Changes to reimbursement of costs for treatment abroad
Going forward, the way Kela reimburses costs for seeking medical treatment abroad without prior authorisation will change, so that the maximum amount reimbursed is the equivalent of the costs for the corresponding treatment in the customer’s own wellbeing services county in Finland. Reimbursement can be paid for costs incurred in an EU or EEA country, Switzerland or the United Kingdom. The changes will take effect retroactively from 1 January 2023.
Parliament has approved amendments to the Act on Cross-Border Healthcare. The amendments will affect the reimbursements paid by Kela for medical treatment without prior authorisation in another EU or EEA country, Switzerland or the United Kingdom.
Customers can seek treatment abroad with or without prior authorisation. Until the present amendments, Kela has reimbursed costs for medical treatment abroad without prior authorisation according to the same principles as reimbursements for costs of private medical care received in Finland.
Going forward, the maximum reimbursement for these costs will be the equivalent of the costs for the corresponding treatment in the customer’s wellbeing services county. In some cases, the reimbursement paid by Kela will increase. However, customers will be required to pay the equivalent of the client charge in the Finnish public health care system.
Persons seeking treatment abroad without a prior authorisation must initially pay all the costs of the treatment out of their own pocket and then apply for reimbursement from Kela afterwards.
Kela does not reimburse costs of healthcare provided in a country other than an EU or EEA country, Switzerland or the United Kingdom.
The treatment must be equivalent to treatment in Finland
Kela reimburses treatments that are deemed medically necessary and that are included in the range of services available in the Finnish public healthcare system. Additionally, the treatment must be equivalent to treatment provided in the Finnish public healthcare system.
If the treatment in question requires a referral in Finland, the customer will also need a referral when seeking treatment abroad.
In each case, Kela asks the wellbeing services county to assess whether the requirements for the reimbursement are met.
The customer can ask Kela for advance information about the reimbursement
Going forward, customers can ask Kela to give them advance information on whether Kela will provide reimbursement for their treatment abroad and to what amount. If the treatment abroad corresponds with the customer’s advance notice, Kela will pay the reimbursement as stated in the advance information.
The Act on Cross-Border Healthcare and the amended provisions on the reimbursement of treatment costs will enter into effect retroactively as of 1 January 2023. However, the President is yet to ratify the act. It is only then that Kela can begin to take customers’ advance notices into account in determining whether a customer is entitled to reimbursement.
Reimbursement of treatment may require prior authorisation
As a consequence of the legislative amendment, a new prior authorisation will be introduced in early 2024 in accordance with the Directive on Patients' Rights.
In some cases, prior authorisation will be required for Kela to reimburse costs of treatment abroad. Prior authorisation will be mandatory for example in the case of treatment that involves a particular element of risk and requires an overnight stay at a hospital. A Government Decree will be issued on the services that require prior authorization.
In 2022, Kela paid out a total of 2.6 million euros in reimbursements for treatment abroad. Of this, 210,000 euros were associated with treatment without prior authorisation in another EU or EEA country or Switzerland.