- What is the procedure for reimbursing treatment costs to the patient?
Treatment costs are reimbursed in a variety of ways depending on whether or not you have travelled abroad to seek treatment or have required medically necessary treatment during your stay abroad (you have suddenly fallen ill during a holiday trip, for example). Only the costs of treatment included in the Finnish health care service selection can be reimbursed. The expenses can be reimbursed retroactively, but you must first pay them yourself.
EU and EEC countries and Switzerland
a) If you sought treatment abroad independently, you can receive reimbursements in the same way as for Finnish private medical treatment.
b) If you require medically necessary treatment during your temporary stay abroad due to sudden illness, for example, you must be provided with the treatment you need upon presenting the European Health Insurance Card. However, if you have paid the costs yourself, you can be reimbursed retroactively in Finland up to the sum that would have been incurred by your municipality of residence had it provided the same treatment. In this case the reference price is the cost of the treatment in public health care in the patient’s municipality of residence. If the treatment received abroad has been more expensive than it would have been in Finnish public health care, you must pay the excess amount yourself.
If you apply for retroactive reimbursement, you can also choose to receive reimbursement in accordance with the legislation of the country that provided the treatment. In this case, Kela will enquire about the amount of the reimbursement from the country in question. The reimbursement may be higher or lower than the reimbursement prescribed by Finnish legislation. It is possible to provide detailed information on the reimbursement legislation and reimbursement sums of other countries.
c) If you have been granted prior authorisation (form S2) for treatment in another EU or EEC country or Switzerland, you will only need to pay the client fee charged in the country providing the treatment. If, despite the prior authorisation granted, you need to pay the real expenses of the treatment, Kela will find out how much reimbursement is paid for the treatment in the country giving the treatment and in Finland. The higher of the two reimbursements will be paid. Expenses will also be reimbursed in a similar fashion in situations where you apply for a prior authorisation after the treatment has been given, and the authorisation is granted.
a) If you have required treatment in a country other than an EU or EEC country or Switzerland, you can be reimbursed for the treatment costs in accordance with the Health Insurance Act in the same way as if you had used private health care service in Finland. You can apply for reimbursement retrospectively from Kela on form SV 128. Travel costs will not be reimbursed.
b) If you seek treatment in a country other than an EU or EEC country or Switzerland, you cannot receive Kela reimbursements for the treatment costs.
- What is the procedure for reimbursing the costs of travel and overnight accommodation?
You are usually required to first pay for the costs of travel and overnight accommodation abroad yourself. Kela will reimburse some of the costs retroactively if certain requirements are met.
EU and EEC countries and Switzerland
If you suddenly fall ill in another EU or EEC country or Switzerland, travel costs will be reimbursed,
in accordance with the pricing of mode of transport deemed necessary, to the nearest local treatment facility where it would have been possible for you to be examined and treated. The costs of the part of travel that took place in Finland will be reimbursed, in accordance with the pricing of mode of transport deemed necessary, from a domestic airport, harbour or national border to the nearest treatment facility where it would have been possible for you to be examined and treated.
If you have sought treatment in another EU or EEC country or Switzerland, the travel costs will be reimbursed in the same way as if you had travelled to the nearest Finnish health care unit where it would have been possible for you to be examined and treated.
The costs of travel and accommodation will be reimbursed up to the place of treatment in another EU or EEC country or Switzerland if Kela has granted you prior authorisation (form S2) for treatment abroad
or if public health care organises your treatment abroad as a purchased service.
You can be reimbursed for additional costs arising from the return trip if you fall in during your stay in another Nordic country and you need to use a more expensive mode of travel for your return than you originally planned. Primarily, the reimbursement should be applied before your travel from the country where you were treated.
Travel costs are not reimbursed if they are incurred in a country other than an EU or EEC country or Switzerland.
- Are the costs of orthodontic treatment provided abroad reimbursed?
Orthodontic procedures are reimbursed based on the Health Insurance Act if they are necessary in order to treat a disease other than a dental disease. Reimbursement for orthodontic treatment provided abroad can be applied for on form SV 128.
- What will Kela reimburse and how much if, for example, I want to go to Tallinn for a €1,500 shoulder operation or dental procedure performed under anaesthesia.
If you seek treatment in Tallinn, the costs are reimbursed in accordance with the Health Insurance Act as reimbursements for medical treatment. In other words, you can receive the same reimbursement you would if you were to use private health care services in Finland. The amounts of health care reimbursements vary according to procedure. You can read about the rates of reimbursements for medical treatment in Kela’s website (in Finnish).
If you have been granted prior authorisation (form S2), your entitlement to reimbursement is different.
- Can I receive reimbursement for medicines purchased abroad that are eligible for special reimbursement?
If you have a valid right to special reimbursement for a medicine, the reimbursement will also be paid for medication purchased abroad. The requirement is that the corresponding medicinal product has been approved for special reimbursement in Finland.
- Are the costs of assistive devices reimbursed if they are incurred abroad?
If you have travelled abroad from Finland to seek treatment and you incur costs due to assistive devices, these costs will not be reimbursed under the Health Insurance Act or any other legislation.
If you are temporarily staying in another EU or EEC country or Switzerland you must be provided with the medically necessary assistive device upon presenting your European Health Insurance Card. For example, if you break your leg and need crutches, you should receive them by presenting your European Health Insurance Card.
- Who is responsible for repairing the assistive device and covering the resulting costs if an expensive device, such as a wheelchair, breaks abroad?
If an assistive device you are using breaks abroad, you are responsible for the repair and the resulting costs. After returning to Finland, you are entitled to receive an undamaged device as a replacement. If you would like to receive a new device abroad, you must arrange the delivery and cover the costs yourself.
Kela or public health care is not obliged to contribute to the costs of the maintenance or repair of an assistive device or participate in arranging the repair if these services are not arranged in the country where you are staying under the privileges afforded by the European Health Insurance Card.
- How long have the costs of medical care abroad been reimbursed?
Kela has reimbursed medical treatment costs incurred abroad for those covered by the Finnish health insurance scheme since 2004 in cases where the person in question independently travels to another EU or EEC country or Switzerland to seek treatment. The costs of emergency treatment were reimbursed long before that. On the basis of the Health Insurance Act, reimbursements have been paid for doctor’s and dentist’s fees, examination and treatment expenses, and medicines.
The Act on Cross-Border Health Care came into force in 2014. Pursuant to the Act, the reimbursements differ when a patient falls suddenly ill abroad and when the patient has independently travelled abroad to seek treatment. The reimbursements also vary depending on whether the costs have been incurred in another EU or EEC country or Switzerland, or outside Europe.
- What is the percentage of the Kela reimbursement for treatment costs incurred abroad
Generally speaking, the reimbursement for medical treatment are about 20–30% of the doctor’s fees and examination and treatment costs at the Finnish price level. The portion of the reimbursement may be lower or higher in some areas.
On average, the reimbursements calculated based on public health care costs are higher. Statistical information on the reimbursements is currently unavailable.
- Why do I first have to pay the treatment costs abroad and apply for the reimbursement later? Why has a payment commitment model not been put in place?
According to the Patient Directive, the patient must first pay for all costs of the treatment him/herself. Reimbursement is provided later by the country responsible for his/her health care costs.
The health care service providers can vary between countries. Not all service providers are covered by the statutory reimbursement system. For this reason, countries do not reimburse each other directly for costs incurred when patients seek treatment abroad. The reimbursement is always determined based on each respective patient’s payment, in accordance with the legislation of the country responsible for the reimbursement.