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Health insurance

To determine where you are subject to social security (including health insurance), two factors are important:

  • Your work situation (paid employment, self-employed, unemployed, seconded, etc.)
  • Country where you live (not your nationality)

There are several systems of public health insurance:

  • Reimbursement principle (cfr. Belgium): mandatory, (partial) reimbursement of costs
  • Natura principle (cfr. Spain): care provided by the government (public doctors, hospitals, etc.)
  • No system (cfr. USA): only private market available

If you live and work abroad, you are subject to local social security.

Remaining subject to Belgian social security

There are a few situations in which you can maintain a link with Belgian social security:

  • Secondment: If your Belgian employer sends you to another country for a temporary assignment, you are a "posted worker". During a secondment, the employment relationship with the employer remains in place so that you no longer have to complete any additional formalities upon your return. Moreover, you remain subject to the social security system of Belgium and exempt from submission in the country of temporary employment. A secondment is only possible in a country with which Belgium has concluded a social security treaty (treaty country). Have a look at the list of treaty countries.


  • Overseas Social Security The Overseas Social Security (OSZ) is a public institution with a state guarantee that offers full coverage in the field of social security (retirement, illness, disability, medical care, accidents, etc.). The OSZ is only possible if you are employed in a country outside the EEA or Switzerland. You can join individually or your employer can insure you with a collective contract. You pay a monthly contribution of your choice, situated between a minimum and maximum amount laid down by law. The amounts are linked to the Belgian price index. More information about OSZ, the rates and how to join can be found on the official website.


Tip: It is often advisable to take out private insurance. Private insurance providers offer the leverage to raise the social aspect to a higher level. Social security in your new host country can be very different from the one in Belgium.

Tip: Doubts about your (international) social security and the reimbursement of your medical expenses? Use the simple and clear platform of the NSSO. You can also send your questions to contact@rsz.fgov.be.

Tip: Would you like some more information about local social security and medical care? You can find useful overviews of almost all international social security systems on the American Social Security website.

Tip: Contact your Belgian health insurer/mutuality in due time before you leave. Explain your situation clearly and ask what you have to do.