Cross-Border Terminal Illness & Advance Care Checklist: Netherlands & Belgium

1. 1

   Palliative care, hospice care, and cross-border health coverage between the Netherlands and Belgium

   Begin with the medical team in the country where care takes place and verify coverage in advance with the Belgian health insurance fund (mutuelle / ziekenfonds) or the Dutch health insurer if cross-border care or relocation between the Netherlands and Belgium is being considered.

   • Palliative care and Wlz assessment in the Netherlands: The general practitioner (huisarts) or treating specialist arranges palliative care at home (community nursing under the Healthcare Insurance Act, Zorgverzekeringswet) or admission to a hospice or homelike hospice (bijna-thuishuis). The national government portal Overpalliatievezorg.nl (operated by the Ministry of Health, Welfare and Sport and Palliaweb / PZNL) provides an overview of end-of-life care options and decision aids [1]. If permanent 24-hour intensive care or close supervision is required, apply for an indication under the Long-Term Care Act (Wet langdurige zorg - Wlz) through the Centrum Indicatiestelling Zorg (Care Needs Assessment Centre, 088 789 10 00), which also provides guidance on Wlz applications from abroad [2].
   • Home palliative care, hospital units, and the palliative lump sum in Belgium: In Belgium, palliative support is provided by mobile home palliative care teams (palliatieve thuiszorgequipes / équipes de soutien de soins palliatifs à domicile) and hospital palliative care units, coordinated through Palliatieve Zorg Vlaanderen in Flanders [3], the Pluralistic Federation for Palliative Care (FBPZ) in Brussels, and the Walloon Federation for Palliative Care (Fédération Wallonne des Soins Palliatifs - FWSP) in Wallonia. The Rijksinstituut voor Ziekte- en Invaliditeitsverzekering (National Institute for Health and Disability Insurance - RIZIV / INAMI) provides patients in the palliative phase, via their health insurance fund (ziekenfonds / mutuelle), with a financial allowance (the palliative lump sum, palliatief forfait / forfait palliatif, for home care supplies and medication) as well as full reimbursement of GP home visits [4]. For cross-border care between the Netherlands and Belgium, confirm in advance with the Dutch health insurer (or the CAK) and the Belgian health insurance fund whether an S1 or S2 form is required.
2. 2

   Executing valid written Advance Directives in the Netherlands and Belgium

   Medical advance directives are governed by the domestic law of the country where treatment is delivered. Prepare separate written directives for the Netherlands and Belgium while your family member has full capacity.

   • Written advance directive in the Netherlands: In the Netherlands, the ill person sets out treatment wishes and limits - such as a refusal of treatment (behandelverbod), a do-not-resuscitate order (niet-reanimeerverklaring), or the designation of a healthcare proxy - in writing with a date and signature in line with Dutch government (Rijksoverheid) guidelines [5]. Discuss this declaration with the GP and medical specialist so that it is immediately recorded in the medical file [1][5].
   • Advance directives and municipal registration in Belgium: In Belgium, the Law on Patients' Rights (Wet betreffende de rechten van de patiënt / Loi relative aux droits du patient) distinguishes between a negative advance directive (negatieve wilsverklaring / déclaration anticipée négative de soins, used to refuse specific life-prolonging treatments and appoint a trusted person or healthcare representative) and specific advance declarations regarding euthanasia, organ donation, and final funeral arrangements (under the remit of the Federal Public Service Health, FOD Volksgezondheid / SPF Santé publique) [3][6]. Provide the negative advance directive directly to the GP and treating physician for inclusion in the patient record, while the advance declaration on euthanasia and the declaration on burial or cremation wishes can also be registered with the civil affairs department (dienst burgerzaken) of the Belgian municipality (for example in Antwerp, Ghent, or Brussels), as explained by Palliatieve Zorg Vlaanderen and Notaris.be [3][6].
3. 3

   Establishing separate financial and healthcare Powers of Attorney in both jurisdictions

   When mental capacity declines, banks, notaries, and public bodies in the Netherlands and Belgium require a power of attorney that complies with their respective national laws and registries.

   • Living will (levenstestament) and CLTR in the Netherlands: Before a Dutch civil-law notary, your family member can execute a levenstestament or notarial power of attorney specifying who is authorized to handle banking, real estate, taxes, and medical decisions. The notary registers the existence of this deed in the Central Register of Living Wills (Centraal Levenstestamentenregister - CLTR) via the Koninklijke Notariële Beroepsorganisatie (Royal Dutch Association of Civil-Law Notaries, information line 0900 346 93 93) [7].
   • Extrajudicial protection mandate (zorgvolmacht) in Belgium: For Belgian bank accounts, real estate, and personal decisions, your family member can - while still holding full mental capacity - execute an extrajudicial protection mandate (zorgvolmacht / mandat extrajudiciaire de protection) through a Belgian notary belonging to the Royal Federation of Belgian Notaries (Fédération Royale du Notariat Belge, accessible via Notaris.be) [6]. To remain valid upon subsequent incapacity without requiring intervention by a justice of the peace (vrederechter / juge de paix), this mandate must be registered in the Central Register of Mandate Contracts (Centraal Register van Lastgevingsovereenkomsten / Registre central des contrats de mandat) [6].
4. 4

   Claiming care leave, palliative leave, and caregiver support

   Employees and informal caregivers can rely on the statutory leave and support schemes of the country where they are employed or where the ill relative resides.

