C M C M ’ S S E R V I C E S A N D B E N E F I T S

CONTENTSRÉGIME COMMUN 6

1. BENEFITS IN LUXEMBOURG 62. DENTAL CARE BENEFITS 93. HOSPITAL STAY ABROAD 134. CMCM-ASSISTANCE 16

PRESTAPLUS 22

DENTA & OPTIPLUS 24

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1. BENEFITS IN LUXEMBOURG

OUTPATIENT SURGERY

The CMCM reimburses the non-covered costs for a surgical procedure up to the amount of the personal contribution as stipulated in Section 35 of the Statutes of the National Health Fund (CNS).

HOSPITALISATION EXPENSES

The CMCM provides a daily flat rate amount of €2.70 at index number 100, for a period of 30 days per calendar year.

In the event of the following, the CMCM will pay a flat rate of 100% of the amount of the difference between the costs for accommodation in a first class hospital room with en-suite bathroom and the reimbursement by the health insurance provider of the costs of accommodation in a 2nd class shared room with two beds for:

a) serious surgery, for the duration of the hospitalisation authorised by the health insurance provider;

b) serious medical treatment, for the duration of hospi-talisation specified in Appendix 1 (c) of the CMCM Benefits Table;

c) surgery for members who receive the special allowance for persons with severe disabilities and who do not receive the benefits provided under the Luxembourg Law of 19 June 1998, for the duration of hospitalisation approved by the health insurance provider;

d) a hospital stay without surgery or serious medical treat-ment for members who receive the special allowance for persons with severe disabilities and who do not receive the benefits of the long-term care insurance provided under the Luxembourg Law of 19 June 1998, up to a maximum of 30 days per calendar year.

In the event of surgery or a serious medical treatment, the CMCM pays a daily flat rate of €1.35 at index number 100 as charged by the hospital for persons hospitalised for observation or admitted to a day clinic. The same flat rate is applied during a maximum of 5 days per calendar year in the event of a hospitalisation for observation or admission to a day clinic without surgery or a serious medical treatment.

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MEDICAL COSTS

In the event of surgery, the CMCM reimburses the non-covered costs of the medical and dental costs according to the rates applied to patients in 2nd class.

In the case of hospitalisation, the CMCM reimburses the non-covered costs of the medical and dental costs according to the rates applied to patients in 1st class:

a) in the event of serious surgery or serious medical treatment;

b) in the event of surgery for members who receive the special allowance for persons with severe disabilities and who do not receive the benefits of the long-term care insurance provided under the Luxembourg Law of 19 June 1998;

c) in the event of hospitalisation without surgery or serious medical treatment for members who receive the special allowance for persons with severe disabilities and who do not receive the benefits of the long-term care insurance provided under the Luxembourg Law of 19 June 1998, up to a maximum of 30 days per calendar year.

In the event of surgery in the Grand Duchy of Luxembourg performed by a university professor from a foreign country who has been duly authorised by the health insurance provider and the CMCM medical adviser, the CMCM will reimburse the non-covered costs of the medical costs, up to the limit of an amount equivalent to double the medical and dental rates applicable in Luxembourg for a hospital stay in a 2nd class room.

COMPANION COSTS

In the event of the following, the CMCM will pay the costs for a companion up to a maximum amount of €9 per day at index number 100 as charged by the hospital, for the duration of the stay covered by the CMCM:

a) serious surgery or serious medical treatment;

b) hospitalisation of a child under 18 years of age;

c) surgery for members who receive the special allowance for persons with severe disabilities and who do not receive the benefits of the long-term care insurance provided under the Luxembourg Law of 19 June 1998;

d) a hospital stay without surgery or serious medical treat-ment for members who receive the special allowance for persons with severe disabilities and who do not receive the benefits of the long-term care insurance provided under the Luxembourg Law of 19 June 1998, for a maximum of 30 days per calendar year;

e) childbirth.

PRE-TREATMENTS & POST-TREATMENTS

Any hospital stay, including re-hospitalisation, which is directly related to a surgical procedure or serious medical treatment, will be covered according to the official rates, during a period of 90 days preceding and following the medical or surgical treatment, upon presentation of a medical certificate by the treating physician confirming that the hospital stay is directly related to the surgery or serious medical treatment.

THERAPY TREATMENTS

Following a surgical procedure or serious medical treat-ment, the CMCM contributes to the costs of a single medically prescribed therapy treatment authorised by the health insurance provider, provided that the therapy treatment begins within 12 months after the member is discharged from the hospital, by paying a maximum daily rate of €3.56 at index number 100 for a period of 21 days.

The CMCM covers the additional costs for a bariatric treatment per member authorised in advance by the health insurance provider in the amount of up to 20% of the official rate specified by the Luxembourg Social Security Administration.

The CMCM contributes to the additional costs for the specific follow-up treatment after bariatric surgery author-ised in advance by the health insurance provider in the amount of up to 20% of the official rate specified by the Luxembourg Social Security Administration.

