Aids

Compensation for approved medical aids by a doctor is 75 % but not more than 500 euros per member per calendar year. The following types of costs for rental or purchase are covered: compression socks, compression vests or orthopaedic leg supports, joint supports after an accident for up to three months, hearing aids and rental costs of a CPAP-device at the beginning of treatment.

Attachments to the compensation application:

• Referral from a doctor (referral is valid for 12 months from when it was written)
• Payment receipt

The compensation is 75% of the cost of a treatment prescribed by a doctor, for a maximum of four treatment visits per year.

Attachments to the compensation application:

• Referral from a doctor (referral is valid for 12 months from when it was written)
• Payment receipt

The compensation is 75 % of the costs of a treatment prescribed by a doctor but not more than 900 euro per member per calendar year. Costs of chiropractor, osteopath or naprapath are calculated to the same maximum amount of 900 euro.

A doctor’s referral is required. The referral is valid for 12 months. 

The physiotherapist must be registered in the central register of professionals: www.julkiterhikki.valvira.fi

Attachments to the compensation application:

• Payment receipt which shows the customer’s name, date of visit, total cost
• A doctor’s referral

Compensation for dental care may be provided after the applicant has been a member of the fund for one year.

The compensation is 75% of the cost, but no more than EUR 1,000 per member per calendar year.

Please note that compensation is not paid for aesthetic treatment or dental care equipment.

75 % compensation includes Kela compensation.

Attachments to the compensation application:

• Payment receipt which shows the customer’s name, date of visit, treatment given, costs and possibly reduced Kela compensation

If the Kela compensation has not been reduced and the treatment is Kela reimbursable, Kela’s Compensation application and  form SV 126 (Statement on treatment provided by dentist/dental specialist and on the related fees) are also required.

The compensation is 75 % of the costs of a treatment prescribed by a doctor but not more than 900 euro per member per calendar year. Costs of physiotherapy are calculated to the same maximum amount of 900 euro.

The person providing the treatment must be registered in the professional social and healtcare central register: JulkiTerhikki (valvira.fi). 

Attachments to the compensation application:

• Referral from a doctor (referral is valid for 12 months from when it was written)
• Payment receipt which shows customer’s name, the name of the treatment provider, the treatment given and the cost in detail

1. Reimbursements from Kela

The compensation is 75% of the cost of medication prescribed by a doctor.

75 % compensation includes Kela compensation.

Costs of Kela´s initial deductible for Kela reimbursable medicines (50 e per calendar year) are not reimbursable by the fund

At a contract pharmacy, you will receive a discount by presenting your Kela card marked with the fund’s identifier (46001).

Pharmaceuticals covered by the reference price system will be compensated for in accordance with the reference price if the price exceeds the reference price and the customer does not want to replace the drug with a reference-priced option. Compensation will be paid in accordance with the price of the drug if the doctor has prohibited replacing the drug with a reference-priced drug.

Medicines related to infertility treatments are not reimbursed by the fund.

Attachments to the compensation application:

• Original payment receipt from the pharmacy
• a copy of the prescription (electronic prescriptions can be printed out at www.kanta.fi).

2. Pharmaceuticals not compensated for by Kela

The compensation is 75% of the cost of medication prescribed by a doctor, but not more than EUR 670 per member per a calendar year.

The maximum amount of pharmaceuticals to be compensated for at a time equals a three-month period of treatment.

Preparations that are prescribed for the treatment of illness and that are included in the medication database maintained by Kela are regarded as pharmaceuticals: https://asiointi.kela.fi/laakekys_app/LaakekysApplication?kieli=en

No compensation is paid for vaccines.

Attachments to the compensation application:

• Original payment receipt from the pharmacy
• a copy of the prescription (electronic prescriptions can be printed out at www.kanta.fi).

Doctor’s fee

a) 75 % of doctor’s appointment fees when the visit is also reimbursable by Kela. 75 % compensation includes Kela compensation.

b) 75 % of the doctor’s fees for examinations related to diagnose and treatment of the illness.

c) 75 % of the doctor’s fees for minor medical procedures but no more than 450 e per procedure. More expensive operations or medical procedures are compensated in accordance section “Medical procedures and operations at private healthcare facilities”.

Compensation is not paid for the costs of infertility treatments or artificial kidney and cancer treatments by a private service provider.

