German cross-border workers

Applicable rules

The insured person is considered a cross-border worker if they work (and are insured) in a different EU country than the one they reside in and under the condition that they return to the country of residence every day or at least once a week. In this case, the country competent in social security matters is the country where they work.

Use of the S1 form

The S1 form is a document of legal entitlement to healthcare benefits delivered by the competent country (country where contributions are paid) and allows registration in the country of residence. In this case, healthcare is delivered in the country of residence as if the concerned person was insured there. The S1 form delivered by the competent healthcare fund must be presented to the health fund in the country of residence. The healthcare fund from the country of residence confirms the registration of the form to the competent healthcare fund.


The cross-border worker insured in Luxembourg must register with the health insurance fund of their place of residence in order to benefit from health care reimbursements. The CNS issues a document of entitlement for this purpose: the S1 form

Following registration as a cross-border worker from Germany, the S1 form is normally sent automatically to to the private address of the insured person, who should present the form to a German health insurance fund of his choice.

If the insured person does not receive the S1 within the fifteen days following the submission of the declaration of entry to the CCSS (Joint Centre for Social Security) they are advised to order the S1.


The cross-border insured and the members of their family are entitled to the same benefits under the same terms and conditions as those to which the residents of the Grand Duchy of Luxembourg are entitled.

The law of the insured's country of residence applies concerning the determination of who qualifies for benefits in their capacity as a member of the insured's family.

For this purpose, the health insurance fund of the country of residence transmits a document of entitlement to the CNS attesting to the fact that members of the family are co-insured in the name of the person insured in Luxembourg.

Certificate of incapacity for work

In case of sickness or accident, the insured person must send the original certificate of incapacity for work directly to the CNS before the end of the third working day that the insured has been on sick leave as a result of the doctor’s findings.

In order to speed up the administrative procedure and to assure a smooth procedure for the remittance of sickness benefits, it is recommended that all documents sent to the CNS include the insured person's individual Luxembourg identification number.

In this regard, it is recommended to ask the doctor to indicate the Luxemburgish national identification number, or, if necessary, to mark it themselves on the back of the medical certificate.

Electronic certificate of incapacity for work in Germany

On 1 October 2021, the electronic certificate of incapacity for work (eAU) was introduced in Germany. This means that German doctors will no longer provide their patients with a printout of the certificate of incapacity for work. Sickness certificates will now be transmitted digitally by doctors' practices directly to the German health insurance funds. This system does not currently exist in Luxembourg. However, until 1 July 2022, the transitional solution provides that doctors must print hard copies of certificates from their practice software for patients who request them. However, the doctor will no longer print 3 documents, but only 2 documents: one for the employer (without diagnosis) and one for the patient (with diagnosis). The latter must also be used to declare the incapacity for work to the CNS.

What do I have to do as a Luxembourg insured person if I am declared ill by a doctor in Germany?

In order to be able to report the incapacity for work to the CNS, you must ask the doctor in Germany to provide you with a printout of the electronic certificate of incapacity for work (printout from the doctor's office software) in duplicate: a copy for the employer and a copy for the patient. The printed copy for the patients has to be sent to the CNS, either by post and the patient can make a copy beforehand, or by email as a scanned document, the patient has to keep the document. This is a transitional solution valid until 1 July 2022.

At the latest on the 3rd day of incapacity for work, the certificate of incapacity for work (copy for the patient) must be sent to the CNS:

  • either by email to
  • or by post to CNS - Incapacity for work - L-2980 Luxembourg.

The CNS is working closely with the German authorities to implement a final and efficient solution by 1 July 2022.

Coverage of healthcare received in the country of residence

With regard to reimbursement of healthcare, treatment provided in the country of residence can only be reimbursed by the country of residence according to its own rates, tariffs and terms.

Coverage of healthcare received in a country other than Luxembourg or other than the country of residence

Necessary/emergency treatment is paid for based on the European Health Insurance Card/EHIC (or if necessary a replacement certificate) issued by the competent country.

Planned inpatient treatment is subject to a prior authorisation from the Medical Board of the Social Security (Contrôle médical de la sécurité sociale - CMSS) and can only be reimbursed if approval is granted. If S2 authorisation is granted by the competent country, the treatment will be paid for by the country where it is provided according to the rates and tariffs applicable there. If the insured person was given a "directive" authorisation from the competent country, the insured person advances the cost and is reimbursed by the competent country according to the rates and tariffs in force there.

Please note that for some ambulatory healthcare, a prior approval by the CNS on the basis of a positive advice by the CMSS is mandatory.

Planned outpatient treatment is paid for by the competent country according to the rates and tariffs in force there.


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