Certain strictly defined disorders may justify a thermal or therapeutic cure in the Thermal Centre in Mondorf-les-Bains. In certain cases, and following authorisation from the CNS, the insured person may follow a cure abroad.
Thermal or therapeutic cures in Mondorf-les-Bains
Administrative procedure
The costs of a thermal or therapeutic cure in Mondorf will only be covered if the insured person has obtained prior authorisation from the CNS.
Generally speaking, the insured person will need to arrange an appointment with a doctor practising in the Centre thermal and present a recommendation from their attending physician. Once the request has been reviewed by the doctor practising in the Centre thermal, it is decided whether there are sufficient reasons to approve it, by checking the patient’s conditions against the list of conditions for which the requested cure is medically indicated. In the case of approval, the doctor at the Centre thermal will submit an authorisation request to the CNS, which checks whether the administrative data is in order and whether the approval of the doctor practising in Mondorf is attached to the request.
The CNS issues prior authorisation in the form of a certificate of coverage. This certificate is valid for one year. If the insured person does not start an authorised cure within one year of the issue date of the authorisation, a new authorisation is required.
Conditions for reimbursement
Health insurance covers the insured person's accommodation costs on a fixed day rate basis. This day rate is paid per night that the insured person spends in a hotel or other establishment authorised to accommodate people, located in the commune of Mondorf. The following types of accommodation are not covered: camping in a tent, staying in a caravan/mobile home, or staying in a furnished or unfurnished room at a private home.
The day rate is paid by the CNS following receipt of an invoice issued by the establishment where the insured person was staying. The invoice, dated and issued in the name of the insured person, must indicate the number of overnight stays, along with the start and end dates of the stay.
Insured persons whose official residence is in the commune of Mondorf-les-Bains are entitled to a fixed day rate from the health insurance. This day rate is paid upon receipt of paid invoices issued for the dates of their cure programme.
If the insured person's stay is interrupted due to the normal cessation of the spa programme at weekends and on public holidays, they are not entitled to any part of the health insurance costs for these days.
Special conditions
For some cures, the CNS statutes dictate specific physical requirements.
Thermal cure for lympho-venous stasis
The thermal cure for lympho-venous stasis (T180) is only covered in the case of complicated venous insufficiency or lymphoedema.
Thermal cure for pathological obesity
Spa treatment for pathological obesity T190 (inpatient treatment) and T192 (outpatient treatment) is covered if the insured has
- either a body mass index (BMI/BMI) greater than 35,
- or a body mass index (BMI/BMI) greater than or equal to 30 in combination with at least one of the following criteria:
- diabetes mellitus with HbA1c >7;
- treatment-resistant hypertension defined as blood pressure greater than 140/90 mmHg, despite treatment for one year with three antihypertensive drugs simultaneously;
- sleep apnoea syndrome as determined by polysomnographic examination in a hospital with a sleep laboratory;
- android morphological type (waist circumference exceeding 88 cm in women and 102 cm in men);
- cardiological history (documented coronary artery disease/cardiomyopathy).
In the case of inpatient obesity treatment, lunch and dinner must be taken at the spa.
Limitations
The insured person is entitled to one cure of the same type per year covered by health insurance and a new authorisation requests may be submitted at the earliest 12 months after the end of the previous cure, with the exception of outpatient back, neck and shoulders cures (back, neck and shoulders).
The costs of a cure interrupted without valid reason cannot be covered by health insurance.
Back, neck and shoulder cures
Outpatient cures (T200, T203 and T206) are to be carried out in a cycle of 24 sessions to be completed within 6 months unless interrupted for medical reasons certified by the treating physician and accepted by the CNS. The waiting period between two series of treatment of the same level is fixed at 24 months except for the shoulders where a new cycle of 24 sessions can be granted in case of pathology of the other shoulder.
Maintenance sessions are covered provided that a cycle of 24 sessions of initial treatment has been granted and performed previously. 2 maintenance sessions per month can be covered.
Cure for pathological obesity
The number of cures for pathological obesity is limited to 2 per insured person. 14 strengthening modules are covered within 18 months of the end of the cure for pathological obesity.
Cures abroad
The insured person can consider a cure abroad only if it cannot be carried out in Luxembourg because specific healthcare is required.
A request for prior authorisation of a transfer abroad, duly completed and medically justified by a doctor, must be submitted to the CNS before the planned cure begins. If the request is approved, the CNS will issue an authorisation for a cure abroad.
The insured person may follow a cure in any Member State of the European Union, Norway, Iceland, Lichtenstein, Switzerland, or in any other country that has signed a bilateral social security agreement with Luxembourg (Bosnia-Herzegovina, Cape Verde, Morocco, Montenegro, Serbia, Tunisia and Turkey). The facility offering the cure must be approved by the relevant authority in the country of stay.
The S2 authorisation, which allows for coverage of the treatment abroad, does not include advances on accommodation or apartment rental costs. These must be paid upfront by the insured person. They will then be reimbursed upon presentation of the corresponding invoices, issued in the name of the insured person, dated and duly paid. If the insured person rents an apartment, the lease must be submitted.
In the event of an authorised cure abroad for a minor, the costs of an accompanying person will be covered by the health insurance fund on request and up to the amount stipulated in the CNS statutes.
The insured person will be required to cover all travel expenses. These will not be reimbursed.
Coverage rates and reimbursement
Various flat rates or one-off services can be covered by the health insurance. Authorised thermal treatments are mainly covered at the rate of 80%.
Loco-regional natural fango (T260) and global natural fango (T261) are covered at a rate of 70%.
The health insurance contributes to the insured person’s accommodation costs on a fixed day rate basis, currently €61,39. This day rate is paid per night that the insured person spends in a hotel or other establishment offering accommodation services in the commune of Mondorf. The chosen establishment must have official authorisation to provide accommodation services, or must have CNS accreditation.
The following types of accommodation are not covered: camping in a tent, staying in a caravan/mobile home, or staying in a furnished or unfurnished room at a private home.
The day rate is paid by the CNS following receipt of an invoice issued by the establishment where the insured person was staying. The invoice, dated and issued in the name of the insured person, must indicate the number of overnight stays, along with the start and end dates of the stay.
Insured persons whose official residence is in the commune of Mondorf-les-Bains are entitled to a fixed day rate from the health insurance, currently €17,94. This day rate is paid upon receipt of paid invoices issued for the dates of their cure programme.
The costs of a cure interrupted without valid reason cannot be covered by the health insurance.