Applying for coverage of healthcare services
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Sickness and maternity insurance provides insured individuals and their families with coverage for healthcare services (hospital, doctor's visits, pharmacy, etc.) delivered by providers legally established in Luxembourg.
Both residents and non-residents are entitled to healthcare coverage through one of several national health insurance funds. The fund with which the insured is enrolled depends on their socio-professional status. This applies to:
- the National Health Fund (Caisse nationale de santé - CNS – or 'Gesondheetskees'), for the private sector;
- the Health Insurance Fund for Civil Servants and Public Employees (Caisse de maladie des fonctionnaires et employés publics - CMFEP), for the public sector;
- the Health Insurance Fund for Communal Civil Servants and Employees (Caisse de maladie des fonctionnaires et employés communaux - CMFEC), for the public sector;
- the CFL Health Insurance Fund (Entraide médicale des CFL - EMCFL), for Luxembourg railway workers.
Who is concerned?
Enrolment with social security confers entitlement to the coverage of costs incurred in the event of an illness, for:
- the main insured person and the members of their family ('co-insured' persons);
- pension beneficiaries;
- persons receiving a replacement income (social inclusion income, known as 'REVIS');
- persons who take out health insurance voluntarily.
Prerequisites
The services must be provided by contracted providers, i.e. providers who:
- have concluded an agreement with the National Health Fund; and
- apply predetermined tariffs (note that in Luxembourg the agreement is automatic for authorised providers).
How to proceed
General remarks
Insured individuals are free to contact the care providers of their choice. However, the health insurance only covers procedures, services and supplies:
- listed in the nomenclature or lists provided for by laws, regulations, conventions and statutes; and
- provided by individuals or institutions authorised to exercise their profession on Luxembourg territory.
In exceptional cases, medical procedures that are not listed in the classification of procedures may be covered, on condition that (i) a detailed medical certificate is provided by the treating physician, and (ii) a favourable opinion is obtained from the Social Security Medical Board (Contrôle médical de la sécurité sociale), which sets a rate for reimbursement by analogy.
Services covered
Categories of benefits in kind
The reimbursement of certain benefits in kind (travel expenses, etc.) is subject to terms and conditions.
'Benefits in kind' includes:
- medical care, in other words, consultations and medical visits with a general practitioner or specialist;
- hospital care, whether out-patient or in-patient treatment;
- pharmaceutical drugs;
- dental care, anaesthesia, orthodontic treatment, dental prostheses;
- treatment delivered by healthcare professionals, such as the procedures and services delivered by nurses, massage and physical therapists, midwives, speech-language therapists, and psychomotor therapists;
- laboratory tests and analyses;
- orthopaedic prostheses, orthoses (braces, splints) and epitheses;
- hearing and voice prostheses;
- travel and transportation expenses;
- visual aids;
- medical devices, apparatuses and other supplies included on specific lists;
- palliative care;
- functional physical therapy and rehabilitation, geriatric rehabilitation, and cardiac rehabilitation;
- funeral allowance, granted in the form of a flat-rate amount, in the event of the death of an insured or a member of their family;
- maternity-related care, including all prenatal and postnatal care, as well as care provided during birth;
- blood products and plasma derivatives;
- organ transplants, in particular the fees for registering with Eurotransplant databases.
Reimbursement and payment
Reimbursement by bank transfer of healthcare costs paid in advance by the insured
1. the insured or co-insured individual goes to see a health professional;
2. the insured person pays the health professional immediately or by bank transfer at a later moment;
3. the insured person sends the bill or statement of fees together with, where applicable, a proof of payment (notification of debit) to the competent health insurance fund in order to be reimbursed;
4. the insured person must, where applicable, attach the medical prescription .
The application for reimbursement must specify:
- the identity and national identification (ID) number of the insured and/or patient; and
- the insured's bank account details: a bank account identification document (relevé d'identité bancaire - RIB) would only need to be attached when an application is being made for the first time, or when there is a change in the banking details.
Any change of bank details can be made via MyGuichet.lu. This online procedure can be carried out with or without authentication using a LuxTrust product or an electronic identity card (eID).
