Special reimbursement and other entitlements to reimbursement for medicine expenses
Customers need a medical certificate B issued by a doctor to apply for an entitlement to reimbursement of medicine expenses at a special rate, to limited reimbursement, or to reimbursement for clinical nutrients. No separate application is required.
Who can be granted entitlement to reimbursement?
Entitlement to medicine reimbursement at a special rate and entitlement to reimbursement for clinical nutrients can be granted to those with certain medical conditions.
For some medicines, the right to reimbursement is limited only to specific uses.
How to apply
- Discuss with your doctor which one of you will send the medical statement to Kela. If you submit the statement yourself, do it as soon as possible. You can send the statement via the OmaKela e-service or mail it to Kela, PL 10, 00056 Kela. No separate application is required. If you are a member of a workplace sickness fund, submit the certificate to your fund.
New Kela card
If you are granted an entitlement to reimbursement, you will later also be mailed a new personal Kela card marked with a number indicating your entitlement. You can use Kela’s Medicinal Products Database to see which medical condition or medicinal products the number refers to.
When the number starts with
- 1, you are entitled to reimbursement at the higher special rate (100%)
- 2, you are entitled to reimbursement at the lower special rate (65%)
- 3, you are entitled to limited basic rate reimbursement (40%)
- 5, you are entitled to reimbursement for clinical nutrients (65%)
- 6, you are entitled to reimbursement for clinical nutrients (40%).
The entitlement to reimbursement may be temporary or permanent. You can check the period for which your entitlement to reimbursement is valid from the backside of your Kela card, the written decision you were sent, or the OmaKela e-service.
Examples of markings on a Kela card
- YE 103 means that the person’s entitlement to reimbursement at the higher special rate 103 (diabetes, insulin-treated) is valid indefinitely.
- AE 205/08.24 means that the person’s entitlement to reimbursement at the lower special rate 205 (chronic hypertension) is valid until 31 August 2024.
Kela will not specifically inform you if your temporary entitlement to reimbursement ends. If needed, you can apply for an extension to your reimbursement entitlement with a new medical statement B.
Reimbursement at the pharmacy
The pharmacy confirms your entitlement to reimbursement by consulting Kela electronically. If you have been granted the entitlement to reimbursement and you have met the initial deductible, you will get the reimbursement due to you right away at the pharmacy. You get the reimbursement even if you do not yet have a new Kela card.
Start date of the entitlement to reimbursement
When Kela grants you an entitlement to reimbursement, the date your medical statement B arrived at Kela will usually be marked as the start date of your entitlement.
If your medical statement B arrived at Kela on 25 October and Kela decided on your entitlement on 15 November, the start date of your entitlement would be marked as 25 October.
Retroactive entitlement to special reimbursement
The general rule is that you get a reimbursement for medicine purchases made on or after the first date of your entitlement.
However, under certain conditions, you may be able to get a reimbursement for medicines purchased before that date. In that case, you can get a special reimbursement for a medicine or a reimbursement for a clinical nutrient that you purchased after your illness was diagnosed. The amount you purchase may not exceed the amount you need for three months’ use.
If you purchased a medicine reimbursable at a special rate or a clinical nutrient before being granted an entitlement to reimbursement, you can claim a reimbursement from Kela after the fact.
Apply within 6 months of the purchase.
Kela may contact you or pay the reimbursement automatically if it finds, based on the medical certificate B, that you are entitled to a special reimbursement for previously purchased medicines.
Retroactive entitlement to basic reimbursement
The general rule is that you get a reimbursement for medicine purchases made on or after the first date of your entitlement. However, under certain conditions, you may be able to get a reimbursement for medicines purchased before that date.
If you purchased a medicine with limited basic reimbursability before being granted an entitlement to reimbursement, you can claim a reimbursement from Kela after the fact.
Apply within 6 months of the purchase.