Updated 31.12.2011
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The CAISSE GÉNÉRALE DE PRÉVOYANCE (CGP) is a complementary health care insurance society which was created on February 8, 1880. Recognised by the State, it operates under the Luxembourg Government's control.
Since 1880 the CGP has been of service to its members, always adapting to meet new demands of our changing society. Since January 1st, 2011, the CGP has more than 38.000 affiliated members.
Evolution of the CGP
With its exciting benefits, the CGP can offer you:
- other advantages, besides death benefits:
- its Local Assistance fund, whose task is to grant:
- sickness benefits,
- maternity benefits,
- allowance with ambulance transport costs.
As the CAISSE GÉNÉRALE DE PRÉVOYANCE (CGP) is affiliated to the Fédération Nationale de la Mutualité Luxembourgeoise FNML (Luxembourg National Health Care Benefits Federation), its affiliates are allowed associate membership to the CAISSE MEDICO-CHIRURGICALE MUTUALISTE (CMCM) (Medical and surgical benefits society), which is a complementary fund, offering additional benefits to those provided by the compulsory sickness benefit funds:
- assistance for hospital stays due to sickness or surgical operations, whether in the Grand Duchy of Luxembourg or abroad,
- dental treatment (dentistry and dental prostheses),
- additional hospital and medical costs for patients staying in hospital in a single room (first class) with the special PRESTAPLUS plan,
- CMCM-ASSISTANCE abroad, in case of:
- emergency treatment needed requiring a stay in hospital, or of the death of a CMCM member,
- by covering, along with other services, the repatriation costs of the sick person or the deceased member.
In the case of dispute, the statutory, regulatory texts and agreements published in the «Mémorial», are the only accepted evidence. 
In the case of death, the CGP's purpose is to give all its current members a death indemnity, which ranges between 109,72 € and 2.194,31 € (14,87 € to 297,40 € at index value 100), according to the amount of dues chosen and age at the time of membership.
Death indemnities are adapted to the cost of living index value, as defined by the relevant and current legislation.
The death indemnities are increased in favor of those members who have been affiliated for a long period.
In the case of a fatal accident, full payment of the death indemnity is paid out, without any waiting period.
Membership with the CGP is on a personal affiliation basis, that is: the spouse or legal partner is not automatically affiliated, even though they may possibly benefit from death indemnities coming from the main affiliate. Therefore, a spouse or legal partner not affiliated with the CGP will not benefit from this very attractive CGP’s Assistance fund. So take out a complementary insurance for your spouse or your legal partner!
P l a n a h e a d: Take out a complementary insurance for your spouse or legal partner! They can also benefit not only from the death indemnity, but also the CGP Assistance fund. A membership form is also available at the Caisse Générale de Prévoyance's secretariat.
To be entitled to the benefits from the Assistance fund, members have to be affiliated for at least three years with the CGP. Affiliation to this Assistance fund is compulsory for all current and honorary members. The annual contributions, paid with the society's dues, amount to 5,02 € (0,68 € at index value 100) by member.
To guarantee payment for benefits from the funds, a statutory reserve has been set up which is not allowed be less than half the annual average, calculated on the basis of the yearly benefits of the last five financial years preceding the current year.
Members struck off or resigned are no longer entitled to the benefits.
All request for reimbursement should be sent to the CGP's secretariat at the latest by May 31th, the following year.
Those entitled to sickness benefit are current and honorary members, as well as legitimate, legitimated, natural and adopted children, as long as they are covered by a coinsurance from their father or mother with an official sickness benefit fund.
The fund benefits consist of partial reimbursement of the difference between health charges paid out in advance by the affiliate during a financial year, as a result of the difference between the total costs due and those met by the legal sickness insurance.
The statutory clauses lay down that, subject to paragraphs 3 to 5 of article 36, the reimbursement amounts to 25% of the difference between the total costs due in 2010 and the reimbursement from the sickness benefit fund, with a minimum of 323,93 € (45 € at index value 100) and a maximum of 8.998,00 € (1.250 € at index value 100) per member. The same lower limit is applied when two spouses or partners are simultaneously affiliated in the sense of the law of July 9th, 2004 relative to the legal impact of certain partnerships.
