Incapacity benefits
Report your incapacity for work and apply for your benefit at the same time. During the first year of incapacity for work, you will receive the benefit payments covering your primary incapacity for work. From the second year, you will receive " invalidity" status and therefore a invalidity benefit. The rules are different for employees, the unemployed and the self-employed.
How do you apply for a benefit?
Employed persons can receive incapacity benefits after their period of guaranteed salary. Unemployed persons can receive benefits from the first day of their incapacity for work. Self-employed persons can receive benefits from the first day of their incapacity if they are off work for more than seven days. Apply for this by filing a incapacity-for-work declaration.
Notify your health insurance fund of your incapacity in good time. That way, you can avoid any financial penalty. This declaration deadline depends on your status. Find out more about the notification period.
Your first benefit will be paid about 45 days after we receive your certificate. This is conditional on us receiving all the necessary documents correctly completed within 30 days.
Download the incapacity-for-work certificate. Have it completed by your treating physician and provide it to us digitally and in a timely manner.
Don't have a certificate of incapacity for work available?
Please ask your doctor to prepare your medical certificate (also referred to as a 'confidentiality form') with all the required details:
- your details
- the identification of the treating physician (physician recognised by the NIHDI)
- date and signature of the treating physician
- start and end date of incapacity for work
- diagnosis: reason and nature of incapacity for work
Employed and unemployed:
Fill in your information sheet via My Helan. Do this right away, so we can process your file more quickly.
Self-employed:
The health insurance fund will ask you to complete some documents:
- An information sheet with questions about your income. Please submit this digitally.
- A questionnaire regarding your professional activity. Please submit this digitally.
- A 'form 225' with questions regarding your family circumstances. Complete this digitally via My Helan.
- Or send all documents by post to Helan Ziekenfonds, Incapacity for Work Department (Dienst arbeidsongeschiktheid), Boomsesteenweg 5, 2610 Wilrijk.
The health insurance fund's medical officer must first recognise your incapacity for work.
- Your incapacity for work is recognised.
- Your incapacity for work is not recognised. If you do not agree with the decision, you can appeal to the employment tribunal.
Once your incapacity for work has been recognised, we will confirm this with a letter. After your benefit file has been reviewed, you will receive another letter notifying you of your daily amount.
Later, if necessary, the medical officer may invite you for a medical assessment.
Benefit payments in the first year
During the first year of incapacity for work, you will receive the benefit payments covering your 'primary incapacity for work&# 39;. This term just refers to the first year of your incapacity for work. The amount of your benefit payment depends on your status.
What daily wage or gross salary do we take into account?
To calculate your daily wage, we need to take into account your wages from your stable or non-stable employment. We refer to stable employment if the conditions of your employment have not changed during the two quarters prior to your incapacity for work.
In the case of stable employment, the daily wage or gross salary we are legally required to take into account is your wage on the last day of the second quarter preceding the start of your incapacity for work. Specifically, if the start date of your incapacity for work falls in:
- January, February, March: gross salary on 30 September of the previous year
- April, May, June: gross salary on 31 December of the previous year
- July, August, September: gross salary on 31 March of the same year
- October, November, December: gross salary on 30 June of the same year
In the case of non-stable employment, we take into account the daily wage or gross salary applicable at the beginning of incapacity for work.
- During the first six months:
The benefit will be 60% of your average daily wage (to a maximum cap). From the third month, you will receive the flat-rate minimum benefit if it proves more favourable. From the fourth month, this flat-rate minimum benefit is linked to your family circumstances. If you qualify, you will automatically receive ‘family circumstances inquiry document’ (document onderzoek gezinslast).
- From the seventh month:
From the first day of the seventh month, another revision of your incapacity for work benefit will take place. From then on, you will receive either 60% of your average daily wage or the minimum benefit, whichever proves more favourable. This means your benefit can increase or decrease.
To calculate your daily wage, we take into account your unemployment fund wage linked to your numerical or letter code and your salary grade unemployment amount. This is the daily amount you receive from your unemployment fund.
