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Brussels Local Reference INFOrmation
Information on the Belgian national health care, with details on who benefits, where and how to register with the authorities and what contributions and benefits to expect.
The Belgian social security system expanded rapidly during the 1950s and 1960s. It includes healthcare, unemployment insurance benefits, child allowances, invalidity and disability benefits and pensions. Essentially it is compulsory for people to be insured and rights are acquired by working. Those who are not working for whatever reason can obtain benefits via social assistance schemes. The government aims to ensure that everyone has at least a basic standard of living in terms of income and access to medical facilities. Temporary PostingsAnyone temporarily posted to Belgium for a period of less than 12 months is unaffected by Belgian social security as long as they are an EEA national or from a country which has an international social security treaty with Belgium. However the employer must make a declaration when they employ such a person to work in Belgium, using a Limosa declaration form. Some workers are exempt from this depending on the type of work they do and the length of time they spend in Belgium
Citizens should check with their own social security office before departure. Belgian Social SecurityAs soon as an individual begins work in Belgium (wherever he is from originally) the employer must take the necessary steps to ensure that the employee is covered by the national social security system. Social security contributions are deducted automatically from salary and are paid to the National Social Security Office (Office National de Sécurité Sociale,ONSS/Rijksdienst voor Sociale Zekerheid, RSZ).
The amount to be paid by an individual is calculated based on gross salary but is around 13 percent, employers' contributions account for over 34 percent. The balance is made up by state subsidies and more recently other sources such as a percentage of the income from VAT. Approximately 96 percent of the social security fund finances benefits for salaried workers, the rest is used to pay for benefits for the self-employed. The overall social security fund is then divided up and managed by offices responsible for different types of benefit that fall into seven categories each dealt with below:
In 2001 the Belgian government set up the Silver Fund. The aim of this fund was to ensure that funding was available to pay for the increasing costs of healthcare and pensions for an ageing population. Budget surpluses and any surpluses from the social security system go into this fund. Entitlement and RegistrationBelgium has reciprocal social security arrangements with many countries. Under these arrangements EU citizens and many from outside the EU, including the United States, can claim and be awarded many of the same benefits as Belgian citizens. However, conditions apply and in almost every case newcomers must be correctly registered with their local town hall (maison communale/stadhuis).They must also have the correct documentation:
For those newcomers with work contracts, many of the formalities of registering within the Belgian system will be taken care of by the employer. Anyone else, for example the unemployed or retired people, should go to their local Public Social Welfare Centre (CPAS/OMCW). There is one in every municipality and they are listed in the telephone directory. Carte SISOnce the person is affiliated to a social security organisation, they will receive a Carte SIS (Social Identity card). This electronic card contains the person's name, social security identification number, birth date and validity period of the card. The identity details and status of an individual are held in a central databank which can be accessed by any arm of the social security system. This card is then used for all procedures with social security institutions. Employers use the card in communication with the authorities. It is also required when picking up medication from a pharmacy or when seeing a doctor, for example. Self-employmentEEA nationals have the right to set up as a self-employed person anywhere in the EU. Self-employed people may be exempt from paying social security contributions in Belgium for up to 12 months if they continue to pay national insurance contributions in their own country. Self-employed people have their own social security system. They must affiliate themselves with a social security fund in Belgium into which they must then pay a percentage of their net income. Contributions are usually payable quarterly. In the first instance they should approach the National Institute of Social Security for the Self-Employed (RSVZ/INASTI/NISSE)
The NISSE takes care of the social status of the self-employed and ensures that the person is properly insured for medical care, incapacity for work or invalidity, maternity insurance, family benefits, pensions and bankruptcy. People who are subject to the usual Belgian regime can pay reduced contributions in the first three years of being self-employed to limit their costs when starting up. However, final contributions are based on actual income and are reviewed at the end of the three years. This means that at the end of that period they may receive a bill for the difference between the amount they paid and the amount they owe. Self-employed contributions are a higher percentage of income than the employees contribution – the exact amount depends on age, length of time as self-employed and income. The contribution amount can be calculated on the Belgian Social Security portal:
BenefitsThere are three social security systems which cater for salaried workers, civil servants and self-employed persons. Essentially they provide benefits to replace income in the event of unemployment, retirement or inability to work. They also provide financial support for childcare costs, healthcare and annual paid holidays. Payment frequency and method depends on the type of benefit awarded. Most benefits such as pensions or child benefit are paid direct by bank transfer at an agreed frequency – usually monthly. There is the option to receive some benefits by cheque posted to the beneficiary's address.
