The national healthcare scheme in Luxembourg, the Caisse Nationale de Santé (CNS), is free at the point of delivery if you are paying into the system and is of a high standard. Since the quality of public healthcare in the country is so good, many residents choose to rely on this alone, but as an expat, you may prefer to take out private health insurance for additional peace of mind.We will take a look below at how to keep your health insurance costs as low as possible if you do opt for private cover, and how to personalize your cover so that you’re not facing high premiums.
Personalising Your Health Insurance Cover
Luxembourg’s health insurance is based on a two-tier system, which partly funds healthcare; the rest is paid for by the government. All citizens are covered under the public system, including expats, as long as they are making contributions.
Your contributions will be deducted from your salary each month and paid into the Luxembourg Health Offices of the CNS, or the Caisse de Maladie, who provide health insurance along with nine other agencies.
The national health scheme covers a wide range of treatments, including:
• medical treatment
• dental treatment
• visual aids such as spectacles and contact lenses
• treatment performed by healthcare professionals
• transport expenses incurred in connection with health care
• psychotherapy for mental disorders
• procedures provided as part of preventive medicine schemes (children’s vaccinations, mammograms, etc.)
It operates on a reimbursement principle, so you will need to pay some costs out-of-pocket and then claim a percentage of them back. You may therefore prefer to take out private health insurance to cover any cost gap.
Depending on how much healthcare you think you may need, you will need to do the maths to work out whether occasional or regular out-of-pocket payments are likely to be cheaper than taking out full private coverage.
Check the small print of any private policy to see whether it covers treatments that you may want to access, such as osteopathy or more advanced dental care, for example, crowns or dental implants.
Remember to check, however, if your potential policy covers pre-existing conditions: the definition of this varies between insurers. Usually the term applies to any conditions which present symptoms, or for which you’ve been treated in the last five years. This normally includes any conditions you were diagnosed with over five years ago, but some insurers have different time limits for diagnosis.
You may also want to check out whether your policy has a ‘hospitalisation’ clause covering you for occasional hospital visits. You will need to discuss this directly with your insurer.
Take a good look at any potential policy for any cover relating to healthcare which does not apply to you: some policies have provision for maternity care, for instance, and if you are not intending to become pregnant (or prefer to rely on the cover provided by the local public maternity system), then you may wish to reduce your policy costs by having such options removed.
You may also be able to reduce the cost of your premium through ‘cost sharing’: this means that you and your insurer will share the costs of any treatment. You will pay up to an agreed limit, and your provider will cover the rest. Different insurers will have different ways of arranging cost sharing, such as the below.
Co-pay: where you pay a fixed sum for your treatment and your insurer covers the rest. For instance, if the total cost of your treatment is €85, and your co-pay amount is set at €40, then you will pay €40 and your insurer will pay €45.
Co-insurance: where you pay a fixed percentage of the total cost and your insurer covers the rest. For instance, if your co-insurance is set at 20%, you will pay 20% of €85 and your insurer will cover the remaining 80%.
Deductibles: where you pay the entire amount allowed for all services provided until the deductible is met. For instance, if your policy has a €1,000 annual deductible, you would pay €85 for each visit to your GP. However, you would then have to pay the entire amount for 11 such visits (€1000/€85 = 11.8) before your insurance began to pay out to the doctor directly.
You may also need to take a look at whether there is an out-of-pocket maximum that you would be expected to pay after your deductible has been met. Let’s say that your plan above, with a €1000 deductible, also has a co-insurance option of 20% and an out-of-pocket maximum of €1500. You will thus pay €85 for 11 visits to the doctor under your deductible until it is met. You will then pay €17 for each visit as your 20% coinsurance, until you reach the co-insurance ceiling of €500 (€1,500 minus the deductible of €1,000), or about 29 more visits (€500€17 = 29.4). At that point (40 total visits in a year), you would pay nothing more for the remainder of the plan year.
It’s worth doing the maths, especially if you don’t think that you’ll need to make more than a couple of visits to your GP in any one policy period. For example, if you just want dental check-ups with an occasional filling, it might be worth working out whether one or two out-of-pocket costs might be cheaper than full dental cover.
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.
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