Insurance charge and membership
Fund membership fee 31 euros per month and the membership is obligatory for all employees working in the companies within the operation area of this Sickness Fund.
It is possible for the insured employee to stay a retired member of the Fund, in case he has been a member of the Sickness Fund for 10 years before retirement or in case he has paid 10 years' membership fees to the Fund.
The membership in the Sickness Fund will be terminated simultaneously with the termination of the employment.
The family members do not belong to the operation area of the Sickness Fund.
Functions related to the National Health Insurance (NHI)
The members are entitled to get, according to the National Health Insurance and regulations given by the Act itself:
- on basis fo an illness, reimbursement for the expenses caused by the treatment of this illness;
- daily allowance for the disability caused by an illness;
- reimbursement for the necessary costs caused by pregnancy and birth;
- maternity-, paternity- and parental allowance and special maternity allowance;
- special care allowance;
- daily allowance meant in Infectious Disease Act, 27 §, and reimbursement for loss of earnings; and
- daily allowance for detachment of human organs and tissues for medical use according to the given law, 11 §.
How to apply
Compensation for medical expenses must be applied for within six (6) months of payment. Fill in the claim form 'Medical care expenses incurred in Finland' (SV 127e). Remember to fill in your account number on each application -form. Enclose with the claim forms filled out by the treatment provider which indicate the treatment given by a doctor or the examination or treatment ordered by a doctor. Mail the claim along with the supporting documents to sickness fund.
Additional reimbursements in accordance with the rules
The Sickness Fund will reimburse costs caused by the necessary treatment to the member who due to illness, pregnancy or birth must turn to a doctor or some other person with required education.
Following costs will be reimbursed: (The reimbursement includes also the payments according to the National Health Insurance)
- 80 percent for the doctor's fees when reimbursement has been received also by virtue of the National Health Insurance, in case of necessary treatment of other than dental illness. However, the fees charges for an operation or procedures comparable to it will not be reimbursed unless the board in each individual case considers reasonable to accept the reimbursement wholly or partly;
- Fees that have been charged for non-institutional care in municipal health center, expect dental care, hospital outpatient clinic fee and charges from day surgery, up to the maximun amounts given in the statute (912/1992) about fees in social welfare and health care;
- Hospital and municipal health center bed-day charges up to the amounts defined in the lowest payment categories of a central hospital (except psychiatric units) and for maximum 30 days during the calendar year;
- The basic fee for institutional care, charged by a hospital;
- Bed-day charges of a rehabilitation center up to the maximum amounts mentioned above, in case that the board in each individual case considers reasonable to agree to it;
- Special fees of a public hospital and fees of a private hospital are reimbursable wholly or partly, if the board in each individual case considers reasonable to agree to it;
- 80 percent for medicines prescribed by a doctor, for clinical nutrients and corresponding products as well as for ointment bases, when reimbursement has been given also by virtue of the National Health Insurance;
- 80 percent for disinfectants and bandages prescribed by a doctor;
- 80 percent for laboratory examinations, pathological examinations and samplings, radiological examinations and procedures, for costs of chemotherapy, dialysis, all those prescribed by a doctor, in case that the examinations and treatments also are reimbursable by virtue of the National Health Insurance;
- 60 percent for physiotherapy, physiotherapeutical examinations, lymph therapy and phototherapy, in case that the examinations and treatments also are reimbursable by virtue of the National Health Insurance;
- 80 percent for laboratory and radiological examination costs, in case they are reimbursable by National Health Insurance but the costs are under the co-payment limit or the examinations have been made in a municipal health center or at a hospital;
- 60 percent for chiropractor, osteopath and naprapath treatment costs and prescribed by a doctor;
- Necessary travel costs, using the least expensive mode of transportation, arising from treatment or acquisition or maintenance of technical aid for rehabilitation, prescribed by a doctor, if another transportation is not justified in light of the illness or traffic conditions. These must also be reimbursable by virtue of the National Health Insurance;
- In case of death of the member, a funeral allowance of 520 euros will be granted.
Decisions issued by National Health Insurance can be appealed. The appeal must be lodged within 30 days of receiving the written decision. The member must deliver the appeal to the Sickness Fund.
The member who is dissatisfied with the additional reimbursement decision can ask for a decision advice from the Insurance Fund Committee meant in Incurance Fund Act §169. The Committee works under the Association of Insurance Funds in Helsinki.
Places where the member can get services at co-payment price
by presenting the kela card;