Benefits

 A doctor's prescription is required for all treatments and examinations.

Not covered: e.g., personal copayments for service vouchers for surgery, general practitioner fees, physician procedures, office fees, vaccinations, medical certificates, parking fees.

• Not all prescription medications prescribed by a doctor are eligible for Kela reimbursement. The eligibility for reimbursement is determined by the Pricing Council, not by Kela or the sickness fund.
• The same principles apply to reimbursement for clinical nutrition products, equivalent products, and basic ointments.
• The fund will not reimburse medicines that are part of the initial deductible for medicines from 1 January 2024. Medical reimbursements have an initial deductible, in year 2025  deductible is 70 euros. You pay for your medication in full yourself until the initial deductible is met. Only after this you will receive medical reimbursement for the products you bought. The initial liability accrues for products included in the reimbursement system. The initial deductible is based on the Health Insurance Act.
• If you do not have your Kela card with you at the pharmacy or have not received it yet, pay for the medication in full and request a receipt and reimbursement application form from the pharmacy. Submit them to the fund along with the original payment receipt. The pharmacy can also access information about the sickness fund through Kela's direct reimbursement inquiry service if you authorize them to do so.

The additional benefits provided by the sickness fund are paid on top of the general Kela reimbursement. The conditions for eligibility for additional benefits are as follows, according to the regulations:

1. Necessity of treatment: The treatment or examination must be necessary for the treatment of the specific illness. Diagnostic tests performed to diagnose the illness are also covered.
2. Necessity of costs: Unnecessary costs will not be reimbursed, even if the treatment itself is necessary. Preventive measures and treatments are also not covered.
3. The examination or treatment must be performed by a properly qualified professional registered in the Central Register of Health Care Professionals maintained by the National Supervisory Authority for Welfare and Health.
4. The examination or treatment must take place in a healthcare facility as defined in Section 3(1) of Chapter 3 of the Sickness Insurance Act.
5. The prescription has been obtained before the examination/treatment.
6. The prescription is valid for one year from the date of issue.
7. Reimbursement is limited to a maximum of 15 times per prescription.

• Insured members are reimbursed for the health center fee, outpatient clinic fee at public hospitals, and the fee for day surgery at public hospitals, up to the maximum healthcare payment ceiling.
• The daily fee for hospital and health center stays at public hospitals is reimbursed for a maximum of 60 days per calendar year for the same illness, up to the maximum healthcare payment ceiling.
• Prescription medications prescribed by a doctor are reimbursed when they are also covered under the Sickness Insurance Act. The reimbursement is based on the reference price used for determining the Sickness Insurance Act reimbursement. Similarly, clinical nutrition products, equivalent products, and basic ointments are also reimbursed.
• 80% coverage of the specialist doctor's consultation fee, up to four visits per calendar year. Note: Fees for procedures performed by the physician, such as mole removal or general doctor´s fee are not covered.
• Laboratory tests included in the board-approved examination list, including pathological examinations, and associated sample collection are reimbursed. The examination list is approved semi-annually or as needed; laboratory tests and pathological examinations are covered.
• Ultrasound and X-ray examinations listed in the board-approved examination list, as determined semi-annually or as needed, are reimbursed when prescribed by a doctor.
• MRI and CT scans ordered by a specialist when the examination has been performed at Pihlajalinna
• 80% of the fees for endoscopic procedures listed in the board-approved list, including the facility charges, are covered.
• 80% of the reimbursement for physiotherapy prescribed by a doctor or for physiotherapy reimbursed by Kela, up to a maximum of 10 treatments in a calendar year. The prescription is valid for one year from the date of signing. Kela reimbursement can be received for four visits per year; these visits do not require a doctor's prescription.
• For prescribed massage, naprapathy, osteopathy, and chiropractic treatments, the reimbursement is 80% up to a maximum of 5 treatment sessions per calendar year if the treatment is provided for the purpose of treating an illness. The prescription is valid for one year from the date of signing.
• Travel expenses are reimbursed according to the deductible for reimbursable trips under the Health Insurance Act. Travel costs are reimbursed using the cheapest means of transportation available, and local transportation expenses are not covered. Visits to the pharmacy are not reimbursed.
• Prescribed bandages, aids, and prostheses are reimbursed up to a maximum of 100 euros per reimbursement occurrence if they cannot be obtained for free otherwise. Reimbursement can be made once per calendar year.
• Prescribed treatment instruments, devices, and meters are fully or partially reimbursed at the discretion of the board.
• In private health care dental treatments and costs prescribed by a dentist, specialist dental technician, and dental hygienist are reimbursed at 80%. The reimbursement is conditional upon also receiving reimbursement according to the Health Insurance Act (SVL). In public health care dental care is reimbursed at 100 %. Additional benefits are paid to those who have been a member of the fund for at least one year. The maximum amount for dental care reimbursements is 500 euros per calendar year. Reimbursement for private dental hygienist treatment requires a private dentist's prescription obtained before the treatment is provided.
• The maximum reimbursement amount for eyeglasses and contact lenses, or alternatively, refractive eye surgery, is a one-time payment of 400 euros after one year of membership in the L&T Health Fund. The reimbursement is conditional upon the lenses being optically ground for vision correction. Reimbursement can be made every third calendar year.
• According to Section 14a of the L&T Sairauskassa rules, reimbursement for eligible surgeries and special procedures is subject to the provision of a B-certification obtained from the shareholder's occupational health care. The applicant must complete a separate application form, including the necessary documentation.