Doctors

The role of doctors

The main duty of doctors is to treat and prevent diseases. This is referred to as primary care, which is mainly provided by general practitioners and specialists in medical practices.

Each person should choose a general practitioner for themselves and a paediatrician and/or general practitioner for their child. These healthcare providers will be the first point of contact in the event of illness and will guide them. If the usual doctor is not available, the insured person may contact another doctor of their choice, in accordance with the principle of free choice of service provider.

Free choice of service provider

Except in case of emergency, the insured person is free to choose a healthcare provider. He can also consult a specialist without first going through a general practitioner and does not need a transfer/prescription from his doctor to consult the specialist. The insured person may change doctors at any time.

However, in a hospital setting, choice can often be limited, as hospital organisational structures allow only health professionals licensed by the hospital to provide medical care.

Medical specialities

In Luxembourg, the term "doctors" (excluding dentists) refers to doctors practicing general medicine and medical specialists. The various medical specialities recognised in Luxembourg are defined by a Grand-Ducal regulation, here are some examples: cardiology, general surgery, dermatology, gastroenterology, ophthalmology, paediatrics, urology, etc.

Mandatory agreement of the doctor

In order for services such as consultations, visits, procedures, medical and care services to be covered by the health insurance fund, they must be delivered by providers who are covered by agreements. In Luxembourg, there is a general and mandatory convention system. All doctors and dentists authorised to practise in Luxembourg are therefore automatically and mandatorily covered by agreements and they have to comply with the nomenclatures and tariffs.

Affiliation to health insurance

Any person working in Luxembourg must be affiliated with the CNS or the competent public sector fund. An insured person may co-insure their family members in order to benefit from medical care in Luxembourg. The insured person receives a social security card with a 13-digit national identification number, which is to be presented to healthcare providers.

Acts and services specified in the nomenclature

In order for an act or service provided by a doctor to be reimbursed, this act or service must be recorded in a nomenclature. For doctors and specialist doctors, these procedures are provided in the nomenclature of acts and services of doctors.

Authorisation

Certain acts or services can only be covered with the authorisation or prior authorisation of the National Health Fund (CNS), with the assent of the Medical Board of the Social Security (CMSS). In the doctors' nomenclature of acts and services and the CNS statutes, these acts are indicated by ACM (authorisation of the Medical Board of the Social Security required) or APCM (prior authorisation of the Medical Board of the Social Security required).

Number of consultations/visits

The CNS only covers:

• 1 consultation or visit from the general practitioner or specialist in the same medical discipline per 24 hours, unless there is an intervention by the emergency medical service,
• 2 consultations or visits by the general practitioner or specialist in the same medical discipline per seven-day period,
• 12 consultations or visits by a general practitioner or a specialist in the same medical discipline per semester (6 months), unless they are consultations or visits delivered during a long stay in the geriatric ward or in hospital, unless a previously requested authorisation was given or a medical justification accepted, with the approval of the Social Security Medical Board.

These restrictions do not apply to prescription renewals and serial injections and dressings.

Personal conveniences

Doctors have the right to charge additional fees for personal conveniences, provided that the insured person has been previously informed about it. The treatment in question can only be started when the insured person authorises the doctor to charge the additional fee. These fees are not covered by health insurance.

Primary care centres (“maisons médicales”)

Primary care centres have been set up to provide a replacement service for general practitioners whenever the insured person requires general medical care during evening or night hours, weekends and public holidays.

During the closing hours of medical practices, primary care centres provide an alternative service in the form of a general medical permanence. It is important to note that these are not emergency services and that in the event of a medical emergency, the insured person must immediately call 112.

In Luxembourg, three on-call primary care centres have been set up: Luxembourg City, Esch-sur-Alzette and Ettelbruck.

Opening hours and exact addresses can be consulted on the Health Portal.

