Maximum invoice amount
The maximum invoice (MAF) helps keep your family’s medical costs under control. When your medical costs reach a maximum amount during the year, your health insurance fund fully reimburses the costs that follow.
How does the maximum invoice work?
When you visit a doctor, dentist or physiotherapist, you usually pay part of the cost yourself. This is called the co‑payment. Only this co‑payment counts towards the maximum invoice (MAF).
Does your family pay a lot in co‑payments in one year? From a certain amount onwards, the health insurance fund covers the additional costs. That amount depends on your family income and your social situation.
Which costs are included?
A medical invoice consists of:
- Reimbursement by the health insurance fund
This part is reimbursed by the health insurance fund. - Co‑payment
This is the amount you pay yourself. Only this part counts towards the maximum invoice. - Supplements
Some healthcare providers charge additional fees. You always pay these yourself. Supplements do not count towards the maximum invoice.
How does the reimbursement work?
The health insurance fund automatically keeps track of how much co‑payment your family pays, based on among other things:
- doctor’s certificates
- hospital invoices
- costs at the pharmacy
Does your family reach the maximum amount? Then you receive additional reimbursements for the co‑payment for the rest of the year.
You do not need to do anything yourself. The health insurance fund calculates and pays everything automatically.
How does the health insurance fund know your income?
The health insurance fund receives the necessary information securely and in encrypted form from the tax authorities. It therefore does not see your exact income.
If the tax authorities do not have data from two years ago, the health insurance fund will ask you to complete a sworn statement.
NEW since 2026
- In the case of admission to a psychiatric hospital, the co‑payment after the first year is now also reimbursed.
- All reimbursed medicines are now included in the co‑payment tracker.
Good to know
There are different types of maximum invoice.
The co‑payment ceiling is not the same for every family. Depending on your personal or family situation, there are different ceilings:
• the income‑based MAF
• the social MAF
• the MAF for a child under 19
• the MAF for people with chronic illnesses
You can read all about it on the RIZIV website.
Practical questions and answers
Based on doctor’s certificates, statements from other healthcare providers, hospital invoices, pharmacy costs, etc., the health insurance fund keeps track of how much co‑payment you pay. There is a total co‑payment ceiling for your family, depending on your family income, and an individual co‑payment ceiling for each person under 19 years old. As soon as one of these ceilings is reached, you have reached the “maximum invoice” and an automatic reimbursement of co‑payments follows. You do not need to take any action yourself.
Please note!
Non‑conventioned doctors, who do not adhere to the official tariffs, may charge supplements. Since supplements are never reimbursed by the compulsory health insurance, they also do not count towards the calculation of the maximum invoice.
- Routine medical care, such as home visits and consultations with GPs and specialists, treatments by physiotherapists, nurses and speech therapists, dental care
- Childbirth
- Prostheses and medicines in categories A, B, C, and certain category D products (analgesics for chronic pain patients and active wound dressings for patients with chronic wounds)
- Care resulting from occupational rehabilitation
- The fixed personal share for medicines dispensed in the hospital (general hospitals and psychiatric hospitals)
- The personal share of the nursing day in case of admission to a general or psychiatric hospital, up to the 365th day
- Fixed fee for the hospital emergency department
- Supplements and fees for enteral nutrition at home via tube or stoma, charged to patients under 19 years old
- The dispensing margin for implants
- Compounded (magistral) preparations
- Fee supplements (an additional amount doctors may charge on top of the official tariff).
- Accommodation costs paid by people residing in a home for the elderly or in a nursing and care home.
- The cost of medicines that are not reimbursed.
- The personal share of the cost of medicines that are reimbursed, but that do not fall under categories A, B or C.
The MAF reimbursements are granted on the basis of the income from two years ago. If there has been a significant drop in income since the reference year, this is considered a situation deserving special consideration. In that case, please contact your health insurance fund.
On the RIZIV website you can find an overview of the income categories used to calculate the co‑payment ceiling.
