Mutuality / Health Fund and Doctors in Belgium – A Guide for Poles (2026)

This guide is for you if you live and work in Belgium or are just moving there – and want to understand how the Belgian healthcare system works: why you need a health fund (mutualité in French, ziekenfonds in Dutch), how much you really pay to the doctor, how to reduce costs, and what to do at night or on weekends. At the end, you will also find a brief section for those who come to Belgium only for a short time, with a Polish EKUZ card.

Last verification: October 21, 2026. Informational material – not legal or medical advice. Amounts and rules may change; confirm them with your health fund or on the INAMI/RIZIV website.

In Brief

How the Belgian System Works – Key Concepts

In Belgium, public health insurance is overseen by the federal institute INAMI (in Dutch RIZIV). However, it does not pay you directly. Health funds do, which – as INAMI states – provide benefits and allowances under its control. Without registering with a fund, you have no right to reimbursements.

INAMI / RIZIV – federal institute for health and disability insurance. It sets rates and reimbursement rules, and oversees health funds.

Mutualité / ziekenfonds – health fund (non-profit association). It reimburses medical costs, pays sick and maternity benefits. It collects contributions and offers supplementary insurance.

CAAMI / HZIV – public supplementary fund. It does the same as mutualité under compulsory insurance but does not collect contributions and has no supplementary insurance.

Ticket modérateur / remgeld – your own contribution: the part of the amount that remains on your side after reimbursement from the fund. Additional charges (suppléments) may apply.

Tiers payant / derdebetalersregeling – the "third payer" system: the fund pays the doctor directly, and you only pay your share on the spot.

BIM / verhoogde tegemoetkoming – increased reimbursement for people with lower incomes and in certain life situations.

DMG / GMD – Dossier Médical Global (Global Medical Dossier), which is the global medical documentation maintained by your permanent family doctor.

MàF / MAF – maximum à facturer, which is the annual limit on medical expenses for a household.

Step by Step: How to Get Insured After Arrival

1. Register and Obtain a Residence Card

   Belgian institutions identify you through an electronic identity document. INAMI explicitly mentions the Belgian identity card or electronic card for foreigners (and for children, Kids-ID or ISI+ card) as the document you show to the doctor and dentist. CAAMI forms also require a valid Belgian electronic document.

2. Choose a Health Fund

   Funds are grouped into five national associations: Christian, neutral, socialist, liberal, and "free" (mutualités libres). An alternative is the regional office CAAMI/HZIV. The scope of compulsory insurance is the same everywhere – the contributions and additional services differ.

3. Fill Out the Registration Form

   For the first registration with a Belgian fund, a simple application form is sufficient. If you change funds, a transfer form is required, and new membership starts from the next quarter (January 1, April 1, July 1, or October 1), provided the application reaches them at least a month in advance – as described by CAAMI.

4. Pay the Contribution (in mutualité)

   In mutualité, you pay a contribution, and when you are up to date with it, you also have supplementary insurance. In CAAMI, there is no contribution. If you do not pay social contributions from your work income, INAMI provides for a separate personal contribution to maintain your right to reimbursements.

5. Choose a Family Doctor and Open a DMG

   At your next visit, ask to open a DMG. Opening and maintaining a DMG is free for you, and the fund automatically extends it if you visit that doctor at least once every two years.

6. Check if the Doctor is "Conventionné"

   Before visiting a new doctor or specialist, enter their name in the INAMI search tool or in the newer Health PRO tool. You will see if they are conventionné, partially conventionné, or non-conventionné.

Mutualité or CAAMI – Comparison

Sources: INAMI – registration with a fund, CAAMI – how to become a member. We do not compare specific packages and contributions of individual funds – they change and need to be checked with the fund itself.

How Much You Pay to the Doctor

You Pay, Then the Fund Reimburses – or Tiers Payant

In the classic model, you pay the doctor the full rate, and the health fund reimburses you part of it. The Polish NFZ describes it this way: in Belgium you first pay the full price, and then you apply for reimbursement of part of the costs from the health fund. However, increasingly, doctors settle electronically with the fund in the tiers payant system, and then you only pay your share.

