Medical approval for fertility treatment
Do you need to take medication as part of a fertility treatment? Then you may receive a fixed reimbursement from the statutory health insurance. For this, you need medical approval from the advising physician.
What is the flat-rate allowance?
The flat-rate allowance is a fixed amount per indication, treatment, or examination, independent of the actual cost. Sometimes the reimbursement is complete; sometimes you still have to pay a co-payment.
The flat-rate allowance covers:
- In-vitro fertilisation
- Egg donation
- Follicle growth stimulation or intrauterine insemination (IUI)
Track the status of your medical approval in My Helan.
Which flat-rate allowances exist?
-
A flat-rate allowance for the medications (mainly hormones) used in IVF and ICSI, egg donation for the recipient, and IUI (intrauterine insemination or stimulation of follicle growth).
-
A flat-rate allowance for the laboratory costs for IVF. For this as well, the gynaecologist must submit an application for medical approval.
- This applies for a maximum of 6 cycles in your lifetime (1 cycle = all required laboratory activities for the insemination of egg cells through IVF/ICSI).
- Also for a maximum number of implanted embryos per cycle.
In rare situations, IVF is performed through a day admission instead of on an outpatient basis. In that case, it may be eligible for reimbursement through the Hospitalia hospitalisation insurance under specific conditions.
What are the conditions for these flat-rate allowances?
A reimbursement is only possible in the case of:
- A fertility treatment for the woman.
- A fertility treatment that starts no later than the day before the woman’s 43rd birthday.
- A gynaecologist affiliated with a recognised fertility centre.
The customer only pays the co-payment, or in some cases nothing at all. It is best to discuss the conditions and costs in advance with the gynaecologist.
How does the application work?
Make an appointment with a gynaecologist who is affiliated with a recognised Belgian fertility centre. If you are eligible for the treatment, the gynaecologist will complete the application form for the advising physician of the health insurance fund.
- Drop it in a Helan mailbox in your area.
- Or send it by post: Helan Health Insurance Fund, Medical Service – Boomsesteenweg 5, 2610 Wilrijk.
We process your application (administrative check) and forward it to the advising physician (medical check). If necessary, he may request additional supporting documents from your treating physician.
Through the My Helan app (mobile) or via My Helan (desktop), you can view the current status of your medical approval at any time.
If the advising physician approves the reimbursement, you will receive an ‘authorization’. Your treating physician will then complete a form for invoicing and send it directly to the hospital pharmacist.
If the advising physician does not approve the reimbursement, you will also be informed of this by letter.
Important to know
For certain treatments, the invoice can become quite high. Make sure you are well informed in advance about any additional costs, so that the possible co-payment does not come as an unpleasant surprise.
