social security - FOD Sociale Zekerheid

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