The change can also be made via the MyGuichet.lu mobile application. To make the change using the mobile application, the insured must:
Note that no postage (stamp) is required for mail sent from inside Luxembourg. Bills or statements of fees for costs paid in advance by persons insured by the National Health Fund may also be submitted in person at a local CNS agency.
5. the reimbursement is made via bank transfer. The reimbursed amount depends on the contractual rate or, where applicable, certain statutory conditions. As such, certain services are subject to prior authorisation from the Social Security Medical Board, without which the fund will not cover the delivered care.
Additional costs incurred for reasons of 'personal convenience' (convenance personnelle - CP) (CP codes) or first-class hospital accommodation (individual room) are fully borne by the insured.
Insured individuals who have taken out supplementary insurance (CMCM or similar) may send the relevant bills to their insurer for additional reimbursement.
Insured individuals who are experiencing financial problems may apply for direct coverage of their healthcare costs through the social security third party payer system.
Reimbursement by check of healthcare costs paid in advance by the insured
Each local branch of the CNS network can issue cheques for the reimbursement of health care, provided that:
- the invoices were paid less than 15 calendar days prior to their presentation; and
- that the amount is at least EUR 100 per household.
Checks issued in this way may be cashed, without extra cost or withholding, at any POST Luxembourg post office.
Direct payment by the National Health Fund
In certain cases, such as for the costs of hospitalisation, pharmaceutical drugs or laboratory services, a part of the costs covered by health insurance is paid directly by the fund. This system of direct payment is known as the third party payer system. The presentation of the social security card is required.
The insured then pays the provider only their own contribution to the healthcare costs (e.g. upon being released from the hospital).
Additional payment
An insured person's contribution to healthcare benefits is capped over the course of a calendar year. In the case of payment for care exceeding 2.5 % of the annualised contributory income, the insured individual is entitled to an additional reimbursement from their health insurance fund for contributions exceeding the threshold in question. To determine the amount exceeding the threshold, the contributions made by both the insured and the co-insured parties are added together.
Details of the reimbursement
For each reimbursement, the competent health insurance fund will send the insured person a detailed statement of reimbursement by post.
In order to simplify procedures, the insured can subscribe to the eDelivery option to receive their reimbursement details in electronic form. Subscription is done via the insured person's private eSpace of MyGuichet.lu in the "Health/Social" section of the "My data" tab.
Once this feature has been activated, the insured person receives an email notification each time a statement of reimbursement is posted in their private eSpace on MyGuichet.lu. This document can also be consulted in the "My messages" tab of the MyGuichet.lu mobile application.
By subscribing to the eDelivery function, the insured person opts out of receiving reimbursement details by post.
Online services and forms
Online services
My data
Who to contact
CNS Department - National Reimbursements
-
National Health Fund (CNS) CNS Department - National Reimbursements
- Address:
-
4, rue Mercier
L-2144
Luxembourg
Luxembourg
L-2980 Luxembourg
- Phone:
- (+352) 27 57 - 1
- Fax:
- (+352) 2757 - 2758
- Website:
- http://www.cns.lu/en
Health Insurance Funds for the Public Sector and Related Sectors
-
Health Insurance Funds for the Public Sector and Related Sectors
- Address:
- Luxembourg
-
Health Insurance Fund for Communal Civil Servants and Employees
- Address:
-
20, avenue Emile Reuter
Luxembourg
B.P. 328 L-2013
- Phone:
- (+352) 45 05 15
- Fax:
- (+352) 45 02 01-222
- Website:
- https://cmfec.public.lu/fr.html
-
Health Insurance Fund for Civil Servants and Public Employees
- Address:
- 32, avenue Marie-Thérèse L-2132 Luxembourg Luxembourg
- Phone:
- (+352) 45 16 81
- Fax:
- (+352) 45 67 50
- Website:
- https://cmfep.public.lu/en.html
-
CFL Health Insurance Fund
- Address:
- 2B, rue de la Paix L-2312 Luxembourg Luxembourg
- Phone:
- (+352) 49 90 - 3416
- Fax:
- (+352) 49 90 - 4501
- Email address:
- emcfl@secu.lu
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Related procedures and links
Procedures
Links
Further information
-
Calculation of financial benefit
on the website of the National Health Fund (CNS)
-
Reimbursement procedure
on the website of the National Health Fund (CNS)
Legal references
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