Staying in Finland: Visitor entitlements under European Health Insurance Card - Outline of Finnish health care system

Transcription

1 Kansaneläkelaits Health Department Staying in Finland: Visitr entitlements under Eurpean Health Insurance Card - Outline f Finnish health care system Health care in Finland is mainly prvided n the basis f residence and is primarily financed with general tax revenues. There are bth public- and private-sectr prviders. Primary health care services are the respnsibility f municipalities and are generally prvided thrugh lcal health centres. In the Åland Islands the prvince f Åland is respnsible fr rganising the health care services. Each municipality has a health centre, with the exceptin f sme small municipalities, which may share resurces with a neighburing municipality. The health centres prvide residents with physician, dental, labratry and radigraphic services. The municipalities wn and perate almst all f the hspitals. In additin there are a few private hspitals. Private-sectr services, which mainly prvide ut-patient care, cmplement the public services. The private sectr als cmprises a few hspitals, rehabilitatin facilities as well as all pharmacies with the exceptin f thse perating in cnjunctin with a general hspital. Patients wh use private-sectr services pay the entire cst f the service t the prvider, after which they can apply fr reimbursement frm Kansaneläkelaits/Flkpensinsanstalten (Kela/FPA) under the Health Insurance Act. This pint is addressed in mre detail at sectin 6 belw. The fllwing is a shrt descriptin f hw EU visitrs can receive medical benefits during a temprary stay in Finland (situatin as in February 2015). In the case f emergency, the number t call is Where t get infrmatin Infrmatin n hw t receive necessary medical benefits in Finland is available n the Internet r ssiaali ja terveys r frm the lcal ffices f Kansaneläkelaits / Flkpensinsanstalten (the latter name is the Swedish equivalent; as Finland has tw fficial languages; the Swedish name is used exclusively in certain regins). A widely used Finnish acrnym is Kela, while FPA is used in the Swedish-speaking and bilingual cmmunities. 2. Hw t find a dctr Patients can cntact a municipal health centre, where health-care prfessinals will assess the need fr medical care accrding t natinal instructins and treatment practices. Patients have t prve their right t benefits by presenting a valid Eurpean Health Insurance Card. Patients may be asked t prve their identity with the passprt r ther travel dcument. Sme health centre services are by law free f charge, but the health centres may charge fr certain services. This varies frm ne municipality t anther. Fr a visit t a dctr (including labratry and X-ray services), the health centre usually charges EUR 16,10 32,10. Persns under 18 are nt charged this fee. Pstisite Käyntisite 1 (5) PL 78 Höyläämötie 1 a B Helsinki Helsinki Puhelin Faksi etunimi.sukunimi@kela.fi

2 Patients can als cntact private physicians, in which case they pay the full fee. Please see sectin 6 fr infrmatin n reimbursements f dctrs' fees. 3. Hw t find a dentist In the event f an urgent need f treatment, patients can cntact the dentist n call at the lcal health centre. A valid Eurpean Health Insurance Card must be presented. Patients may be asked t prve their identity with the passprt r ther travel dcument. The health centre will charge the patient the relevant c-payments (cst-sharing by the patient) accrding t a fixed scale f charges (usually less than EUR 80). Persns under age 18 receive dental services free f charge. It shuld be nted that nt all health centres maintain a 24-hur dental service. Patients can als cntact private dentists, in which case they pay the full fee. Fr reimbursement, see sectin Hw t get medicatin Patients can btain the medicatin prescribed by a dctr r dentist frm any pharmacy. The full price f the medicine must be paid at the pharmacy. The patient gets a receipt, which can be used t btain a reimbursement (details in sectin 6). 5. Hw t get hspital treatment Hspitals require a referral frm a physician in rder t admit a patient. Hwever, in emergencies patients can cntact a hspital directly. A valid Eurpean Health Insurance Card must be presented in rder t get the medical benefits t which residents are entitled in a public hspital. Patients may be asked t present their passprt r ther travel dcument as prf f identity. The charge fr hspital bed-day inpatient care is EUR 38,10. Persns under age 18 need nt pay the daily charge fr mre than seven days within a calendar year. The charge fr hspital ut-patient care is EUR 32,10. The charge fr day surgery is EUR 105,50. If a persn is admitted int a private hspital, the patient must pay all csts, but a reimbursement can be claimed frm a lcal ffice f Kela/FPA. It shuld be nted that n reimbursement is awarded in respect f the basic daily charge. Fr mre infrmatin n reimbursements, see the fllwing sectin. 6. Hw t get reimbursements in Finland If services are btained frm a private dctr r dentist, the patient must at first pay the full fee charged. If the fee is paid directly t the dctr r dentist (i.e., nt t a bank accunt), the patient gets an itemized and receipted statement f fees. Otherwise the receipt that the patient btains when paying the fee must be attached t the fee statement when claiming a reimbursement. The dctr may refer the patient t a private clinic fr examinatins such as labratry tests r X-rays, in which case the patient pays the full charge fr the examinatins and gets a receipt. The patient shuld then bring r pst the receipts, the statements, the valid Eurpean Health Insurance 2 (5)