REHABILITATION AND FUNCTIONAL RESTORATION

For health insurance-approved treatments in a rehabilitation centre in connection with a surgical procedure or serious medical treatment, the CMCM covers the costs up to a maximum daily amount of €2.70 at index number 100, for a period of 90 days preceding and 180 days following the actual medical treatment or surgery.

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EXTERNAL AND INTERNAL PROSTHESES

The CMCM reimburses the cost for external prostheses up to 40% of a maximum amount of €1,500.

The CMCM reimburses the cost for internal prostheses up to 40% of a maximum amount of €1,500.

The CMCM reimburses the cost associated with the pur-chase of a wig authorised by the health insurance provider following chemotherapy or radiotherapy treatment or in the case of alopecia areata. The CMCM reimburses up to a maximum amount of €200.

HEARING AIDS

The CMCM reimburses the costs related to the purchase of hearing aids authorised by the health insurance provider up to a maximum amount of €100.

ORTHOPAEDIC SHOES

The CMCM contributes to the costs related to the purchase of orthopaedic shoes authorised by the health insurance provider up to a maximum amount of €100.

IN-VITRO FERTILISATION (IVF)

The CMCM pays a portion of the non-covered medical costs and costs related to in-vitro fertilisation treatments up to a flat rate of €450 per session, regardless of the method used. This benefit is limited to a maximum of four attempts.

MISCELLANEOUS COSTS

The CMCM reimburses the non-covered costs for medi-cation and physiotherapy related to a surgical procedure or serious medical treatment covered by the health insurance provider in accordance with the official rates applied by the health insurance provider for a duration of 90 days preceding and 180 days following the actual surgery or medical treatment.

HOME CARE

The CMCM reimburses the additional costs for home care approved by the health insurance provider and related to a surgical procedure or serious medical treatment up to the maximum limit of the official rates and up to a maximum of €50 per beneficiary for a period of 30 days following the actual medical treatment or surgery.

PREVENTIVE MEDICINE

a) Laboratory tests:The CMCM reimburses the following maximum amounts:

- €100 for a prenatal genetic screening for chromo-somal abnormalities (trisomy 13, 18, 21);

- €50 for determination of the foetal RHD genotype by testing the maternal blood;

- €30 for the “Omega 3 Index” cardiovascular risk marker;

- €30 for the “Lp-PLA2 enzyme” cardiovascular risk marker.

b) Osteopathy: CMCM covers the costs of osteopathic treatments with a licensed osteopath, up to a limit of a maximum amount of €10 per calendar year.

c) Cardiology:Physical performance test: CMCM contributes to the costs of a physical perfor mance test authorised by the health insurance provider, up to a limit of a maximum amount of €15 per calendar year.

USEFUL TELEPHONE NUMBERS

SERVICES IN LUXEMBOURG -HOSPITALISATION DEPARTMENT 49 94 45-500

CONTACT PERSONSHOFFMANN Henri, Head of DepartmentSTEIN Guy, Assistant Head of DepartmentCAPPONI DeborahFEIL-HOSCHEID FlorenceFIGUEIRA DE CARVALHO Claudine GOMES CarineGRATIA Sacha QUARATO Teresa RAAS Patrick RODRIGUES Rita ROSSI-TRAUSCH Nathalie

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2. DENTAL CARE BENEFITS

GENERAL PROVISIONS

1. Only dental treatments listed in the official rates are covered by the CMCM.

2. The CMCM reserves the right to ask to view an itemised invoice and statement supplied by the health insurance provider.

3. The benefits may not, under any circumstances, exceed the remaining amount owed by the member after the health insurance provider has paid its share.

4. The CMCM will not cover the patient’s personal contribution stipulated in the relevant Grand Ducal Regulation if the member has not visited the dentist for preventive care for at least two consecutive years.

THE CMCM COVERS THE NON-COVERED INCURRED COSTS UP TO 100% OF THE OFFICIAL RATES FOR THE FOLLOWINGPROCEDURES:

GUM AND DENTAL CARE

DS1 Descaling in one or several sessionsDS2 Medical treatment of periodontosis, per session DS3 Correction of dental occlusion and selective

grinding, per sessionDS20 Local anaestheticDS21 Regional anaesthetic

DENTAL EXTRACTIONS

DS61 Simple extraction of an upper single-root or multiple- root tooth

DS62 Simple extraction of a lower molar DS63 Extraction of a tooth during cellular or osseous

accidents, upper incisivo-canine, premolar, upper molar group

DS64 Extraction of a tooth during cellular or osseous accidents, lower molars

DS65 Simple extraction of the roots of single or multiple root teeth

DS66 Extraction of roots of a tooth by fragmentationDS67 Extraction of roots of a tooth with alveolectomyDS68 Extraction of a malpositioned toothDS71 Plugging of one or several alveoli for post-operative

haemorrhage, in a later session, per sessionDS72 Treatment of alveolitis following one or several

extractions, per sessionDS73 Resection of alveolar edges after multiple extractionsDS74 Gingival suturing with or without partial resection

of an alveolar ridge

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DS75 Extended gingival suture on a hemimaxillary or an incisivo-canine block with or without resection of an alveolar ridge

