Repayment

or most routine, but also specialised determinations in clinical biology, there is a health insurance reimbursement (NIHDI) through your mutual insurance company. For this, certain rules must be met, which are determined per test by the National Institute for Health and Disability Insurance (NIHDI). These rules are applied by laboratories when drawing up your invoice. However, the NIHDI sometimes requires a contribution from the patient, the co-payment.

In order to be able to apply the reimbursement rules correctly, your physician need to mention your mutuality details on the application form, for example by means of a mutuality device.
In addition to traditional reimbursement, there are individuals who are entitled to an 'enhanced' intervention. The so-called OMNIO status. This status is automatically granted to anyone receiving social benefits (such as living wage, disability, income guarantee for the elderly). You can also apply to the health insurance fund for OMNIO status if you have an income below the limit amount.

Third-Party Payment Scheme 

In our country, there is a so-called ‘third-party payment scheme’. This means that for the reimbursed tests, you only have to pay for your personal share (co-payment), the lab settles the other costs directly with the health insurance fund.

Structure of an invoice 

An invoice for services in clinical biology is established through rules laid down in a Royal Decree. The cost of a performance is determined by the government and is expressed in a B-value. The precise calculation of the total invoice is quite complex and is partly determined by the number and nature of the requested benefits, lump-sum payment and mandatory remunerations according to your social status:

1. Reimbursed benefits: benefits that are reimbursed in accordance with the NIHDI rules are borne in full or in part by the health insurance fund; in these, the patient pays nothing or the co-payment.
2. Non-reimbursable benefits: benefits that are not reimbursed according to the NIHDI regulations are charged directly to the patient.
3. Flat fee: is determined on the basis of the number and type of NIHDI-reimbursed provisions carried out; in this, both the mutual health insurance organisation and the patient pay a share (patient contribution). For the smallest applications, there is no share for the patient.

More detailed information on the calculation can be found on the government website: https://webappsa.riziv-inami.fgov.be/Nomen/nl/search.

With effect from 1 January 2023, the General Administration of Taxation has drawn up new rules regarding the exemption from tax (VAT) on medical care. All medical services whose purpose is the protection, including preservation or restoration, of human health will remain exempt from VAT. However, a limited number of analyses that do not serve a ‘therapeutic purpose’ will now be subject to VAT. These are the analyses performed in the context of insurance investigations or legal proceedings. For such examinations, our laboratory is obliged to charge 21% VAT.

Details of the structure of our invoices can always be found on the back of the invoice sent to you.
If you have any questions or comments, please contact our invoicing department on 03/30 30 830 or via accounting@aml-lab.be.

Payment terms

Each invoice is considered final unless the recipient sends a reasoned protest by registered letter within 21 days of the invoice date. Invoices are payable within 30 days from invoice date. 

In case of non-payment or incomplete payment of the amount due on the due date, you will still receive a notice of default free of charge so that you have at least 14 days to pay without additional costs after sending this reminder/notice of default.  The penalty clause provides that additional costs will be charged to you thereafter: €20 for invoices up to €150, €30 for invoices between €150.01 and €500, and €65 for invoices higher than €500 this according to the "XIX Consumer Debts" code of 4 May 2023. In addition, late payment interest may also be charged on the outstanding amount at the interest rate cf. the law of 2 August 2002 on combating late payment in commercial transactions.  
After expiry of the payment deadlines, in the event of non-payment, your file may be transferred to a debt collector.

Nomenclature

The value assigned to each determination performed on an invoice is calculated on the basis of the so-called B-value which is determined by the NIHDI.  
Whether the cost price for this analysis is borne by the health insurance fund or the patient and therefore reimbursed or not, in other words, is governed by different types of NIHDI rules:

Diagnostic rules: the test will only be reimbursed if the condition states in the diagnostic rule is met. The conditions apply to:

• Competence for performance
• Competence of the applicant: tests are sometimes only reimbursed if the applicant can present a certain specialisation
• Characteristics of the analysis carried out: e.g., method
• Characteristics of the patient: certain disorder, age category, etc.
• Number of times an analysis may be performed (e.g. maximum 2 times per year)

Cumulation rules: le test ne sera PAS remboursé s'il figure dans la même collection qu'un certain autre test.

Maximum rules: a test will be reimbursed a maximum number of times per sample collection.

Consult our 'Information brochure' for an overview of the main cumulative and diagnostic rules or consult the website of the NIHDI.