Finding my way around the Mutualité chrétienne

MUTU_GUIDE_10_04f_BL_Layout 1 31/08/10 15:55 Page1
Finding my way around
the Mutualité chrétienne
Practical guide
MUTU
A L IT E
CHRE
TIENN
E
La solidarité, c’est bon pour la santé.
MUTU_GUIDE_10_04f_BLa_Layout 1 31/08/10 16:57 Page2
Table des matières
Introduction
4
The low-down on your mutual insurance
company
4
Enrolling with the mutual
healthcare company
5
Dependant or main policyholder?
5
When should you enrol with a mutual
insurance company?
5
Your important documents
7
How to obtain a reimbursement
9
Higher reimbursements
9
Incapacity to work
12
Incapacity to work and invalidity
12
Injured in the course
of an accident?
13
Hospitalisation
14
Declaration of admission
14
Billing
15
To contact us
16
The Mutualité chrétienne (MC) propose free publications on various themes: Incapacity to work,
hospitalisation insurances, MAF...
Request them on 0800 10 9 8 7 (free call), order them on www.mc.be or meet us in one of our closest
MC agencies.
2
MUTU_GUIDE_10_04f_BL_Layout 1 31/08/10 15:55 Page3
Introduction
Welcome to Belgium!
Many people think that we have one of the best social security
systems in the world. It may be true. If so, it is the result of a long
struggle by our insurance company to ensure access to quality
medical care. We hope the following pages will provide you
with all the information you need to benefit from our social security and from our compulsory Sickness/Incapacity Insurance.
What kind of system is the Belgian
social security ?
The social budget is divided into several major
fields such as the old age pension fund, the unemployment fund and sickness/incapacity insurance.
What is a “Mutualité”?
The principal role of the “Mutualité chrétienne”
(MC) is to ensure partial reimbursement of health-
care costs and to provide alternative financial income during a period of incapacity to work. In addition to this primary role, the insurance company,
within the framework of the INAMI (National Institute for Sickness/Disability Insurance), provides
additional services for its members.
The management of the Sickness Insurance
System is entrusted by law to a “Mutualité” such
as the Christian Health Insurance Company. We
are proud to announce that more than 4,400,000
Belgians are registered with the Mutualité chrétienne (MC).
© stockxpert
The low-down on your
mutual insurance company
3
MUTU_GUIDE_10_04f_BL_Layout 1 31/08/10 15:55 Page4
How can I benefit from the healthcare
system in Belgium?
Three situations:
> When you visit professional healthcare providers.
> When you are admitted to hospital.
> When you receive a drug prescription.
First of all, we invite you to enrol with our “Mutualité”.
In doing so, you will receive a “Mutualité” membership number. This is an easy and efficient way
for all your mutual health insurance documents to
be stored and retrieved, together with those of your
dependants: yellow detachable labels, SIS card.
At the MC, we want to be there for you from the
cradle to the grave, which is why our benefits and
services are varied and evolve along with your
needs and those of your family.
The MC also provides:
> reimbursements and contributions for vaccination, eye care, dental care, home help, medical
transport, alternative healthcare, etc.;
> hospitalisation insurance;
> holidays and leisure for all;
> information about your rights and their protection;
> solidarity movements.
Did you know?
The self-employed are covered by a special
system but they also contribute to the social
security system.
The MC advisers
They are at your service in each MC agency and are there to support you, advise you and listen to you
in order to find the most appropriate solution to your health situation. They can also steer you towards
our different departments: social department, pensions department, etc.
Do not hesitate to ask your questions to them!
4
MUTU_GUIDE_10_04f_BL_Layout 1 31/08/10 15:55 Page5
© stockxpert
Enrolling with the mutual
healthcare company
Dependant or main policyholder?
There are different categories of subscriber:
When should you enrol with
a mutual insurance company?
The insured
A main policyholder is a person (whether employed, self-employed, unemployed or retired)
who “triggers” the entitlement to healthcare
(his or her personal right as well as that of any
dependants).
The dependant
A dependant is a person who benefits from the
healthcare entitlement via the main policyholder.
Who can be a dependant?