DS76 Surgical enucleation of a small volume cystDS77 Treatment of a cyst by marsupialisation DS78 Excision of a fibrous callusDS79M Material costs in the case of suturing

SURGICAL EXTRACTIONS

DS88 Surgical extraction of an impacted or unerupted tooth

DS89 Surgical extraction of an impacted canine DS90 Surgical extraction of odontoids or impacted or

unerupted supernumerary teeth, germectomy DS91 Surgical extraction of an impacted or unerupted

tooth during inflammatory accidentsDS92 Surgical extraction of an unimpacted, erupted

tooth, the crown of which is submucosalDS93 Surgical extraction of an impacted ectopic tooth

(crowned, gonion, mandibular ramus, basilar edge of the mandibular ramus and the chin, sinus)

DS94 Alveolar extraction of a root compressed in the sinus

DS95 Alveolar lavage of the maxilliary sinus DS96 Alveolar curretage, granulectomy, esquillectomy

ORTHODONTICS

DT10 Orthodontic mouldings supplied at the till DT11 Examination of the position of teeth with mouldingsDT21 Treatment of the malposition of teeth using differ-

ent devices before the start of active treatmentDT22 Treatment of the malposition of teeth by inclined

plane of more than two teeth before the start of active treatment

DT23 Reduction of interdental space by ligature or traction

DT31 Orthodontic treatment with a removable device, started before 17 years of age, first period of 6 months, on placement of the device

DT32 Orthodontic treatment with a removable device, started before 17 years of age, first period of 6 months, at the end of this period

DT33 Orthodontic treatment, with a removable device, second period of 9 months at the end of this period

DT34 Orthodontic treatment with a removable device, requiring several mouldings and devices by significant asynchronism of evolutionary rates of the teeth and skeleton, third period; in the 21st month of treatment

DT35 Orthodontic treatment with a removable device, requiring several mouldings and devices by significant asynchronism of evolutionary rates of the teeth and skeleton, third period; at the end of active treatment, in the 27th month of treatment

DT36 Orthodontic treatment, with a removable device, for labial or labio-maxillary fissure, started before 17 years of age, annual fee, at the end of the annual period

DT41 Orthodontic treatment with a fixed device, started before 17 years of age, first period of 6 months, on placement of the device

DT42 Orthodontic treatment with a fixed device, started before 17 years of age, first period of 6 months, at the end of this period

DT43 Orthodontic treatment, with a fixed device, second period of 9 months at the end of this period

DT44 Orthodontic treatment with a fixed device, requir-ing several mouldings and devices by significant asynchronism of evolutionary rates of the teeth and skeleton, third period; in the 21st month of treatment

DT45 Orthodontic treatment with a fixed device, requir-ing several mouldings and devices by significant asynchronism of evolutionary rates of the teeth and skeleton, third period; at the end of active treatment or in the 27th month of treatment

DT46 Orthodontic treatment, with a fixed device, for labial or labio-maxillary fissure, started before 17 years of age, annual fee, at the end of the annual period

DT61 Bracing of a group of hemiarch teeth after orthodontic treatment

DT62 Bracing of a complete arch after orthodontic treatment

Contrary to the preceding text and subject to approval by the health insurance provider and the application of Section 11 (3) of the Statutes, the non-covered costs may be reimbursed up to 20% of the official rate for procedures DT41, DT42, DT43, DT44 and DT45.

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THE CMCM PAYS A FLAT RATE FOR DENTAL TREATMENTS UP TO THE MAXIMUM AMOUNTSSHOWN NEXT TO EACH PROCEDURE:

DENTAL AND GUM CARE

JOINT DENTAL PROSTHESIS

FOR THE FOLLOWING TREATMENTS, THE CMCM PAYS A FLAT RATE OF UP TO €45 PER ELEMENT IF PRECIOUS METALS ARE USED:

DB21 Cast crownDB24 Three-quarter crownDB29 Post crown with root ring (Richmond type)DB30 Porcelain or solid resin post-crown (Davis type)DB48 Spring bridge elementDB49 Solid metal bridge elementDB50 Resin bridge elementDB51 Veneer bridge element or tube tooth

DS5 Metallic brace in parodontosis or fracture of the alveolar ridges €50

DS6 Prosthetic dental brace or bite guard €50

DS18 Full reconstitution of a post crown tooth €18

DS19 Reconstitution of a resin angle on the incisivo-canine group €18

DS33 Gold restoration €13

DS34 Inlay, one side €35

DS35 Inlay on two sides of a tooth €35

DS36 Inlay on three sides or onlay, per tooth €35

DA11 Synthetic resin base plate €50

DA12 Injected resin base plate or reinforced plate or cast plate €50

DA13Prosthetic skeleton (with the exception of a single tooth and with a minimum of two means of attachment)

