Renewal deadlines and duration of validity

Dental treatment

The total or partial relining of a removable denture is covered once per denture and per calendar year starting with the second relining (art 40 of the CNS statutes).

Standard plaque removal is covered twice per calendar year (from 1 January to 31 December of the same year) and periodontal plaque removal is covered once per calendar year.

Fixed prostheses are only renewed in periods of twelve years.

Removable dentures are only renewed every five years.

However, by way of derogation, the renewal periods may be reduced by the Medical Board of the Social Security in the following cases:

• Maxillofacial bone fracture
• Neoplasia involving the maxillo-oral region
• Treatment with a very high dose of biphosphonates
• Dental prosthetic treatment before the age of 17

(art. 42 of the CNS statutes)

Nursing treatment

Unless contrary indications exist on the medical prescription issued by the doctor, medical prescriptions for nursing treatment are only covered by the health insurance fund if the prescribed treatment begins within thirty days of the issue date of the prescription (art. 49 of the CNS statutes).

Dietetic

In order for acts performed by dieticians outside the inpatient hospital setting to be eligible for health insurance, the relevant medical prescription must be validated by the National Health Fund. This validation must be requested within ninety (90) days of the issuing of the medical prescription. Through this validation, the insured person obtains a certificate of coverage which guarantees the cost coverage under the statutory conditions (art. 53 of the CNS statutes).

Acts performed after a maximum period of twelve (12) months from the date of the prescription for the first consultation of the initial dietetic treatment or for the extension of the dietetic treatment are no longer opposable to the health insurance (art.54 of the CNS statutes).

The health insurance covers only one initial dietetic treatment and one extension of the initial dietetic treatment per disease every three (3) years. The three (3) year period starts from the date of the initial consultation for the initial dietary treatment (art. 54bis of the CNS statutes).

Physiotherapy and massage treatment

To be covered by health insurance, medical prescriptions for the services of masseurs and masseur-physiotherapists provided outside the inpatient hospital setting must be validated by the CNS. This validation must be requested within thirty-one days of the prescription issue date. The validation comes in the form of a certificate of coverage that guarantees the services will be covered according to the statutory conditions. (art. 56 of the CNS statutes)

Acts issued after a maximum period of three (3) months from the date of issue of the prescription are no longer enforceable against the health insurance. By way of derogation, this period is:

• twelve (12) months from the date of issue of the medical prescription in the case of a serious pathology;
• four (4) months from the date of validation of the prescription for acts prescribed as part of a surgical operation on the locomotor apparatus.
   (art.57 of the CNS statutes)

Speech therapy

To be covered by health insurance, medical prescriptions for the services of speech therapists must be validated by the CNS. This validation must be applied for within thirty days of the prescription issue date. The validation gives the insured person an entitlement to cover that guarantees the services will be covered according to the statutory conditions (art. 60 of the CNS statutes).

In the absence of instructions to the contrary from the doctor, medical prescriptions for speech therapy are only covered by the health insurance fund if the treatment prescribed begins within six months of the prescription issue date (art. 61 of the CNS statutes).

Midwifery

The code VSF81 (Post-partum perineal rehabilitation, maximum 8 sessions) will only be covered by the health insurance if the related sessions are performed within twelve (12) months of the date of delivery. (art.65 of the CNS statutes)

In the absence of instructions to the contrary from the doctor, medical prescriptions for midwifery services are only covered by the health insurance fund if the treatment prescribed begins within thirty days of the prescription issue date. (art. 66 of the CNS statutes)

Psychomotor treatment

In the absence of instructions to the contrary from the doctor, medical prescriptions for psychomotor treatment are only covered by the health insurance fund if the treatment prescribed is begun within six months of the prescription issue date.

If the waiting period exceeds six months, and the service provider certifies this, the preceding provision does not apply (art. 68 of the CNS statutes).

Analyses

In the absence of instructions to the contrary from the doctor, medical prescriptions for laboratory or clinical biology services are only covered by the health insurance fund within two months of the prescription issue date.

However, if the services are not all provided at the same time the last service provided remains covered by the health insurance fund within a maximum of six months from the prescription issue date (art. 75 of the CNS statutes).

Thermal and therapeutic cures

With the exception of outpatient cures for the treatment of cervical and shoulder pain or back pain (neck, shoulder and back pain), the protected person is entitled to only one cure of the same nature per year. The authorisation of the National Health Fund is renewable at the earliest twelve months after the end of the previous cure.

The health insurance covers 14 strengthening modules within 18 months of the end of the cure for pathological obesity.

The health insurance scheme covers 12 strengthening modules following bariatric surgery within 12 months of the date of issue of the insurance certificate.

The treatment of cervical and shoulder pain or dorsolumbar pain must be carried out in a cycle of 24 sessions to be completed within 6 months, unless the treatment is interrupted for medical reasons certified by the attending physician and accepted by the National Health Fund.

The waiting period between two series of treatments of the same level is fixed at 24 months except for the shoulders where a new cycle of 24 sessions can be granted in case of pathology of the shoulder on the other side.

Health insurance coverage is limited to 2 maintenance sessions per month.

The prior authorisation of the National Health Fund for a cure must be renewed if the cure has not been started within one year of the notification of the authorisation.