Requests for obtaining sickness benefit for charges not covered during a financial year should be sent to the CGP's secretariat at the latest by May 31, the following year. Reimbursement statements from the legal sickness benefit fund, as well as the receipts from the pharmacy and from other medical expenses need to be attached.
Supporting documents considered, are those healthcare invoices that have already been accepted by the legal sickness benefit funds. Invoices incurred abroad are treated in accordance with Luxembourg tariffs.
Maternity benefit is paid out for each child, per affiliated member or parent. Prior to having the right to claim this benefit, members need to have been affiliated with the CGP for at least three years.
In the case of multiple births, the benefit is paid out for each child. This is also paid in the case of the birth of a natural child, an adopted child under 4 years old or a stillborn child.
Maternity benefit is calculated, in accordance with the index value, as defined by the legislation pertaining to it, and in effect on October 1st, of the year preceding the birth of the child. So the benefit amounts to 215,95 € (30 € at index value 100) for each child born in 2011, per affiliated member or parent. This amounts to 221,35 € for children born in 2012.
Maternity benefit is paid out upon presentation of a birth certificate, respectively a child's death certificate. In the case of adoption, you will need to provide a new birth certificate.
The delay of foreclosure, beyond which affiliates or their entitled are no longer permitted to assert their rights to the statutory benefits, is set at 3 years, counting from the date of the birth, the presentation of the death certificate, or the judgment date of the adoption ruling, of the child in question.
Those entitled to assistance with ambulance transport costs (art. 38 the statutes) are:
a) actual and honorary members;
b) children belonging to the affiliate's household and for which legal statutory family benefits are paid out.
Ambulance transport costs will be met both within the country and abroad, according to the form B6 and codes "Travel and transport benefits" in the Union des Caisses de Maladie (Legal Sickness Benefit Fund Union) statutes and appearing respectively in annexes I and II of the Caisse Générale de Prévoyance statutes.
Subject to the application of the appropriate clauses in points 4 and 5 below, participation in ambulance transport costs amount to the difference between the rates foreseen in sub 2 before and the benefit coming from the legal sickness benefit insurance and, if should be the case, from the Caisse Médico-Chirurgicale Mutualiste (CMCM).
Applying what has just been said, the maximum sum for the benefit is calculated as follows:
- the amount of legal sickness benefit insurance to be reimbursed is worked out from the rates or codes appearing in annex I, “ambulance transport within the country”;
- the amount of the legal sickness benefit insurance and that of the CMCM to be reimbursed are worked out from the rates or codes appearing in annex II, "ambulance transport abroad".
- However, the total amount of benefit cannot exceed the sum of 500 € per beneficiary and per calendar year.
Furthermore, the benefit cannot, in any case, exceed the amount remaining to be paid by the person eligible, after the sickness benefit insurance and/or the CMCM's contribution.
To be entitled to the benefit, the following supporting documents need to be presented:
- request for reimbursement, available for claimants through the CGP's secretariat;
- original invoices from the ambulance transport company for the expenses exceeding the amount met covered by the sickness benefit insurance, respectively, copies or photocopies of the invoices for expenses already paid by the insured;
- the reimbursement statements from the legal sickness benefit insurance.
If during the course of the year, the legal sickness benefit insurance modifies its clauses applicable to ambulance transport, the Caisse Générale de Prévoyance governing board can step in and help you out.
Transport by air and taxi-ambulances are not covered by the Caisse Générale de Prévoyance's emergency insurance fund.
All requests for obtaining benefit for ambulance transport expenses, concerning those expenses not covered during a particular financial year, should be sent to the CGP's secretariat at the latest by May 31, the following year.
... you will need to fill in a membership form, which will be sent to you by the CGP secretariat, who you can contact for any further information: Secretariat: 51 rue de Strasbourg à L-2561 Luxembourg (1st floor, Tel.: 47 45 93, Fax: 40 00 38, info@cgp-mutuelle.lu