If you are entitled to a disability benefit at the basic rate and the illness or disability causes special expenses, you can be awarded a disability benefit at the middle rate instead of a disability benefit at the basic rate.
The special expenses must be:
Due to illness or disability
The expenses are incurred due to an illness or a disability that causes impaired functional ability and on the basis of which you are entitled to care allowance or disability allowance.
You have not incurred such expenses before the onset of disability or illness. The assessment of whether the expenses constitute extra expenses is always made individually.
Expenses are incurred for at least six months.
The expenses are due to, for instance, obtaining necessary services or buying medicines as required by good clinical practice.
Expenses that you pay for yourself
You do not receive compensation for the expenses from some other payer.
Special expenses include
- Home help, support services and home health care
Costs for services considered necessary due to the illness or disability may be considered special expenses. Costs for home help services are usually divided between the adults that live in the same home.
- Assisted living
Monthly charges for assisted living are not taken into account in full, however. Only necessary expenses for care and household chores are taken into account as special expenses. Care expenses include expenses incurred for necessary assistance, guidance or supervision in personal activities of daily living.Separate documentation concerning these expenses is always needed, indicating the share of the care fee in the total fee and the services included in the care fee.
- Institutional and hospital care
Expenses related to hospital care are usually considered special expenses only when they are incurred for at least 6 months. The care must be necessary and related to the illness on the basis of which disability allowance or care allowance is granted.
Expenses for respite care can be taken into account as special expenses. One prerequisite is that the respite care is regular during a period of at least six months or it is repeated annually.Fees for long-term institutional care are not considered special expenses.Whether the expense is to be included in special expenses is determined from case to case.
- Doctors’ and dentists’ fees
Doctors’ and dentists’ fees are considered special expenses if they are due to the illness or disability on the basis of which disability allowance or care allowance is granted. These expenses must also be continuous.
Ordinary medical care expenses, such as costs for eye and vision examination or costs for ordinary dental care, are not considered special expenses.
Expenses related to rehabilitation are considered special expenses if the rehabilitation is prescribed by a doctor, follows good clinical practice and continues for at least six months.
Costs for physical exercise (such as gym or hydrobics) are usually not accepted as special expenses.
- Travel expenses
As regards costs for travel related to health care or rehabilitation, copayments under the Health Insurance Act can be taken into account. However, at the most an amount corresponding to the maximum annual limit on out-of-pocket travel expenses can be taken into account.
- Medicine expenses
The costs must be incurred due to the illness or disability on the basis of which disability allowance or care allowance is granted.
The patient’s out-of-pocket expenses for prescription medicines are taken into account. Costs for medicines that are not reimbursed under the Health Insurance Act may also be taken into account. The situation is considered case by case.
Special expenses do not include
Care, clothing, food and health:
- medical supplies and appliances
- purchase and use of assistive devices
- personal hygiene
- special clothing and extra clothing expenses
- special diet
- purchase and use of panic alarm phone
- natural health products and homeopathic products
Mobility, home and leisure:
- copayments for transport service arranged by the municipality
- travels abroad and holiday travel
- gardening, renovations
- hobby activities
- purchase and maintenance of a car
Wages, fees and reimbursements for travel costs:
- own loss of earnings (e.g. wages not received due to illness or care of a child or wage costs for substitute)
- trustee’s fee
- reimbursement for travel costs of remunerated caregiver or personal assistant
- wage of personal assistant granted under the Act on Services for Persons with Disabilities
- fee for long-term institutional care
- fees to family member, relative or friend
- fees for day activity when not related to rehabilitation prescribed by a doctor
- other travel costs than travel costs related to treatment and rehabilitation prescribed by a doctor
- costs for days off for informal caregiver who has concluded agreement on informal care
- costs for days off for person who cares for family member or relative