20 JULY 2007. - An Act to amend, with respect to private health insurance contracts, the Act of 25 June 1992 on the land insurance contract (1)

ALBERT II, King of the Belgians,
To all, present and to come, Hi.
The Chambers adopted and We sanction the following:
Article 1^er. This Act regulates a matter referred to in Article 78 of the Constitution.
Art. 2. A chapter IV, as follows, is inserted in Title III of the Act of 25 June 1992 on the land insurance contract:
“Chapter IV. - Health insurance contracts
Section I^re. - Preliminary provisions
Art. 138bis -1
Definitions
§ 1^er. By health insurance contract, you must hear:
1° Health care insurance which guarantees, in the case of illness or in the case of illness and accident, benefits relating to any preventive, curative or diagnostic medical treatment necessary for the preservation and/or recovery of health;
2° Incapacity for work insurance which, in the case of illness or in the case of illness and accident, totally or partially compensates the reduction or loss of professional income due to the incapacity of a person's work;
3° disability insurance that guarantees a benefit in the event of illness or in the event of illness and accident;
4° non-mandatory care insurance that provides benefits in the event of total or partial loss of autonomy,
Are excluded from the definition of the health insurance contract:
(a) temporary travel and assistance insurance that guarantees the benefits referred to in paragraph 1^er;
(b) the statutory occupational accident insurance and related supplementary accident insurance;
(c) accident insurance;
(d) the solidarity benefits referred to in Article 1^er the Royal Decree of 14 November 2003 establishing the solidarity benefits related to the supplementary social pension plans;
(e) the solidarity benefits referred to in Article 1^er of the Royal Decree of 15 December 2003 establishing the solidarity benefits related to social pension agreements.
§ 2. A collective health insurance contract, health care insurance and/or incapacity for work insurance and/or disability insurance and/or collective care insurance entered into by one or more insurance takers for the benefit of several persons professionally related to the insurance taker at the time of the affiliation. These people are called the primary insured in this chapter.
The insurance taker may also contract collective health care insurance and/or incapacity for work and/or disability and/or care for the benefit of the family members of the principal insured. These people are called "coassured" in this chapter.
Section II. - Individual health insurance contracts
Art. 138bis -2
Scope
The provisions of this section apply to individual health insurance contracts.
These provisions are applicable to the insurance taker and family members who are affiliated with their health insurance.
Art. 138bis -3
Duration of insurance contract
§ 1^er. Without prejudice to the application of articles 6, 7, 11, 14, 15, 16, 17, 24 and except for fraud, health insurance contracts referred to in Article 138bis -1, § 1^er, 1°, 3° and 4° are concluded for life. Health insurance contracts referred to in Article 138bis -1, § 1^er, 2°, are valid until the age of 65 or an earlier age, if this age is the normal age to which the insured person completely and definitively terminates his professional activity.
§ 2. Without prejudice to the application of Article 30, § 3, contracts may be entered into for a limited period of time at the express request of the insurance owner and if there is any interest in the contract.
§ 3. The provisions of this section are not applicable to health insurance contracts offered in an incidental manner in relation to the primary risk, the duration of which is not for life.
Art. 138bis -4
Tariff and contractual amendments
§ 1^er. Except as mutually agreed by the parties and the exclusive request of the insurance owner, as well as in the cases referred to in §§ 2, 3 and 4, the insurer may not make changes to the technical bases of the premium or to the conditions of coverage after the health insurance contract has been concluded.
The modification of the technical bases of the premium and/or the conditions of coverage by mutual agreement of the parties under paragraph 1^er, can only be performed in the interest of the insurance taker.
§ 2. The premium, deductible and benefit may be adjusted to the date of the annual premium maturity based on the Consumer Price Index. To the extent that the Banking, Financial and Insurance Commission, referred to in section 44 of the Financial Sector Supervision and Financial Services Act of 2 August 2002, hereafter referred to as the CBFA, agrees on the basis of the finding of a sustainable change in costs, the premium, the deductible and the benefit may also be adapted on the basis of representative and objective parameters, where the CBFA notes a difference between the change in consumption and
CBFA sets objective parameters in consultation with the Federal Centre for Health Care Expertise. This checks the validity of the methodology for selecting and calculating the values of the objective parameters. CBFA conducts the periodic calculation of these values. If he considers it necessary, the King sets the objective parameters by order deliberately in the Council of Ministers.