3 Card frm and any ther relevant dcuments t a lcal ffice f Kela/FPA. The ffice addresses can be fund in the phne bk r n the Internet at The patient may be asked t present his/her passprt r ther travel dcument as prf f identity at the lcal ffice f Kela/FPA. There is an applicatin n the reverse side f the dctr's statement f fees which the patient must cmplete, r at least write dwn his/her permanent address and the current date, as well as prvide infrmatin abut his/her bank accunt (name f the bank, its address and SWIFT cde, accunt number including IBAN/BIC), and then sign the applicatin. It is als pssible t send the dcuments alng with the cpy f the Eurpean Health Insurance Card by pst t the lcal Kela/FPA ffice. Kela/FPA will pay the reimbursement int a bank accunt. Reimbursement must be claimed within six mnths f the riginal expenditure. N reimbursement is awarded fr the c-payments charged by public health care prviders. Kela/FPA will pay a reimbursement accrding t the fllwing rules. The applicable tariffs can be fund n Kela s website (in Finnish). Dctr s fees Dental care Kela reimburses part f the private dctr's fees accrding t a schedule f fixed charges (in Finnish). The reimbursable fee specified in schedule f fixed charges is ften smaller than the fee actually charged by the dctr. Reimbursements are available fr the cst f dental and ral treatment prvided by a dentist in private practice, treatment prvided by dental hygienist n a dentist s referral, the cst f labratry and radilgy tests prescribed by a dentist, and the cst f travel required t btain dental treatment. Kela reimburses private dentists' fees accrding t a schedule f fixed charges (in Finnish). Csts fr ral and dental examinatins can be reimbursed nce per calendar year. Csts fr labratry and radilgy tests prescribed by a dentist reimburses accrding t a schedule f fixed charges (in Finnish). N reimbursement is available fr the fllwing items: dental care btained frm public-sectr prviders prsthetic prcedures such as the manufacture r repair f remvable dentures dental crwns, bridges r implants (exceptin: frnt-veterans and mine clearance wrkers) the services f a dental technician (exceptin: frnt-veterans and mine clearance wrkers) rthdntic prcedures (can be reimbursed under special circumstances) perids in which yu are being treated in a public hspital r institutin. 3 (5)

4 Examinatin and treatment charges The csts f examinatins and treatments prescribed by a dctr in private practice reimburses accrding t a schedule f fixed charges (in Finnish). The reimbursable fee specified in the schedule f fixed charges is ften smaller than the fee actually charged by the dctr. Reimbursements are available fr examinatins and treatments t which yu are referred t by a private dctr. These include labratry and radilgy tests psychlgical evaluatins medical treatment chemtherapy physical therapy. The treatment must be medically necessary and prvided within 12 mnths f when the dctr gave yu the referral. If yur dctr refers yu t a series f treatments, yu can be reimbursed fr up t 15 sessins. Medicine expenses Travel csts The cst f drugs prescribed fr use in the treatment f an illness is reimbursed in full r in part. The basic rate f reimbursement applies t the majrity f drugs, which means that the reimbursement is 35% f the csts f the reimbursable prduct prescribed by a dctr. In severe and lng-term diseases a number f listed drugs qualify fr reimbursements f 65% f the csts r fr reimbursements f 100% f the csts exceeding EUR 3 per drug. If the drug belngs t the reference price system the reimbursement price fr the drug is the reference price. The excess f the reference is paid by the patient. If the patient's wn csts fr reimbursable drugs during ne calendar year exceed EUR 612,62 the excess f EUR 1.50 per drug is reimbursed. N reimbursements are available fr nnprescriptin medicines r fr certain pharmaceuticals withdrawn frm the reimbursement scheme. Travel csts incurred while seeking treatment (frm the nearest prvider) are reimbursed. If an ambulance has been used, a medical certificate prviding the need fr special transprtatin must be presented. The patient s c-payment is EUR 16 per ne-way trip. Exceeding csts are reimbursed. Kela tracks patients annual ut-f-pcket travel csts. Once the patient reaches the maximum limit f EUR 272 he/she will receive a card stating that he/she has reached the ut-f-pcket maximum. By presenting the card t the driver, the patient can travel free f charge if the transprt prvider has a cntract with Kela. If the patient pays fr the trip, he/she can claim reimbursement frm Kela afterwards. 4 (5)

5 7. Certain treatments must be pre-arranged befre arriving in Finland If yu need dialysis r xygen therapy during yur stay in Finland, yu r yur health care institutin must arrange the treatment with a relevant hspital befre cming t Finland. Hspital cntact infrmatin is available n the Internet ( Mst but nt all hspitals n the list prvide xygen therapy and dialysis. If the hspital des nt prvide such service, it can infrm yu where treatment is available. 5 (5)