social security - FOD Sociale Zekerheid

- the personal shares in the day charges in a general hospital (entire stay) and in apsychiatric hospital (only for the first 365 days)- the lump-sum personal share for medicines during hospitalisation- enteral nutrition via catheter or gastrostomy for persons younger than 19- material for endoscopy and viscerosynthesis- delivery margins (supplements) for implants.As soon as the amount of the personal share of a beneficiary or a member of his family for certaintypes of medical care reaches a fixed cap, the costs for further care are entirely reimbursed by themutual insurance funds. The fixed maximum amount varies in function of the beneficiary's socialcategory, his age or in function of the family income. This maximum amount is, as from 1 January2009, reduced by 100 € for the family when one family member has individually paid 450 €of patient fees during each of the two preceding calendar years (maximum billing for chronicdiseases).There are different types of maximum billing:- social maximum billing- income-based maximum billing- maximum billing on the basis of individual entitlementSocial maximum billingThe contribution of the insurance is set at 100% of the reimbursement basis as soon as the totalamount of the personal shares (for medical care that has been provided during the current year)that the family has actually paid reaches 450 €. This advantage is only granted to persons entitledto higher reimbursements, their life partners and their dependants. As from 1 January 2009however, this amount is 350 € when one family member has individually paid 450 € of patientfees during each of the two preceding calendar years (maximum billing for chronic diseases, cf.above).Maximum billing on the basis of individual entitlementThere is a special solution for children under the age of 19.Children who are younger than 19 years and who have actually paid 650 € of personal shares on 1January of the year in which maximum billing is granted can be individually eligible for maximumbilling, and this without taking into account the income of their family.For children who have individually paid 450 € of patient fees during each of the two precedingcalendar years, the maximum amount is increased to 550 € as from 1 January 2009.Income-based maximum billingHere, the family as it is registered in the National register is taken into account. All families areeligible for income-based maximum billing. The amount of the actually paid personal fees differsaccording to the net yearly family income.46