Understanding healthcare and health insurance in Belgium

Moving to Belgium is an exciting step that offers many new opportunities and experiences. For anyone wishing to emigrate to Belgium, it is crucial to familiarise themselves with the Belgian healthcare system and the various health insurance options in advance. This comprehensive guide is aimed at anyone daring the adventure of emigrating to Belgium, as well as professionals, families and retirees who plan to make it their new home.

The Belgian healthcare system is considered one of the best and most accessible in Europe. It is based on the principle of universal healthcare and ensures that all residents have access to high‑quality medical care – regardless of income, age or state of health. Compulsory health insurance (the so‑called "Mutuality" or "health insurance fund") covers practically the entire population, including emigrants and persons of other nationalities who stay in the country for more than six months. Unlike in Germany, where one can choose between statutory and private health insurance, in Belgium statutory compulsory insurance is mandatory for all residents – regardless of employer or income. Basic insurance is financed Social security contributions contributions. The responsible national institute is INAMI/RIZIV (National Institute for Health and Disability Insurance), which sets the rates and reimbursement rules. The system works primarily through a reimbursement system: the patient generally pays for treatment costs upfront and then submits the receipt to their mutuality. The mutuality then reimburses the official rate (usually 75–100% of the INAMI/RIZIV rate). In addition, you can take out take out private supplementary insurance. This system is solidary and without risk selection – no one may be refused because of their state of health.

Every person settling in Belgium is required to register with a health insurance fund (Mutuality or Ziekenfonds). For registration, you need the national register number (obtained after registering with the municipality). There is no longer a fixed registration deadline – you can decide when to join a fund. However, you can only claim benefits from the date of registration with the fund. Depending on the language region, there are various funds, including the Christian Health Fund, the Free Health Fund, the Liberal Health Fund, the Neutral Health Fund, the Socialist Health Fund, and the Auxiliary Fund for Sickness and Invalidity Insurance (HKIV) as a public institution. The annual membership fee for employees is typically about €100.

Benefits of basic insurance include , among others: visits to general practitioners and specialists (the state covers about 75 percent of the costs), dental treatments (with varying reimbursement rates), hospital stays in standard wards (costs for the hospital package are about €43.52 for the first day and €16.25 for the second day, decreasing), mental health care (since 2026, long‑term psychiatric treatments are capped), certain medications (not all are fully reimbursed), vaccinations (all vaccination data is centrally stored digitally via "Vaccicard" from 2026), and emergency treatments in Belgium and within the EU.

Generally not covered are certain specialised treatments, additional fees for non‑conventional doctors, and luxury items in hospital such as a single room without medical necessity. Supplementary insurance is required for these.

In Belgium, there is moderate patient cost‑sharing in the form of the Ticket(personal co‑payment). A visit to a conventional GP costs about €27, of which the mutuality reimburses about €25 – the co‑payment is then only €2. The maximum co‑payment rate is 25 percent for general medical care and 40 percent for specialised care. The reimbursement shortfall is particularly high for specialists or if you visit a non‑conventional doctor who may charge higher fees.

The most important instrument for limiting out‑of‑pocket costs is the Maximum à facturer (MAF)– a system that caps annual personal expenses per patient. Once the personal co‑payment reaches a certain income‑dependent amount during the year, the Ticket Modérateur is waived for all further treatments that year. From 2026, the threshold for eligible persons is lowered, and long‑term psychiatric treatments and previously uncovered medicines have been included in the MAF system.

One of the biggest differences from the German system – and particularly important for many Germans – is the absence of a referral requirement. Unlike in the Netherlands or the United Kingdom, Belgium does not require a GP as a gatekeeper: you can directly consult a specialist without restrictions – for most specialities such as dermatology, cardiology or orthopaedics, no referral is needed. However, it is recommended to see a GP first, who can coordinate further treatment for serious illnesses. The GP also has access to your digital patient record (if you grant access), which can significantly improve care. The emergency number for medical emergencies is 112; additionally, there is the number 1733 for out‑of‑hours medical on‑call services.

Registration with a health insurance fund is particularly easy for immigrants from other EU countries. After registering with the municipality (receiving your national register number), you can register online or at a local branch with one of the seven major mutualities. Children under 18 are generally insured free of charge via the insured parent. For non‑employed persons, it is possible to join a mutuality, but a higher contribution is then due. The HKIV is an alternative if you do not wish to join any other mutuality – it performs all statutory health insurance tasks, but without additional benefits.

Statutory compulsory insurance covers a solid basic medical care that is completely sufficient for most people. However, if you wish to have additional benefits – such as free choice of doctor (access to private doctors for shorter waiting times), better hospital accommodation (two‑ or single‑bed room), treatment by the head physician, or access to private clinics – you can take out private supplementary insurance. This is entirely voluntary.

For private doctors, the average waiting time decreases significantly: according to a recent study by the Federation of Austrian Industries, the waiting time for contract doctors can be up to 63 days, while appointments with private doctors are usually available within a few days. Private insurance typically covers benefits such as cost coverage for special class accommodation (single or double room), free choice of doctor (access to private doctors), and outpatient medical treatments.

– DIRECT ACCESS TO SPECIALISTS: In Belgium, you can generally consult a specialist directly without a referral. However, a referral from your GP is advantageous for reimbursement purposes.

 

– MAKING APPOINTMENTS: For GPs, a prior appointment is required (except in emergencies).

 

– EMERGENCY NUMBERS: In emergencies, dial 112 for the emergency services. For non‑urgent medical help outside office hours, dial 1733 (medical on‑call service).

 

– PAYMENT PROCESS: You generally pay the entire bill directly to the doctor or hospital and then submit the receipt to your health insurance fund – usually digitally via your eID (electronic identity card), which also serves as a health card. Bring it to every medical appointment.

 

– EUROPEAN HEALTH INSURANCE CARD: If you are not yet registered with a Belgian mutuality, you can use the EHIC temporarily for emergency treatment. For permanent cover, however, registration with a mutuality is required.

 

– LANGUAGE: In most medical practices, depending on the region, Dutch or French is spoken; in the German‑speaking Community, German is spoken. In Brussels, many doctors also speak English.

Moving to Belgium requires careful planning and a good understanding of the healthcare system. We at KOCH Moving Logistics are by your side to make your dream of emigrating to Belgium as smooth as possible.