The mutual insurance company reimburses, via the compulsory health care and compensation insurance (a branch of social security), part of the costs related to hospitalisation but not all of them. Taking out hospitalisation insurance makes it possible to obtain reimbursement of costs not reimbursed by the compulsory health insurance.
Hospitalisation insurance is often taken out individually, but sometimes your employer insured you via a so-called group insurance. Get informed!
If you wish to be covered by hospitalisation insurance, you can:
- either you get affiliated with a mutual insurance company, a national union or a mutual society which, in the compulsory supplementary insurance, provides for hospitalisation or daily indemnities from a mutual insurance company but the cover will be limited;
- or you take out hospitalisation insurance with a mutual society;
- or you take out hospitalisation insurance with an insurer.
The hospitalisation service can, therefore, be offered to you by a private insurer, a national union, a mutual society, a mutual society offering insurance products or by a mutual insurance company.
The choice is yours!
Mutual insurance companies manage the compulsory insurance, but beyond the legal role, they developed a whole range of related services, including supplementary insurance. Each mutual insurance company has its own policy in this area. The services are highly diversified according to the mutual insurance companies, but members generally have access to hospitalisation cover. The amount of the additional contribution also varies from one mutual insurance company to another. The cover offered as part of the hospitalisation service also varies according to the entity that offers it. In concrete terms, it means that what is covered by one is not necessarily covered by the other and that financial interventions can be very different from one mutual insurance company to another.
Moreover, the hospitalisation service available to a member of a mutual insurance company is, sometimes, compulsory or optional.
If the hospitalisation service is compulsory, it is compulsory for all persons affiliated to the mutual insurance company and each person affiliated to the mutual society has access to this service regardless of age (no limit at 65), sex and state of health (no limitation for pre-existing illnesses, chronic illnesses, disability, etc.). Likewise, no member can be excluded on the basis of age or state of health and the cover covers conditions that existed prior to affiliation. The contributions for the service are fixed and there can be no segmentation (i.e. the contribution cannot take the characteristics of the person covered into account: gender, age, whether or not he or she smokes, health problems, sports or eating habits, etc.) but a difference in contributions is possible depending on the composition of the household. But keep in mind that in the context of compulsory supplementary insurance, the hospitalisation service may be modified by the general meeting of the mutual insurance company provided that it is approved by the Oversight Office for Mutual Insurance Companies. In concrete terms, it means that from one year to the next, a mutual insurance company can modify its offer in terms of guarantees or the contribution requested.
In future, the optional hospitalisation service will no longer be managed by the mutual insurance company itself but by a mutual society offering insurance products created by the mutual society or of which it is a section. The civil company is subject to the same rules as those governing private sector hospitalisation insurance. Indeed, the law of 26 April 2010 on various provisions concerning the organisation of supplementary health insurance pursued the objective of harmonising Belgian legislation to put private insurers and mutual insurance companies on an equal footing. However, in some respects the mutual society differs from a private insurer. Firstly, it does not pursue a profit-making objective but an objective of solidarity, and secondly, only those who are members of a mutual insurance company affiliated to this mutual society can be insured. So, keep in mind that if you change your mutual insurance company for your supplementary insurance, you may be obliged to change your mutual society, and the contract is, therefore, not necessarily for life.
Find out and compare the guarantees offered (the cover), their durability over time and the requested premiums/contributions!