What does supplementary health insurance cover?

health insurance

Complementary health insurance

You can avoid expensive hospital bills with supplemental hospitalization insurance, reduce dental care bills with supplemental dental care insurance, and limit outpatient health care or alternative medicine costs with supplementary health insurance.

What is supplementary health insurance?

Some insurance companies, such as AG Insurance, include the costs of outpatient (health) care in the hospitalization insurance. You can also extend your hospitalization insurance with supplementary health insurance for alternative medicine. At AG Insurance, you can thus extend your hospitalization insurance to the Delta formula, to cover the costs relating to alternative medicine. But be careful, however, you can only benefit from them if they are linked to hospitalization.

Other companies, such as DKV, for example, offer separate formulas for supplementary health insurance, which you can combine with each other or take out separately. At DKV you can, for example, take out supplementary health insurance:

  • only for outpatient costs, without having taken out hospitalization insurance at home
  • for the costs of outpatient care and alternative medicine, without having taken out hospitalization insurance with them
  • or you can combine hospitalization insurance with outpatient insurance. You can make use of outpatient insurance, without hospitalization.

This does not prevent DKV from also offering cover for outpatient costs and outpatient costs in its hospitalization insurance.

Is supplementary health insurance compulsory?

Complementary health insurance is not compulsory. This is insurance that comes in addition to the compulsory health insurance, for which you and your family are affiliated with a mutual insurance company of your choice. . As mentioned earlier, compulsory health insurance contributes only partially, if at all, to health care costs. Complementary health insurance covers all or part of the costs of outpatient health care and/or alternative medicine, after intervention by the statutory health insurance and even if the mutual does not provide for any intervention.

What does supplementary health insurance cover?

Complementary health insurance offers either full or partial compensation for outpatient care costs or compensation for outpatient costs and those relating to alternative medicine. As mentioned earlier in this article, outpatient costs are sometimes included in hospitalization insurance. It is always better to check it by reading the general conditions of your insurer. But what exactly does supplementary health insurance coverage do if you choose to cover the costs of outpatient care and/or alternative medicine?

Outpatient costs – the different covers

Outpatient costs are the costs that go hand in hand with outpatient treatment, such as the cost of a visit to your doctor or specialist, but also the cost of medication, hearing aids, etc. Below you will find some examples of outpatient costs that are partially or fully covered, whether or not compulsory health insurance has been paid:

  • Medical services: coverage of medical services following a consultation or visit.
  • Paramedical services – paramedical treatments: coverage of costs inherent in services or treatments such as physiotherapy, physiotherapy, nursing care, and sometimes also speech therapy. Please note that these costs will only be fully or partially covered if they have been prescribed by a (registered) doctor.
  • Medical devices: this category includes costs related to devices such as glasses, contact lenses, crutches, orthopedic insoles, hearing aids, compression stockings, casts, etc. You do not have to notify your insurer in advance for approval. . There are also devices that must be prescribed by a (registered) doctor and approved by your insurer, such as orthopedic devices for example. If in doubt, it is best to contact your insurer beforehand or consult the general conditions.
  • Artificial Limbs and Prostheses: This category provides coverage for the cost of artificial limbs and prostheses, excluding dental prostheses. Here too, you must be able to produce a prescription from a (registered) doctor. Some insurers require advance notice.
  • Medicines, bandages, and medical equipment: the costs are totally or partially covered, provided there has been a prescription by a (certified) doctor.

Alternative medicine – the different coverages

For the following treatments and services, an intervention is only foreseen if they have been prescribed by a doctor or an approved physiotherapist.

  • Homeopathic treatment and homeopathic medicines
  • Acupuncture
  • Osteopathy
  • chiropractic

Non-registered doctor or specialist?

As we have already explained, it is important that a licensed healthcare provider prescribes the treatment or treats you. But what happens if the doctor or specialist is approved (has an INAMI code), but is not approved? Do you also benefit from coverage through your supplementary health insurance?

Yes. The treatments of approved doctors/specialists who are not under the agreement, are fully or partially covered by the complementary health insurance and this after intervention or not of the compulsory health insurance. In other words, if the compulsory health insurance does not provide for intervention for a specific treatment carried out by a doctor or a specialist, not under the agreement, you can always call on your complementary health insurance. In short, your complementary health insurance always offers cost coverage, even if the doctor is not under contract. In the context of supplementary health insurance, the only thing that matters is that the doctor or specialist is registered with INAMI and that the treatment/consultation is linked to an illness, childbirth, or an accident.

By aamritri

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