Why is it worthwhile to have supplementary health insurance?

Are you coming to Luxembourg and wondering about the level of health care benefits? The price level is high in Luxembourg. Want to know how easy it is to find a doctor and how the health care system works, including reimbursement?

This is what we propose to discuss in this article. For this, we interviewed Fabio Secci, General Manager of CMCM, a mutual health insurance company established in Luxembourg since 1956.

Good health coverage in Luxembourg

Governed by the Caisse Nationale de Santé or CNS, the health care system in Luxembourg is compulsory for all employees and self-employed persons.It can be qualified as a quality system, both in terms of access to care and the level of reimbursement of benefits.

Access to health care is easy thanks to a large number of doctors. In general practice, the NHA system is very effective. It covers 80 to 90% of the expenses of a general practitioner. This is also the case for medical reimbursements to certain specialists. In addition, medical expenses for a minor under the age of 16 are reimbursed at 100%!

But a system of care that empowers

However, some expenses will not be covered by the NHA. Indeed, while benefits are generally covered, the CNS does not reimburse certain medical expenses at all or very little. This is particularly true for dental and vision-related expenses.

When it comes to hospitalization, expenses are well covered, but not in full. Reimbursements can be up to 90% of the costs if the hospitalization is done in multiple rooms. This is not the case in a single room.

The reason for not reimbursing the full cost of care is patient responsibility. Indeed, the need for medical care may be, in some cases, the result of a certain negligence in our relationship with health.

Furthermore, it is important to understand that nothing is free. In Luxembourg, unlike some countries such as France, patients must pay their medical expenses in advance. Indeed, caring is a charge or an expense borne by the community. Receiving care is the result of a collective effort and solidarity.

How does it work in practice?

A non-optimal overall system for hospitalization

Benefit from a single room or first class hospitalization

In Luxembourg, in case of hospitalization, you can benefit from a single room. This is called a first class room. In this case, the final rate may increase by up to 70% over the general rate prescribed by the NHA. Not only the costs of the room alone, but also the costs of all doctors in connection with the hospital stay are affected by the first class increase. But the NTC will not cover the price difference between first and second class.

Single rooms are few and far between in Luxembourg. Hospitals often reserve them for long-term hospitalization. As a rule, there are more requests than satisfied requests.

Development of “First Class” hospital offers

“But the development projects of hospitals and clinics will be very much oriented towards the creation of single rooms. The long-term objective is to offer 80% single rooms,” says Mr. Secci, head of the mutual health insurance company CMCM. The legislation will be attentive to this evolution. Not all single rooms will be treated as first class. The quota has not been set at this time, but the current ratio could be met.

Additional services such as à la carte meals or pay TV should also be available for this type of service.

Coverage of first-class hospital rate differentials

On the day of your hospitalization, if there is no group room available, you may be hospitalized in a single room, known as first class. In addition, your illness may be contagious and will require you to isolate yourself in a single room. In either case, you will not be asked to pay a surcharge above the general hospital rate.

For a short stay and in the case of a benign intervention, opting for a single room is not “imperative”. But for a long stay and/or an operation requiring a lot of rest, this first class option is not a luxury.

In this respect, the CMCM health insurance company, and even certain complementary health insurance companies, cover this difference in hospital rates through various offers.

A somewhat rigid health care system with care abroad

There are two types of care abroad.

There is no specialist in Luxembourg who can deal with the problem.

For care not offered in Luxembourg, the patient must first request the agreement of the CNS. To do so, he/she must complete the S2 form. However, these medical expenses incurred abroad will not be covered in full by the CNS. However, CMCM and some supplemental insurance companies may reimburse the difference depending on their offerings.

Health care offers exist in Luxembourg, but practices are less comfortable

In case medical care offers exist in Luxembourg, but the practices are less comfortable than those offered abroad, the reimbursement of the CNS is partial. Indeed, the CNS will cover the 80% equivalent to the cost of an operation in Luxembourg. Therefore, if the cost of the operation abroad is higher than the cost of the operation in Luxembourg, you will have to pay the difference.

It is therefore important to compare the proposals of complementary insurances, including CMCM, in order to know the limits applied in terms of reimbursement for care abroad.

Very light coverage for dental and vision care

Dental and vision care can be a significant budget. These expenses are not or only marginally taken into account by the NHA. It is therefore important to choose a complementary mutual insurance.

NHA reimbursement for dental care is no longer adequate

In Luxembourg, dentistry is facing a problem from the past. The general NHA system is no longer adequate.

Indeed, the Luxembourg nomenclature applied to dental procedures is very old. As a result, many current benefits are not mentioned. As a result, more and more benefits are not covered by the NHA.

This is the case with implants, for example. This practice, which is very common today, consists of screwing a crown in place of an original tooth that had to be removed. The rates are now totally free. In fact, significant differences can be found between different dentists. Therefore, it is important to have a good supplement.

Vision care is poorly covered by the NHA

The Luxembourg general scheme of the CNS reimburses eyeglass frames every 3 years. Lenses can be covered every year, under certain conditions.

The CNS only accepts the use of relatively thin lenses for very strong corrections (above 7). In this case only, these thin lenses will be reimbursed at 80%. On the other hand, below this level of correction, you will have to opt for “fairly thick” and therefore unattractive lenses to hope for a partial reimbursement. But these days, aesthetics are important. You should therefore be able to choose relatively thin lenses, even if they are not reimbursed by the CNS.

Similarly, the NHA will not cover the cost of eye surgery to go without glasses. However, thanks to its “Denta&Optiplus” option, the CMCM will always reimburse refractive surgery. The reimbursement can even go up to 1000€ per eye and the third party payment is applied

In conclusion, our tips for good health coverage

The Luxembourg health care system is a good one. But it has remained in some ways very conservative. More and more benefits are not reimbursed.

For good health care coverage, we recommend:

CMCM does not require any medical records and accepts everyone. Whether you are healthy, sick, old or young, everyone is welcome at CMCM.

The membership fee is a family fee. The whole family is systematically covered, unlike insurance companies.

Worldwide assistance abroad is already included in the basic package. CMCM covers all repatriation costs, as well as hospitalization costs abroad up to 100,000 euros. In addition, a trip cancellation option due to illness is included up to 1,500 euros per member.

In addition, CMCM offers a 10% discount to single youth under 30.