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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:
Enrolment with social security confers entitlement to the coverage of costs incurred in the event of an illness, for:
The services must be provided by contracted providers, i.e. providers who:
Insured individuals are free to contact the care providers of their choice. However, the health insurance only covers procedures, services and supplies:
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.
The reimbursement of certain benefits in kind (travel expenses, etc.) are subject to conditions.
'Benefits in kind' includes:
1. the insured or co-insured individual goes to see a health professional;
2. the insured person pays the 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:
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.
Each local branch of the CNS network can issue cheques for the reimbursement of health care, provided that:
Checks issued in this way may be cashed, without extra cost or withholding, at any POST Luxembourg post office.
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 contribution to the healthcare costs (e.g. upon being released from the hospital).
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 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.
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.