The Verwilghen Act

WHAT IS THE VERWILGHEN ACT?

The Verwilghen Act (20 July 2007, since incorporated into the Insurance Act of 2014), also known as the "once insured, always insured" act, protects employees enrolled in a collective health insurance agreement. When an employee leaves the company, they can continue the insurance they enjoyed through their employer on an individual basis. This is done without medical acceptance and without waiting periods. This is an individual right obtained through the Verwilghen Act. The insurer must offer them equivalent guarantees. Or in other words: guarantees comparable to the coverage the employee enjoyed with the employer.

For you as an employer, the law essentially means you must follow a number of administrative obligations. There are 2 communication moments: upon joining the plan and upon leaving the plan.

AT THE TIME OF JOINING

When your employee enrols in the insurance, you must inform this member that they can take out a waiting policy. The waiting policy ensures that their hospitalisation insurance remains affordable in the future as well. Inform your current and future employees that they can already secure a favourable rate now for when they later continue their hospitalisation insurance individually.

What do you communicate?

That your employee can prepare for their later individual continuation through the insurer's product, for example:

• AG: via AG Care Vision, see also the documents here
• DKV: via DKV Horizon (note: a DKV Horizon is not possible for every situation, contact us)
• AXA: via www.hospi4ever.com
• with the login you received for this as an employer (one-pager to hand to the employee)
• the employee can also reach www.hospi4ever.com via their MyAxa environment

A waiting policy that exactly matches what the Act intended is not commercially available. This may well seem odd, but it does not release you as an employer from communicating about this anyway. Policies are offered that closely resemble what the Act originally intended. And in the spirit of the Act, you must still keep communicating that your employees need to be aware of the fact:

• that during their employment they are insured through the employer and (usually) their dependent family members can optionally join under very favourable group conditions.
• that after their employment they have the legal right to personally continue the policy, and that the premium of that policy will be much higher
• that they can avoid this risk of a high price after their employment by taking out a waiting policy

When do you communicate this?

Immediately upon commencement of employment.

AT THE TIME OF LEAVING THE COMPANY

When your employee leaves your company, you must inform this member that the insurance can be continued individually, without medical acceptance and with continuation of pre-existing conditions. The condition, however, is that the member was continuously insured for 2 years under "a similar health insurance agreement entered into with an insurance undertaking".

This can therefore be an individual or collective contract concluded with a commercial insurance company (AG, Axa, DKV, Ethias, KBC, ...).

What do you communicate?

• That they were insured under the collective health insurance agreement until date x
• That they are entitled to an individual continuation
• That they have a period of thirty days to submit the application
• The insurer's contact details (contact person, policy details, how to proceed).

You can find the documents you can use for this, or how to proceed, for example:

• AG: here
• DKV: here
• AXA: via www.hospi4ever.com
• with the login you received for this as an employer (one-pager to hand to the employee)
• the employee can also reach www.hospi4ever.com via their MyAxa environment

When do you communicate this?

The law sets strict deadlines. The employer first informs the employee that their protection will lapse and that they can continue individually. The employer must do this within 30 days following the loss of the collective guarantee. After that, the employee has 30 days (extendable by another 30 days) to submit the new application to the insurer and claim their right. This way, the employee can continue their insurance without interruption. The entire procedure must be completed within 105 days, otherwise the insurer may refuse coverage, charge additional premiums, or impose medical exclusions.

RISK FOR THE EMPLOYER

In theory, an employer who does not respect the communication obligation can be sanctioned. An employer who, for example, does not communicate that a later personal continuation will be more expensive could end up liable for life for the extra cost between the individual policy and the collective policy.

FORMAL REQUIREMENTS

The insurers provide a package of information for you as an employer at the start of the plan. This includes: logins to their platforms, and information on their website to reduce the administrative burden for you as an employer to a minimum. We recommend including the communication obligation in the standard procedure and documents given to the employee upon commencement and termination of employment. Regular information sessions, a permanent notice on an intranet or similar, or regular mention in a newsletter allow you as an employer to demonstrate that you do indeed take the duty to inform seriously.