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  • GROUP CASIER RISK & INSURANCE srlLedeberg (Gent)

Medical cost insurance and waiting policy


Useful information!

If you receive a collective hospitalisation policy (occupational illness agreement) through your employer, you have received information from your employer in the context of the Verwilghen Law, but surely you still have some questions:

  • If you already have an individual insurance, what should you do?
  • In case of resignation or retirement: how can we continue individually?
  • In case of divorce, or depature of children, what action to take?
  • Do I take a waiting insurance? With which company? What are the obligations?
  • What will be the type of insurance contract in case I continue individually?

If you are already insured individually, you can cancel your existing contract by issuing a certificate of affiliation to the collective agreement (with mention of the start date). Ask for this certificate from your employer's HR.

Better yet: turn your individual contract into a waiting policy. It is possible - and evenvery desirable - if your individual contract already exists with DKV or AG. This way, you will keep your initial age AND your current individual policy when you continue the insurance individually at DKV or AG.

  • As a result, you will pay a lower premium: the premiums for an individual policy are much higher than in a group contract and are related to you age or an age group.
  • In addition, with a waiting policy you have the guarantee that your subsequent individual policy will contain the same solid and extensive guarantees as the collective policy or the already existing individual one.

Be careful not to make this change too soon, but only at the time of collective coverage. That's why it's better to ask for a certificate containing the start date of affiliation to  your employer.

Individual continuation

When you resign or retire, your employer is obliged to inform you that your affiliation ends and that you can apply for an individual continuation with the group insurance company.

The insurance company of your group insurance will provide you with an offer based on your age at the time of resignation or retirement and you will have no medical formalities to complete if you can prove an existing coverage of at least two years in a row (in one or more successive contracts).

In addition, you can benefit from a tax exemption of 9,25%. After the end of your affiliation you have up to 105 days after the end of your collective coverage to finalize this individual offer. If you accept, the individual continuation will begin retroactively: a possible stay in the hospital during this period will be covered! If, however, you do not accept the offer and you decide to take an insurance elsewhere, you will not be covered and in addition you risk medical formalities with possible surcharges or even exclusions...

A proposal for individual continuation will always be based on the offer of the individual insurances at that moment. See below for the current possibilities with AG and DKV, the market leaders.

Conclusion: always ask an offer for individual continuation and get informed on time!

  • The above information is also applicable to family members, affiliated in the same collective agreement! After a divorce, the ex-partner will have to leave the group insurance and may therefore apply for an individual continuation offer. It's the same for children as long as they are no longer financially dependent on you.
  • If you have a disability guarantee - often an additional guarantee in supplementary pension insurance - it is important for you to know that the same principle applies to an individual continuation of this guarantee. This is a very interesting possibility in case you change your professional status from employee to become independent: this coverage can be transfered to a contract in your name or on behalf of your new company.

Waiting policy

A waiting policy is not an obligation and has only sense if you are affiliated to a collective hospitalisation insurance. This insurance allows you to pre-finance your future individual insurance. Today you pay a little more for a private contract to "freeze" / block your age and to guarantee a lower premium for your future individual insurance. This age can even be the starting age of your individual contract if you have one from DKV or AG.

Attention: Starting from 18/12/2017 it is no longer possible to subscribe a new DKV waiting policy (DKV Horizon)! Only an existing individual policy (IS, IS+, IS2000, Hospi Premium) can still be modified.

Some additonal important points:

  • The choise of the insurance company for your waiting police also entails your choice of your future individual insurance! For example: the DKV Horizon waiting policy (from 01/04/2016 to 18/12/2017) automatically directs you to a DKV Hospi Premium (and therefore not to the other DKV products)! The waiting police of AG (AG Care Vision) automatically directs you to a AG Care Hospitalisation.
  • Taking the waiting police at the same insurance company may have advantages: you may be able to benefit from a tax exemption (9,25%) and no medical questionnaire (within 30 days after connection).
  • Not all insurance companies offer a waiting policy and there is no offer at all for the additional guarantee disability or ambulatory cost plans.
  • As already mentioned above, an existing individual contract DKV or AG is preferrably switched to their guarantee of 'waiting policy'.
  • If you change employers and you again benefit from a collective plan with the new employer: you can keep your waiting policy, the insurance company of your new collective plan doesn't matter.
  • Taking a waiting policy for children is pointless since the minimum age is 20 or 25.
  • In some cases, the waiting insurance can be offered as an option in the collective contract (choice of the employer).

Check out the link below for more information about the waiting insurance of AG Insurance (AG Care Vision).

Other insurers or health funds

In addition to other insurance companies (as for Ethias, AXA, KBC, DVV or Argenta), health funds offer an individual hospitalisation contract, and perhaps also a waiting policy. Pay attention: oftenly premiums are cheaper but guarantees are instead less extended and/or  there are restrictions on the amount of compensation. Inform and compare!

Beware if you decide to swith to another health fund (end of membership), you cannot stay in their hospitalisation plan.

More info and steps to take?

Consult your usual and trusted insurance broker!

Pieter Verbeke - 26/04/2018

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