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 will be reimbursed for the costs up to the sum that corresponds to the costs of similar dental care provided in his own wellbeing services county.

Grounds for Jorma’s right to treatment

Since Jorma is covered by Finnish national health insurance, he is entitled to seek treatment in another EU or EEA country, Switzerland, Great Britain or Northern Ireland.  He can freely seek treatment by arranging it with the treatment provider. However, Switzerland, Great Britain and Northern Ireland are not legally obliged to treat Jorma if he has travelled there independently to access health care services.

Kela will reimburse the costs of treatment sought in another EU or EEA country, Switzerland, the United Kingdom or Northern Ireland up to a sum corresponding to the costs of similar treatment provided in Jorma’s own wellbeing services county. Jorma will always have to pay the client fee that would be charged for similar treatment in public healthcare in Finland.

Jorma could have asked Kela for prior notification of what kind of reimbursement he could receive for the treatment. Kela grants reimbursements in the manner indicated by it if the treatment has been provided according to the information provided by the client.

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.