How does the state health insurance system work?

Luxembourg’s health insurance is based on a joint Beveridge (universal government funded healthcare) and Bismarck (co-pay between employer and employee) model. About 84% of healthcare funding is paid by the government and from health insurance: the Mutual Medico-Surgical Fund (Cause Médico-Chirurgicale Mutualiste) is comprehensive and compulsory. It is governed jointly by the Ministries of Health and Social Security.

An amount will be deducted from your salary each month and paid into the Luxembourg Health Offices of the Caisse Nationale de Santé (CNS – National Health Fund), or the Caisse de Maladie, who govern health insurance along with nine other agencies.

If you are self-employed, you will need to sign up with the Joint Centre of Social Security, and they will send you your social security card. If you are a cross-border worker then you will need to make sure that your dependents are covered in Luxembourg as well as your country of residence. You will either need a Luxembourg social security card or you can submit your documentation to the CNS, who can co-insure you.

You will then be covered for most health-related appointments. Luxembourg operates on a reimbursement system, so you will need to pay your costs upfront and then claim them back. Usually you will be refunded within three weeks, for 80-100% of the costs. You will need to send your receipts, along with your social ID number and a bank statement, into the CNS.

This does not apply to hospital treatment: the CNS will settle the bulk of the cost directly with the healthcare provider and you will only need to pay the difference. Luxembourg does not have any private hospitals: they are all CNS-run.

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Who is eligible for state healthcare?

All citizens are covered under the public system, including expats, although there are some differences for cross-border workers. If you are an EU citizen and have an EHIC card, then you will be able to use this for emergencies, but not as a substitute for either state or private coverage.

How do you apply to join the state health insurance system?

Your employer has to register you within eight days of you starting work. They will then be sent a form from the CCSS on which you will need to note down your family members, and following this you will be sent a social security card (Carte de Sécurité Sociale). This functions as your medical insurance card and you will need to take it with you when you first visit your local GP, and for any hospital or specialist visits.

What is covered by the state health insurance system?

The national health scheme covers:

  • medical treatment
  • dental treatment
  • visual aids (spectacles, contact lenses etc.)
  • treatment performed by healthcare professionals
  • medical biology analyses
  • prostheses
  • medicines
  • medical devices
  • hospital treatments and stays
  • therapeutic and convalescent cures
  • general and occupational rehabilitation
  • transport expenses incurred in connection with healthcare
  • palliative care
  • blood products and plasma derivatives
  • organ transplants
  • psychotherapy for mental disorders
  • chemotherapy
  • radiotherapy
  • haemodialysis
  • procedures provided as part of preventive medicine schemes (children\'s vaccinations, mammograms, etc.)
  • physiotherapy

Emergency hospitalization should be reimbursed from 80-100%..

Prescriptions will be reimbursed but not fully – usually up to 78%.

Are retirees covered by state medical insurance?

If you are applying for residence in Luxembourg as an expat, you will need proof of health insurance before you can be issued with a residency permit, so taking out private cover before you arrive is essential. Consult the Joint Social Security Centre (Centre commun de la sécurité sociale - CCSS) to check if you are eligible to make voluntary contributions as a proposed long-term resident, or if your contributions can be deducted at source from your pension.

Are students covered by state medical insurance?

If you are a student who is the dependent of a resident with state coverage, you will be included in their policy up until you are 27.

If you are an international student and do not have private insurance, you must register with the CCSS. They will manage your contributions.

You must provide proof of adequate health insurance to cover you during your stay.

Will your family be covered by your insurance?

Yes, your family will be covered. This includes:

  • spouses
  • partners
  • children under your legal guardianship under 30 years old
  • parents
  • direct relatives or relatives by marriage to the third degree where they take care of the household of the insured person instead of a spouse

If you cease to be insured; for example, if you become divorced, you can still apply for health insurance by:

  • continuing to pay contributions following a loss of insurance, on the condition that you were insured for at least six continuous months immediately before you were uninsured and you submit the application within three months to the CCSS;
  • otherwise, by taking out optional insurance. Contributions will be paid from the date of your first request, but benefits may only be claimed after a period of three months

Is dental treatment covered by state health insurance?

If your dentist is linked into the Caisse de Maladie, then some of your dental or orthodontic costs will be covered, including dental implants. Dental prosthetics, for example, will be covered up to 80% of the full cost, except for restorative maxillo-facial prostheses.

What are the contribution rates for state health insurance?

The amount you pay will depend on your salary, but in general contributions will be around 5.9% of gross income from both yourself and your employer, who must also pay into the fund on your behalf. There is an annual cap of €6225. The cap cannot exceed 5 times the minimum wage.

If you are self-employed, you will have to pay the whole amount yourself, and it will depend on your income. Some trades — manual workers, for instance — have to pay a slightly higher percentage (9-10%, split between themselves and their employer), but if your income is limited, you will only need to pay 5.2%.

If you are unemployed or a pensioner, then your contributions will be taken from your benefits at source. 1% of all this goes towards the ‘Dépendence,’ which is a separate type of national insurance covering long-term care.

Why buy private health insurance?

National medical insurance covers most of the population but around 75% of Luxembourg’s residents pay for some private cover for the usual reasons such as top-up, additional facilities and speed of care.

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What is covered by private health insurance?

Private health insurance will give you faster access to treatment and better facilities. Depending on the plan selected, it will also cover elective cosmetic surgery and more advanced dental treatment.

Note that there is now an optional scheme — the Guichet — which is affiliated to CNS and which allows you a degree of extra cover via voluntary payments. This means you can be reimbursed for extras not covered by the main national fund, and provides you with cover if you are no longer eligible for state insurance. Guichet contributions are just over €100 a month.

How much does private health insurance cost?

This is going to depend on your budget and the kind of package you want to opt for, but it is also worth checking with your employer to see if they offer private coverage as part of your employment package.

For those seeking international private medical insurance (iPMI) cover for multiple countries including Luxembourg, numerous variables can have an impact on the cost.

The most important variables are:

  • age (the higher the more expensive)
  • area of cover (i.e. in addition to Luxembourg, which other areas is coverage required in? If those other areas include any of the US, the Caribbean, Singapore, China, Hong Kong or Dubai this can significantly increase the overall price)
  • product choice (higher end insurance products are more expensive)

Other variables include:

  • deductibles
  • co-insurance
  • payment frequency
  • gender
  • nationality
  • country of residence

As so many variables have an effect on the cost of international private medical insurance in Luxembourg it becomes very difficult to give accurate estimates without knowing the full details of the coverage required. However, as a very rough guide, using a standard profile of a 40 year old British male with no deductibles, no co-insurance, a middle tier plan/product, all modules included and worldwide coverage excluding the US, a ballpark price of around £4,000/$5,000 might be expected. Were coverage to be expanded to include the US then the premium could increase to almost double that amount.

Which companies offer private health insurance?

The big international companies such as:

  • Aetna
  • Allianz
  • AXA
  • Bupa Global
  • Cigna Global
  • Pacific Prime

all operate in Luxembourg.

You may also want to look more locally, either at a non-profit health insurance agency or a mutual association (mutuelles), as these are linked into the state system via the Ministry of Social Security.

Glossary of health insurance terms

Caisse Nationale de Santé (CNS) / Caisse de Maladie - National health insurance system

Carte de Sécurité Sociale - Social security card

Cause Médico-Chirurgicale Mutualiste - Mutual Medico-Surgical Fund

Centre commun de la sécurité sociale (CCSS) - Body which governs affiliation and the collection of contributions for all branches of social security

mutuelles - mutual association

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