Health insurance in Belgium

The Belgian health insurance market is a mature market. Supplementary health insurance represents a total market value of EUR 2.5bn GWP^[1] growing at a low pace (annual GWP growth rate of 3.6% over 2018-22). From this number, mutualities capture about EUR 1 bn while insurers underwrite EUR 1.5bn, of which EUR 950m is in collective contracts.

While 80% of the Belgian population is covered for hospitalization, only 14% benefit from an ambulatory coverage and 19% from a dental coverage. Hospitalization is often provided by the employer (48% of the population benefits from a collective policy); ambulatory and dental are usually individual coverages.

In the insurance field, four large players capture the largest market shares, followed by a group of tier two players. Disruptive entrants are starting to claim their share of the market, thereby accelerating the transformation of other players. Mutualities are highly active in the development of new products in the individual segment and pay significant attention to client satisfaction.

To ensure simplicity and clarity for the insured, products are increasingly offered in standard modules (hospitalization/ambulatory/dental). New products also tend to offer different levels of protection for each of these modules, typically with a basic/medium/premium tariff structure. As an example, DKV has recently revisited its individual hospitalization product range following this logic.^[2]

The new standard for customer experience is digital and app-based, as patients now expect to find all health-related needs in one app. Beyond claims, this may include: early detection diagnostics (symptom checker), second opinions, appointment booking, teleconsultation, pharmacy delivery, general health coaching, and integration of activity apps.

Health insurance is therefore as much about prevention as it is about cure. ‘Care’ encompasses a broader scope, including preventive measures to maintain and promote overall health and wellbeing.

Mental health and wellbeing services are important prevention themes in a country where more people are in disability and long-term disease status, than people looking for a job (High Council for Employment report March 2024^[3]). When it comes to work disability, re-integration is also crucial in the first 6 months of absence. Developing the right partnerships to support the re-integration path is therefore of societal and economic importance.

In the collective segment, insurers encourage the convergence of employee benefits and health in one integrated digital journey (for example, AG integrates new prevention and health-related services in their MyEmployeeBenefit app). This of course also creates more stickiness as employees get used to a one-stop app.

Insurers increasingly seek relevant partners in the ecosystem to make a real impact. Some insurers have already started taking significant steps along this path and partnerships with insurtechs are emerging (for example, in teleconsultation: Doktr.be, which so far has partnerships with AG, Vanbreda, and Solidaris).

Leveraging the ecosystem is a rapid approach to deploying and supporting new use cases along the journey that would otherwise take time to build, such as developing partnerships with practitioners and pharmacy networks, or integrating new healthtech applications, including diagnostics.

The Belgian health insurance sector already has a tradition of leveraging the ecosystem and several insurers have opted for a TPA (Third Party Administration) model, given the scale of their portfolio. Insurers will now have to decide on their role in the ecosystem ranging from ‘risk carrier’ to facilitating and orchestrating the healthcare journey. Some large global players have already made a choice: AXA has rebranded its digital healthcare platform (DHP), in collaboration with Microsoft, as Healthanea^[4] in 2023, with a mission to ‘move healthcare from a siloed approach towards an integrated, seamless, data-driven, and patient-centric journey’. The platform is currently working with AXA entities in Belgium, France, Germany, Italy, Spain, Switzerland, and UK, with a view to developing external cooperation use cases.

Insurers and mutualities are facing an accelerated ‘blurring of boundaries’ of health insurance in the broader healthcare ecosystem. In this context, they can decide to be a participant in the ecosystem as an expert risk carrier, or take a more active orchestrator role – e.g., by integrating services into their healthcare journey or enabling these services with data platforms. Health is also at the core of the ESG debate in the sector – societal impacts, risks, and opportunities (IROs) for insurers, mutualities and social secretariats (and more broadly, employers) – have undeniably material impacts that can be improved.

KPMG in Belgium has recently conducted multiple strategic, market analysis, value proposition, and transformation engagements in healthcare and health insurance. We also engage with executives and boards during ecosystem and platform workshop sessions to explore these new business models.

Please do not hesitate to reach out for a discussion.

1. _{Assuralia, 2023}
2. _{Hospitalisatieverzekering - Bereken uw premie | DKV}
3. _{Arbeidsongeschiktheid en de re-integratie van werknemers op de arbeidsmarkt - Maart 2024 | Hoge raad voor de Werkgelegenheid (belgie.be)}
4. _Healthanea