How health insurance & healthcare work in Belgium

Ever tried to understand Belgian health insurance as an expat?

It's like trying to read a manual written in three languages... because it literally is.

But here's the thing:

Belgium has one of the best healthcare systems in Europe (ranking 5th).

The problem?

Most expats make expensive mistakes because they don't understand how it works.

Today, we’ll show you exactly how Belgian health insurance works.

Quick Summary: Belgian health insurance is mandatory for all residents and workers. You have 3 months to register or face fines up to €2,500.

This guide shows you exactly how to navigate Belgium's healthcare system, avoid costly mistakes, and get covered fast.

Let's dive right in.

Is health insurance mandatory in Belgium? (Yes)

Health insurance is legally required for anyone living or working in Belgium.

This isn't a suggestion. It's the law.

Specifically, the Law of July 14, 1994 makes health insurance compulsory for:

• All employees (even on day one)
• Self-employed individuals
• Students staying over 3 months
• Unemployed residents
• Retirees
• Family members of workers

TLDR: If you're in Belgium for more than a tourist visit, you need health insurance.

What is the 3-month rule?

Here's something most guides won't tell you:

You have exactly 90 days from arrival to register for health insurance.

Miss this deadline?

You're looking at:

• Fines up to €2,500
• Retroactive payments from your arrival date
• Potential residence permit problems

What happens if you don't get Belgian health insurance?

Skipping health insurance in Belgium is financially irresponsible.

Here's what will happen:

Immediate consequences (month 1)

• Zero reimbursements: You pay 100% of medical costs (unless you have expat health insurance)
• No subsidized medications: Full pharmacy prices
• Limited hospital access: Emergency care only

Legal penalties (month 3+)

• Administrative fines: €250-€2,500
• Employer fines: Up to €2,500 (they'll pass this to you)
• Late registration fees: €50-€250 extra

Long-term (year 1+)

• Visa renewal blocks: Your residence permit is at risk.
• Debt accumulation: One surgery can cost €10,000+.
• No preventive care: You’ll be ineligible for free cancer screenings, dental cleanings, etc.
• Credit impacts: Unpaid medical bills affect your Individual Credit Register (ICR) score

The worst part?

Belgian authorities actively check. This isn't something you can "forget" about.

How Belgian healthcare actually works: 3-pillar system

Belgian healthcare looks complicated.

But it's actually pretty simple once you understand the structure.

Think of it like a three-layer cake:

Layer 1: Social security funding (the foundation)

This is where the money comes from.

If you're employed:

• Your employer pays 25% of your gross salary
• You pay 13.07% of your gross salary
• About 7.35% goes specifically to health insurance

Layer 2: Mutualités (Health funds)

These are non-profit organizations that handle your benefits.

Belgium has 6 major ones:

Here's the kicker: They all provide the exact same basic coverage.

The only differences? Extra non-essential perks (for example, gym discounts or the amount subsidized for glasses).

Layer 3: Optional supplements (”top up insurance”)

This covers what public insurance doesn't:

• Single hospital rooms
• Dental implants
• Alternative medicine
• Comfort medications

What does Belgian health insurance cover?

What's covered (the good news)

Belgian insurance covers a lot:

These figures are not always exact: sometimes you’ll pay a little more, sometimes a little less.

Medications are covered too, but the amount depends on their category:

• Category A (vital): 100% covered
• Category B (important): 75-80% covered
• Category C (symptomatic): 50% covered
• Category Cx (comfort): 0% covered

What's not covered (the bad news)

Here's where healthcare can get expensive:

• Single hospital rooms: +€150-300/day (not covered)
• Non-convention doctors: Can charge 300% more
• Dental implants: €1,500-3,000 each (zero coverage)
• Adult orthodontics: €3,000-6,000 (not covered)
• Cosmetic procedures: 0% coverage
• Alternative medicine: Usually not covered

Our tip: It’s possible to get these services covered. It’s why 4.6 million Belgians get supplementary insurance.

How does the Belgian reimbursement system work?