(art. 80 of the CNS statutes)

Orthopaedic prostheses, orthoses and orthopaedic and therapeutic shoes

Prescriptions for orthopaedic prostheses and orthopaedic footwear for which no estimate is required under article 88 of these statutes must be filled within the time limit specified by the prescribing doctor on the prescription or, if no such time limit is specified, within three months of the date on which it is issued by the doctor.

Under penalty of being unenforceable against the health insurance, prescriptions and therapeutic protocols subject to quotation by virtue of article 88 of the present statutes, shall be transmitted for validation to the National Health Fund before the expiry of a period of three months from the date of issue of the prescription or the therapeutic protocol. On pain of inadmissibility, the prescription or the therapeutic protocol must be accompanied by the estimate and any documentation whose transmission for validation is required by virtue of the present statutes.

(art. 87 of the CNS statutes)

The renewal period for orthopaedic prostheses and orthoses is generally five years.

However, specific renewal periods are applied to orthopaedic prostheses and orthoses included in a special list annexed to these statutes.

The renewal period for orthopaedic and/or therapeutic shoes is one year from the date of issue of the last pair of shoes covered.
By way of derogation from the previous sentence, the renewal period for P6070110 "Hausschuhe für Diabetiker (1 Paar)" is four years and runs independently of the renewal period for P6070120 "Therapieschuhe für Diabetiker (1 Paar)".
The renewal period for supplies P6070140 "Orthopädische Hausschuhe nach Maß für Diabetiker (1 Paar)" and P6070141 "Orthopädische Hausschuhe nach Maß für Diabetiker - Nachlieferung (1 Paar)" is also four years and runs independently of the renewal period for supplies P6070130 "Orthopädische Schuhe nach Maß für Diabetiker (1 Paar)", respectively P6070131 "Orthopädische Schuhe nach Maß für Diabetiker-Nachlieferung (1 Paar)".

If a repair or adaptation of an orthopaedic prosthesis or orthosis for an amount exceeding 25% of the amount reimbursed at the time of acquisition of the supply is established within the six months preceding the expiry of the renewal period, this period is automatically extended by twelve (12) months. This provision does not apply to orthopaedic and/or therapeutic footwear.

For the calculation of the renewal period, the date of issue of the supply as shown on the invoice shall be taken into account.

By way of derogation from the renewal periods set in accordance with the preceding paragraphs, the Medical Inspectorate of Social Security may reduce these periods on the basis of a reasoned medical prescription in the case of persons in growth, in the event of abnormal wear for which the beneficiary is not responsible, in the event of intercurrent events or if a repair is no longer justified according to criteria of functionality or economy.

(Art. 91 quinquies)

Within a 12-month period, insured persons are entitled to 2 pairs of round-knitted compression stockings/tights and 4 pairs of flat-knitted compression stockings/tights. The prescription can be renewed at the end of the 12 months.

For other compression garments, a decision is taken on the basis of a justified medical prescription (ordonnance médicale motivée).

Prescriptions

To be covered by health insurance, prescriptions for medications must be dispensed within the time specified by the doctor on the prescription or, if no time is specified, within three months of the prescription issue date.

However, in the case of prescriptions specifying several successive supplies of medications, the last supply provided remains covered by the health insurance fund within a maximum of six months from the first supply (art. 94 of the CNS statutes).

Glasses

Except in the case of dioptre changes greater than or equal to +/- 0.50, the health insurance fund only covers the supply of one frame and one pair of lenses every three years, per vision. A dioptre change of +0.25 in one eye and -0.25 in the other eye is considered equivalent to a dioptre change of 0.50. A dioptre change of +0.25 in the same direction in both eyes is not considered equivalent to a dioptre change of 0.50.

The starting point for calculating the renewal interval is the date of the last cover provided by the health insurance fund (art. 126 of the CNS statutes).

Contact lenses

The renewal period for contact lenses is 3 years, except in the case of a change of diopter as defined for glasses or in the case of another specific medical indication. (art. 128 of the CNS statutes).

Medically assisted procreation

Titles for in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) are issued for a maximum period of six (6) months from the date of issue of the title.

(art. 143bis of the CNS statutes)

Medical devices and hearing aids

Prescriptions for medical devices listed in files B1 and B2 must be filled within the time limit specified by the doctor on the prescription or, if not specified, within three months of the date on which the doctor issues the prescription. (art. 150 of the CNS statutes)

The time limit for the renewal of hearing aids (file B3) is five years for an adult.

By way of derogation, this period shall be reduced to three years for children and young people who have not reached the age of 18 years on the delivery date of the last hearing aid covered by health insurance.

The time limits shall be calculated from the delivery date of to the last hearing aid device covered.

The determination of the renewal period is based on the age attained by the insured person at the time of the delivery date of the last hearing aid covered.

One additional earmold per hearing aid is covered during the renewal period, but no earlier than six months after the date of delivery of the first earmold. For children and young people who have not yet reached the age of 18, earmolds will be covered without a renewal period.

In the event of an upgrade to a stereoacoustic hearing aid within the period stipulated in these Articles of Association, the renewal period begins on the date of delivery of the stereoacoustic hearing aid. (art. 152 of the CNS statutes)

Unless otherwise indicated by the doctor, medical prescriptions for the services of psychotherapists can only be reimbursed by the health insurance scheme if the treatment prescribed therein is begun within 90 days of the date of issue of the prescription. (art. 71quater of the CNS statutes)