What do I need to look out for when receiving healthcare abroad (EU, EEA and Switzerland)?
A distinction must be made between emergency (essential) treatment and planned treatment. The terms of coverage depend on whether the treatment abroad is urgent (essential treatment) or planned.
Emergency treatment (essential treatment during the stay)
If you are staying abroad (holidays, studies, detachment etc.), any essential treatment is paid for on the basis of the European Health Insurance Card (EHIC).
Upon presentation of the EHIC or a replacement certificate, you can receive treatment in the country where you are staying under the same conditions as a resident.
It is possible to deliberately decide to seek treatment abroad before leaving Luxembourg.
Inpatient care (at least one overnight stay) requires prior authorisation from Luxembourg in order for the treatment to be covered. Upon presentation of a transfer request issued by a specialist doctor and following a favourable opinion from the CMSS, two types of agreement are possible.
- Either the CNS issues an S2 form, which guarantees coverage for planned care in the treatment country according to the rates and tariffs in force there.
- Or the CNS issues a "directive" authorisation, i.e. a letter of coverage that tells you the treatment is authorised and that the invoices paid will be reimbursed at Luxembourg tariffs. (Naturally, the reimbursement cannot exceed the costs actually paid.)
Outpatient care (hospital care with no overnight stay or outside of the hospital, for instance in a medical practice...)
For outpatient treatment (hospital treatment with no overnight stay or treatment outside hospital, e.g. at a doctor's practice etc.), prior authorisation is not required. However, if the treatment provided involves highly specialised and costly medical infrastructure or equipment, authorisation is necessary. Planned outpatient treatment is reimbursed by Luxembourg according to Luxembourg rates and tariffs.
Which country's legislation applies in cases of emergency care received in a EU Member State, Switzerland, Iceland, Liechtenstein or Norway?
If immediate access to healthcare proves necessary during a temporary stay in a EU Member State, Switzerland, Iceland, Liechtenstein or Norway, regardless of the purpose of the stay (holiday, studies, detachment etc.), treatment will be paid for based on your European Health Insurance Card.
The European card certifies that you are entitled to any health treatments necessary from a medical point of view in the country where you are staying, subject to the nature of the treatment and the planned length of your stay. This means that you are entitled to care from a medical viewpoint in order to ensure that you do not have to interrupt your stay to seek treatment.
The European Health Insurance Card entitles you to the same treatment as residents of the country where you are staying. This applies equally to procedures/conditions as to the price of the care received.
When and how can I use the European Health Insurance Card?
The European card can be used in all the Member States of the European Union as well as in Iceland, Liechtenstein, Norway and Switzerland when you need healthcare, whether you are on holiday, studying or travelling for work, subject to the length of your stay. Under a bilateral agreement with the respective countries, the European Health Insurance Card is also valid for stays in Macedonia, Serbia and Montenegro.
Your European Health Insurance Card is issued in your name and cannot be used by anyone else. If you are no longer insured in the country that issued the card, it can no longer be used. The card certifies that you are entitled to the necessary healthcare in the Member State where you are staying in order to continue your stay under safe medical conditions rather than having to interrupt your stay to seek treatment at home. Presenting the card entitles you to payment or subsequent reimbursement of medical costs incurred in the country you are visiting. This means you can be reimbursed directly for the costs incurred by the health insurance fund in the country where you are staying.
When and how am I not allowed to use the European Health Insurance Card?
The card cannot be used for planned treatment, i.e. when the only reason for your travel is to receive healthcare or medical treatment.
The European Health Insurance Card can only be used with approved healthcare providers, i.e. providers associated with the country's social security system. However, if the treatment is delivered by a non-approved or private provider, the costs can still be reimbursed under the terms of directive 2011/24 according to Luxembourg conditions and tariffs.
What can I do if my European Health Insurance Card is not accepted?
For necessary treatments, you must pay the costs for the medical care received and apply for reimbursement either from a health insurance fund in the country where you are staying or from your competent fund.
- If invoices are sent/given to the fund in the country you are visiting, you will be reimbursed according to the rates and tariffs of that country.
- If invoices are sent/given to the competent fund, it will ask the fund in the country visited for the tariffs applied (using form E126/S067). As soon as a response is received, you will be reimbursed according to the rates and tariffs of the country you visited. In addition, when the invoices are sent/given to your competent fund you can expressly request to be reimbursed based on Luxembourg rates and tariffs.
With an approved healthcare provider and for necessary treatment, the card can normally not be refused.
If I fall ill abroad and I do not have my European Health Insurance Card, what can I do?
