The Belgian health system works on a simple idea that surprises many newcomers: you do not get a card from the state, you join a mutualité (ziekenfonds in Dutch), a non-profit health fund that reimburses part of your care. Doctors are paid per visit, you pay, and the fund reimburses you. Health insurance in Belgium is compulsory in practice, and the first affiliation is a form, not an ordeal.
How does health insurance in Belgium work?
The compulsory insurance is the same everywhere, run through the INAMI (the national health insurance institute). What differs between funds is the services and the supplementary insurance they sell on top. The INAMI puts it plainly: to be entitled to reimbursement and to sickness or maternity allowances, you must join a mutuality.
You can pick one of the private mutualities or the CAAMI, the public fund. The CAAMI takes any person, whatever their profile, and offers the compulsory insurance only. It says that, if you are in order with Belgian social security, you pay nothing more. Its online sign-up needs a Belgian electronic ID and a card reader; otherwise you use a paper form.
Who pays what?
- Employees and self-employed people. Cover is financed through social contributions on your pay or income.
- Residents without professional income. You can still be covered, by paying personal contributions collected quarterly by your mutuality. The INAMI scale for 2026 shows 931.12 euros per quarter at the normal rate, 465.55 euros if your annual income is under a ceiling (46,716.82 euros since 1 September 2026), 78.93 euros under the ceiling for increased reimbursement, and nothing under the integration income or if you are entitled to increased reimbursement. Your mutuality works out your amount.
- Supplementary insurance. Private mutualities add it for a fee. The CAAMI does not offer it.
What are the steps to join health insurance in Belgium?
- Before leaving, take your European Health Insurance Card for the first weeks and ask your home insurer how long cover lasts. If your home country remains responsible, for example for pensioners, request an S1.
- Register at your commune to get your national number. See the Belgian national number explained.
- Choose a mutuality and complete its form. A single form is enough for a first affiliation.
- Add your family, who benefit through your rights.
If you are in between situations, for example a new job that starts next month or a pension from another country, which route fits you can be unclear. Moovy can tell you whether you need an S1, personal contributions or an employer-based affiliation.
Why is the EHIC not enough?
The EHIC covers necessary care during a temporary stay, under the same conditions as insured people in the host country. It does not cover planned treatment, private care or repatriation. Once you live in Belgium, you need a Belgian affiliation or a registered S1.
What changes for pensioners?
If your pension comes from another EU country, you can ask your pension country for an S1 and hand it to a Belgian mutuality. You are then treated as insured in Belgium at the expense of the paying country.
What if you are British?
The UK GHIC replaces the EHIC for temporary stays. To join a mutuality, you must first be in regular residence in Belgium; GOV.UK explains that residents must register with a health insurance fund. UK state pensioners can ask the NHS Overseas Healthcare Services for an S1 and register it with their mutuality. Read moving to Belgium from the UK.
What mistakes should you avoid?
- Staying on the EHIC. It is for visits, not for life.
- Forgetting your identity card. The INAMI notes it is requested, notably at hospital and, from 1 October 2026, at the dentist.
- Not paying personal contributions. Reimbursements depend on contributions being paid.
- Assuming all funds are the same. The compulsory insurance is identical. Compare the supplementary services and prices.
- Changing fund at the wrong time. A change takes effect at the start of a quarter.
Your health affiliation is part of the sequence in moving to Belgium. Do it in the first weeks, once your commune registration is under way.
What does the compulsory insurance cover?
Since 2008 all Belgian insured persons are covered for both small and large risks, including self-employed workers for small risks (INAMI). In practice you pay your doctor, dentist or pharmacist and your fund reimburses a share, so you still have a personal share to pay. Hospital stays, specialist visits and medicines follow the same logic, with different reimbursement rates. Increased reimbursement exists for people with low income.
What the compulsory insurance does not do is cover extras such as many comfort items in hospital. Supplementary insurance sold by the funds covers some of these, which is why it is worth comparing offers.
How do you choose between the funds?
Because the compulsory cover is identical, compare these points when choosing health insurance in Belgium:
- the price and content of the supplementary insurance;
- the opening hours and the number of local offices;
- the digital services and language support;
- the speed of reimbursement.
You can change fund, and the change takes effect at the start of a quarter. The CAAMI is the simplest choice if you only want the compulsory insurance and no supplementary cover.
What if your income changes?
Students can join with an attestation from their higher education institution. Dependants whose income exceeds the authorised limit must join as principal members. When unemployment benefits end, some people keep their right to reimbursement for a set period; if you return to work during that time, your compulsory insurance is maintained. If your situation changes, tell your fund.
What about the identity card?
The INAMI notes that your identity card is requested in hospital and, from 1 October 2026, at the dentist. Carry your electronic card, which is also your proof of insurance in practice.
How do you handle the first weeks?
Before your affiliation is in order, you may be uninsured for a short period. Keep your EHIC with you for unplanned care in the first weeks, ask your home insurer how long cover continues, and join a fund as soon as you have your national number. Do not postpone the form: reimbursements depend on being affiliated.
For the rest of the first weeks, see moving to Belgium. If you are a pensioner, ask the body that pays your pension for an S1 before you leave.
What do you do if you fall ill before you are affiliated?
Keep your EHIC with you in the first weeks. It covers medically necessary care during a temporary stay, under the same conditions as insured people in Belgium. For emergencies, call 112 or go to the hospital; carry your identity card. Once your affiliation is in order, ask your fund how to claim back costs you paid in the meantime, since rules on retroactivity depend on your situation. Keep all receipts and prescriptions.
What about the language at the doctor?
Doctors in Brussels often speak several languages, while elsewhere the local language is likely to be needed. Many mutualities have multilingual services or websites. Your on-call doctor can be reached on 1733, and the Poison Centre on 070 245 245.
Does your employer take care of anything?
An employer deducts social contributions from your pay, but you still choose and join your health fund yourself. Join in the first weeks, once you have your national number. See the Belgian national number explained.