Refunding

Procedure

The insured person who has made the advance payment must send the original invoice together with a valid proof of payment to the CMFEP within two (2) years from the date of payment. After this period, the invoices are outdated and can no longer be reimbursed by the health insurance.

The reimbursement is made by bank transfer to the beneficiary's account.

When making your first request for reimbursement, please remember to provide us your bank details in IBAN format and attach a bank identity statement from your bank (relevé d’identité bancaire - RIB). The statement can be printed from your webbanking application once the operation is completed.

Note that you can also update your bank details via the MyGuichet platform or you can use the link “Bank account change”.

You only need to send us your bank details once, so there is no need to repeat them every time you send us your invoices. These data remain valid until you instruct us otherwise. However, a restriction of such changes promotes the efficient and transparent flow of payments.

Attention: Every change / closure of a bank account should be provided expeditiously.

Where do I send my claim for reimbursement?

Caisse de maladie des fonctionnaires et employés publics

32, av. Marie-Thérèse
L-2132 Luxembourg

If you are sending your claim from Luxembourg, you do not need to put a stamp on the envelope, as the postage is paid by the health insurance fund. It is not yet possible to send us your claims electronically.

What documents should be included with your claim?

• the original invoice (if the original invoice is lost/damaged, ask your doctor for a certified copy). Please note that copies, scanned documents or PDFs are not accepted for reimbursement
• a valid proof of payment; when the invoice has been paid in cash, the mention "for receipt" with the date of payment and the doctor's signature are considered as proof of payment
• in the case of payment by bank transfer or webbanking, you need to attach a copy of the debit advice which can be downloaded after the payment has been made. The reference on the debit advice and the amount must correspond to those on the invoice
• the doctor's prescription if required, for example, for all care and supplies (except for certain types of visual aids) that are not provided by the doctor himself
• when the medical services are subject to prior agreement, this document is to be attached to the refund request (e.g. an authorisation from the health insurance fund, a certificate of reimbursment from the CNS for physiotherapy, dietetics or speech therapy, or a duly completed estimate for dental prostheses from our medical correspondant)

Who is entitled to reimbursement?

Normally the reimbursement of medical care for the insured person and his family members is made in favour of the principal insured person. In the event of separation and/or divorce, reimbursements for children will be allocated to the parent who has custody of them. If the bills were paid by a person other than the main insured (parent without custody rights), the "other beneficiary" form must be completed in order to obtain reimbursement to the bank account of the person who advanced the costs. In this case it is important to specify that the proof of payment must clearly mention the name of the principal (in case of bank transfer) or the person advancing the fees (cash payment).

Some practical tips:

• keep photocopies of the invoices: If you are insured with a supplementary fund, do not forget to make copies before sending the originals to the CMFEP
• make sure that each document shows the name and the exact and legible social security number (13-digit identification number) of the person who claimed the treatment
• as all claims for reimbursement are currently scanned, please follow the instructions below to ensure that your submissions are processed quickly and efficiently

Avoid:    

• attaching documents with staples or tape
• attaching a cover sheet or cover letter (Please find enclosed...)
• attaching Post-it notes to the documents
• enclosing VISA/Bancomat tickets
• marking manual entries on invoices with pens or highlighters
• sending us certificates of incapacity for work
  
• sending us medical certificates for leave for family reasons  

Adhere to the following order:        

1. Invoice no. 1 + debit advice No. 1 + prescription if needed
   
2. Invoice No. 2 + debit advice No. 2 + prescription if needed
   
3. Invoice No. 3 + debit advice No. 3 + prescription if needed (etc.)

What deadlines do I have to expect for the refund?

Luxembourg invoices are refunded within 2 to 3 weeks. If Luxembourg and foreign invoices are submitted at the same time, the refund may be delayed. As a rule, the processing time for national invoices is shorter, which means that you will only be reimbursed for foreign invoices at a later date.

The reimbursement statement

All CMFEP reimbursements are documented in the reimbursement statement, which is sent to you by post each time the CMFEP makes a payment.

Insured persons who are registered on the myguichet.lu portal can receive their reimbursement statement in digital form. All you need to do is tick the "edelivery" tab, which you will find under "My data / Health-Social / Health insurance / Inbox eDelivery".