§ 3. Unless otherwise agreed in the insurance contract and, within the limits set out in paragraph 2, the amount of the premium and/or the conditions of coverage may be adjusted in the event of a lasting change in the actual cost of guaranteed benefits having a significant impact on the cost or extent of guaranteed benefits and/or in the event of circumstances, including legal or regulatory amendments, also having a significant impact on the cost or extent of guaranteed benefits.
The proposed contractual or tariff adaptation is directly proportional to the extent of the increase in the actual cost of secured benefits and/or circumstances, including legal or regulatory amendments. In addition, this amendment can only focus on the elements of the contract on which the significant influence of these events is exerted.
Influence must be recognized as significant by CBFA in consultation with the Federal Centre for Health Care Expertise. CBFA also ensures compliance with the limits set out in paragraph 2. The King may set the rules to be followed in order to obtain the CBFA decision.
The CBFA is believed to have recognized the significant character and proportionality when it did not respond within 30 days of receiving the application for recognition. This period is suspended for a maximum period of 30 days, in which the Federal Centre for Health Care Expertise must render its opinion to the CBFA.
§ 4. The amount of the premium, the period of deficiency and insurance conditions can be adjusted in a rational and proportional manner
- changes in the insured's profession with respect to health care insurance, incapacity for work, disability insurance and care insurance and/or
- changes in the income of the insured, in respect of disability and disability insurance, or
- when the social security system changes its status with respect to health care insurance and incapacity for work insurance,
provided that these amendments have a significant impact on the risk and/or cost or extent of guaranteed benefits.
Art. 138bis -5
Incontestability
Once a period of two years has elapsed from the date of entry into force of the health insurance contract, the insurer may not invoke section 7 with respect to unintentional omissions or inaccuracies in the statements of the insurance or insured person, where these omissions or inaccuracies relate to a disease or condition of which symptoms have already been identified at the time of the contract.
The insurer may not invoke an unintentional omission or inaccuracy when the illness or condition has not yet been demonstrated in any way at the time of the conclusion of the insurance contract.
Art. 138bis -6
Chronic diseases and persons with disabilities
For a period of two years from the entry into force of this article, the applicant for insurance, who suffers from a chronic illness or disability and who has not reached the age of sixty-five years, is entitled to health care insurance, provided that the costs related to the disease or disability that exist at the time of the conclusion of the insurance contract may, without prejudice to the application of section 138bis, The premium must be the one that would be claimed to the same person if it was not chronically ill or disabled.
Without prejudice to the application of sections 5 and 95 with respect to genetic data information, a document that accurately sets out the target disease or disability, as well as the costs excluded from the coverage or subject to limited coverage, is attached to the insurance contract. The model of the document is stopped by the King.
Without prejudice to the jurisdiction of courts and tribunals, disputes relating to costs excluded from coverage or limited coverage are first submitted to a conciliation body constituted by the King by order deliberately in the Council of Ministers.
The requirement to provide health care insurance to applicants who are chronically ill or with disabilities will be subject to an assessment, no later than eighteen months after the entry into force of this article, in which the CBFA, the Professional Union of Insurance Companies (Assuralia) and patient associations will participate. Before the expiry of the two-year period referred to in section 1^er The King shall determine, by order deliberately in the Council of Ministers, whether that obligation is maintained beyond that period of two years.
Art. 138bis -7
§ 1^er. The insurance provider shall inform the insurer, in writing or electronically, of the time a member of the insured family leaves the insurance contract and of the new place of residence of the insured family.
Based on these data, the insurer submits to the insured within 30 days an insurance offer in accordance with sections 138bis -3 and 138bis -4. The insurer informs the insured that the offer also applies to family members. It cannot invoke the fact that the risk is already realized.
The insured has a period of sixty days to accept the insurance proposal in writing or electronically. The right to accept the offer expires on the expiry of this period.
§ 2. The insurance contract that the insured has accepted begins to run when the insured loses the benefit of the previous insurance.
Section III. - Individual prosecution
a collective health insurance contract
Art. 138bis -8
Conditions of granting
§ 1^er. Unless it loses the benefit of the collective health insurance contract for the reasons referred to in sections 6, 7, 14, 16 and 24 and, in general, in the event of fraud, any person affiliated with a collective health insurance has the right to continue, in whole or in part, that individual insurance when it loses the benefit of collective insurance, without having to undergo an additional medical examination or to complete a new medical questionnaire.
