The insured person who submits an invoice or fee note for reimbursement to the CNS receives a reimbursement statement containing various information, including the details of the reimbursement itself, the registered bank details or the current amount of the personal participation.
This page aims to help the insured person to read and understand the statement received, by giving a few examples.
The details of the reimbursement
The first column of the reimbursement statement informs about the supplier (N°1 fournisseur) i.e. the name of the healthcare provider (doctor, physiotherapist, nurse etc.) or the supplier (pharmacist, orthopedist etc.). The service or supply as codified in the various nomenclatures (N°2 Prestation) appears directly in the following column.
Next, the insured person can find the invoiced amount (N°3 Montant facturé) i.e. the amount charged by the healthcare provider or supplier including the non-refundable amounts or the amounts billed in excess of the conventional rates covered by the health insurance.
All non-refundable amounts or exceedances are not included anymore in position N°4 Fund Tariff (Tarif Caisse). The amount indicated is the amount which constitutes the basis for the calculation of the reimbursement and which can be found in the respective nomenclature.
The next column informs the insured person about the personal or statutory participation (N°5 participation statutaire ou personnelle). It is the amount payable by the insured person in accordance with the statutory provisions and which must be deducted from the fund tariff in order to obtain the refunded amount. That amount is indicated in the last column of the reimbursement statement (N°6 Montant remboursé).
Finally, the reference (N°7 référence) indicated behind the name of the insured person is important because that number enables CNS services to identify the reimbursement. It is essential that the insured person indicates this reference together with their matricule number whenever they contact CNS for information about a specific reimbursement.
Example of reimbursement
A dentist charges 300 € for a facing crown (DB23) and 100 € for precious metals.
- The invoiced amount stands at 400 €.
- The amount which constitutes the reimbursement base of the health insurance is 202.00 €.
- The reimbursement is made at a rate of 80% of the tariff of the health insurance, so 161,60€
- The participation of the insured person amounts to 41€.
Important note: Personal conveniences CP are not refundable by the health insurance fund.
In this case, the reimbursement statement presents itself as follows:
Each reimbursement statement indicates the bank account details currently entered into the CNS computer system. Reimbursements are always transferred to this account.
It is recommended to check that the bank account details included on each reimbursement statement received are correct.
If the details are correct, please do not specify the bank account details every time a reimbursement request is made.
If the account number is no longer correct and/or if the insured person wishes to provide a new bank account, the new bank account details must be sent:
- by using the online form
- via e-mail to email@example.com
- by mail
The reimbursement statement (on the back) also informs about the amount of the personal participation following article 154bis of the CNS statutes.