> Children/young adults under the age of 25:
children, grandchildren, “au pair” girls, etc.
> Persons living with the insurance holder and
whose revenues are lower than a given ceiling: spouse, ascendant, cohabitant.
> A spouse living separately who provides for
at least one child who can be considered as
a dependant, who receives maintenance,
who can receive sums due to the other
spouse or who receives a part of the spouse’s
pension (and whose revenues are lower than
a given ceiling).
You can register with the insurance company
as a resident, a student, a worker or a person
under the cover of another person. In any of
those cases, check our conditions.
To register as a resident,
you need to bring along the following
documents:
The resident permit, for foreigners from countries that are not part of the European Economic Area.
To register as a student,
you need to bring along the following
documents:
The certificate of registration that you have received from the university or higher-education
establishment (duplicate accepted).
5
MUTU_GUIDE_10_04f_BL_Layout 1 31/08/10 15:55 Page6
To register as a worker,
you need to bring along the following
documents:
A document certifying that you are duly covered by the social security system from your
employer or a copy of your employment agreement.
To register as a person under
the cover of another person,
you need to bring along the following
documents:
© jupiter images
Please come and pick up the necessary registration form with the contact details of the person you are living with (“Mutualité” stamps of
SIS card) or come along with the person you
are living with in order to complete the documents directly with him/her.
Do not forget your ID or your registration certificate from the foreigners’ registry.
6
MUTU_GUIDE_10_04f_BL_Layout 1 31/08/10 15:55 Page7
© stockxpert
Your important documents
When you enrol with the mutual insurance company, you receive different useful documents in the
course of your contacts with it that will allow you
to benefit from healthcare and its reimbursement.
© jupiter images
The social security identity
card or SIS card
All main policyholders or dependants have their
own SIS card. The SIS card contains information
about the various social security sectors.
1
Did you know?
> Always keep your SIS card on you. You will
need it whenever you go to a pharmacy, hospital or clinic, consult your mutual insurance adviser, etc.
> The persons entitled to request your SIS card
can only “read” the data they need to help you.
> The SIS card is useless abroad. For travel
abroad, please request the appropriate document.
2
7
3
4
5
The visible data are :
1 national number
2 surname and the first two first names
3 date of birth
4 gender
5 card number
6 date of entry into force of the card
7 chip
6
It is important for us to have accurate and up-todate information. Contact your mutual insurance
company in the following cases:
> accident (private life, traffic, occupational, etc.);
> change to your professional status;
> change of address;
> change of bank account;
> loss of the SIS card;
> sickness/hospitalisation;
> marriage/cohabitation;
> separation/divorce;
> birth/adoption;
> retirement;
> death.
7
MUTU_GUIDE_10_04f_BL_Layout 1 31/08/10 15:55 Page8
The chip also contains data that can only be read
by special devices. This is the number of your
mutual insurance company, your member number with the mutual insurance company, the date
on which your healthcare entitlements begin and
end and your access to third-party payment.
The identification labels
Each policyholder and dependant receives detachable identification labels in their name. They
contain a string of information that allows you to be
identified: the name and number of the mutual insurance company, your name, address, member
number and reimbursement code. They are used to
identify documents such as treatment certificates
after a visit to the doctor, physiotherapist, etc.
The treatment certificate
After each consultation with a healthcare provider (doctor, dentist), you will receive a treatment
certificate containing information about the treatment received and the price paid for it. You must
submit this certificate to your mutual insurance
company to be reimbursed a part of what you
have paid. Please note that a part of the cost remains payable by you. This part is known as the
“co-payment” or “personal share”. Any supplements can also be added to this amount payable
by you.
At the pharmacy, for all reimbursed drugs, you only
pay the amount of the co-payment.
Did you know?
At the MC, the detachable identification labels
are yellow, which is why you will sometimes
come across the term “yellow label” in our letters, contacts, etc.
> Each time you visit or consult a doctor, dentist,
etc. you will receive a treatment certificate
(green, white, blue or orange). Do not lose it, as
without a certificate, there can be no reimbursement!
> You have two years to request and obtain a
reimbursement for treatment received. Once
this deadline has passed, your treatment will no
longer be reimbursed.
