The cost of health procedures in Luxembourg to you as an expat depend on whether you are covered by the country’s national health insurance scheme, the Caisse Nationale de Santé (CNS).You will be entitled to healthcare under the CNS if you are registered into the scheme and are making regular, mandatory national insurance contributions, which will be deducted directly from your salary. Some people choose to take out private health insurance to cover added extras.
State health insurance costs in Luxembourg
Luxembourg has the highest level of health spending per capita in Europe. Around 84% of healthcare is funded by social security contributions and the rest by patients themselves. The CNS is a reimbursement scheme, so patients must pay some upfront costs and then claim a percentage back.
In 2015, 95.2% of Luxembourg’s population were covered by the national scheme, but over half of the population had complementary Voluntary Health Insurance (VHI). Almost half of Luxembourg’s workforce are cross-border employees, so one third of everyone insured with the CNS actually lives outside the country. If this applies to you as a cross-border worker, you should check your public insurance coverage both in Luxembourg and in the country you actually live in.
In 2014, around 16% of patients insured with the CNS preferred to access healthcare abroad, a higher percentage than anywhere else in the EU. These people, according to the WHO, fall into two categories:
(1) Non-resident cross-border workers from the French-Belgian-German border region. As employees in Luxembourg, this group is automatically insured with the CNS but access care in their country of residence.
(2) Luxembourg residents accessing specialised health services that are unavailable in Luxembourg’s public hospitals (e.g. paediatric cancer care and organ transplant). They are treated in neighbouring countries and the WHO reports that CNS is “very generous” in pre-authorising medical care outside Luxembourg itself.
What is covered by the state health insurance system?
The national health scheme covers:
• medical treatment
• dental treatment
• visual aids
• treatment performed by healthcare professionals
• medical biology analyses
• medical devices
• hospital treatments and stays
• therapeutic and convalescent cures
• general and occupational rehabilitation
• transport expenses incurred in connection with health care
• palliative care
• blood products and plasma derivatives
• organ transplants
• psychotherapy for mental disorders
• procedures provided as part of preventive medicine schemes (children’s vaccinations, mammograms, etc.)
How much does treatment cost in the public system?
The CNS, as above, operates on a reimbursement system: 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.
If you visit your GP, you will need to pay some upfront costs yourself: this is in the region of 10-20% of the total cost. If you’re in a vulnerable group, are a student, unemployed or a child under the age of 27, your treatment will be free. Most GPs are self-employed and your doctor will set their own scale of fees.
Hospital stays will cost you around €19-22 per night, and around €10 for a day visit. You must have a referral from your doctor unless you’re admitted in an emergency (cas d’urgence or spoedgeval), in which case you’ll be treated for free even if you don’t have insurance. However, be aware that costs may kick in as soon as your case is no longer deemed to be critical.
If you think you might need long term inpatient care, then it’s advisable to look into a separate form of insurance called assurance dépendence.
If your dentist is linked into the CNS, then some of your dental or orthodontic costs will be covered, including dental implants, but the amount that the CNS will reimburse for both dental treatment and eye care will be capped and you may also need to get pre-approval for some treatments.
Prescriptions will be reimbursed but not fully – usually around 78%. If your medication is deemed non-essential, you’ll have to pay a higher percentage of the cost – around 60% – yourself.
How much does treatment cost in the private sector?
The cost of your treatment in the private sector will depend on whether you have private health insurance or are making out-of-pocket payments.
Although all of Luxembourg’s hospitals are publically owned, there are a number of private healthcare clinics and GPs, mainly for elective cosmetic surgery. Most people rely on the CNS, since treatment is of a high quality, but some expats may choose to take out private cover in order to close any gaps between the cost of treatment and the reimbursement provides by the state, or to access diagnosis and treatment more quickly.
In addition, although hospitals are public, they may offer some private services for which you will have to pay extra. Examples include phone calls, TV access or additional food. If you want a private room, you’ll need to have private health insurance.
Doctors at the Centre Hospitalier du Luxembourg (CHL) and two other inpatient facilities are salaried by the hospitals themselves, but CNS still pays the hospitals a fee-for-service for the medical services they provide, so these institutions come under the aegis of the public healthcare system.
Luxembourg has been cracking down recently on unlicensed practitioners carrying out cosmetic procedures in the private sector, such as fillers, and is increasingly attempting to regulate cosmetic surgery.
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