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February 23, 2024

The ambulatory plan: a valuable benefit for employers and employees

What are the rules on the reimbursement of costs for dental care, new glasses or a scan? You can’t claim for these ‘ambulatory costs’ on your hospitalisation insurance, and your health insurance fund will only provide limited reimbursement. Because ambulatory costs can be high, 43% of Belgian employers now offer an ambulatory plan that covers these costs. In the latest episode of our video podcast, insurance expert Bert Van den Broeck talks about the importance and benefits of this insurance for employers and employees.

The original recording of this videopodcast is available in Dutch and French.

14% of Belgian families delay medical care for financial reasons.

In a country such as Belgium, this is a remarkably high figure, especially when you consider its social security and health care facilities. As an employer, you can provide a response to this with collective ambulatory health insurance. We’d go so far as to say that an ambulatory plan is good for your employees’ health. It removes the financial barrier, so that they seek professional help sooner and are therefore less likely to drop out of work.

What exactly are ambulatory costs?

An ambulatory plan covers all costs for medical care provided outside hospital and not paid or reimbursed by hospitalisation insurance. These costs are called ‘ambulatory costs’. We distinguish between two types of costs:

  • High-frequency, low costs: these are costs that occur often but involve a low amount each time, such as a consultation with the GP, medication from the pharmacy or sessions with the physiotherapist.
  • Low-frequency, high costs: these are costs that only occur occasionally, but immediately involve a considerable amount, such as orthodontics or a dental implant.

The reimbursement of medical costs through the health insurance fund is limited

If you’re admitted to hospital, your hospitalisation insurance will intervene to cover the costs. The same goes for some 30 serious diseases such as diabetes and cancer. But what about all the other ambulatory costs of health care? These can be quite high, and are only partially reimbursed by the health insurance fund. An ambulatory plan can provide a solution for costs that are not reimbursed and therefore remain the patient’s responsibility.

After reimbursement from the health insurance fund, 19% remains to be paid by the family.

The rise of the ambulatory plan

Around 80% of Belgian families have a hospitalisation plan today. The ambulatory plan is not yet so well established, but it is catching up fast, as is clear from these figures for the proportion of companies in our portfolio with an ambulatory plan: 14% in 2011, 34% in 2021 and 43% in 2023.

The value of an ambulatory plan will increase even further in the future. Hospital admissions are growing ever shorter and an increasing proportion of medical costs is incurred outside the hospital bill. You can use your ambulatory plan for these. 

The many benefits for every employee

Every employee faces ambulatory costs, so everyone also experiences the benefits of an ambulatory plan:

  • Direct savings: Given that the average family spends 50 euros per month that would be covered by an ambulatory plan, the financial benefit for your employees is immediately clear.
  • No waiting times or medical screening: With a collective plan, employees avoid the long waiting times and medical screenings that apply to individual insurance.
  • Prevention: An ambulatory plan lowers the barrier to medical care and encourages people to receive more preventive mental and physical health care. For example, a session with a psychologist, which can often even be arranged as a teleconsultation.
On average, 50 euros per month would be covered by an ambulatory plan.

The cost for your organisation

As an employer, you’re in the driving seat: you can offer a plan that’s tailored to the wishes and budget of your organisation. You can arrange limited cover or offer a full option plan that covers dental and/or optical care in addition to general medical care. As well as your employees, you can include their family members too. Finally, you can opt for reimbursement up to a certain maximum amount per year or as a certain percentage of the submitted costs each time.

A smart investment for any employer

As an organisation, you pay attention to your employees’ health and well-being so that they feel good and can be the best version of themselves. An ambulatory cost plan is the ideal way to make care as accessible as possible for them. At the same time, it can be an extra weapon in the war for talent.

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