Long-term care

Long-term care insurance is one of the branches of the social security system. It covers the cost of assistance and care required by dependent persons.

What does it mean to be dependent?

A person is considered to be dependent if they regularly need help from a third party to perform activities of daily living, due to illness or a physical, psychological or mental disability.

The activities of daily living include :

  1. personal hygiene: help and care to keep the body clean;
  2. in the field of elimination: assistance and care aimed at eliminating bodily waste ;
  3. in the field of nutrition: aids and care aimed at assisting with eating and drinking and enteral feeding;
  4. in the field of clothing: help and care with dressing and undressing;in the area of mobility: help and care with changing position, moving around and getting in and out of home.

In principle, the person must require this assistance with the essential acts of life for at least three and a half hours a week, and the state of dependency must last, in all probability, more than six months or be irreversible.

If a person needs help for a short period of time or only to maintain the household or prepare a meal, they are not dependent within the meaning of the law.

However, in the event of significant and regular need duly established by the State Office for Assessment and Monitoring of the long-term care insurance (Administration d'évaluation et de contrôle de l'assurance dépendance (AEC)), home adaptations, assistive technology and related training may be allocated regardless of the threshold defined above (need for assistance ≤ 3.5 hours/week) if, in all probability, the illness or impairment exceeds six months or is irreversible.

What benefits are available?

Various long-term care insurance benefits are available and may be granted on the advice of the State Office for Assessment and Monitoring of the long-term care insurance.

Benefits in kind

This is assistance provided by a healthcare provider, in particular a care and assistance network, care home, integrated centres for the elderly, semi-stationary centres. Benefits in kind are invoiced directly by the healthcare provider to the CNS - Long-Term Care Insurance Department.

Assistive technology and home adaptations are benefits in kind.

Cash benefits

This assistance is provided by a third party known as the " Caregiver ". The caregiver is identified and assessed by the State Office for Assessment and Monitoring (AEC) of the long-term care insurance scheme. Cash benefits are paid to the account of the dependent person who pays the caregiver.

Further information can be found on the State Office for Assessment and Monitoring (AEC) website.

 

What steps need to be taken?

If you think you are eligible for long-term care insurance benefits, you should apply to the National Health Fund (CNS).

The request for benefits consists of

  • a form to be completed by the person making the request or their legal representative AND
  • a medical report (R20) to be completed by the attending physician.

The request for benefits is complete if and when the two documents are received by the Caisse nationale de santé (CNS) - Long-Term Care Insurance Department.

 

The same form can be used for a request for review/reassessment.

The medical report (R20) is free of charge for the applicant: the doctor will be paid directly by the long-term care insurance company.

In order to define the nature and quantity of the benefits to which the dependent person is entitled, it is essential to assess their state of dependency.

The assessment will be carried out by a consultant from the State Office for Assessment and Monitoring of the long-term care insurance (AEC) after an appointment has been made.

You do not need to make a request if you have a palliative care certificate of coverage.

I have a "palliative care" certificate of coverage. What long-term care insurance benefits do I have access to?

The "palliative care" certificateof coverage automatically gives access to the majority of long-term care insurance benefits.

If you are the beneficiary of a "palliative care" certificate of coverage, you do not need to submit a request for long-term care insurance benefits or an R20 medical report from your doctor. You are not assessed by the State Office for Assessment and Monitoring of long-term care insurance (Administration d'évaluation et de contrôle de l'assurance dépendance (AEC)).

Service provider for assistance and care for activities of daily living

You can call on the services of an assistance and care provider for the activities of daily living in the areas of hygiene, nutrition, mobility, clothing and elimination. You also have access to individual care, activities to support independence and help with housekeeping when you are at home. In an establishment, you can also benefit from activities to support your independence, as well as companionship.
You will not have to pay the costs of this care in advance, which will be billed directly to the CNS by your service provider.

Incontinence supplies

Coverage for incontinence equipment, where applicable, is automatic in an establishment.
However, to receive the lump-sum payment for incontinence equipment when care is provided at home, you will need to provide a prescription to activate coverage.
The prescription can be sent by email to the following address:

assurancedependance@secu.lu.