Did you know?
> Always stick a yellow label on every document
sent to your mutual insurance company: treatment certificate issued by a doctor, dentist, physiotherapist, etc.
> keep a few labels with you at all times, they will
come in useful when you consult a doctor, dentist
or when you go along to the mutual insurance
company to request information or submit your
treatment certificates.
8
Your personal file online
The MC’s website (www.mc.be) allows you to
consult and print your reimbursements, to order
your labels or a new SIS card (in the event of
theft, loss, damage, etc.), to order and print an
incapacity to work certificate, to check your
personal data and those of persons under the
age of 18 in your care.
MUTU_GUIDE_10_04f_BL_Layout 1 31/08/10 15:55 Page9
How to obtain a reimbursement
The amount of the fees of the healthcare provider as well as the
amount that will be reimbursed to you by the mutual insurance
company is determined by statutory agreements.
The registered healthcare provider
This healthcare provider undertakes to apply the
official treatment rates agreed between the mutual insurance companies and the representatives of the healthcare providers. Only your
personal share (or co-payment) will remain
payable by you.
The non-registered healthcare
provider
This healthcare provider has chosen not to
adhere to the agreement between the medical
and insurance professionals and is therefore free
to set their fees for the services provided. This
means that if you consult this type of healthcare
provider, only the rate of the agreement will be
reimbursed. The additional fees that the doctor
may charge as well as the co-payment are payable by you.
The partially registered healthcare
provider
There are also healthcare providers who apply
the registered healthcare provider rates at
certain times or on certain days or depending on
the place where they practise (private practice,
clinic, etc.).
Unfortunately it is not always easy to establish
when exactly these standardised rates are
applied by this kind of healthcare provider.
© Istock
However, the healthcare providers are free to adhere to these
agreements or not. Those who adhere to them are called “registered healthcare providers”.
Higher reimbursements
The Preferential Reimbursement Rate
Beneficiary (“Bénéficiaire de l’intervention
majorée” or BIM)
Health-Invalidity Insurance legislation allows patients to benefit from higher reimbursements for
medical treatment and drugs. This is known as
the Preferential Reimbursement Rate. Those
who benefit from it are therefore known as the
Preferential Reimbursement Rate Beneficiaries
or BIM (Bénéficiaire de l’intervention majorée)
(formerly VIPO).
These are:
> persons entitled to a social benefit: integration
income (or equivalent benefit from the CPAS),
disability allowance, children suffering from a
physical or mental disability of at least 66%, beneficiaries of preferential family allowances
(since 1 January 2008), guaranteed income for
the elderly. These persons have a right to the
preferential allowance without an income
check;
> widows/widowers, the disabled, orphans, pensioners, unemployed persons over the age of 50
(for more than one year), beneficiaries of preferential family allowances due to handicap.
These beneficiaries must have an income
limited to a certain ceiling, as confirmed by an
income check.
9
MUTU_GUIDE_10_04f_BL_Layout 1 31/08/10 15:55 Page10
www.mc.be
Find out a host of information about the benefits
and services offered by the MC, the opening
times of our agencies, the latest from your region,
download forms and documents and much more.
On our website, you can also consult the amount
of the fees charged by the registered healthcare
providers as well as the refunds rates. You can
check whether your healthcare provider is registered and whether they apply the official rates.
For information in English, click "Que faire en cas
de∑" on the left-hand menu, then click "Welcome
to Belgium".
> beneficiaries of the preferential rate;
> beneficiaries whose household has a taxable
gross annual income no higher than the amount
of the integration income;
> those fully unemployed for more than 6 consecutive months (head of family or single parent);
> beneficiaries of preferential family allowances.
The healthcare providers are free to apply the
third-party payment system or not (except in the
event that you have a global medical file). If your
healthcare provider practises the third-party payment system, their fees will be directly paid by the
mutual insurance company up to the amount
covered by Healthcare and Invalidity Insurance.
Maximum Billing
(“Maximum à facturer” or MAF)
The government has also introduced a second
system. This allows all households whose annual
income is below a certain ceiling to benefit from
preferential reimbursements for medical treatment and drugs. This is the Omnio status. A
check of the annual income of the year preceding
the request determines whether the household is
eligible for this status.
