Anyone wishing to receive in-patient treatment abroad must seek the prior approval of the National Health Fund (Caisse nationale de santé - CNS).

A standard appointment with a general practitioner (GP) within the European Union, the European Economic Area (EEA) and Switzerland, and not requiring the use of highly specialised and costly equipment, does not require prior authorisation.

Who is concerned

All persons who have sickness and maternity insurance in Luxembourg, and who must or wish to be treated abroad.

Prerequisites

The insured must seek the prior approval of the CNS. It is recommended that applications for such authorisation be submitted 1 week before the scheduled treatment.

How to proceed

Applications for prior authorisation

To obtain prior approval to be treated abroad, insured individuals must submit an application for prior authorisation to the CNS. The application should be issued by the insured's GP. The CNS provides a standard form that must be completed by the insured's GP.

The application is submitted to the Social Security Medical Board (Contrôle médical de la Sécurité sociale) for its opinion. If the application is accepted, the insured person receives a certificate of authorisation for transfer abroad from the CNS.

Scheduled healthcare not subject to prior authorisation (out-patient care)

Non-hospital or out-patient care refers to all procedures or services delivered by a doctor or other healthcare provider, including medical consultations and minor surgical procedures, which do not require a hospital stay or medical supplies.

The CNS reimburses expenses incurred for such care abroad.

As such, insured persons who wish to receive healthcare or acquire medical supplies abroad, must pay all bills 'upfront'. When they return to Luxembourg, they simply need to send the bills for the expenses they incurred abroad to the appropriate health insurance fund and the expenses will be reimbursed at the rates in force in Luxembourg. The bills must be duly receipted and accurately describe the services delivered, in French, German or English.

Exceptions

Some services may, by way of exception, be subject to prior authorisation (e.g., physiotherapy, radiography, nursing care).

If an authorisation is required by the Luxembourg classification of medical procedures and rates (nomenclatures médicales), or by the statutes of the CNS, it must be given before the trip abroad for expenses to be covered. In that case, the procedure for obtaining the authorisation is the same as for obtaining authorisation for hospital care.

Scheduled healthcare subject to prior authorisation (inpatient care and/or care requiring highly specialised and costly equipment)

For hospital care scheduled abroad, 2 types of agreement can be issued by the CNS in response to an application for prior authorisation for transfer abroad:

• an S2 agreement (described in Regulations (EC) 883/2004 and 987/2009), which guarantees coverage of scheduled care in the country of care, at the rates and fees in force in that country. In principle, expenses are covered through the third-party payer system, which means that the health insurance fund in the country of treatment pays for the care directly, and the insured person only pays the patient's share and any supplemental costs. If the third-party payment system does not apply, the insured person will have to pay the costs upfront and then apply to the local health insurance fund or the Luxembourg fund to have their costs reimbursed at the rates and fees in force in the country of treatment. Additional reimbursements may be requested from the appropriate insurance fund in Luxembourg.
• a Directive 2011/24 agreement (described in Directive 2011/24/EU). In this case, the insured person must pay all costs upfront and then apply to the Luxembourg fund to have their costs reimbursed at the rates and fees and under the conditions in force in Luxembourg.

If a special means of transport is required (such as an ambulance, taxi or aeroplane), the doctor who prescribed the transfer abroad must submit an application for 'authorisation for transfer abroad' by ticking the appropriate box in the application form. In the absence of an agreement to pay for the means of transport, the insured person is entitled to a travel allowance upon request.

A fast-track application can also be filed with the Social Security Medical Board for coverage of an accompanying person's living expenses. The health insurance will cover these expenses provided that the presence of that person is certified as indispensable by the insured's physician abroad. Special authorisation is not required in the case of a minor.

Coverage for treatment programmes

Treatment programmes abroad are covered by health insurance, provided they have been authorised in advance by the National Health Fund on the basis of a reasoned opinion from the Social Security Medical Board. These treatment programmes must take place at an approved institution. Travel expenses are not covered.

To apply, the same application form for prior authorisation to transfer abroad must be used. 

Coverage for scheduled care in a third country

A distinction must be made between countries that have a bilateral agreement with Luxembourg and third countries that do not.

Countries with a bilateral agreement

Any planned medical treatment in one of these countries is subject to prior approval by the CNS, based on a favourable opinion by the Social Security Medical Board. The application procedure is the same as that which applies for the EU, the EEA and Switzerland.

Countries with no bilateral agreement

In response to a reasoned request from a medical specialist, backed by a favourable opinion of the Social Security Medical Board, it may be possible to obtain an authorisation for transfer for medical treatment in a third country with which Luxembourg does not have a bilateral agreement. If approval is given, the insured person will receive a certificate of coverage from the CNS.

They must pay all costs upfront and, on their return, apply to have their expenses reimbursed. The Social Security Medical Board will set the amount to be reimbursed.

In the case of an agreement for treatment outside the European Union and outside the European continent, the insured person is entitled to a special lump-sum travel allowance. The same allowance is due to an authorised accompanying person.

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