Hospital admission declaration: FAQ

Hospital admission declaration: FAQ

1. Frequently asked questions

What if I suffer from a serious illness without being admitted to hospital?

Patients with diabetes (for example) receive long-term treatment, but are rarely hospitalised. We refer to this as outpatient cover for serious illness. The list of serious illnesses that are eligible for this cover can be found in the general policy conditions or in the glossary under the category of serious illnesses.

What happens if I'm abroad?

In general:

  • The policy cover is valid worldwide, unless you travel abroad specifically to receive medical care. In that case, KBC will only provide cover if you have a prior reimbursement agreement in place with your health insurance fund before your trip.
  • KBC will only take action after you have received your statutory compensation from your health insurance fund.
  • If the country in which you receive care is not a member of the European Union, or if Belgium has not signed an agreement with that country, then the reimbursement you receive from KBC will be limited. Please see your policy for more details.

Make sure you look up the details of your health insurance fund's travel assistance centre before you travel. Here are a few examples:

  • MUTAS (CM – Liberale Mutualiteit – Vlaams & Neutraal Ziekenfonds) = +32 2 272 09 00
  • MUTAS (Sociale Mutualiteit) = +32 2 272 08 80
  • Mediphone Assist (Partena) = +32 2 778 94 94

What should I do if I am admitted to hospital abroad?

  • If you are admitted to hospital abroad, you should always contact your health insurance fund's assistance helpline within 48 hours.
  • You should show your European health insurance card if you are in a country where it is valid.
  • You should never pay your hospital invoice abroad. If you are asked to do so then you should get in touch with your assistance helpline immediately.
  • Once you are able to, you can then make a declaration to KBC via the Hospitalisation call centre in order to recoup any remaining costs. It is not possible to declare a hospital admission abroad on KBC Assist. The AssurCard can also only be used in Belgian hospitals.

Are patient transport services covered?

Patient transport services are covered under specific conditions:

  • The transport must be related to a hospital admission.

This means that transport to a consultation or to an outpatient treatment that does not involve hospital admission,
such as radiotherapy, is not covered.

  • The transport must be specially medically adapted (so a taxi would not be covered, for example).

The costs of patient transport should always be submitted to your health insurance fund first.

The insured sum reimbursed by KBC depends on the policy conditions you chose. You can find further details in your general policy conditions.

Is day surgery also covered?

Day surgery is only covered if a statutory accommodation fee for the medical treatment is also charged.

Which costs are not reimbursed?

KBC does not reimburse everything. Here are some of the costs that are not reimbursed:

  • Telephone charges, beverages, additional conveniences
  • Toiletries
  • Any medication that is not related to the hospital admission
  • Outpatient care that is not subject to statutory compensation

Do I have to stay in a private, double or shared room?

You are free to choose whichever room you want. Whether we reimburse the hospital invoice in full or in part will depend on:

  • your policy conditions
  • the choice you made on your admission form

You should therefore read your policy conditions carefully or phone the Hospitalisation call centre before you choose a room.

Who can I make a declaration for?

You can make a declaration for yourself or for members of your family. Adult members of your family can also make a declaration on your behalf. You can make a declaration on the KBC Assist app (24 hours a day, 7 days a week) or by phoning the Hospitalisation call centre on 0800 90 068 (on business days between 8 a.m. and 5 p.m.). 

2. Glossary

Outpatient expenses

Outpatient expenses are expenses for medical care that is provided without the patient being admitted to hospital. This might include physiotherapy before and after a back operation. In cases of serious illness, it may also include the reimbursement of costs for the patient’s many consultations and doctor’s visits.

AssurCard (third-party-payer system)

The AssurCard is an electronic chip card that looks like a bank card. It’s the key to an electronic system that considerably simplifies administrative and financial headaches caused by hospitalisation. You no longer have to pay the hospital invoice yourself before requesting the amount from KBC Insurance:

  • KBC Insurance pays the hospital directly (third-party-payer system)
  • The insured person no longer has to make an advance payment on admission
  • The only amount that the insured person still needs to pay is their chosen deductible, along with any non-insured costs.

 

Expensive hospitals

In the event of an admission to an expensive hospital, 50% of the personal share remains payable by the insured person if they opt for a private room with supplements on their admission form.

What if you choose cover for a twin or multiple-occupancy room on your insurance policy, but you decide to pick a single room on your admission form when you are admitted to hospital? In that case, the compensation will be limited to the flat fee per day spent in hospital.We’ve drawn up a list of expensive hostpitals based on a number of criteria relating to the fees charged by each hospital. These criteria have been submitted to a notary-public. Our list of expensive hospitals can be found under the special conditions of your hospitalisation insurance.

Deductible

The amount of the insured costs that is borne by the insured person. This amount applies to each insured person and each insurance year, regardless of the condition.

Hospital admission

A medically necessary stay of at least one night in a hospital or a stay in a day hospital. Admission to a day hospital is considered to be a hospitalisation provided that the medical treatment is reimbursed at a fixed rate by the National Institute for Health and Disability Insurance (NIHDI) on the basis of the national agreement entered into between hospitals and health insurance funds.

Informed consent

A written agreement between doctor and patient in which the patient agrees with the treatment proposed by the doctor and the costs of the operation. This generally relates to costs for which no statutory compensation is provided, such as new technology treatment (robotic surgery) and cosmetic surgery.

Kiosk

There is an AssurCard kiosk in every hospital. We no longer use these kiosks. Use our Assist app or call our hospitalisation claims hotline to claim under your hospitalisation insurance with us and find out right away what’s covered.

Non-insured costs

Certain costs are not covered by hospitalisation insurance, such as phone calls and Internet use.

Pre- and post-hospitalisation

Medical care that is provided during the period before the start and after the end of an insured hospital admission. We reimburse the following costs and treatment on receipt of the hospital bills, which should preferably be submitted together:

  • Consultations, tests and treatment prescribed by a doctor, provided that these give right to statutory compensation
  • Pharmaceutical and homoeopathic products that are prescribed by a doctor and purchased from a dispensing chemist, provided that they are included in the list of specialities of the compulsory health and invalidity insurance
  • Rental of medical equipment prescribed by a doctor

Insurance year

The period of twelve months beginning on the annual principal renewal date of the insurance contract.

Serious illnesses

If the insured person is suffering from one of the serious illnesses listed in the policy, the costs of the following services will be covered provided that they are medically required by the insured person and directly related to the serious illness in question:

  • Consultations, tests and treatment prescribed by a doctor, provided that these give right to statutory compensation
  • Pharmaceutical and homoeopathic products that are prescribed by a doctor and purchased from a dispensing chemist, provided that they are included in the list of specialities of the compulsory health and invalidity insurance
  • Rental of medical equipment prescribed by a doctor
    This cover applies to insured persons who suffer from one of the following illnesses: AIDS, amyotrophic lateral sclerosis, brucellosis, cerebrospinal meningitis, cholera, diphtheria, encephalitis, cancer, leukaemia, malaria, anthrax, cystic fibrosis, multiple sclerosis, kidney dialysis, paratyphoid fever, smallpox, poliomyelitis, progressive muscular dystrophies, scarlet fever, diabetes, tetanus, tuberculosis, typhoid fever, viral hepatitis, spotted fever, Alzheimer’s disease, Creutzfeldt-Jacob’s disease, Crohn’s disease, Hodgkin’s disease, Parkinson’s disease and Pompe’s disease.

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