Laboratories

Health-maternity insurance in Luxembourg covers acts and services provided by laboratories. A prior medical prescription is always mandatory. In certain cases, the CNS must authorise acts or services.

Conditions of coverage

The CNS covers laboratory analyses at the provided rates and tariffs, as long as they are listed in the table of the nomenclature of acts and services carried out by laboratories. The insured person is free to choose any laboratory (except in emergencies and in the case of inpatient hospital treatment).

Medical prescription

Medical analyses carried out by laboratories must be prescribed on a prior medical prescription in order to be covered by health insurance.

Unless the doctor specifies otherwise, medical prescriptions are valid for a period of two months from the date the prescription is issued. If analyses are split, the last of these may be carried out within six months of the prescription's date of issue.

Limitations

Medical motivation

For certain analyses, the doctor's prescription must indicate a medical justification. A common example is a blood test to check vitamin D levels. A simple prescription without a medical indication cannot be covered by the CNS.

Cumulation rules and maximum coverage

For certain analyses, the nomenclature sets out cumulation rules or a maximum number of acts. Thus, certain acts cannot be cumulated for coverage: if they are prescribed together, coverage will be limited by the rules of cumulation.

For other analyses, a limited number of acts can be covered. A common example is infectious serology testing: a maximum of 12 acts per prescription can be covered. However, for a first pregnancy check-up, the maximum number of acts covered is set at 16.

Blood collection at home

The flat rate for travel expenses for blood collection at home is only covered by health insurance if the prescribing doctor specifies on the medical prescription why it was medically necessary to take the blood sample at the insured person's home.

Laboratory analyses that doctors can perform themselves in their own medical practice

Doctors are authorised to perform routine tests in their own practices. These routine tests are recorded in a restrictive list. Examples include a partial urine test using a test strip or a throat swab for pyogenic streptococcus antigen by direct testing. The limited list of common practice tests can be found below.

Treatment abroad

Medical analyses abroad at the initiative of the insured

If the insured person decides to consult a laboratory abroad to undergo medical analyses, the insured pays the laboratory's invoices directly and requests reimbursement from their competent health insurance fund.

In this case, the insured must send the original and duly paid invoices to their competent fund to receive reimbursement according to Luxembourg rates and tariffs. For a treatment authorised by means of an S2 form or for a treatment that has become medically necessary during a temporary stay abroad (in Europe or Switzerland), the insured receives reimbursement according to foreign rates and tariffs.

It is important to also include the original and prior medical prescription when requesting reimbursement. The 13-digit national identification number must be indicated. For a first reimbursement request, 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.

CNS – Service Remboursements internationaux
L-2980 Luxembourg

If the medical prescription lists acts or services that are not included in the nomenclature of acts and services provided by laboratories, coverage will not be possible, unless the insured has requested a prior authorisation for transfer abroad or a "directive" authorisation.

Medical analyses at a laboratory abroad on the initiative of a hospital in Luxembourg

Analyses carried out during inpatient or outpatient treatments in a hospital are included in the variable costs of the hospital, i.e. they are covered through the hospital budget. If the hospital's own laboratory is unable to carry out the requested analyses, they will forward it to another laboratory (abroad or in Luxembourg). In general, the costs are covered through the hospital's budget and the insured person will not have to pay upfront. However, if the insured person has received an invoice and has already submitted a reimbursement request to the CNS, the invoice will be returned to the insured person, who will then have the option of being reimbursed by the hospital.

Medical analyses during a hospital consultation abroad

Reimbursement for analyses carried out during a consultation in a hospital abroad is based on the LABO flat rate in Annex K of the CNS statutes.

Medical analyses in the country of residence of a cross-border worker

For cross-border workers, the health insurance fund of the country of residence is in charge of covering medical analyses provided in that country.

Special cases

Human genetics and anatomopathology

The "Laboratoire national de santé" (LNS) has been tasked with setting up a unique diagnostic centre in the field of human genetics and anatomic-pathology (Law of 8 March 2018).

Consequently, the field of human genetics and anatomic-pathology is excluded from the authorisation procedure for acts not included in the nomenclature of medical analysis and clinical biology laboratories. A common example is the non-invasive prenatal test (NIPT) for trisomy 21. Any request should be submitted directly to the LNS.

Invoicing for genetic analyses abroad

In the event of invoicing for genetic analyses abroad by a laboratory or hospital, the CNS will reimburse the costs if the insured person presents :

• an original, detailed invoice
• a detailed and motivated prior medical prescription (e.g. search for genetic anomalies, family member already affected by cancer, etc.)

Reimbursement is made under the "GENET" scheme in annex K of the CNS statutes.

Payment method

Payment method in Luxembourg

In general, the method of payment for analyses carried out by a laboratory in Luxembourg is third-party payment (the CNS pays the laboratory directly) if, at the time of sampling at the laboratory, the insured is able to present a medical prescription and the corresponding social security card. The insured person must pay for laboratory analyses undertaken without a Luxembourg social security card or without a medical prescription.

If a prescription includes analyses that are not, or not fully, covered by the third-party payment system following a negative opinion from the Medical Board of the Social Security (e.g. in the case of cumulation rules, maximum coverage and acts not provided in the nomenclature), these must be paid in full by the insured person. In this case, the laboratory issues an invoice containing the full amount charged for the analyses, indicating the services covered by health insurance and those that are at the personal expense of the insured. In the case of acts not provided in the nomenclature with a certificate of coverage from the CNS, the analyses carried out may be covered through the third-party payment system.

If the insured has paid for analyses that can be reimbursed (e.g. if the card was not presented), the paid invoice and the original medical prescription must be sent to the competent health insurance fund for reimbursement.

Payment method abroad

If medical analyses are carried out abroad, the insured person generally pays the laboratory invoices directly and applies for reimbursement with their competent health insurance fund.

In this case, the insured person must send the duly paid original invoice, together with the original and prior medical prescription, to the competent health insurance fund. The 13-digit national identification number must be indicated. For a first reimbursement request, 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.

CNS – Service Remboursements internationaux
L-2980 Luxembourg

Coverage rate

The coverage rate for laboratory acts is one hundred percent (100%) of the tariffs specified in the nomenclature.