BIM in Brussels: a federal status, an extreme regional reality

What is the BIM status?

The Increased Reimbursement Beneficiary (Bénéficiaire de l'Intervention Majorée — BIM in French, Verhoogde Tegemoetkoming — VT in Dutch) is a Belgian social status granting better reimbursement of medical costs (consultations, medications, hospital stays) and triggering, in cascade, a series of derived rights (energy, water, mobility, taxation, housing, childcare).

The status is defined by the federal law on compulsory health insurance, managed at the federal level by INAMI / RIZIV, and granted by the health insurance funds ("mutuelles" / "ziekenfondsen") or by the CAAMI / HZIV for unaffiliated persons. Two access routes coexist:

• Automatic granting for recipients of specific social benefits (CPAS integration income, GRAPA pension top-up, disability allowances).
• Application-based granting for households whose income falls below an annual ceiling (jobseekers or invalidity recipients for more than three months, single-parent families, etc.), with systematic annual income verification before 1 April.

Since 1 October 2024, automatic granting has been extended to single people unemployed or in incapacity for three months or more.

Why a Brussels file on a federal scheme?

Three reasons make the Brussels angle unavoidable.

1. A BIM share without parallel

According to INAMI / IMA figures relayed by the press, about 30 % of the Brussels population qualified for BIM in mid-2025, compared with ~25 % in Wallonia and ~15 % in Flanders. For minors, the gap is even wider: in January 2021, IBSA recorded 33 % of Brussels under-18s on BIM (90,107 children), against 19 % in Wallonia and 13 % in Flanders.

2. An extreme municipal gradient

The regional snapshot conceals an internal gap of 1 to 5. According to the same IBSA figures (BCSS, January 2021):

• 48 % of minors on BIM in Molenbeek-Saint-Jean
• 9 % in Woluwe-Saint-Pierre

This spread is unique on a Belgian scale: no other urban basin shows such a gap between adjoining municipalities of fewer than 100,000 inhabitants.

3. A 2025-2026 squeeze effect

Two federal dynamics converge on the Region:

• The long-term unemployment reform (in force on 1 January 2026) caps benefits at two years. According to figures from the College of Courts relayed by the press on 29 April 2026, 919 Brussels residents have already filed lawsuits to challenge the end of their unemployment benefits (879 cases at the French-speaking labour court, 40 at the Dutch-speaking one). Nationwide: 4,794 lawsuits, and around 86,000 long-term jobseekers have reportedly lost their benefits since 1 January. These people mostly switch to integration income (RIS) — a trigger for automatic BIM.
• A bill tabled on 31 March 2026 in the Chamber's Health Committee aims to tighten BIM eligibility criteria (introduction of a wealth criterion, RIS-style). If passed, around 600,000 BIM beneficiaries nationwide would be affected.

Brussels, which concentrates the highest current beneficiary share and the strongest exposure to the unemployment-to-RIS shift, is the region where this double movement bites hardest.

Institutional framework: who does what?

Brussels derived rights: the cascade mechanism

Beyond healthcare reimbursement, BIM unlocks significant regional and community rights.

• Water (Vivaqua) — social BIM contribution: fixed share of EUR 5 per household + EUR 50 per household member, covering about 25 % of the annual water bill.
• Mobility (STIB): discounted subscriptions, in combination with other social statuses.
• Childcare (ONE): free care in approved facilities for BIM households, scheme expanded in 2023.
• Energy (protected customers): federal social tariff, with BIM as a major gateway.
• Taxation: exemption from the property tax on the main residence under certain conditions, variable municipal allowances.

These derived rights are conditional on BIM status. Any change at federal level therefore produces a domino effect on the entire regional and community architecture.

Non-take-up: a central, under-documented issue

According to mutual fund estimates from 2023, taken up in regional reports, 30,000 to 35,000 people would be eligible for BIM in Brussels without claiming it. The 2016 thematic report of the Joint Community Commission on non-take-up of rights, produced by the Observatory for Health and Social Affairs, remains one of the rare systemic analyses of this phenomenon in Belgium.

Several specifically Brussels factors fuel non-take-up:

• Administrative and linguistic density (FR/NL/EN/AR) among recently arrived populations.
• Stacked precarious statuses (temporary work, undocumented residents — about 50,000 according to the 2025 Welfare Barometer) which complicates access to triggering schemes.
• Threshold effect of the income criterion (a slightly higher income causes the loss of all derived rights).
• Information scattered across INAMI, mutual funds, CPAS, Vivaqua and STIB.

Since 2023, the City of Brussels CPAS runs a dedicated unit to identify eligible non-beneficiaries.

2025-2026 timeline

• 1 October 2024: extension of automatic BIM to single persons unemployed or in incapacity for three months.
• 9 December 2025: Vivalis publishes the Brussels report on poverty and social health inequalities, focused on Brussels' "precariat".
• 15 January 2026: Brupartners adopts an opinion on the "Social-Health" strategy for the 2024-2029 legislature (opinion A-2026-001).
• 12 February 2026: the new Brussels government's regional policy declaration includes a transversal axis on "fight against non-take-up of care and rights".
• 31 March 2026: a bill (MR group) is tabled in the Chamber Health Committee, tightening BIM criteria (wealth criterion added, RIS-style).
• 15 April 2026: Vivalis publishes the Welfare Barometer 2025, putting Brussels poverty risk at 23 % (vs 7 % in Flanders, 13 % in Wallonia) and RIS recipients at 47,304 on 1 January 2025 (more than in Flanders, despite a five-times-smaller population).
• 29 April 2026: the press documents 919 Brussels lawsuits against the end of long-term unemployment benefits (College of Courts, via De Standaard / BX1 / BRUZZ).

Connections with other BGM files

• acs: subsidised non-profit employment contracts often open access to RIS, the trigger for automatic BIM; strong overlap.
• seniors-a-bruxelles: GRAPA opens automatic BIM; in Saint-Josse-ten-Noode, 59 % of seniors were BIM in 2024 (Vivalis, municipal Zoom).
• slrb: the socio-economic profile of social housing tenants largely overlaps with BIM beneficiaries; any change in the social housing stock has a direct impact on the cascade of derived rights.

Issues to track

• Non-take-up: do the City of Brussels CPAS unit and the October 2024 automatism extension produce a measurable drop in eligible non-beneficiaries?
• Unemployment → RIS → BIM shift: how many Brussels residents excluded from unemployment in 2025-2026 effectively become automatic BIM, at what pace, and at what regional cost in derived rights?
• Federal bill: if the BIM tightening is passed, how many Brussels residents lose the status, and which regional derived rights fall with it (threshold effect on Vivaqua, STIB, ONE)?
• Coherence of regional schemes: do Vivaqua, STIB and ONE thresholds strictly follow BIM status, or should regional decoupling be prepared to absorb a possible federal shock?
• Cocom steering: is there effective coordination between Vivalis, Iriscare, CPAS and mutual funds on Brussels BIM, or do silos prevail?