social security - FOD Sociale Zekerheid

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For the calculation, the following maximum patient fee amounts are taken into account:Patient fee for the preferentialcategory (outpatients)Patient fee for ordinarybeneficiaries (outpatients)A category(specialties necessary for life) No patient fee (2)- B category(therapeutically importantpharmaceutical specialities)- B category: large packagesC category (medicines forsymptomatic treatment)Cs categoryCx category15 %- Max. 7,30 €25 %- Max. 11,00 €- Max. 9,00 €- Max. 13,70 €50 %- Max. 9,00 € - Max. 13,70 €60% - Unlimited patient fee80% - Unlimited patient feeA large package is a package containing more than 60 units.However, in addition to this patient fee, a supplement (the difference between the price that hasto be paid and the reimbursement) of maximally 10.80 € can also be charged in the context ofthe reference reimbursement.Magistral preparations are subdivided according to their <strong>social</strong> and therapeutic utility. Forordinary beneficiaries, the reimbursement rates are expressed in lump sum amounts and varybetween 0 EUR, 1.12 EUR or 2.24 EUR, and 0 EUR, 0.30 EUR or 0.60 EUR for beneficiaries of thepreferential scheme.In case of hospitalisation in a general hospital, a lump sum of 0.62 € per care day is invoiced forthe reimbursable pharmaceutical specialties. Magistral preparations are included in the day careprice.C.3. Hospital costsIn case of a stay in a general hospital, the patient fee is a lump-sum amount, in addition to themedical drugs (amounts on 1 July 2011):Beneficiaries 1er jour (*)À partirdu 2ème jourA partirdu 91ème jourOrdinary beneficiaries without dependants 41,70 € 14,43 € 14,43 €Ordinary beneficiaries with dependants(including those who have to pay alimony due toa judicial decision or a barrister's statement, andtheir dependants)41,70 € 14,43 € 5,12 €Dependent children of ordinary beneficiaries 32,39 € 5,12 € 5,12 €Beneficiaries of the VIPO-status and theirdependants5,12 € 5,12 € 5,12 €44
Beneficiaries in a situation of controlledunemployment and who have been fullyunemployed since at least twelve months,either with a family or single, as well as theirdependants(*) Lump sum amount of 27.27 € included32,39 € 5,12 € 5,12 €For the first day, a lump sum amount of 27.27 € shall be charged per hospital stay, regardlessof any technical medical care being administered. The lump sum amount is not charged topreferential scheme beneficiaries.As from the 91st day, all categories of beneficiaries, except for ordinary beneficiaries withoutdependants, pay a patient fee of 5.12 €.In case of a stay in a psychiatric clinic, the beneficiary's patient fee during the first five years is thesame as for a stay in a general hospital. Starting from the sixth year, the patient fee shall be 24.04 €for ordinary beneficiaries without dependants, 14.43 € for beneficiaries of the preferential schemeand the unemployed without dependants or who do not have to pay alimony due to a judicialdecision or a barrister’s statement and 5.12 € for all other beneficiaries.C.4. Other health care institutionsIn addition to a stay in a (general or psychiatric) hospital, medical care administered in restand care homes (MRS), psychiatric care homes (MSP), rest homes for the elderly (MRPA) and/or common residences for elderly people, day care centres and protected living schemes openentitlement to a lump sum reimbursement.D. Maximum billing (Maximumfactuur – Maximum à facturer – MaF)A part of the costs for medical care is reimbursed by the mutual insurance funds. However, theamount that remains to be paid after the reimbursement by the mutual insurance funds (i.e. thepersonal share or patient fee) can still be high in case of a long-term or serious illness. Maximumbilling provides a solution to this problem.Maximum billing gives the beneficiary and his family the guarantee that only a fixed amount (thisamount is determined on the basis of the family's incomes) of the medical costs has to be paid.The family consists in principle out of one person who usually lives alone or out of two or morepersons who usually live together at the same place. The composition of the family is thusdetermined by the information from the National Register of physical persons.Medical costs include:- the patient fees for medical care provided by doctors, dentists, physiotherapists, nursesand other care providers- the patient fees for pharmaceutical specialities of categories A, B and C and for magistralpreparations (prepared by the chemist himself)- the patient fees for technical care (such as operations, x-rays, lab tests, technical tests,…)45
Page 1: social securityEverything you have
Page 4 and 5: Table of contentsPreface 3Table of
Page 6 and 7: IntroductionA. The importance of so
Page 8 and 9: at new social categories (e.g.: the
Page 10 and 11: E. The Charter of the socially insu
Page 12 and 13: FinancingThe financing in the three
Page 14 and 15: B. Alternative financingBesides the
Page 16 and 17: Statistics and budgetsIn the course
Page 18 and 19: Budget of the National Institute fo
Page 20 and 21: C. Extension of the salaried person
Page 22 and 23: In the salaried persons' scheme, ev
Page 24 and 25: holidays and for children receiving
Page 26 and 27: 4) Social supplementsThose entitled
Page 28 and 29: If a person does not meet the condi
Page 30: Eligible workers (cf. above) who re
Page 33 and 34: D. Early retired and young people h
Page 35 and 36: B. Retirement pensionsTo obtain a r
Page 37 and 38: B.2. Career“Career years” are y
Page 39 and 40: C. Survivor's pensionsA survivor's
Page 41 and 42: Medical careWhat exactly is medical
Page 43: - Persons entitled to one of the be
Page 47 and 48: Income categories (in €) (2010)Am
Page 49 and 50: For an unemployed person, the amoun
Page 51 and 52: C. Federal civil servantsThe sickne
Page 53 and 54: A.2. Self-employed womenSelf-employ
Page 55 and 56: B.2. Indemnity for loss of incomeNo
Page 57 and 58: E. Civil servantsThe civil servant
Page 59 and 60: There are a few small differences l
Page 61 and 62: Workers in the private sector and a
Page 63 and 64: The social insurance in case of ban
Page 65 and 66: C. Serious illness of a child or pa
Page 67 and 68: B - 1 Multilateral agreementsMultil
Page 69 and 70: C - 2. Granting of the benefitsThes
Page 71 and 72: For the elderly, there is also a th
Page 73 and 74: What is the right to social integra
Page 75 and 76: The amount of the integration incom
Page 77 and 78: D. Guaranteed family benefitsGuaran
Page 79 and 80: B. Public social security instituti
Page 81 and 82: F.G.T.B.:Fédération Générale de
Page 84: © 2011FPS Social SecurityAdministr

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