Published on and written by Cyril Jarnias
Belgium is regularly ranked among the countries with the best healthcare systems in the world. In several recent rankings, it has placed in the top 10 for quality, accessibility, and efficiency of care, with over 10% of its GDP devoted to health since 2009. For an expat, this is reassuring… provided you understand how the system works and what it entails in practice, from the visa to the first consultation with a general practitioner.
Expatriates must register with the social security system and a health insurance fund to benefit from reimbursements. Private insurance can supplement this coverage. Access to doctors, hospitals, dentists, and emergency care is detailed, with specific information for mental health and according to profiles (students, families, non-EU nationals).
A universal, compulsory, but not “free” system
The Belgian system is based on a compulsory health insurance combined with a wide range of public and private providers. The state sets the main rules, regulates the base rates, and delegates the management of reimbursements to health insurance bodies, while allowing some freedom to providers (doctors, hospitals, dentists) and private insurers.
All residents in Belgium must be insured, primarily through the public system (health insurance fund/mutualiteit/ziekenfonds), often supplemented by private insurance. The system is not free: it involves paying contributions and co-payments, followed by a partial reimbursement.
In return, the system offers very broad access: freedom to choose a doctor, no strict requirement to see a general practitioner before a specialist, very high hospital density, numerous pharmacies, basic coverage for dental and psychiatric care, and capping mechanisms for household medical expenses for low-income households.
Social Security, NOSS and NIHDI: who does what?
The Belgian social security system is administered by the National Office for Social Security (NOSS/RSZ/ONSS). It centralizes the social contributions deducted from workers’ salaries, the income of self-employed individuals, and certain allowances. The health and disability insurance is managed by the National Institute for Health and Disability Insurance (NIHDI/RIZIV/INAMI), which sets reimbursement rules, accredits providers, and finances the health insurance funds.
For expatriates, the online tool “Coming2Belgium” allows you to check your social rights based on your nationality, status (employee, self-employed, retiree, student, etc.) and the bilateral agreements between Belgium and your country of origin. The official social security portal, www.socialsecurity.be, also centralizes the necessary technical information.
Funding comes from several sources: social contributions on labor income, taxes, VAT, compulsory contributions to health insurance funds, and direct patient participation (co-payments).
The compulsory health insurance requirement for expatriates
Belgian law requires anyone settling in the country to obtain insurance for healthcare. New residents are normally given 90 days after arrival to get their affairs in order. Ignoring this obligation is not trivial: fines of up to €2,500 and retroactive payment of contributions may be demanded, not to mention the lack of reimbursement in case of a health problem.
For citizens of the EU/EEA/Switzerland and British citizens with a GHIC, the European Health Insurance Card (EHIC) allows temporary access to necessary care at the resident rate. It does not replace enrollment in the Belgian system once you become a resident. Nationals of third countries must generally justify insurance of at least €30,000 to obtain a Schengen visa, then integrate into the Belgian system once settled.
Step 1: Registering at the commune and obtaining a national number
The first step after arrival in Belgium is to register with the commune (municipality) of your place of residence. This registration must in principle be done within eight days. You submit your passport or identity card, your residence permit or visa, as well as proof of address (lease, accommodation certificate, utility bill…).
After a residency check by a neighborhood officer, the commune assigns a national register number (RRN/NRN). This number is essential for registering with social security and joining a health insurance fund.
For employees, the employer normally handles the formalities: registration with the NOSS, wage declarations, payment of social contributions. On the payslip, a deduction of approximately 13.07% of gross salary covers all branches of social security (health, unemployment, pension, etc.). The employer adds an employer contribution of about 25–27%. Of this total, a significant portion (several percent of gross) effectively funds health insurance.
Percentage of net income that self-employed individuals must pay in quarterly social contributions.
Unemployed people receiving benefits and certain allowance recipients are also covered, their contributions being handled through other mechanisms. Belgian or resident students who work part-time contribute at reduced rates.
Step 3: Choosing a health insurance fund (mutualiteit/ziekenfonds)
This is the central step for actually accessing care: affiliating with a health insurance fund, i.e., a health insurance body approved by the NIHDI. These funds, called mutualités in French and ziekenfondsen in Dutch, are private legal entities but non-profit, heavily regulated by the state.
They all offer the same mandatory coverage base (consultations, hospitalization, essential medicines, basic dental care, maternity, etc.), as this part is defined at the federal level. However, they distinguish themselves through their supplementary insurance, their services, and sometimes their “philosophical” leaning (Christian, socialist, liberal, neutral…).