For this purpose, the principal insured person must, during the two years preceding the loss of the collective health insurance contract that is pursued, have been permanently affiliated with one or more successive health insurance contracts signed with an insurance company within the meaning of this Act.
§ 2. The insurance owner or, in the event of bankruptcy or liquidation, the insurance owner's curator or liquidator shall notify the principal insured, in writing or electronically, not later than thirty days after the loss of the benefit of the collective insurance, the precise moment of the loss and the possibility of pursuing the contract individually. In addition, he informs the principal insured of the time limit in which he or she and, if so, the insured person may exercise their right to individual prosecution. The insurer or, in the event of bankruptcy or liquidation, the curator or liquidator shall, at the same time, transmit to the principal insured the contact information of the insurance company concerned.
The principal insured person and, where applicable, the insured person shall have a period of thirty days to inform the insurer in writing or electronically of their intention to continue the collective health insurance contract, in whole or in part, individually. The period begins on the day of receipt of the courier by which the insurance taker or, in the event of bankruptcy or liquidation, the curator or liquidator of the insurance taker informs the principal insured in writing or electronically that he or she may decide to continue the collective health insurance contract of which he or she has lost the benefit. This period expires in any case after one hundred and five days after the day of loss of the benefit of collective health insurance.
The insurer has a fifteen-day time limit to submit to the principal insured person and, where applicable, to the insured person, in writing or electronically, an insurance offer in accordance with sections 138bis -3 and 138bis -4. The insurer cannot invoke the fact that the risk is already realized.
At the same time as the insurer addresses its offer, the insurer shall inform the principal insured person and, where appropriate, the insured person on the terms of warranty, including covered benefits, exclusions, the reporting period. He also reminds the principal insured person and, where applicable, the insured person of the thirty-day period available to accept the offer either in writing or electronically.
The principal insured person and, where applicable, the insured person shall have a period of thirty days to accept the insurance offer in writing or electronically. This period begins on the day the insurer receives the offer referred to in paragraph 3. The right to individual prosecution expires on the expiry of this period.
§ 3. When the insured person loses the benefit of the collective insurance for another reason than the loss of the benefit of that insurance by the principal insured person, the insured person has a period of one hundred and five days, from the time he loses the aforementioned benefit, to inform the insurer, in writing or electronically, of his intention to exercise his right to individual prosecution.
The insurer has a 15-day period to make an insurance offer in accordance with sections 138bis -3 and 138bis -4 electronically or in writing. The insurer cannot invoke the fact that the risk is already realized.
The insured person has a period of thirty days to accept the insurance offer in writing or electronically. This period begins on the day of receipt of the insurer's offer referred to in the second paragraph. The right to individual prosecution expires on the expiry of this period.
§ 4. The insurance contract accepted by the insured takes place when he loses the benefit of collective insurance.
Art. 138bis -9
Information to be provided by the insurer
§ 1^er. The insurer informs the insurance taker of the possibility for the insured to pay an individual premium. The insurance taker shall promptly transmit this information to the principal insured.
The payment of these additional premiums, provided that they have been paid year-by-year without interruption, has the effect that in the event of an individual prosecution the premium referred to in section 138bis -11 is fixed taking into account the age of the insured at the time he began paying the additional premiums.
The age for calculating the premium referred to in section 138bis -11 is increased proportionally, in the event of a temporary interruption in the payment of the additional premiums referred to in paragraph 2, depending on the interruption.
§ 2. If the insurer failed to fulfill the duty of information referred to in § 1^er, the premium of the individual health insurance contract is, by derogation from section 138bis -11, calculated taking into account the age of the principal insured or the insured at the time of his membership in the collective insurance. The insurer must demonstrate that it has fulfilled the duty of information referred to in § 1^er.
If the insurance taker failed to transmit the information referred to in § 1^er to the principal insured, the lessee is required to pay to the insurer the difference between the premium calculated on the basis of the age reached at the time of the exercise of the right to the individual prosecution of the contract and the premium calculated on the basis of the age of the principal insured at the time of his or her membership in the collective insurance. The premium for the individual health insurance contract that is claimed for the principal insured is also in this case, by derogation from section 138bis -11, calculated taking into account the age of the principal insured at the time of his membership in the collective insurance. It is the responsibility of the insurance licensee to demonstrate that it transmitted the information referred to in § 1^er.
