Claiming compensation for illness and accident insurance treatment expenses
The most convenient way to file a claim for compensation is through our Web Service, which you can log in to using your banking codes. We will begin to process your claim within five working days after you have submitted all the necessary documents.
1. You must always first pay the expenses yourself and seek compensation from the Finnish Social Insurance Institution (Kela) for the expenses based on the Health Insurance Act, unless the service provider has already deducted them from your treatment or medical expenses.
2. Have ready all of the receipts and documentation related to the claim. You will receive instructions for sending them once you have sent your claim. The attachments needed »
3. Log in to our Web Service and select Claims form from the menu on the left. If you wish to fill in a new application, select New claim below. If you wish to fill in a claim extension concerning a prior claim, select the correct claim from the list and then select Claim extension from the summary that opens up below.
4. We will begin processing your claim within five business days of receiving the necessary documents.
6. Fill in all of the fields and click on Continue to save the information on the page. Fill in each of the claim's pages within 15 minutes so that your information does not disappear. If you use more time, the claim form's information will be cleared due to data security reasons.
7. Send the claim form from the summary page. You will be given instructions for sending your receipts once you have filled in the form. When your form has been sent, you can print it out for yourself.
Attachments to be sent with your claim
When making a claim, include the name and national insurance number of the insured person on all documents. The documents required depend on the expense in question. Please see the list of the requirements below.
Send us the attachments as a message on our Web Service or by mail to the following address:
P.O. Box 627
Expenses in private health care institutions
- Originals of the expense receipts, if the Social Insurance Institution's compensation has been reduced at the health care institution (the reduction will show in the receipt) or
- The original decision of the Social Insurance Institution regarding reimbursement under the Sickness Insurance Act as well as copies of the expense receipts supporting the decision of the Social Insurance Institution (if reimbursement was applied for from the Social Insurance Institution's office)
- Expense receipts mean the invoice from the care institution or a receipt from the care instutions' payment terminal with an attachment showing the doctor's treatment received and a form showing the fees charged as well as any possible prescriptions for examinations or treatment. When a claim for psychotherapy is made, we need a B doctor's statement written by a psychiatrist.
Expenses for public sector health care
- The original invoice from a health centre or polyclinic visit and the payment receipt or a print-out of an invoice paid online which shows the archive number.
- The original chemist's receipt for medicine costs as well as a copy of the prescription. Instead of the prescription for the medicine, you can provide the bill generated by the chemist (the insurance will not cover any possible service charges levied by the chemist).
When making a claim from accident insurance, you must also supply
- The medical records entry from the first doctor's visit
- For dental injuries, the dentist's recommendation for treatment together with the estimate of costs
Hospital insurance or insurance for nursing care
- Doctor's statement or other clarification of the need for hospital care and its duration
- Original hospital invoice and receipt of payment (compensation is taxable income for the part in excess of the real costs)
Coverage of care costs for illness or accident
In accordance with the insurance conditions, medical expenses insurance will cover the medical expenses that are not covered through any legal reimbursement regime and which the insured has to pay themselves for their care. You must first apply for compensation under the Sickness Insurance Act from the local office of the Social Insurance Institution. The application time is six months from incurring the expenses.
If the claim is not made within six months of incurring the expenses payment will be reduced by the amount of compensation available under the Sickness Insurance Act.
Several private health care service providers apply for Social Insurance Institution payments on behalf of their patients. In such a case, your bill is reduced directly by the proportion paid by the Social Insurance Institution and you can make your insurance claim with us directly.
Preliminary decisions or application for payment commitment
If you are going for an expensive examination or procedure, we recommend that you check the compensation in advance.
We will give preliminary decisions i.e. compensation promises for the costs of expensive procedures. You can inquire about reimbursement of expenses from your insurance for investigations or treatments that have been recommended for you by phone from our claims service on 0200 31100. The claims handeler will often be able to give a verbal premilinary decision regarding reimbursement of expenses on the telephone. Once you have the preliminary decision, you must first pay the costs yourself and they must be reduced by the compensation paid by the Social Insurance Institution. After this you can make a claim from your insurance.
We give payment commitments for expensive surgical procedures. In order to obtain payment commitment, you must provide a doctor's explanation that includes the reason for the procedure and its need as well as a cost estimate. Once you have the payment commitment the institution treating you can invoice the insurance company directly for the costs of the procedure in accordance with the payment commitment given.
You can send doctors' explanations or statements related to preliminary decisions and payment commitments by email to the following address (the necessary files attached): firstname.lastname@example.org or by fax to 010 516 7514.
Our Customer Service number