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

16 Special Solidarity Fund KCE Reports 133
2.3.6 Reimbursement of expenses for medical treatment abroad (art. 25sexies)
The SSF refunds costs for non-reimbursable medical treatment abroad, as well as travel
and stay costs for the patient and for his companion, if “worthy of consideration”.
Other requirements for reimbursement are:
• The advisory physician of the health insurance fund has approved the
treatment of the patient abroad;
• A medical specialist, authorized to practice medicine in Belgium and
specialized in the treatment of the specific disease, has prescribed the
medical treatment. Prescription has to be prior to the start of the
treatment.
2.3.7 Common criteria of eligibility for reimbursement
Despite the fact that the requirements are specific and cumulatively applicable within
each article of the law, the following criteria show up in most categories:
• Expensive;
• Threatening the vital functions of the patient;
• Proven scientific value, effectiveness of the treatment;
• No alternative available within the compulsory health system;
• Prescription made by a medical doctor, specialized in the treatment of the
related disease.
Further, the SSF does not reimburse costs related to medical treatment if the patient
has any other rights for reimbursement. This actually means, the patient has to verify if
he/she could benefit from any private insurance he/she subscribed or from other public
insurance systems before entering a demand under the SSF regulation. The patient has
to provide a declaration on honour, stating he/she does not benefit similar rights. There
is however no control on the faithfulness of the declaration.
The personal financial situation of the patient is currently not taken into account, when
deciding on reimbursement (or portion of reimbursement) by the SSF. As mentioned
earlier financial protection measures exist within the compulsory health insurance
system.