Your hospital bill does not stop where the health fund stops
Hospital insurance covers what you would otherwise pay yourself.
What the health fund does not pay, you pay yourself
In Belgium you are required to be a member of a health fund, and it reimburses your hospital costs only in part. Some of the bill always stays with you. If you choose a single room, every doctor involved in your treatment may charge a supplement on top of the statutory rate, including the anaesthetist or the radiologist you never met. How much that is differs per hospital and is set out in your admission declaration. Your health fund does not step in there.
On top of that, a stay does not begin when you walk in and does not end when you go home. The tests beforehand, the medication afterwards, the home nursing: hospital insurance covers that period too, but exactly how long differs per policy. That is usually the difference between two policies that cost the same on paper.
And then the point most people find out too late. If you have cover through your employer, it stops when you change jobs or retire. You have the right to continue it individually, but usually at a higher premium. Anyone who starts looking for the first time at that moment also runs into a medical questionnaire, a waiting period before cover starts, and sometimes exclusions for what was already there.
That is the real reason not to put this off. Not because you will be in hospital tomorrow, but because hospital insurance is cheaper and broader for as long as you do not need it.
Why Ōmata
You open the chat and we ask only the questions that set your cover. Your age and household, whether you already have something today through your employer or your health fund, and what matters to you: the choice of room, the period before and after the stay, or dental care. No three-page form, no details we will not use afterwards.
With that we go and look at different insurers and come back with the policy that fits your situation. We are a broker, so we place insurers’ policies and not those of the health funds. If a health-fund arrangement is the better choice in your case, we say so.
And if you are admitted, you can use the same chat or call the number on your policy. You reach the same point of contact. We file your claim and follow your file, including when the bills keep arriving after your stay.
How to start
You send a message through the chat on this page.
You answer a few targeted questions about your situation. No long form.
You get a tailored proposal usually within two working days, explaining what is covered, up to what amount, and what is not in the policy.
If you agree, you confirm the proposal.
What a conversation with Ōmata looks like
You do not need to know which policy you are looking for, and there is no form to fill in.
Start your request
Viktor is online
You are talking to an AI assistant. You can ask for a human colleague to take over at any time.
- CustomerI am changing jobs and losing my hospital insurance. I am 54.
- ŌmataThere is something important here: you have the right to continue that group cover individually, without a new medical questionnaire. That deadline is short. When exactly does your policy stop?
- CustomerEnd of next month.
- ŌmataWe will set that in motion right away. What is the policy number, and with which insurer?
- CustomerI still need to look up the policy number, it is a hospital insurer arranged through my employer.
- ŌmataNoted. I will pass this on to our expert as urgent — send the policy number as soon as you have it. You will hear from us this week.
Try it yourself
Who this is for
Anyone without a group policy, or anyone who has one and does not know what happens when it falls away.
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Anyone losing their group policy
On dismissal, on retirement or on becoming self-employed. The moment most people search for this.
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The self-employed
No employer, no group policy. What you do not arrange does not exist.
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Families with children
Children are cheap to add and end up in hospital more often than their parents expect.
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Anyone approaching retirement
Exactly when the chance of a stay rises, the policy through work falls away.
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Anyone with a procedure on the horizon
Note: a condition already known is excluded. Taking it out early is the whole point.
Who this is not for
- Anyone with good cover through work. While it runs you usually do not need a second. Do ask what happens if you leave or retire.
- Anyone with sufficient supplementary cover through their health fund. Some health funds offer their own hospital cover. Compare before adding a second.
- Anyone who would never choose a single room. Most of the gap sits in the supplements charged only there. Without that choice the gap is considerably smaller.
- Anyone wanting an existing condition covered. What is already known at inception is excluded. This policy looks forward.
What hospital insurance covers
Hospital insurance pays what is left after the health fund’s contribution to a stay: the patient’s share, room and fee supplements, materials and implants, medication, and usually the costs in a period before and after the stay. Serious illnesses are often covered outside a hospital stay as well.
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Patient’s share and own contributions The part of the bill that is yours after the health fund has paid.
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Room and fee supplements The item that makes the difference.
In a single room doctors may charge supplements; in a double or shared room they may not.*
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Materials, implants and medication Prostheses, suture material and medicines during the stay, often with their own limit per category.
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Costs before and after the stay Examinations, consultations and care in a period around the stay, when they relate to the same condition.
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Serious illness outside hospital A list of conditions — cancer, MS, diabetes and others — whose treatment is covered even without a hospital stay.
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Day surgery More and more procedures happen without an overnight stay.
Check that they are expressly covered.
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Children up to a certain age Usually cheap or even free to include while they live with you.