Third-party payment (“Tiers-payant”)
The third-party payment system makes it possible
not to have to advance the total amount of certain
services. Only the personal share (or co-payment) is paid. Certain services must be billed via
third-party payment (e.g. during hospitalisation).
The provisions vary according to the conditions
of the agreement in question.
For consultations and visits to the doctor, thirdparty payment cannot apply unless you belong to
one of the following categories:
10
Which healthcare costs are covered?
> The co-payments relating to the fees of doctors,
physiotherapists, nurses, paramedics, etc.*
> The co-payments relating to technical practices
such as surgery, technical examinations, laboratory examinations, etc.
> The co-payments relating to category A, B and
C drugs (except for Cx and Cs). (You will find an
indication of the category on the drug packaging).
> Certain hospitalisation costs.
* The supplements charged on top of statutory fees are not
covered.
© fotolia
The Omnio status
Maximum Billing (MAF) guarantees that each
household does not have to pay more than a certain amount per annum for its healthcare. This
amount is determined according to the social
category or income of the household. All persons
living at the same address (as at 1 January of the
Maximum Billing year) are considered as part of a
same Maximum Billing household. There is no
distinction between married persons and cohabitants. Single people are also considered as a
“household”.
MUTU_GUIDE_10_04f_BL_Layout 1 31/08/10 15:55 Page11
For whom?
There are several types of Maximum Billing with
different ceilings: Income Maximum Billing, Social
Maximum Billing, Individual Maximum Billing.
For the application of Maximum Billing, the
amounts still payable by the patient are limited to
a ceiling. This is determined according to the
amounts of the taxable income of the household.
To find out more, contact your mutual insurance
adviser.
The global medical file
(“Dossier Médical Global” or DMG)
The global medical file (DMG) contains the healthcare data, the minutes of meetings (consultations
and visits) with the family doctor, the data and results of consultations with specialists. Everyone is
entitled to open a global medical file.
The benefits for the patient
As soon as you have chosen to entrust your global medical file to your general practitioner, you
benefit from a 30% reduction on the co-payment
of your consultations with this practitioner.
Did you know?
In the event of a chronic disease, you can benefit
from a specific contribution.
Contact your MC adviser to find out more.
If you are 75 years old or over or if you are a chronic patient, you are also entitled to a 30% reduction on the co-payment of the home visits of a
general practitioner; this reduction also applies to
all the general practitioners who have access to
your file.
What do you need to do?
If you wish to entrust the management of your
medical file to your doctor, ask him at your next
consultation. To create your file, your doctor will
charge special fees that will be reimbursed to you
in full. If you keep your file open, these fees will
be claimed (and reimbursed) every year.
Generic drugs
When a pharmaceutical firm launches a new drug
on the market, it benefits from the exclusive sale
of the product for 20 years (patent period). Once
this protection period expires, other firms can use
this active substance contained in the reference
product to market a drug that will have exactly the
same virtues. When an equivalent effectiveness
is recognised for the two drugs, the new drug obtains the “generic” label and is eligible for reimbursement on the condition that it is at least 30%
cheaper. The reference drug is therefore no longer exclusive and its reimbursement rate is reduced. It is then only reimbursed up to the amount
reimbursed for the generic drug.
© fotolia
The generic drug is thus at least 2.7 times cheaper
than the price of the corresponding reference
drug (4 times for the preferential reimbursement
rate beneficiary).
11
MUTU_GUIDE_10_04f_BL_Layout 1 31/08/10 15:55 Page12
© stockxpert
Incapacity to work
When you are unable to work (following an illness or an accident), you are advised to notify
your mutual insurance company as quickly as
possible using the “incapacity to work certificate”. Have it completed by your family doctor,
stick a yellow label on it and send it to us by post.
PLEASE NOTE: you cannot slip the certificate into
the mutual insurance company’s green letter box
as the postmark serves as proof of postage.
Depending on your status, you have between 48
hours and 28 days to notify your mutual insurance
company of your incapacity to work. Find out
more from your adviser who will inform you of the
maximum deadline applicable to you. In the event
of doubt, send it within 48 hours.
