Seeking treatment abroad
You can seek treatment in another EU or EEA country, Switzerland, Great Britain or Northern Ireland and get reimbursement from Kela for the costs for the treatment. If you receive treatment abroad for an acute illness or an accident, this is not considered as seeking treatment.
You can seek treatment on your own initiative without prior authorisation or apply for prior authorisation from Kela to seek treatment. The amount of the reimbursement depends on the way in which you have sought treatment.
You get reimbursement for the costs for the treatment if you are covered under the Finnish national health insurance scheme or you have a municipality of residence in Finland. You may also be entitled to reimbursement in case you are not covered for national health insurance benefits in Finland but Finland is responsible for your medical care expenses.
Seeking treatment on own initiative without prior authorisation
When you seek treatment on your own initiative without prior authorisation, you should yourself find a suitable place of treatment and check your possibilities of obtaining treatment there.
You will receive reimbursement at the most to the amount that equivalent treatment would have cost in Finland in your wellbeing services county. Kela requests the necessary information from the healthcare provider of your wellbeing services county.
One prerequisite for reimbursement is that the treatment is deemed medically necessary and that the treatment provided is included in the range of services available in the Finnish healthcare system. The treatment must correspond to the treatment that you would have received in the Finnish public healthcare system. You need a referral for the treatment, if a referral is needed for equivalent treatment in the Finnish public healthcare system.
You can ask Kela for advance information about the reimbursement
Before you seek treatment, you can ask Kela to investigate whether you can receive reimbursement for the treatment and what the amount of reimbursement would be. Ask for advance information from Kela well in advance of seeking treatment. Kela needs time to decide on your application because Kela asks the public healthcare provider for the necessary information.
When you seek treatment abroad on your own initiative, you will first have to pay all the costs yourself. You must claim reimbursement afterwards within 6 months from the date of paying the costs.
Seeking treatment with prior authorisation
If you plan to seek treatment with prior authorisation, you should yourself find a suitable place of treatment and check your possibilities of obtaining treatment there with prior authorisation. Kela determines your right to prior authorisation on the basis of your application.
Apply for prior authorisation well in advance of seeking treatment. Kela needs time to decide on your application because Kela needs a statement from the public healthcare provider.
The public healthcare provider should support the granting of prior authorisation if all the following criteria are met:
- The treatment is necessary in your case.
- The treatment is included in the treatments provided by the public healthcare system in Finland.
- Your treatment cannot be arranged in Finland within the limits of the waiting times guarantee.
If the public healthcare provider supports the granting of prior authorisation, Kela grants a prior authorisation (certificate S2) that you should submit to the treatment provider.
If you have prior authorisation, you pay only the user fee charged abroad for the treatment.
Apply for prior authorisation and claim reimbursement for the treatment you have received within 6 months of paying the costs for the treatment.
If you despite prior authorisation have to pay all the costs for the treatment yourself, you can claim reimbursement from Kela.
Ingrid, who lives in Vaasa, wants to seek treatment in Sweden. She applies for prior authorisation from Kela. Kela asks Vaasa Central Hospital for a statement on whether the preconditions for granting prior authorisation are met. Vaasa Central Hospital gives a statement supporting the granting of prior authorisation. On the basis of the statement, Kela grants Ingrid an authorisation.
Reimbursement for travel costs and medicines
When you have sought treatment abroad on your own initiative, the travel costs are reimbursed as if you had travelled to the nearest treatment facility in Finland where you could have received the necessary treatment or examination. Medicines purchased abroad are reimbursed on the same grounds as medicines purchased in Finland.
When you have sought treatment with prior authorisation, you receive reimbursement for medicine and travel costs as well as for the costs for the stay in connection with the treatment. If the healthcare provider considers that an accompanying person is necessary, it is also possible to receive reimbursement for the expenses of the accompanying person.
Antti, who lives in Salo, has travelled to Paris for specialised medical care. Antti receives reimbursement for the travel costs according to the costs for travelling to Turku University Hospital. If Antti had travelled to Paris for primary healthcare, the travel costs would be reimbursed according to the costs for travelling to the health centre in Salo.