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. In Luxembourg, the national health insurance funds are the following:
- the National Health Fund (Caisse nationale de santé – CNS – or "Gesondheetskees"), for the private sector;
- the Health Insurance Fund for Civil Servants and State Employees (Caisse de maladie des fonctionnaires et employés publics - CMFEP);
- the Health Insurance Fund for Communal Civil Servants and Employees (Caisse de maladie des fonctionnaires et employés communaux – CMFEC), for the public sector;
- the CFL Health Insurance Fund (Entraide médicale des CFL - EMCFL), for Luxembourg railway workers.
Who is concerned
Enrolment with social security confers entitlement to the coverage of costs incurred in the event of an illness, for:
- the main insured person and the members of their family (so-called 'co-insureds');
- pension beneficiaries;
- people receiving replacement income, i.e., the Guaranteed minimum wage (Revenu minimum garanti - RMG) (RMG - Revised);
- persons who take out health insurance voluntarily.
The healthcare services must be provided by approved providers, in other words, providers that have entered into an agreement with the National Health Fund, and have agreed to apply pre-determined rates (note that in Luxembourg, contractual agreement is automatic for any provider authorised to establish a practice).
How to proceed
Insured individuals are free to contact the care providers of their choice. However, only those procedures, services and supplies listed in the Luxembourg classification of procedures and rates (nomenclature), or in similar such lists provided for by Luxembourg laws, regulations, agreements and statutes, and delivered by persons or institutions authorised to practice their profession in Luxembourg, are covered by health insurance.
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.
Categories of benefits in kind
The reimbursement of certain benefits in kind (travel expenses, etc.) are subject to conditions.
'Benefits in kind' notably means:
- medical care, in other words, consultations and medical visits with a general practitioner or specialist;
- hospital care, whether out-patient or in-patient treatment;
- pharmaceutical drugs;
- dental care, anaesthesia, orthodontic treatment, dental prostheses;
- treatment delivered by healthcare professionals, such as the procedures and services delivered by nurses, massage and physical therapists, midwives, speech-language therapists, and psychomotor therapists;
- laboratory tests and analyses;
- orthopaedic prostheses, othoses (braces, splints) and facial prostheses ;
- hearing and voice prostheses;
- travel and transportation expenses;
- visual aids;
- medical devices, apparatuses and other supplies included on specific lists;
- palliative care;
- functional physical therapy and rehabilitation, geriatric rehabilitation, and cardiac rehabilitation;
- funeral allowance, granted in the form of a flat-rate amount, in the event of the death of an insured or a member of their family;
- maternity-related care, including all prenatal and postnatal care, as well as care provided during birth;
- blood products and plasma derivatives;
- organ transplants, in particular the fees for registering with EUROTRANSPLANT databases.
Reimbursement and payment
Reimbursement by bank transfer of healthcare costs paid in advance by the insured
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 attach the medical prescription where applicable.
The application for reimbursement must specify:
- the identity and national identification (ID) number of the insured and/or patient;
- the insured's bank account details: a bank account identification document (relevé d'identité bancaire - RIB) would only need to be attached when an application is being made for the first time, or when there is a change in the banking details.
Note that no postage (stamps) is required for mail being sent in 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.
Reimbursement by check of healthcare costs paid in advance by the insured
Each local agency in the CNS agency network may issue checks for the purpose of reimbursing healthcare costs, provided that the relevant bills had been paid no more than 15 days before the date of application, and that their amount is as least EUR 100. Checks issued in this way may be cashed, with no cost or withholding, at any POST Luxembourg post office.
Direct payment by the National Health Fund
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. For this system to operate, a social security card is required.
In this case, the insured 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 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.
Details of the reimbursement
For each reimbursement, the competent health insurance fund will send the insured person a detailed statement of reimbursement by post.
In order to simplify the procedure, the insured person can subscribe to the service "eDelivery" on MyGuichet.lu. This service allows to receive the detailed statement of reimbursement in the form of an electronic document ("eDocument"). Once this feature has been activated, the insured person receives a notification by email each time a statement of reimbursement is posted in his or her private eSpace on MyGuichet.lu.
By activating the eDelivery service, the insured person waives the right to receive a detailed statement of reimbursement by post.
Forms / Online services
Who to contact
Health Insurance Fund for Civil Servants and Communal Employees20, avenue Emile Reuter
Phone : (+352) 45 05 15Fax : (+352) 45 02 01-222
Health Insurance Fund for Civil Servants and State Employees32, avenue Marie-Thérèse
Phone : (+352) 45 16 81Fax : (+352) 45 67 50