If you do not have your European Health Insurance Card with you, the cover for medical treatment according to the same conditions and prices as residents does not apply. For example, even if certain emergency/necessary treatments are free (paid for directly by the foreign health fund) for residents, you may have to pay a fee.
You will have to advance all the costs for the treatment received and ask your competent health fund for a refund on your return.
However, if you are hospitalised urgently during a temporary stay abroad, your competent fund can - upon request - send you, the hospital or the foreign health insurance fund a temporary replacement certificate which guarantees the same level of protection as your European Health Insurance Card. On the basis of this certificate, treatment will be covered as if you were insured in the country where the care is provided.
Which country's legislation applies in cases of planned care received in a EU Member State, Switzerland, Iceland, Liechtenstein or Norway?
If you want to seek treatment from a doctor, physiotherapist or other healthcare provider in a foreign surgery, health centre, clinic or hospital, you do not need prior authorisation from the CNS.
You must pay the costs of the treatment in full and apply for reimbursement from the Luxembourg health fund. You will be refunded according to the conditions and tariffs in force in Luxembourg.
If the treatment involves an overnight inpatient stay or highly specialised medical facilities (on the list of treatments subject to prior agreement), prior authorisation is necessary.
- If authorisation is granted for a transfer abroad, you will receive an S2 form as specified by regulation 883/2004. This form is issued following a favourable opinion from the CMSS and certifies your right to planned treatment in another European Union Member State, Iceland, Liechtenstein, Norway or Switzerland. On presentation of the S2 to the health insurance institution in the country where the treatment will be provided, you will receive healthcare under the same conditions as people insured in that country. The treatment covered by the authorisation is thus paid for according to the conditions and tariffs in the country where it is provided.
- In addition, payment can take place under the terms of directive 2011/24/EU on the application of patients' rights in cross-border healthcare. The provisions of the directive apply if an S2 form cannot be issued because the treatment does not fall within the scope of application of the health insurance (e.g. rare illnesses), the treatment is provided in a private institution or you choose to apply the provisions of the directive. In this case, you pay the costs of the treatment in full and are refunded by your competent fund in Luxembourg according to the conditions and tariffs in force in Luxembourg.
NB. Make sure you keep detailed invoices so that the refund can be made at Luxembourg tariffs.
If I fall ill abroad, where should I send my medical certificate of incapacity for work?
An insured person in Luxembourg should send all medical certificates of incapacity for work to the CNS within 3 days. This means that if you fall ill in your country of residence or during a temporary stay abroad and you receive a medical certificate of incapacity for work, the certificate should always be sent to the health insurance fund in your country of affiliation rather than your country of residence.
If you are staying in a country that does not issue medical certificates of incapacity for work, the health insurance fund in the country you are visiting will still be able to issue a form certifying your illness. This form should be sent to the CNS.
Under what circumstances can a refund at Luxembourg tariffs be refused?
A refund may be refused, partially or in full, because of:
- Treatment not provided for in Luxembourg;
- Limits specified by the classification system (e.g. reductions, combinations of treatments, more than three actions, actions that cannot be combined with a consultation etc.);
- Medication not included on the positive list of medications;
- Analyses with no prior medical prescription attached;
- Analyses invoiced by a medical clinic (grand ducal regulation restrictive list);
- Physiotherapy, speech therapy, hearing aids without entitlement;
- Physiotherapy by a provider other than a physiotherapist, e.g. a midwife;
- Services that are non-refundable in Luxembourg (dental crowns with no prior quotation, adult orthodontics, orthosis over €125 etc. with no quotation and the prior authorisation of the CMSS);
- Psychomotor treatment without the prior authorisation (APCM) of the CMSS;
- Renewal interval not respected;
- Requirement for entitlement to cover for physiotherapy, speech therapy and hearing aids;
- Requirement to entitlement for medication not included on the positive list (following a request from a doctor);
- Prior authorisation from the CMSS for psychomotor treatment...
This is not an exhaustive list.
Any medical technique or diagnostic method used by a foreign specialist doctor involving hospital infrastructure and inpatient or partial inpatient accommodation costs not covered by prior authorisation from the CMSS (S2 form) will not be reimbursed and must be paid for in full.
What is the normal waiting time for the reimbursement of medical costs incurred abroad?
For emergency treatment abroad, the reimbursement time depends on the timeliness of the response provided by the foreign health insurance fund. When emergency treatment is provided, Luxembourg requests the tariff from the fund in the country where you were staying. This means that the reimbursement time varies depending on the time the various foreign funds take to respond.
In the case of planned outpatient treatment (without prior authorisation) in a country of the EU, EEA and Switzerland, Luxembourg issues the refund according to Luxembourg conditions, rates and tariffs. The normal waiting time is a few weeks.