The Federal Public Service Social Security website has a brochure "Everything you wanted to know about the Belgian social security system" which contains comprehensive information and addresses.
HealthcareAnyone working in Belgium pays mandatory social security contributions and in addition will usually be required to join a health insurance scheme (mutuelle/mutualiteits) run by one of the private or mutual insurers (this may be linked to a union). People may choose which insurance scheme they join although often their employer will automatically enrol them in one. The insurance provided covers the insured and also any dependants such as a non-working spouse and any children. The cost of care is then partially or fully refunded depending on certain criteria fixed by law. There is a six-month waiting period before members can receive reimbursements of medical costs, although people who are entitled to benefits in another EU country will be covered in this six-month period. Self-employed people are only insured for major risks, for example hospital surgery and radiography, but can take out additional cover for minor risks. This extra cover then entitles them to partial reimbursement for consultations, certain dental care, physiotherapy, prostheses and medication when not in hospital. When medical costs are incurred, the individual is asked to pay a portion of the costs. This is known as the personal share. This amount can be subject to a fixed maximum (a concept referred to as maximum billing) calculated with reference to income. For minor medical treatment the individual usually makes payment in full direct to the healthcare provider. They are given a certificate which they then submit to the health insurance scheme to allow reimbursement. Individuals are reimbursed at a rate which depends on the type of care, the provider used and their own personal status, for example disabled, widowed, pensioner, employed. For hospital stays and for medication from a pharmacy, the individual pays only their personal share. The hospital or pharmacy reads the SIS card to determine the type of cover given then collects the balance directly from the health insurance fund. Some people choose to take out additional healthcare insurance to cover them for any amounts not refunded by their health insurance scheme. Incapacity benefitsIn the event of an individual being declared unfit for work as a result of an illness, there is a benefit to replace income. In most cases the employer pays a guaranteed income for 14 days for workers and 30 days for employees. At the end of this period, the benefit changes and is called a work incapacity benefit. Benefit is administered by the National Institute for Sickness and Invalidity Insurance (INAMI/RIZIV). The amount which an individual receives depends on their salary and how long they are unable to work. Initially the benefit represents 60 percent of previous salary (subject to a maximum reference salary). However, it is adjusted downwards in some cases after the first 30 days. In all cases the amount paid from the first day of the seventh month of incapacity is reviewed and a minimum payment is made that takes into consideration an individual's family situation. The self-employed are given a fixed sum in the event of illness or incapacity. Claimants should contact INASTI. Occupational illnessesThe Belgian system has a list of disorders which are recognised as occupational illnesses and which normally entitle the sufferer to compensation. Workers and civil servants are covered by this benefit, but the self-employed are not. The funds are administered by the Fund for Professional Diseases (FBZ/FMP) who decide whether or not a claim is allowed. Accidents in the workplaceEmployers must have adequate insurance against accidents at work. Incidents on the way to or from work are classified as accidents at work and workers are therefore covered for these too. Employers handle any claims for benefits. Civil servants are covered by a separate scheme. The self-employed are not insured against accidents at work. For more information consult the Fund for Accidents at Work (FAO/FAT) (in French, Dutch and German). Benefits for familiesThere are several benefits in this category. Administration is handled by the National Office for Family Benefits for Salaried Persons (Office National d'Allocations Familiales pour Travailleurs Salariés/Rijksdienst voor Kinderbijslag voor Werknemers/Zentralanstalt Für Familienbeihilfen Für Arbeitnehmer, ONAFTS). They have offices in all the major cities including Brussels.
