Reimbursement principle for medical and health care expenses
In anticipation of a forthcoming generalization of third-party payment, patients must pay the full amount of their medical expenses to health care providers. In the second stage, they will be able to request reimbursement for this health care from health insurance funds and complementary health insurance companies.
In order for your health care to be covered, your employer must first register you with the Centre Commun de la Sécurité Sociale. Once registered, you can then obtain reimbursement of all or part of your medical expenses and health care from your health insurance company based on receipts.
The National Health Fund (CNS) is the health body for private employees. The CMFEP is the insurance body for people working in the Luxembourg public sector.
Both allow the insured person and his/her dependents to benefit from the reimbursement of medical expenses, drugs, hospitalizations, analyses and medical care, ….
To be reimbursed, medical expenses must be related to a doctor’s consultation, dental expenses, hospital expenses, etc. Purchases of medications and other products dispensed in pharmacies are also covered by prescription.
The health funds reimburse these medical expenses on the basis of the bills and invoices issued by the health care providers. However, they must meet all the professional legal obligations required in Luxembourg.
This reimbursement is made in part or in full, according to a nomenclature of procedures and a list of reimbursement rates published by these organizations.
Third-party payment system
Since 2013, the social third-party payment is effective for the most disadvantaged households.
Under the third-party payment system, CNS pays the health care costs directly to the relevant provider. The recipient of the care does not have to advance these medical expenses. To do so, he will have to present his social security card to the health care provider, to benefit from the part covered by the third-party payer. He will then just have to pay the part that is not taken in charge.
The third-party payment system should be generalized soon.
How to get reimbursed for medical expenses and medications?
Procedures for NHA management
As a private sector employee or beneficiary/co-insured person, you can be reimbursed in part or in full for your medical expenses and medications by the NHA.
First, your employer must register you with the CCSS.
All you have to do is send your health insurance fund (CNS or CMFEP) the receipted invoices for reimbursement.
Please note that some medical or paramedical procedures are not covered by the National Health Fund.
What documents and information should be submitted to the NHA for reimbursement?
Health care expenses incurred by a physician or health care provider
Original bills for fees or other medical expenses paid must be sent to the National Health Fund.
When requesting reimbursement from the health insurance companies, you must enclose the following documents with your claim:
- The original paid bill of fees
- Proof of payment (copy of the bank transfer made) if the fee invoice was not paid directly by the provider by immediate payment, on the spot
- The indication of your bank account number for reimbursement by bank transfer (only if it has not been filled in before)
- The patient’s 13-digit registration number
The cost of medication purchased from a pharmacist, with a medical prescription, is directly covered by the NHA,
This is done upon presentation of your health insurance card. The coverage is total or partial according to a precise nomenclature. You will just have to pay the pharmacist the part not covered by the health insurance.
What is the mailing address to send medical claims to the NHA?
For all your claims for reimbursement of doctors, specialists, dentists, …. you must send the above documents to the National Health Fund.
CNS Caisse nationale de santé – Service Remboursements, 4 Rue Mercier L-2980 Luxembourg
Cross-border commuters who are affiliated to a health insurance fund in their country of residence are of course entitled to receive medical treatment in their country. Reimbursement of health care costs will then be made by the health insurance fund of the country of residence.
If the patient is treated in Luxembourg, the CNS will reimburse the cost of the treatment.
Reimbursement of doctors’ fees and drugs in the clear
On the website of the CNS (National Health Fund), you will find the legal billing rates for doctors, according to the wording of the codes present on the medical fee memoranda. The NHA will reimburse your medical expenses up to these legal rates, not beyond.
To find out the percentage of reimbursement for drugs, you can consult the list of drugs and the percentage of reimbursement by clicking on this link.
- Dental expenses: in addition to dental expenses, 2 scaling procedures are reimbursed per year, as well as anaesthesia for fillings
- Expenses for organic glasses and contact lenses: partial coverage, with improvement
- Work stoppages: maximum compensation period of 78 weeks
- 100% reimbursement of children’s medical expenses for speech therapy, psychomotor therapy and nursing care and/or GP consultations .
- Lymphatic drainage: 24 prescribed sessions, possibility of purchasing compression stockings in 2 pairs every 12months
Reimbursement of health expenses for urgent care abroad
In case of urgent care abroad, a distinction must be made between European Union countries and Switzerland and other destinations.
In the European Union and Switzerland, urgent care is theoretically reimbursed on the basis of the European Health Insurance Card.
In other countries, you will be obliged to advance all the costs and to check with your health insurance fund on your return to see what the possible reimbursement is.
In any case, remember to ask for detailed and receipted invoices, written if possible in one of the common European languages (French, German, English).
To facilitate reimbursement, also make sure the physician you consult or provider is licensed and contracted (as opposed to a private practitioner).
In any case, we advise you to contact your health insurance company to find out about possible reimbursement terms before your departure.
Supplementary insurance to improve the reimbursement of medical expenses
The CNS and the CMFEP do not reimburse health care costs, health care expenses and medication in full.
To improve your medical reimbursements, consider taking out a mutual health insurance policy. For a monthly fee, it will cover the difference and optimize your reimbursement rate for medical expenses .
Supplementary health insurance is not mandatory in Luxembourg. On the other hand, it can be a very good investment against life’s accidents. Don’t hesitate to ask for quotes from several companies.
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