Compulsory health insurance through a health fund

Belgium has compulsory health and disability insurance, supervised by the national institute for health and disability insurance, known as INAMI in French and RIZIV in Dutch. The benefits are paid by health insurance funds, the mutualités or ziekenfondsen, under INAMI’s control. A person must join a fund to have care reimbursed or to receive sickness, maternity, birth and adoption allowances, and the fund checks that they meet the conditions.

There is a choice of fund. Most belong to five national unions tied to Belgium’s traditional pillars: Christian, socialist, liberal, neutral and independent. The alternative is the public auxiliary fund (CAAMI in French, HZIV in Dutch), which gives the same compulsory benefits, charges no membership fee and offers no complementary cover. Members of the other funds pay a membership fee that opens their fund’s complementary services.

From DIMONA to cover: how a new hire is enrolled

When a job begins, the employer files a DIMONA hiring declaration. That alerts the employee’s health fund, which invites them to register as an insured worker; an INAMI circular from 2022 says the fund makes contact within 60 days. Cover depends on social security contributions paid to the National Social Security Office (ONSS, or RSZ in Dutch) reaching a minimum amount.

There is no separate health premium on the payslip. Health insurance is financed through general social security contributions. Federal employment guidance gives the private-sector employee’s personal contribution as 13.07% of gross salary as of 2026, lower for low earners; check the current figure. The employer pays its own contribution on top, at a rate that depends on structural reductions, so ask for the figure that applies. Nobody can opt out of compulsory health insurance on income grounds.

Dependants on the employee’s rights

Dependants, the personnes à charge, receive care on the insured person’s rights. INAMI lists children under 25, a spouse or one cohabiting partner, and parents among them. Adult dependants must live with the insured person and stay under an income ceiling, which does not apply to children. Registration goes through the employee’s own fund, so it is worth asking an incoming hire early whether a partner or children will rely on their cover.

Hospitalisation insurance: Belgium’s usual top-up

The supplementary cover Belgian employees most often expect is hospitalisation insurance (assurance hospitalisation or hospitalisatieverzekering). The FSMA, which supervises insurance conduct, describes it as optional cover that tops up compulsory insurance for hospital stays caused by illness, accident or childbirth, and for some care before and after a stay. It can include family members, and employers sometimes provide it through a group policy. For individual policies, the insurer may not cancel the policy without valid reason or change the premium, benefits or deductible except in exceptional cases.

Two rules shape the cost. ONSS instructions treat employer premiums for hospitalisation insurance as outside remuneration, so no social contributions are due on them, when the benefits complement a social security benefit, for individual and group policies alike. Separately, INAMI applies a 10% contribution to hospitalisation insurance premiums, employer-paid and employee-paid, when the daily benefit is at least 12.39 euro; that is the rule INAMI states as of 2026, so check the current figure. Do not assume an employer-paid policy is free of income tax for the employee.

An international plan as an addition, and who may provide it

Health fund membership and ONSS contributions are compulsory for a Belgian employee, so a global plan cannot replace them. It can sit on top, much like hospitalisation insurance does, with the extra cover set by the plan the insurer offers.

Insurance conduct in Belgium is supervised by the FSMA, while the National Bank of Belgium handles prudential supervision of insurers. INAMI’s rules expressly deal with hospitalisation policies taken out across borders, where its 10% contribution still applies and is withheld by a Belgian intermediary or by the foreign insurer itself. Whether a particular insurer from outside the EU can cover a Belgian resident directly is for the insurer to confirm.

Why an employer of record needs care in Belgium

Belgian law, the Law of 24 July 1987, bans in principle putting workers at another company’s disposal when authority over them passes to the business using them. The federal employment service describes narrow exceptions: licensed temporary agency work, and limited loans of staff approved in advance by the labour inspectorate. If an arrangement breaks the rule, the business using the worker and the worker are treated as bound by a permanent employment contract from the start of the work.

That makes an employer of record arrangement in Belgium something to structure carefully rather than a quick route to a hire, and whether a given model fits an exception is a legal question. Before any engagement, check the hiring structure and the tax on any benefit with a local adviser or tax professional. Whoever lawfully employs the person files DIMONA and pays ONSS contributions, and that is what gives the employee compulsory cover through their chosen fund. Our guide to health coverage for EOR staff and contractors abroad explains who arranges cover under each route, and insurance changes for remote teams covers the US commercial lines a hire abroad can affect.

Getting an introduction for a Belgian hire

We do not place health plans. For international cover that adds to the Belgian system for someone on your team, we can introduce you to a benefits partner that handles health coverage for international and remote teams. Through the quote form on this page, tell us where in Belgium the person lives, your headcount outside the US, which dependants would be included and how the person is or will be employed, and we will hand the request to the partner. Eligibility, plans and pricing rest with the partner and the insurer.

Hiring in neighbouring countries as well? See the pages for the Netherlands, France and Germany, the Europe comparison, the international overview or the employee benefits hub.

A few useful answers

Common questions

Does an employee in Belgium have to join a health insurance fund?

Yes. To have care reimbursed or receive sickness and maternity allowances, a person joins a mutualité or ziekenfonds, or the public auxiliary fund. The employer’s DIMONA declaration starts the process.

Is there a separate health premium on a Belgian payslip?

No. Health insurance is financed through general social security contributions paid to ONSS by the employee and the employer.

What is hospitalisation insurance in Belgium?

Optional cover that tops up compulsory insurance for hospital stays from illness, accident or childbirth. Employers sometimes provide it through a group policy, and INAMI applies a contribution to the premiums.

Can a US company use an employer of record in Belgium?

Only within narrow limits. Belgium bans lending workers to another company in principle, with narrow exceptions such as licensed temporary agency work, so whether a given employer of record model is lawful is a legal question to settle before the hire.

Can an international plan replace Belgian health insurance?

No. Fund membership and social security contributions are compulsory, so a global plan can only add to them.

International Health Insurance for Remote Employees in Belgium