What is the Maximum invoice?

The Maximum invoice is a protective measure which limits the amount of medical expenses payable by you during a calendar year.
When the sum of co-payments reaches a certain ceiling (determined by your income or your social category), your health insurance then refunds you in full most of the healthcare received subsequently (capped at the amount of the legal fee) and provided until December 31st of that same year.

Your co-payment counter is reset to zero at the start of each calendar year.

What is a co-payment?

Doctor, hospital, nurse… whatever healthcare provider you consult, you always pay part of your care: the co-payment.

The co-payment is the difference between the official rate of the fee, paid to the healthcare provider, and the amount refunded by your health insurance company.

Over time, the accumulation of these co-payments can represent a significant burden for your household, but you can count on your Neutral health insurance company, which applies the Maximum invoice.

Need more information regarding the legal fee or co-payment? We invite you to consult the official INAMI website or to contact your health insurance company.

Which services are taken into consideration in the Maximum invoice ?

The services are taken into consideration in the Maximum invoice are particularly :

  • Consultations, visits and technical procedures with your doctor, procedures provided by physiotherapists, dentists, nurses, speech therapists, etc.;
  • Some hospitalisation costs;
  • A, B, C medications (maximum co-payments 13,50 €);
  • Pharmaceutical preparations (prepared at the pharmacy);
  • The delivery margin for implants;
  • Enteral nutrition for children under 19 years old;

Contact your health insurance company for further information.

Warning! Supplements (for example for a single room or for fees) are not taken into account in the Maximum invoice.

How does your Neutral health insurance company apply the Maximum invoice?

To benefit from the refund of co-payments, your health insurance company considers the following elements:

  • the composition of your household on January 1st of the year in question: all the people living under the same roof form a household for the Maximum invoice;
  • your household’s net taxable income from 2 years ago;
  • the existence of a social category within your household (Supplemented Refunds status);
  • chronic health care expenses, if someone in your household:
  • has accumulated at least a certain amount of co-payments during the last 2 calendar years
    • benefits from  « chronic conditions » status (see "Chronic illnesses");
      • One of these two conditions grants a reduction in the ceiling of 112,62 € (see " What are the applicable ceilings ?").

For example :

  • In 2022, your household's total co-payments reach 2,500 € and your household's total net taxable income amounted to 25,000 € in 2020.
  • A ceiling of 732.03 € is applied to your household and your health insurance refunds you 1,767.97 € (see “What are the applicable ceilings?”).
  • If the co-payments of a person in your household exceeded 477.54 € in 2020 and 487.08 € in 2021, a ceiling of 619.41€ is applied to your household for the Maximum invoice year 2022 and your health insurance company will refund 1,880.59 €.
What care is taken into consideration in the Maximum invoice ?

The services taken into account for the Maximum invoice are in particular:

  • Co-payments for consultations with your doctor, physiotherapist, dentist, nurse, speech therapist, etc.;
  • Hospitalisation costs: co-payments in the price of the hospitalisation day (max. of 12 months in a psychiatric hospital);
  • A, B, C medications and master preparations;
  • The delivery margin for implants;
  • enteral nutrition for children under 19 years of age;
  • etc.

Contact your health insurance company for more information.

Warning! Supplements during hospitalisation (for example for a single room or fees) are not taken into account!

What are the applicable ceilings?

Depuis 2017, les plafonds Màf sont indexés chaque année civile.
Since 2017, the Maximum invoice ceilings have been indexed each calendar year. The list of income brackets and corresponding ceilings is available on the INAMI website.

What should you do?

You do not have to complete any formalities.
From the moment your household is entitled to a refund of co-payment fees, you will automatically receive a payment from your health insurance company.
In the event of us not having all the information necessary to determine your right, our departments will contact you to obtain it.
For your part, if your income decreases significantly over the course of a year (in the event of loss of your job, for example), contact your Neutral health insurance company as quickly as possible.

You may benefit from more favourable rights!