Reimbursement according to the rules and rates of the country in which you received healthcare

Regulations (EC) 883/2004 and 987/2009 – the S2 form

If you have health insurance coverage in Belgium, then you are entitled, subject to certain conditions, to travel to another country in the European Union*, or to Iceland, Liechtenstein, Norway or Switzerland to receive planned healthcare.

What should you do?

Under Regulations (EC) 883/2004 and 987/2009*, all planned healthcare in another country is subject to prior authorisation* (S2 form*). This applies to:
- outpatient care (e.g. consulting a specialist, purchase of reimbursed medicines, etc.) and
- inpatient care (e.g. a surgical procedure in a hospital requiring at least one overnight stay, etc.)

You will need to apply for prior authorisation* to your health insurance fund*.

Reimbursement

Once you have shown your prior authorisation* (S2 form)* to a health insurance fund*, or the healthcare provider*, in the country where the treatment is taking place, you are entitled to healthcare subject to the conditions applying to public health insurance (fees, reimbursement rules, etc.) in the country where you are receiving treatment. Ultimately, Belgium will reimburse the costs of the treatment, for which you were granted prior authorisation, to the country of treatment.

Depending on the legislation of the country where you receive the planned healthcare, the healthcare is either free of charge or, if you have to pay, the costs are reimbursed. If you have paid some or all of the costs yourself, and have not taken, or were not able to take, the necessary steps to receive reimbursement from a health insurance fund* in the country of treatment, then, on your return home, you may claim reimbursement from your Belgian health insurance fund*.

The costs are reimbursed according to the rules and rates of the country where you received the planned healthcare.

Complementary reimbursements

If, according to the rates of the country of treatment, the amount reimbursed is lower than the reimbursement which you would have received if the healthcare had been provided in Belgium, then your health insurance fund* must reimburse the difference. This right to additional reimbursement is sometimes referred to as the ‘complementary Vanbraekel reimbursement’*. You do not receive this ‘complementary Vanbraekel reimbursement’* automatically: you must submit a claim for it to your health insurance fund*.

The prior authorisation* (S2 form*) only covers reimbursement of the actual healthcare. The prior authorisation* does not cover the travel, hotel and restaurant costs (except for the cost of accommodation and meals in the hospital) which you, and any accompanying person, incur for your journey to the country of treatment. Your health insurance fund* must reimburse you the travel costs which would be refunded by the compulsory health insurance regime if you had received the healthcare in Belgium. This entitlement to a complementary reimbursement is also sometimes referred to as the ‘complementary Herrera reimbursement’’*.

When can you not use an S2 form?

You need to know that you can not use an S2 form* when the planned healthcare is provided by an individual private healthcare provider (doctor, dentist, etc.) and in a private hospital.

More info?

For more information on the reimbursement of planned healthcare, applying for prior authorisation*, conditions and restrictions concerning entitlement to the complementary Vanbraekel and Herrera reimbursements, contact your health insurance fund*.

 

* cf. Glossary