CM insurance

No, you do not have to report your admission to CM's insurance companies in advance.

No, anyone who is affiliated with CM-Hospitaalplan will not receive a ticket for this. So you don't have to bring anything with you, hand it in or mention anything at the hospital.

You can freely choose your hospital, unless you are transported by 112 in an emergency.

If your doctor is affiliated with a hospital, your freedom of choice is also limited. In principle, your doctor contacts the hospital to record the admission and make the necessary medical arrangements (e.g. reservation of an operating room).

You can compare hospital rates with the ' Compare Hospital Rates ' application.

A hospital is an institution that is legally recognized and where scientifically proven diagnostic and therapeutic resources are used.

The following institutions are not considered hospitals:

• medical-pedagogical institutions;
• retirement and care homes, rest homes for the elderly and hospitals and parts of hospitals that have special recognition as RVT;
• thermal treatment institutions;
• rehabilitation centers;
• sanatoriums and preventoria;
• psychiatric care homes;
• private practices not recognized as general hospitals.

You make a number of choices on the admission statement that have an important influence on the final cost. The document is not specifications, the hospital cannot predict all costs in advance. But it is binding. So read the admission statement thoroughly before signing it and keep your copy carefully.

CM-Hospitaalplan reimburses costs outside Belgium up to 1,000 euros per calendar year and per insured person. As a CM member you also enjoy travel assistance abroad.

There is no reimbursement for planned hospitalizations outside Belgian territory for which permission has not been given by CM's consulting physician.

In principle, your doctor decides on the duration of your stay. But as a patient you have the right to leave the hospital whenever you want.

If this happens against the doctor's advice, you must sign a document stating that you are leaving at your own risk. The doctor then declines all responsibility for the consequences of your departure.

Yes, the hospital may request an advance. The amount depends on your room type and is stated on the admission statement. After seven days, the hospital can ask you for a new advance. The amount may be higher if you do not have health insurance in order.

A hospital may not refuse you admission (in a communal room), even if you cannot pay the advance.

You will find a list of the items on the payment overview via this link.

The maximum reimbursement is 22,000 euros per member per calendar year for both hospital admissions and pre- and post-treatment.

The reimbursement for admission to a psychiatric hospital is always limited to 1,250 euros per insured person and per calendar year.

The limitation of 1,250 euros does not apply to admission to a psychiatric department of a general hospital (PAAZ). The admission and the costs of pre- and post-care are reimbursed without limitation:

• child neuropsychiatry (K, service code 340);
• day care in a K service (K1, service code 350);
• night nursing in a K shift (K2, service code 360);
• neuropsychiatry service (A, service code 370);
• day care in an A-shift (A1, service code 380);
• night nursing in an A-shift (A2, service code 390);
• psychiatric service (T, service code 410);
• day care in a T-shift (T1, service code 420);
• night nursing in a T-shift (T2, service code 430);
• intensive treatment service for psychiatric patients (IB, service code 480);
• psychogeriatric disorders service (S6, service code 660).

Half of the daily rate for your recovery stay in Ter Duinen (Nieuwpoort), Hooidonk (Zandhoven) and Nivezé (Spa) is reimbursed for a maximum of thirty days per calendar year. Always provide CM with proof of these costs, together with this completed form .

Since January 1, 2023, costs for reception and care in a short stay are reimbursed at 50% of the amount actually paid, with a maximum of 15 euros per day of short stay with overnight stay, for a maximum of 28 short stay days with overnight stay per calendar year.

Have you received your hospital bill? Take them by the hand and start filing the tax return. You do not need a scanner or camera for this, the declaration is made on the basis of the invoice number.

Here you will find a video that shows you step by step how it works. After the declaration, you will receive a payment overview and the refund on your account number.

Can't you submit your tax return digitally? Then print the declaration form , complete it and deliver it signed together with your hospital invoice by e-mail or via a CM mailbox .

Reimbursement will not be made automatically for the costs below. Always provide CM with proof of these costs, together with this completed form.

• invoices for urgent patient transport (100 or 112 transport)
• invoices from the recognized recovery centers Ter Duinen in Nieuwpoort, Hooidonk in Zandhoven and Domaine de Nivezé in Spa
• remaining medical costs after reimbursement by another hospitalization insurance

Please note that CM-Hospitaalplan also provides reimbursement for the costs of examinations directly related to your hospital admission, 1 month before and 3 months after your admission. Please note: this does not apply to all day admissions.

All co-payments and reimbursable supplements such as GP visits, medicines, follow-up appointments in the hospital or specialist's practice, laboratory costs, etc. are automatically reimbursed. So you don't have to take any action yourself. You can of course still submit doctor's certificates via the CM mailbox.

