The sickness fund reimburses Kela-reimbursed medicines prescribed by a doctor fully based on their reference price. If the insured buys a medicine whose price exceeds the reference price, he/she must pay the part of the price exceeding the reference price at the pharmacy.
The fund also reimburses the medicine-specific copayment (EUR 4.50/medicine) applicable to the higher special rate of reimbursement and the medicine-specific copayment (EUR 2.50/medicine) after meeting the annual maximum limit on out-of-pocket costs.
In 2021, the sickness fund also compensates its members for the initial deductible under the Health Insurance Act, EUR 50/year.
You can check the price and reimbursability of medicines and find out what generic equivalents are available for them in Kela’s Medicinal Products Database.
The sickness fund recommends the use of agreement pharmacies. However, if you buy medicines from other pharmacies, file a claim for reimbursement with the fund yourself.
To claim compensation, send the claim form SV 178, ‘Claim – Medicine expenses incurred in Finland’, the payment receipt and a statement from the pharmacy about your medicine purchases to the sickness fund.
You get the statement about your medicine purchases from the pharmacy; compensation cannot be paid based on the payment receipt alone.