Unscheduled treatment abroad
The decision to seek planned medical treatment abroad can be motivated by a variety of reasons, such as the search for specialist care, advanced medical technology or shorter waiting times.
However, organising medical treatment abroad requires good preparation and a clear understanding of the procedures to be followed.
Scheduled medical treatment abroad is medical treatment that can be planned in advance and does not require immediate intervention.
Unscheduled medical care required during a temporary stay abroad is defined as healthcare that cannot be postponed until I return to my home country without risking aggravating my state of health.
Everything I need to know
I identify the country in which the scheduled treatment will be carried out within the two categories:
- Category 1: European Union (EU), Switzerland, Norway, Iceland and Liechtenstein
- Category 2: Bosnia-Herzegovina, Macedonia, Montenegro, Serbia, Turkey, and all other non-agreement countries.
The reimbursement of my scheduled treatment abroad also depends on whether or not I need prior authorisation from the CNS.
I can check which conditions apply by clicking on the relevant tab.
- Countries in category n°1
- Countries in category n°2
- Authorisation necessary or not?
- How to obtain authorisation
- Two types of authorisation
- How to request coverage
- Frequently asked questions
I have scheduled treatment in a country of the European Union, Norway, Iceland, Liechtenstein or Switzerland
Whether or not my planned treatment abroad is covered depends on whether or not I need prior authorisation from the CNS.
When do I need prior authorisation?
I need prior authorisation from the CNS for:
- inpatient hospital care (with at least one overnight stay in hospital),
- outpatient hospital treatment requiring highly specialised and costly hospital infrastructure or medical equipment (click here for the list of treatments subject to prior authorisation),
- provided in specialised rehabilitation, convalescence and spa establishments.
The cost of such treatment without prior authorisation is not reimbursed and remains entirely at my expense.
When do I not need prior authorisation?
I do not need prior authorisation from the CNS for:
- a simple consultation with a doctor abroad,
- outpatient treatment that does not require highly specialised and expensive hospital medical facilities or equipment,
- an MRI scan,
- ...
My procedures for obtaining prior authorisation
What procedures do I need to follow?
My request for prior authorisation, duly completed and medically justified by a doctor (general practitioner or specialist based in Luxembourg or abroad) must be sent to the CNS if possible at least two weeks before the planned treatment is due to begin. The doctor must state the medical reasons why treatment is impossible or inappropriate in Luxembourg.
I send my request by post to
Caisse nationale de santé
Service Transfert à l'étranger
L-2980 Luxembourg
Or by e-mail in PDF format to tae.cns@secu.lu.
Important! A prior request is not sufficient to ensure reimbursement of the costs of my scheduled treatment abroad. I must obtain prior authorisation.
What should I do if I am refused prior authorisation?
If I receive a refusal from the CNS for my transfer abroad, I can lodge an appeal with the CNS Board of Directors by registered post within forty days of the notification.
To be admissible, the appeal must be signed by the insured person, their legal representative or their authorised representative (lawyer or representative of a professional organisation or trade union, holding a special written power of attorney).
Two types of authorisation
On presentation of a request for transfer drawn up by a doctor and after a favourable opinion from the CNS, two types of authorisation are possible, both of which are issued for the specific healthcare establishment for which the request was made. They include the date of validity, the type of treatment requested by the prescribing doctor, and the name and address of the foreign establishment or supplier:
- S2 authorisation: I receive an S2 form (regulation 883/2004) if the claim concerns an establishment or hospital authorised by the country of treatment. Following a favourable opinion from the CNS, this form certifies my right to scheduled treatment in another European Union country, Norway, Iceland, Liechtenstein or Switzerland.
- Authorisation directive 2011/24 (on the application of patients' rights in cross-border healthcare): I receive a directive 2011/24 authorisation if an S2 form cannot be drawn up (because the care is provided in a private or non-conventionalised establishment), or if I expressly request it from the CNS.
Duration of validity of the authorisation
The CNS's agreement is valid for the period indicated therein, generally that requested by the prescribing doctor. To extend or renew this agreement, the prescribing doctor must submit a new request in the same way as the first.
How is authorised healthcare abroad covered?
Coverage depends on the situation: with or without an authorisation, and if an authorisation is required, depending on the type of authorisation.
1. I have received an S2 agreement
By submitting my S2 form to the local health insurance, I can benefit from the same conditions and rates as residents. However, this form does not guarantee that I will be reimbursed for the full amount, but it may enable me to obtain coverage through third-party payment.
If third-party payment does not apply, I will be reimbursed according to local rates. I must send the paid invoices directly to the local health insurance fund, the one where I submitted the S2 authorisation, to obtain reimbursement.
2. I have received a directive authorisation 2011/24
I receive a certificate of coverage (‘directive authorisation’) explaining the reimbursement terms and conditions: costs to be paid in advance, reimbursement to be requested from the relevant Luxembourg health insurance fund, according to the fixed tariffs or lump sums.
I pay in full for the authorised care provided, and the CNS will reimburse me under the conditions and at the rates applicable in Luxembourg.
Please note! The costs invoiced may be substantial and far exceed the amount reimbursed by the CNS. To be on the safe side, I should ask for a quote before committing to any scheduled treatment abroad.
3. I had treatment abroad without the necessary authorisation
If I did not need prior authorisation from the CNS, I will pay the costs in advance and send the paid and receipted invoices to the CNS by post.
