Compensations

Expenses to be compensated for

Aids

Compensation for approved medical aids by a doctor is 75 % but not more than 500 euro 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
  • 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
  • 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

Visits on 31.12.2022 or before: The fund covers costs only if they are also reimbursable by Kela. 75 % compensation includes Kela compensation.

You will no longer receive Kela-compensation for visits made on 1.1.2023 or after but you will still receive the fund’s compensation.

Attachments to the compensation application:

  • Payment receipt which shows the customer’s name, date of visit, total cost and possibly reduced Kela compensation
  • A doctor’s referral
  • Visits on 31.12.2022 or before: If the Kela compensation has not been reduced referral from a doctor (Kela form SV 3FM), treatment report from the physiotherapist (SV 3FS) and the Kela’s Compensation application are also required.

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
  • 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).

Visits on 31.12.2022 or before: 

The funds additional benefit is paid when the visit is also reimbursable by Kela. The compensation is 75% for the treatment of illness. 75 % compensation includes Kela compensation.

Fertility treatments are not reimbursable by the fund.

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, Kela’s Compensation application and SV 120 Form for reporting doctors’ fees (statement on the treatment given by a doctor and on the related fees) are also required.

Visits on 1.1.2023 or after:

a) 75 % of doctor’s appointment fees when the visit is also reimbursable by Kela.
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 and the amount of the deducted Kela compensation
  • If Kela reimbursement has not been deducted:  –
    • 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
  • 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
  • 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
  • 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.

Compensation when the payment day is on 31.12.2022 or before: 

Compensation for eyeglass frames is paid every two calendar years. Compensation for lenses, contact lenses OR vision correction surgery is paid once per calendar year.

The compensation is 75%, but not more than the following:

  • Frames EUR 130
  • Spectale lenses EUR 400
  • Multi-vision lenses EUR 400
  • Contact lenses EUR 130
  • Vision correction surgery EUR 400

The compensation for an optician’s fee for an eye examination is 75%.

Compensation when the payment day is on 1.1.2023 or later:

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

Compensations when the operation is performed on 31.12.2022 or before:

The fund pays additional compensation for operations and procedures performed at private healthcare facilities if the procedure is also eligible for reimbursements from Kela. The compensation is 75%, but no more than EUR 1,500 per calendar year. Treatment day fees are compensated for in accordance with public hospital rates.

75 % compensation includes Kela compensation.

The principles of compensation for minimally invasive knee surgery have been amended as of 15 June 2017.

The principles of compensation for acromion surgery have been amended as of 1 January 2019.

If you are planning to have your knee degeneration treated by keyhole surgery or your acromion operated on, you should check in advance with the service provider about the eligibility of the procedure for reimbursements from Kela.

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, Kela’s Compensation application and SV 120 Form for reporting doctors’ fees (statement on the treatment given by a doctor and on the related fees) are also required.

Compensations when the operation is performed on 1.1.2023 or after: 

Compensation is 75 % of the costs of procedures for which the fund has made an advance decision. The maximum amount of compensation is 1500 euros per calendar year. 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 on 31.12.2022 or before: 

The compensation for laboratory examinations, X-ray examinations, magnetic resonance imaging and ultrasound examinations performed based on a referral from a doctor is 75% if such examinations are also eligible for reimbursements from Kela.

75 % compensation includes Kela compensation.

Compensation is not paid for ultrasound examinations during pregnancy.

A referral from a specialist is required for magnetic resonance imaging.

 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, Kela’s Compensation application and doctor’s referral (SV 3) are also required.

 

Examinations on 1.1.2023 or after:

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 1000 euros in a calendar year.

Attachments to the compensation application:

– A doctor’s referral
– 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.

Applying for compensation

Compensation must be applied for within six months of paying the fees.

The application can be sent online or by regular mail: 

1.e-Service called Iris

You can log in to the service from this link Omasairauskassa or enerkemi.omasairauskassa.fi. After logging in you can choose English version from the upper right corner. By going to “Own information” on the left, you can select English as your language.

If you are a new Iris user, you must first agree to the electronic processing of your own data. Go to enerkemi.omasairauskassa.fi and log in to the service with Suomi.fi IDs.

You will not be able to make a claim until you have received a notification in your email that you have joined the service. You will receive a subscription message within 1-2 working days after we have activated your username.

You can use Iris with all the most common browsers. We recommend that you use the latest versions of supported browsers. The service works best with Mozilla Firefox. Avoid using the service with Internet Explorer (IE).

2 Sending application by regular mail

Applications can be mailed to the fund to the following address: Vakuutuskassa Enerkemi, P.O. Box 100, 00048 Fortum

Other considerations:

The attachments required for a compensation application are listed under Expenses to be compensated for on the fund’s website.

If the benefit you applied for is Kela reimbursable, you will receive two separate decisions, one concerning reimbursements from Kela and one concerning additional compensation paid by the fund.

If your service provider is not our contract partner, you can allow the Kela compensation to be deducted by the service provider. After this you can apply for additional compensation from the fund.

Through Iris it is not possible to apply for compensation for private medical fees if they are Kela-reimbursable and the Kela compensation has not already been deducted. The application must then be made through  OmaKela. Application instructions can be found on Kela’s website. 

Appeal against the decision

Paragraphs 14-17 of the fund’s rules describe the compensations by the fund and its limitations. If you want to appeal against the decision, you will find the guide here.

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