Targetting PMI in the Benelux region

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The Benelux region is popular with expatriates and most health cover is provided by insurance. Tim Mutton, therefore, outlines what brokers need to know about providing medical insurance in the area.

The three countries that make up the Benelux region Belgium, Holland and Luxembourg are all popular destinations for expatriates. In addition they all provide a base for the European Union government departments as well as many European corporate headquarters for companies including Shell, Unilever, General Electric and IBM.

Belgium and the Netherlands ranked within the top 25 countries to live in, according to the HSBC Expat Explorer survey 2010, with both offering high standards of living, while their economies were ranked six and eighth in the world, according to Ernst & Young.

English is widely spoken and, with each country providing healthcare under insurance-based schemes, there are many opportunities for intermediaries to create partnerships with providers and, in particular, through corporate clients, to target expats.


Belgium and the Netherlands ranked within the top 25 countries to live in.

Health insurance in Luxembourg
Health insurance is mandatory in Luxembourg. Basic cover is provided by social security with contributions paid by both employers and employees. Non-working foreigners must produce proof of health insurance to obtain a residence permit. Working expatriates who qualify for ‘non-resident' tax status, may not be required to contribute to national social security if they are covered by employer's healthcare plans, if not they must arrange a private plan.

Accessing healthcare in Luxembourg
Hospital services are good although there are no private hospitals in Luxembourg. All are run by the state and non-emergency hospital admissions arranged by GPs.

The policyholder pays the doctor directly and is reimbursed by their insurer. This is similar for dentists, although major dental work needs to be pre-approved by the insurance company or national health service. And drug sales are strictly regulated in Luxembourg, whether over the counter remedies or a prescription.

Opportunities in Luxembourg
The individual client relocating to Luxembourg must have evidence of health cover before entry so they should be advised to have a suitable plan before they leave. There are also opportunities for intermediaries to set up appropriate cover for their company clients expanding into Luxembourg.

Drug sales are strictly regulated in Luxembourg, whether over the counter remedies or a prescription.

Health insurance in Belgium
Health insurance is compulsory in Belgium and basic cover is provided by the national social security system, with contributions paid by both employers and employees.

All employees and self-employed people in Belgium must contribute to a health insurance fund (mutualité/ziekenfonds) as part of the normal social security enrolment process. After enrolling into the fund there is a six-month waiting period before a claim can be made unless the client was previously covered by a state health care plan in another EU country.

For most medical services, the bill must be paid and receipt submitted for reimbursement. Reimbursements are usually less than the charges incurred, and most Belgians take out supplementary health insurance to upgrade their cover.

Most Belgians take out supplementary health insurance to upgrade their cover.

Accessing healthcare in Belgium
In Belgium there are two kinds of hospitals. An hôpital or ziekenhuis has its own staff on duty 24 hours a day. A clinic (clinique/kliniek) is private with its own staff to provide patient services, but where GPs are in charge of patient care.

A Belgian identification card or passport as well as a SIS (Système d'Information Sociale) card is required for anyone treated under the public health system. Proof of private health insurance may also be needed although not all hospitals accept insurance plans.

Patients pay a deposit when admitted to hospital and pay the bill weekly unless the hospital has arrangement for the insurer to bill them directly.

It is normal practice in Belgium to pay the doctor directly for both regular consultations and services. Doctors normally only accept payment in cash or by cheque and provide a reimbursement receipt.

 It is normal practice in Belgium to pay the doctor directly for both regular consultations and services.

Dentists are paid directly for their services and also provide a receipt for reimbursement. Major dental work requires pre-approval whereby the dentist submits a proposal to the insurance company or national health service.

The selling of drugs and medicines is strictly regulated , whether over-the-counter remedies or prescriptions. A chemist or pharmacy (pharmacie/apotheek) is often the only place to buy medicines.

The health insurance opportunity in Belgium
Belgium's mandatory health insurance fund means there is access to healthcare domestically after a six-month waiting period. There are opportunities for intermediaries with expat clients who want more immediate access to healthcare, or for those who want to return home for treatment.

Health insurance in the Netherlands
In the Netherlands, the government is not in charge of the day-to-day management of the healthcare system. Private contractors are responsible for the provision of services and the government for accessibility and quality.

Expatriates paying income tax are obliged to purchase health insurance from a Dutch insurance company. Failure to do so can result in a fine. Foreigners who settle in the Netherlands and remain while receiving an income from abroad, however, are not always required to purchase local insurance. Their length of stay determines this.

The government has defined a basic package and health insurers are legally obliged to offer at least this level of cover, which includes GP care, medical specialists and obstetricians, hospital stay, dental care, medicines, prenatal care, patient transport and paramedical care.

Fees for the basic health insurance package (circa €95 per month) are annually determined by insurers. Although the Ministry of Health set a standard premium, the insurers determine the additional fee to be paid by charging a certain rate and a no-claim charge. It is with these additional fees that the insurance companies compete with each other.

Expatriates paying income tax are obliged to purchase health insurance from a Dutch insurance company.

Identification is required before receiving treatment. Prescriptions should be taken to the apotheek (pharmacy) and the cost of prescribed medicines are refunded by the insurance.

Opportunity in the Netherlands
All residents must have a local health insurance plan from a local insurance provider as a minimum. For expat clients who want to access healthcare in their home country or any other European country, an international plan may be a good top-up solution.

It's true that the Benelux countries, while so close to each other geographically, have very different approaches to the provision of healthcare. However, the opportunities for growth in this region are there for those intermediaries that have a growing book of expat clients.

Tim Mutton is European business development director at Now Health

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