social security - FOD Sociale Zekerheid

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- 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
Income categories (in €) (2010)Amounts of the personalfees (in €)Reduced amounts forchronic diseasesProtected status (social maximum billing) 450 350Income-based maximum billingUp to 16,457.15 450 350Between 16,457.16 and 25,299.79 650 550Maximum billing on the basis ofindividual entitlementChildren under the age of 19650 550Between 25,299.80 and 34,142.46 1.000 900Between 34,142.47 and 42,616.66 1.400 1.300As from 42,616.67 1.800 1.700This maximum amount is reduced by 100 € for the family when one family member hasindividually paid 450 € of patient fees during each of the two preceding calendar years. Forincome-based maximum billing, the amounts are thus respectively 350 €, 550 €, 900 €, 1,300 €and 1,700 €.47
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 and 44: - Persons entitled to one of the be
Page 45: Beneficiaries in a situation of con
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

social security - FOD Sociale Zekerheid

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