Among the major groups are:
| Type of fund | Examples | Noted particularities |
|---|---|---|
| Christian | CM | Largest network, extensive supplementary coverage |
| Socialist | Solidaris, FSMB | Strongly established in Wallonia and Brussels |
| Liberal | Mutualité Libérale | More “neutral” political orientation |
| Independent | Partenamut, Mutualité Neutre | Apolitical positioning |
| Public | CAAMI/HZIV | Offers only the mandatory base, no extras |
Registration generally requires the national register number, a copy of the residence permit, proof of employment or contributions, and bank details. Affiliation is free for the mandatory part, but an annual membership fee (for example €64 in 2025, sometimes at a reduced rate) is required, to which the premiums for supplementary insurance are added if desired (often €8 to €12 per month for certain packages).
Many health insurance funds in Belgium apply a waiting period of up to six months before reimbursing certain care, the time needed to verify the payment of social contributions. To cover this initial settling-in period, it is highly recommended to take out international private insurance.
ISI+ card, eID, and Global Medical Dossier
Once affiliated, the insured person receives a card linked to their file: the ISI+ (for those who do not yet have or no longer have a Belgian electronic identity card) or the eID (electronic identity card). This card serves as proof of insurance and enables the link with the Global Medical Dossier (DMG), i.e., the history of care, prescriptions, vaccinations, etc.
Presenting your health insurance fund card to a healthcare professional (doctor, hospital, pharmacy) activates the third-party payer system or the electronic transmission of care certificates, avoiding paying upfront. Furthermore, starting in 2025, mandatory electronic invoicing by doctors and dentists for outpatient care will make reimbursement procedures even simpler and faster.
How care is reimbursed: co-payments, MAB, and agreed-upon rates
The Belgian system mainly operates on a reimbursement basis: the patient pays (or a portion), and the health insurance fund reimburses the portion provided for by regulations. The term co-payment refers to the part remaining the patient’s responsibility.
For a consultation with an accredited general practitioner, the official rate is around €27–30. The health insurance fund reimburses about 75% of the reference rate. The patient’s share is generally less than €6 for a standard insured person, or even less for people with preferential status (low income, certain allowances).
Base rate for a specialist consultation, with a patient share of about €12 for an accredited procedure.
To prevent expenses from skyrocketing for low-income households or in case of chronic illness, a “Maximum Billing” (MAB) system exists. Beyond an annual ceiling of co-payments that depends on household income, additional medical costs covered by insurance are almost fully reimbursed. This mechanism is particularly important for expatriates with children or chronic illness.
In 2021, about 87% of general practitioners in Belgium were accredited with the NIHDI, thereby committing to apply official rates.
Public vs private: why almost everyone has supplementary insurance
Public insurance covers the essentials of necessary care: consultations, hospitalization in a shared room, vital medicines, physiotherapy within certain frameworks, basic dental care, pregnancy monitoring, childbirth, etc. However, coverage is only partial, and some procedures are reimbursed very little, if at all (private hospital room, cosmetic surgery, certain dental or ocular prostheses, alternative medicine, etc.).
Percentage of the Belgian population with private hospitalization insurance in addition to basic coverage.
These private insurance policies can be taken out:
– either directly with an insurance company (Cigna Global, AXA, Allianz Care, APRIL International, DKV Belgium, AG Insurance, Business & Expats Health Insurance…);
– or through one’s health insurance fund, which offers hospitalization and dental products;
– or through one’s employer, as more and more companies offer group hospitalization insurance to employees.
The maximum monthly cost of supplementary health insurance in Belgium for full coverage.
For an expatriate, international insurance plays a key role at the beginning of the stay, during the time it takes to register and “build up rights” in the Belgian system, but also to cover care in other countries (returns to home country, business trips, etc.) and to plan for repatriation in case of a serious problem.
Who is covered and under what conditions?
Belgium covers almost the entire resident population through compulsory health insurance, but the terms vary by category.
Contributing employees are covered, as are their dependents, provided the latter have little or no income of their own and generally reside at the same address (with exceptions, e.g., for student children under 25). Self-employed individuals also insure their dependents.
Students can choose between remaining covered by the insurance of their home country (via the EHIC) or affiliating with the Belgian system. Children are covered free of charge as dependents of their parents until age 18, and until 25 if they pursue full-time higher education.
Unemployed people receiving benefits, pensioners residing in Belgium, recipients of certain social allowances are also covered, their rights being linked to past payment of contributions or European coordination agreements. Asylum seekers have access to urgent medical aid, but affiliation with a health insurance fund generally occurs after refugee status is recognized.