Incapacity to work and invalidity
During the first days or weeks of your incapacity
to work, and depending on your type of contract,
your employer will continue to pay your salary. In
fact you are entitled to the guaranteed salary
(“Salaire garanti”). At this time, you do not as yet
receive allowances via your mutual insurance
company.
12
Did you know?
> Make your declaration on time, otherwise your
allowances will be cut by 10% up to the day of
receipt of your certificate.
> The medical adviser can convene you to a
medical examination. An unjustified absence
will lead to a provisional or definitive suspension
of the payment of your allowances.
> During your incapacity to work, all reprisal of
part-time work must be previously authorised by
the medical adviser.
> For a stay abroad, ask us for advice at least 15
days before your departure.
> As soon as the medical adviser recognises your
incapacity to work, you will receive a series
of documents. Some are to be completed and
returned to your mutual insurance company,
others are to be kept.
MUTU_GUIDE_10_04f_BL_Layout 1 31/08/10 15:55 Page13
Injured in the course
of an accident?
Primary incapacity to work
The first year as from the start of your incapacity
is called the “primary incapacity to work” period.
> For employees: the allowance is payable after
the guaranteed salary period. This depends on
several factors (type of employment contract,
trial period).
> For the unemployed: the allowance becomes
payable as from the beginning of your incapacity.
> For the self-employed: during the first month
of incapacity to work, no allowance is payable
(qualifying period).
Invalidity
If you have incapacity to work status for more
than a year, this is then known as “invalidity”. The
allowance rate will be reviewed regardless of
your status (employee, unemployed, self-employed).
Throughout the duration of your incapacity, the
medical adviser of the mutual insurance company
performs regular controls on the basis of your
declarations and medical examinations.
In case of an accident, notify your mutual insurance company.
If the medical costs are incurred following an
accident, specify this each time you submit a
reimbursement request giving the date of this
accident. Keep your proof of payment and reimbursement.
Do not sign any document without having consulted your mutual insurance company, even if the
sums proposed appear to be huge: they must
cover the consequences of your accident up to
the end of your days!
Did you know?
> Keep all the documents relating to your accident:
medical costs, physiotherapist, travel to the
doctor, to hospital, co-payments, etc.
> Tell your mutual insurance company that these
costs are linked to an accident.
13
MUTU_GUIDE_10_04f_BL_Layout 1 31/08/10 15:55 Page14
Hospitalisation
When arriving at the hospital, you must complete
a declaration of admission known as “choice of
room and financial conditions”.
This document is drawn up in two copies: one
copy for the hospital and another for you. Keep
your copy safely: it may come in useful if you need
to dispute the bill! The Protection department responsible for defending the interests of the MC
members can help you to clarify any anomalies or
problems with your bill.
What is the point of the declaration
of admission?
This document lists the financial information relating to your hospitalisation. It will allow you to
better identify the various elements that will have
an impact on the final bill. In fact it clearly sets
out the room supplements and the supplements
for the medical services (the fee supplements).
14
With the declaration of admission,
do we know in advance the exact
amount of the bill?
No, the declaration of admission is not a quotation. In fact, it does not make it possible to estimate the exact amount you will be billed because
certain costs are not foreseeable. For example,
it is difficult to determine in advance the amount
of certain medical costs, in particular expenditure
linked to complications, but also of certain nonmedical costs. But be careful, certain costs, such
as miscellaneous costs, or costs that are not
foreseeable, are not listed, whereas they can be
partially or totally payable by you and can be very
high. You can ask the hospital to inform you of
the prices of products and services such as telephone, television, beverages, etc.
Hospi solidaire
By choosing the MC, you have made the right
choice! In fact, the MC is the only mutual insurance company in Belgium to offer all its members
hospitalisation insurance automatically included
in the supplementary insurance. Thanks to Hospi
Solidaire you are guaranteed a good cover for
your hospitalisation costs.
© sxc
Declaration of admission
© sxc
The mutual insurance company covers hospitalisation costs. However, the patient sometimes risks having to pay additional costs. As
from admission to hospital, important decisions
have to be taken: type of room and choice of
doctor in order to avoid nasty financial surprises. The costs linked to a hospitalisation can
vary significantly depending on the hospital,
doctor and type of hospitalisation.
