Is outpatient care covered by your hospitalisation insurance?

Health insurance companies use the term ‘outpatient care’ regularly. But what exactly is outpatient care? Below you can read what outpatient care is, about the difference between outpatient care and a day admission, and when you get reimbursed for outpatient expenses.

What is outpatient care?

Outpatient care refers to medical expenses that do not require hospitalisation. Examples include medication, the purchase of glasses or lenses or a visit to a physiotherapist.

What is the difference between outpatient care and day admission?

For minor procedures such as treatment of varicose veins, wisdom teeth extraction or keyhole surgery, you are often admitted to hospital for a few hours or a day. Is an overnight stay in hospital not required? In that case, we refer to it as day admission.

Day admission is not the same as outpatient care (which you can also get in hospital). You will normally be reimbursed for most expenses of day hospitalisation if you have hospitalisation insurance.

Outpatient treatment expenses in hospital are only reimbursed through your hospitalisation insurance if there is a connection with a recent hospital admission. Suppose your child falls and is taken to the hospital emergency department to treat the wound. Your child can return home after receiving treatment and does not need to be hospitalised. The cost of care and any transport via ambulance will then fall under the heading 'outpatient care' as there is no hospital admission.

When do you need hospitalisation insurance? 

Find out in our free e-book.

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Are outpatient treatments covered by your hospitalisation insurance?

Some types of care may well be covered by your hospitalisation insurance, if they are linked to a hospital admission. These treatments are called pre-admission care and aftercare: the care you receive before and after a hospital admission. Medical expenses can be reimbursed as pre-admission care and after care if:

  • They were performed within the period covered by your hospitalisation insurance
  • They are linked to the diagnosis for which you were admitted.

Need advice or guidance?

Have a question about our Hospitalia policy plans, cover or price? Not sure whether a cost will be reimbursed through your hospitalisation insurance? We are happy to help you. contact one of our customer advisers through one of several channels. We will look at your questions together.

Helan Independent Health Insurance Fund is the insurance agent (n° CDZ 5006c) for ‘MLOZ Insurance’, the VMOB of Independent Health Insurance Funds, (Register of Legal Entities in Brussels, 422.189.629, recognised under no. CDZ 750/01 for branches 2 and 18). View the data sheet and the General Terms and Conditions. Belgian law applies to the insurance contract. The term of the contract is whole life. In the event of any complaint, contact the complaints department of Helan Health Insurance Fund or the insurance ombudsman. For more information about purchasing this/these product(s), please contact Helan Health Insurance Fund. Helan Onafhankelijk ziekenfonds, Boomsesteenweg 5, 2610 Wilrijk, 0411.696.011, RPR Antwerpen,