Annual maximum limit on out-of-pocket costs

The part of the price of reimbursable prescription products that you pay yourself counts towards your annual maximum limit on out-of-pocket costs. If the medicines you buy are not covered by the reimbursement system, they also do not count towards the annual maximum.

In 2019, the annual maximum is set at €572. If you reach it, you become entitled to an additional reimbursement for your medicine costs. That means that you only pay a €2.50 copayment for your medicines for the rest of the year. You cannot be reimbursed for a new batch of medicine until you have used nearly all of the previous batch at the indicated dosage.

Any purchases of medicines, clinical nutrients and emollient creams covered by the reimbursement system count towards the annual maximum. The initial deductible also counts towards the annual out-of-pocket maximum. However, should the price of the medicine exceed the reference price, the exceeding part does not count towards the annual maximum.

Additional reimbursement

The additional reimbursement is typically provided directly at the pharmacy. The exception is the purchase that takes you over the annual maximum limit, for which you must apply to Kela for an additional reimbursement.

Kela keeps track of your progress towards reaching the annual maximum based on information received from pharmacies. Kela sends you a letter when you reach the maximum telling you about your entitlement to additional reimbursement. The letter includes a form for claiming additional reimbursement. The information that you have reached the annual maximum is also updated to Kela's online customer service system and is communicated to pharmacies. The letter does not tell you the amount by which you exceed the annual maximum.

You can track your progress towards reaching the annual maximum through Kela's online customer service (in Finnish and Swedish) by selecting Sairaanhoitokorvaukset > Lääkkeiden omavastuukertymä. You see the cumulative amount of medicine purchases for which you have been paid a reimbursement.

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