STORY: Read about how the right to treatment works in practice

Seeking treatment without prior authorisation

Jorma’s dental care in Estonia

Jorma has a cavity in his molar tooth. After surveying dentists and tooth filling prices in Estonia, he books an appointment at a dental clinic in Tallinn.

Jorma travels to Tallinn and gets his tooth fixed without problems. The dentist gives him an invoice that he must pay himself.

Jorma claims reimbursement of his dental care costs from Kela using form SV 128. He receives the same Kela reimbursement for treatment in Estonia as he would have for visiting a private dentist in Finland.

Grounds for Jorma’s right to treatment

As an EU citizen, Jorma is entitled to seek treatment in another EU/EEA country or in Switzerland. He can freely seek treatment by arranging it with the treatment provider. Kela will reimburse costs of treatment sought in another EU/EEA country or in Switzerland in the same manner as those of private health care in Finland.

The amount of reimbursement is based on Kela’s tariffs for reimbursement. If Jorma’s treatment costs are below the tariff, he receives reimbursement for the exact cost of the treatment. In dental services, it must be noted that aesthetic and prosthetic treatments (for example, tooth whitening) do not usually quality for Kela reimbursement.

Kela also reimburses travel costs relating to treatment. Without prior authorisation, Kela reimburses travel costs up to Jorma’s nearest health centre, and the deductible is €25. This means that the trip to Tallinn is not reimbursed; Jorma must pay for the ferry tickets himself.

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