€140

DA21 Impression per individual impression tray €10

DA22 Functional impression, open mouth technic €18

DA23 Functional impression, closed mouth technic €18

DA31 Prosthetic tooth €20

DA32 Counterplated tooth €8

DA33 Gold veneer €12

DA37 Retention using gravity, magnets, springs, implants or soft resin €18

DA42 Simple hook €5

DA43 Complex hook €18

DA44 Prosthetic skeleton hook €18

DA45 Attachments €40

DA52 Repair of fracture on metal base plate (installation extra) €50

DA64 Addition of a complex hook after impression €18

SECONDARY DENTAL PROSTHESIS

DB23 Veneer crown €85

DB25 Telescopic crown anchoring a secondary prosthesis €90

DB26Articulation, slide or similar construction incorporated in a crown or an inlay anchoring a secondary prosthesis

€40

DB28 Inlay acting as a bridge pillar €40

DB31 Reconstitution on pivot inlay per crown €40

DB33 Porcelain jacket crown €85

DB36 Unsealing of a post-crown tooth or a broken post-crown root €5

DB37 Repair of a joint prosthesis, unsealing and resealing not included €13

DB47 Ceramo-metallic bridge element €85

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IN ADDITION TO THE BENEFITS LISTED ABOVE, THE CMCM ALSO COVERS:

- for temporary removable dentures, the cost of up to 20% of the official rate;

- for temporary fixed dentures, the cost for the 12 upper and lower anterior teeth up to a maximum of €13 per element as follows:

16 - 11 / 21 - 2646 - 41 / 31 - 36

- for periodontal surgery, the cost of up to €90 per half-arcade, each for a period of 5 years;

- for dental implants, the cost of up to €120 per implant.

USEFUL TELEPHONE NUMBERS

DENTAL CARE DEPARTMENT 49 94 45-600

CONTACT PERSONSBAUMANN Yves, Assistant Head of DepartmentBIANCO Sara BINTNER Danielle DA LUZ FORTES Edith FETTES Jean-Luc MONTEIRO Mireille NOTHUM Christiane REITER RomaineURBING Guy

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3. HOSPITAL STAY ABROAD

TYPES OF BENEFITS

The CMCM, within the scope of its provisions, provides additional reimbursements to supplement the compulsory health insurance in the event of surgery or serious medical treatment abroad.

The CMCM covers the costs either: - by paying directly through the “third-party settlement” (“tiers payant”) method or

- by reimbursing the costs to the member through the “settlement by reimbursement” (“Règlement par remboursement”) method.

ADVANTAGES OF THE “THIRD-PARTY SETTLEMENT” (“TIERS PAYANT”) METHOD

The CMCM covers the examination, medical, surgery, hospitalisation and other associated costs according to the provisions of the bilateral agreements:

FRANCE

In the recognised hospitals under contract in Paris, Nancy and Strasbourg, full coverage of the costs incurred in con-nection with a hospital stay in a private room (1-bed room).

GERMANY

In the hospitals recognised by the Knappschaft public health insurance organisation, full coverage of the medical and hospitalisation costs incurred in connection with a shared, semi-private room (private patient in a 2-bed room).

BELGIUM

In the recognised hospitals under contract, full coverage of the medical and hospitalisation costs incurred in connec-tion with a hospital stay in a private room (1-bed room).

SWITZERLAND

In the specialist hospitals under contract, coverage of the surgery and associated costs up to the rate of a shared, 2-bed room (semi-private).

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BENEFITS OFFERED THROUGH THE “SETTLEMENT BY REIMBURSEMENT” METHOD (RÈGLEMENT PAR REMBOURSEMENT)

Hospitalisation Costs

In the event of surgery or serious medical treatment, the CMCM provides a maximum daily flat rate of €11 at index number 100 for the duration of the hospitalisation authorised by the health insurance provider.

In the event of a hospital stay without surgery or serious medical treatment, the CMCM provides a maximum flat rate of €11 at index number 100 for a maximum of 50 days per calendar year.

Medical Costs

In the event of surgery or serious medical treatment, the medical costs will be reimbursed to the member for a hospital stay in a second class room up to the limit of the amount equivalent to double the medical rates applicable in the Grand Duchy of Luxembourg.

In the event of a hospital stay without surgery or serious medical treatment for members, the CMCM will reimburse the medical costs and related fees up to a maximum amount of €100 at index number 100 per calendar year.

Additional Costs

In the event of surgery or serious medical treatment, the CMCM will reimburse the costs of medications, medical examinations, and medical sundries and aids reimbursable by the social security administration of the country in which the member is hospitalised, up to a limit of 40% of the official rates applicable in that country.

GENERAL BENEFITS OF THE “THIRD-PARTY SETTLEMENT” AND “SETTLEMENT BY REIMBURSEMENT” METHODS

Apart from the specific benefits provided through the two abovementioned methods, the CMCM also contributes to the following costs:

HOW DO I USE THE “THIRD-PARTY” SETTLEMENT METHOD?

The CMCM can issue a cost commitment note if: - the treating physician has issued a medical certificate in advance confirming the need for medical and surgical treatment abroad;

- there is prior approval by the health insurance provider (S2 certificate);

- the CMCM’s medical adviser is in agreement with the need for medical and surgical treatment abroad.

WHAT DO I DO IN THE CASE OF AN EMERGENCY?

