Complementary payment

Beneficiary

Article 154bis of the CNS statutes states that within any calendar year (1st of January to 31st of December), the total/maximum personal participation of the insured person to healthcare services may not exceed the limit of 2.5% of their annual contributory income for the previous year.

If this threshold is exceeded, the insured person may request an additional refund for the portion of their participations that exceed this threshold.

Paiement complémentaire Art154bis

Verification of the total participation of an insured person at a given point in time

The "complementary payment" section on the back of each reimbursement statement contains details about the total value of the insured person's participation to the services set out in article 154bis on the date concerned, for both the current year (Y) and the previous year (Y-1).

Insured person Year Y-1 Year Y
Matricule ...€ ...€

The values shown represent the insured person's personal participation to healthcare services up to the date of the statement concerned for the respective year.

Important note: the value of the insured person's participation for the previous year may still vary/increase:

If the insured person sends a refund request in 2016 (the current year) for services received in 2015 (the previous year), their personal participation to these healthcare services will be added to the total value of their personal participations for 2015 (the previous year) and will appear on the reimbursement statement.

Services and supplies included in the personal participation

The insured person's personal participations to the following services and supplies are taken into account:

  • Medical treatments;
  • Dental treatments excluding prosthetic treatments;
  • Services provided by nurses;
  • Services provided by dieticians;
  • Physiotherapy and massage treatments;
  • Speech and language therapy treatments;
  • Midwife treatments;
  • Psychomotor therapy treatments;
  • Medical thermal cures;
  • Costs associated with orthopaedic prostheses, ortheses and craniofacial prostheses;
  • Pharmaceutical products;
  • Medical equipment and devices covered by the health insurance.

The monthly contributory income figure is the figure shown on the monthly pay slip/pension statement.

Calculating the insured person's total/maximum participation

Calculation for applications from 2018/2019

The calculation is based on the individual's annual contributory income for the previous year. This is calculated by adding together the individual's monthly contributory income for each of the 12 months concerned. In this case, the monthly contributory income may not be lower than the Guaranteed Minimum Income (RMG). If, for example, the total monthly income is lower than the RMG, the monthly contributory income will be virtually increased to the RMG level.

Example: Income below the RMG. The RMG is taken as the contributory income.

For an individual who earns €1,250 gross per month throughout the year, the 2.5% threshold will be calculated as follows:

RMG on 01.01.2016 for a single person: €1.348,18

1.348,18*12*2.5%=404,40

 

Example: Income above the RMG. The actual income received is taken as the contributory income.

For an individual who earns €2,500 gross per month throughout the year, the 2.5% threshold will be calculated as follows:

12 x €2,500 x 2.5% = €750 = the individual's maximum participation

When the personal participations within a given calendar year exceed this amount, the person may request a complementary reimbursement. The part which exceeds this amount will be reimbursed.

As such, the higher the person's income, the higher their maximum participation. Since the contributory income cannot be less than the RMG, 2.5% of the RMG may be taken as a practical baseline figure. There is no need to request an additional refund if the total value of the personal participation is below this threshold, i.e. €404,40.

Calculation for applications from 2020 onwards

The calculation is based on the individual's annual contributory income for the previous year. This is calculated by adding together the individual's monthly contributory income for each of the 12 months concerned. In this case, the monthly contributory income may not be lower than a minimum threshold in the amount of 1501,65 (to the index of 834,76 as of 1 January 2020). If, for example, the total monthly income is lower than the minimum threshold, the monthly contributory income will be virtually increased to the amount mentioned above.

Example: Income below the minimum threshold. The amount of 1501,65 is taken as the contributory income.

For an individual who earns €1.250 gross per month throughout the year, the 2.5% threshold will be calculated as follows:

The minimum threshold for a single person: €1.501,65

1501,65*12*2.5%= €450.50

 

Example: Income above the minimum threshold. The actual income received is taken as the contributory income.

For an individual who earns €2,500 gross per month throughout the year, the 2.5% threshold will be calculated as follows:

12 x €2,500 x 2.5% = €750 = the individual's maximum participation

When the personal participations within a given calendar year exceed this amount, the person may request a complementary reimbursement. The part which exceeds this amount will be reimbursed.

As such, the higher the person's income, the higher their maximum participation. Since the contributory income cannot be less than the minimum threshold, 2.5% of this minimum threshold may be taken as a practical baseline figure. There is no need to request an additional refund if the total value of the personal participation is below this threshold, i.e. €450.50

In order to determine whether the insured person exceeds the limit, the participations of the insured person and their co-insured as defined in article 7 of the Social Security Code are being totalled.

A new request must be submitted each year.

Procedure for requesting complementary payment

If the insured person believes that they have reached the relevant threshold, they can submit their complementary reimbursement request. Requests for the current year may be submitted no earlier than 1st of May of that year.

Example: Threshold exceeded before 1st of May of the current year.

In the beginning of the current year, the insured person finds that the value of their personal participation for the current year, as shown on the final line of the "complementary payment" section on the back of the reimbursement statement, has already exceeded their maximum participation based on their contributory income for the previous year.

The insured person may then submit a refund request no earlier than 1st of May of the current year. They will receive a refund for the amount they have paid above the threshold up to that date. This request is applicable for the entire year. The insured person will not need to submit a new request until the following year.

Example: Threshold exceeded after 1st of May of the current year.

The insured person's total personal participation exceeds the threshold at any point in 2016. They may submit a request up to and including 31/12/2018.

Similarly, the insured person notices during 2016 (current year) that their personal participations for 2015 (previous year), as shown on the first line of the "complementary payment" section on the back of the CNS reimbursement statement, exceeded their threshold as a result of a refund request submitted in 2016 for a service delivered in 2015. In order for the insured persons request to be valid, they must submit it before the end of the second calendar year following the year in which they reached the threshold.

 

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