Self-employed nurse in Belgium: contributions, NIHDI social status, pension

The first year: what lies ahead for a Home nurse

Main or side occupation: what a self-employed nurse pays

A self-employed home nurse joins a social insurance fund before the first round of care. As a main occupation, they pay 20.5% of net income up to €75,024.54, with a minimum of around €925.59 per quarter, management fees included.

Many nurses, however, start alongside a hospital job, as self-employed people with a side activity. In that case, no contribution is due below €1,922.16 of net annual income; above it, the ordinary rate applies to the whole income, not only to the part above the threshold.

Anyone joining for the first time as a main occupation pays around €477.98 for each of the first four quarters, fees included. These amounts are provisional. The NISSE adjusts them 2 to 3 years later on actual income, as explained in the first-year trap.

Visa, NIHDI number and W/97 agreement: before the first patient

Three steps come before the first round. The visa from the FPS Public Health authorises you to practise; some schools have it issued automatically. The NIHDI number then lets you certify the home care services in article 8 of the nomenclature, in your own name or within a group practice. Finally comes joining the national agreement between nurses and health insurance funds.

The NIHDI registration form is sent after the visa. If it leaves no later than one month after the visa is issued, your registration date is the same as the visa date; never earlier. The number has eleven digits, and the first eight stay with you for your whole career.

The W/97 agreement sets the fees that nurses under the agreement charge. It also opens, under conditions, the social status and the telematics premium, reserved for nurses who keep patient records in approved software. Under the third-party payment system, billing must go through MyCareNet, which removes the need to send paper certificates to the health insurance funds.

The nurse's NIHDI social status: an annual premium, under three conditions

The NIHDI social status is an amount the NIHDI pays each year for nurses under the agreement, into a pension or income insurance contract. It is €650.36 for premium year 2025, against €629.34 for 2024. It is not paid into a current account, except for a pensioner who is still working.

Three conditions govern entitlement. Having joined the agreement for the whole year, except the year you receive your NIHDI number, which gives an amount pro rata to the full months of membership. Being self-employed as a main occupation for the whole year, except the first. Having billed between €33,000 and €150,000 of article 8 services, thresholds reduced for recognised periods of inactivity.

The contract receiving the premium must start no later than 31 December of the premium year, then be linked to the file by 15 June of the following year. The calculation runs automatically from July and the decision follows from September. Expect close to a year between the year worked and the money invested.

Pension: the social PLCI/VAPZ, the natural home for the social status

The statutory pension of a self-employed person remains thin. The first top-up is the PLCI/VAPZ: up to 9.4% of reference income in the social PLCI/VAPZ, with a ceiling of €4,701.54 in 2026, deductible as a business expense. The ordinary PLCI/VAPZ is capped at €4,086.34.

The social PLCI/VAPZ also funds a solidarity component: incapacity, invalidity, death. In a job where you lift, turn and support patients, that component matters. It is also a contract that can receive the NIHDI social status: one subscription, before 31 December, settles both questions. The PLCI simulator works out the net cost after tax.

Protection: back, road and liability

A home nurse combines two risks: patient handling and hours on the road. In case of sick leave, the NIHDI pays a flat rate whatever the income: around €2,148.64 per month with dependants, €1,704.56 for a single person, from the first day if the incapacity lasts at least 8 days.

Income protection closes the gap with actual income, up to around 80% of professional income with most insurers. On liability, a medication error or a fall during care can make the nurse liable: professional liability insurance covers such damage, with usual limits of €1,250,000 to €2,500,000 per claim.

• Income protection: read the exclusions for back problems and mental health conditions, common causes of sick leave in care work.
• Group practice: check who covers for whom during sick leave, and whether your liability insurance covers care given for a colleague.
• Car: the policy must cover declared professional use, not just commuting.

Tax and VAT: a car that costs more than you think

Since 1 January 2022, the article 44 VAT exemption has covered care with a therapeutic purpose. Nursing care falls under it: the nurse charges no VAT to patients, but cannot recover the VAT they pay either. On the car, fuel, servicing and equipment, the 21% remains a cost.

Nursing is a liberal profession. The flat-rate business expense allowance is capped at €5,340 for 2026 income: with a car on the road every day, actual expenses often exceed it. Claiming them requires keeping every receipt and a mileage log. Deductible expenses and the home office have their own rules.

Whether a car is deductible depends on its engine type, emissions and order date. Before choosing the car for your rounds, have someone check what you will actually be able to deduct. For a costed comparison, you can be contacted by an accredited professional.

Mistakes we often see

• Signing the contract meant to receive the NIHDI social status at year end: it must start by 31 December at the latest, or the premium for the year cannot be paid.
• Staying in a side activity while counting on the social status: it is reserved for nurses self-employed as a main occupation, apart from the first year.
• Budgeting VAT on the car and equipment as recoverable, when exempt care gives no right to deduction.
• Choosing the car for your rounds without checking its deductibility, which depends on the engine type and order date.
• Spending the gap between provisional starter contributions and real income, then facing the adjustment two to three years later.
• Relying only on the NIHDI benefit after a back injury, with no income protection to cover fixed costs.

Further reading

The pages on this site that explore each of the points covered here in more depth.

• PLCI simulatorWork out a social PLCI/VAPZ that also receives your NIHDI social status.
• Self-employed as a side activityThe rules for providing home care while keeping a hospital job.
• Self-employed dentist: NIHDI social status and pensionThe same social status mechanism, for dentists under the agreement.
• Income protection for the self-employedClosing the gap between the NIHDI flat rate and the income from a round.
• First year self-employed: the contributions trapWhy a starter's provisional contributions are only a down payment.
• Be contactedAn adviser or broker registered with the FSMA can contact you. Free and without obligation.

Frequently asked questions