Long-term care

... YES!

And without making a request or providing a medical report!

In detail... Here are my rights.

The ‘palliative care’ entitlement automatically gives me access to the majority of long-term care insurance benefits.

As a beneficiary of a palliative care entitlement, I am not required to submit a claim for benefits to the long-term care insurance scheme or to provide an R20 medical report from my doctor. Furthermore, I am not assessed by the AEC.

1. Provider of assistance and care for the essential acts of life

I can call on the services of an assistance and care provider for the essentials of life, including hygiene, nutrition, mobility, dressing and elimination. I can also take advantage of individual childcare, activities to support independence and assistance with housekeeping when I'm at home. In an institution, I can access activities to support independence and accompaniment. One notable advantage is that I will not have to pay the costs associated with this care in advance, as they will be billed directly to the CNS by the service provider.

2. Incontinence equipment

Incontinence equipment is automatically covered in a care establishment.

However, in order to receive the lump-sum payment for incontinence equipment when care is provided at home, I must provide a prescription to activate coverage.

The prescription can be sent by email to the following address: assurancedependance@secu.lu.

3. Technical aids

I can also benefit from the technical aids listed in Annex 2 of the Grand-Ducal Regulation of December 2017 amending the amended Grand-Ducal Regulation of 22 December 2006: List of technical aids covered by the nursing care insurance for people receiving palliative care.

I or a member of my family can go directly to the Service moyens accessoires (SMA) located at 20-22, rue Geespelt, L-3378 Livange, with a medical prescription. Alternatively, my aids and care provider can send an e-mail to the following address: assurancedependance@secu.lu. He should specify the equipment required as well as my weight and height details in order to best meet my needs.

4. Home adaptions

As a person in receipt of a palliative care entitlement, I unfortunately do not have access to home adaptation services.

5. Cash benefit

If I am already covered by long-term care insurance and receiving a cash benefit, this cash benefit will continue to be paid when I become eligible for a palliative care voucher.

An acknowledgement of receipt is sent to me as soon as the CNS receives a complete application (application form and R20 medical report).

Then... The CNS responds according to the case and the request.

1. Aids and care benefits

The decision on the provision of aids and care, together with the summary of the dependent person's care, is sent by recorded delivery to the dependent person or their legal representative.

2. Home adaptation

A letter providing information on adapting the home is accompanied by a mandate form to be completed by the claimant or his/her legal representative and returned to the CNS - Département Assurance dépendance.

3. Technical assistance (paramedical equipment)

Technical assistance approved in advance by the Administration d'évaluation et de contrôle is made available:

• leased by the long-term care insurance scheme from a supplier and made available to the dependent person
  
• as a purchase (bought by the long-term care insurance scheme) for the benefit of the dependent person
  

Please note: Retroactive reimbursement is not possible for private purchases made before receiving the response... A prior request to obtain long-term care benefits and the prior opinion of the Administration d'évaluation et de contrôle are essential.

... YES! Any decision may be appealed.

Refusal decisions are accompanied by a copy of the opinion of the Administration d'évaluation et de contrôle on which the Caisse nationale de santé (CNS) - Département Assurance dépendance (Long-term Care Insurance Department) bases its decision.

In the event of disagreement, I may lodge an objection with the Board of Directors within 40 days and by registered post after being notified of the decision of the long-term care insurance.

To this address: Caisse nationale de santé, Conseil d'administration, L-2978 Luxembourg

If I live abroad and I think I am entitled to long-term care insurance, I can apply for:

• cash benefits (help provided by a third party, called a ‘carer’) ;
  
• benefits in kind (technical aids, home adaptations, help provided by a healthcare provider).
  

Cash benefits

Cash benefits are paid by the country where I am insured and where I pay contributions (against the risks of illness and dependency). These benefits can be exported to another EU country.

Benefits in kind

Benefits in kind are provided by my country of residence and in accordance with the provisions applicable in that country. This means that any technical aids, home adaptations or help from a care provider must be requested from the health insurance fund in my country of residence.

Example

I am a cross-border worker living in France, affiliated to the health insurance scheme in Luxembourg and recognised as dependent:

• Cash benefits: Luxembourg pays the cash benefits.
  
• Benefits in kind: I must contact my health insurance fund in France to have benefits in kind covered.
  

What's important to know: entitlement to benefits may vary depending on residence and/or affiliation.

You can find more information on the Administration d'évaluation et de contrôle (AEC) website.