Am I eligible to become a sickness fund member?
Tradeka’s sickness fund membership is exclusively for the employers specified in these rules and for their employees. The employers are Osuuskunta Tradeka, Restel Fast Food Oy, Restel Liikenneasemat Oy, Restel Mexican Food Oy, Restel Oy, Restel Ravintolat Oy, Tradeka-sijoitus Oy, Tradeka-Yhtiöt Oy, Lehtipiste Oy, Paletti Oy, Med Group Oy, A-Katsastus Group Oy, A-Katsastus Oy, Ajovarma Oy, Karto Oy ja Putinki Oy.
If you are under an open-ended employment contract, you can become a fund member after a trial period.
If you have a part-time employment contract, your average working time, stated in your contract, must be at least 21 hours/week or 63 hours/three weeks.
If your employment is for a fixed term of over 6 months, you can become a member after a trial period. There is, however, an additional prerequisite: the occupation must be your primary source of income.
Your fund membership ends as you resign from the service of a fund-eligible employer, you retire, or a fund-eligible employer is no longer your primary source of income. Membership fees are not returned.
What is a sickness fund?
Tradeka’s sickness fund is your employment benefit. The sickness fund operates as an employer’s fund regulated by the Health Insurance Act. Among other things, this means that the fund processes applications reimbursed by Kela as set out in the Health Insurance Act. In other words, all your health insurance matters are handled by the fund. It also provides advise for applying benefits.
In addition, the sickness fund provides additional benefits, such as reimbursements for e.g. spectacle purchases and dental care. Please see the Reimbursements page for all benefits.
Is the membership fee charged automatically?
Yes, the fund membership fee is automatically deducted from your salary. The membership fee is 0,75 % of your gross income, or up to 420 euros per calendar year.
For instance, if your gross income is 2,000 euros per month, your membership fee is 15 euros a month, i.e. 180 euros a year.
Besides membership fees, the additional benefits offered by the fund and some of the administrative costs are funded also by employers’ support payments. In addition, as part of the Tradeka group’s corporate responsibility strategy, Tradeka-Yhtiöt Oy also funds the operations by paying a share of all members’ membership fees.
According to fund rules, the board of directors may raise or lower the membership fee for a limited term.
How do I prove I am a fund member?
Your membership is verified with your Kela card.
Kela will send you a new card once you become a member of Tradeka’s sickness fund. The new card includes a fund ID indicating your fund membership.
If your membership ends, Kela will send you a new card again.
What do I do if I become ill?
When you become ill, let your closest supervisor know about it immediately.
Provide proof of sick leave issued by a doctor or an occupational health nurse to your supervisor or the payroll office. Follow your organisation’s instructions.
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. The quickest way to do this is with an online application. You may also pick up a form from a Kela office or from the fund office. Instructions on filling out the form are available at Kela’s website.
If you do not know whether your sick leave is paid, ask your supervisor.
Remember to submit your sickness allowance claim within two months of the start of your illness.
Kela will provide you with a decision that outlines your benefits per the Health Insurance Act. This decision includes the payment dates for sickness allowances, parental leave allowances, and health care allowances. Any additional benefits are paid once your application has been processed by the fund.
When are costs reimbursed?
Reimbursements are paid only for costs accumulated during fund membership. The member is not entitled to fund reimbursements during unpaid leaves, such as job alternation leave, study leave, or childcare leave.
Costs are assumed to be accumulated at the time of treatment or examination. When reviewing annual reimbursement totals, the grounds for compensation are determined by the time of treatment. The time of payment is not relevant.
A reimbursement by the sickness fund requires that you have a medical certificate before seeking treatment or examination. Examination and treatment referrals and referrals to physical therapy are valid for one year. A dentist’s referral to a dental hygienist is valid for two years.
Are there limitations to reimbursements?
No reimbursements are made if a fund member becomes ill during a temporary layoff, stoppage of work (strike), or unpaid leave.
However, the board of directors of the sickness fund may diverge from this with a temporary decision – as it has done during the coronavirus pandemic: fund members that were temporarily laid off were entitled to reimbursements since March 2020 until the end of March 2021.
How do I apply for a reimbursement?
