Compensations

Expenses to be compensated for

Aids

Compensation for approved medical aids by a doctor is 75 % but not more than 500 euro per member per calendar year. The following types of costs for rental or purchase are covered: compression socks, compression vests or orthopaedic leg supports, joint supports after an accident for up to three months, hearing aids and rental costs of a CPAP-device at the beginning of treatment.

Attachments to the compensation application:

The compensation is 75% of the cost of a treatment prescribed by a doctor, for a maximum of four treatment visits per year.

Attachments to the compensation application:

The compensation is 75 % of the costs of a treatment prescribed by a doctor but not more than 900 euro per member per calendar year. The fund covers costs only if they are also reimbursable by Kela. Costs of chiropractor, osteopath or naprapath are calculated to the same maximum amount of 900 euro.

The treatment facility or the person providing the treatment must be approved by Kela:www.julkiterhikki.valvira.fi

Attachments to the compensation application:

  • Compensation application
  • Referral from a doctor
  • Payment receipt
  • Treatment report from the physiotherapist (Kela form sv 3 fs)

Compensation for dental care may be provided after the applicant has been a member of the fund for one year.

The compensation is 75% of the cost, but no more than EUR 1,000 per member per calendar year.

Attachments to the compensation application:

  • Compensation application
  • Payment receipt
  • SV 126 (Statement on treatment provided by dentist/dental specialist and on the related fees)

The compensation is 75 % of the costs of a treatment prescribed by a doctor but not more than 900 euro per member per calendar year. Costs of physiotherapy are calculated to the same maximum amount of 900 euro.

Attachments to the compensation application:

Reimbursements from Kela

The compensation is 75% of the cost of medication prescribed by a doctor.

At a contract pharmacy, you will receive a discount by presenting your Kela card marked with the fund’s identifier (46001).

Pharmaceuticals covered by the reference price system will be compensated for in accordance with the reference price if the price exceeds the reference price and the customer does not want to replace the drug with a reference-priced option. Compensation will be paid in accordance with the price of the drug if the doctor has prohibited replacing the drug with a reference-priced drug.

Attachments to the compensation application:

  • Original payment receipt from the pharmacy
  • a copy of the prescription (electronic prescriptions can be printed out at www.kanta.fi).

 

Pharmaceuticals not compensated for by Kela

The compensation is 75% of the cost of medication prescribed by a doctor, but not more than EUR 670 per member per a calendar year.

The maximum amount of pharmaceuticals to be compensated for at a time equals a three-month period of treatment.

Preparations that are prescribed for the treatment of illness and that are included in the medication database maintained by Kela are regarded as pharmaceuticals.

https://asiointi.kela.fi/laakekys_app/LaakekysApplication?kieli=en

 

Attachments to the compensation application:

  • Original payment receipt from the pharmacy
  • a copy of the prescription (electronic prescriptions can be printed out at www.kanta.fi).

The compensation is 75% for the treatment of illness.

Attachments to the compensation application:

  • Compensation application
  • Payment receipt
  • SV 120 Form for reporting doctors’ fees (statement on the treatment given by a doctor and on the related fees)

The compensation is 75 % of the costs of a treatment prescribed by a doctor but not more than 1200 euro per member per calendar year.

The psychologist or psychotherapist must be included in the register of social welfare and healthcare professionals maintained by the National Supervisory Authority for Welfare and Health (Valvira).

  • You can search for a suitable therapist here.

Attachments to the compensation application:

The compensation is 75% on the cost of a treatment prescribed by a doctor.

Attachments to the compensation application:

The fund pays additional compensation for substance abuse treatment and detoxification, unless the fund’s specialist deems this unreasonable in an individual case. The compensation is up to 75% of the total cost.

An advance decision may be applied for on the eligibility of the treatment for compensation.

The following documents must be attached to an application:

  1. A treatment and rehabilitation plan by a doctor
  2. A report on the implementation of the treatment
  3. A report on the cost of the treatment and its payment

The compensation is 75% of the cost of a treatment prescribed by a doctor, for a maximum of three  treatment visits per year.

Please note that, according to the rules of the fund, compensation will be paid if the treatment is provided by a person with a professional education who is included in the register of social welfare and healthcare professionals maintained by the National Supervisory Authority for Welfare and Health (Valvira).

Attachments to the compensation application:

Compensation for glasses, contact lenses and laser surgery may be provided after the applicant has been a member of the fund for one year.

Compensation for eyeglass frames is paid every two calendar years. Compensation for lenses, contact lenses OR laser surgery is paid once per calendar year.

The compensation is 75%, but not more than the following:

  • Frames EUR 130
  • Spectale lenses EUR 400
  • Multi-vision lenses EUR 400
  • Contact lenses EUR 130
  • Laser surgery EUR 400

The compensation for an optician’s fee for an eye examination is 75%.

You can apply for compensation for the cost of glasses via mail or by sending your receipts to the fund via email to enerkemi@fortum.com.

Attachments to the compensation application:

  • Compensation application
  • A payment receipt, including the prices of the frames and lenses and the eye examination with the customer’s name
  • A copy of the optician’s customer record or the prescription by the ophthalmologist

The compensation is 75 % of the costs.

Costs of hospital treatment days are compensated for up to 100 days within a calendar year.

Costs of home hospital or domiciliary care visits are compensated for up to 100 times within a calendar year.

Attachments to the compensation application:

The fund pays additional compensation for operations and procedures performed at private healthcare facilities if the procedure is also eligible for reimbursements from Kela. The compensation is 75%, but no more than EUR 1,500 per calendar year. Treatment day fees are compensated for in accordance with public hospital rates.

The principles of compensation for minimally invasive knee surgery have been amended as of 15 June 2017.

The principles of compensation for acromion surgery have been amended as of 1 January 2019.

If you are planning to have your knee degeneration treated by keyhole surgery or your acromion operated on, you should check in advance with the service provider about the eligibility of the procedure for reimbursements from Kela.

Attachments to the compensation application:

The compensation for laboratory examinations, X-ray examinations, magnetic resonance imaging and ultrasound examinations performed based on a referral from a doctor is 75% if such examinations are also eligible for reimbursements from Kela.

Compensation is not paid for ultrasound examinations during pregnancy.

A referral from a specialist is required for magnetic resonance imaging.

 

Attachments to the compensation application:

The compensation is 75% on the cost of a treatment prescribed by a doctor if the treatment is also eligible for reimbursement from Kela.

 Attachments to the compensation application:

The compensation is 75 % of the costs but not more than 100 euro per member per calendar year. To obtain compensation you have to first apply for and receive compensation from a private voluntary insurance.

Attachments to the compensation application:

The decision of the insurance company which states the compensation and  the deductible.

Applying for compensation

  • Compensation must be applied for within six months of paying the fees.
  • Applications can be mailed to the fund to the following address: P.O. Box 100, 00048 Fortum or by   e-mail    (enerkemi@fortum.com).
  • The attachments required for a compensation application are listed under the fees to be compensated for on the fund’s website.
  • After the compensation has been paid, you will receive two separate decisions, one concerning reimbursements from Kela and one concerning additional compensation paid by the fund.
  • If your service provider is not our contract partner, you can have the reimbursement from Kela deducted from the fee you pay to your service provider, after which you can apply for additional compensation from the fund.

Omaposti is the quickest way to receive your compensation calculation. Select the Enerkemi Insurance Fund from the list of senders.

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