I have obtained the CNS's authorisation. What do I need to do abroad before treatment begins?
Before starting treatment, I should find out from the foreign provider/centre and, if necessary, from the local health insurance fund, whether reimbursement via form S2 is possible:
- If I contact the provider/centre, they can tell me whether they accept the S2 authorisation or whether other procedures are necessary. In general, it is the provider/centre abroad that initiates the procedures with the local health insurance fund.
- If, for some reason, the provider/centre does not accept it without providing details, I contact the health insurance fund in the country of treatment to find out more.
What should I do if the healthcare provider abroad does not accept my S2 authorisation?
The foreign healthcare provider may not accept the S2 form. In this case, I must pay the invoice and claim reimbursement.
In principle, in the case of in-patient treatment, an approved centre invoices the care directly to the health insurance fund in the country of treatment. However, some foreign providers require an authorisation/certificate of coverage from the local health insurance fund.
- To avoid any inconvenience, I should check with the foreign provider/centre beforehand.
If, after my inpatient treatment, the facility issues me an invoice for the full costs despite having received an S2 form, I should first attempt to secure direct coverage from the facility through third-party payment using the S2 form.
My treatment was paid for under authorisation S2. Am I entitled to a supplementary payment from the CNS?
I can request additional reimbursement from the CNS if the costs I incur are higher than for the same treatment in Luxembourg. If this is the case, I will receive additional reimbursement within the limits of the rates and tariffs set by the CNS.
Important! Additional fees or costs for personal reasons/conveniences, such as a private room, cannot be covered.
- Authorisation necessary or not?
- How to obtain authorisation
- Two types of authorisation
- How to request coverage
I have a treatment scheduled outside the European Union and outside the following countries: Norway, Iceland, Liechtenstein and Switzerland
Do I need prior authorisation?
Yes, for any type of treatment scheduled in a country outside the European Union and outside the following countries: Norway, Iceland, Liechtenstein and Switzerland, I must obtain prior authorisation from the CNS.
The costs of such treatment without prior authorisation are not reimbursed and remain entirely at my expense.
My procedures for obtaining prior authorisation
What procedures do I need to follow?
My request for prior authorisation, duly completed and medically justified by a doctor (general practitioner or specialist based in Luxembourg or abroad) must be sent to the CNS if possible at least two weeks before the planned treatment is due to begin. The doctor must specify the medical reasons why treatment is not possible or appropriate in Luxembourg, another European Union country, Norway, Liechtenstein, Iceland, or Switzerland.
I send my request by post to
Caisse nationale de santé
Service Transfert à l'étranger
L-2980 Luxembourg
Or by e-mail in PDF format to tae.cns@secu.lu.
Important! A prior request is not sufficient to ensure reimbursement of the costs of my scheduled treatment abroad. I must obtain prior authorisation.
What should I do if I am refused prior authorisation?
If I receive a refusal from the CNS for my transfer abroad, I can lodge an appeal with the CNS Board of Directors by registered post within forty days of the notification.
To be admissible, the appeal must be signed by the insured person, their legal representative or their authorised representative (lawyer or representative of a professional organisation or trade union, holding a special written power of attorney).
Two types of authorisation
Even if the application for authorisation is the same, the types of authorisation differ depending on whether the country in question is linked to Luxembourg by a bilateral agreement on social security, or is a country without such an agreement.
Countries with bilateral agreements: Bosnia-Herzegovina, Macedonia, Montenegro, Serbia, Turkey
Some agreements provide for a specific form which, if authorisation has been granted, allows cover to be provided at the rates and tariffs applicable in the country of treatment.
Similar to form S2, the CNS will send me an authorisation form, depending on the country of treatment:
- Bosnia-Herzegovina: LU-BiH112
- Macedonia: L-RM112
- Montenegro: MNE/L-112
- Serbia: SRB/LUX 112
- Turkey: TR/L-3
Non-convention countries (e.g. Egypt, United States, India, etc.)
With a doctor’s justified request and a favourable decision from the CNS, I can obtain authorisation for medical treatment in a non-convention country. This authorisation is provided in the form of a certificate of coverage (titre de prise en charge) issued by the CNS.
I must pay the full cost in advance and claim reimbursement on my return. The CNS sets the amount to be reimbursed or decides whether a supplementery payment may be applied.
How is treatment covered?
Coverage differs depending on whether the country in question is linked to Luxembourg by a bilateral social security agreement, or whether it is a non-agreement country.
1. I have received authorisation for treatment in Bosnia-Herzegovina, Macedonia, Montenegro, Serbia or Turkey
By presenting my authorisation form to the local provider/health insurance fund, I can benefit from the same conditions and rates as residents. However, this form does not guarantee that I will be reimbursed for the full amount, but it may allow me, ideally, to obtain reimbursement via the third-party payment scheme.
If third-party payment does not apply, I will be reimbursed according to local rates. I must send the invoices paid directly to the local health insurance fund, the one where I submitted the authorisation, to obtain reimbursement.
2. I have received reimbursement for treatment in a non-convention country
I pay the full cost of the authorised treatment and request reimbursement from the CNS upon my return. The CNS will reimburse me under the conditions and at the rates applicable in Luxembourg, or will decide whether a supplementary payment may be granted.
Important! The costs invoiced can be substantial and far exceed the amount reimbursed by the CNS. To be on the safe side, I should ask for a quote before committing to any scheduled treatment abroad.
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