Who is concerned
This case concerns pensioners who meet the following criteria:
- the pensioner receives a Luxembourg pension only;
- the pensioner lives in another Member State of the European Union (EU), the European Economic Area (EEA) or Switzerland;
- the pensioner is not working in their country of residence.
Country competent for medical coverage
If a pensioner receives only one pension from Luxembourg and resides in another Member State of the EU or EEA or in Switzerland, Luxembourg is competent in terms of medical coverage.
Procedures
Registration of the pensioner in the State of residence
The pensioner must order an S1 form from the National Pension Insurance Fund (CNAP) in Luxembourg. The CNAP processes the application and forwards the S1 form to the CNS, which will forward it to the pensioner. The pensioner must submit this form to the health insurance fund in their country of residence. The S1 document certifies that they are entitled to medical cover in their country of residence.
Registration of dependent family members in the State of residence
If dependent family members (child, spouse/partner; determined according to the legislation of the country of residence) accompany the pensioner, an S1 form must also be issued for each one of them.
The health insurance fund in the country of residence has to contact the CNS in order to request the S1 form (S1 M/F) for each dependent family member. This serves as proof for the competent country that the family members are dependent family members under the local legislation.
If they are not recognised as dependent family members, they will have to find alternative medical coverage through the local healthcare system, possibly by paying social security contributions.
Reimbursements
Medical expenses in the State of residence
The health insurance fund of the country of residence reimburses healthcare costs incurred in that country, in accordance with the conditions, provisions, rates and tariffs applicable in that country.
Medical expenses in Luxembourg or abroad
For all other healthcare expenses (Luxembourg and abroad), the Luxembourg health insurance fund is responsible for reimbursements. Certain scheduled treatments abroad (example: inpatient hospital treatment) require a prior authorisation from the Luxembourg health insurance fund.
Exception: the countries listed in Annex III of Regulation 987/09 (Member States applying for reimbursement of benefits in kind on a flat-rate basis, see link under "More information") are competent for prior authorisation in the context of the European Coordination.