What hospital insurance does not cover
Not covered are conditions already known at inception, cosmetic procedures without a medical reason, and what happens during the waiting period. Comfort unrelated to care is excluded too.
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Pre-existing conditions What was already known or under treatment at inception is excluded, and that exclusion usually stays for life.
That is why taking it out early counts.
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The waiting period The first months after inception are usually not covered, except for an accident.
For pregnancy a longer period generally applies.
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Cosmetic procedures What is not there for medical reasons falls outside.
The line is sometimes disputed, and the policy defines it.
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Comfort unrelated to care Television, telephone, an extra bed for a visitor: the policy pays for care, not a hotel.
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Costs above the limits per category For implants and materials there are often separate maximums.
Two policies can differ widely there.
Just ask
What the health fund already pays, and what is left
For an ordinary hospital stay the compulsory health insurance pays most of the daily rate, the fees and most of the examinations. That is the base, and you already have it.
What is left falls into three parts. The patient’s share: the part that is legally yours. The non-reimbursed items: certain materials, implants and medicines. And the supplements: what the hospital and the doctor may charge on top of the official rate.
The single room is the whole discussion
In a double or shared room doctors may not charge fee supplements. In a single room they may, and they do — with percentages that vary widely by hospital and by doctor.
On top of that comes the room supplement: an amount per night the hospital charges for the room itself. That too differs from one institution to another.
You lose your policy through work. What now?
This is the moment most people arrive on this page. You change jobs, you are made redundant or you retire, and your employer’s group policy stops — often just as the chance of a hospital stay rises.
There is a statutory right to continue group hospital cover individually, without a new medical questionnaire and without a new waiting period. That right is worth more than it sounds: looking for a new policy later in life with a medical history means exclusions and loadings.
Waiting period and pre-existing conditions
Two mechanisms mean you cannot insure what is already under way, and both are why this policy is best taken out early.
The waiting period is the time after inception in which nothing is paid yet, except for an accident; for pregnancy a longer period applies. Pre-existing conditions are what was already known or under treatment when you signed: those are excluded, and that exclusion usually stays for life. Hence the honest answer on age — usually still possible, but with more exclusions the longer you wait.
What determines the price
A figure without your details is a guess. What determines the premium, we can list.
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Age
The heaviest factor, and it gets heavier every year.
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Room choice
With or without cover for a single room.
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Medical history
The questionnaire determines the exclusions.
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Excess
A contribution of your own per stay or per year lowers the premium.
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Limits
The maximum reimbursed per category.
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Household
Whether partner and children are on the same policy.
Frequently asked questions
I am losing my policy through work. What now?
There is a statutory right to continue group hospital cover individually, without a new medical questionnaire and without a new waiting period.* The premium is higher than the group rate your employer paid. Important: the deadlines are short and the right lapses. Ask about it before your policy stops.
What does a single room really cost?
That depends on the hospital and the doctor. In a single room doctors may charge fee supplements and the hospital a room supplement; in a double or shared room they may not. The same procedure can therefore produce a bill that is a multiple of another. That difference is exactly what this policy covers.
What does the health fund already pay?
Most of the daily rate, the fees and most examinations. What is left is the patient’s share, some non-reimbursed materials and medicines, and the supplements. The last is by far the largest item, and it depends entirely on the room you choose.
Is a pre-existing condition covered?
No. What was already known or under treatment at inception is excluded, and that exclusion usually stays for life. That is the main reason to take this out early and not when something is on the horizon.
How long is the waiting period?
Usually a few months after inception, except for an accident — that is covered immediately. For pregnancy and childbirth a longer period generally applies. The exact length is in the policy and differs by insurer.
Can I still take this out at my age?
Usually yes, but with more exclusions and a higher premium the longer you wait. Some insurers apply a maximum age for a new policy. If you are coming from a group policy, look at the right to individual continuation first: that is almost always the better route.
Who is behind Ōmata?
Ōmata Insurance is the AI-first studio of the Induver group and a sister company of Group Induver NV: two companies within the same group, not parent and subsidiary. Ōmata puts you in touch with Group Induver NV, an insurance broker holding FSMA number 016880; that is where the advice and the policy come about. The full identification is set out in the legal notices.
About Ōmata
Ōmata is the AI-first insurance studio of Group Induver. You tell us what you want to insure over chat; usually within two working days you receive a proposal, drawn up by an insurance broker at Group Induver NV, registered with the FSMA under number 016880.
Ready to start?
Send us a message and tell us briefly what you want to insure. You get an immediate reply and your proposal usually within two working days.
Notes on the asterisks on this page
- The exact rules and percentages for fee and room supplements in a single room vary by hospital and by doctor.
- The statutory right to continue group hospital cover individually carries its own conditions and deadlines; these are confirmed by Group Induver before you rely on them.