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 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.
Important: In foreign countries, medical prescriptions may differ from Luxembourg prescriptions. It is essential that the prescription is prior and detailed, on which the doctor indicates exactly which values are to be analysed.
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.
Important: In the event of a medical examination abroad, doctors may perform other examinations/analyses that are not included in this list in Luxembourg. Coverage by the CNS is only possible for procedures included in the restrictive list of the Grand-Ducal regulation of 22 June 2018 (list of laboratory tests that doctors can perform in their medical practice).
Transmission of analyses by the Luxembourg laboratory
When a laboratory in Luxembourg is unable to perform a medical analysis for technical reasons, they forward the biological samples to another laboratory in Luxembourg or in a country of the European Union (EU), the European Economic Area (EEA) or Switzerland. If the prescribed act is listed in the Luxembourg nomenclature, authorisation from the CNS is not required. For analyses not listed in the Luxembourg nomenclature, authorisation from the CNS is required, subject to approval (ACM) of the Medical Board of the Social Security (CMSS). This authorisation can also be requested once the analyses have been carried out. However, please note that authorisation may not be granted.
The coverage for transmission or the realisation of analyses in a laboratory located in a country outside the EU, EEA or Switzerland is subject to prior authorisation (APCM) by the CNS, with the assent of the Medical Board of the Social Security (CMSS). It is up to either the laboratory, the doctor or the insured to submit the request for prior authorisation to the CNS. The insured should determine with the above-mentioned parties who will submit the request for prior authorisation.
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
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.
Acts not listed in the nomenclature
Medical analyses not listed in the nomenclature may be covered with an authorisation (ACM) from the CNS. This authorisation can be requested before or after the tests by the laboratory, the insured person or the prescribing doctors.
However, certain conditions must be fulfilled: the insured must present symptoms that indicate the presence of an illness. Analyses carried out for research purposes to determine the probability of diseases cannot be covered.
If coverage is not granted, a copy of the refusal is sent to the applicant and in any case to the insured person. The insured person must pay for the analyses in question. In the event of a favourable opinion, the CNS will issue a certificate of coverage, which guarantees that these analyses are covered.
Authorisation is requested by submitting a detailed prescription/certificate from the attending doctor to the CNS. In addition, the doctor can choose to enclose any other relevant documents allowing for a better assessment of the request by the Medical Board of the Social Security (Contrôle médical de la sécurité sociale CMSS). The CNS then forwards the request to the CMSS. The CMSS provides a positive or negative opinion. The opinion of the CMSS is binding on the CNS.
If the request for authorisation is submitted by either the attending doctor or the insured person, the CNS will ask for the exact costs of an analysis if it is not mentioned in the request. At the insured's request, the laboratory will provide an estimate of the overall costs of the analyses and the terms of coverage.
The decision of the CNS is communicated to both the insured and the applicant.
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 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
The coverage rate for laboratory acts is one hundred percent (100%) of the tariffs specified in the nomenclature.
Please note: The coverage rate always refers to the tariffs applicable in Luxembourg. If a medical analysis costs EUR 50 abroad and the same analysis only costs EUR 20 in Luxembourg, the insured receives a reimbursement corresponding to 100% of the 20 euros set out in the Luxembourg nomenclature for this particular analysis.