Who pays for your care?

You can receive treatment or care abroad and only pay what locals pay. You must have a certificate of entitlement to medical care: the European Health Insurance Card (EHIC) or prior authorisation (S2). If you live in another EU or EEA country or in Switzerland, Kela may grant you the certificate S1 (previously E106 or E121). Register the certificate with the health insurance institution in your country of residence.

The country that provided the treatment will invoice Finland for the costs for the treatment. Although you may not have to pay for the treatment, Finland will still receive an invoice for the expenses.

Usually, Finland will be invoiced an amount that reflects the actual costs of your care. The country of residence may invoice pensioners and their family members a fixed amount. The fixed amount is based on the average healthcare costs of the respective countries. Countries who charge a fixed amount include Ireland, Spain, Cyprus, Portugal, Sweden, Great Britain and Northern Ireland. Other countries charge the actual costs for the treatment.

If you visit Finland or live here and your medical expenses are covered by another EU or EEA country or Switzerland, Kela will invoice the costs incurred in Finland from the country that has granted you the European Health Insurance Card or certificate S1 (former E106 or E121).

The costs for treatment are invoiced retroactively for EU and EEA countries and Switzerland. In Finland, Kela administers the invoicing and payments. Kela pays the costs out of state funds. Finland has an agreement with the Nordic countries, Great Britain and Northern Ireland that the costs are billed only if the client has received care on the basis of prior authorisation in the form of either E112 or S2.

Examples of actual costs of treatment abroad

Stomach bug while on vacation

Mia getsa stomach bug during her trip to Poland. She visits the doctor at the local public health centre. Mia presents her European Health Insurance Card and only pays the same user fee as local residents pay, 50 euros. The actual cost of Mia’s treatment is 700 euros, so Poland invoices Finland for the remaining 650 euros. 

Treatment for a Finnish pensioner living in Germany

Martti has diabetes, lives in Germany and is paid a pension from Finland. He has registered the certificate of right to treatment (S1 or E121) that is issued by Kela. Martti regularly sees a doctor and have laboratory tests done. Each time, he pays the same fee as local residents, 15 euros. The actual cost is 500 euros per visit. Germany sends Finland an invoice for the rest of the costs, 485 euros.

Treatment in Estonia

Margit wants to have treatment in Estonia. She has been given prior authorisation (S2) from Kela. Since she has prior authorisation, Margit pays only the local client fee of 35 euros for her treatment in Estonia. The actual cost of the treatment is 13,000 euros. Estonia sends Finland an invoice for the rest of the costs, 12,965 euros. Kela sends the hospital district Margit belongs to an invoice for the costs.

Examples of fixed sum invoicing of treatment abroad

Treatment for a Finnish pensioner with bronchitis living in Spain

Mikko lives in Spain and gets pension from Finland. He has registered a certificate of right to treatment (S1, previously E121) issued by Kela with the local sickness fund. Mikko seeks treatment for a prolonged cough at the health centre. He is diagnosed with bronchitis. He does not have to pay any client fee, since pensioners do not locally have to pay any such fees.

During the year, Mikko needs no other medical treatment in Spain. Since Spain invoices Finland a monthly fixed amount  for the healthcare for pensioners, there is no separate invoicing for the doctor’s fee and medical expenses. Temporary stays in Finland, summer holidays for instance, do not interrupt the invoicing period.

Examples of actual costs of treatment in Finland

French citizen in accident in Finland

Maud is spending Midsummer in Finland and gets a deep cut in her hand. At the emergency department, Maud presents the European Health Insurance Card issued by France and gives her address in France. She is invoiced for the local client fee, 40 euros. The actual cost of the treatment was 1,400 euros. The public healthcare unit that treated Maud invoices Kela for the remainder of the costs (1,360 euros). Kela pays a state-funded compensation for the cost of the treatment to the public healthcare provider. France is invoiced for the costs.

Maud applies to Kela for reimbursement for travel expenses using the form SV4 and for medicines using form SV178. She sends a copy of her European Health Insurance Card with her application. Kela reimburses Maud for travel expenses and medicines in accordance with the Health Insurance Act. Kela then invoices France for these reimbursements.

A Swede has surgery in Finland

Madeleine, who lives in Sweden, is treated at Vaasa Central Hospital. Madeleine has prior authorisation (E112 or S2) granted by Sweden. Madeleine receives an invoice for the user fee, 60 euros. The actual cost of the treatment was 10,000 euros. The public healthcare unit invoices Kela for the remainder of the costs (9,940 euros). Kela will pay a state-funded compensation for the cost of the treatment to Vaasa hospital district. Sweden is invoiced for the costs.

Examples of fixed sum invoicing of treatment given in Finland

Treatment for an Estonian pensioner living in Finland

Estonian Kaidi, 67, lives in Finland but gets a pension from Estonia. She has registered a certificate of right to treatment (S1 or E121) issued by Estonia with Kela. Kaidi needs regular care monthly and laboratory tests due to elevated blood pressure and asthma.  Kaidi pays the local user fee for the public healthcare treatment received. Kaidi is reimbursed directly at the pharmacy for prescribed medicines. Finland invoices Estonia a fixed amount monthly for the healthcare given to Kaidi during the months Kaidi has lived in Finland.

For 2017 the costs are still invoiced as fixed amounts.

Starting 1 January 2018, Finland invoices the actual costs for healthcare for pensioners living in Finland for whose costs of treatment another country is liable.