Usually reimbursements require a Kela-approved form filled out by the place of care. However, if the Kela reimbursement has already been deducted, you only need to provide the invoice to the fund.
An invoice from public health care services is also sufficient. Pay the invoice first and then provide it to the sickness fund.
If you submit the form filled out by the place of care, attach a filled-out, signed reimbursement application and a copy of the payment receipt. If you are applying for several reimbursements at once, one application is enough.
Keep the original receipts so you can provide them to the fund if necessary.
Apply for a reimbursement within 6 months of receiving treatment or having an examination done.
You may submit your application
- by e-mail
email@example.com or firstname.lastname@example.org
- by mail
Jaakonkatu 3, 01620 Vantaa
Kela applications via Kela’s online service
Where can I see a doctor?
To be reimbursed for a visit to the doctor or a treatment, you must use services provided by an occupational health care service provider, i.e. Terveystalo, or public health care services. The fund has a direct reimbursement agreement with Terveystalo, meaning that you only pay the copayment. Terveystalo will charge the rest from the fund.
Remember to present your Kela card with the fund ID 48015. Terveystalo does not charge you with an office fee.
How many times a year can I see a doctor?
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.
Are visits to the dentist reimbursed?
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. Terveystalo and Oral will charge the rest from the fund. If you use another dentist, please provide the fund with a Kela-approved form filled out by the place of care. Or, if the Kela reimbursement has already been deducted, you only need to provide an invoice to the fund.
Which medicine is reimbursable?
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.
Does the fund reimburse therapy sessions?
Yes, it does. However, short-term psychotherapy and rehabilitative psychotherapy requires a referral from a psychiatrist. 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. Keep in mind that the sickness fund has a direct reimbursement agreement with Terveystalo, meaning that you only pay the copayment. If you go elsewhere, you need to provide the fund with a referral from a psychiatrist and your paid invoice.
Rehabilitative psychotherapy reimbursement is applied from Kela. Instructions are available at Kela’s website.
Can I make an appointment with a physiotherapist or a massage therapist?
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. Massages are not reimbursed.
Physiotherapy requires a referral. Once you have it, you may choose any physiotherapist you wish. The sickness fund has a direct reimbursement agreement with Fysios Oy, meaning that you only pay the copayment if you use their services. When using other providers, you first pay for the treatment yourself. In this case, please provide the following documents either to the fund or directly to Kela:
- application SV127,
- receipt of payment,
- doctor’s referral, and
- your physiotherapist’s report on the provided physiotherapy
Do I have to pay for spectacles?
No. After a year’s membership, the sickness fund will also reimburse 80% of the cost of spectacles prescribed by a doctor or an optician. However, the maximum reimbursement is 250 euros over two calendar years, i.e. every other year.
You only have to provide the fund with the receipt of payment with your name and your prescription on it.
Does the fund reimburse arch supports?
Yes, the fund compensates 40% of the price of arch supports, up to 30 euros over two calendar years, i.e. every other year.
You may acquire the customised arch supports without a doctor’s referral or seeing a physiotherapist. Simply visit your local sporting goods store or buy the supports together with your new work shoes. However, please note that the arch supports must be uniquely fitted, i.e. specifically customised for you. No reimbursement is paid for off-the-shelf arch supports.
Are travel expenses reimbursed?
Yes, you are eligible for travel expense reimbursement. If travel necessitated by treatment or examination of illness causes you expenses, please fill out a travel expense application (SV4) at Kela’s online service. In addition, you must present a certificate or other report on the treatment in question.
For more information on reimbursable travel and modes of transport, please see Kela’s website.
Which treatments are non-reimbursable by the fund?
The fund does not reimburse the following treatments and procedures:
- assisted reproductive technology, or fertility treatment, and related medicine
- institutional and surgical theatre fees and equipment rental
- treatments by chiropractors, osteopaths, and massage therapists
What should I do if I am not happy with a reimbursement decision?
If you are not satisfied with a decision, you may appeal it. The fund will assist you on appeals and other change requests.
For any reimbursements regulated by the Health Insurance Act, the appeal is first made to the Social Security Appeal Board and then to the Insurance Court, if necessary.
For any additional benefits paid by the fund, please request the Finnish Financial Ombudsman Bureau to provide a recommendation for resolution.