Transportation by ambulance refers to transportation carried out by an ambulance in situations other than those of vital distress, when that ambulance is used
- by public services under the jurisdiction of the State or the communes;
- in a commercial capacity by private individuals or commercial companies;
- by public service establishments or non-profit organisations working in the field of health or assistance and rescue.
Transportation for serial medical treatments refers to multiple transfers of the insured person between their habitual place of residence and the place where they undergo a planned treatment consisting of at least four sessions within a period of ninety (90) days:
- in a hospital for treatments focussing on chemotherapy, radiotherapy and haemodialysis;
- in the national functional rehabilitation and readaptation centre or in the geriatric or cardiac rehabilitation unit of a hospital;
- in a hospital for a special treatment which has been authorised by the Medical Board of the Social Security (Contrôle médical de la sécurité sociale CMSS).
Usually, serial transport by ambulance is not carried out by public services under the jurisdiction of the State or the communes.
Conditions for coverage
The "File B6" from annex A of the CNS statutes provides for the situations where the health insurance covers transport and travel services. In all situations covered by the file B6, travel and transportation costs are not covered beyond a distance of a maximum of 400 km for the outbound journey. In exceptional cases, the CNS can authorise coverage requested with a detailed medical report issued by the treating doctor and with a prior authorisation from the CMSS for travel and transportartion costs up to a distance of 600 km for the outbound journey.
Prior authorisation from the Medical Board of the Social Security
With the exception of emergency cases duly justified or except if the CNS statutes provide for a specific derogation, a prior authorisation from the Medical Board of the Social Security CMSS is always required in order to cover transport services abroad. The same applies to serial transportations within Luxembourg.
Prior medical prescription
Serial transportation by ambulance both in Luxembourg and abroad is covered provided that a prior medical prescription issued by the treating doctor on a specific form and previously accepted by the Medical Board of the Social Security, specifies separately for the outward and return journeys the medical reasons which make a reclined or immobilised position indispensable.
The stipulations concerning a prior medical prescription and a prior authorisation by the Medical Board of the Social Security for the continuation of serial transportations by ambulance are waived in the case of hospital treatment relating to chemotherapy, radiotherapy and haemodialysis.
Serial transportation by ambulance for treatments in the national functional rehabilitation and readaptation centre or in a geriatric or cardiac reeducation unit of a hospital are covered for a maximum of twenty (20) days of treatment only.
Terms of coverage
The portion of the costs covered by the health insurance can be paid by the CNS directly to the transporter if, at the request of the insured person, a certificate of coverage (titre de prise en charge) has been issued prior to transport and if this certificate has been accepted by the transporter within the framework of the agreements provided for by the Social Security Code or, in the absence of an agreement, within the framework of the conditions for approval which define the relations between the CNS and the transporters.
The costs relating to transportation paid upfront by the insured persons are covered upon presentation of paid and receipted invoices, accompanied by the prescription and, if applicable, the required authorisations.
The burden of proof that the transportation was carried out in order to receive services covered by the health insurance in the situations provided in the CNS statutes lies with the person claiming such costs.