According to INAMI, from January 1, 2022, family doctors can apply tiers payant to every patient. They must do it mandatorily:

• for patients with BIM status during office visits – a legal obligation since October 1, 2015 (except for home visits);
• for all patients during video or phone consultations – since August 1, 2022.

For specialists, tiers payant is not mandatory but possible. We did not find official information that in 2026 the obligation was extended to all patients of family doctors.

How Much is Your Share – Family Doctor

The amounts refer to INAMI rates for a conventionné doctor – a non-conventionné doctor may add a surcharge. The exemption for young people with BIM and DMG from their own contribution applies since October 1, 2023. For people over 75 and those with chronic illnesses, DMG also reduces the share of home visit costs by 30%. The amounts of the share without DMG depend on the type of service and are not provided here – check them on the poster in the waiting room or with the fund.

Conventionné or Not – Why It Matters

A conventionné doctor adheres to rates established in agreement with INAMI. A non-conventionné doctor may add surcharges, and a partially conventionné doctor applies official rates only during certain hours. Many providers (including dentists, physiotherapists, nurses, pharmacists) must display a poster with prices and convention status; for doctors, the poster is not yet mandatory. If someone does not clearly show their status, according to INAMI, they cannot charge surcharges.

BIM Status – Increased Reimbursement

With intervention majorée, you benefit from lower costs for visits, medications, and hospital stays. Some people receive it automatically (e.g., those receiving integration income from CPAS or income guarantee for seniors). Others – such as single-parent families, unemployed individuals, or those unable to work for at least 3 months – must apply at the fund with a declaration of household income. Gross income for tax purposes counts, including from abroad. We did not verify specific income thresholds for 2026 – ask your fund about them.

Important change: from January 1, 2025, doctors cannot charge outpatient surcharges to patients with BIM granted automatically, and from January 1, 2026, also to those granted BIM after an income assessment – regardless of whether the doctor is conventionné.

Maximum à Facturer – Annual Spending Limit

MàF guarantees that a household will not spend more on medical treatment than a set annual amount. When your own contributions exceed the threshold, the fund reimburses further costs in full – automatically, once a month. There are four types of MàF: income-based, social, for children under 19, and for those with chronic illnesses. The limit includes, among others, own contributions to doctors, dentists, and physiotherapists, reimbursed medications, and daily hospital charges. A household consists of all individuals registered at the same address as of January 1 of that year. We do not provide the threshold amounts for 2026 – they depend on income and can be checked with the fund.

Dentist, Hospital, Psychologist

Dentist

Dental treatment in Belgium is only partially reimbursed. Bring your electronic document and your children's documents to the dentist: from October 1, 2026, the dentist must verify your identity when settling with the fund in the tiers payant system – even if you pay nothing.

Hospital and Hospital Insurance

Compulsory insurance covers part of the costs of a hospital stay, and the daily hospital charge counts towards the MàF limit. You cover the rest, including any surcharges, unless you have separate hospital insurance (assurance hospitalisation / hospitalisatieverzekering). Such a policy can be held privately, as part of the supplementary fund's offer, or from an employer; we did not verify its scope and prices. When employed, ask the HR department if such a policy is included in the package and if you can add your family to it.

Psychologist

Since 2021, INAMI finances first-line psychological assistance through mental health networks. You do not need a referral. Rules from April 1, 2024:

The psychologist must have a contract with the network, and the number of hours in this contract is limited – so you may need to look for another therapist. You can find networks in the previous INAMI search tool (Health PRO does not support them yet).

Emergency Cases: 112 and 1733

Call 1733 when symptoms are not life-threatening but cannot wait until your doctor returns. The call costs the same as a regular call, and the visit to the on-call doctor costs the same as a visit to your family doctor. After connecting, you choose the menu language (1 – Dutch, 2 – French, 3 – German, 4 – English) and enter your postal code. The menu language does not guarantee that the operator will speak that language. In some parts of the country, on-call points still have their own numbers – if 1733 does not work in your region, the system will inform you.