For citizens of the EEA and Switzerland, European Regulations coordinate social security systems. You generally only contribute in one country at a time. Periods of contribution in other Member States can be taken into account for opening rights in Belgium. Forms such as the S1 allow for the transfer of health rights from one country to another, which is useful, for example, for European retirees settling in Belgium.
Belgium has also concluded bilateral social security conventions with about 25 non-European countries, including the United States, Canada, Japan, South Korea, and the United Kingdom (via post-Brexit agreements). These agreements organize the coordination of contributions and rights, but their details vary: for some countries not covered by such an agreement, access to Belgian social security remains partial (no unemployment and, sometimes, no pension).
Concrete cost of a consultation or medication
For a newly arrived expatriate, it is useful to quickly get an idea of the real cost of common care, before and after reimbursement. The table below summarizes some indicative figures for an insured person affiliated with the public system, using accredited providers:
| Type of care | Indicative total cost | Public reimbursement share | Typical co-payment |
|---|---|---|---|
| Consultation with a GP | ~ €27–30 | ~ 75% | ~ €5–6 |
| Specialist consultation | ~ €50 | ~ 60–70% | ~ €12 |
| Emergency room visit (excluding procedures) | €100–150 | variable share | €25–40 |
| Hospitalization in shared room (per day) | ~ €20 patient fee | remaining billed to fund | €20 + possible supplements |
| Ambulance (simple trip) | €60–600 depending on distance and care | ~ 75% for insured | possible remaining €50–100 |
For medications, Belgium works by categories:
| Medication category | Type of product | Public reimbursement rate |
|---|---|---|
| A | Vital medicines (e.g., anti-cancer drugs) | 100% |
| B | Therapeutically essential | 75–85% |
| C | Symptomatic treatment | 50% |
| Cx | Contraceptives | 20% |
| D | Non-reimbursable (OTC, comfort, etc.) | 0% |
At the pharmacy, by presenting your insurance card, the reimbursed share is directly deducted. The patient only pays their personal contribution. Over-the-counter medicines (simple analgesics, vitamins, certain syrups…) are not reimbursed.
Hospitals, doctors, and language: finding a provider suited to expatriates
The Belgian hospital network is dense, with over a hundred hospitals, including many university hospitals and university clinics (UZ Leuven, UZ Brussel, UZ Gent, Cliniques Universitaires Saint‑Luc, CHU de Liège, etc.). Most operate under a non-profit status. Expatriates in Brussels, Antwerp, or Ghent can turn to hospitals or medical centers accustomed to an international clientele, often equipped with language services.
General practitioners are the gateway to the healthcare system. It is advisable to designate a primary care physician for better care coordination and optimized reimbursements via the Global Medical Dossier. Their usual hours are Monday to Friday, 8 a.m. to 5:30 p.m. Outside these hours, an on-call service is accessible by dialing 1733 or 1773 (depending on the region) or 1710 in Brussels to reach an on-call doctor.
For specialist consultations, no referral letter from the GP is legally required, but having one can improve the reimbursement level and the coherence of medical follow-up. Many specialists practice both in hospital and in private practice.
In major cities like Brussels, medical centers such as Schuman Medical Practice or Berlaymont GP Group specifically target the international community. They have multidisciplinary teams fluent in English, French, Dutch, as well as other languages like German, Italian, Swedish, Polish, and Arabic. To facilitate the search, online platforms like Doctoranytime, Doctena, Ordomedic, and Air Doctor allow filtering practitioners by spoken language.
Emergency care, phone numbers, and ambulances
In case of a life-threatening emergency, the number to dial in Belgium and the EU is 112. This call is free and accessible to all, including tourists without insurance. It provides access to ambulance, fire, and police services. 101 is reserved for police emergencies, while 1733 allows, in many regions, to reach a medical on-call service for non-life-threatening situations.
The country has a graduated emergency response system comprising basic ambulances, paramedic teams (PIT), and mobile units with an emergency physician (MUG/SMUR). After stabilization, the patient is transported to the most suitable hospital based on distance and required care. Any hospital with an emergency department is required to accept patients transported by these services.
The ambulance ride is not free: for a Belgian insured person, part of the cost is reimbursed, but a co-payment, on the order of €50 to €100, usually remains payable. Without affiliation, the full bill is due, with the possibility of subsequently requesting reimbursement through your travel or private insurance.
An official mobile application, “112 BE“, available on iOS and Android, facilitates emergency calls with automatic geolocation and options for deaf or hard-of-hearing persons.
Care for children and vaccination
The children of expatriates residing in Belgium are in principle entitled to the same rights as Belgian children, provided their parents are affiliated with a health insurance fund. They are listed as dependents, without an additional contribution, until age 18 (and often until 25 if they pursue full-time studies).
