The health sector in Belgium and the Grand Duchy of Luxembourg is renowned for its quality and accessibility. However, national approaches vary in terms of organisation, funding and access to care. This analysis also highlights the specific challenges for cross-border workers, many of whom live in Belgium but are covered under the Luxembourg health system.
Structure of the health system: public and private
Belgium: A mixed system with public sector predominance
The Belgian system combines public and private services. Managed by mutual insurance companies (mutuelles), social security reimburses a large proportion of medical fees. Nevertheless, part of the cost remains payable by the patient, often covered by supplementary insurance.
Luxembourg: Universal and solidarity-based public health system
Luxembourg offers universal health cover through the National Health Fund (CNS), which reimburses the majority of medical expenses. Cross-border workers benefit from the same rights as residents, but some treatments may still need to be paid in part by the patient.
Funding and cover for treatment
Belgium: Social security contributions and the role of the mutuelles
The Belgian system is funded by social security contributions. The mutuelles cover a large part of treatments, but some services require supplementary insurance.
Luxembourg: Social contributions and extended cover provided by the CNS
The Luxembourg system is based on social security contributions and the CNS mainly reimburses standard healthcare costs. However, non-reimbursable costs may arise, particularly for cross-border workers, who often have to take out supplementary insurance.
Why take out supplementary health insurance in Luxembourg?
Despite the CNS reimbursing at a high level, some areas are either not covered or only partially reimbursable. They include:
- major dental treatment (implants, complex prostheses, etc.),
- glasses, contact lenses or laser surgery,
- additional fees charged by doctors who do not have a contract with the CNS,
- procedures performed outside the territory or not covered by the nomenclature,
- hospital comfort services (private room, etc.).
These fees can accumulate quickly, particularly for cross-border workers who sometimes get treatment in both countries with different reimbursement scales. Supplementary insurance allows you to:
- secure reimbursement in Belgium and Luxembourg,
- access better care without a budget constraint,
- and avoid unpleasant surprises during hospitalisation or specialised treatment.
Reimbursement of treatment costs for Belgian cross-border workers affiliated with the CNS
Cross-border workers residing in Belgium but affiliated with Luxembourg’s CNS are entitled to reimbursement for treatment received in Belgium, under certain conditions.
Steps to follow:
- Obtain the statement of the Belgian mutuelle for all treatments that the INAMI (National Institute for Health and Disability Insurance) can reimburse: medical consultations, dental care, physiotherapy, speech therapy, etc.
- Provide a BVAC certificate for the medication prescribed.
- Send these documents to the CNS for reimbursement based on Luxembourg’s rates.
- For eye care (glasses or contact lenses), send the statement from the Belgian mutuelle or the CNS if it was involved.
Note that the reimbursement is often lower than the Belgian rate, which means the patient is responsible for paying the difference (so-called ticket modérateur).
Cross-border workers benefit from services in Luxembourg
Belgian cross-border workers in Luxembourg who have received medical treatment in Luxembourg must take certain steps to have their expenses reimbursed by the National Health Fund (CNS). In principle, the CNS pays for the care provided, but if payment is not directly made, a request for reimbursement must be submitted.
Steps to follow:
Covering healthcare costs
When cross-border workers consult a healthcare professional in Luxembourg, the CNS generally covers the care provided. If payment is not directly made, the cross-border worker must submit a request for reimbursement.
Documents to send the CNS
- Reimbursement request form (available on the CNS website).
- An invoice with a breakdown of the medical care provided (including a description of the treatments, amount and date).
- Proof of payment (receipt or other document confirming payment).
- Copy of the cross-border worker's social security card.
Submit your request
Send the documents to the CNS either by post or by email if possible.
Verification and reimbursement
The CNS processes the request, generally within 4 to 6 weeks, then sends out a notification containing the reimbursed amount. The reimbursement goes straight to your bank account.
Appeal in the event of refusal
In the event of a problem (refusal or questions), cross-border workers can contact the CNS or submit a complaint.
Involvement of supplementary insurance such as DKV Luxembourg
To cover these remaining costs, you are advised to take out supplementary insurance in Luxembourg, such as DKV Luxembourg. Depending on the nature of the treatment, the documents to provide are different:
- INAMI reimbursable treatment: send the statement of the Belgian mutuelle to DKV for reimbursement of the patient-paid contribution (often 100%).
- Prescribed medication: attach the BVAC certificate.
- Treatment not reimbursed by the INAMI (psychologist, alternative medicine, etc.): send the original invoice straight to DKV.
- Glasses/eye care: provide the statement of the CNS or the mutuelle, DKV will reimburse depending on the policy ceilings.
Note that you should not send the CNS “complément” statement to DKV: it is not reimbursable.
| Type of treatment or expense | Document to provide | Send to | Observations |
| INAMI reimbursable treatments (doctor, dentist, physio) | Statement of the Belgian mutuelle | CNS + DKV Luxembourg | CNS reimburses based on the LU rate, DKV covers the patient’s contribution. |
| Prescribed medication (pharmacy) | BVAC certificate | CNS + DKV Luxembourg | For supplementary reimbursement. |
| INAMI non-reimbursed treatments (psychologist, alternative medicine) | Original invoice | DKV Luxembourg | In accordance with the policy guarantees. |
| Glasses/eye care | Statement of the CNS or the mutuelle | DKV Luxembourg | Reimbursement in accordance with the EASY HEALTH ceilings. |
| CNS “complément” statement | — | Do not send to DKV | This document cannot be reimbursed. |
Conclusion
The Belgian and Luxembourg healthcare systems offer high-quality services, but they work in very different ways. The Belgian system is based on a number of stakeholders (mutuelles, private insurance companies), while Luxembourg favours a centralised system with a high level of solidarity.
However, even in Luxembourg, supplementary cover such as EASY HEALTH from DKV Luxembourg is useful, if not necessary, to cover all medical needs, particularly in the case of specialist treatment, comfort options or consultations outside the country. For cross-border workers, this supplement is even more crucial as they navigate between two systems with different reimbursement mechanisms.
EASY HEALTH de DKV Luxembourg
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