Registering with the social security system and having healthcare expenses reimbursed as a recipient of replacement income

Persons residing in Luxembourg who receive replacement income or are entitled to the social minimum wage are subject to compulsory enrolment with the Joint Social Security Centre (Centre commun de la sécurité sociale – CCSS) if they are not subject to enrolment with the social security system in another capacity. Once enrolled, such persons are entitled to the services provided by the health insurance fund and can have their healthcare expenses reimbursed under the same conditions as an insured employee.

The following benefits are considered replacement income:

  • unemployment benefits;
  • allowances paid due to incapacity for work (compensatory benefits);
  • the social minimum wage (both the supplementary allowance and the integration allowance);
  • allowances for the severely disabled.

Who is concerned

Any person residing in Luxembourg who receives replacement income is automatically enrolled with the CCSS and are covered by sickness and maternity, accident and dependency insurance.

Regarding income for severely disabled persons, only disabled workers who work in sheltered workshops are covered by accident insurance.

Prerequisites

To qualify for mandatory insurance, a person must satisfy the conditions for entitlement to:

How to proceed

Deduction of and basis for social security contributions

A distinction is made between recipients of unemployment benefits and recipients of the social minimum wage.

Recipients of unemployment benefits

Out-of-work employees receive a replacement income which is calculated based on the salary they received while they were employed.

Out-of-work self-employed persons receive replacement income which is calculated based on the income used to determine their contribution base for the two previous financial years.

However, the contribution base may not be less than the social minimum wage or more than five times that wage.

Workers' social security contributions are deducted from this income by the National Employment Administration (Agence pour le développement de l'emploi - ADEM), which pays the contributions directly to the CCSS.

Recipients of the social minimum wage

The integration allowance is given to persons who are able to comply with integration measures. It is therefore a form of financial aid for job-seekers.

This allowance is equal to the hourly social minimum wage for a skilled worker multiplied by the number of hours to be provided.

Contributions are deducted at source from the amount of the allowance paid.

Recipients of a supplementary allowance (social minimum wage)

A supplementary allowance is paid to households in which one or more persons are unable to comply with labour-market integration measures, or are temporarily exempt from doing so.

The supplementary allowance is meant to make up the difference between their income, if any, and the social minimum wage. It is intended to provide beneficiaries with sufficient means of livelihood.

Contributions are deducted from this allowance and calculated based on the person's total income. As such, their income and the supplementary allowance are both subject to contributions.

The contributions are automatically deducted at source from the person's income.

Coverage of healthcare expenses

Through their enrolment with the CCSS, and with sickness and maternity insurance in particular, insured persons and their families are covered for healthcare services (hospital, doctors, pharmacies, etc.) provided by healthcare professionals legally established in Luxembourg.

Such coverage is generally in the form of reimbursements by the CNS to persons who have advanced the costs of healthcare services. In some cases, it can be in the form of direct payments (third-party payment system).

Reimbursement of expenses advanced by insured persons

  1. the insured person visits a healthcare professional (general practitioner or specialist);
  2. at the end of the visit, the insured person pays the healthcare professional's fees and/or invoices either immediately in cash, or subsequently by bank transfer;
  3. the insured person must then submit an application by post to the competent health insurance fund for reimbursement of the expenses incurred. Their application must mention/contain:
    • the insured individual's identity and national identification number;
    • the insured individual's bank account details, if it is a first-time request, or if their bank details have changed;
    • the original receipted statement of fees, or if the payment was made at a later time, proof of payment in the form of an account statement. The account statement can be either a copy of the original or printed from an online banking website. However, a transfer order alone is not sufficient.
  4. the application letter is sent to the appropriate health insurance fund, without postage if the application is sent in Luxembourg;
  5. reimbursement will be made by wire transfer within a few weeks. The amount reimbursed depends on the contractual or statutory rate.

Certain healthcare/medical procedures (such as plastic surgery) are subject to prior authorisation from the Social Security Medical Board (Contrôle médical de la Sécurité sociale), without which no coverage will be provided by the health insurance fund.

Additional costs incurred to satisfy personal wishes and convenience, such as a first-class room during an inpatient hospital stay, are fully borne by the insured individual, unless they have taken out supplementary insurance.

Reimbursement by cheque

On an exceptional basis, each local office in the CNS network is authorised to issue checks for the purpose of reimbursing benefits in kind, provided that the corresponding bills/invoices were settled fewer than 15 days prior to the day of submission and amount to at least EUR 100. Such cheques can be deposited free of charge or withholding at any Post Office branch (P&T).

Direct payment by the health insurance fund

In some cases, such as for hospital treatment, medicine or biomedical tests, insured individuals are not required to advance the full cost of the healthcare service they receive. This system of direct payment by the competent health insurance fund is known as the third-party payer system. For the system to operate, the insured individual must produce a social security card.

Insured individuals need only pay healthcare providers for the portion of the expenses that remains to be borne by them.

In the calendar year, an insured individual's contributions to the cost of healthcare benefits is capped. In the case of payment for care exceeding 2.5 % of the annualized 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 their co-insured parties are added.

Exceptional assistance

Persons who temporarily find themselves in a precarious economic situation, for whom the payment of a bill/invoice represents an insurmountable burden, may receive exceptional assistance from the CNS.

