The form "Claim for reimbursement to a person other than the main insured" is to be used if you wish to:
- obtain reimbursements on your own account previously registered with the CNS
- if you have paid costs upfront for another person (other than your co-insureds)
- for yourself (you are co-insured)
- change a prior declaration
IMPORTANT: If the CNS does not yet know your bank details or if you want to change them, please use the procedure "Communication of bank account with the CNS" here:
www.cns.lu > Change of bank account
Article 84 alinéa 1 du Code de la sécurité sociale
Les prestations relatives aux soins de santé peuvent être valablement versées, soit à l’assuré, soit à toute autre personne justifiant avoir effectué la prestation ou la dépense afférente(…).
Instructions for completing the form
In the form's first panel, the identification number is that of the person claiming the reimbursement. This person must sign at the bottom of the page.
Next, one of the checkboxes A or B or C must be ticked:
Box A - Declaration of payment during a given period
Please indicate the specified period (the beginning and possibly the end).
Select one of the following boxes, if you certify that you are paying/have paid for healthcare services for
- a person other than your co-insureds, indicating the identification number and the surname and first name of the insured for whom you have paid the costs
- yourself, if you are co-insured
Box B - Declaration of payment for enclosed services
This box must be ticked if you certify that you have exceptionally paid for the enclosed services. These invoices, together with the form, must be sent by post to the CNS.
Box C - Change of a prior declaration
You should tick this box if you wish to change a prior declaration. You must indicate the identification number, the surname and first name of the person previously registered as the beneficiary of refunds.
Sending the request to the CNS
If you are attaching receipted invoices/statement of fees to your claim, please send it by post only to
- CNS L-2980 Luxembourg.
In all other cases, simply fill in the (interactive) form and send it to the CNS
- either by email to firstname.lastname@example.org,
- or by post to CNS L-2980 Luxembourg.