Treatment abroad

According to the European regulation, insured individuals have the right to reimbursement of medically necessary healthcare, taking into account the nature of the services and the expected duration of their stay. The reimbursement is carried out according to the legislation of the treatment country, as if the individual were insured under that legislation.

In the event of a medical emergency occurring during a stay in a European Union member country, the European Economic Area, or Switzerland, we recommend presenting your European Health Insurance Card (EHIC) to the hospital or healthcare provider.

The European Health Insurance Card can only be used with contracted providers, meaning providers that are affiliated with their country's social security system. Presenting the European card ensures coverage or reimbursement of medical expenses on-site based on the rates and fees applied to social security beneficiaries in the host country. If you do not have your European Health Insurance Card with you, upon request, the CMFEP can issue a temporary replacement certificate for the treatment period. This form can be submitted, if necessary, to the foreign health fund or the hospital to ensure direct coverage of medical expenses.

In cases where the provider does not accept the EHIC, you must pay for the received care upfront and request reimbursement either from the competent health insurance fund at the place of stay or, upon your return, from the CMFEP. The CMFEP will initiate a billing process with the competent fund of the treatment country and reimburse you the amount communicated by that fund. This process generally takes between 4 to 6 weeks after the submission of bills for reimbursement.

These countries include: Bosnia and Herzegovina, Cape Verde, North Macedonia, Morocco, Montenegro, Serbia, Tunisia, Turkey.

When staying in a contracted country, Luxembourgish insured individuals are required to request a certificate of entitlement to in-kind benefits from the CMFEP before their departure, covering the duration of their stay. This certificate can be requested through our contact formor online via the myguichet.lu portal.

In case of illness or a medical emergency during your stay in a contracted country, you can request direct coverage of medical expenses by the local health insurance fund using your certificate of entitlement. If you have to pay upfront for the received care or if you prefer not to handle matters locally, the CMFEP will initiate a billing process with foreign institutions.

Please provide us with the original, paid invoices, along with your social security number, if applicable.

Upon the insured's explicit request, the CMFEP can also reimburse invoices based on Luxembourgish rates.

It's important to clarify that the certificate of entitlement only covers emergency situations. Any invoice related to non-emergency care or the purchase of supplies will not be covered by the CMFEP.

The European Health Insurance Card is not valid in a country other than a European Union member state, Switzerland, or a country in the European Economic Area, and not bound to the Grand Duchy of Luxembourg by a bilateral agreement in the field of health insurance. The CMFEP does not issue a special certificate to cover the period of your stay in such countries.

Only urgently required medical care that becomes immediately necessary during your stay is covered by health insurance.

Urgent medical care provided in these countries is covered according to Luxembourgish rates and fees. To facilitate billing in accordance with local scales and nomenclatures, we advise you to always request a detailed invoice written in one of the official languages of Luxembourg or in English.

Due to the rates applicable abroad, reimbursements from the CMFEP, calculated based on Luxembourgish rates, may significantly differ from the actual incurred expenses. We recommend obtaining supplementary travel insurance for any stay in a non-contracted country. The CMFEP cannot advance payment for medical care abroad, even if the costs exceed the financial capacity of the insured individual.

Students who are pursuing their studies in a European Union (EU), European Economic Area (EEA), or Swiss member country remain affiliated with Luxembourg as co-insured family members. The reimbursement of necessary medical care is provided through the European Health Insurance Card. This card is also still accepted in the United Kingdom.

We advise students to inquire locally about the registration procedures to follow in order to obtain coverage for medical care by the foreign health fund using the European Health Insurance Card.

Regarding healthcare services not covered by the aforementioned methods, the CMFEP will initiate a billing process with institutions in the country where the student is studying.

Upon explicit request, the student can claim reimbursement for medical care based on the Luxembourgish rate.

Regarding treatments subject to planning, such as inpatient hospital care or care involving specialized and costly equipment, prior authorisation from the CNS (National Health Fund) is required.

In order to undergo these treatments abroad and be eligible for reimbursement, it is necessary to obtain prior authorisation from the CNS. The authorisation request is submitted by your treating physician using a standardized form.

