Health of cross-border workers: comprehensive guide

Cross-border workers work in Luxembourg but live in another country, such as France, Belgium, or Germany. Given their status, they have a special situation when it comes to health coverage.

This guide is designed to answer your questions and help you navigate the administrative procedures and specificities related to your status as a cross-border worker in Luxembourg.

What is a cross-border worker in Luxembourg?

A cross-border worker is someone who works in Luxembourg but lives in another country, such as France, Belgium, or Germany, at least one day a week. This hybrid situation involves specific administrative procedures to ensure adequate health coverage.

Health insurance affiliation: double registration

As a cross-border worker, you are affiliated with the Luxembourg National Health Fund (CNS) through your employer. However, in order to benefit from healthcare coverage in your country of residence, you must also register with the health insurance fund in your country of origin. Here's how it works:

The National Health Fund (CNS) issues a document establishing entitlement, known as the " S1 form." This document is called the " BL1 form " for Belgian cross-border workers.

General framework for cross-border workers

Cross-border workers receive the document at their home address. They must then submit it to the CPAM (French Social Security) office in their place of residence.

If the insured person has not received the document within 15 days of the Luxembourg Joint Social Security Center (CCSS) receiving their declaration of entry, they must order the document themselves.

Please note! However, this process is not automatic if the cross-border worker is employed by a temporary employment agency. They must submit a written request.

Special case of French cross-border workers

Documents relating to the rights of French cross-border workers residing in the departments of Meurthe-et-Moselle and Moselle are sent directly to the primary health insurance funds. This document is called S072. Once registration has been validated, the insured person receives confirmation of registration from the relevant primary health insurance fund (CPAM). No further action is generally required.

Coinsurance for family members: extended coverage

Cross-border workers and their family members are entitled to Luxembourg benefits under the same conditions as Luxembourg residents. To qualify, family members must be dependent on the insured person. The health insurance fund in your country of residence must therefore send a certificate to the CNS confirming that you are responsible for your family.

The legislation of the country of residence determines the status of family members entitled to benefits. If the spouse is employed in the country of residence, family members are generally dependent on the spouse.

Sick leave: what should you do if you are a cross-border worker?

If you are sick and unable to work, here are the steps to follow to claim your right to sick leave in Luxembourg:

1. Inform your employer: As soon as you are aware of your incapacity, you must inform your employer as soon as possible. A medical certificate is required for sick leave of more than 2 working days.
2. See your doctor to obtain a sick leave certificate for absences of more than two days.
3. Send your medical certificate: The medical certificate must be sent to the CNS before the end of the third day of incapacity. Be sure to include your Luxembourg national identification number (13-digit number on your insurance card) on the certificate. The second copy must be provided to your employer within the same time frame.

Find out more about sick leave and sick pay in Luxembourg.

However, depending on your country of residence, it is not always possible to obtain certificates of incapacity for work in the form required by the CNS. This is particularly the case in Belgium, where most certificates of sick leave consist of a single section. It is therefore advisable to ask your doctor for a duplicate to give to your Luxembourg employer.

Penalties for non-compliance with the sick leave procedure

In Luxembourg, penalties are imposed for failure to declare certificates of incapacity for work. If you fail to send your medical certificates to the CNS, it may send you a written reminder. In the event of a repeat offense, a fine of up to €750 may be imposed.

Authorized absences in the event of sick leave for cross-border workers

Permitted outings during sick leave.

No outings are authorized during the first five days of sick leave. This applies regardless of any indication to the contrary on the medical certificate. Only outings to see a doctor, visit the social security office, or attend any other medical appointment are authorized.

From the sixth day onwards, outings are permitted under certain conditions and if the doctor has not noted any other contraindications on the medical certificate. Outings may then take place between 10 a.m. and 12 p.m. and between 2 p.m. and 6 p.m. They must be documented in case of inspection by the National Health Fund.

Checks at the place of residence of the cross-border worker

As with Luxembourg residents, the CNS may carry out an administrative check at the place of residence of the cross-border worker. Checks are carried out between 8 a.m. and 9 p.m., starting on the first day of sick leave.

The patient is therefore required to provide the exact address of where they are staying during their sick leave. If this is not possible, the person must be reachable by phone or email.

In the event of absence, the inspector will leave a note at the place of inspection. The patient must then justify their absence within three working days of the date of the inspection.

Coverage of healthcare costs for cross-border workers

Of course, cross-border workers are entitled to healthcare coverage. The CNS covers the reimbursement of healthcare costs, but there are differences depending on where you receive care.

• Coverage of healthcare in Luxembourg: Costs are covered by the CNS, in accordance with Luxembourg conditions.
• Reimbursement of medical care in your country of residence: Care is covered by the health insurance fund in your country of residence, in accordance with local rates and conditions. You should therefore contact your local health insurance fund.
• Medical care received in another country: If you need care in another EU or EEA country or in Switzerland, the European Health Insurance Card entitles you to reimbursement according to local rates. Outside these areas, social security agreements with Luxembourg may apply.

As a cross-border worker, it is crucial to understand your healthcare rights and to complete the necessary administrative procedures.

By following our advice and staying informed about your obligations, you can benefit from healthcare in Luxembourg. You will also ensure that you have adequate health coverage in your country of residence.

For more information, consult official resources or contact the National Health Fund (Caisse Nationale de Santé) for any specific questions.

More information on healthcare in Luxembourg

For all the information you need about working as an expatriate, see our guide on How to work in Luxembourg as a foreigner, which offers valuable advice and details about the Luxembourg labor market.