- During the first six months:
The benefit will be 60% of your average daily wage (to a maximum cap). If your unemployment allowance per day is lower than this 60%, your benefit will be matched to your unemployment allowance. From the third month, you will receive the flat-rate minimum benefit if it proves more favourable. From the fourth month, this flat-rate minimum benefit is linked to your family circumstances. If you qualify, you will automatically receive ‘family circumstances inquiry document’ (document onderzoek gezinslast).
- From the seventh month:
After the first day of the seventh month, another revision of your incapacity for work benefit will take place. From then on, you will receive either 60% of your average daily wage or the minimum benefit, whichever proves more favourable. This means your benefit can increase or decrease.
- Self-employed people receive a flat-rate payment, which is a fixed amount per day. That amount depends on your family circumstances.
- Fewer than seven days incapacitated for work: for short periods of illness (7 days), a so-called carensperiode (a waiting period during which you are not entitled to any benefit payments) applies. There is no entitlement to health insurance benefits for this kind of short period of illness.
- Incapacitated for work for more than seven days: the 'carensperiode' does not apply to periods of illness longer than seven days. You will receive benefits from day one.
Benefit payment from the second year
From the second year onwards, you have 'invalidity status' and therefore will receive an invalidity benefit. 'Invalidity' is a term used to describe being unable to work for more than one year. This has nothing to do with incapacity to work or disability. Invalidity benefit is also paid by your health insurance fund.
The amount of your invalidity benefit depends on your last gross salary and family circumstances:
- Employed or unemployed with dependants: 65% of the average daily wage (capped)
- Single person: 55% of the average daily wage (capped)
- Cohabiting person: 40% of the average daily wage (capped)
If you have a long-term illness, your health insurance fund can pay you the past-service bonus once a year, on top of your invalidity benefit. The past-service bonus tracks the health index and is a flat rate amount.
The invalidity benefit for the self-employed is a fixed, flat-rate, daily amount. The amount of the benefit depends on your family circumstances, and whether or not you cease your business activities.
If you have a long-term illness, your health insurance fund can pay you past-service bonus, on top of your invalidity benefit, once a year. The past-service bonus follows the health index and is a flat-rate amount.
Fixed sum for third-party assistance
Are you incapacitated and need help from others? Then you may be entitled to the additional fixed sum 'for third-party assistance'. How do you apply for third-party assistance? Who is eligible for third-party assistance? And how does it work with your tax return?
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Downloading a proof/statement of your incapacity for work on My Helan
Are you looking for a statement or proof of your incapacity for work for a certain period of time? You can easily download that yourself at Mijn Helan! You can choose between a statement with or without mention of your benefit payments.
Date of benefit payment
Are you employed, unemployed or self-employed? Indicate your employment status belowto see when your benefit will be paid. Please note that this calendar is only applicable after you have received your first benefit payment. The date of payment also differs depending on whether you have been incapacitated for work less than or more than one year.
View the calendar to track when we will transfer your replacement income to your bank. It may take a few days for the amount to reach your account, depending on your bank. As soon as we transfer the payment, you will receive an email notification. The time at which you receive this email may vary for each payment. Indicate in your profile on My Helan whether or not you want to receive a notification via email.
Please indicate your circumstances
Impact on your tax return
Both primary incapacity benefit and invalidity benefit payments are a replacement income. You have to declare your replacement income in your annual tax return.
- In the first year, a withholding tax of 11.11% is generally deducted for employees and the self-employed. For unemployed people, a withholding tax of 10.09% is deducted, if withholding tax was also deducted at your unemployment institution.
- From the second year onwards, no withholding tax is applicable. Nevertheless, incapacity benefits are not tax exempt. The settlement is made with the following year's tax assessment. By paying in advance, you can avoid a high tax bill.
- A maximum of 3.5% is deducted from incapacity benefits for the pensions sector (applicable only to employees and the unemployed).
Read more about the ‘start of your incapacity for work'
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Track and manage your benefit file on My Helan
- initiating your benefit file
- track your benefit payments
- add documents to your benefit file digitally
- request holidays, return to work, voluntary work
- and so much more!
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, www.helan.be.