Maternity insurance

Eligibility conditions

Entitlement to maternity benefits is confirmed when you receive a maternity record book from the Medical Benefits Department of the C.C.S.S. (after receipt of the mother-to-be's pregnancy declaration) containing the various forms needed to obtain:

In order to obtain this document, the mother-to-be or her spouse, if she herself does not have an occupational activity entitling her to similar benefits, must satisfy the following conditions:

  • proof of one month of valid registration during the three months prior to the month of the  estimated conception date,
  • proof that a registration has not ceased to have effect for the entire duration of the period between the start of the pregnancy and the  first diagnosis of pregnancy,
  • have worked at least 75 hours each month in the period between:

When the claimant cannot prove sufficient activity and the mother-to-be is not entitled to maternity benefits under another social security scheme, benefits may be paid from the social fund, under the following conditions:

  • for reimbursement of medical expenses:
    • at the  estimated conception date or at the start of the 8 weeks prior to the estimated delivery date, the claimant must prove the minimum number of stipulated working hours to qualify for sickness benefits,
  • for maternity pay:
    • the mother-to-be's registration must have started, at the latest, during the month of conception without necessarily being prior to this and not ceased to have effect before the end of the prenatal leave (8 weeks before the estimated date of delivery),
    • furthermore, the claimant must satisfy the condition of the stipulated working hours for the reimbursement of medical expenses.

Entitlement to these two types of benefit (reimbursement of medical expenses and maternity pay) may be applied separately.

Medical expenses

For the mother-to-be, some medical expenses are covered in full. These are:

  • treatments included in the maternity record, the reimbursement of which is requested using a form from this record book,
  • treatments performed after the sixth month of pregnancy,
  • along with maternity-related hospital stays, up to a maximum of 12 days.

Full coverage or exemption from patient contribution, does not mean that the medical expenses incurred will be fully reimbursed, but simply that no deduction will be applied to the fund's reimbursement tariff.

However, the reimbursement tariff may, in some cases, be less than the invoiced fee, particularly:

  • if you have used a non-contracted doctor
     or
  • if you are not in the green category and the delivery takes place in a clinic or public hospital with the choice of a practitioner's private practice.

Healthcare professionals contracted to the C.S.M.

Maternity leave

Benefit payments for periods of work interruption due to pregnancy are designed to provide a replacement income for pregnant employees who stop work for the pre and postnatal leave periods stipulated by legislation.

To claim these benefits, the mother-to-be must be:

  • salaried,
  • eligible, under her own business activity, for a maternity record book,
  • prove a loss of wages as a result of stopping work for maternity,
  • and thus effectively stop this activity during the benefit payment period, for at least eight weeks.

The amount of the daily maternity benefit is equivalent to 90% of the employee's average gross daily salary over the twelve months prior to the start of prenatal leave. This average daily salary is calculated under the same conditions as health insurance.

Recovery period

The recovery period depends on the household composition (number of children that the mother-to-be already has or number of dependent children in the home) and the number of children expected.

If multiple births are expected, you should send a certificate produced by the treating physician confirming the number of children to be born, to the fund as soon as possible.

  Duration in weeks Total leave period Prenatal period Postnatal period Option to transfer prenatal leave Option to transfer postnatal leave
SINGLE PREGNANCY Already 2 dependent children or viable births 16 8 8 4 0
SINGLE PREGNANCY 2 or more dependent children or viable births 26 8 18 4 2
TWIN PREGNANCY   34 12 22 4 4
2+ CHILDREN TO BE BORN   46 24 22 4 0

Transferring prenatal leave:

Based on a favourable opinion from the treating physician, some of the prenatal leave, up to a maximum of 4 weeks, can be carried forward to the postnatal leave.

Furthermore, if the birth occurs prior to the estimated date, the portion of prenatal leave not taken can be carried forward to the postnatal period.

Transferring postnatal leave:

It is possible to transfer a portion of the postnatal leave to the prenatal period, up to a maximum of:

  • two weeks in the case of a single pregnancy, if the mother-to-be has already given birth to two children or if there are at least two dependent children in the household;
  • four weeks only if the birth of two children is expected.

There is no particular procedure to be followed to transfer this leave; within the limit of the periods indicated above, the date of cessation of work given on the certificate of absence for maternity is used to determine the expiry of maternity leave.

If the birth takes place after the estimated date of delivery, postnatal leave is not reduced to reflect the extended period covered under prenatal leave.

If a maternity-related medical condition justifies that a woman stops work after the end of the 5th month of pregnancy, an additional 2-week recovery period may be granted on medical grounds, this is not necessarily related to prenatal leave.

It should be noted that breastfeeding cannot, in itself, be considered as a justified reason for prescribing a work interruption extending the postnatal leave, except in cases where the health of the newborn baby requires this feeding method.

Special case

Performing artists, employees handing substances presenting a danger to the child and, more generally, insureds whose position includes work that is incompatible with their condition, may request daily sickness benefit.

The payment of these benefits from the Social Funds is always optional and subject to assessment by the fund's departments.