Compensation
General information about compensation
The sickness fund compensates costs arising from necessary medical care. Compensation is paid to the extent that it exceeds compensation paid pursuant to the Finnish Health Insurance Act or another act.
The entitlement to compensation under § 13 of the fund’s rules begins when membership begins and ends when membership ends. Compensation is only paid for expenses incurred during membership.
The compensation paid by Sairauskassa Silta is calculated based on total costs. The compensation includes both the compensation under the Health Insurance Act and the additional compensation paid by the fund. Example: doctor’s fee EUR 100, of which the total compensation is 70%, i.e. EUR 70. The compensation includes the possible compensation under the Health Insurance Act (Kela’s reimbursement) EUR 30.00 and/or the fund’s additional compensation EUR 40,00.
Compensation for costs arising from medical care must be claimed within 6 (six) months from the date when the payment was made.
The claim processing time is two weeks from the arrival of the claim (excluding holiday periods, during which the processing time may be longer).
Compensation is claimed via the electronic service Iris or by sending a claim to the sickness fund by post.
Please do not send claims for compensation by email for information security reasons.
The sickness fund does not issue payment commitments.
Receipts for additional benefits are no longer sent to members’ home addresses as of 1 January 2018. Members can easily check the total compensation they have received from the sickness fund on their account statement or via Iris. Kela will continue to send members its official decision concerning the reimbursement paid by it. A receipt for the additional benefit compensation is sent on request.
The sickness fund does not compensate the following, among other things:
- Office, outpatient clinic, electronic prescription, Kanta or similar fees collected by private service providers
- Cosmetic procedures
- Invoice fees
- Invoices for uncancelled appointments.
- Vaccinations
- Driving licence examinations
- Certificates written for benefits other than those under the Health Insurance Act
- Parking costs.
Office fees
Sairauskassa Silta and the medical centres Aava, Mehiläinen and Suomen Terveystalo, and also HammasOskari, have signed a national agreement based on which no office fees are charged to members of Sairauskassa Silta.
The customer must present their Kela card, on the back of which is the workplace fund number 46401. Retired members have their own fund membership card to prove their membership. Remind the receptionist of this. If there are any problems, ask the receptionist to call the sickness fund at the number 050 366 5604.
Office costs are not covered by Kela’s or the sickness fund’s compensation system.
Reimbursement cannot be requested from Sairauskassa for costs paid with an Epassi!
Some of the employers who use Epassi have extended the use of the benefit to wellness services (massage, dental care, etc.). Please note that you cannot apply for reimbursement from Sairauskassa for costs paid with Epassi.
Epassi is a tax-free employee benefit paid by the employer, and it cannot be converted into money through Sairauskassa.