In the case of an urgent transfer abroad in the event of a sudden illness or accident, without prior approval by the CMCM, the medical certificate and the health insurance certificate must be submitted to the CMCM as soon as possible.

If the request for approval by CMCM has not been made within the period specified in the preceding paragraph, the member may still receive reimbursement of the benefits in accordance with the “Third-party settlement” (“Tiers payant”) method, but only upon submission of the relevant receipted invoices for a hospital stay in a hospital or clinic centre with which CMCM has accordingly entered into an agreement.

RECOMMENDATION

To optimally utilise the benefits, you should always contact the CMCM as soon as possible.

SETTLEMENT BY REIMBURSEMENT TO THE MEMBER

In a hospital with which the CMCM has not entered into an agreement, the benefits for medical and surgical treat-ment abroad are partially covered by the “settlement by reimbursement” method. With this method, the member must first pay for all incurred costs with his / her own funds.

The submission of a certificate from the treating physician confirming the need for medical / surgical treatment abroad as well as the approval of the health insurance provider (S2 certificate) are required.

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EXTERNAL AND INTERNAL PROSTHESES

The CMCM reimburses the cost for external or internal prostheses up to 40% of a maximum amount of €1,500.

The CMCM reimburses the cost associated with the pur-chase of a wig authorised by the health insurance provider following chemotherapy or radiotherapy treatment. The sum of the reimbursement is up to 40% of a maximum price of €250, with a renewal period of 3 years.

ACCOMMODATION COSTS FOR A COMPANION

In the event of surgery or a serious medical treatment, the CMCM will pay a portion of the accommodation costs for a companion up to a maximum amount of €10 at index number 100 per day for the duration of the CMCM-approved period that the member is hospitalised.

Submission of the receipted original invoices is required.

THERAPY TREATMENTS

Following a surgical procedure or serious medical treatment, the CMCM contributes to the costs of a single medically prescribed therapy treatment authorised by the health insurance provider, provided that the therapy treatment begins within 6 months after the member is discharged from the hospital, by paying a maximum daily rate of €2.00 at index number 100 for a period of 21 days.

PRE-TREATMENTS AND POST-TREATMENTS

For a period of 90 days preceding and 180 days following the actual period of hospitalisation, the CMCM will reimburse the non-covered costs of medication, examinations and medical sundries related to the surgery or serious medical treatment according to the official rates.

The pre-treatment and post-treatment costs related to a hospital stay are reimbursed in the periods mentioned above in accordance with the official rates or pursuant to the provisions of the “settlement by reimbursement” or “third-party settlement” method.

TRAVEL EXPENSES AND MEDICAL TRANSPORTATION COSTS

In the event of an outpatient medical/surgical treatment, the CMCM will pay the member and, if the member is hospitalised, a companion as well, a one-time flat rate sum based on the distance travelled (round trip) in the amount of:

- €30 for a distance exceeding 200 km; - €45 for a distance exceeding 300 km; - €60 for a distance exceeding 400 km; - €75 for a distance exceeding 500 km.

In the event of a series of treatments, the flat rate amounts listed above are only paid once per calendar month.

The costs for the transportation by ambulance, helicopter or medical airplane authorised by the health insurance provider will be covered in the amount up to 30% of the official rate.

REPATRIATION EXPENSES

The CMCM covers the transportation costs related to the repatriation of the deceased person up to a maximum amount of €1,240.

USEFUL TELEPHONE NUMBERS

SERVICES ABROAD DEPARTMENT 49 94 45-700

CONTACT PERSONSMARTINS Miguel, Head of Department DUARTE Bella ESSLINGEN-SCHMIT Pia REHLINGER Thierry TOISUL David

Please note that the benefits may not, under any circum-stances, exceed the remaining amount owed by the member after the health insurance provider has paid its contribution.

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4. CMCM-ASSISTANCE

HOSPITALISATION

In the event of emergency hospitalisation due to an accident or sudden illness occurring during a temporary stay abroad, CMCM-Assistance covers the costs up to €100,000 per member.

If the injured or sick member cannot be transported and has to be hospitalised for longer than 10 days, CMCM-Assistance pays for the costs of a round-trip train or airplane ticket to enable one family member to come to visit the ill or injured or sick member.

If the injured or sick member has to remain hospitalised past his / her originally scheduled return date, CMCM- Assistance will pay a portion of the accommodation costs for a person waiting for the return in the amount of up to €50 per day and for a maximum duration of 7 days.

MEDICAL TRANSPORTATION AND RESCUE-RELATED COSTS

Unlimited coverage of the costs of transportation by ambu-lance or any other required means of medical transportation (helicopter or medical airplane) and the rescue-related costs when abroad, including skiing accidents or accidents in places difficult to access.

REPATRIATION

In the event of illness or injury, CMCM-Assistance will arrange repatriation of the member by the most suitable means (ambulance, train, commercial airline flight or medical airplane) and cover the associated costs.

EMERGENCY MEDICAL CONSULTATION ABROAD

In the event of outpatient treatment not involving surgery, the CMCM will reimburse the remaining non-covered medical costs and related charges as well as dental costs after the health insurance provider has paid its contribution, up to an annual maximum of €1,250 per calendar year.

