The different special conditions of ambulatory care insurance Ambulatory care insurance: the different special conditions

For many company managers, ambulatory insurance today is a supplement to the basic insurance, which benefits the various employees. It is insurance that covers the most important medical expenses such as: buying a new pair of glasses, annual visits to the dentist, appointments with the doctor, etc. Ambulatory care insurance therefore allows companies to attract employees, because the results of several studies have shown that an average Belgian has to pay about ¼ of his pocket to pay for his medical treatment. This guide provides you with the various special conditions of ambulatory care insurance.

Benefits of ambulatory insurance for the company’s employees

Typically, medical costs take away most of the power of employees in a company. Ambulatory insurance therefore constitutes a significant alternative to fulfill the latter’s purchasing power. Actual outpatient insurance:

  • provides a concrete benefit for the employees of a company in that they are reimbursed for ordinary medical expenses every time they visit a specialist doctor, have a consultation with a general practitioner or buy medicine at the pharmacy. This option allows Belgians to optimally manage their salary, as they spend an average of 437 euros each year on medical expenses;
  • constitutes a real alternative to wage increases. For example, a company must pay 156.25 euros for a gross salary increase of 50 euros. This allows the employee to withdraw 50 euros as a net benefit. On the other hand, the employee with ambulatory insurance can enjoy the same benefit, but the company only has to pay 54.63 euros (including tax);
  • is a complementary offering that gives companies a real advantage to stand out from the competitive market in terms of SMEs looking to hire similar talent;
  • represents a very simple offer, as employees can enter medical expenses directly using a digital platform, etc.

Outpatient care insurance aims to encourage workers to take care of themselves. It therefore contributes to good health for the company’s employees.

What does ambulatory care insurance cover in Belgium?

Today, 8 out of 10 households in Belgium have hospitalization insurance through an employer. In addition, 1 in 7 Belgians have an outpatient insurance that offers hospitalization insurance. Outpatient care represents paramedical and medical care that is generally provided outside the hospital, isolated from any hospitalization.

The outpatient costs that concern Belgians the most are those related to:

  • long-term treatments: this concerns cancer, Parkinson’s disease, dementia, etc. ;
  • dental implants, crowns and orthodontics;
  • rare or chronic diseases;
  • medicines not reimbursed;
  • medicines for the elderly and which are not expensive, etc.

Outpatient treatment can therefore be carried out by a Medical Psychological Center (CMP), a Part-Time Therapeutic Reception Center (CATTP), a Day Hospital (HDJ), etc.

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