Health insurance in Luxembourg: CNS and access to healthcare

The Caisse Nationale de Santé (CNS) is the organization responsible for managing the public health insurance system in Luxembourg. The CNS is a public institution, often referred to as CNS national health fund and operates under the supervision of the Ministry of Health.

The CNS service includes health insurance coverage for all residents and workers in Luxembourg. This covers medical and hospital care, dental care, prescription medications, and other healthcare services. Besides, it provides a CNS reimbursement for medical expenses and manages healthcare services in the country.

Read more about Healthcare in Luxembourg in the special articles of the knowlege library. We have recently published new articles covering:

• Dental care and dentists in Luxembourg
• Mental health for kids and adults
• Medication and pharmacies in the country

The cost of the public health insurance system is shared between employees and employers, who are required by law to contribute to the CNS health fund system to benefit from medical services. The amount of the contribution is based on the employee's salary and the nature of the work.

What is CNS

It is the national health insurance system in Luxembourg. It provides health insurance coverage to residents and workers in Luxembourg and is responsible for reimbursing medical expenses, managing healthcare services, and promoting public health initiatives in the country. CNS operates under the supervision of the Ministry of Health.

What is CCSS

Centre Commun de la Sécurité Sociale in Luxembourg, which is also known as the Joint Center for Social Security. This department is responsible for managing the social security system in Luxembourg, including health insurance, pension insurance, and other social benefits. The CCSS is a public institution and is supervised by the Ministry of Social Security. Its primary role is to ensure that social security contributions are collected and distributed to those who are entitled to them.

How to get medical care in Luxembourg

You will need to get state health insurance or private insurance or pay from your pocket to access medical services in the country. When it comes to state insurance, all employed citizens are obliged to pay social contributions. The contribution sum is divided equally between the employers and the employees. The tax is automatically subtracted from the wages along with other social taxes. Money goes to the CNS (the Caisse de Maladie). Such payment entitles people to receive reimbursed health care in Luxembourg — this means, that you pay for treatment, and then the government gives you money back for things that it covers.

• Self-employed people and entrepreneurs pay contributions on their own. The amount of the contribution depends on the employment and the person's occupation.
• Retired and non-working people pay contributions from their allowances.
• Family members (spouses, partners, relatives) — can be co-insured with the family member who is paying the insurance fees.
• Children up to the age of 29 are insured alongside the parent who pays the insurance contributions. From the age of 30, the co-insurance option is available only with the CNS' approval and if the person (child) is studying for a university degree.

Senior people, yet unemployed and other people who only plan to obtain a residence permit in Luxembourg must get a private health insurance plan before they arrive in the country.

What state health insurance covers

In Luxembourg, the state health insurance, which is provided by the CNS insurance services, covers a wide range of medical treatments and related procedures. The coverage includes, but is not limited to quite an impressive list of things:

• laboratory tests;
• treatment by physicians;
• treatment by general practitioners;
• prescription medications;
• hospitalization;
• inpatient care;
• rehabilitation;
• pregnancy and childbirth expenses;
• basic dental treatment;
• vision and hearing aids (glasses, contact lenses, etc.);
• paramedical services;
• transplantation;
• prosthetics;
• psychiatric care;
• homeopathy.

In addition to these basic healthcare services, the CNS reimburses and covers preventive health measures, such as vaccinations, cancer screenings, and even free contraception. The costs of medications are reimbursed from 40% to 100%, according to the medication. You can find a list of reimbursable medications on the CNS website.

Normally, the doctor will inform the patient about the amount that can be reimbursement by CNS. Afterward, they will decide how much the patient is paying for the treatment on their own and how much will be reimbursed.

How to get health insurance in Luxembourg

An example of the both sides of the CNS card. Collage by Luxtoday with images from CNS website

In order to do so for a state healthcare plan, you will have to register at the Social Security Center (CCSS) and obtain a CNS card, which will be issued by the Caisse nationale de santé (CNS). You can always choose private insurance for yourself and your family. Obtaining private insurance makes sense, if you rely a lot on treatments, that are not covered by CNS.

In Luxembourg, health insurance is mandatory for all residents, including foreigners who live or work in the country. The process for obtaining any health insurance depends on your specific circumstances, but here are some general steps:

For EU citizens

If you are an EU/EFTA citizen and are temporarily living in Luxembourg, you can access treatment through your European Health Insurance Card (EHIC). The European Health Insurance Card is a free card issued by your national health insurance provider that gives you access to medically necessary, state-provided healthcare in any of the 27 EU countries, Iceland, Liechtenstein, Norway, Switzerland, or the United Kingdom.

