We will now give you a number of examples. This list is not complete and does not cover all possible situations which may occur.

You live in Belgium

Example – no prior authorisation* required


You have health insurance cover in Belgium and wish to buy a hearing aid in the Netherlands.
You apply for prior authorisation* (S2 form*) to your health insurance fund*. The medical officer* of your health insurance fund* refuses authorisation, because the conditions set out in Regulations (EC) 883/2004 and 987/2009 are not met (e.g. you could in fact buy a hearing aid in good time in Belgium).
Since the purchase of a hearing aid is not on the list of healthcare services for which prior authorisation* is required, you can buy this hearing aid without prior authorisation* in the Netherlands.
You must pay the full amount upfront, then when you return home, you must submit the original receipt to your health insurance fund* and claim reimbursement. Your health insurance fund* will reimburse you, according to the rules and rates of the Belgian compulsory health insurance system.

Example – prior authorisation* required


You require surgery, and have chosen to have the operation carried out in a private hospital in the United Kingdom. The surgical intervention as such is reimbursed by the Belgian compulsory health insurance.
Since this planned medical treatment requires at least one night’s stay in hospital, prior authorisation* is required. You apply for prior authorisation* to the medical officer* of your health insurance fund*.
Following an assessment of your medical file, the medical officer* decides that you are entitled to a prior authorisation*: he will not give you an S2 form*, since the operation is taking place in a private hospital, but, instead, an ‘ad hoc’ document*.
You must first pay the hospital bill, and on your return you must submit the original invoice to your health insurance fund* and request repayment. Your health insurance fund* will reimburse you the costs according to the rules and rates of the Belgian compulsory health insurance regime.

Attention! If the medical officer*, following an assessment of your medical file, refuses to grant you prior authorisation* and you nevertheless go ahead with the surgery in a private hospital in the United Kingdom, you must pay all the costs yourself and are not entitled to reimbursement.

You live in another country of the European Union*, Iceland, Liechtenstein, Norway or Switzerland, where you are entitled to healthcare, to be paid for by Belgium.

Example – no prior authorisation*


You live in France, where you are entitled to healthcare, to be paid for by Belgium, and buy a hearing aid in Spain. You did not apply for prior authorisation*. Are you entitled to have the cost of the hearing aid reimbursed?
Since the purchasing of a hearing aid is not on the list of healthcare services for which prior authorisation* is required, you may buy this hearing aid in Spain without prior authorisation*.
You must pay the full amount upfront, and when you are back home you must submit your original receipt to your Belgian health insurance fund* and request reimbursement. Your health insurance fund* will reimburse you the cost according to the rules and rates applied by the Belgian compulsory health insurance system.

Example – prior authorisation* required


You live in Austria, where you are entitled to healthcare to be paid for by Belgium. You need surgery – with at least one overnight hospital stay – and have chosen to have the operation in a public hospital in Germany.
You must submit your application for prior authorisation* (S2 form*) to the Austrian health insurance fund*. This health insurance fund* will check whether the conditions set out in Regulation (EC) 883/2004 are met, and then send on the application, with its advice, to your Belgian health insurance fund*.
The medical officer* of your Belgian health insurance fund* decides whether or not you will be granted a prior authorisation* (S2 form*).
If the medical officer* decides that the conditions are met and that you can be granted a prior authorisation*, he will provide you with an S2 form*.
This S2 form* authorises you to have the surgical operation carried out in Germany. The costs of this treatment are reimbursed according to the rules and rates applied by German public health insurance.
You may also be entitled to a complementary reimbursement under Belgian compulsory health insurance; for this you must contact your Belgian health insurance fund*.


You live in Cyprus*, Finland, Ireland, the Netherlands, Portugal, Spain, the United Kingdom, Sweden, or Norway,
and
- you currently receive a Belgian pension or Belgian disability benefit, and you, as well as your family members, are entitled to receive healthcare in that country to be paid for by Belgium,
or
- you are entitled there, as a family member, to receive healthcare in that country, to be paid for by Belgium, although the main beneficiary lives in another country of the European Union*, in Iceland, Liechtenstein, Norway or Switzerland.

Example


You live in Portugal, and wish to travel to Spain to receive planned medical services.
In all cases, you must apply for prior authorisation* to the health insurance fund* in your home country.
Irrespective of
- whether you choose treatment/reimbursement based on the provisions of Regulations (EC) 883/2004 and 987/2009 or the European directive 2011/24/EU,
- or whether or not these planned healthcare services require prior authorisation*,
your Portuguese health insurance fund* is the competent institution
- to grant or refuse prior authorisation*, and
- to reimburse (or not to reimburse) the cost, according to the rules and rates of the Portuguese public health insurance system.

Attention! Your Belgian insurance fund is not authorised to grant prior authorisation* or to reimburse the costs according to the rules and rates of the Belgian compulsory health insurance system.

 

* cf. Glossary