Child preventive care is largely organized by regional bodies:
In Belgium, child and youth support is organized by the Communities. Here are the main bodies according to your region of residence.
For children aged 0 to 3, the reference organization is Kind en Gezin.
For children aged 0 to 6, the reference organization is ONE (Office de la Naissance et de l’Enfance).
For children and youth aged 0 to 20, the reference organization is Kaleido Ostbelgien.
These public services offer free health check-ups, weigh-ins, vaccinations, parenting advice, and maintain the child’s health record (Child’s Record Book). Basic vaccines (diphtheria, tetanus, pertussis, polio, measles, etc.) are provided free of charge. Polio vaccination is compulsory.
In case of illness, parents can consult a private pediatrician or a general practitioner. Some hospitals, like the Queen Fabiola Children’s University Hospital in Brussels, have specialized departments for children.
Dental care: what is covered, what is not
Belgium integrates dental care into its insurance system, but in a limited way. An annual check-up, scaling, simple cavities, or extractions are generally partially reimbursed. As part of a specific oral healthcare program, an annual check-up is strongly recommended, even essential, to maintain a good level of reimbursement for the following year: ignoring this check-up can lead to a significant reduction in coverage.
For adults, major dental procedures (crowns, bridges, implants, adult orthodontics) are often very costly with low or no public coverage. For children under 18, some care, including part of orthodontics, is much better reimbursed, provided the treatment starts before an age limit (e.g., before age 15 for conventional treatment, with the possibility of extension up to 22).
Costs vary from one dentist to another, and the accreditation with the NIHDI plays a full role: a fully accredited practitioner applies the official rate; a non-accredited one can charge significant supplements. Some benchmarks:
| Dental procedure (adults) | Indicative total cost | Common public reimbursement | Possible remaining charge |
|---|---|---|---|
| Consultation + annual exam | ~ €70–80 | ~ €70–75 | a few euros |
| Scaling/simple filling | ~ €30–40 | 60–75% | €10–15 or more |
| Root canal | ~ €90 | ~ €80 | €10–15 |
| Crown, bridge, implant | €400–1,300 and more | low or none | almost the entirety |
Facing these amounts, many expatriates opt for supplementary dental insurance (often as an option with an insurer like DKV, Helan, Solidaris, etc.). But these products almost always have waiting periods (six months for curative care, twelve months for orthodontics and implants) and annual reimbursement ceilings.
Mental health: an often overlooked but well-structured component
The Belgian system includes a fairly broad range of mental health services: psychologists, psychotherapists, psychiatrists, mental health centers, specialized hospital departments. An advantage for expatriates: direct access to a psychologist or psychiatrist is possible, it is not mandatory to go through a general practitioner to get an appointment, although it is often advised to coordinate treatments, especially if medication is considered.
Total number of psychology sessions that can be reimbursed per year for an adult, under conditions, with a modest personal contribution.
For young people under 23, access is even more favorable: several programs provide for a certain number of sessions (up to 10 or 20 per year) largely, or even fully, covered, particularly for the prevention of distress, management of depression, anxiety, or behavioral disorders.
Expatriates can find support from community organizations like the Community Help Service (CHS) in Brussels, offering a mental health center and a 24/7 helpline in English, as well as private practices specializing in cultural transitions. Sessions with a private psychologist typically cost between €70 and €80 for 45 to 60 minutes. These fees are rarely fully reimbursed by public health insurance, unless the therapist is accredited. Private insurance can cover part of the costs.
Special cases: workers, self-employed, students, retirees, tourists
The situation of an expatriate is not the same depending on whether they are working, studying, looking for a job, or just spending a few months in Belgium.
Status-based guide to understand your health insurance obligations and options in Belgium.
Automatic affiliation with Belgian social security and obligation to join a health insurance fund. Dependents are covered through the same organization.
Depending on agreements, possibility to remain covered by the home country system (with form A1, S1) or to switch to the Belgian system in case of local contributions.
Obligation to register with a social insurance fund, pay quarterly contributions, and join a health insurance fund. Studying supplementary insurance is recommended.
EU/EEA/UK students: the EHIC/GHIC is useful, but registration with a Belgian health insurance fund is advised for a long stay. Non-EU students: health insurance required for the visa, then possible registration with the Belgian system.
European pensioners: eligible via the S1 form. Third-country nationals: check bilateral agreements or take out robust international insurance.
EHIC (EU) or GHIC (UK) for necessary care. Complementary travel insurance is recommended. For Schengen visas, insurance of at least €30,000 is mandatory.
