Coverage of contact lenses for certain pathologies
List of pathologies
Contact lenses are only covered by health insurance for the following pathologies:
- ametropia greater than or equal to 6 diopters,
- irregular astigmatism under the condition that the improvement of the visual acuity attains at least 20% compared with ordinary glasses,
- unilateral and bilateral aphakia,
- anisometropia higher than 3 diopters,
- fixation nystagmus,
- corneal dystrophy,
- evolutive myopia,
- corneal or scleral trauma.
In the case of the following affections an authorization by the Medical board of social security is required:
- facial or cranial trauma making the usage of contact lenses painful,
- cutaneous hypersensitivity making the use of contact lenses impossible (allergy to the material).
In order to be covered by health insurance, the invoice must be accompanied by a medical prescription indicating the number of the pertaining pathology.
Contact lenses are reimbursed in accordance with the tariffs provided for by the agreement between the CNS and the professional association of opticians (Fédération des patrons opticiens et optométristes du Grand-Duché de Luxembourg).
Services and supplies included in the price of contact lenses
The supply of contact lenses whose coverage is provided by the health insurance also includes:
- Trial, adaptation and examination sessions held in an office specially fitted for these purposes with appropriate examination instruments.
- The first supply of special waterproof cases with a solution for sterilization, hydrophilic and isotonic treatment of the contact surfaces.
- Four trial, adaptation and examination sessions taking place within twelve months of the delivery of the contact lenses. If, within thirty days of the first trial session, an intolerance of the front section of the eye is noticed and for this reason, after two new trial sessions held within two months of the first trial, the contact lenses covered by the health insurance cannot be delivered, only three trial sessions can be billed.
- The exchange of contact lenses within the framework of the conventional guarantees.
The renewal period for a contact lens is 3 years, except in the case of a change of diopter as defined for eyeglasses or in the case of another specific medical indication.
Method of payment
The insured person pays the optician's bill directly and requests reimbursement from their competent health insurance fund.
The insured submits the original, paid and receipted invoice to their competent health insurance fund. The 13-digit national identification number must be provided.
As part of the full reimbursement (if all requirements for coverage are met, see below), the invoice must be submitted with the original medical prescription.
For a first reimbursement claim, a certificate of banking details (relevé d'identité bancaire RIB) must be enclosed. Letters sent to the CNS from within Luxembourg do not require a postage stamp.
Contact lenses are reimbursed at 100% of the conventional rates if all the requirements for coverage are met. In order to be covered by health insurance, the invoice must be submitted with the original medical prescription.
Fixed coverage as a replacement for glasses
If the insured does not meet one of the conditions for the coverage of contact lenses, but does meet the conditions for the coverage of frames and lenses, they may request coverage of contact lenses by means of a fixed price for glasses, the amount of which is made up as follows:
- The amount of thirty euros (€30) corresponding to the rate of reimbursement for a frame.
- The amount corresponding to the price of the lenses that would have been covered if glasses had been provided.
The health insurance scheme will only pay for contact lenses if the invoice contains the refraction values of the glasses.
In the case of successive deliveries of contact lenses, several invoices can be cumulated up to the amount of the aforementioned fixed coverage, provided that the bills are presented all at once.