THE FUND REIMBURSES

The Fund reimburses expenses arising from necessary treatment for an insured person who, due to illness, pregnancy, or childbirth, must seek the care of a doctor or another appropriately trained professional.

Expenses paid with E-pass or other employee well-being payment methods cannot be reimbursed by the health fund.

File your claim within 6 months of the original expense.

If you are unsure, please confirm the reimbursability with the Fund’s office.

The Sickness Fund has signed a direct compensation agreement with:

  • Pharmacies in Vaasa and its nearby region,
  • Yliopiston Apteekki pharmacies (detailed list on the Fund’s website)
  • Mehiläinen throughout Finland
  • Terveystalo, throughout Finland
  • SynLab, throughout Finland

Always present your KELA-card when visiting these places. If you do not present your KELA-card, you must pay the entirety of the fees yourself. The service providers are NOT ALLOWED to deduct the KELA-reimbursement.

DOCTOR´S FEES
  • 100% of doctors’ fees

-excluding dentists’ fees and fees for surgery or a similar procedure performed in a private health clinic.

  • 100% of Kela-reimbursed medicine, clinical nutrients, any equivalent products and emollient creams prescribed by a doctor.
  • Prescription drug costs included in the initial deductible are also reimbursed, even if no reimbursements are made under the Health Insurance Act.

Examinations prescribed by a doctor:

  • Laboratory and pathology 100%
  • X-ray 100% 
  • ultrasound examinations 100%
  • MRI scans and other radiological examinations, that aren’t mentioned above 70%
  • Neuropsychological examinations 50 %.
  • Hospital fees 100%
  • Outpatient clinic, day surgery and daily hospital fees (max. 180 days per member).
  • Health center fees 100%
  • Annual fees, appointment fees and daily hospital fees

WITH DOCTOR´S REFERRAL 70%:

  • Physiotherapy
  • Massage
  • Naprapathy
  • Osteopathy 
  • Chiropractic treatments 
  • Chiropody treatments provided by a podiatrist
  • 20 treatment sessions per calendar year
  • Psychotherapy 100% (reimbursed by Kela)
  • Copayment of psychotherapy sessions reimbursed by Kela
  • Travel expenses reimbursed by Kela 100%
  • the nearest place of care using the cheapest means of transport. Travel costs by special means of transport are reimbursed if they are necessary due to the nature of the illness or the traffic conditions. The need for special transport must be certified by a doctor or hospital. Always order a taxi for a journey reimbursed by kela from a specific regional phone number, learn more https://www.kela.fi/transport-by-taxi
  • Accommodation costs reimbursed by Kela 100%
  • only accommodation allowance as specified in the Health Insurance Act is reimbursed, and this applies if the member has had to stay overnight in an accommodation establishment or in accommodation provided for patients by a medical or research institution during a reimbursable trip.
  • Facility fees max. €200 per reimbursement (private health clinics).
  • Office fees will NOT be reimbursed.
  • Medical aids prescribed by a doctor max. €170 per reimbursement
  • Dressings, support equipment and prostheses

AFTER ONE YEAR OF MEMBERSHIP:

  • Up to a maximum of €450 for the cost of dental care over two years.
  • ATTENTION! A member shall pay for the treatment received in full and then apply for reimbursement from the sickness fund.

AFTER FIVE YEARS OF MEMBERSHIP:

  • Up to a maximum of €550 over five years for the cost of dentures or their repair.
  • ATTENTION! A member shall pay for the treatment received in full and then apply for reimbursement from the sickness fund.

 

AFTER ONE YEAR OF MEMBERSHIP: 

  • Eyeglasses or contact lenses €450 over two years
  • or for laser eye surgery, up to a maximum of €900 (2×450) per reimbursement, provided that spectacles are not replaced for five years after the operation.
  • ATTENTION! A member shall pay for the eyeglasses, contact lenses or vision correction surgery in full and then apply for reimbursement from the sickness fund.
  • Eye test by an optician 100%

DENTAL CARE:

  • For a pensioner, the reimbursement is €225 over two years

EYEGLASSES:

  • For a pensioner, the reimbursement is €225 over two years
  • or €450 for eye surgery under the same terms and conditions as for other fund members.

PHYSIO TERAPHY, MASSAGE ETC. WITH A DOCTOR´S REFERRAL:

  • Physiotherapy 50%
  • Massage 50%
  • Naprapathy 50%
  • Osteopathy 50%
  • Chiropractic treatments 50%
  • Chiropody treatments provided by a podiatrist 50%
  • 20 treatment sessions per calendar year

Expenses from private medical clinics are not reimbursed for pensioners.

However, the Fund’s board has deemed it reasonable to agree to reimburse the following medical fees:

  • ophthalmologist
  • urologist
  • gynecologist

Insured persons who receive both salary and pension simultaneously are regarded, in matters of supplementary benefits, as being equivalent to those in active employment.

  • Fund member’s funeral allowance for relatives/estate €1,010.
  • The Fund may also reimburse other medication expenses, either in full or in part, if the board deems it reasonable to approve them on a case-by-case basis.

According to the Fund’s rules, reimbursable examinations and treatment procedures must be provided by a health care professional who is registered in the Central Register of Health Care Professionals maintained by the Finnish National Authority for Medicolegal Affairs, or the procedures and treatments must be performed at such a unit providing private health care services as referred to in Chapter 3 Section 3 Paragraph 1 of the Health Insurance Act.