Belgium has two payment methods:

Method 1: Third-party payment

Here’s how it works:

1. Show your ISI+ card (card that shows that you are covered by Belgian social security)
2. Pay only your share (for example, €5.95 for GP visits)
3. Insurance pays additional costs to the doctor directly

Best of all? No paperwork needed.

This method is available for:

• All hospitals
• Most pharmacies
• Some GPs and specialists
• Lab tests

Method 2: Pay and claim

The process is slightly different:

1. Pay the full amount upfront
2. Get an "attestation" (proof of payment) from your healthcare professional.
3. Submit the attestation to your mutuality, usually via an app, website, or post
4. Get reimbursed in 5-10 days (starting from the moment they confirm receiving your claim)

The “pay and claim” method is usually used for:

• Most doctor visits
• Specialists
• Dental care
• Physiotherapy

Do you have to pay for healthcare in Belgium?

Technically, yes. You’ll have to pay for treatment, but only up to a certain point.

Why?

Because Belgium has something called Maximum Billing (MAF).

What does it do?

It limits your annual “out-of-pocket” (what you pay yourself) medical costs.

The amount is based on income:

• Low income: €250/year maximum
• Average income: €650/year maximum
• High income: €1,900/year maximum

After hitting your cap, everything is 100% covered.

When to get expat health insurance in Belgium

If you’ve just moved to Belgium, you’ve got three main health insurance options.

Two of them (public and private health insurance), we’ve already discussed: They are for residents who are already registered.

But here’s the catch:

To join the public system, you need to pay into social security.

And to get private insurance, you must already have public coverage.

So what happens if you’re:

• Applying for a visa?
• Waiting to start your job?
• Or still waiting on your residence permit?

That’s where expat health insurance comes in.

It’s designed to be your bridge to the Belgian system (the safety net that keeps you covered while you’re getting settled).

Here’s what you need to know:

• Expat health insurance is designed specifically for newcomers in Belgium.
• It’s ideal if you need proof of insurance for your visa application (it’s actually one of the official Belgian visa requirements)
• Or if you’re in that awkward in-between phase before you’re officially registered

Here are the key benefits it provides:

• It’s usually cheaper than public or private plans
• It covers you for up to 5 years (depending on the provider)
• It excludes pre-existing conditions, which keeps costs lower

Expat health insurance is your fast, flexible, and affordable entry ticket to Belgian healthcare.

Once you’re integrated into the public or private system, you can switch easily. No gaps, no fines, no stress.

How to get health insurance in Belgium: Step-by-step

Here's exactly how to get covered:

Step 0: Get expat health insurance

Skip this step if you’ve already received your National Registration Number (11-digit code assigned to all residents registered in Belgium).

If you’ve not yet received it (for example, if you just moved or are applying for a visa), you should seriously consider expat health insurance.

It ensures that if anything bad happens to you, you’ll be able to afford healthcare while proceeding with the next steps (it’s also a mandatory step in the visa application process).

Step 1: Social security registration

As an employee, your employer registers you with ONSS (National Social Security Office in Belgium) automatically.

All you have to do is provide them with your National Registration Number, which you’ll get once you’re officially registered in Belgium.

If you’re a freelancer or self employed, you must register with a social security fund. These include:

• Acerta
• Xerius
• Liantis
• UCM

Step 2: Choose your mutualité

To choose your mutualité, remember that they all offer the same core coverage. The only difference will be in small extras and bonus programs.

Once you’ve chosen your preferred mutualité, you can:

1. Go to the relevant mutuality website (CM, Solidaris, etc.)
2. Click "Join" or "Inscription"
3. Upload your documents:
   • Passport/ID
   • Employment contract
   • Residence permit (or proof of application)
   • Belgian bank account IBAN
   • For freelancers only: Proof of self-employment registration and a business plan (if it’s a new business)
4. Get temporary certificate of membership immediately (you can use this to get medical treatment)

Step 3: Cancel expat health insurance

Once you’re into the Belgian public system, you can safely cancel your expat health insurance.

If something happens and you need medical attention, you’ll be covered.

Step 4: Receive ISI+ card

The ISI+ card shows that you are covered by Belgian social security.

It will arrives by mail in the 2 weeks following your application.

There’s no need to activate it — you can start using it as soon as you receive it.

