Care program
People with certain chronic illnesses, such as diabetes, chronic kidney insufficiency, long Covid and others can start a care program. Such a program includes appropriate follow‑up and treatment.
What is a care program?
A care program organises the follow‑up and treatment of a patient with a chronic illness. The GP plays a crucial role in this and collaborates with other healthcare providers when needed.
Care programs offer significant support for people with chronic illnesses. They ensure appropriate follow‑up and treatment for patients with chronic conditions.
Have you already opened a global medical record with your GP? Check it right away in your file, because this allows you to pay less out‑of‑pocket for your GP visits.
Care program for type 2 diabetes or chronic kidney disease
A care program for type 2 diabetes supports you in the proper follow‑up of your health, in collaboration with your GP and specialist. The program offers, among other things, full reimbursement of consultations, education sessions and tools such as a blood glucose meter and test strips. You are eligible if you meet certain conditions, such as the use of insulin and regular check‑ups. Read more on the RIZIV website.
To start a care program, a care contract must be drawn up.
Your GP prepares a care program contract together with you and the treating medical specialist. This contract is valid indefinitely. You, your GP and your specialist all sign it.
Your GP sends a copy of the contract to your health insurance fund.
Your advising physician will inform you of the start date of your care program.
Start‑up program diabetes
The number of people with type 2 diabetes continues to rise. For many patients, it takes a long time before they receive the correct diagnosis. With an early diagnosis followed by appropriate treatment, serious health consequences can be avoided. To help establish and treat the condition more quickly, patients can make use of the ‘diabetes start‑up program’.
The GP makes the diagnosis and provides support. Depending on the patient’s needs, referrals can be made to other healthcare providers. In this start‑up program, the out‑of‑pocket cost for certain services is waived, and you can also benefit from free diabetes education.
For more information about this start‑up program, you can contact your treating physician.
Care program for children with obesity
Obesity is a serious and chronic form of overweight with a major impact on quality of life, including for young people.
That is why the range of reimbursed care programs without a personal contribution was recently expanded to include children and young people between 2 and 17 years old with obesity.
This is good news in the search for appropriate and, above all, affordable support. Starting a personal program together with a treating physician and a team of professional caregivers increases the chances of better treatment and reduces the risk of relapse.
Discuss it with your treating physician
You are not on your own. Your physician can start a tailored care program based on your personal situation and initiate coordination between the different caregivers. This multidisciplinary team of physicians, dietitians, psychologists and others then works closely together to restore your child’s disrupted eating patterns and address any underlying emotional causes.
Read all about reimbursements for personalised care programs for nutrition‑related conditions.
The GP, paediatrician or a physician working at the CLB or Kind en Gezin will refer you for further treatment to a dietitian or a Paediatric Multidisciplinary Obesity Centre (PMOC).
- You follow a program of 10 sessions spread over 2 years with a dietitian.
- Or you follow a multi‑year multidisciplinary program in a specialised Paediatric Obesity Centre (PMOC) in Belgium, in consultation with your treating physician.
This specialised care for obesity in children is free of charge and fully reimbursed.
This Helan benefit is valid for customers of Helan Independent Health Insurance fund who are up to date with their health insurance contributions. Read all about the conditions.
Care program for children and adolescents with an eating disorder
The range of reimbursed care programs without a personal contribution was recently expanded to include children and young people up to 23 years old with an eating disorder.
Eating disorders include conditions such as anorexia, bulimia and binge eating disorder.
The treating physician is responsible for initiating and monitoring the care program. A treatment plan is drawn up, there is multidisciplinary coordination, and referrals are made to specialised dietary and psychological care.
Starting a personal program together with a treating physician and a team of professional caregivers increases the chances of better treatment and reduces the risk of relapse.
Discuss it with your treating physician
You are not on your own. Your physician can start a tailored care program based on your personal situation and initiate coordination between the different caregivers. This multidisciplinary team of physicians, dietitians, psychologists and others then works closely together to restore your child’s disrupted eating patterns and address any underlying emotional causes.
Read all about reimbursements for personalised care programs for nutrition‑related conditions.
In this care program, your physician determines the treatment plan with multidisciplinary coordination and follow‑up.
- You follow a program of 10 (sometimes up to 20) individual sessions per year with a psychologist affiliated with a network, in addition to any group sessions.
- Or you follow 38 sessions per year with a dietitian affiliated with a network. This corresponds to two sessions of 60 minutes each and 36 sessions of 30 minutes.
- Or you start a part‑time treatment over one or several half‑days per week, with therapy for children, young people or the entire family as a complement to the options above or alongside an inpatient stay. This will become possible in the course of 2025 for young people with the most complex care needs.
This specialised care for children and teenagers up to 17 years old with an eating disorder is free of charge and fully reimbursed, provided that the physician has prescribed and initiated the care program.
