Medical approval for medication
The compulsory health insurance reimburses many types of medication. In most cases, your health insurance fund settles this directly with the pharmacist or the hospital, so you don’t have to pay anything upfront. For other medications, however, you must first obtain approval from the advising physician of the health insurance fund in order to qualify for reimbursement.
How does the application work?
The doctor who prescribes your medication submits the request for medical approval — digitally or on paper — to your health insurance fund. The advising physician of your health insurance fund reviews this request and checks, according to the guidelines of the RIZIV, whether you meet the conditions. If you do, you receive medical approval: the authorisation for reimbursement of the requested medication.
With this medical approval and your doctor’s prescription, you can collect the medication from your pharmacy. Your pharmacist settles the reimbursement directly with your health insurance fund via the third‑party payment scheme. You only pay the co‑payment.
Track the status of your medical approval in My Helan.
Online application
Is your prescribing doctor submitting your application for medical approval digitally? If so, we’ll receive your application straight away and can get started on it more quickly. We’ll walk you through the process.
This is done through the MyCarenet software.
We process your request (administrative check) and forward it to the advising physician (medical check). This may take up to 3 weeks. Through the My Helan app (mobile) or via My Helan (desktop), you can view the current status of your medical approval at any time.
There are 3 possible scenarios:
- Medical approval
Your doctor receives a response via MyCarenet, and you receive the medical approval by post. With this approval and your prescription, you can collect the medication from your pharmacy. You only pay the remaining co‑payment.
- Request for additional information
Sometimes the advising physician needs more information before making a decision. In that case, both you and your doctor receive a letter requesting additional details. The health insurance fund then waits for your prescribing doctor’s reply before making a final decision.
- Refusal
If you do not meet the RIZIV conditions, your request for medical approval will be refused. Your doctor is informed via MyCarenet, and you receive a letter with the decision. In consultation with your doctor, you can look for a cheaper alternative medication or continue using the same medication at full cost.
Paper application
Your doctor can also submit the application for medical approval to the health insurance fund on paper. Otherwise, the procedure is the same as for an online application.
Keep this document safe so you can submit the request to the advising physician of the health insurance fund. Attach a white adhesive stamp of the patient.
- Drop it in a Helan mailbox in your neighbourhood.
- Or send it by post to: Helan ziekenfonds, Medical Service – Boomsesteenweg 5, 2610 Wilrijk.
We process your request (administrative check) and forward it to the advising physician (medical check). This may take up to 3 weeks. Through My Helan, you can view the current status of your medical approval at any time.
There are 3 possible scenarios:
- Medical approval
Your doctor receives a response via MyCarenet, and you receive the medical approval by post. With this approval and your prescription, you can collect the medication from your pharmacy. You only pay the remaining co‑payment.
- Request for additional information
Sometimes the advising physician needs more information before making a decision. In that case, both you and your doctor receive a letter requesting additional details. The health insurance fund then waits for your prescribing doctor’s reply before making a final decision.
- Refusal
If you do not meet the RIZIV conditions, your request for medical approval will be refused. Your doctor is informed via MyCarenet, and you receive a letter with this decision. In consultation with your doctor, you can look for a cheaper alternative medication or continue using the same medication at full cost.
Good to know
While waiting for the medical approval, you can already purchase the medication with your prescription. You will then pay the full amount, without any guarantee that approval will be granted.
If the advising physician later approves your request, you can send Helan the delivery certificate from your pharmacy so the reimbursement for your medication can be processed.