Art. 138bis -10
Guarantees
§ 1^er. The individual health insurance contract offers at least similar guarantees to those offered by the collective health insurance contract.
Individual health care insurance guarantees are considered similar if the following elements of collective health care insurance are taken over:
1° the choice of the room: the full or partial reimbursement or the non-refunding of costs incurred in a single, double or common room;
2° the reimbursement formula: the reimbursement (partial) of actual costs or the reimbursement of costs on the basis of the INAMI level of reimbursement in the context of legal health care insurance, or the possibility of a lump sum intervention;
3° pre- and post-hospitalization: whether or not the ambulatory costs related to hospitalization occur within a specified period before or after hospitalization; if these costs are covered, this period must be at least one month before and three months after hospitalization;
4° Severe diseases: whether or not the ambulatory costs related to serious diseases.
Individual incapacity insurance guarantees are considered to be similar if they provide, such as incapacity for collective work, the payment of the same percentage of the loss of income incurred or the same fixed amount, however limited if any to the loss of income incurred. Individual incapacity insurance, which continues the incapacity for collective work insurance, is valid until the legal age of the pension or an earlier age, if it is the normal age to which the insured person completely ceases to work and permanently.
Individual disability insurance guarantees are considered similar if they provide for the payment of the same fixed amount or compensation calculated on the basis of the same parameters as those taken into account in the framework of the collective disability insurance.
Individual dependency insurance guarantees are considered to be similar if they provide, such as collective care insurance, the payment of the same fixed amount or the same compensation for costs due to the total or partial loss of autonomy.
§ 2. Without prejudice to Article 138bis -3, § 1^er, the individual continuation of the collective health insurance contract takes place without imposing a new waiting period. The guarantee cannot be limited and no additional premiums can be imposed because of the changes in the health condition of the insured during the collective health insurance contract.
Art. 138bis -11
Prime
For the calculation of the premium of the individual health insurance contract, it is taken into account only:
1° of the age of the insured at the time of the individual prosecution of the contract, without prejudice to Article 138bis -9, § 1^er;
2° of the risk assessment elements, as they existed and were assessed when the collective health insurance contract was entered into;
3° of the social security system and the status to which the insured person is subject;
4° in respect of health care, disability insurance and care insurance, as well as the profession of the insured;
5° in respect of the insured's incapacity for work, occupation and professional income.
Art. 3. With respect to existing health insurance contracts referred to in section 138bis -2 of the Act of 25 June 1992 on the land insurance contract, which, at the time of the coming into force of this Act, do not meet the requirements of section 138bis -3, the insurance company proposes to the insurance owner, no later than two years after the entry into force of this Act, a new health insurance policy, a new insurance policy. The insurance taker decides within thirty days of the receipt of the proposal, to subscribe to it or to maintain the duration of its current health insurance.
With respect to existing collective health insurance contracts, a two-year transitional period is applicable from the coming into force of this Act.
Art. 4. This Act comes into force on the same day as the law to establish mutualities in the Act of 6 August 1990 on mutualities and national mutuality unions a regime similar to that provided for in Title III, Chapter IV, Sections 1 and 2, of the Act of 25 June 1992 on the land insurance contract, inserted by the Act of 20 July 2007.
Promulgation of this law, let us order that it be clothed with the seal of the State and published by the Belgian Monitor.
Given in Brussels on 20 July 2007.
ALBERT
By the King:
Deputy Prime Minister and Minister of Justice,
Ms. L. ONKELINX
Minister of Economy,
Mr. VERWILGHEN
Seal of the state seal:
The Minister of Justice,
Ms. L. ONKELINX
____
Notes
(1) Regular session 2006-2007.
House of Representatives.
Parliamentary documents. - Bill No. 51-2689/1. - Amendments, No. 51-2689/2-3. Report on behalf of the Commission, No. 51-2689/4. - Text adopted by the Commission, No. 51-2689/5. - Text adopted in plenary and transmitted to the Senate, No. 51-2689/6.
Senate.
Parliamentary documents. - Project referred to by the Senate, No. 3-2355/1. Report on behalf of the Commission, No. 3-2355/2. - Decision not to amend, No. 3-2355/3.