Applying for coverage of healthcare services

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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:

the National Health Fund (Caisse nationale de santé – CNS – or 'Gesondheetskees'), for the private sector;
the Health Insurance Fund for Civil Servants and Public Employees (Caisse de maladie des fonctionnaires et employés publics – CMFEP), for the public sector;
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 ('co-insured' persons);
pension beneficiaries;
persons receiving a replacement income (social inclusion income, known as 'REVIS');
persons who take out health insurance voluntarily.

Prerequisites

The services must be provided by contracted providers, i.e. providers who:

have concluded an agreement with the National Health Fund; and
apply predetermined tariffs (note that in Luxembourg the agreement is automatic for authorised providers).

How to proceed

General remarks

Insured individuals are free to contact the care providers of their choice. However, the health insurance only covers procedures, services and supplies:

listed in the nomenclature or lists provided for by laws, regulations, conventions and statutes; and
provided by individuals or institutions authorised to exercise their profession on Luxembourg territory.

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.

Services covered

Categories of benefits in kind

The reimbursement of certain benefits in kind (travel expenses, etc.) are subject to conditions.

'Benefits in kind' includes:

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 epitheses;
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, where applicable, attach the medical prescription .

The application for reimbursement must specify:

the identity and national identification (ID) number of the insured and/or patient; and
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.

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:

have a private eSpace; and
link their private eSpace with the MyGuichet.lu mobile app.

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.

Reimbursement by check of healthcare costs paid in advance by the insured

Each local branch of the CNS network can issue cheques for the reimbursement of health care, provided that:

the invoices were paid less than 15 days prior to their presentation; and
that the total amount is at least EUR 100.

Checks issued in this way may be cashed, without extra 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. 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).

Additional payment

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.

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 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.

Forms / Online services

Activate the eDelivery function for documents sent by the health fund

Go to the procedure

Activer la fonction eDelivery pour les documents envoyés par la caisse de maladie

Accéder à la démarche

Die Funktion eDelivery für die von der Krankenkasse zugeschickten Dokumente aktivieren

Den Vorgang öffnen

Request for a change of a bank or post office account with a health fund

Go to the procedure

Demande de changement du compte bancaire/postal auprès d'une caisse de maladie

Accéder à la démarche

Antrag auf Änderung der einer Krankenkasse mitgeteilten Bank-/Postkontoverbindung

Den Vorgang öffnen

Authentic sources

Health insurance - My situation

Access your health insurance data

Consult my data

Caisse de maladie - Ma situation

Consultez votre affiliation à une caisse de maladie

Consulter mes données

Krankenkasse - Meine Situation

Einsicht in Ihre Krankenkassendaten

Meine Daten einsehen

Who to contact

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National Health Fund (CNS)
CNS Department - National Reimbursements

125, route d'Esch
L-2980 Luxembourg
Luxembourg

Phone : (+352) 27 57 - 1

Fax : (+352) 27 57 27 - 58

(+352) 27 57 - 1 CNS Department - National Reimbursements Path to CNS Department - National Reimbursements

Double click to activate the map

Health Insurance Funds for the Public Sector and Related Sectors
Health Insurance Fund for Communal Civil Servants and Employees

20, avenue Emile Reuter

Luxembourg
Postal address :
B.P. 328 L-2013

Phone : (+352) 45 05 15

Fax : (+352) 45 02 01-222

(+352) 45 05 15 Path to Health Insurance Fund for Communal Civil Servants and Employees More information on Health Insurance Fund for Communal Civil Servants and Employees
Health Insurance Fund for Civil Servants and Public Employees

32, avenue Marie-Thérèse
L-2132 Luxembourg
Luxembourg

Phone : (+352) 45 16 81

Fax : (+352) 45 67 50

(+352) 45 16 81 Path to Health Insurance Fund for Civil Servants and Public Employees More information on Health Insurance Fund for Civil Servants and Public Employees
CFL Health Insurance Fund

2B, rue de la Paix
L-2312 Luxembourg
Luxembourg

Phone : (+352) 49 90 - 3416

Fax : (+352) 49 90 - 4501

(+352) 49 90 - 3416 emcfl@secu.lu Path to CFL Health Insurance Fund More information on CFL Health Insurance Fund

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