Persons who wish to benefit from home adaptations paid by the long-term care insurance must send their application to the National Health Fund (Caisse nationale de santé - CNS).
The long-term care insurance may grant financial aid for home adaptations (examples: walk-in shower, elevator, concrete ramp) in order to keep the dependent person at home, to increase their autonomy and to facilitate their daily hygiene and care tasks in areas such as:
- personal hygiene;
- preparation of meals;
- mobility both inside and outside their home.
Adaptations to housing are covered on decision by the long-term care insurance's Administration for Evaluation and Controls (Administration d'évaluation et de contrôle - AEC). The amount of the coverage may not exceed EUR 28,000.
Who is concerned
Each person registered with the health insurance and their co-insured family members are entitled to long-term care insurance. Each person is entitled to long-term care insurance, regardless of income, provided they have been recognised as dependent.
Persons who take out voluntary health insurance must have been affiliated with their health insurance fund for at least one year.
Individuals registered with the National Health Fund (Caisse nationale de santé - CNS) who have been recognised as dependent persons, but who do not reside in Luxembourg (e.g. cross-border workers) have to contact the health fund in their country of residence in order to receive coverage of the costs for adaptations made to their home as this constitutes a benefit in kind.
Persons residing in Luxembourg who are affiliated with a health fund in another EU Member State may be eligible for coverage in Luxembourg for adaptions to their home.
The long-term care insurance can cover the costs to have adaptations made to the home for persons who do not reach the 3.5 hours threshold for basic day-to-day tasks.
Applicants who are tenants or commonhold owners of their home must submit a document indicating their landlord's or commonhold association's express agreement.
Applicants who are neither the owner nor the tenant in their personal name must provide proof of their right to reside in the home to be adapted.
Applicants are required to wait for the assessor sent by the Administration for Evaluation and Controls of the long-term care insurance (AEC) before ordering any adaptation works in their home. Applicants must wait for the approval from the AEC. The law does not provide for retroactive reimbursement.
How to proceed
Submitting the application for home adaptations
A person who wishes to benefit from long-term care insurance must submit their application for long-term care benefits by post to the National Health Fund (CNS) at the following address:
Caisse nationale de santé - Assurance dépendance
B.P. 1023 - L-1010 Luxembourg
The application consists of2 parts:
- the form to be completed by the applicant who must check the corresponding box on the form;
- the medical report (R20) attached to the second part of the form and completed by the applicant's general practitioner.
The medical report (R20) is free of charge for the applicant: the general practitioner is paid directly by the long-term care insurance.
In this report, the doctor provides information on the applicant's state of health. While the role of the doctor is important, they are not the ones who decide whether the person is dependent.
The Administration for Evaluation and Controls of the long-term care insurance (AEC) drafts the specifications of the adaptions to be carried out and forwards the section with the functional changes to the applicant for validation purposes. If the applicant is a tenant, the functional section of the specifications will be sent to the commonhold association and the owner of the home.
If the practical section is approved, a technical section is prepared and forwarded to the applicant.
Upon receiving the specifications, the applicant must, if possible, seek detailed price quotations from at least 2 different companies.
The applicant also undertakes to seek all necessary authorisations for the adaptations to be made.
The cost for the home adaptations will only be covered once. In exceptional cases duly justified for professional reasons, the adaptation of a second accommodation may be granted in the following events:
- the applicant is leaving the parental home; or
- a final decision of separation between places of residence.
The total cost of the home adaptations may not exceed EUR 28,000 per dependent person.
The CNS may eventually cover the additional cost for the rent due to a necessary move to an adapted or adaptable housing. The amount of the additional coverage cannot exceed EUR 350 per month, and it cannot exceed the maximum cumulative amount of EUR 28,000.
The beneficiary is required to reside in the housing where the adaptions were made for at least 12 months from the beginning of the adaptation works. This 12-month period is extended by an additional month for each additional amount of EUR 350 granted.
If this time limit is not complied with, the beneficiary of the aid will have to reimburse the aid received and also pay EUR 350 per month of occupancy which was not respected.
Each change in address must be notified within 1 month to the National Health Fund (CNS).
However, upon advice from the Administration for Evaluation and Controls of the long-term care insurance (AEC), the National Health Fund can exempt the beneficiary from having to reimburse the aid if legitimate reasons resulted in the leaving of the place of residence.
If the applicant does not agree with the CNS's initial decision, they may oppose it before the CNS's executive committee. To do so, they need only send a letter to the executive committee of the CNS within 40 days of the decision. The procedure is described in the decision that the person receives.
If the applicant does not agree with the decision of the CNS's executive committee, they may file an appeal, within 40 days of receiving notification of the decision, with the Social Security Arbitration Tribunal (Conseil arbitral de la sécurité social - CASS) located in Luxembourg. A simple petition on plain paper submitted to the CASS will suffice.
CASS decisions can, themselves, be appealed if the amount in dispute is in excess of EUR 1.250. Applicants have to address the High Council of Social Security (Conseil supérieur de la sécurité sociale) within 40 days of the notification of each decision.