The CNS explained
However, the number of doctors per inhabitant is below the average for OECD countries, and can vary quite a bit, depending on the region or commune you live in. The University of Luxembourg has started a new medical degree to help increase the number of doctors.
In addition, there has been criticism of the non-digital system used for reimbursing healthcare costs, and the government recently announced that plans are in place to scrap the paper system in a few years' time.
So, before you start your journey to understanding the healthcare system of the Grand Duchy, here are two acronyms you should familiarise yourself with:
CCSS (Centre Commun de la Sécurité Sociale) or the Joint Centre for Social Security
CNS (Caisse Nationale de Santé) or the National Health Fund.
How to get CNS healthcare
If you work in Luxembourg then your employer must declare this to the CCSS which will send you a letter confirming you are part of the social security system. As ever, there are exceptions, including employees at the European Union institutions who do not join the CNS but have separate cover, and employees on secondment to international companies or organisations who may receive private medical cover as part of their expatriate worker package. If you're self-employed you will need to register first with the CCSS to gain access to the CNS.
Once you are registered for work (and contributions) you should receive your social security card which will cover you for illness, maternity, work related accidents or illnesses, old age, disability and long-term care. The card has a 13-digit national identification number which you must present to healthcare providers and use when you claim reimbursements for healthcare.
Covering family members
Children or minors under the age of 30 who live in Luxembourg can be co-insured with a parent. Spouses by marriage or civil partners can also join the CNS scheme, if they are not covered by another scheme. If your spouse recently moved to Luxembourg then you must fill out a form confirming they are no longer eligible for care or are claiming in another healthcare system. That covers most of Europe and countries with reciprocal agreements with Luxembourg. If your spouse comes from a country which is not covered by these forms, you may need to provide a sworn statement.
If your spouse works for an EU institution and you are paying CCSS contributions that entitle you to CNS cover, you must register your children (if you are both parents) with the CNS, and take them out of the EU institution scheme. You can however, still claim for expenses not covered by the CNS. You will need to show what was reimbursed, which is often provided with your invoice, say for example, for glasses.
What happens if I stop work?
You are entitled to healthcare benefits for the month you finish work and three months afterwards as long as you have paid contributions for the six months previously.
How the system works
If you pay the costs upfront (either by card or invoice), then you must send the original paid and receipted invoices to the CNS indicating your national ID number, and including details of your bank (the bank can provide a "relevé d'identité bancaire" (RIB)) with your first claim.
Remember to include proof of payment if you paid by bank transfer rather than debit card. You can usually download a PDF of this a day or so after the transaction via online banking.
Forms should be sent to: CNS National Reimbursement Service, L-2980. No stamp is required.
Some healthcare costs can be settled directly between the CNS and the supplier. This is pretty much the case with pharmacies, and with hospitals, physiotherapy and laboratories. In this case you'll be asked to pay the portion of the cost that is not covered by the CNS. The government plans to introduce a system where doctors and dentists can also only charge for additional costs not covered by the CNS, but this system is not in place yet.
Whilst hospital costs such as beds are paid directly by the CNS, adults over 18 years must pay a participation cost of between €10-€20 per day/night. Also, each doctor consulted will issue their own medical invoice which you must pay upfront and then request reimbursement. The CNS does not cover the cost of a private room in a hospital.
Doctors and dentists
You can use a doctor, dentist or paediatrician as long as they have an agreement with the CNS. Most medical care, medication and hospital care is covered, but some drugs may require prior authorisation from the CNS or its Medical Board (CMSS).
Doctors and dentists must comply with rates fixed by the CNS. Reimbursement for doctors is 100% for children under 18 years and 88% for adults.
Dental care of up to €60 per calendar year is covered by the CNS, after which procedures are reimbursed at different rates and tariffs.
Dentists can set their own fees "with tact and moderation", but they must tell you the costs in advance in a written estimate including treatment, materials, fees and the amount that will be reimbursed. Check-ups are reimbursed to 88% of standard rates. Treatments for tartar removal, cavities, root canal work or surgical removal of a tooth are also reimbursed at 88% but this only applies to tartar removal once every six months.
Orthodontic treatment is covered for patients less than 17 years old, with prior consent from the CNS for guards or braces, but be aware that not all costs for private dentists are not covered, so check first what you will get back before committing. False teeth are covered by between 80-100% with replacement for removable dentures every five years and fixed ones every 12 years.
You must have a prescription for medication and it must be on the "positive list" for you to be reimbursed.
The CNS will issue a certificate of coverage for treatments such as physiotherapy, speech therapy or specific medical supplies.
Incapacity to work
An employer must continue to pay you during sick leave or following an occupational accident or illness until the end of the month that you take your 77th day of sick leave. After that the CNS will pay benefits for a total of 78 weeks. Medical certificates should be sent before the end of the third day of sick leave to CNS Services Gestation des Indemnités Pécuniares (Department of Financial Compensation Payment) L-2979.
To be entitled to maternity leave you must have completed six months of work in the 12 months preceding your leave. Pre-natal leave is eight weeks before the due date, and post-natal leave is 12 weeks – so a total of 20 weeks. If you're due date is delayed, you will still receive 12 weeks' leave after the birth. To request maternity payment, you must submit a medical certificate indicating your due date within the last 12 weeks of your pregnancy. Certificates should be sent to CNS Services Gestation des Indemnités Pécuniares (Department of Financial Compensation Payment) L-2979.
You can find out more information on maternity leave in our article Understanding Family Benefits.
If you live across the border you can choose a fund in your country of residence and the CNS will issue an international registration form to register with that fund. After this, that fund and country will be responsible for providing your healthcare.
Leave for sick children
Parents can between them take a fixed amount of paid leave for sick children as follows:
12 days between the ages of 0 to 3 years
18 days between the ages of 4 to 12 years
5 days between the ages of 13 to 17 years (if hospitalisation is necessary)
Family hospice leave for sick relatives is five working days or 40 hours per year. You can find more information on this, incapacity benefits, leave for sick children and cross-border workers healthcare on the CNS website.
More information and forms
Forms for co-insurance, the European Certificate of Health Insurance, or details for reporting the loss or theft of your CNS card, a change of bank details or address, can be found on the CNS website.
You can find out more about registering with a doctor or dentist, finding a medical specialist, getting glasses or contact lenses, or applying for an EHIC for travel within the EU, at the LT Expat Hub Health section.