Types of cover

When does Hospi van Payroll reimburse medical expenses?

Hospi via Payroll provides worldwide cover. After the individual joins the scheme, they are immediately reimbursed in the event that the following medical expenses are incurred (the insured person is free to choose their doctor and hospital):

  • hospitalisation fees in case of illness, accident or childbirth;
  • medical expenses for two months before and six months after hospitalisation (pre/post);
  • medical expenses for 32 serious illnesses.

What amount is reimbursed?

Hospi via Payroll provides for the complete reimbursement of hospitalisation expenses on the condition that at least one insured medical service with statutory compensation is charged on the hospital invoice. If this is not the case, 50% of the medical expenses charged on the hospital invoice will be reimbursed.

No excess applies for admission to a double/shared room.
If the insured person has opted for a private room during their hospitalisation, an annual excess of EUR 175 applies per insured person.

In terms of ambulant costs incurred during the pre/post period (two months before and six months after hospitalisation) and for the 32 serious illnesses, 100% of the fees are reimbursed if the statutory health insurance compensates this. If statutory health insurance does not cover these ambulant costs, Hospi via Payroll will reimburse 50% of the amount up to EUR 5,000 per insured person and per insurance year.

For medical techniques and materials – including prosthetics, orthopaedic appliances and prosthetic limbs – reimbursement is limited in each case to a maximum of EUR 5,000 per insured person per insurance year.

Reimbursement is capped at 50% in all cases for alternative medicine (homeopathy, osteopathy, chiropraxis and acupunture) and fertility treatments with statutory compensation.

Reimbursement for hospitalisation for nervous disorders or mental illnesses is limited to a maximum of two years per insured party per insurance year, whether consecutively or otherwise, and is counted from the beginning of the first instance of hospitalisation.

When abroad, reimbursement is limited to urgent and unexpected hospitalisation. Reimbursement is unlimited if compensation is paid by Belgian statutory health insurance; otherwise, it is limited to 50% of the total amount due on the hospital invoice.

What is not insured?

Hospi via Payroll reimburses expenses for all medically necessary hospital admissions. However, it does not cover medical expenses that arise due to the following:

  • Dental treatment, except where medically necessary as a consequence of a covered illness or covered accident;
  • Aesthetic treatment, except in cases of reconstructive surgery as a consequence of a covered illness or covered accident;
  • Experimental treatments and cures that have not been medically tested;
    Vaccinations, contraception, sterilisation;
  • Fertility treatment without statutory compensation;
  • Food and food supplements, vitamins and minerals, hygiene and cosmetic products;
  • Euthanasia;
  • Intentional or reckless actions;
  • Active participation in riots, acts of war, crimes or acts of terrorism;
  • Use of drugs, alcoholism, alcoholic intoxication or abuse of medication;
  • Accidents during lucrative sporting activities;
  • Ongoing hospitalisation at the point of affiliation.

Additional services

  • Medi-Link: a third-party payment scheme from Vanbreda Risk & Benefits where the hospitalisation invoice is directly settled with the hospital
  • AssurPharma: all pharmacy receipts are immediately sent to Vanbreda Risk & Benefits
  • Simple online claims process
  • Simple administration through collaboration with SD Worx.
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