulsory insurance for medical care must affiliateor register with a health insurance fund (either a mutual insurance fund or a regionalservice of the Auxiliary fund for sickness and invalidity insurance or the Health insurancefund of the Belgian national railway company Holding (NMBS - SNCB)). The choice is free,except for permanent staff of the Belgian railways;b) The right to health care opens only if contributions have been paid and equal a minimumamount. If contributions do not equal the minimum amount, payment of additionalcontributions shall be required to preserve entitlement to medical care.c) In principle, you do not have to achieve a six-month qualifying period before medical carecan be reimbursed by the insurance for medical care, unless in exceptional cases explicitlymentioned in the regulation and never when the above-mentioned contribution obligationhas not been fulfilled.41