Third party paying arrangement
With the 'third party paying scheme' (also called 'third party paying scheme') you only pay your co-payment to your healthcare provider (GP, dentist, specialist). That is the part of the costs that is not reimbursed by CM.
The remainder of the amount (of the official fee) is settled directly between the healthcare provider and CM. You don't have to do anything for this yourself.
The scheme does not apply to fee supplements those partially contracted or non-conventional healthcare providers can ask. These are always paid in full by you.
All healthcare providers can apply the paying third party scheme. In many cases, application of the scheme is even mandatory.
Important : do you need proof of your hospitalization insurance ? Create an account on My CM so that you can track and view the refunds. Sometimes the healthcare provider will also give you proof of the cost of your treatment. You can add this piece of evidence to the overview of your reimbursed services.
Take your eID with you
Take your electronic identity card (eID), ISI+ card, Kids ID or a recent yellow sticker with you when you go to a healthcare provider.
Check by your healthcare provider
For example, your healthcare provider looks at your health insurance fund data via a secure network. This states whether your health insurance is in order and whether you have the increased allowance (VT status). In that case, there is a code at the bottom of your yellow sticker that ends with 1.
When is it mandatory?
Are you entitled to increased compensation (VT status)? Then your GP is obliged to apply the paying third party scheme for your consultations.
- All general practitioners are obliged to do this, whether they are contracted or not. With the 'Look up healthcare providers' application you can check for yourself whether healthcare providers are conventional or not.
- The paying third party scheme applies to consultations and technical services during consultations (e.g. sutures).
- Even if you do not wish this, your GP must apply the paying third party scheme.
- Exception: GPs may apply the scheme for home visits , but are not obliged to do so, even if you have the increased allowance.
In addition, the application of the paying third party scheme is also mandatory:
- for remote consultations ;
- for the care charged in the event of a hospitalisation ;
- for organized mammographic breast cancer screening ;
- for certain dental care for cancer patients or anodontia (the dentist may not charge a supplement);
- for stoma equipment (art.27);
- if you ask your healthcare provider to apply the scheme to monitor your type 2 diabetes (102852).
When is it not mandatory?
- The third party paying scheme is optional for all benefits in kind for which it is not mandatory.
- In that case, the care provider freely chooses whether to apply the scheme or not.
- The paying third party scheme is often applied in pharmacies and home nursing.