Maximum invoice
Are you not well off or are you seriously ill for a long time? Then medical costs can weigh heavily on the budget. The maximum bill (MAF) limits annual medical costs for families to a ceiling amount. All co-payments above that ceiling amount will be reimbursed by CM.
These costs are counted to calculate expenses and are refunded if the ceiling is exceeded:
- co-payments for benefits provided by doctors, dentists, nurses, physiotherapists and other healthcare providers;
- co-payment for medicines from categories A, B and C (not Cs and Cx) and for pharmaceutical preparations ;
- co-payment for technical services such as operations, X-rays, lab tests;
- certain costs in the event of hospitalization, such as the personal share in the bed-day price (for admission to a psychiatric hospital, only up to the 365th day);
- delivery margin for implants.
CM maintains the co-payment counter
CM keeps track of the co-payment counter per family and per member.
Co-payment above the ceiling amount?
Does the co-payment exceed the ceiling amount? CM will then automatically reimburse you.
Do you buy medicines?
Has the ceiling amount been reached and are you purchasing medicines from the pharmacy that qualify for the maximum invoice? Then you no longer have to pay a co-payment at the pharmacy. This will be settled automatically between the pharmacist and CM.
What are the conditions?
There is an income MAF and a social MAF.
- Every family is eligible for the income MAF.
- Are there people in your family who are entitled to an increased allowance? Then you can enjoy an additional right to the social MAF.
- Read all about these different types of MAF here.
Frequently asked questions
All persons who, according to the National Register , live together at the same address on January 1 constitute a family. The system therefore takes the actual situation into account. No distinction is made between married people and cohabiting couples. Single people are also considered a family.
Exceptions
- Persons in a care-dependent situation may be an exception. As a special protection, they can, under certain conditions, be considered a separate family . This can be important, for example, for the chronically ill, persons with disabilities or other care-dependent persons who live with a family with a high income.
- A second exception applies to families where one or more persons are entitled to the increased allowance . The beneficiary, the partner and their dependents are considered a separate family to which the social MAF applies. However, the income MAF continues to apply to the entire family.
Both the annual income limits and the co-payment ceilings are indexed annually.
Social MAF
The annual ceiling amount for medical costs is 506.79 euros (or 394.17 euros if at least one family member has chronic medical expenses or chronic condition status ).
This applies to certain social categories , for example to those who are entitled to the increased allowance, unless this was granted on the basis of an integration allowance and the partner has an income.
Income MAF
The annual ceiling amount for medical expenses depends on the net taxable family income of the second year preceding that for which entitlement to the MAF is being examined.
Example : When examining the ceiling amount for 2023, CM bases itself on the net taxable income of 2021.
| Family without a family member with chronic medical conditions or chronic condition status | Family with at least one family member with chronic medical conditions or chronic condition status | |
|---|---|---|
| Annual income | Ceiling amount | |
Amounts valid from January 1, 2023 | ||
| Up to 12,186.41 | 250.00 | 137.38 |
| 12,186.42 – 21,801.89 | 506.79 | 394.17 |
| 21,801.90 – 33,516.33 | 732.03 | 619.41 |
| 33,516.33 – 45,230.81 | 1,126.20 | 1,013.58 |
| 45,230.81 – 56,457.17 | 1,576.68 | 1,464.06 |
| From 56,457.18 | 2,027.16 | 1,914.54 |
- For children under nineteen years of age, a ceiling of 732.03 euros always applies, regardless of family income. If the family ceiling is 506.79 euros, this amount obviously applies.
- For children with additional child benefit, a ceiling of 450 euros applies if they:
- received additional child benefit on July 4, 2002;
- and are entitled to additional child benefit during the calendar year in question.
The ceiling amount can be reduced by 112.62 euros :
- if you have a chronic condition status;
- or if the co-payment for a family member was at least 487.08 euros in 2021 and at least 477.54 euros in 2020.
Example: if the co-payment of a family member rose to EUR 477.54 or more in 2020 and to EUR 487.08 or more in 2021, the ceiling amount will be reduced by EUR 112.62 for the entire family in 2022.
- If the family income has decreased since the reference year (see section 'Income MAF'), you can request a revision of the income category.
- The revision takes into account the ' current' annual income . The method of calculating this income varies depending on the time of the application.
- The revision should lead to a new income category with a co-payment ceiling of 506.79 or 732.03 euros . This ceiling can still be lowered if you qualify for extra protection for the chronically ill (see above).
- You can contact CM for both the request for revision and more information about the calculation.