Healthcare in Luxembourg: from the CAK's S1 to the CNS, and then 88 percent back
Luxembourg is a treaty country. With a Dutch statutory pension you apply for an S1 form at the CAK, register with it at the Caisse nationale de santé and get the Luxembourg social security card. The system works by reimbursement: you freely choose a doctor, also a specialist without referral, pay yourself and get 88 percent of the tariff back — or the doctor settles directly with the fund.
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In Luxembourg you are insured through one health fund, the Caisse nationale de santé (CNS). Dutch people have to learn the system briefly: you pay the doctor, and the fund pays you.
How you get into the CNS depends on your situation:
- Retired, with a Dutch statutory pension or benefit: with an S1 form from the CAK.
- Employed: through your employer.
- Self-employed: through the Centre commun de la sécurité sociale.
Retired: the S1 route through the CAK
Luxembourg is on the list of treaty countries. If you have a Dutch statutory pension or benefit, you report to the CAK. You get an S1 form, and with that you're entitled to care in Luxembourg at the expense of the Netherlands.
For that you no longer pay a Dutch health premium, but a treaty contribution: the contribution the CAK charges for this care. In most cases it is withheld automatically from your pension. Luxembourg charges you no premium of its own on top. You don't fall under the Luxembourg insurance but under the Dutch, and Luxembourg only provides the care.
Apply for the form well before your departure. The CAK's processing time is at most four weeks. Only cancel your Dutch policy once it's settled. A gap between two systems is the most expensive thing that can happen to you in this journey.
Registering with the CNS
With your S1 you register with the CNS, by post or at the counter. The CNS registers your cover and reports it back to the Netherlands. You get the Luxembourg social security card with your matricule, the number every doctor, pharmacy and the hospital asks for. From that moment your care is reimbursed at the same rates and conditions as for a Luxembourg insured person.
The form in your drawer is no insurance. Only after this registration are you known in the system.
Free choice, and 88 percent back
The Luxembourg system has no gatekeeper. You freely choose a doctor, and you may go straight to a specialist without first passing a GP.
This is how reimbursement works:
- You pay the bill yourself and submit it to the CNS.
- At a doctor, the CNS reimburses 88 percent of the official tariff, and 100 percent for children up to eighteen.
- The remaining 12 percent is your own share, plus anything a doctor charges above the tariff.
Whoever wants to avoid advancing the money looks for a doctor who takes part in paiement immédiat direct (direct payment). Then the CNS pays its share directly to the doctor and you pay only your own share.
For a hospital stay of more than three days and for a fee above a hundred euros the doctor may send the bill straight to the fund anyway. An admission with an overnight stay is reimbursed at 100 percent according to the tariff.
| What | Amount or period |
|---|---|
| reimbursement of a doctor's bill, adults | 88% of the official tariff |
| reimbursement of a doctor's bill, children under 18 | 100% |
| hospital admission with an overnight stay | 100% according to the tariff (not the 66% surcharge for first class) |
| doctor settles directly with the CNS | for a stay longer than 3 days or a fee above € 100 |
| processing time of the S1 application at the CAK | at most 4 weeks |
| CAK route for early retirement closes | expected 1 November 2026 |
What the system is, and what it isn't
Healthcare in Luxembourg is good and close by, with hospitals in the city, Esch and Ettelbruck. Many doctors speak French, German and English; Dutch less so. Count on waiting times for specialists, and on an own share at every visit that you didn't know in the Netherlands.
If you work in Luxembourg: the route through the employer
Whoever takes up employment is affiliated to the CNS through the employer, with the Luxembourg premium, and gets the same card that way. Your Dutch insurance ends on the day your Luxembourg one begins, and the CAK doesn't come into it. Whoever is self-employed affiliates through the Centre commun de la sécurité sociale, the central office of Luxembourg's social security.
The deadline for early retirement
As expected, from 1 November 2026 only new applicants with AOW, Anw, WAO, WIA or Wajong will be admitted to the healthcare route for pensioners. The CAK reports that the European institutions have provisionally agreed to the amendment of Annex XI to Regulation 883/2004 (the European social security rules). Whoever leaves on early retirement without AOW then falls outside it. They are dependent on a private policy or, when working, on the CNS through the employer.
Whoever is already a client keeps their rights. Whoever is on the edge has an interest in being registered before that date.
In Vertrekklaar this is phase 1 of 5 of the journey, step 1.2: the same steps, but for your situation — in your order, tickable, and with the deadlines watched. See the whole journey to Luxembourg or go straight to step 1.2 in the open plan.
What this rests on
The facts in this article come from these official pages. Rules change. When in doubt, go by the source, not this article.
- NederlandWereldwijd — the scheme for living abroad and the treaty countries — nederlandwereldwijd.nl
- NederlandWereldwijd — how do I arrange my health insurance through the CAK — nederlandwereldwijd.nl
- CNS — access to care for whoever is insured in another country — cns.public.lu
- CNS — doctors, free choice, 88 percent reimbursement and direct payment — cns.public.lu
- CAK — emigrating on early retirement, the expected change from 1 November 2026 — hetcak.nl
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