   • Care leave and municipal Wmo support in the Netherlands: Under the Work and Care Act (Wet arbeid en zorg), employees in the Netherlands can apply to their employer for short-term care leave (kortdurend zorgverlof, up to twice the weekly working hours per 12 months at a minimum of 70% pay) and long-term care leave (langdurend zorgverlof, up to six times the weekly working hours per 12 months) under Dutch government (Rijksoverheid) rules [8][9]. For domestic help, home adaptations, and respite care, contact the Social Support Act desk (Wmo-loket) of the Dutch municipality of residence (such as Rotterdam, Eindhoven, or Maastricht) and MantelzorgNL for national caregiver guidance.
   • Palliative leave and informal caregiver leave in Belgium: Employees in Belgium are entitled to thematic palliative leave (palliatief verlof / congé pour soins palliatifs) to care for an incurably ill person in the terminal phase for 1 month, which can be extended twice by 1 month (up to a maximum of 3 months) [10]. For this leave, the patient's treating physician completes Medical Certificate 2 (Medisch attest 2), and the Rijksdienst voor Arbeidsvoorziening (National Employment Office - RVA / ONEM) pays a career-break allowance [10][11]. Belgium also offers recognized informal caregiver leave (mantelzorgverlof / congé d'aidant proche), which first requires official recognition as an informal caregiver through the health insurance fund (ziekenfonds / mutuelle).
5. 5

   Aligning wills, bank accounts, pensions, and inheritance tax across both countries

   Coordinating Dutch and Belgian wills and estate documents in advance avoids delays in unblocking bank accounts and filing inheritance tax declarations.

   • Estate preparation and settlement in the Netherlands: Consult a notary of the Koninklijke Notariële Beroepsorganisatie on whether a will with an express choice of law under the EU Succession Regulation is advisable; after death, the notary prepares the certificate of inheritance (verklaring van erfrecht) after checking the Central Register of Wills (Centraal Testamentenregister) [7]. The Sociale Verzekeringsbank (SVB) handles termination of the AOW state pension and applications for a survivor benefit under the Surviving Dependants Act (Anw) [12]. Heirs can accept an estate unconditionally, renounce it, or accept it under benefit of inventory (beneficiair aanvaarden) via the district court registry in accordance with the guidelines of the Dutch Judiciary (de Rechtspraak) [13]. The Belastingdienst processes the inheritance tax return (erfbelasting) and the final F-biljet income tax return (Bereavement Tax Helpline: 0800 235 83 54) [14].
   • Estate preparation and settlement in Belgium: In Belgium, the Federale Pensioendienst (Federal Pensions Service - SFP / MyPension.be, reachable via the Pension Line at 1765) administers the statutory survivor pension (overlevingspensioen) or transitional allowance (overgangsuitkering) for a surviving spouse [15], while the health insurance fund (ziekenfonds / mutuelle) handles any funeral grants and reimbursement of outstanding medical bills. Upon death, Belgian bank accounts are frozen and are only released upon presentation of a certificate or deed of succession (attest of akte van erfopvolging / certificat ou acte d'hérédité), issued by a notary or the Legal Certainty Office (Kantoor Rechtszekerheid) of FOD Financiën after tax and social security checks [6][16]. For a death occurring in Belgium, the inheritance tax return (aangifte van nalatenschap / déclaration de succession) must be filed within 4 months (or 5 months if the death occurred in another European country): with the Flemish Tax Administration (VLABEL) if the deceased's last tax residence was in Flanders [16], or with FOD Financiën (Federal Public Service Finance / SPF Finances) for Brussels and Wallonia [16].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Recording wishes in the palliative phase (Wensen vastleggen in de palliatieve fase) — Overpalliatievezorg.nl (Ministerie van VWS)
2. [2]
   Applying for long-term care (Wlz) from abroad — Centrum Indicatiestelling Zorg (CIZ)
3. [3]
   Advance care planning and advance directives (Vroegtijdige zorgplanning en wilsverklaring) — Palliatieve Zorg Vlaanderen
4. [4]
   What the health insurance fund reimburses: Palliative care — Rijksinstituut voor Ziekte- en Invaliditeitsverzekering (RIZIV / INAMI)
5. [5]
   How do I draw up an advance directive (wilsverklaring)? — Rijksoverheid
6. [6]
   Protecting your loved ones: advance directives and extrajudicial care mandate (zorgvolmacht) — Koninklijke Federatie van het Belgisch Notariaat (Notaris.be)
7. [7]
   Arranging a living will (levenstestament) and power of attorney with a notary — Koninklijke Notariële Beroepsorganisatie (Notaris.nl)
8. [8]
   Caregiver leave (zorgverlof) for relatives — Rijksoverheid
9. [9]
   How do I apply for care leave (zorgverlof)? — Rijksoverheid
10. [10]
    Palliative leave: conditions and duration — Belgium.be (Federale Portaalsite)
11. [11]
    Medical Certificate 2 - Palliative leave or time credit for palliative care — Rijksdienst voor Arbeidsvoorziening (RVA / ONEM)
12. [12]
    What is the Anw survivor benefit (nabestaandenuitkering Anw)? — Sociale Verzekeringsbank (SVB)
13. [13]
    Procedure for accepting or renouncing an inheritance — De Rechtspraak
14. [14]
    Inheritance tax (erfbelasting) and surviving relatives — Belastingdienst
15. [15]
    Pension entitlement: Survivor pension (Overlevingspensioen) — Federale Pensioendienst (SFP)
16. [16]
    Inheritance declaration (aangifte van nalatenschap) and unblocking bank accounts — FOD Financiën