Posted Worker, S1, and Polish NFZ

EU rules determine which country insures you. INAMI describes them from the perspective of Belgium, but they work the same way in reverse:

• You work for a Belgian employer – you pay contributions in Belgium, and the country of work becomes the country of insurance for you and your dependents. You register with a Belgian fund.
• You are posted by a Polish company – you remain in the system of the country where you usually work. In Belgium, you use EKUZ, and if you move your residence there – you need an S1 form from the country of insurance, which you register with the Belgian fund.
• You live in Belgium and work in another country (cross-border worker) – you register the S1 form from the country of work with your chosen Belgian fund and receive treatment in Belgium as if you were insured there.

When exactly your insurance with NFZ expires after leaving depends on whether someone in Poland is still paying contributions for you. Check your status with NFZ before you start using the Polish EKUZ card.

Short Stay in Belgium with a Polish EKUZ Card

If you are insured with NFZ and come to Belgium for a short time (vacation, visits), EKUZ gives you the right to necessary medical assistance on the same terms as Belgians. According to NFZ material for Belgium:

• usually, you pay the full amount first, and seek reimbursement of part of the costs from the Belgian health fund or after returning to your NFZ branch;
• get a certificate from the doctor for the services provided (attestation de soins donnés / getuigschrift voor verstrekte hulp) and keep the original invoices and copies of prescriptions;
• the own contribution for outpatient and dental visits is not reimbursed by NFZ, and the costs of private treatment are reimbursed at most according to Polish rates;
• you cover the return transport to Poland yourself.

The NFZ material on Belgium (file available for download from "Rules in Individual Countries") is dated 2020 and contains sample rates – we do not transcribe them as they may have changed.

How to Find a Doctor Who Speaks Polish

There is no official Belgian list of doctors by language, and the INAMI search tool shows the name, INAMI number, specialization, address, and convention status – not the language. Therefore:

1. Ask Your Health Fund

   Ask if the fund can point out practices in your area that accept patients in Polish.

2. Ask the Local Polish Community

   Polish parishes, Saturday schools, and associations in your city are usually the best sources of reliable recommendations.

3. Check Filters in Appointment Booking Services

   If you book appointments online, check if the service allows filtering doctors by language – and do not treat such a declaration as a guarantee.

4. Always Verify Status in INAMI

   When you have a name, check in the INAMI search tool if the doctor is conventionné – this determines whether you will pay the official rate.

Common Mistakes

• Delaying registration with a health fund – without it, you will not receive reimbursements or sick benefits.
• Lack of DMG – you pay more for each visit to the family doctor, although opening it is free.
• Visiting a non-conventionné doctor without checking – and being surprised by a surcharge.
• Calling 112 with an issue that is appropriate for the 1733 on-call service (or vice versa in life-threatening situations).
• Misplacing certificates and invoices – without them, reimbursement is difficult or impossible.
• Assuming BIM is granted automatically – in many situations, you need to apply.
• Taking a child to the dentist without a Kids-ID or ISI+ card.

Frequently Asked Questions

Do I need to register with mutualité if I work in Belgium?

To have the fund reimburse your medical costs and pay benefits, you must belong to a health fund – mutualité or CAAMI/HZIV.

Is CAAMI "worse" than mutualité?

No, in terms of compulsory insurance – the benefits are the same. However, you will not receive a supplementary package in it.

Must the family doctor accept me without paying the full amount?

Mandatory – if you have BIM status (office visit) or during teleconsultation. In other situations, tiers payant is an option, not an obligation.

How much does a psychologist cost?

With a psychologist contracted with the mental health network, an adult pays 11 euros for an individual session (4 euros with BIM), the first is free. Outside the network, you pay according to the psychologist's price list.

I have a Polish EKUZ and live in Belgium permanently. Is that enough?

EKUZ is intended for temporary stays. If you work in Belgium, you are insured by the country of work. If you are insured in Poland and live in Belgium, the appropriate route is usually the S1 form – ask NFZ.

Fact-Check Summary

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