A non-hospitalised insured person has scheduled hospital treatment abroad and is travelling by ambulance from Luxembourg to another country. Coverage for such ambulance transport is subject to certain conditions.
Conditions of coverage
The insured person must take the necessary preliminary steps for the treatment abroad to be covered by the health insurance.
For any reimbursement of transport costs for scheduled treatment, the insured must have a certificate of coverage issued by the CNS valid for the period during which the treatment takes place.
Certificate of coverage
In order to obtain this certificate of coverage, the attending physician must specify separately for the outward and return journeys the medical reasons for which a reclining or semi-seated position is essential, on a prior medical prescription.
This prior application must be sent to the CNS. The CNS carries out an administrative check of the application. If this check is satisfactory, the CNS issues a certificate of coverage, which is sent to the insured person.
Please note: If the return journey is not made on the same day as the outward journey, it is up to the foreign treating doctor to issue the medical prescription.
Reimbursment / Coverage
The insured may:
- hand over the certificate of coverage to the approved transport provider and ask him to apply for coverage through the third-party payment system. If all the conditions are met, the insured person only pays to the provider the part of the costs not covered by the health insurance.
- advance the costs and subsequently request reimbursement from the CNS. The documents to be enclosed are the paid invoice from the approved transport provider and the valid proof of payment.
Simple transport by ambulance is covered at the rate of seventy percent (70%) of the invoices established on the basis of:
- of a minimum of thirty-nine euros and seven cents (€39.07) per trip,
- or of an amount of one euro and twenty-nine cents (€1.29) per kilometer
For the calculation of the route, the shortest distance is taken into account between:
- the normal station of the ambulance closest to the insured's departure,
- the place of departure of the insured,
- the place where he receives treatment,
- the place to which the insured person returns, if necessary, after receiving treatment,
- the place where the ambulance is normally stationed.
For simple transport by ambulance abroad, 30% of the statutory tariff remains payable by the insured. To this participation are added possible supplements charged by the transport companies. If possible, find out about the prices charged by the transport companies before choosing a provider.
The third-party payment system can only be operated by the CNS with providers approved by the CNS. The insured person must advance the costs if he is transported by a foreign transport company.
Transport costs are only covered up to a maximum distance of 600 km for the outward journey.
In other words, if the S2 authorisation is granted for treatment in a hospital at a distance of more than 600 km, the certificate of coverage is only granted for a maximum distance of 600 km.