The Control Office of the Mutual Health Funds and the National Unions Mutual Health Funds
The Control Office of the mutual health funds and the national unions of mutual health funds was created in 1990. It is a public interest institution under the guardianship of the Ministry of Social Affairs. A mutual health fund is a private non-
profit association of individuals aiming at promoting the physical, psychological and social well-being, within a spirit of providence, mutual assistance and solidarity.
It is managed by a Council, composed by a chairman and six members named by the King for a renewable period of six years: two members chosen among the civil servants of the National Institute for sickness and disability insurances; one member designated by the Banking and Financial Commission; three members chosen on behalf of their legal, social, financial or actuarial skills.
Besides taking part in the execution of the compulsory insurance, the mutual health funds must at least organise a service of free or complementary insurance in order to intervene financially in favour of their members in the cost for prevention and treatment of sickness and invalidity, or allow benefits in case of disablement or when the situation is such that the physical, mental or social welfare can be improved. Additionally, they must supply aid, information, guidance and assistance in order to improve the physical, mental or social welfare.
The National Institute for Health and Disability Insurance (RIZIV/INAMI)
The National Institute for Health and Disability Insurance (INAMI) organises and financially manages healthcare insurance in Belgium.
From within INAMI the Service for Medical Evaluation and Control (SECM) is developing highly efficient systems and tools of evaluation, prevention, detection and investigation of improper use of the federal healthcare resources (€18 billion) by healthcare providers and suppliers.
This results in active surveillance of good medical practice and the imposition of appropriate sanctions.
Joining the Network has allowed INAMI to adopt “best practices” in tackling healthcare fraud in Belgium and throughout Europe.
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The Intermutualistic Agency (NIC/CIN)
The Nationaal Intermutualistisch College is an organisation in which all Belgian Sick Funds are represented. The most important role of a Sick Fund is to execute or to carry out all legal dispositions concerning the Belgian health insurance. This primarily means: managing a sizeable membership administration, reimbursing healthcare bills from all kinds of healthcare providers, and paying benefits in case of an incapacity to continue working as a contracted labourer, employee, or self-employed. These expenses are funded by Government advancement. Sick Funds must provide detailed information to the government in order to justify their expenses. Sick Funds are paid a certain fee by the Government to perform these tasks. In addition to these important tasks, every Sick Fund provides a variety of services and benefits, for which the Sick Funds ask a membership fee.
All Belgian citizens must be member of a Sick Fund of their own choice, or by default will automatically become member of a Sick Fund service provided by the government. Because Sick Funds have mutual interests, face the same problems and challenges, it is only logical they should consult with each other on different levels. The Nationaal Intermutualistisch College is the highest level of consultation between Belgian Sick Funds.
Vanbreda International
Vanbreda International has over 50 years of experience in designing, implementing and managing cross-border medical insurance and employee benefits programmes and products for international organisations, multinational corporations and their international workforce. With 379 employees, the company has offices and sales representatives in Europe (Belgium, the Netherlands, Germany, France, the UK and Switzerland), the Middle East (UAE), Asia (China, Singapore and Malaysia) and the U.S. Vanbreda International serves over 330,000 plan members on a 24/7 basis across 192 countries. In 2008 the company processed 3.6 million medical bills, totalling 410 million EUR in reimbursements.