I am a cross-border worker: which rules apply?
You are considered to be a cross-border worker if you work (and are insured) in a different EU country from where you live and you return to your country of residence every day or at least once a week. In this case, the competent country in terms of healthcare is the country where you work.
A social security card mentionning your 13-digit personal identification number (matricule) will be issued after registration of your insurance with the CCSS (Joint Center of social security).
This number must be indicated whenever you contact a social security administration.
In order to obtain reimbursements in your country of residence, you have to register with a healthcare fund from your place of residence using a document of entitlement to benefits issued by the competent healthcare fund (S1 form or BL1 form for Belgian residents).
Why an S1 form? What do I have to do with it?
The S1 form is a certificate of entitlement to healthcare issued by the competent country (the country where insurance contributions are paid) and allows for registration in the country of residence. This means that healthcare can be provided in the country of residence as if the person concerned was insured there. The S1 issued by the competent health insurance fund should be given to the fund in the country of residence. The fund in the country of residence will confirm the form's registration to the competent fund.
The document of entitlement is issued by the CNS and stays valid until the end of the professional activity or in case of a temporary insurance until the end date marked on the document of entitlement.
Before you can ask the form necessary for registration in your country of residence, you have to wait to get the declaration of entry by the CCSS (Joint Center of Social Security), proving that you are insured to the CNS.
I am a cross-border worker: does the Luxembourg health insurance fund intervene if the fund in my country of residence refuses to reimburse healthcare provided in my country of residence?
With regard to reimbursement of healthcare, treatment provided in the country of residence can only be reimbursed by the country of residence according to its own rates, tariffs and terms. Only Belgian cross-border workers and former cross-border workers benefit from a specific regime based on the provisions of the Belgium-Luxembourg agreement of 24 March 1994. This agreement specifies that the CNS will provide an additional reimbursement for treatment provided in Belgium at the level of the average reimbursement rate in Luxembourg (93.4% for 2013).
I am a cross-border worker: how are the costs of healthcare received in a country other than the country of residence or Luxembourg paid for?
Necessary/emergency treatment is paid for based on the European Health Insurance Card/EHIC (or if necessary a replacement certificate) issued by the competent country.
Planned inpatient treatment is subject to a prior authorisation from the Medical Board of the Social Security (Contrôle médical de la sécurité sociale - CMSS) and can only be reimbursed if approval is granted. If S2 authorisation is granted by the competent country, the treatment will be paid for by the country where it is provided according to the rates and tariffs applicable there. If the insured person was given a "directive" authorisation from the competent country, the insured person advances the cost and is reimbursed by the competent country according to the rates and tariffs in force there.
Planned outpatient treatment is paid for by the competent country according to the rates and tariffs in force there.