If you move to another European country permanently, you should register for state insurance with the S1 form instead of using the EHIC each time you need to see a doctor. This concerns cross-border workers, posted employees, pensioners, and government servants.

Each EHIC card is valid for a limited period, and its expiration date can be found on the card. To order an EHIC or a replacement certificate in Luxembourg, you must provide your 13-digit national identification number (matricule number) for the CNS to process the request.

To order a new card or a replacement certificate, visit the website of the Joint Centre of Social Security or request a provisional replacement certificate via MyGuichet. The card must be requested three weeks before departure or its expiration date, and it will be sent to the official address of the insured person.

How to obtain a CNS card

If you plan to be insured by the state health insurance and CNS system, you will need to go through a process of application and enrollment. In Luxembourg, health insurance is mandatory for all residents, including foreigners who live or work in the country.

What is a CNS card

It is a double-sided social security card with a 13-digit national identification number. Every time you go to the hospital, to a doctor's appointment, or to buy medicine at the pharmacy, you will have to show your CNS card.

The front side contains the necessary information about the insured person and grants the right to health care in Luxembourg. The reverse side is called European Health Insurance Card, and it provides health insurance coverage throughout Luxembourg, Switzerland, and Macedonia, as well as the EU and EEA countries (Norway, Liechtenstein, and Iceland).

For salaried workers, your employer will help you issue the card. The card application must be filled out within 8 days of the start date of the employment contract. If you are self-employed, you will need to register with the CNS yourself and make contributions.

What documents are needed for CNS card

• Proof of identity (passport, ID card, etc.);
• Proof of residence (e.g. utility bill receipt);
• Residence permit in Luxembourg;
• Document confirming your employment (contract).

Where to obtain a CNS card

To obtain a card for state health insurance in Luxembourg, you will need to request it at the Social Security Center (CCSS). If you reside in Luxembourg legally and have Residence Permit, you know what matricule is. As soon as you obtained your identification number from the National Register of Natural Persons (RNPP), and started your job in Luxembourg (or at least started paying social contributions for self-employed), you and your family members are entitled to receive CNS cards.

To order a card, you need to visit the health insurance card page of the CCSS website and put in your matricule number, to request it. In case you have paid contributions, and all the information is correct, you will receive your card in 3 weeks at the address of your official residence.

If you need special help and want to do this in person, you must follow this link or register with MyGuichet.lu to apply for a CNS card. In the application form, you will have to specify:

• your CCSS membership status;
• the exact purpose of the meeting request;
• date and time for the meeting.

Family members' co-insurance

In Luxembourg, family members can be included in the same health insurance plan as the primary insured person. So-called co-insurance is free of charge. The primary insured person can include their spouse (or PACS partner), children, and sometimes other family members who are dependent on them, such as elderly parents or disabled adult children, into the united plan.

To enroll family members in the plan, you need to make requests, it is not done automatically with your insurance. The primary insured person needs to fill out an application form, submit it to the «service coassurance» and provide proof of identity and residence for each family member, that needs to be co-insured.

Family members who are included in the plan will have access to the same medical services and treatments as the primary insured person. To maintain coverage, family members will need to renew their enrollment each year by submitting a new application form and any required documents.

Address:

Caisse nationale de santé
Service Coassurance et Signalétique

L-2980 Luxembourg

Phone: +352 27 571

How to get reimbursed by CNS

You may be eligible for reimbursement from CNS if you have already paid for medical treatment or services that are covered under your health insurance plan. The purpose of reimbursement is to help you offset the cost of medical expenses and ensure that you have access to necessary healthcare services. After you have paid, you can submit a reimbursement claim to the CNS. This can be done online, by mail, or in person at a CNS address office.

Documents for reimbursement by wire transfer

For CNS reimbursement by bank transfer (the most modern and convinient way that exists for now) you must provide the documents listed below, and send them to CNS address for consideration. Yes, postal mail is still very popular in the country for dialogue with governmental structures. Mail to CNS is free of charge when it is sent from Luxembourg.