This Helan benefit is valid for customers of Helan Independent Health Insurance fund who are up to date with their health insurance contributions. Read all about the conditions.
Care program for long Covid
To start a care program for long‑term Covid (also called long‑COVID‑19 or post‑COVID‑19), your GP charges the start code during the first consultation. No care contract needs to be drawn up for this.
The diagnosis of long‑term Covid is made when, after a coronavirus infection, you experience symptoms that persist for at least 12 weeks, have a clear impact on your daily life, and cannot be explained by another diagnosis. The most common symptoms include fatigue, shortness of breath, chest pain or pressure, muscle pain, headaches, heart palpitations, loss of taste and/or smell, memory and concentration problems (brain fog), anxiety and depression.
All patients for whom the diagnosis of long Covid is established are eligible for this program; a hospital stay is not required.
Do you suspect long‑term Covid? Visit your GP. They can make a diagnosis, draw up a personal treatment plan and refer you to the appropriate healthcare providers.
Based on your personal needs, your GP draws up a treatment plan. There are two types of care programs:
- Monodisciplinary program: you receive support from one healthcare provider.
- Multidisciplinary program: you receive support from several healthcare providers. Your GP works together with a team of caregivers (psychologist, speech therapist, physiotherapist, dietitian, …). Within this team, a care coordinator is appointed.
If you have started a monodisciplinary program but later feel the need for support from other caregivers, the program can be continued as a multidisciplinary one.
The care program lasts 6 months and can be extended once for another 6 months. If specialised care is needed, your GP will refer you to the appropriate provider.
As a patient, you pay nothing for the specific services included in this program. For most services, no co‑payment or supplements may be charged.
Important: for services that already have an existing reimbursement scheme, co‑payments and supplements may still be charged (such as for the first 18 sessions of standard physiotherapy or for psychological care).
Good to know
The success of a care program requires active involvement from the patient. Depending on the type of care program, you and your GP determine which goals you will actively work toward.
Practical questions and answers
To start a care program, you must meet certain conditions.
- You sign a care program contract of unlimited duration.
- You have at least 2 contacts (consultation or home visit) per treatment year with your GP.
- You consult at least once per treatment year a medical specialist authorised to sign a care program.
- Your GP manages your global medical record.
Specific conditions for patients with type 2 diabetes
- You follow an insulin treatment with 1 or 2 insulin injections per day, or your treatment with oral antidiabetics is insufficient.
- The switch to insulin injections or insulin therapy must be considered.
- You are not pregnant and do not have a pregnancy wish.
- You are physically able to consult your GP and diabetologist regularly.
- You do not have type 1 diabetes.
Specific conditions for patients with chronic kidney insufficiency
- You are at least eighteen years old.
- You have chronic kidney insufficiency in a severe stage (GFR < 45, determined twice by blood analysis) or chronic kidney insufficiency with proteinuria of more than 1 g/day (determined twice by urine test).
- You have not undergone a kidney transplant.
- You are not on kidney dialysis.
- You are physically able to consult your GP and nephrologist regularly.
Specific conditions for patients with long‑term Covid
- Your GP establishes the diagnosis of long‑term Covid.
- The GP initiates the care program for long‑term Covid by attesting the start code.
Care programs offer major support for people with chronic conditions.
- You are guaranteed that your GP and specialist will work closely together in the approach, treatment and follow‑up of your condition.
- You receive all necessary information to manage your condition as effectively as possible (healthy lifestyle, medication, regular medical check‑ups, …) through a personal care plan.
- For the duration of the care program, you receive full reimbursement of the co‑payment for consultations with your GP, other physicians in the GP’s group practice, and the specialist.
- Depending on your condition, you may obtain specific medical equipment on prescription from the pharmacy or an accredited supplier.
Specific benefits for patients with type 2 diabetes
- Free training by a certified diabetes educator.
- Reimbursement of 2 treatments per year by a podiatrist.
- Reimbursement of 2 sessions per year with a dietitian.
- Free self‑care materials (blood glucose meter, strips and lancets) via the pharmacist with a medical prescription.
Specific benefits for patients with chronic kidney insufficiency
- Reimbursement of 2 to 4 sessions per year with a dietitian.
- A free blood pressure monitor available via the pharmacist with a medical prescription.
Specific benefits for patients with long‑term Covid
- The patient does not have to pay anything. Only co‑payments and supplements may be charged for services that already have an existing reimbursement scheme (such as the first 18 sessions of standard physiotherapy or psychological care).
- A care program only starts after the general practitioner has sent a copy of the contract to your health insurance fund. After that, the advising physician will inform the patient, the GP and the specialist of the start date.
- Your health insurance fund pays the GP and the specialist a fixed fee for guiding a care program.
- Your health insurance fund reimburses you the co-payment for consultations with the GP and the specialist.
- Your health insurance fund helps you pursue a healthy lifestyle, with tips on healthy eating, regular exercise or quitting smoking.
