Tradeka’s sickness fund only reimburses services provided by an occupational health care service provider, i.e. Terveystalo, and public health care services. The reimbursement is 80% of the doctor’s fee. Terveystalo does not charge you with an office fee.
The fund reimburses a maximum of eight visits at Terveystalo over a calendar year, including visits to an ophthalmologist and a gynaecologist. There is no limit for public health care services, so you may visit your local health centre as much as you need to.
The fund has a direct reimbursement agreement with Terveystalo, meaning that you only pay the copayment. Terveystalo will charge the rest from the fund.
After a year’s membership, the sickness fund will also reimburse your dental care. The maximum reimbursement for dental care is 500 euros per calendar year. You may choose your own dentist. Terveystalo and Oral have a direct reimbursement agreement with the fund, so you only pay the copayment at these locations.
Hospital and health centre fees
The fund reimburses 80% of outpatient clinic fees, 80% of outpatient surgery fees, and 80% of health centre visit fees.
Daily hospital/health centre care fee reimbursement is 80%. However, the maximum reimbursement for a daily hospital fee is €34/day for a maximum of 60 days in a calendar year.
Treatment and care
The fund reimburses 80% of prescribed laboratory tests and radiology exams provided by an occupational health care service provider, i.e. Terveystalo, and public health care services, provided that the related examination or treatment is reimbursable according to the Health Insurance Act.
Magnetic tests require a specialist referral and other imaging tests (such as x-rays and ultras) require regular referrals. Laboratory tests also require a referral, and they must be reimbursable by Kela. Kela does not provide reimbursements for laboratory test packages.
For cancer treatments, the sickness fund only reimburses costs accumulated through public health care services.
The sickness fund reimburses 80% of prescribed medicine, excluding the €50 copayment. This means that you are liable for the €50 copayment, and the fund reimbursement applies for the exceeding amount. A direct reimbursement is applied when you use your Kela card labelled with the sickness fund ID. The pharmacy then charges you only for the 20% copayment. The sickness fund has a direct reimbursement agreement with over 800 pharmacies.
The fund also provides a special rate of reimbursement if a fund member is entitled to such medicine. The lower special rate is 80% of purchased medicine. The higher special rate is 100% of purchased medicine for the amount exceeding €4.50.
After medicine purchases have exceeded the annual copayment limit, all medicine is fully reimbursed for the amount exceeding the €2.50 copayment.
Short-term psychotherapy and rehabilitative psychotherapy
The fund reimburses 80% of short-term psychotherapy and rehabilitative psychotherapy prescribed by a psychiatrist and for psychologist’s treatment and examination prescribed by a doctor. The maximum for such reimbursements is €1,000 per calendar year.
You can book a psychiatrist’s appointment at Terveystalo or with public health care services. When you have your referral, you can book an appointment for short-term psychotherapy at any therapist. The sickness fund has a direct reimbursement agreement with Terveystalo, meaning that you only pay the copayment.
The fund reimburses 80% of prescribed physiotherapy and physiotherapeutic examinations, provided that the therapy or the exams are reimbursable by Kela. The maximum reimbursement is 375 euros per calendar year.
Physiotherapy requires a referral. Once you have it, you may choose any physiotherapist you wish. The sickness fund has a direct reimbursement agreement with Auron Oy, meaning that you only pay the copayment if you use their services. When using other providers, you first pay for the treatment yourself.
When you feel it is time to start using arch supports, have a doctor refer you to an expert physiotherapist. The sickness fund compensates 40% or up to 30 euros over two calendar years. In other words, the maximum reimbursement is €30 every other year.
Spectacles and contact lenses
After a year’s membership, the fund reimburses 80% of spectacle or contact lense costs. However, the maximum reimbursement is 250 euros per two calendar years, i.e. every other year.
What is not reimbursed?
The fund does not reimburse the following treatments and procedures:
- assisted reproductive technology, or fertility treatment, and related medicine
- institutional and surgical theatre fees
- treatments by chiropractors, osteopaths, and massage therapists
If your sick leave lasts over 10 days, your employer will apply for a sickness allowance. If your sick leave is unpaid, please submit a sickness allowance claim at Kela’s online service.
Birth of a child
The sickness fund handles applications for maternal, paternal, and parental leave allowances, including for pregnancy, labour, and adoption, according to the Health Insurance Act.
Maternal, paternal, and parental leave are regulated in the Employment Contracts Act. According to the act, parents are entitled to childcare leave. No additional fund benefits are paid during childcare leave.
The fund processes maternal, paternal, and parental allowance applications and any special rate treatment applications for its members. Submit your applications at Kela’s online service (www.kela.fi/asiointi).
If you have any questions related to allowances and applying for them, the sickness fund will be glad to help.
If a member dies, the fund pays out a €1,700 funeral allowance. The fund submits the application and the instructions to the estate.
For health care, any necessary travel expenses are reimbursed for a one-way trip for the amount exceeding 25 euros. The reimbursement for using your own car is €0.20/km. The copayment for travel expenses is €300 per calendar year. Any exceeding amount is reimbursed by Kela in full.
For more information on reimbursable travel, please see Kela’s website (https://www.kela.fi/matkat).
Travel expenses require a specific application (SV4) that should be submitted at Kela’s online service. In addition, you must present a certificate or other report on the treatment in question.
The fund reimburses 80% of the office fees at treatment and care facilities. Terveystalo does not charge you with an office fee.
The payment dates for sickness allowances, parental leave allowances, and health care allowances are provided in the Kela decision.
The fund pays any additional benefits as soon as possible once the application and the relevant appendices have been processed.