Health insurance top-up in Luxembourg: the guide to choosing well
Skimming?
We've prepared the shortcut for you.
What the CNS reimburses and what it doesn't
The CNS is the mandatory foundation of your healthcare coverage in Luxembourg. You're automatically enrolled as soon as you start working here, through the Centre commun de la sécurité sociale (CCSS). Your employer has 8 days to register you.
How CNS reimbursement works
The CNS reimburses based on agreed tariffs. For a GP consultation, the CNS tariff is around €59.50 and the CNS reimburses 88%, roughly €52.36. You pay the difference yourself - that's the co-payment.
Since 2024, the paiement immédiat direct (PID) simplifies things: if your doctor uses PID, the CNS share is paid directly to the practitioner. You only pay your personal contribution at the surgery. No more advancing the full amount and waiting for reimbursement.
For children under 18, coverage is 100% with no personal contribution.
Where out-of-pocket costs really hurt
On paper, CNS coverage looks decent. In practice, certain expenses leave real bills:
Glasses: the CNS reimburses lenses up to €49 and frames up to €30. A pair of prescription glasses often costs between €300 and €600. The rest is on you.
Dental: routine care is reimbursed at 88% of the agreed tariff. But dental prostheses, implants and orthodontic treatment are poorly covered. A dental implant can cost between €1,500 and €2,500 and the CNS barely contributes.
Private hospital room: the CNS covers hospitalisation in a shared room. If you want a private room ("first class"), the surcharge is yours. For a maternity stay, that can mean €1,500 to €2,000 in extra costs.
Alternative medicine: osteopathy, acupuncture, homeopathy are generally not covered by the CNS.
Psychology: sessions with a psychologist are not reimbursed by the CNS, except in specific cases.
The CNS complementary reimbursement: a little-known safety net
Few people know this, but the CNS offers a complementary reimbursement mechanism (article 154bis of its statutes). If your cumulated personal contributions exceed 2.5% of your annual insurable income in a calendar year, you can request reimbursement of the difference.
In concrete terms, if you earn €4,000 gross per month, your threshold is €1,200 per year. If your out-of-pocket costs reach €1,500 in the year, you can recover €300. The application is made online via MyGuichet.lu (ouvre dans un nouvel onglet). It's not a replacement for supplementary insurance, but it's worth knowing about.
Why take out supplementary health insurance
What a top-up plan actually covers
A supplementary health insurance picks up where the CNS stops. Depending on the plan, it can cover:
The 12% co-payment on consultations, all or part of private room hospitalisation costs, fee overruns, dental prostheses and implants (usually with an annual cap), glasses and contact lenses (some insurers reimburse up to €500 every two years), alternative medicine (osteopathy, chiropractic, acupuncture), refractive surgery (laser eye treatment), and even an international second medical opinion service.
The level of coverage depends on the plan: some are limited to hospitalisation, others also cover outpatient care and dental.
The tax advantage: your premiums are deductible
The premiums you pay for your supplementary health insurance are deductible from your taxable income under article 111 of the income tax law (L.I.R.). In practice, this reduces your tax base. The exact saving depends on your tax bracket and the other deductions you're already using in that category.
This is an often underestimated argument: your top-up plan doesn't really cost the advertised price once the tax effect is factored in.
PID changes the game
Before PID, you advanced 100% of costs at the doctor, sent the invoice to the CNS, then the statement to your insurer. Two administrative round trips.
Since 2024, with the paiement immédiat direct, you only pay your personal contribution at the doctor. To get that contribution reimbursed by your insurer, you send them the PID receipt. Some insurers offer a mobile app to submit supporting documents in just a few taps.
How to choose your supplementary health insurance
The criteria that actually matter
Hospitalisation: this is the heaviest financial item. Check whether the plan covers a private room, chief physician fees, and companion costs.
Dental: look at annual caps for prostheses and implants. This is often where plans differ the most.
Glasses: compare allowances for glasses and contact lenses. Some insurers also cover laser eye surgery.
Alternative medicine: if you regularly see an osteopath or acupuncturist, check it's included in your plan.
Waiting period: certain benefits are only activated after 3 to 6 months of membership. If you have a care project (pregnancy, glasses, operation), plan ahead.
Medical questionnaire: most private insurers require a health questionnaire when you join. Depending on your history, certain conditions may be excluded or surcharged.
Ageing provision: some contracts include a provision that stabilises your premium over time. Without it, your premium rises with age, sometimes sharply after 50.
Private insurer or complementary fund: what's the difference?
In Luxembourg, two types of organisations offer supplementary health insurance:
Private insurers (DKV, Foyer, AXA, Baloise) operate on a classic insurance model. Premiums are calculated based on your age and health profile. Benefits are generally broader and more customisable. You fill in a medical questionnaire when joining.
Complementary funds like the CMCM operate on a solidarity model: no medical questionnaire, single family contribution, no selection at entry. In return, reimbursement caps are often lower and benefits less flexible.
The right choice depends on your situation: if you're young and healthy with specific needs (dental, premium optical), a private insurer will often be more suitable. If you're looking for basic accessible coverage without formalities, a complementary fund may do the job.
Special case: cross-border workers
If you're a cross-border worker enrolled with the CNS, you can take out supplementary health insurance in Luxembourg that covers your care on both sides of the border. Be careful: a standard health top-up from your country of residence (for example a French complémentaire) generally doesn't cover the Luxembourg CNS system. You need a contract specifically designed for people enrolled with the CNS.
Frequently asked questions
The CNS covers routine care well (consultations, medication, hospitalisation in a shared room). But for dental, optical, alternative medicine or a private hospital room, out-of-pocket costs can be significant. Most residents and cross-border workers top up the CNS with supplementary insurance.
No. In Luxembourg, unlike France, employers have no legal obligation to offer supplementary health insurance to their employees. It's up to you to take one out if you wish.
Prices vary widely depending on the insurer, the plan and your age. Expect between €30 per month for basic hospitalisation cover and over €200 per month for a comprehensive plan including dental, optical and alternative medicine. For cross-border workers, prices are generally slightly higher.
No, there is no legal obligation in Luxembourg. However, some employers offer group contracts at advantageous rates. Check with your HR department.
With private insurers, there may be age limits for new subscriptions and premiums increase with age. Certain complementary funds accept members with no age limit and no medical questionnaire.