Compensation is paid for the following:

  • costs of treatment deemed necessary by a health care professional
  • costs of basic health care and specialised medical care
  • services free of charge to the patient, such as maternity and child health clinic services and health centre doctor’s appointments of persons under 18 years old

The compensation cannot exceed the amount of the costs arising from providing the service, less the client fees charged to the person in question.

Costs that are compensated

Kela pays state compensation for treatment costs when the patient in question has presented the treatment provider with a valid certificate of right to treatment, such as

  • a European Health Insurance Card granted by another country or a certificate that can serve as a temporary substitute for it
  • prior authorisation (form E 112 or S2) to seek treatment granted by another country
  • a European Health Insurance Card for pensioners with a lime green back
  • a certificate of entitlement to medical care in Finland granted by Kela
  • a passport of another Nordic country, United Kingdom or Australia

State compensation is also paid for costs when emergency treatment has been provided to persons who do not have a municipality of residence in Finland. This requires that the costs have not been charged to the persons themselves or another party, such as a travel insurance company or other private insurance provider.

State compensation is paid for the hospital transfer of registered patients in Finnish public health care in the following cases:

  • Another EU or EEC country or Switzerland is responsible for the patient’s treatment costs and he/she is transferred from one public health care unit to another in Finland.
  • The patient lives in another Nordic country and he/she is transferred to the country of residences for further treatment.

As regards purchased services, the payment of state compensation may be possible if a public health care provider has purchased the treatment from a Finnish private service provider or a service provider operating in another EU or EEC country or Switzerland. The precondition for this is that the treatment costs of the patient in question are eligible for state compensation.

State compensation is paid for the costs of interpretation arranged for a patient in treatment if a health care professional in public health care has deemed it necessary.

Costs that are not compensated

Kela pays state compensation for the following costs:

  • client fees
  • overuse fees
  • translation costs of documents
  • transport costs when a patient is not registered in a treatment facility
  • costs of hospital transfers abroad (with the exception of hospital transfer to another Nordic country)
  • costs of prehospital emergency care when the service has been purchased from a private service provider or rescue service
  • treatment costs when the person in question has sought treatment in Finland without prior authorisation (form E 112 or S2) from another EU or EEC country or Switzerland – this also includes interpretation costs

Applying for state compensation

State compensation can be applied for from Kela on form Y 31. The compensation must be applied for within 12 months of the end of the month during which the costs were incurred.

A copy of the person’s certificate of right to treatment must be appended to the state compensation application. A certificate of right to treatment is not required in the case of emergency treatment.

Kela’s Centre for International Affairs provides information on state compensation through a telephone helpline for authorities.

Appealing a Kela decision

A municipality or joint municipal authority can appeal a Kela decision on state compensation with the Social Security Appeal Board and further with the Insurance Court.