Optimalisatie van de werkingsprocessen van het Bijzonder ... - KCE

14 Special Solidarity Fund KCE Reports 133
• chronically ill children (art. 25quinquies)
• medical treatment abroad (art. 25sexies)
Below we give an overview of the criteria, applicable for the different items.
2.3.1 Reimbursement of treatment costs for rare indications (art. 25bis)
Reimbursement of the treatment costs for rare indications has to meet the following
additional requirements:
• The treatment is expensive;
• Medical treatment is prescribed by a medical doctor specialized in the
treatment of the related disorder and authorized to practice medicine in
Belgium;
• Medical treatment has a scientific value and effectiveness which is largely
recognized by the medical profession. The medical treatment has to have
outgrown the experimental phase;
• The compulsory health insurance system can’t provide an alternative;
• Medical treatment is used for an indication threatening vital functions of
the patient.
2.3.2 Reimbursement of treatments costs for rare diseases (art. 25ter § 1)
The SSF can provide reimbursement of medical costs for patients suffering from rare
diseases.
Additional requirements are:
• The medical treatment is considered as expensive;
• The compulsory health insurance system does not provide a therapeutic
alternative treatment;
• Medical treatment is used for a rare disease that threatens the vital
functions of the patient;
• The medical treatment is prescribed by a medical doctor specialized in the
treatment of the specific disease and authorized to practice medicine in
Belgium;
• The medical profession recognizes the treatment as the specific approach
for the rare disease.
2.3.3 Reimbursement of costs for rare diseases requiring a continuous and
complex treatment (art. 25ter §2)
The costs for rare diseases requiring a continuous and complex treatment can be
reimbursed by the SSF.
Additional requirements for reimbursements are:
• Treatment as a whole is expensive;
• Treatment is related to a threat of the vital functions of a patient. The
threat of the vital functions is directly and specifically a consequence of
the rare disease;
• The compulsory health insurance system does not provide a therapeutic
alternative;
• The complex treatment is prescribed by a medical doctor, specialized in
the treatment of the specific disease and authorized to practice medicine
in Belgium.