You can read how to interpret the notice here (only in french).

Keep these reimbursement statements carefully! They serve as proof of payment for the supplementary insurances and, if applicable, for the tax administration. The CMFEP can issue a duplicate of the original if specifically requested.

An insured person who has paid the costs upfont may request direct reimbursement by Multiline provided that the amount to be reimbursed exceeds EUR 100 and that the invoices have been paid within 15 days of the date on which the request is submitted.

Foreign invoices can not be submitted for direct reimboursment.

For direct reimbursement by Multiline, the insured person must present the original, paid invoices at the CMFEP counter. The reimbursement of the part covered by the health insurance is made by instant bank transfer to the beneficiary's account.

If the insured person is unable to come to the counter in person, she/he may authorise a third party to make the necessary arrangements with the CMFEP. The insured person must issue a written power of attorney in favour of the person authorised to present the bills for reimbursement. The insured person must enclose a copy of his or her identity card and a copy of the identity card of the person authorised to present the invoices.

The social third-party payment request allows people on low incomes not to have to pay the costs for medical care in advance and then claim reimbursement from the health insurance fund.

The persons concerned must apply to their communal administration, which is the only authority competent to judge whether the granting of social third-party payment is actually appropriate. If it is, the municipality issues a certificate to the person concerned (limited to three months) together with a book of labels to be affixed by the provider to the invoices concerned.

Invoices marked with the yellow label are to be submitted to the CNS - TPS Department - for direct reimbursement to the care provider.

The personal contribution and the non-objectionable services (personal convenience CP1 - CP7) are to be paid by the patient.

An insured person who, due to financial difficulties, is temporarily unable to pay the bills may apply for exceptional assistance.

Exceptional assistance allows the CMFEP to pay bills directly to the care provider without the insured having to advance the costs.

The written request must meet the following criteria:

• it concerns a bill issued by a doctor or supplier approved by the CNS
• it concerns a specific bill exceeding the amount of EUR 250, the payment of which represents an insurmountable burden for the person in the circumstances. The invoice must relate to a service for which the date of issue of the invoice does not precede the date of the application by more than three months.
• it relates to a bill which cannot be covered by the third-party payment system
• it concerns a bill for which all the conditions for reimbursement are met

In order to assess the merits of the claim, the insured person must attach a statement setting out his or her precarious economic situation and any documents he or she considers useful to the claim.

The patient is responsible for any excess charges and costs invoiced for personal reasons (convenance personnelle).

Persons whose cumulative annual contribution exceeds a threshold of 2.5% of the annual contributory income of the year preceeding the application, may benefit from an additional reimbursement by the CMFEP.

Example:

With an annual income in 2020 of 40,000 euros, the minimum threshold of 2.5% is reached when the annual contribution for 2021 exceeds an amount of 1,000 euros. The amount of the cumulative annual contribution is shown on the back of the reimbursement details.

The following benefits and supplies are taken into account for the calculation of the cumulative contribution:

• medical treatments
• dental treatments
• services provided by nurses
• services provided by dieticians
• services provided by physiotherapist
• speech and language therapy
• midwifery care
• psychomotor therapy treatments
• thermal cures
• cost for orthopaedic prostheses, ortheses
• pharmaceutical products
• medical equipment and devices covered by the health insurance scheme
• services provided by psychotherapists

For information: dental prostheses (implants, crowns, etc.), visual aids, benefits and medicines not reimbursed by health insurance are not considered for the calculation of the cumulative contribution.

When the threshold is reached the persons concerned can apply for complementary reimbursement from the 1st of May of the following year using this form.

Any insured person who has a complaint about a refund, a refusal to pay, processing times or file management, can communicate it to us by telephone or email.

As far as possible and in compliance with the applicable laws and regulations, we will do our best to answer your questions and resolve the problem in a professional manner. Often a phone call will help to clarify a conflicting situation and find a solution that suits both parties.

Any person who considers herself/himself to be aggrieved by a decision of the CMFEP may request the notification of a appealable decision taken by the President of the Council of administration (or his delegate). The insured person has a period of forty (40) days to contest this decision by means of a written objection to be sent by registered letter to the following address:

CMFEP

Conseil d’administration

L-2091 Luxembourg