Make sure to attach these documents:

• Original receipts, invoices, and any payment documents. The number indicated on the invoice must be shown on the notice/statement of charges. No screenshots of documents will be accepted!
• Payment confirmation. Proof of payment is considered to be:
  • the «pour acquit le» indication, followed by the doctor's or provider's signature and the date of payment;
  • the stamp or signature of the financial institution indicating «payé (paid)», «pour acquit (to receive)», «virement exécuté (transfer completed)», etc;
  • the bank account notice («avis de débit bancaire»).
• Foreign bank documents (e.g. statements) can only be accepted if they include the date of payment, account number, and confirmation that the payment has been made.
• Bank account number. The first time you contact the CNS for reimbursement, you must give your bank account number (IBAN and BIC codes). Don't forget to enclose your bank statement (relevé d'identité bancaire). The bank can issue this document for you.

• National Identification Number. The inquiry must contain the name, address, and 13-digit identification number of the insured person.

What else is important? If the residence address has been changed drastically the CNS must be notified about it. But if the person moves within Luxembourg, there is no need to inform the company.

Where to send the documents for reimbursement

You can do this by post to the CNS address for reimbursement. You must send the originals of all documents for medical services provided by the doctor or other expenses by mail to the CNS address.

The refund will come within three weeks. The money will be transferred to your bank account and you will receive a notice in the mail.

Address:

CNS – Service Remboursements nationaux

L-2980 Luxembourg

Phone: +352 2757 — 4260

If you received medical care outside of Luxembourg, the refund is considered in each individual case. The CNS will only start the reimbursement process after it has received notification from the country where the medical care was provided.

Why one might need private health insurance

Additional private health insurance in Luxembourg is used to cover costs that are not included in public health insurance. Obtaining it makes sense, if you rely a lot on treatments, that are not covered by CNS.

Certain things are not included in the coverage.

• Various dental treatments, like orthodontics for adults, implants and cosmetic dentistry,
• non-prescription medication,
• alternative therapies,
• non-necessary cosmetic procedures,
• hospitalization costs (sometimes), and
• ophthalmologist treatment, that was not prescribed by a general practitioner.

It is a good option in case of unforeseen medical expenses in a foreign country as well, or in case of emergency hospitalization, when you want a little bit more comfort when staying in hospital.

How does it work

The insurance company enters a contract with a medical facility and includes certain types of care in it.

If you need services that are not covered by the agreement, you will have to pay for them yourself and then ask your insurance company for reimbursement.

Social care

Social aid is available to the unemployed and low-income residents of Luxembourg. If the resident does not have insurance, the Social Welfare Office takes care of the expenses related to disability, illness, medical intervention, age-related illnesses, or hospitalization. In order to receive the allowance, you have to contact the local Social Security Administration in your commune.

How to get social aid

Most of the time, you have to be present in person. But in exceptional cases, you can ask for assistance by phone.

In-person

You have to visit the local social services office in your commune and make a verbal request for assistance. The application can be submitted in paper form or sent to an e-mail address.

By phone

This method can be used due to limited mobility or specific personal circumstances of the applicant. The Welfare Officer will invite the applicant to the office or will come to the applicant's home to process the application.

The Social Security Administration will conduct a background check to get a complete picture of the situation. The verifications are conducted to assess the applicant's situation and suggest possible improvements.

All the results of the social security check, the information provided by the applicant, and all documents are kept in an individual social security file in the applicant's name.

When all documents are available, Social Security proceeds with the application. Records are made in the application register and sent to the administrative board of the Social Security Administration for further review.

Application review period

A decision on social assistance will be made within 25 working days from the date of application.

Each decision is either delivered to the applicant by mail or delivered in person. A receipt must be signed by the applicant when delivered in person.

In urgent cases, the decision is made immediately, depending on the applicant's situation. A social audit may be conducted later.

The Social Security Administration can request a refund if the recipient obtained the funds that were not accounted for as part of the check. Likewise, if the applicant's financial situation has improved over time — they will ask money back sometimes.

Other healthcare details in Luxembourg

Women's Health

In Luxembourg, women's health is a part of the country's healthcare system, and the CNS covers a range of medical services and treatments related to it. Some of the services, that are covered by CNS, include:

In addition to these medical services, the CNS also covers other aspects of women's health, such as mental health services, including therapy and counseling for depression, anxiety, and other mental health conditions.

Most of the costs associated with pregnancy, prenatal care, childbirth, and postpartum care are covered by state health insurance. But home deliveries are not covered by state!

Also, women in their 50s and 70s can be examined for breast cancer with the national screening program.

Emergency medical care

The ambulance phone number is 112.

Treatment is free, even if you do not have insurance.