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DEATH

In the case of a member’s death, all formalities and the expenses associated with the transportation of the remains to the place of interment in the Grand Duchy of Luxembourg or in one of the bordering countries will be covered by CMCM.

In the event that a close relative dies (spouse, partner, relative in direct ascending or descending line, sibling), CMCM-Assistance will provide the member who is currently abroad with a train or plane ticket so that he or she can attend the funeral.

TRAFFIC ACCIDENT

In the case of a traffic accident involving physical damage, CMCM-Assistance will bring the members back to their place of residence if their vehicle cannot be repaired within 10 days.

MATERIAL ASSISTANCE IN THE EVENT OF A TRAFFIC ACCIDENT

In the event of a traffic accident involving physical damage and on the condition that the vehicle title is registered in the name of the member, CMCM-Assistance guarantees the return of the vehicle to the member’s place of residence using the most suitable means to return it.

IF THE VEHICLE IS STILL OPERABLE:

- coverage of the cost of a train ticket or airplane ticket to allow the member to take the repaired vehicle back home;

- return of the vehicle by a driver sent to the place of the accident if the member is not available.

IF THE BROKEN-DOWN VEHICLE CANNOT BE REPAIRED AT THE PLACE OF THE ACCIDENT, BUT CAN BE REPAIRED IN THE MEMBER’S PLACE OF RESIDENCE:

- CMCM-Assistance arranges for the return of the vehicle if its market value is higher than the cost of the repair;

- If the repair costs exceed the market value, CMCM- Assistance will only cover the cost related to the legal abandonment of the vehicle;

- CMCM-Assistance guarantees the procurement and delivery of replacement parts needed to repair the damaged vehicle, subject to repayment of the costs by the member;

- CMCM-Assistance will cover the costs of towing the vehicle to the closest automobile repair shop up to a maximum amount of €75, provided the costs are not covered through another insurance policy;

- CMCM-Assistance will cover the hotel costs of members who have to wait for the repair of their vehicle at the place of the accident up to a maximum of €75 per beneficiary.

COUNTRIES OF INTERVENTION FOR PERSONAL ASSISTANCE

For members residing in the Grand Duchy of Luxembourg:In all countries in the world with the exception of the Grand Duchy of Luxembourg.

For members living in the bordering countries of the Grand Duchy of Luxembourg:Starting from a distance of 50 km from their place of residence, in all countries in the world with the exception of the Grand Duchy of Luxembourg.

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COUNTRIES WHERE MATERIAL ASSISTANCE IS PROVIDED IN THE EVENT OF A TRAFFIC ACCIDENT WITH PHYSICAL DAMAGE

In all countries in Europe (for Russia, European zone up to the Urals) and in the following countries: Algeria, Morocco, Tunisia, Egypt, Jordan, Syria, Lebanon, Israel and Turkey, with the exception of the Grand Duchy of Luxembourg:

- for members residing in the Grand Duchy of Luxembourg;

- for members living in the bordering countries of the Grand Duchy of Luxembourg who are more than 50 km from their place of residence.

TRIP CANCELLATION

In the event a client is obliged to cancel his / her trip for a major medical reason, CMCM-Assistance reimburses the expenses incurred.

EVENTS COVERED

- A client’s inability to travel due to an illness, accident or unplanned hospitalisation of at least 1 night (preventing him/her from travelling);

- Death of a client.

To understand the events covered correctly, illness and accident are defined as follows:

a) Illness: Any deterioration in a person’s health that is not caused

by an accident and whose cause and symptoms can be determined medically, thus enabling a diagnosis and the necessary treatment.

b) Accident: Each impairment in health caused by a sudden event

that is external to the person’s body, occurring beyond of the insured person’s control, for which the cause and symptoms may be medically detected, thereby provid-ing a diagnosis and the necessary treatment.

AMOUNTS COVERED

The reimbursement made by CMCM-Assistance may never exceed the costs actually paid for the transport used (plane, train or boat) and the cost of the stay (rental, hotel), minus an excess of €50 per trip.

The maximum amount reimbursed is set at €750 per beneficiary and per trip, and the total sum may not exceed an annual total of €1,500 per beneficiary.

The flights / return trips, with any stopovers, form a single trip.

Catering and other expenses related to the trip are not reimbursed by CMCM-Assistance.

-OUR PARTNERINTER MUTUELLES ASSISTANCE

118 avenue de Paris, Niort, France

24 / 247 / 7

IF CALLING LUXEMBOURG FROM A FOREIGN COUNTRY+352 44 44 44

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OPTIONAL GUARANTEES

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PRESTAPLUS

BENEFITS OF PRESTAPLUS

BENEFITS

The benefits provided by Prestaplus are calculated on the basis of the benefits paid by the compulsory health insurance of the Grand Duchy of Luxembourg. The benefits may not, under any circumstances, exceed the remaining amount owed by the member after the health insurance provider has paid its contribution.