The CM Insurance service automatically processes all these related costs at the following times:

• 4 months after your discharge from the hospital
• 7 months after your discharge from the hospital

You will receive a reimbursement of the costs of your admission (according to the hospitalization guarantee). You will not be reimbursed for costs during the pre- and post-treatment (1 month before to 3 months after admission).

You will receive a reimbursement of the costs of your admission (according to the hospitalization guarantee). You will not be reimbursed for costs during the pre- and post-treatment (1 month before to 3 months after admission).

• The co-payment and the flat rate for your medicines will be fully reimbursed, regardless of your room choice.
• The room supplement for your single room will be reimbursed up to 55 euros per day.

• The costs for an overnight stay for one person in a member's hospital room will be reimbursed up to 35 euros per day.
• The accommodation costs associated with the donorship that are medically required for the treatment of the member will be fully reimbursed

• Fertility treatments
  This applies to both the (day) admission and the pre- and post-treatment (from 1 month before to 3 months after the procedure). The total reimbursement is limited to 1,000 euros per insured person, regardless of the number of fertility treatments.
   
• Breast reductions
  During the first three years of your membership with CM-Hospitaalplan, the costs are reimbursed in the same way as a pre-existing condition. Afterwards, they will be reimbursed according to the reimbursements for hospital admission and pre- and post-treatment. The total reimbursement is always limited to 1,000 euros per insured person.
   
• Procedures to treat obesity (e.g. liposuction, gastric banding, etc.)
  During the first three years of your membership with CM-Hospitaalplan, the costs are reimbursed in the same way as a pre-existing condition. Afterwards, they will be reimbursed according to the reimbursements for hospital admission and pre- and post-treatment. The total reimbursement is always limited to 1,250 euros per insured person.

CM-Hospitaalplan reimburses the following costs that are directly related to your home birth and that occur from 1 month before the birth until 3 months afterwards:

• co-payment for medical care and treatment;
• fee supplements (up to 100% of the established rate);
• reimbursable medicines.

A lump sum of 100 euros is awarded for the costs of medical-technical aids.

If you want to limit your hospital bill for breast reconstruction, choose a hospital that has signed an agreement with the Riziv .

In these hospitals, expensive (aesthetic) supplements are prohibited for breast reconstruction with your own tissue in a double room. The charging of supplements in a single room is limited.

These supplements are reimbursed from CM-Hospitaalplan in accordance with the provisions of the general terms and conditions.

• Medicines - for which there is also reimbursement from the compulsory health insurance - are fully reimbursed from 1 month before to 3 months after the hospital admission.
• Non-reimbursable medicines are not reimbursed by CM-Hospitaalplan in the period from 1 month before to 3 months after the hospital admission.

Plaster material - for which there is also a reimbursement from the compulsory health insurance - is fully reimbursed.

The first refundable prosthesis or the first refundable orthopedic device prescribed by a doctor will be fully reimbursed.

The first prosthesis or orthopedic device is also reimbursed up to 3 months after hospital admission if not placed during the admission itself.

• Implants - for which there is also reimbursement from the compulsory health insurance - are fully reimbursed from 1 month before to 3 months after the hospital admission.
• Non-reimbursable implants and parapharmaceutical products (e.g. support stockings, cervical collars) are fully reimbursed up to 2,500 euros per hospitalization if they can be legally charged and this for the period from 1 month before to 3 months after the hospital admission.

Only the costs related to your (day) admission for dental care and the removal of wisdom teeth will be reimbursed. This does not include the costs during the pre- and post-treatment.

In the event of hospitalization due to a serious illness or accident requiring dental care, the pre- and post-care costs are also reimbursed.

With a few exceptions, there is no reimbursement for dental implants.

Yes, these costs are fully reimbursed, from 1 month before admission to 3 months after hospital admission.

Fee supplements are reimbursed up to 100% of the established rate, regardless of room choice. Fee supplements from 1 month before hospital admission until 3 months after admission will also be reimbursed up to 100% of the established rate.

The franchise, which is only applied to the reimbursement of fee supplements for admissions to a single room, is:

• 0 euros for a hospital admission for childbirth;
• 100 euros per hospital admission for a traditional admission with an overnight stay;
• 175 euros per hospital admission for a day admission.

These franchises are applicable per hospital admission with a maximum of 350 euros per calendar year.

Fees for services that may be legally charged but that the statutory health insurance does not reimburse are reimbursed up to 200 euros per hospital admission if they do not fall under the insurance exclusions.

• malignant tumors (e.g. cancer);
• malignant blood diseases (e.g. leukemia, Hodgkin's disease);
• neuromuscular disorders such as MS (multiple sclerosis) and ALS (amyotrophic lateral sclerosis;
• Parkinson's disease;
• meningitis;
• AIDS;
• liver cirrhosis due to hepatitis;
• diabetes type 1;
• kidney disorders requiring kidney dialysis;
• cystic fibrosis;
• systemic scleroderma with organ involvement;
• Crohn's disease and ulcerative colitis.

