What to do with your notification form?
To do:
- Apply your mutuality sticker.
- Fill out the fields 4 to 6 on this notification form.
- Sign the document. It should be signed by yourself, your physiotherapist and your surgeon.
You should have received this form at the beginning of your rehabilitation at the hospital (together with your prescription).


Cost table depending on the amount of weeks of rehabilitation
TOTAL Cost | Reimbursed by mutuality | Personal share (reimbursed by private hospitalisation insurance) | |
Preop (includes activity tracker) | € 90,65 | € 78,77 | € 11,88 |
1-2 weeks | € 240,65 | € 199,29 | € 41,36 |
3-4 weeks | € 390,65 | € 319,81 | € 70,84 |
5-6 weeks | € 508,15 | € 410,03 | € 98,12 |
7-8 weeks | € 610,65 | € 485,25 | € 125,40 |
9-10 weeks | € 703,15 | € 550,47 | € 152,68 |
11-12 weeks | € 795,65 | € 615,69 | € 179,96 |
TOTAL Cost | Reimbursed by mutuality with preferential rate | Personal share preferential rate (reimbursed by private hospitalisation insurance) | |
Preop (includes activity tracker) | € 90,65 | € 86,54 | € 4,11 |
1-2 weeks | € 240,65 | € 226,03 | € 14,62 |
3-4 weeks | € 390,65 | € 365,52 | € 25,13 |
5-6 weeks | € 508,15 | € 473,31 | € 34,84 |
7-8 weeks | € 610,65 | € 566,10 | € 44,55 |
9-10 weeks | € 703,15 | € 648,89 | € 54,26 |
11-12 weeks | € 795,65 | € 731,68 | € 63,97 |