Paediatric emergencies

When a child falls seriously ill, a paediatric primary care centre (“maison médicale”), is available or, in second instance, the paediatric emergency services, which are both located within the "KannerKlinik" at the Luxembourg Hospital Centre (CHL). After the administrative admission at the KannerKlinik's reception desk, a triage and guidance nurse will refer the patient either to the paediatric emergency services or to the paediatric primary care centre, depending on the reason for admission and scientific triage criteria.

The paediatric emergency services are open 24 hours a day.

The paediatric primary care centre offers care provided by paediatric doctors, from Monday to Friday between 7 p.m. and 10 p.m. all year round; on weekends and on public holidays, from 9 a.m. to 9 p.m.

The Paediatric Policlinic manages EMERGENCIES 7 days a week from 8 a.m. to 8 p.m. It is located on the ground floor of Kirchberg Hospital.

The paediatric emergency services take care of children from birth to the age of 15.

Medical care scheduled abroad (member state of the EU, the EEA and Switzerland)

The insured person may choose to deliberately seek treatment abroad:

Outpatient care (care in hospital without overnight stay or outside the hospital, e. g. medical practice...)

Prior authorisation is not required. Scheduled outpatient care is reimbursed by Luxembourg according to Luxembourg conditions, rates and tariffs. When care is provided using highly specialised and costly hospital infrastructure or medical equipment, prior authorisation is required.

Inpatient care or care requiring the use of highly specialised and costly infrastructure or medical equipment

A prior authorisation from Luxembourg is required for coverage, upon presentation of a transfer request filled out by a doctor and following a favourable opinion from the CMSS.

Emergency care (medical care required during a stay abroad)

When traveling abroad, immediate access to healthcare may be necessary. In order to avoid any inconveniences, different steps must be taken before, during and after the holidays. Destinations can be subdivided into three categories.

Care received in the country of residence of a cross-border worker

For cross-border workers, the health insurance fund of the country of residence is responsible for reimbursing healthcare provided in that country. For medical care provided in Luxembourg or any other country, the cross-border worker may request reimbursement from the CNS.

Reimbursement of costs

Tariffs

The tariffs for medical acts and services are set in a nomenclature concluded as part of the agreement between the Association of Doctors and Dentists (AMMD) and the CNS. Doctors are required to comply with these rates (exceptions: personal convenience and 1st class tariffs).

The insured paid the medical invoices

In general, the insured person pays the doctor's invoice directly and requests reimbursement from his competent health insurance fund.

In this case, the insured must send the original, duly paid and receipted invoices to his competent fund. The 13-digit national identification number must be indicated. If this is the first request for reimbursement, a bank account number (RIB) must be enclosed. For submissions to the CNS from Luxembourg, the insured does not need to apply a stamp to the envelope.

CNS – Service Remboursements  

L-2980 Luxembourg

The third-party payment system

In the case of inpatient treatment in a hospital, if the stay exceeds three days or if the invoice for medical fees per doctor exceeds 100 euros, the doctor may send the invoices directly to the CNS (third party payer).

Refund rates

In Luxembourg

For consultations in doctors' practices and outpatient treatment in hospitals, the reimbursement rate is 88% of the fees set for adults and 100% for children and young people under 18 years of age.

In the case of inpatient or semi-stationary treatment (=ambulatory in place of supervision), invoices are covered at the rate of 100% of the fees in the nomenclature of acts and services of doctors (excluding the 66% increase in the case of first-class treatment).

Abroad (EU, EEA or Switzerland)

In the event of scheduled outpatient treatment without prior authorisation: Treatment is reimbursed by Luxembourg according to Luxembourg conditions, rates and tariffs.

In the event of scheduled inpatient treatment with prior authorisation: Upon presentation of the S2 to the health insurance institution of the State indicating where the treatment will be carried out, the insured person is entitled to the same conditions of coverage at the same rates as the insured in the country of treatment.

In case of urgent treatment: The presentation of the European Health Insurance Card guarantees the insured person coverage or reimbursement of medical expenses on site.