Attachments to the compensation application:

• Payment receipt showing the customer´s name, date of visit, total cost
• If Kela reimbursement has not been deducted from doctor’s appointment fees  –
  • Payment receipt
  • SV 120 Form for reporting doctors’ fees (statement on the treatment given by a doctor and on the related fees)
  • Application form SV 127e

Office fees and similar other fees charged by the medical center are not reimbursable.

The compensation is 75 % of the costs of a treatment prescribed by a doctor but not more than 1200 euro per member per calendar year.

75 % compensation includes Kela compensation.

The psychologist or psychotherapist must be included in the register of social welfare and healthcare professionals maintained by the National Supervisory Authority for Welfare and Health (Valvira) JulkiTerhikki (valvira.fi)

Attachments to the compensation application:

• Referral from a doctor (referral is valid for 12 months from when it was written)
• Payment receipt
• Information about possible decision of Kela´s psychotherapy

The compensation is 75% on the cost of a treatment prescribed by a doctor.

Attachments to the compensation application:

• Referral from a doctor (referral is valid for 12 months from when it was written)
• Payment receipt

The fund pays additional compensation for substance abuse treatment and detoxification, unless the fund’s specialist deems this unreasonable in an individual case. The compensation is up to 75% of the total cost.

An advance decision may be applied for on the eligibility of the treatment for compensation.

The following documents must be attached to an application:

1. A treatment and rehabilitation plan by a doctor
2. A report on the implementation of the treatment
3. A report on the cost of the treatment and its payment

The compensation is 75% of the cost of a treatment prescribed by a doctor, for a maximum of three treatment visits per year.

Please note that, according to the rules of the fund, compensation will be paid if the treatment is provided by a person with a professional education who is included in the register of social welfare and healthcare professionals maintained by the National Supervisory Authority for Welfare and Health (Valvira).

Attachments to the compensation application:

• Referral from a doctor (referral is valid for 12 months from when it was written)
• Payment receipt

The compensation is 75 % of the cost of a treatment given by a nurse in the treatment of illness.

Attachment to the compensation application:

• Payment receipt which shows the customer’s name, date of visit, treatment given and costs related.

Please note that no compensation is paid for costs of supplies.

Compensation for glasses, contact lenses and laser surgery may be provided after the applicant has been a member of the fund for one year.

75 % of the cost of eyeglasses and contact lenses prescribed by a doctor or optician, the optician’s contact lens fitting fee and eye examination, vision correction surgery or monthly payments of for eyeglass leasing contracts. The maximum amount of compensation is 550 euros per member per calendar year.

Attachments to the compensation application:

• A payment receipt, including the payment day, the prices and the customer’s name

The compensation is 75 % of the costs.

Costs of hospital treatment days are compensated for up to 100 days within a calendar year.

Costs of home hospital or domiciliary care visits are compensated for up to 100 times within a calendar year.

Attachments to the compensation application:

• Copy of the invoice

Compensation is 75 % of the costs of procedures for which the fund has made an advance decision. The maximum amount of compensation is 2000 euros per calendar year (year 2024). The fund’s compensation responsibility applies to treatment in accordance with generally accepted, good treatment practice.

An advance decision is applied for by sending the medical reports to the fund, which show the procedure to be performed, the reasons that led to the procedure and a cost estimate.

Minor procedures performed by a doctor (e.g. removal of moles) are reimbursed based on the section “Doctor’s fees”.

Examinations 

75 % of examinations prescribed by a doctor or a dentist to treat or diagnose an illness; laboratory tests, pathology tests and radiological tests with the following exceptions and clarifications:

– A referral from a specialist is required for magnetic resonance imaging.
– Compensation is not paid for ultrasound examinations during pregnancy
– Compensation is not paid for examinations related to infertility treatments.

The maximum amount of additional benefit compensation is 1300 euros in a calendar year (year 2024).

Attachments to the compensation application:

– A doctor’s referral (referral is valid for 12 months from when it was written)
– Payment receipt which shows the customer’s name, date of visit, treatment given and costs itemized.

The compensation is 75 % of the costs but not more than 100 euro per member per calendar year. To obtain compensation you have to first apply for and receive compensation from a private voluntary insurance.

Attachments to the compensation application:

The decision of the insurance company which states the compensation and  the deductible.