Yes, fee supplements are reimbursed up to 100% of the established rate upon recognition of serious illness. The co-payment for medical care and treatment will also be fully reimbursed in those cases.

Medicines, implants, synthesis materials, plaster materials, stoma and incontinence materials will be fully reimbursed if health insurance also reimburses.

The rental of medically necessary equipment will be fully reimbursed in those cases. Always provide CM with proof of these costs, together with this completed form .

1. Deliver CM

• This form is signed by yourself and your GP/specialist
• a recent medical report from your specialist, which your GP can retrieve from your medical file

You can send documents to CM via [email protected] or via a CM mailbox . If necessary, you will have to apply for an extension for this recognition over time. CM will provide you with the appropriate form for this in a timely manner.

2. You will receive your refund

Once your application is approved, you will automatically receive reimbursement for outpatient costs directly related to your condition. This may include GP visits, medicines, follow-up appointments in the hospital or specialist practice, laboratory cabinets and more.

You will receive the refund every 3 or 12 months.

3. You submit other costs manually

Costs that cannot be processed automatically must be submitted manually via [email protected] or via a CM mailbox .

To do this, you complete the 'request for non-automatic reimbursement for outpatient costs' form.

You add proof of the costs incurred:

• invoices from recognized recovery centers Ter Duinen in Nieuwpoort, Hooidonk in Zandhoven and Domaine de Nivezé in Spa
• invoices for the rental of medical equipment
• invoices for urgent patient transport (100 or 112 transport)

Reimbursement will not be made automatically for the costs below. Always provide CM with proof of these costs, together with this completed form.

• invoices for urgent patient transport (100 or 112 transport)
• invoices from the recognized recovery centers Ter Duinen in Nieuwpoort, Hooidonk in Zandhoven and Domaine de Nivezé in Spa
• remaining medical costs after reimbursement by another hospitalization insurance

• Costs for the following services and their consequences and complications:
  • (purely) aesthetic care or treatment, rejuvenation treatments or care with aesthetic purposes;
  • preventive criminal investigations;
  • spa treatments (e.g. thermalism, thalassotherapy, hygienic diet cure);
  • breast enlargements;
  • treatments and medicines whose usefulness has not been scientifically proven;
  • dental prostheses and dental implants;
  • performances that are not necessary for the recovery of health;
  • costs resulting from the practice of dangerous sports and any sport as a professional activity, including training;
  • costs for deliberate medical treatments abroad without the permission of the advising physician.
• Costs resulting from:
  • wars or disasters;
  • disturbances, riots, collective violence;
  • intentional or reckless acts, bets or challenges;
  • crime;
  • drunkenness or alcohol intoxication, use of narcotics;
  • facts caused by radioactive, toxic or explosive substances.
• Costs that may not legally be charged.

We speak of a medical accident when you experience abnormal damage during medical treatment, a hospital admission or a medical examination. You can receive compensation for this. If you have a complaint about a medical accident, you can contact the Assistance to CM members service .

• The statutory co-payment for urgent patient transport (100 or 112) is reimbursed up to 250 euros per calendar year. The condition is that the transport is followed by a hospital admission guaranteed by CM-Hospitaalplan. Always provide CM with proof of these costs, together with this completed form .
• For non-urgent patient transport, there is a CM reimbursement from the CM services and benefits package .

The personal share for non-urgent patient transport requested from the Mutas service in the context of oncological treatment or kidney dialysis is reimbursed up to a maximum of 250 euros per calendar year. You do not have to provide invoices yourself, the refund will be automatic. You do need recognition of serious illness to receive this reimbursement.

The choice of room plays an important factor in the cost of your hospitalization:

• No room supplements or fee supplements may be charged in a double or multiple-bed room.
• Room and fee supplements are permitted in a single room.

If you do choose a single room, the reimbursement from CM-Hospitaalplan is limited:

• Room supplements are refundable up to 55 euros per day.
• Fee supplements are reimbursed up to 100% of the statutory rate. These supplements can be expensive at some hospitals. It is best to check this with the hospital in advance.
• In addition, a deductible is applied when staying in a single room. The deductible is 175 euros for a day hospitalization and 100 euros for an overnight hospitalization. No deductible is applied in the event of a birth.

Important: during the first three years of membership, there is no reimbursement of room and fee supplements for a single room for hospitalizations due to a pre-existing condition or illness. The admission is reimbursed in the same way as hospitalization in a double or multi-bed room. In the case of pregnancy, this applies to the first nine months of connection.

• CM Insurance Terms of Use
• General terms and conditions 2023
• General terms and conditions 2024
• Information document CM Hospital Plan