No pension from the state of residence and several pensions from other states

Who is concerned

This case concerns pensioners who meet the following criteria:

• the pensioner receives a Luxembourg pension;
• the pensioner also receives a pension from a second or several Member States of the European Union (EU), the European Economic Area (EEA) or Switzerland;
• the pensioner resides in a third State of the European Union, the European Economic Area (EEA) or Switzerland;
• the pensioner is not working in that third State and does not receive a pension from that State.
  

Country competent for medical coverage

The pensioner is not entitled to medical coverage in their State of residence, since they have never worked/paid contributions or resided there, provided that this right is based solely on the residence. However, the pensioner is entitled to health insurance on behalf of one of the States from which they receive a pension.

In order to determine the competent State, in accordance with Article 24 of the Regulation (EC) 883/2004, priority rules have been established: the State which entitles the insured person to health insurance rights is the one where they have been insured for the longest period of time, provided that they would be entitled to health insurance if they resided in that State. If this period is identical in several States, the last State of affiliation is responsible for medical coverage.

Procedures

Registration of the pensioner in the State of residence

The pensioner must order an S1 form from the pension fund of the competent State. They must submit this form to the fund in their country of residence. This document certifies that they are entitled to medical coverage 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 of them.

The fund of the State of residence has to contact the CNS in order to request the S1 form (S1 M/F) for each dependent family member. This constitutes proof for the competent health insurance fund that the family members are dependent family members under the local legislation.

If they are not recognised as dependent family members, they should be affiliated directly to the local system, possibly by paying social security contributions.

Reimbursements

If the Luxembourg pension fund (CNAP) issued the S1 form

Medical expenses in the State of residence

The health insurance fund of the country of residence reimburses healthcare expenses incurred in that country, in accordance with the conditions, regulations, rates and tariffs applicable in that country.

Medical expenses in Luxembourg or abroad (outside the country of residence)

For all healthcare expenses incurred in Luxembourg and abroad (outside the country of residence), the Luxembourg health insurance fund is responsible for reimbursements. For certain treatments planned abroad (e.g. inpatient hospital treatment), the Luxembourg health insurance fund must issue a prior authorisation (exception: Annex III of the regulation 987/09).

If the pension fund of a Member State of the EU, EEA or Switzerland (other than Luxembourg) issued the S1 form

Medical expenses in the State of residence

The health insurance fund of the country of residence reimburses healthcare expenses incurred in that country, in accordance with the conditions, regulations, rates and tariffs applicable in that country.

Medical expenses in the competent State (the one that issued the S1 form) or abroad

If the pensioner is registered using the S1 form - issued by one of the States listed in Annex IV of the Regulation (EC) No 883/2004 (additional rights for pensioners returning to the competent Member State) - and receives medical care there, the fund of that State is responsible for covering any healthcare expenses incurred (necessary during a temporary stay or planned) in that State and abroad.

If the State that issued the S1 form is not listed in Annex IV, only medically necessary care during a stay on the territory of that State will be paid directly by the institution of that State on the basis of a valid European Health Insurance Card. For scheduled treatment abroad, the pensioner must apply to the fund in their State of residence.

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 establishing prior authorisation for scheduled care in the context of the European Coordination.