What are the grounds for granting a prior authorisation?
The criteria for granting a prior authorisation or the possibility to deny authorisation are laid down in EU legislation. When deciding on a prior authorisation, the applicant’s health status and the likely course of the illness are taken into consideration.
Kela must grant a prior authorisation if the following conditions are met:
- your treatment need is medically justified
- you would be entitled to the treatment in question within the public health care system of Finland
- the Finnish public health care provider is unable to arrange for treatment within a medically justifiable time period.
The prior authorisation may be denied if:
- the treatment is not available or provided in public health care
- the Finnish public health care provider can organise the treatment or similar treatment within a medically justifiable time period.
What do I need to do when I travel abroad for treatment with a prior authorisation?
- Seek a care provider that suits you and find out whether it accepts the prior authorisation. Make sure that the treatment place operates with appropriate licences in the country in question.
- Apply for a prior authorisation from Kela. Kela will grant the authorisation, if public health care recommends it.
- Agree on the arrangements involved in obtaining treatment with the care provider.
- Submit the requisite medical records to the treatment provider and, if necessary, have them translated into a language that the care provider understands. You can check your information entered in Patient Data Repository (KanTa) at My Kanta Pages.
- Take with you the prior authorisation form sent to you by Kela.
- You will pay the local client fee for the treatment. You can claim reimbursement from Kela retrospectively for trips, medication and residence. In some cases, you can also claim reimbursement for the costs of an accompanying person.
- Remember that treatment is provided in accordance with the national legislation and health care system of each respective country.
- The statutory patient insurance of the country providing treatment is applied in the case of treatment injuries. You cannot receive compensation from Finland for a treatment injury incurred abroad. You must apply for compensation from the country providing treatment. However, possible medically necessary follow-up treatment can be provided in Finland.
Apply for a prior authorisation from Kela
In Finland, a prior authorisation is applied from Kela. Instructions for applying for a prior authorisation are available on Kela’s website. Kela’s Centre for International Affairs will help you in applying for a prior authorisation if necessary.