Assistive technology

You may also benefit from the assistive technology listed in Annex 2 of the Grand-Ducal Regulation of December 2017 amending the amended Grand-Ducal Regulation of 22 December 2006:
List of assistive technology covered by long-term care insurance for people receiving palliative care.

You or a family member can then take a medical prescription directly to the Service moyens des accessoires (SMA – 20-22, rue Geespelt à L-3378 Livange / / Adresse Mail : contact@sma.lu  / / Tél : 4057331) or your care and assistance provider can send an e-mail to assurancedependance@secu.lu indicating the equipment required and your weight and height to best meet your needs.

Home adaptation

However, as a beneficiary of a palliative care certificate of coverage, you do not have access to home adaptation benefits.

Cash benefits

If you already benefit from long-term care insurance and receive a cash benefit, this cash benefit will continue to be paid if you subsequently receive a palliative care certificate of coverage.

 

How will I be informed of the decision?

An acknowledgement of receipt is sent as soon as a complete request is received (request form and R20 medical report).

Assistance and care services

The decision on the assistance and care services, together with the summary of the care provided to the dependent person, is sent by registered mail to the dependent person or their legal representative.

Home adaptation

A letter providing information on home adaptation is accompanied by a mandate form to be completed by the applicant or their legal representative and returned to: Caisse nationale de santé (CNS) – Département Assurance dépendance.

Assistive Technology

Assistive technology, granted in advance by the State Office for Assessment and Monitoring, is provided:

  • on a rental basis, through the long-term care insurance, by  a supplier and made available to the dependent person
  • in the form of an purchase (bought by the long-term care insurance) for the benefit of the dependent person

There is no retroactive refund for private purchases.

A prior request for long-term care insurance benefits and the prior opinion of the State Office for Assessment and Monitoring of the long-term care insurance are essential.

Decision of refusal

Refusal decisions are accompanied by a copy of the opinion of the State Office for Assessment and Monitoring on which the National Health Fund (CNS) - Long-Term Care Insurance Department is based.

Each decision is accompanied by a list of appeal procedures.

In the event of disagreement, the insured may submit an objection to the Council of Administration within 40 days by registered mail following notification of the Long-Term Care Insurance's decision.

Caisse nationale de santé
Conseil d'administration
L-2978 Luxembourg

What benefits does long-term care insurance provide in an international context?

As in Luxembourg, anyone who thinks they are eligible for long-term care insurance benefits can apply for them:

  • cash benefits (assistance provided by a third party, known as a " Caregiver ");
  • benefits in kind ( assistive technology, home adaptations, help provided by a health care provider, e.g. assistance and care network, home care, integrated centres for the elderly, semi-stationary centres).

Cash benefits

Cash benefits are due from the country in which the applicant is insured and pays contributions (against sickness and long-term care risks). These benefits can be exported to another EU country.

Benefits in kind

Benefits in kind are provided by the country of residence and in accordance with the provisions in force in that country. This means that any assistive technology, home adaptation or help from a healthcare provider must be requested from the health insurance fund in the country of residence.

Example

If a cross-border worker residing in France is insured with the health insurance scheme in Luxembourg and is recognised as dependent, Luxembourg will pay cash benefits. However, the cross-border worker will have to contact the health insurance fund in their country of residence to be reimbursed for benefits in kind.

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

Further information can be found on the State Office for Assessment and Monitoring (AEC) website.

For further information:

Département Assurance Dépendance
Service Gestion des demandes
E-mail: adetra.cns@secu.lu
Tél.: 27 57 – 4455

When am I entitled to cash benefits under long-term care insurance?

The following table shows the dates of payment of cash benefits for 2023.

Month Liquidation
(transfer can take 3-4 days)
November (2023) 13.11.2023
December (2023) 11.12.2023
January 15.01.2024
February
19.02.2024
March
18.03.2024
April
15.04.2024
May
17.05.2024
June
17.06.2024
July
15.07.2024
August
19.08.2024
September
16.09.2024
October 14.10.2024
November
18.11.2024
December
16.12.2024

For any questions about cash benefits under long-term care insurance:

Département Assurance Dépendance
Service Liquidation
E-mail: adespeces.cns@secu.lu
Tél.: 27 57 – 4455

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