To determine where you are subject to social security (including health insurance), two factors are important:

• Your work situation (paid employment, self-employed, unemployed, seconded, etc.)
• Country where you live (not your nationality)

There are several systems of public health insurance:

• Reimbursement principle (cfr. Belgium): mandatory, (partial) reimbursement of costs
• Natura principle (cfr. Spain): care provided by the government (public doctors, hospitals, etc.)

Working abroad

If you are employed or self-employed in another EU country, you have to register with the social security system in your host country. You and your dependants consequently are subject to the social security system of that country.

Seconded abroad

If you are seconded to another country for less than 2 years, you can remain insured in Belgium. Ask your Belgian health insurer for a S1 form and a European Health Insurance Card (EHIC). This entitles you and your dependants to healthcare in the host country.

If you still want to be entitled to social security rights in Belgium, you will need an A1 form. As an employee, you ask your employer for this. As a self-employed person you have to apply to your health insurer. During your foreign stay, you should also be able to show the A1 form at any given time.

Are you seconded for more than 2 years?

You can apply for an exemption to remain subject to the Belgian social security system for the duration of your secondment. An exemption can only be granted with the consent of both countries concerned and is only valid for a certain period of time. If you are not granted an exemption, you are obliged to switch to the local social security system and pay contributions there. If you do not want this, you have to stop working in your host country for at least 2 months.

Transborder employee

If you work in one country and live in another, you are entitled to medical treatment in both countries. You have to register with a health insurer in your country of employment and then apply for an S1 form there. This form allows you and your dependants to register for health insurance in your country of residence.

Retired

If you receive a pension from your country of residence, the health insurance of that country covers the medical costs, regardless of whether you also receive a pension from another country. If you do not receive a pension from your country of residence, you will be covered by the health insurance of the country where you have been insured the longest. Apply for an S1 form from your health insurer and give it to the health insurer in the host country upon arrival. The form entitles you to health insurance in the country where you are staying.

If you live abroad as a pensioner, there is no right to reimbursement of your medical expenses for health care at the expense of Belgium. However, there is an exception if you as a pensioner meet the same conditions:

• • live in a country that applies the European regulations or in a country Belgium has concluded an agreement with that includes healthcare (Algeria, Bosnia-Herzegovina, Kosovo, Croatia, Macedonia, Montenegro, Serbia, Tunisia, Turkey)

AND

• do not receive a pension from your country of residence

Tip: Contact your Belgian health insurer/mutuality in due time before you leave. Explain your situation clearly and ask what you have to do.

Sources:

https://europa.eu/youreurope/citizens/work/unemployment-and-benefits/country-coverage/index_nl.htm

https://europa.eu/youreurope/citizens/health/when-living-abroad/health-insurance-cover/index_nl.htm