You should find out in advance the possibility to use prior authorisation from the potential treatment provider. As a general rule, prior authorisation can be used in the public healthcare system of another EU or EEA country or of Switzerland.
A prior authorisation consists of a paper form with the code S2. The form has been translated into the official languages of the EU countries, and it is filled out by the authority responsible for granting authorisation.
Granting or denial of prior authorisation
The criteria for granting prior authorisation or the possibility to deny authorisation are laid down in EU legislation. When deciding on prior authorisation, the applicant´s health status and the likely course of the illness are always taken into consideration.
Kela must grant prior authorisation if the following conditions are met:
- Your treatment need is medically justified
- In Finland, you would be entitled to the treatment in question within the public healthcare system
- The public healthcare provider is unable to arrange for treatment within a medically justifiable time period.
Prior authorisation can be denied if the treatment is not available in the public healthcare system, or if the public healthcare system can arrange or provide the treatment or equivalent care in Finland within a medically justifiable time period.
If you have been granted prior authorisation for treatment in another EU or EEA country or in Switzerland, you will pay the same client fee for the treatment as a resident in the country in question. If the treatment provider is not part of the local public healthcare system of the destination country, they cannot, as a rule, approve a prior authorisation.
Applying for prior authorisation
Prior authorisation is always applied for from the authorities of the country of residence. The decision on the application is given by the country responsible for the costs of your treatment.
- If you live in Finland, you can apply to Kela for prior authorisation on form SV 129.
- Attach to the application a medical certificate ‘B’, or other equivalent document provided by a public health professional, such as a copy of your medical history or a free-format statement concerning your state of health.
- Find out in advance whether the treatment provider will accept a prior authorisation (form S2).
The processing time for prior authorisation applications in Kela is appropriately 3–6 weeks. If Kela receives an application for authorisation from the public healthcare system which includes the aforementioned statement, processing time is approximately two weeks.
You can also apply to Kela for prior authorisation retrospectively on form SV 129, if you have received treatment in another EU or EEA country or in Switzerland. Kela will process your application for prior authorisation retroactively in the same way as if you had filed an application before receiving treatment. If authorisation is granted, Kela can reimburse the costs incurred from your treatment up to the amount that equivalent treatment would have cost in your municipality´s public healthcare service. Costs are reimbursed in the same way also in the event that despite prior authorisation, you have to pay the actual costs of treatment yourself.
Decision on prior authorisation
Kela always requests a statement from the public healthcare service responsible for your treatment, i.e. usually the hospital district pursuant to your municipality of residence, for the purpose of making a decision concerning prior authorisation. In the statement, the public healthcare service provides an opinion as to whether the criteria for prior authorisation are fulfilled.
If you do not have a municipality of residence in Finland, Kela will request a statement from the Hospital District of Helsinki and Uusimaa.
The hospital district will assess on a case-by-case basis on medical grounds whether prior authorisation can be granted. The assessment is made on the basis of your medical and application documentation. The assessment takes into consideration, for example, the treatment need, the medical grounds for treatment and the possibilities of arranging treatment in Finland.
Hospital districts have 21 days to provide Kela with a statement. The hospital district´s statement is binding on Kela, which either grants or denies the application on the basis of the statement.
Kela will grant prior authorisation if the hospital district does not provide Kela with a statement within the specified period before the matter is considered.
A doctor operating within the private healthcare sector cannot provide a statement concerning priori authorisation on the basis of which Kela would give a decision. Kela´s decision is always based on a statement issued by a hospital district or another public healthcare organisation. You can, however attach to your application a statement issued by a doctor or other healthcare professional operating in the private healthcare system.
Kela´s decision concerning prior authorisation may be appealed to the Administrative Court of Appeal. Decisions by the Administrative Court of Appeal can be further appealed to the Supreme Administrative Court if the Supreme Administrative Court grants leave to appeal.
If you have received prior authorisation from Kela
Kela will send the favourable decision regarding your application by mail and enclose the prior authorisation (form S2). The prior authorisation will be sent to your home address or to a mailing address you have separately agreed on with Kela.
The prior authorisation consists of a paper form in Finnish or Swedish. The code on a prior authorisation granted by Kela is S2, which is visible in the upper right-hand corner of the form.
Kela has filled in the necessary information in Finnish, Swedish or English. The details of the treatment provider and the date of treatment are included in the prior authorisation.
- If the exact date of treatment is not known, Kela can grant a prior authorisation for a maximum of 12 months ahead.
- If part of your treatment has already been carried out, prior authorisation can be granted for a period back-dated up to six months.
Take the prior authorisation with you to the treatment provider. Treatment is always given in accordance with the legislation and treatment practices of the country providing the treatment.
If you need someone to accompany you on the journey, you will be responsible for their travel arrangement too. If an escort on the journey has been essential, their travel and accommodation costs can be reimbursed retrospectively by Kela. The necessity of an escort must be mentioned in the statement by the public healthcare provider concerning prior authorisation.
If prior authorisation is granted to an under-age child, an escort is always necessary. In such a case, Kela will reimburse the travel and accommodation costs of the escort without separate accounts.
Costs and reimbursements
You pay the same client charge for treatment as a local patient in equivalent circumstances.
If the treatment provider is not part of the local public healthcare system, they cannot, as a rule, approve a prior authorisation. In circumstances such as this, you may have to pay the actual costs of treatment yourself, but you will be able to seek reimbursement retrospectively from Kela by filling out form SV 128.
The actual costs of your treatment under a prior authorisation will be invoiced retrospectively from Kela. Kela will then invoice the costs from the hospital district that issued the statement for your application.
You are responsible for travel and other arrangements relating to treatment as well as for costs arising from these. Kela will reimburse you retrospectively also for the costs of travel, medicines, an escort and accommodation. You can apply retrospectively for reimbursements from Kela on form SV 128 within six months of paying the costs.