Applications for exceptional assistance must be made in writing and be in connection with: 

  • a specific bill/invoice (which means that if a person has 3 bills/invoices, 3 separate applications must be submitted);
  • a bill/invoice issued by a CNS-approved healthcare provider or supplier;
  • a service or product for which all conditions for coverage have been satisfied;
  • a service or product that is not covered directly by the third-party payer system;
  • a bill/invoice for over EUR 250. Costs billed for services/products obtained as a matter of 'personal convenience' (CP), or exceeding originally quoted costs, are not taken into account in the EUR 250.

The application must be made within 3 months of the date of issue of the bill/invoice.

In filing their application, applicants must also specify why the bill/invoice represents an 'insurmountable burden' on their current economic situation. To do so, they should attach any documents that they consider relevant.

If exceptional assistance is approved, the CNS will make a wire payment to the provider or supplier and the insured individual will not be required to advance any funds and apply for subsequent reimbursement. The personal contribution will still have to be paid by the insured individual.

Forms / Online services

AUTHENTIC SOURCES

Health insurance - My situation

To complete your application, the information about you collected from this form needs to be processed by the public administration concerned.

That information is kept by the administration in question for as long as it is required to achieve the purpose of the processing operation(s).

Your data will be shared with other public administrations that are necessary for the processing of your application. For details on which departments will have access to the data on this form, please contact the public administration you are filing your application with.

Under the terms of Regulation (EU) 2016/679 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, you have the right to access, rectify or, where applicable, remove any information relating to you. You are also entitled to withdraw your consent at any time.

Additionally, unless the processing of your personal data is compulsory, you may, with legitimate reasons, oppose the processing of such data.

If you wish to exercise these rights and/or obtain a record of the information held about you, please contact the administration in question using the contact details provided on the form. You are also entitled to file a claim with the National Commission for Data Protection (Commission nationale pour la protection des données), headquartered at 1, Avenue du Rock'n'Roll, L-4361 Esch-sur-Alzette.

By submitting your application, you agree that your personal data may be processed as part of the application process.

Caisse de maladie - Ma situation

Les informations qui vous concernent recueillies sur ce formulaire font l’objet d’un traitement par l’administration concernée afin de mener à bien votre demande.

Ces informations sont conservées pour la durée nécessaire par l’administration à la réalisation de la finalité du traitement

Les destinataires de vos données sont les administrations compétentes dans le cadre du traitement de votre demande. Veuillez-vous adresser à l’administration concernée par votre demande pour connaître les destinataires des données figurant sur ce formulaire. Conformément au règlement (UE) 2016/679 relatif à la protection des personnes physiques à l'égard du traitement des données à caractère personnel et à la libre circulation de ces données, vous bénéficiez d’un droit d’accès, de rectification et le cas échéant d’effacement des informations vous concernant. Vous disposez également du droit de retirer votre consentement à tout moment.

En outre et excepté le cas où le traitement de vos données présente un caractère obligatoire, vous pouvez, pour des motifs légitimes, vous y opposer.

Si vous souhaitez exercer ces droits et/ou obtenir communication de vos informations, veuillez-vous adresser à l’administration concernée suivant les coordonnées indiquées dans le formulaire. Vous avez également la possibilité d’introduire une réclamation auprès de la Commission nationale pour la protection des données ayant son siège à 1 Avenue du Rock'n'Roll, L-4361 Esch-sur-Alzette.

En poursuivant votre démarche, vous acceptez que vos données personnelles soient traitées dans le cadre de votre demande.

Krankenkasse - Meine Situation

Ihre in diesem Formular erfassten personenbezogenen Informationen werden von der zuständigen Verwaltungsbehörde verarbeitet, um Ihren Antrag erfolgreich abzuschließen.

Diese Informationen werden von der Behörde für den zur Verarbeitung erforderlichen Zeitraum gespeichert.

Die Empfänger Ihrer Daten sind die im Rahmen Ihres Antrags zuständigen Verwaltungsbehörden. Um die Empfänger der in diesem Formular erfassten Daten zu erfahren, wenden Sie sich bitte an die für Ihren Antrag zuständige Behörde.

Gemäß der Verordnung (EU) 2016/679 zum Schutz natürlicher Personen bei der Verarbeitung personenbezogener Daten und zum freien Datenverkehr haben Sie das Recht auf Zugang, Berichtigung und gegebenenfalls Löschung Ihrer personenbezogenen Informationen. Sie haben zudem das Recht, Ihre erteilte Einwilligung jederzeit zu widerrufen.

Weiterhin können Sie, außer in Fällen, in denen die Verarbeitung Ihrer Daten verpflichtend ist, Widerspruch einlegen, wenn dieser rechtmäßig begründet ist.

Wenn Sie diese Rechte ausüben und/oder Einsicht in Ihre Informationen nehmen möchten, können Sie sich unter den im Formular angegebenen Kontaktdaten an die zuständige Verwaltungsbehörde wenden. Sie haben außerdem die Möglichkeit, bei der Nationalen Kommission für den Datenschutz Beschwerde einzulegen (Commission nationale pour la protection des données, 1, Avenue du Rock'n'Roll, L-4361 Esch-sur-Alzette).

Wenn Sie Ihren Vorgang fortsetzen, akzeptieren Sie damit, dass Ihre personenbezogenen Daten im Rahmen Ihres Antrags verarbeitet werden.

Who to contact

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