Looking for a bit of peace of mind

Did you know that each year, in 1 in 3 households, a family member is admitted to hospital? Hospitalization is something everyone experiences sooner or later. In most cases a hospital stay is not such a pleasant experience. Being well prepared for whatever is coming already provides some peace of mind.

We describe below what is involved in an admission to hospital and how the reimbursement of medical expenses works. The conditions described below apply to hospitalization insurance taken out by your employer with AG Employee Benefits.
Before admission
admitted to hospital
The choice of hospital and room type is more important than you think.

​In many cases you will know a few weeks or days in advance that you will have to spend time in hospital, e.g. for surgery. In this case you choose in advance the hospital and the type of room.

  • Selecting a hospital

    The choice of a hospital is free, but often depends on a number of factors. Regardless of the location, each hospital has its specializations. It pays to choose a hospital that specializes in the treatment you require, even if this means travelling a little further. It can also be that your attending physician or specialist is attached to a particular hospital. In that case, your physician will arrange your admission to the hospital to which he or she is affiliated.


 

  • Selecting a room type

    The choice of a room type seems simple, but there are a few important points to bear in mind. You are well advised to check in advance whether your hospitalization insurance covers the room and fee supplements for a single room. If it does not, you may do better to opt for a double or multi-person room, as supplements in a single room can add up fast and high. Hospitals cannot charge such supplements for a double room.
    Also note the possible deductible (own portion), i.e. the amount that is not reimbursed by the hospitalization insurance. Such an excess is often linked to your room choice, e.g. you pay the first € 75 a year for a stay in a single room.

 

Once you have chosen your hospital and room type, it's time to report your admission to your insurer. At AG Employee Benefits there are several ways of doing this: online, by telephone or in writing. You will find detailed explanations here.

If you have to go into hospital, it can be that you have already received treatments prior to the admission. These so-called 'outpatient' or 'ambulatory costs' are usually reimbursed by your hospitalization insurance.

Please read the 'Medical care after admission' section below for more details.

While in hospital

​Once in the hospital, you must sign the declaration of admission. This document contains, among other things, the room choice and other information on the subsequent billing of your hospital stay. After signing the admission form, the hospital will sometimes ask for an advance.

If you're insured through AG Employee Benefits and you have Medi-Assistance, there is no advance to be paid.  

While in hospital there is no need to be worried about the repayment of your costs. But do expect to have to pay some additional costs that are not reimbursed by your insurance, such as special meals, in-room magazines or a haircut.

admitted to hospital
During your hospital stay there is no need to concern yourself with the medical costs.
After the hospital stay
admitted to hospital
Medical costs incurred before or after your hospitalization are eligible for a reimbursement when they are directly related to the reason for your hospitalization.
  • The bill

    The hospital will send the hospital bill only 2 to 3 months after the end of your stay. This will tell you the share that has already been paid by your health insurance and the portion that you have to pay yourself. Your personal contribution consists of the co-payment (patient contribution) and any supplements. These depend on your choice of room. Read your bill carefully, checking for example the room type invoiced (at the top) and miscellaneous expenses (bottom of the invoice).

     Where you have the optional Medi-Assistance cover, AG Employee Benefits will receive the hospital bill and pay directly to the hospital. You will then receive a settlement statement, with any non-reimbursed costs deducted from the repayment of your medical care before and after your hospital stay. 
    In other cases, the bill is sent to your home. In this case, you first pay the hospital, but our ultimate intervention in the costs remains the same, with or without Medi-Assistance.

 

  • Medical care after admission

    It often happens that you need to take medication in the weeks following your hospital stay, receive treatment (e.g. physiotherapy) or return to the hospital for checks. This is so-called outpatient (or ambulatory) care. Your hospitalization insurance will reimburse these costs if incurred within a certain period before or after your hospital stay, if the INAMI/RIZIV recognizes the costs, and if they are directly linked to the reason for admission. You may request in writing the reimbursement of these costs.
Also useful to know

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
admitted to hospital
Outpatient operations ('One-day hospitalization') are reimbursed by your insurance, staying in the emergency ward is not.