Contributions are paid by both employers and employees, and most forms of public assistance (unemployment benefit, old age pensions, certain forms of sickness and maternity benefits) are paid net of withholdings for health insurance, the benefit authority effectively paying the employer contributions.
Foreigners coming to live in Luxembourg without working (e.g. retirees and the ‘idle’ rich) must generally produce proof of health insurance in order to obtain a residence permit. There are special health insurance plans, valid in a number of countries, designed specifically for the needs of expatriates and those who travel frequently. If you qualify for ‘non-resident’ tax status, you may not be required to contribute to national social security, in which case you will probably be covered by your employer’s health care plan. (You should check!)
Employees and the self-employed must contribute to the appropriate health fund (caisse de maladie) according to their profession. Both employer and employee contribute towards health insurance, and it’s the employer’s responsibility to withhold the appropriate amounts from your pay and remit them to the relevant health fund. The normal contribution amounts to 5.44 per cent of gross income, up to a maximum contribution of €6,225, divided equally between employers and employees. Self-employed people must pay the full contribution. Manual workers in certain trades pay a higher rate (9.9 per cent), split evenly between employee and employer, and those on public assistance usually pay a reduced rate of 5.2 per cent (half paid by the benefit authority). Those on unemployment benefit, old age pensions and other kinds of income-replacement benefit have health insurance contributions deducted from their benefit payments.
Cover is for all dependent members of your household, including children up to the age of 27 if they’re full-time students or unemployed, and includes most treatment by GPs and specialists, laboratory tests, prescriptions and hospitalisation.
In Luxembourg, the health care system works on a reimbursement basis whereby you submit receipts for consultations, treatment and medicines to your caisse for reimbursement at the appropriate rate, which varies from 80 to 100 per cent. Your first consultation for a given illness is reimbursed at 80 per cent and subsequent consultations within 28 days at 95 per cent. Prescriptions are normally reimbursed at 78 per cent, although there are four categories of prescription with reimbursement levels ranging from 0 to 100 per cent. Dental treatment and eye care are also included, although some services are subject to pre-approval and you may be required to have regular annual check-ups. The caisse normally reimburses you for emergency medical treatment abroad (provided you haven’t travelled expressly for that purpose) at the same rates as for equivalent services in Luxembourg.
There’s a separate insurance for long-term care, called assurance dépendence, financed through a 1 per cent withholding tax on employees, professional revenues and income-replacement benefit payments. This provides benefits toward the cost of long-term care in nursing homes or other extended care facilities in Luxembourg.
Many people in Luxembourg take out supplementary insurance with one of the non-profit health insurance agencies or mutual associations ( mutuelles) affiliated to the Ministry of Social Security. Many employers offer supplementary cover as a benefit of employment, either at cost to the employee or on a shared fee basis. A mutuelle pays the portion of your medical fees that isn’t covered by your caisse and may offer extended coverage for such things as hospitalisation (i.e. private rooms), eye care (spectacles and contact lenses), dental treatment and medical services outside Luxembourg. The cost of supplementary coverage is normally low, but it applies on a per person basis (i.e. you must pay extra to insure your spouse, children or other dependants). If you have particular needs or circumstances or if you want to use doctors or medical facilities in other countries, it’s possible to purchase private supplementary health insurance through an insurance agent.
This article is an extract from Living and Working in Holland, Belgium & Luxembourg.