HOSPITALISATION

In the event of minor to moderate surgery, including childbirth, Prestaplus reimburses the costs for a hospital stay in the Grand Duchy of Luxembourg at a rate of the difference between hospital accommodations in a 1st class room with en-suite bathroom and the reimbursement by the health insurance provider for a 2nd class hospital room in a shared room with two beds, up to a maximum amount of €13 at index number 100.

In the event of surgery, members who opt for the medical and hospital risk coverage and who are unable to obtain accommodations in a 1st class hospital room will receive a contribution of €10 per day of the hospital stay in the 2nd class room for miscellaneous costs incurred, up to a maximum of 30 days per calendar year.

In the event of hospitalisation without surgery, Prestaplus reimburses the costs of the hospital stay at a rate of the difference between hospital accommodations in a 1st class room with en-suite bathroom and the reimbursement by the health insurance provider for a stay in a 2nd class hospital room in a shared room with two beds, up to a maximum duration of 30 days per calendar year.

MEDICAL COSTS

In the event of minor to moderate surgery, including childbirth, Prestaplus covers the price difference between 1st class medical costs and the reimbursement of medical costs by the health insurance provider according to 2nd class rates.

In the event of hospitalisation without surgery, Prestaplus covers the price difference between 1st class medical costs and the reimbursement of medical costs by the health insurance provider according to 2nd class rates, up to a maximum duration of 30 days per calendar year.

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PRESTAPLUS

TRANSPORTATION COSTS

The CMCM reimburses the costs of three (3) ambulance transports per calendar year authorised by the health insurance provider and up to a maximum of 30% of the official rate up to a maximum amount of €100.

The CMCM covers the cost of one (1) ambulance transport not reimbursed by the health insurance provider per calendar year, up to a maximum amount of €30.

N.B.: A round trip on the same day is considered to be one single transport.

ORTHOPAEDIC SOLES

The CMCM covers the costs for orthopaedic soles authorised in advance by the health insurance provider for children up to the age of 16 and up to a maximum amount of €25, with periodic renewal after a period of 3 years, starting from the date of the last reimbursement by CMCM.

PREVENTIVE MEDICINE

a) Mondorf Plus: Members of the CMCM benefit from a special rate of €400 instead of €458 for the “SportMed” program offered by the Domaine Thermal de Mondorf. In addition, the CMCM awards a one-off contribution of €60 on presentation of evidence certifying that the set targets have been reached. Mondorf Plus is a custom 12-week program with a focus on getting back in shape:

- 20 activities to choose from; - supervision by a professional coach; - session with nutritionist; - several evaluations during the 12 weeks.

b) Osteopathy: CMCM covers the costs of osteopathic treatments with a licensed osteopath up to a limit of a maximum value of €15 per calendar year.

c) Psychological support: Die CMCM covers the cost of psychological support for children and teenagers under 18, up to a limit of €25 per calendar year.

d) Cardiology: Physical performance test: CMCM contributes to the costs of a physical per-formance test authorised by the health insurance provider up to a limit of €10 per calendar year.

The Prestaplus benefits cannot be combined with the international benefits as listed on pages 13-15.

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DENTA & OPTIPLUS

DENTAL CARE BENEFITS

The contribution by the CMCM is limited to the benefitsfor dental care provided for in the official rates.

For the following procedures, the CMCM contributes up to a maximum of 75% of the remaining amount owed by the member after the contributions have been paid by the health insurance provider and the CMCM RÉGIME COMMUN:

DENTAL CARE AND PERIODONTAL TREATMENT

DENTAL CARE

The CMCM covers dental care up to an annual maximum amount of €600 per beneficiary, without exceeding the maximum amount per procedure listed below:

The CMCM contributes to the costs of: - composite fillings in the amount of €8 per tooth, up to a maximum amount of €40 per calendar year;

- Pulpectomy treatment, up to a maximum amount of €20 per calendar year.

PERIODONTAL TREATMENTS

The CMCM covers the cost of a periodontal treatment up to an annual maximum amount of €200 per beneficiary.

N.B.: Benefits for periodontal treatment combined with benefits for dental care cannot exceed the annual maximum amount of €600 per beneficiary.

BENEFITS OF DENTA & OPTIPLUS

DS5 Metallic brace in parodontosis or fracture of the alveolar ridges €50

DS6 Prosthetic dental brace or bite guard €50

DS18 Full reconstitution of a post crown tooth €30

DS19 Reconstitution of a resin angle on the incisive-canine group €30

DS33 Gold restoration €30

DS34 Inlay, one side €50

DS35 Inlay on two sides of a tooth €150

DS36 Inlay on three sides or onlay, pertooth €150

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DENTA & OPTIPLUS

ORTHODONTICS

The CMCM covers the costs of the following orthodontic procedures up to an annual maximum amount of €350 per child.

