Reimbursement of Implants in Belgium

The Belgian Healthcare system 

With a population of 10.8 million, Belgium has three official languages: Dutch, French and German.  Dutch is spoken by around 59% of the population, French by around 40% and German by less than 1%.

The Belgian population is universally covered by statutory health insurance (mutualité or ziekenfonds).  All individuals entitled to health insurance must join or register with a sickness fund.  For historic reasons, some healthcare funds are limited to members of various religious, political or professional groups, but most funds are open to everyone.

Each fund charges the same basic contribution as well as providing similar benefits, but some take longer than others do to make repay the fees.  Similar to France, healthcare is not free at the point of delivery.  The patient first pays the full bill, submits the receipts for reimbursement and the money is then paid directly into the claimant’s bank account.

For people who are not in a specific preferred group, state reimbursement covers 75% of the fee.  Therefore, most Belgians take out supplementary health insurance to cover the portion of their bill, which is not reimbursed.

Reimbursement for Procedures

Belgian healthcare providers will use the nomenclature of medical benefits, which is a coded list of medical services, reimbursed by the compulsory health insurance.  The list is an annex of the Royal Decree of 14-9-1984.  Updates to the list are published in the Official Gazette as amendments to that Annex and presented on the NIHDI (RIZIV/INAMI) website.

Reimbursement for Implants

Recently, a few companies selling implantables in the Belgian market faced reimbursement difficulties due to new regulations requiring the listing of their products in the Belgian publication list of notified products.  As of July 1st, implants that are not published will not be reimbursed by the compulsory health insurance. 

To adjust to these changes, we wanted to share with you the steps that should be taken by any company selling implantables in the Belgian market.

*  To get listed, each company or its distributor, should fill in a form that can be accessed via this link: https://www.riziv.fgov.be/webprd/appl/pimplants/

*  The required details include: the product’s name, the distributor’s and manufacturer’s name and the target price in Euro.

*  Once the National Institute for Health and Disability Insurance (NIHDI) verifies the application, the products are published on the website and may be reimbursed in Belgium.

Mediclever’s team of European reimbursement experts can work with your company to prepare an application that matches your company’s interests (instead of the distributor’s).