Last Updated on 22/09/2025

Medical overcharge

You are not alone! We are all in the same situation when facing medical overcharging in Luxembourg. It’s not uncommon to receive several bills for one and the same medical service, or a higher invoice. We may also be asked for advance payments.

The staff of the European Institutions and their families benefit from the Joint Sickness Insurance Scheme (JSIS). JSIS stems both from the European Civil Service Staff Regulations and the Protocol on the Privileges and Immunities of the Union European. As such, it has definite assets such as the free choice of doctor throughout the EU. The idea was also to ensure a competitive package for reimbursement. So, what is happening?

The root cause for higher medical invoices is that JSIS is seen as a private health care system. Therefore, JSIS is kept outside the mechanism of mutual compensation of health care costs between (national) public health care systems. Furthermore, national public health care providers feel free to invoice JSIS-affiliates as they please (‘tariffs libre’).

Until the end of 2018, there were 2 agreements to avoid excessive invoicing for JSIS-affiliates. On the one hand the agreement with the Luxembourgish Association of doctors and dentists (outside hospital). Further to a Court judgment regarding discrimination, the Commission terminated this agreement by October 2018, so that doctors and dentists outside hospitals invoice as for national affiliates. This is largely respected by doctors and dentists outside hospitals.

On the other hand, the convention with the Luxembourgish hospitals foresees that EU staff can be invoiced according to given tariffs per category of intervention. This works out to still a comparative overcharging for EU staff, even if the mechanism allows for some foreseeability.

In 2019, the EU General Court ruled in the Wattiau case that the Luxembourg medical overcharging of EU staff was an indirect discrimination based on nationality, as EU Officials and Agents are presumably foreign nationals. Therefore, the convention between the JSIS and the Luxembourg’s hospitals is not functioning in the sense that it does not provide for the safeguards intended for the JSIS affiliates, to the contrary. Luxembourg does not recognize overall discrimination in this regard. Rather, it refers to the way the Luxembourgish hospitals are financed: to a large part out of direct taxes, paid by fiscal residents of Luxembourg, who thus contribute substantially to the financing of the hospital care, EU staff does not contribute in the same way. Furthermore, the hospitals have overall increased their tariffs since. The regular exchanges between the Commission (on behalf of JSIS beneficiaries) and the Luxembourgish State still have not led to any solution. However, the EU-institutions underline that medical costs in Luxembourg must decrease if Luxembourg wants to remain attractive.

Other EU Institutions places of work have their own concerns too. The JSIS surely needs to be modified with new or modified rules to ensure its functioning. Union Syndicale Fédérale (USF), our Federation is very active on that file. USF political line regarding the health services and the medical cost coverage for employees for all EU Institutions and other EU bodies is laid down in its related resolution urging:

  • That the ‘employees’ benefit from the same health services and same health cost level as any other residents/nationals that reside in the same Country/Region.
  • That the ‘employees’ shall benefit from freedom of choice of medical care (currently valid only for JSIS beneficiaries).
  • That the ceilings for medical reimbursements shall be reviewed and adapted according to real medical costs and inflation, so that the defined reimbursement levels can be effectively respected as foreseen.

In the meantime, staff and their families based in Luxembourg are facing the multiple billing and higher prices mentioned above.

Some typical questions we receive:

  • Is it normal to pay the entirety of medical services before applying for a reimbursement?
  • Why some medical services impose an advance payment?
  • What kind of support can I get in case of an advance payment obligation?

Regarding the latter, child deliveries as well as most surgical operations allow for a direct billing to the JSIS. Moreover, for some medical services (i.e., psychological support, specific dental treatment) a prior authorisation is required to get reimbursed from the JSIS.

The devil is in the detail. The reimbursement conditions are different depending on the medical service you receive and the beneficiary. Union Syndicale Fédérale-Luxembourg can help you assess the situation and advise you in full confidentiality. Do not hesitate to contact us.

A ‘Memorandum of Understanding’ was signed in 2024 by the Commission, the Luxembourg State, and the Federation of Luxembourg Hospitals. It is a declaration of intent to achieve short- and medium-term results with a view to regulating costs (with the aim of paying them at cost). This action is the recognition of the Ferlini and Wattiau caselaw. Union Syndicale Fédérale-Luxembourg follows this file and will see if it will effectively solve the hospital costs issue.

Disclaimer:

We always try to provide you with the latest information. However, the fast evolution of the situation does not always allow us to timely update this page content. The references hereunder (leaflets and news) might provide you with additional information. However, if you need to have a quick update don’t hesitate to contact us: REP-PERS-OSP-USF-LUXEMBOURG@ec.europa.eu 

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