08-06-2007
The Royal Decree of April 1, 2007 determining the conditions for granting a higher insurance reimbursement, addressed in article 37, §§ 1 en 19, of the Law regarding the mandatory insurance for medical care and social benefits, coordinated on July 14, 1994, and the introduction of the OMNIO benefits (BS 03-04-2007)
As from July 1, 2007 the OMNIO benefits are added to the mandatory health care insurance. People who are granted these benefits will receive a higher reimbursement for medical care from their health insurance. The system of higher reimbursement has existed for many years but has applied only to people who were granted the WIGW benefits in the past, and specific groups of people with a low income. However, the OMNIO benefits will be applied to all people with a low income.
– Who is eligible?
The benefits are granted to all families with a limited income. Income is the only condition taken into account. In order to be eligible, the gross family income of 2006 should be under 13,312.80 euro, increased with 2,464.56 euro per additional family member. All taxable gross incomes are taken into account: company and professional incomes, incomes from movable assets and real estate, foreign incomes, pensions, social security payments, … The calculation of the family income is based on the total of all people who lived at the same address on January 1, 2007 according to the civil register (whether or not there is a family relation). In certain circumstances people who are depending on health care can be considered a separate family. More specifically, this is relevant to disabled people and people with chronic illnesses who live in a family whose income is higher than the maximum amount.
– What benefits?
Every person with OMNIO benefits, as well as their family members, is granted a higher reimbursement amount. This means that for medical care they pay a lower patient contribution. The person with OMNIO benefits will also be taken into account for the so-called social maximum bill and some hospital supplements cannot be charged.
– When can the OMNIO benefits start to apply?
As from July 1, 2007 people can be granted the OMNIO benefits, if they applied for them before June 30. You can apply for the benefits from last April 2 onwards.
Whoever applies for the benefits after June 30, this year, can be granted the benefits from the first day of the quarter following the application date. An application done in July, for example, can only be granted from October.
The benefits are valid until the end of the calendar year in which the application was filed.
– How to apply?
The OMNIO benefits have to be applied for by filling out a standard form that is available at every health insurer. This form is a formal sworn declaration mentioning the gross taxable incomes of all family members (in 2006). Every application has to contain a copy of the last tax assessment notice and the payslips of all family members.
Who is already granted the higher reimbursement amount, does not have to do anything. This system will continue to apply to them as long as they meet the income criteria for the OMNIO benefits.
Pay attention! Your health insurer might not be aware of the fact that you apply for the OMNIO benefits. If you think you meet the requirements, it is better to file an application yourself.
– Reimbursement of incorrectly paid amounts
If inspection shows that someone was incorrectly granted the OMNIO benefits because he or she did not mention the real income, the incorrectly paid amounts are to be reimbursed. If the sworn declaration was incorrect, the Law prescribes a fine.
Translation: Magali
Source: Quick messages, VIBEG vzw