The mutualiteit, the co-payment and the S1: how healthcare works for Dutch people in Belgium
Where you are insured depends not on where you live but on where you work: cross-border workers keep their Dutch insurance with healthcare allowance, whoever works in Belgium chooses a health fund, and pensioners go through the CAK with a country-of-residence factor. Plus the co-payment, the global medical file, the maximum bill, the Flemish care premium of € 100 and the hospitalisation insurance everyone takes out.
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Written and checked by Auke on , against the sources at the bottom. Is something no longer right? Report it below and I'll fix it.
Which country insures you for healthcare depends on where you work, not where you live. That is the most important healthcare question for a Dutch person in Belgium: not "which health fund" but "which country".
Below, first three scenarios, and then the Belgian system itself: the health fund (the mutualiteit), the co-payment at the doctor and the insurances that come with it.
First: which country insures you?
Three scenarios:
- If you keep working in the Netherlands, you simply remain insured in the Netherlands: you keep your health insurer and your healthcare allowance. With an S1 form from your insurer you also register with a Belgian mutualiteit and are entitled to care in both countries. Your family members without income of their own come along through the CAK, against a treaty contribution per family member, and for family members under eighteen you pay nothing.
- If you go to work in Belgium, the Dutch insurance stops and you are obliged to join the Belgian public health insurance.
- If you are retired, you become a treaty beneficiary through the CAK. An S1 opens the Belgian mutualiteit, the Netherlands bears the costs, and you pay the CAK a contribution multiplied by the country-of-residence factor. For Belgium that is 0.8165 in 2026, so roughly four fifths of the Dutch premium burden, with the right to care in both countries retained.
If you leave before your AOW age, mind the date. The CAK route is expected to remain open from 1 November 2026 only to new registrants with a statutory benefit: AOW, Anw, WAO, WIA or Wajong. If you bring only an early retirement pension, an RVU benefit or an early occupational pension, you then fall outside it. You then arrange the affiliation with a mutualiteit until AOW age at your own expense. Whoever is already a CAK client keeps their rights. What exactly changes, and what you can do now.
The health fund and the co-payment
In Belgium you choose a mutualiteit, a health fund: CM, Helan, Solidaris and others. Or you choose the premium-free Auxiliary Fund, the HZIV, a public institution with the same statutory benefits but without membership fee and without supplementary insurance. At a mutualiteit you pay a membership fee, and for that you get the supplementary insurance: the services and benefits on top of the compulsory insurance.
At the doctor you first pay yourself and are left with a personal share: the remgeld (co-payment). Against that stand dampers you have to switch on actively.
- The global medical file. This is the most important: have your regular GP open it. It costs you nothing and the co-payment per consultation drops. For whoever is 75 or older or chronically ill, the personal share for a home visit also drops by 30%. Children and young people up to and including 24 with increased reimbursement have paid no co-payment at all at the GP and the specialist since 1 October 2023.
- The maximum bill, for big years. If the medical costs your family pays itself reach the ceiling in a year, the health fund automatically reimburses everything above it monthly, and you get a certificate at the first payment. The family is everyone living at the same address on 1 January; a single person counts too.
And the dentist has its own logic: whoever skips a year gets less reimbursed the year after. Going every year from day one therefore literally pays.
| Damper or premium | What applies |
|---|---|
| Global medical file | free via your regular GP; lower co-payment |
| Co-payment home visit, 75+ or chronically ill, with GMD | 30% lower |
| Co-payment up to and including age 24 with increased reimbursement | € 0 at GP and specialist |
| Maximum bill | ceiling per family per year; automatic reimbursement above it |
| Auxiliary Fund (HZIV) | no membership fee, no supplementary insurance |
| Flemish care premium | € 100 a year from age 26 (€ 35 with increased reimbursement), pay before 30 April |
| Care premium after moving to Flanders | first payment within 6 months |
| Fine for not paying twice | € 250 (€ 100 with increased reimbursement) |
| Country-of-residence factor Belgium for the CAK (2026) | 0.8165 |
The insurances that come with Belgium
Two things no law requires but almost every Belgian has:
- The hospitalisation insurance covers the room and fee supplements (the extra charges for the room and the doctors) that can mount up considerably on a hospital stay in a single room. Through the health fund it is cheapest, through the employer often free; ask about it in the employment conditions.
- The family insurance (private liability) is the standard there for a few tens of euros a year.
If you live in the Flemish Region, one obligation is added that newcomers often miss: the Flemish care premium of € 100 a year from age 26. You pay it to one of the six care funds before 30 April. If you come to live in Flanders, you pay the first time within six months of the move. If you don't pay on time, the Flemish government affiliates you ex officio with the Flemish Care Fund. Not paying twice or not in full costs a € 250 fine.
The care premium is a separate bill. It doesn't come via your mutualiteit membership fee and not via your pay, but via a transfer form from the care fund, usually that of your health fund. Whoever moves in summer and leaves the form in the pile misses the six months without noticing.
In Vertrekklaar this is phase 5 of 5 of the journey: the same steps, but applied to your situation — in your order, tickable, and with the deadlines watched. See the whole journey to Belgium.
What this rests on
The facts in this article come from these official pages. Rules change. When in doubt, go by the source, not this article.
- RIZIV — joining a health fund or the Auxiliary Fund — riziv.fgov.be
- RIZIV — the global medical file — riziv.fgov.be
- RIZIV — the maximum bill — riziv.fgov.be
- CAK — family members of cross-border workers (S1) — hetcak.nl
- CAK — retired to a treaty country — hetcak.nl
- CAK — emigrating with early retirement, the expected change as of 1 November 2026 — hetcak.nl
- Country-of-residence factors 2026 (Stcrt. 2025, 38064) — zoek.officielebekendmakingen.nl
- Agentschap Integratie en Inburgering — health insurance as a residence condition — vreemdelingenrecht.be
- Departement Zorg — the Flemish care premium, the deadline and the fine — departementzorg.be
- Wikifin (FSMA) — hospitalisation insurance — wikifin.be
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