Pharmacies, prescriptions, and medication for expatriates
Belgian pharmacies, easily recognizable by their illuminated green cross, play a central role in the system. The pharmacist is legally responsible for the safety of dispenses: they must ensure the absence of dangerous interactions and can, unless otherwise indicated, replace a brand-name medicine with its less expensive generic equivalent.
For prescription medicines, a prescription from a doctor authorized in Belgium is generally required. A prescription from another EU country may be accepted, provided the medicine exists on the Belgian market (possibly under a different brand name). Expatriates on chronic treatment are advised to arrive with an initial sufficient supply and to know the International Nonproprietary Name (generic name) of their medicines.
At the pharmacy, the third-party payer system is widely used: by presenting their eID or ISI+ card and their prescription, the patient only pays the non-reimbursed portion. Category D medicines (comfort, OTC) remain fully payable. For night or weekend on-call service, supplements may be charged. These are only reimbursed if you have private insurance that provides for it.
Online purchases of medicines without a prescription are only authorized via a pharmacy accredited by the FAMHP, identifiable by a specific EU logo. Prescription medicines, on the other hand, cannot be delivered; they must be reserved online and picked up at a pharmacy.
International private insurance: why it remains strategic for expatriates
Even though the Belgian system is very protective, an expatriate has good reasons to consider international or supplementary private insurance:
Supplementary insurance allows you to fill the gaps in the Belgian public system and access extended services for optimal protection.
Covers costs during the waiting period before full activation of public rights (often up to six months).
Reimburses co-payments and high supplements from non-accredited providers or private hospital rooms.
Funds care like dental implants, glasses, alternative medicine, intensive psychotherapy, or long-term rehabilitation.
Provides coverage outside Belgium (travel, returns home), with repatriation assistance and medical evacuation.
Offers services like 24/7 video consultations, a second medical opinion, mental health support, and multilingual customer service.
Premiums vary depending on age, geographical scope (Europe, worldwide excluding USA, worldwide including USA), chosen deductibles, and possible exclusions. Providers like Cigna Global, Allianz Care, AXA, APRIL International, Business & Expats Health Insurance, or DKV offer plans specifically designed for expatriates.
Practical advice for starting your healthcare journey as an expatriate
Beyond purely legal and financial aspects, a few reflexes facilitate getting to grips with the Belgian system:
For a smooth installation in Belgium, anticipate your health coverage before departure by subscribing to international insurance that is visa-compatible. Scan and translate your main medical documents. Upon arrival, register quickly with the commune, then with social security and a health insurance fund to limit the period without reimbursement. Identify a general practitioner and, if necessary, a pediatrician near you. Locate the nearest pharmacy and hospital with an emergency department. Save the emergency numbers (112, 1733/1773) and those of your insurer in your phone. Check billing and reimbursement procedures with your insurer, and prioritize INAMI-accredited providers to control costs. For mental health, turn to multilingual structures affiliated with the Commission of Psychologists.
In summary
Healthcare for expatriates in Belgium is based on a subtle balance: a compulsory, comprehensive, and widely accessible public system, but one that does not cover everything and leaves an important place for private insurance. The quality of care, the freedom to choose providers, the extent of the hospital and pharmaceutical network make it a particularly comfortable destination from a medical point of view.
To fully benefit from the Belgian healthcare system, an expatriate must: register quickly with the authorities, understand the essential role of health insurance funds, anticipate the waiting periods of insurance policies, distinguish between accredited and non-accredited care providers, and realistically assess the need for supplementary insurance. Once these mechanisms are understood, the system proves to be clear, efficient, and offers a high level of health security.
Disclaimer: The information provided on this website is for informational purposes only and does not constitute financial, legal, or professional advice. We encourage you to consult qualified experts before making any investment, real estate, or expatriation decisions. Although we strive to maintain up-to-date and accurate information, we do not guarantee the completeness, accuracy, or timeliness of the proposed content. As investment and expatriation involve risks, we disclaim any liability for potential losses or damages arising from the use of this site. Your use of this site confirms your acceptance of these terms and your understanding of the associated risks.
Cyril Jarnias is an independent expert in international wealth management with over 20 years of experience. As an expatriate himself, he is dedicated to helping individuals and business leaders build, protect, and pass on their wealth with complete peace of mind.
On his website, cyriljarnias.com, he shares his expertise on international real estate, offshore company formation, and expatriation.
Thanks to his expertise, he offers sound advice to optimize his clients' wealth management. Cyril Jarnias is also recognized for his appearances in many prestigious media outlets such as BFM Business, les Français de l’étranger, Le Figaro, Les Echos, and Mieux vivre votre argent, where he shares his knowledge and know-how in wealth management.
