With salaried employment rising steadily (+1.1% in the first quarter of 2024 compared with the first quarter of 2023), Luxembourg is seeing a steady increase in the number of new members of its social security system, both residents and cross-border commuters. The CNS counted 954,000 insured persons at the end of December 2023.
But how many CNS employees are there to manage the reimbursements of all these employees, and how long does it take to be reimbursed? Paperjam asked the health ministry about these issues, as well as about Immediate Direct Payment (paiement immédiat direct, or PID), which is intended to remove some of the reimbursements, since patients no longer have to pay in advance when their doctor signs up for it.
5 to 6 weeks of delay for the majority
As of 16 August, 392 doctors, including 95 dentists, were using the PID, compared with 283 on 30 June. As a reminder, in 2022, Luxembourg had 2,762 registered doctors. So there are still many doctors to convince.
With regard to reimbursement times, the health ministry claims that 15-20% of all invoices received by the CNS are reimbursed within a week. “These are invoices that can be scanned without manual intervention or checking, read by optical recognition and settled automatically by the system.” “Simple” paid invoices (like the C1 from a doctor).
No agents dedicated solely to reimbursements
For invoices that require manual intervention or checking, there are two scenarios: around 75% of these invoices can be reimbursed “fairly quickly, because the check or intervention by the administrator is not too complex: the time taken is then five to six weeks,” says the health ministry.
For the remaining 25%, the ministry concedes a “longer lead time of around 12 weeks, because more complex manual entries and additional checks have to be carried out.” These are applications from abroad, for example. It should be noted that there are no agents assigned solely to the task of refunds. “Employees in the departments that manage refunds also work on activities that are directly or indirectly linked to refunds: preparation, checking, answering policyholders’ questions, administrative tasks, etc. In addition, agency staff take on the task of processing refunds. Agency staff also carry out tasks in the reimbursement department.” the ministry replied.
4,953,671 invoices reimbursed in 2023
In any case, the CNS’s benefits-in-kind department has around 94 FTEs (full-time equivalents) working on the national and international reimbursement process. The agency service (part of the customer relations department) employs around 49.6 FTEs as counter staff, and work related to reimbursements accounts for around 90% of their activity. This means that 143.6 FTEs work on the reimbursement process.
So, 143.6 FTEs for 954,000 policyholders, meaning one CNS agent for approximately 6,640 policyholders. In its 2023 annual report, the CNS states that of the total of 4,953,671 invoices reimbursed, 3,475,107 were scanned and 375,294 were entered manually by the agency and paid by bank transfer. In the 14 CNS branches, an average of 6,500 appointments are made each week.
Use of temporary staff
In a parliamentary reply (no. 1059) in August, labour minister (CSV) and health and social security minister (CSV) referred to the recruitment of Adem jobseekers (14 in 2024) and the use of temporary employment agencies (12 people). A total of 26 people were recruited through these channels in 2024.
The ministers explain that some employees “had to be reassigned internally” to ensure progress, in particular with the implementation of the IDP. “The CNS has needed additional staff to make up for delays in the benefits-in-kind and insured relations departments. As a result, in 2024, the CNS temporarily recruited 26 additional FTEs (temporary staff, employment support contracts (CAE), fixed-term contracts) for these two departments,” the ministry told Paperjam.
This article was originally published in .