MUTU_GUIDE_10_04f_BL_Layout 1 31/08/10 15:55 Page15
Billing
© sxc
When you are admitted to hospital, the mutual insurance company pays an amount on the basis of
the rate of a shared room. This payment is made
directly by the mutual insurance company to the
hospital. This method of payment is known as the
third-party payment. As a patient in a hospital you
yourself cover many other costs: a personal share
per hospitalisation, a few compulsory fixed costs
(drugs, clinical biology, etc.), a personal contribution to the price per day, the supplements charged
for a two-bed or individual room, additional costs
for a telephone, etc.
To cover these additional costs, the mutual insurance companies and the private insurance companies offer you hospitalisation insurance. Thanks
to Hospi Solidaire and its optional hospitalisation
insurances, the MC contributes more to the costs
linked to hospitalisation. Different packages are
available to meet your needs.
Did you know?
> In a shared or 2-bed room, a registered healthcare provider cannot charge supplementary fees.
In a single room, it may do so.
> A non-registered doctor can request supplements
in all types of room.
> As soon as you get to the hospital, you can request to be treated by a registered doctor.
> If you are a protected patient (see page 22), the
supplementary fees and/or rooms costs are prohibited in a shared and two-bed room, for all doctors
(whether registered or otherwise).
> The supplementary fees and room supplements
can add up to significant amounts on your final bill.
> If the hospitalisation requires an implant (hip, gastric band, etc.) your doctor must be in a position to
inform you of the price (sometimes very high) of
the material implanted.
> The various costs (telephone, fridge, television,
costs for accompanying adults, etc.) can also be a
non-negligible amount, especially for a long stay.
The hospital is obliged to provide you with a list of
the prices of the various most common costs.
© sxc
Preparing for your hospitalisation
By consulting www.mc.be, you can compare the
prices charged by all the country’s hospitals. A
very useful tool to prepare for your hospital stay!
You can also simulate the costs that a hospital stay
could incur.
And if you do not have Internet access, you can telephone free of charge on 0800 10 9 8 7 or pop into
one of the MC agencies. Our advisers will sit down
with you to make this comparison on your behalf.
15
MUTU_GUIDE_10_04f_BL_Layout 1 31/08/10 15:55 Page16
To contact us
> Tel. 0800 10 9 8 7 (free call)
> Monday to friday from 8:30 to 6pm and saterday from 9am to 13pm
> www.mc.be
Regional Headquarters
MC Brabant wallon
Bd des Archers 54, 1400 Nivelles
Tél. : 067 89 36 36
brabant.wallon@mc.be
MC Province de Luxembourg
Rue de la Moselle 7-9, 6700 Arlon
Tél. : 063 211 711
arlon@mc.be
MC Hainaut Oriental
Rue du Douaire 40 - 6150 Anderlues
Tél. : 071 54 85 48
anderlues@mc.be
MC Province de Namur
Rue des Tanneries 55, 5000 Namur
Tél. : 081 24 48 11
namur@mc.be
MC Hainaut Picardie
Rue Saint-Brice 44, 7500 Tournai
Tél. : 069 25 62 11
haipi@mc.be
MC Saint-Michel
Bld Anspach 111-115, 1000 Bruxelles
Tél. : 02 501 58 58
st.michel@mc.be
MC Liège
Place du XX Août 38, 4000 Liège
Tél : 04 230 16 40
contact.liege@mc.be
MC Verviers-Eupen
Rue Laoureux 25-29, 4800 Verviers
verviers@mc.be
Editeur responsable : Jean Hermesse, chaussée de Haecht 579/40, 1031 Bruxelles
ERP629 – Septembre 2010 – Image de couverture : © Sxc
Imprimé sur papier recyclé
In our main brochure, “Davantage pour votre santé”,
you will find out all our benefits and services,
request it free on 0800 10 9 8 7 (free call)
or visit www.mc.be
MUTU
A L IT E
CHRE
TIENN
E
La solidarité, c’est bon pour la santé.