Checking insurability: how to read Member Data

You check insurability through Member Data, the MyCareNet service that requests your patient's insurance details from their health insurance fund (mutualité). It shows, among other things, the fund membership, the insurability period and the codes you need for billing. Always read that data for the date of the treatment. A response confirming insurability does not, on its own, tell you whether a specific physiotherapy session will be reimbursed.

What information do you get through Member Data?

Member Data, also known as Gegevens van het lid in Dutch or Données du membre in French, replaces the former insurability service. As a physiotherapist, you consult it through your practice software or the MyCareNet portal. You request data for a patient and a specific date or period.

According to the NIC documentation, the information available depends on the professional group. As a physio, you will not necessarily see the same data as a pharmacist or GP. The labels on screen also differ from one software package to another. The fields below help you read the response.

How do you read the main fields?

What do CG1, CG2 and increased reimbursement mean?

CG1 and CG2 are not nomenclature codes. They describe the patient's insurance rights. You might see 110/110 or 131/131, for example. In those examples, the final digit 1 indicates increased reimbursement, often abbreviated as VT or referred to as BIM. Let your software process the full codes and check the validity period of that status.

For billing, use the corresponding physiotherapy fees and reimbursements. Do not simply copy an old health insurance sticker or a previously saved BIM tick box.

According to the NIC specification, the combination 000/000 indicates insurability that is not in order. First check the identity and the period, then ask the health insurance fund to clarify the situation.

Why does the date matter so much?

There are two dates to keep apart: when you request the data and which treatment you need it for. If you bill a session from 31 August on 3 September, you need to check the rights for 31 August.

A fictional example: a patient becomes entitled to increased reimbursement from 1 September. You bill a session from 31 August and one from 3 September together. The new status then does not automatically apply to both sessions. Consult the right period and let your software apply the rights for each date of service.

The same applies when a patient changes health insurance fund. A response can contain several periods. Do not replace all the old billing data with today's situation.

What do you check before treatment?

1. The right patient. Compare the identity and INSZ with your record. A successful request for the wrong person gets you nowhere.
2. The right period. Request insurability for the planned treatment date. Make this a standard check for every new patient or new course of treatment.
3. The response itself. Check the rights, the BIM status and any messages. Also look at when the data was last requested.
4. The conditions for physiotherapy. Check the prescription, the pathology category, the relevant sessions and any required notification or approval. Member Data does not do those checks for you.
5. What you tell your patient. Discuss the amount to be paid and any uncertainty about reimbursement beforehand. Note down what still needs to be clarified.

Which messages need extra attention?

Registered with a community health centre. If the flat fee covers physiotherapy, care outside that centre is in principle not covered by the usual per-session reimbursement. Agree with the centre and the health insurance fund on how the treatment is arranged and paid for. Simply having the patient pay and handing them a certificate does not solve that question.

Chronic condition status. This is a separate insurance status. It does not replace an approval for an E list condition. A palliative status, if reported, must also be assessed together with the applicable nomenclature conditions.

Membership starting later, ended or changing. Look at the dates involved. If the response is unclear, request the relevant period again or contact the health insurance fund. Do not draw conclusions about the whole course of treatment from a single message.

What do you check before you bill?

1. Are all dates of service covered? Check the data for the sessions you are billing now. Request it again if the period you need is missing or if you have doubts about stored data.
2. Are the amounts correct? Look at the nomenclature code, your agreement (convention) status, the applicable fee and the patient's reimbursement.
3. Are the prescription and approvals in order? Also check the validity period and any conditions attached to an approval. Read how to request and follow up an eAgreement.
4. Are you using the right payment method? eFact is for third-party payment; you use eAttest when the patient pays the full amount upfront. Increased reimbursement does not in itself make the general third-party payment scheme mandatory for physios.
5. Can you find the response again? Keep the request and its reference in your software. After sending, also follow up on the response to the invoice or certificate.

Is a payment commitment a guarantee of reimbursement?

Member Data distinguishes between a request for information and a request for billing. With the latter, the health insurance fund can include a payment commitment number. That is part of the insurability data provided; it is not an approval of your prescription, nomenclature code or treatment approval.

A green result in Member Data is therefore not the same as an accepted eFact submission. Our overview of eAttest, eFact and eAgreement explains which service handles which step.

What if you don't get a usable response?

No response or a technical error: you cannot conclude from this that your patient is uninsured. Check the error message, your connection and the eHealth status dashboard. For login problems, also check your eHealth certificate and its expiry date.

A response, but not in order: check the patient and the period, and ask the health insurance fund for clarification. In the meantime, do not promise a reimbursement you cannot confirm. The care request and the financial side each need careful attention.

Make Member Data a fixed step in how your practice runs. Our overview of eHealth for physiotherapists places this check alongside the other electronic services.

Read more

Requesting an eAgreement: from prescription to response

From a legible prescription to the health insurance fund's decision: how to prepare an eAgreement, follow up its status and provide missing information.

eHealth · 10 September 2026

Requesting and renewing your eHealth certificate

Requesting a new eHealth certificate or renewing your existing one? Here is how to do it on Windows and Mac, from the card reader to the settings of your practice software.

eHealth · 27 August 2026

Digitalisation 2027: a checklist for physios

Prepare your physiotherapy practice step by step for 1 January 2027. A schedule for certificates, software, practice runs and team agreements, including the official exceptions.

eHealth · 19 August 2026