Step 5: Get private health insurance

If you want to get the best benefits, coverage and reimbursements, you should seriously consider private health insurance.

It’s not mandatory, but ensures you get access to the best treatments, facilities and personel for a fraction of the cost you’d have to pay if if you were on public insurance only.

Step 6: Payments (for freelancers and self-employed only)

When you’re self employed, you must pay your social security fund quarterly.

The exact dates can vary year to year, but generally the payments are due on:

• March 20th
• June 20th
• September 20th
• December 20th

These payments cover your contributions to health insurance, pension, and other social benefits.

How much does Belgian health insurance cost?

Let's talk money (because no one wants to overpay for health insurance).

Here’s what to expect cost-wise in Belgium:

If you're employed

Payments (and cost) are automatic, based on and deducted from your salary:

If You're Self-Employed

Quarterly payments based on your income:

Should you get private health insurance?

Our opinion is that private health insurance is crucial (even essential).

Why?

Because public health insurance only goes so far.

For example…

Hospitalisation insurance.

Hospitalization insurance is the coverage most Belgians never skip.

Why? Because your public plan only covers part of your hospital stay.

You’re still on the hook for things like:

• Lab tests
• Doctor consultations
• Blood transfusions
• Medication
• Single-room upgrades

Those “extras” can add up fast — one short hospital stay can easily hit four figures.

That’s why nearly 9 out of 10 Belgians (88%) have hospitalization insurance.

It takes a potential €3,000–€10,000 bill and turns it into a manageable monthly cost.

Dental insurance

Again, a private dental insurance can help you bridge your public coverage’s gap:

With dental insurance, you can expect to pay almost 0 for all of these (with a few caveats, like waiting periods and limits — but generally, unless you have excellent oral health, these policies are worth it.

In short…

If you want peace of mind, and protection from big, unexpected bills, private health insurance is your best bet.

The bottom line

Belgian healthcare is excellent once you understand it.

Yes, the registration seems complex. But it's actually straightforward when you follow the steps.

Your total budget should be:

• Employees: €150-250/month (including supplements)
• Self-employed: €250-400/month (including supplements)
• Families: Add €50-100/month for kids

The most important things to remember:

1. Register within 90 days (non-negotiable). While waiting, get expat health insurance.
2. Get hospitalization insurance
3. Submit claims immediately (money back faster)

Belgium's healthcare system ranks 4th in Europe for a reason: Once you're in, you'll have access to world-class medical care at incredibly reasonable prices.

The key is getting set up correctly from the start.

Frequently Asked Questions

Can I use my home country insurance instead?

Only for the first 3 months with EHIC (EU citizens) or if you're a posted worker with A1 certificate. After that, Belgian insurance is mandatory.

What if I travel frequently?

Belgian insurance covers emergencies EU-wide. For broader coverage, add international travel insurance or consider expat insurance like Feather.

I'm only here for 6 months. Do I need Belgian insurance?

Yes, if you're working. Consider expat insurance for simpler administration if your stay is under 1 year.

Can I switch mutuality?

Yes, once per year during January. The process takes 5 minutes online.

Are pre-existing conditions covered in Belgium?

Belgian public insurance covers everything - no exclusions for pre-existing conditions. Private supplements may have restrictions.

How do I find an English-speaking doctor?

Use doctoranytime.be and filter by language, or ask your mutuality for recommendations. Brussels and Flanders have the most options.

Is dental care really that expensive?

Basic care is affordable (€60-80 for cleaning). Major work (implants, crowns) is expensive without supplementary insurance.

What if I lose my job?

You maintain coverage through unemployment benefits or can pay voluntarily. Your mutuality will guide you through the transition.

Can my spouse work if they're on my insurance?

Yes, but once they earn income, they need their own registration. Children stay on family coverage until 25 (if studying).

Do I need to speak French or Dutch?

Not necessarily. Many doctors speak English, especially in cities. But learning key medical terms helps.

This guide is based on official Belgian government sources including INAMI/RIZIV, ONSS/RSZ, and major mutuality websites. All rates current for 2024-2025. For personalized advice, consult your mutuality, insurance broker, or contact us.