Are outpatient operations also covered?
Outpatient operations ('one-day hospitalization') are today more the rule than the exception for keyhole surgery and minor surgical interventions such as arthroscopy, extraction of wisdom teeth, and treatment of varicose veins. You stay one day in the hospital and are allowed home the same day. Where the hospital invoices your hospital stay as one-day hospitalization, your hospitalization insurance refunds your costs.
Usually, the hospital views the stay as a one-day hospitalization if you:
- are fully anaesthetized, or
- stay in a hospital room.
To be quite sure, you can best check in advance with your treating physician or the hospital. You should not confuse one-day hospitalization with urgent care received in a hospital, such as placing a plaster cast on a broken foot or an emergency admission. These are settled through an 'outpatient bill' and your hospitalization insurance reimburses only if the care relates to a recent hospitalization.
What happens in the case of an accident?
If you land in hospital after an accident, the same conditions apply as for a planned hospitalization. Obviously you cannot inform us of this admission in advance.
You can read here full information about hospitalization following an accident.
What about childbirth?
You may rest assured: once you are affiliated to a corporate hospitalisation insurance through your employer, the costs of childbirth are in most cases reimbursed.
Please visit our page about pregnancy and childbirth.
Finally, some important points ...
If you are unexpectedly admitted to a foreign hospital on vacation, you can expect the same cover and services from your hospitalization insurance as in Belgium.
Your employer may also have taken out extended forms of cover for you. Check your convention or ask your personnel department for more details. Below we give you a brief overview of these optional forms of cover at AG Employee Benefits:
- With the Ambucare Flexible insurance, outpatient care can be reimbursed throughout the year, even separate from hospitalization. This reimbursement can be requested simply in writing.
- Where your employer has included the Medi-Assistance third-party payer agreement in your insurance, you are often entitled to additional services such as home help, childcare, transportation, maternity care, ... Request them by phone within 30 days of your hospitalization on 02 552 53 64.
- With the optional Delta cover, the pre- and post-treatment period covered is extended to two months before and six months after your hospital stay. The Delta cover also includes reimbursement of, among other things, fertility treatments (after fertility problems) and alternative medicine such as homoeopathy.
- It is not inconceivable that you will be unable to work for some time after a hospitalization. Where your employer has taken out Occupational disability insurance, you will receive an additional income during the period you are unable to work on top of the statutory benefit. This can be requested using this form.
Note: You must make the application within 30 days of the onset of the disability.
- In the case of a prolonged absence from work after your hospitalization, for example because further treatment or a long recovery period is necessary, your employer is not obliged to pay the premiums for your group insurance. If your employer has opted for Waiver of Premiums cover, AG Employee Benefits takes over the funding of your group insurance until you get back to work. In this way the accrual of your supplementary pension is not endangered