Hospitalisation insurance

What is hospitalisation insurance?

Hospitalisation insurance is supplementary insurance, over and above the health insurance which is compulsory by law. It covers medical expenses in case of hospitalisation due to illness or an accident, or for childbirth. Certain costs of the hospitalisation and the pre- and follow-up treatment will be reimbursed by such an insurance policy.

How does it work?

In case of hospitalisation due to illness or an accident, or for childbirth, the expenses can be considerable. The statutory health insurance only partly reimburses the costs. Patients can protect themselves against often considerable and unexpected costs of hospitalisation by taking out supplementary hospitalisation insurance for themselves and, if so desired, for the members of their families, with a private insurance company or an insurer belonging to a health insurance fund.

Hospitalisation insurance is often subscribed individually. However, sometimes the employer provides employees (and, if they so wish, the members of their families) with such insurance through a collective insurance policy.

What rules apply?

Taking out hospitalisation insurance is not compulsory. It is supplementary to the legally mandated health insurance, for which the insured person and the members of his or her family join a health insurance fund of their choice.

The legislation provides for a number of mechanisms to ensure the protection of holders of an individual hospitalisation insurance. Thus the insurer may not put an end to the insurance contract without valid reason, nor alter the premium, the payments or the deductible, except in exceptional circumstances. The premium is to be calculated by reference to the individual situation of the insurance policyholder (age, health, etc.)

Before taking out hospitalisation insurance, it is important not only to verify what claims are covered, but also to check what claims are excluded from the insurance (such as pre-existing conditions) and to verify whether the contract specifies maximum amounts of compensation.

Within the limits established by the contract, the hospitalisation insurance provider reimburses the amounts not repaid by the compulsory health insurance. Moreover, a deductible often applies. In that case, the insured person will have to bear part of the costs him/herself.

What does the FSMA do?

The FSMA supervises compliance with the insurance legislation, in particular by verifying the clarity and comprehensibility of insurance documents.