DT10 Orthodontic mouldings supplied at the till DT11 Examination of the position of teeth with mouldingsDT21 Treatment of the malposition of teeth using different

devices before the start of active treatmentDT22 Treatment of the malposition of teeth by inclined

plane of more than two teeth, before the start of active treatment

DT23 Reduction of the interdental space by ligature or traction

DT31 Orthodontic treatment, with removable device, started before 17 years of age, first period of 6 months, on placement of the device

DT32 Orthodontic treatment, with removable device, started before 17 years of age, first period of 6 months, at the end of this period

DT33 Orthodontic treatment, with removable device, second period of 9 months at the end of this period

DT34 Orthodontic treatment, with removable device, requiring several mouldings and devices by signif-icant asynchronism of evolutionary rates of the teeth and the skeleton, third period in the 21st month of treatment

DT35 Orthodontic treatment, with removable device, requiring several mouldings and devices by signif-icant asynchronism of evolutionary rates of teeth and the skeleton, third period, at the end of active treatment or in the 27th month of treatment

DT36 Orthodontic treatment, with removable device, for labial or labio-maxillliary fissure started before 17 years of age, annual fee, at the end of the annual period

DT46 Orthodontic treatment, with fixed device, for labial or labio-maxillliary fissure started before 17 years of age, annual fee, at the end of the annual period

DT61 Bracing of a group of hemiarch teeth after ortho-dontic treatment

DT62 Bracing of a complete arch after orthodontic treatment

The CMCM covers the costs for the treatments below up to a maximum amount of €250 per measure.

DT41 Orthodontic treatment, with fixed device, started before 17 years of age, first period of 6 months, on placement of the device

DT42 Orthodontic treatment, with fixed device, started before 17 years of age, first period of 6 months, at the end of this period

DT43 Orthodontic treatment, with fixed device, second period of 9 months at the end of this period

DT44 Orthodontic treatment, with fixed device, requiring several mouldings and devices by significant asynchronism of evolutionary rates of teeth and the skeleton, third period, in the 21st month of treatment

DT45 Orthodontic treatment, with fixed device, requiring several mouldings and devices by significant asynchronism of evolutionary rates of teeth and the skeleton, third period, at the end of active treatment or in the 27th month of treatment

Contrary to Article 7 (1), the CMCM grants a one-time contribution of €350 per beneficiary for orthodontic treatments for members aged 17 and older.

Example:

Total reimbursement by CMCM (RÉGIME COMMUN + DENTA & OPTIPLUS):

€366.92 + €1,000.00 = €1,366.92

PROCEDURES COST REIMBURSEMENT

Health Insurance Régime commun Denta & Optiplus

1st Child DT41 €900.00 €418.10 €83.62 €250.00

DT42 €950.00 €417.80 €83.56 €250.00

2nd Child DT43 €1,000.00 €525.30 €105.06 €250.00

DT44 €950.00 €473.40 €94.68 €250.00

TOTAL €3,800.00 €1,834.60 €366.92 €1,000.00

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DENTA & OPTIPLUS

DENTURES AND IMPLANTS

The CMCM covers the costs for dentures up to an annual maximum amount of €2,500 per beneficiary, however without exceeding the maximum sum of €3,500 over two consecutive years, subject to the maximum limit per procedure listed below:

FIXED DENTURES

REMOVABLE DENTURES

OTHER BENEFITS

If the health insurance provider refuses to cover the costs, the reimbursement for the abovementioned procedures is limited to a maximum of 80% of the maximum amounts per procedure.

DENTAL IMPLANTS

The CMCM covers the costs of dental implants up to a maximum amount of €350 per implant and up to an annual maximum amount of €1,400 per beneficiary.

Crown, post crown, bridge, Telescopic crown €400Inlay, inlay core, hinge €150

Removable partial denture (model casting) €400Denture, plastic or metal base €150Bracket or attachment €100

Maximum amount per procedure €80

VISUAL AIDS AND REFRACTIVE SURGERY

For the following benefits, the CMCM covers up to 80% of the remaining amount owed by the member after the contributions have been paid by the health insurance provider and the CMCM RÉGIME COMMUN.

GLASSES

CORRECTIVE LENSES

Annual maximum contribution of €100 per beneficiary for the cost of corrective lenses.

FRAMES

Annual maximum contribution of €30 per calendar year for the cost of frames.

CONTACT LENSES

Annual maximum contribution of €100 per beneficiary for the cost of contact lenses.

REFRACTIVE SURGERY

The CMCM contributes to the medical costs for refractive surgery up to a maximum amount of €500 per eye.

Example:Total reimbursement by CMCM

(RÉGIME COMMUN + DENTA & OPTIPLUS):

€240.00 + €700.00 = €940.00

N.B.: The benefits provided by CMCM for dentures and dental implants may not exceed the annual maximum amount of €2,500 or the maximum amount of €3,500 over two consecutive years.

NUMBER COST REIMBURSEMENT

Health Insurance Régime commun Denta & Optiplus

Implants 2 €1,900.00 - €240.00 €700.00

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Postal Address L-2971 Luxembourg

Luxembourg-Gare Office 49, rue de Strasbourg

Tel. 49 94 45-1 Fax 48 25 81

E-mail prestations@cmcm.lu www.cmcm.lu

FOR MORE INFORMATION, VISIT WWW.CMCM.LU