Last updated more than 5 years ago
Persons residing in Luxembourg who receive a replacement income or are entitled to the social inclusion income (revenu d'inclusion sociale - REVIS) are subject to compulsory enrolment with the Joint Social Security Centre (Centre commun de la sécurité sociale - CCSS) provided 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 inclusion income (REVIS), both the inclusion benefit and the activation benefit;
- 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.
To qualify for mandatory insurance, a person must satisfy the conditions for entitlement to:
- unemployment benefits;
- compensation paid in the event of incapacity for work (compensatory allowance following redeployment);
- social inclusion income (formerly: guaranteed minimum income or RMG);
- income for severely disabled people.
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 Agency (Agence pour le développement de l'emploi - ADEM), which pays the contributions directly to the CCSS.
Persons in receipt of the inclusion benefit of the REVIS
The inclusion benefit (formerly the "supplementary allowance" of the guaranteed minimum income) is a form of financial aid granted to households to provide those who have no income, or whose income falls below a certain threshold, with a basic means of livelihood.
This benefit is calculated on a flat rate base which may be increased.
Contributions are deducted at source from the amount of the allowance paid.
Persons in receipt of the activation benefit of the REVIS
The activation benefit (formerly the "integration allowance" of the guaranteed minimum income) is aimed at financially supporting a person taking part in an enablement programme.
The activation benefit is calculated on the basis of the social minimum wage for an unskilled worker, taking account of the number of hours worked.
Contributions are deducted at source from the amount of the benefit.
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.) delivered by providers 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
- the insured person visits a healthcare professional (general practitioner or specialist);
- 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;
- 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. It does not matter whether the bank statement is a copy of the original or has been printed from an online banking website. However, a transfer order alone is not sufficient.
- the application letter is sent to the appropriate health insurance fund, without postage if the application is sent in Luxembourg;
- 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 contribution to their healthcare costs 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 the co-insured parties are added.
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.
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