What does prior authorisation mean, and where can I get one in Finland?
You can apply for prior authorisation (form S2) for treatment that is provided in another EU or EEA country, Switzerland or the United Kingdom. If you are granted prior authorisation, you will pay the same amount for the treatment as local residents. Your municipality of residence will pay the rest of the treatment costs. Agree on the practical matters with the treatment provider and ensure in advance that the provider accepts the prior authorisation.
Apply for prior authorisation from Kela. Attach a statement about your treatment, such as a doctor’s statement, to the application. Kela will ask public healthcare for a statement on your case and grant the prior authorisation if the healthcare of your municipality of residence supports it.
Can I come to Finland for treatment with prior authorisation?
Yes, you can, as long as you have prior authorisation in accordance with EU Regulation 883/2004 (S2 form). Apply for prior authorisation from the health insurance institution of your country of residence, and agree on the arrangements for the treatment directly with the treatment provider. In Finland, prior authorisation can be used in public healthcare. You will pay the same client fee for the treatment as local residents.
If you have any other prior authorisation (e.g. under the Patient Directive), you will pay the cost of the treatment yourself, after which you will be able to claim reimbursement from your health insurance institution.
Can I choose the place for treatment with a prior authorisation myself?
Yes, you can. Find a treatment provider that suits you and find out whether the provider accepts the prior authorisation (S2 form). As a rule, the S2 form is accepted only in public healthcare or a place that has an agreement with the public healthcare system. Prior authorisation is granted for a specific country and specific treatment. The prior authorisation also has a deadline within which you must seek the treatment.
What are the grounds for granting a prior authorisation in Finland?
Public healthcare in your municipality of residence will evaluate your application. Prior authorisation must be granted if the treatment is justified in your particular case and included in the public healthcare services in Finland, and it is not possible to arrange treatment for you in Finland within the time limits defined under the waiting times guarantee system. In some cases, prior authorisation may be granted based on, for example, language or cultural criteria, even if the treatment is also available in Finland.
Can Kela or public healthcare reject my application for prior authorisation if I leave Finland to seek treatment abroad?
There is no obligation to grant a prior authorisation if the treatment you need can be arranged in Finland within the time limits defined under the waiting times guarantee system. The treatment must also be included in the service choices in public healthcare in Finland. Thus, prior authorisation can be refused if the treatment is not included in public healthcare in Finland. That said, prior authorisation may be granted based on, for example, language or cultural criteria, even if the treatment is also available in Finland.
Public healthcare in your municipality of residence will evaluate your particular case. Kela grants or refuses prior authorisations according to the statement by public healthcare. Kela cannot refuse your application for prior authorisation if public healthcare recommends its granting.
Can I receive reimbursement for travel costs if I leave Finland to receive treatment abroad with a prior authorisation?
Yes. If you travel abroad to receive treatment with prior authorisation, you can apply for reimbursement from Kela for the travel costs. Kela will reimburse travel costs above the copayment up to the place of treatment in the destination country. You can also apply for reimbursement for the costs of medicines and your stay. If healthcare considers that an accompanying person is necessary, reimbursement can also be obtained for that person’s costs.
Can I apply for prior authorisation afterwards in Finland?
Yes. You can apply for prior authorisation retrospectively if you have paid all the costs of the treatment yourself. The authorisation must be granted if you would have received it anyway before the treatment. Apply for authorisation and reimbursement from Kela within six months of paying for the treatment. Prior authorisation can be granted for deliberately seeking treatment abroad. You cannot apply for prior authorisation in case of sudden illness.
What is the difference between prior authorisation under the Patient Directive and the Regulation?
Under EU legislation, there are two possibilities for reimbursement when patients seek treatment abroad: prior authorisation in accordance with EU Regulation 883/2004 (form S2) and in accordance with Patient Directive 2011/24/EU. Prior authorisation under the Regulation can be used in public healthcare. Prior authorisation under the Directive can be used both in public healthcare and private healthcare.
In Finland, only prior authorisation under the Regulation is used because prior authorisation under the Directive has not been introduced in Finland. Therefore, the reimbursement model under the Directive in Finland does not, in practice, require applying for prior authorisation, but you can travel for treatment without prior authorisation.