A birth grant is paid for each child (at the earliest two months before the birth) and there is also an adoption allowance paid where children are adopted. There is also conventional child benefit and additional benefits for children who are orphaned. Salaried workers, self-employed persons and civil servants can all benefit from these payments. Other benefits exist to assist those with disabled children but these are handled by the Public Social Welfare Centre – CPAS. Anyone who does not fall into one of the categories above can apply for a guaranteed family benefit via the social assistance scheme. Maternity and paternity benefitsWomen receive maternity benefit while on maternity leave. The benefit is equivalent to 82 percent of salary for the first 30 days and then drops to 75 percent, subject to a maximum salary. Women may take up to 15 weeks maternity leave. At least eight weeks must be taken after the birth and at least one week must be taken before the date when the baby is due. Following the birth of a child, the father has a right to ten days paternity leave, seven of which will be paid for by the social security system at 82 percent of salary (subject to a maximum). There are similar benefits in the event of an adoption.
Annual Paid HolidaysThe Belgian system makes a distinction between workers and employees. Employees have their paid holidays provided for them by the employer. Workers are entitled to paid holidays too, but the number of days depends on the number of days worked in Belgium during the previous calendar year. This means that there is no payment in the first year of working in Belgium and that for the second year of working it is proportional to the number of days worked in the first year. Paid leave is usually a minimum of 20 days after one year's service. Payment for workers comes from the National Holiday Allowance Office (Office National des Vacances Annuelles, ONVA/Rijksdienst voor Jaarlijkse Vakantie, RJV/Landesambt Für Jahresurlaub).
Unemployment benefitAnyone who loses their job has a right to unemployment benefit as long as they fulfil certain criteria. They must have worked for a certain number of days within a given period and be able and available to work. New arrivals who have not yet worked in Belgium will normally be refused unemployment benefit.
Time CreditsBelgium has a scheme for those who want to work less or stop work completely for a period. It is designed to help those who wish to spend time with their children or who need to care for a sick person. Under the scheme workers receive an interruption allowance during the period of reduced hours or no work. Not all employers offer this scheme and there are limits on the number of staff taking advantage of this scheme at any one time. Separate rules also apply to those over 50. New arrivals in Belgium will have to build up entitlement before they can take advantage of this scheme. Pre-retirement pension and pensionsAnother scheme, which is now being scaled down, is the pre-retirement pension. Under this arrangement companies found it easier to lay off older workers as they received additional compensation (the pre-retirement pension) as well as standard unemployment benefit. The retirement age in Belgium is 65 for men and was 60 for women. However, this has gradually been increasing and by 2009 the retirement age for women will be 65 as well. There is a statutory pension paid on retirement (at the official age or older). Entitlement to the statutory pension is acquired by working. Anyone spending time in Belgium and working builds up their entitlement under the Belgian system. Widows and widowers are also entitled to an amount following the death of a spouse who was entitled to a pension. Payment of a pension can be quite complex as there are different schemes depending on employment status at the time of retirement e.g. employee, civil servant or self-employed. For more information contact the National Pensions Office (Office National des Pensions )
Most people also take out supplementary plans. Some of these individual and group schemes have tax advantages for workers and are government supervised. The self-employed can also take out supplementary pensions with either social insurance funds or with private companies. Social Assistance BenefitsThese benefits are available to those who are not included in the social security system outlined above. They are financed by taxation revenue. Social assistance is dealt with by the Public Social Welfare Centre (CPAS/OMCW) present in each municipality. It is there to provide everyone with a minimum income which will enable their integration in society. It also deals with guaranteed incomes for families, the elderly and the disabled.
Transferring BenefitsIn certain circumstances benefits can be transferred to Belgium from another country. Contact the local social security office in your home country before departure to see if any existing benefits can be transferred to Belgium. Pension benefits are transferable for EEA citizens. Where an EEA citizen has worked in two or more EEA countries they can combine state pension contributions paid in each country in order to qualify for a level of benefit. Choosing a DoctorPatients are usually free to choose any doctor and can even see several doctors at the same time. Medical records are not centralised so it is the responsibility of the patient to tell a doctor if another doctor has records on him. A system exists allowing patients to choose a main General Practitioner and, in return for a registration fee, a larger amount of the consultation fees is reimbursed by the health insurance fund (mutuelle/mutualiteits) than for those not registered with someone. This is to encourage a patient's medical records to be held with just one doctor. Further Information
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