These authorisations (S2) are processed by the CNS's Foreign Transfer Service. You can contact this service via email: tae.cns@secu.lu

Any type of supplement, such as a first-class room, is not covered by the Caisse de Maladie des Fonctionnaires et Employés Publics (CMFEP).

In cases where authorised treatments are performed in a non-contracted hospital, it will not be an agreement (S2) but a directive agreement (2011/24). In this case, the insured person must always pay the full cost of the treatment upfront.

Insured individuals can, upon written request, claim travel expenses and accommodation expenses (hotel), provided that the treatment has been authorised and that the travel and accommodation dates correspond to the authorisation period.

Following the Decker Kohl rulings by the European Court of Justice in April 1998, EU nationals can seek medical treatment and purchase medical products in another Member State and be reimbursed according to the rates of their home country. The ECJ relies on the principle of the free movement of services and goods.

Therefore, an insured person can freely consult a healthcare provider/supplier in an EU Member State, the European Economic Area, or Switzerland and obtain reimbursement for the healthcare/products according to Luxembourgish rates and fees.

Conditions and restrictions:

• reimbursement is limited to outpatient care. Any planned inpatient hospital treatment (with an overnight stay in the hospital) as well as any treatment requiring the use of highly specialized medical equipment is subject to prior approval by the CNS (National Health Fund) upon favorable advice from medical control
  
• reimbursement is strictly limited to services/products listed in national schedules and lists. Acts and services by doctors and dentists, medical supplies, and medications purchased at a pharmacy not covered by national lists and schedules are not eligible for health insurance coverage
• when the statuses, lists, and schedules stipulate that a service/product requires prior approval from medical control, a title of coverage (e.g., physiotherapy, speech therapy, dietetics, etc.), or a quote (e.g., dental prosthesis, orthodontic treatment, orthopedic equipment over €125, etc.), this condition must also be met if the care/products are provided/purchased abroad
• a separate prior medical prescription is required for all services/products that are not provided by the doctors themselves (e.g., medical tests, medications)
• travel and accommodation expenses are not covered by health insurance
• reimbursement is provided upon presentation of original paid invoices and within the limits of the rates and fees specified in the CNS statutes

This information is exclusively intended for diplomatic and consular officers stationed abroad, as well as members of the Public Force deployed overseas.

Reimbursement Procedures:

In accordance with agreements signed between the supervisory ministries and the Caisse de Maladie des Fonctionnaires et Employés Publics (CMFEP), agents posted abroad are entitled to additional reimbursement. This reimbursement is provided by the CMFEP for diplomatic mission agents and by the Ministry for Public Force agents.

The detached agent must attach to any submission of medical invoices from the country of their posting a statement of the incurred expenses. See LINKS DIPLOMATES/PUBLIC FORCE. In this statement, only invoices for services provided in the country of assignment should be listed.

The agent must include with their reimbursement request:

• the statement of services provided
• original, detailed, and duly paid invoices
• a motivated medical prescription for all treatments and products/supplies not provided by doctors themselves
• a title of coverage issued by the National Health Fund for treatments by healthcare professionals other than physicians (e.g., physiotherapists, dietitians, speech therapists, etc.)
• a prior approval from the Medical Control of Social Security for dental prostheses, orthodontic treatments, orthopedic supplies exceeding €125, and any other services requiring prior approval. (LINK)
• a medical control approval for all services subject to prior authorisation (LINK LIST APCM)

If invoices are not in French, German, or English, the agent is requested to either provide a detailed explanation, by invoice, of the services rendered or to include a translation. For long-term and/or expensive inpatient hospital interventions, we kindly ask you to attach a report from the treating physician to allow the medical control to make an analogy with Luxembourgish schedules.

The additional reimbursement is calculated based on the maximum rates set out in the respective agreements. For diplomats, the supplementary reimbursement will be provided along with the regular health insurance reimbursement. It will appear on your reimbursement statement under the "Diplomat" tariff code. For Public Force agents, the supplementary reimbursement will be disbursed by the supervisory ministry and will not appear on the health insurance reimbursement statement.

Furthermore, we would like to inform concerned insured individuals that due to the complexity of foreign invoice pricing and supplementary reimbursement calculations, the reimbursement process may take approximately 3 months.