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The General Directives for members of the Clerical Employee Sickness Fund Meta
Valid as of 1.1.2019, until further notice
PO Box 666
Meyer Turku Oy (P32)
THE FUND BOARD 2019
Jokinen Sami, chair
Salo Osmo, vice chair
The purpose of these general directives is to inform briefly about the Clerical Employee Sickness Fund Meta and fund’s most commonly paid compensations.
More detailed directives are found in the rules of the Clerical Employee Sickness Fund Meta. Additional information can also be received by contacting directly with the sickness fund.
NB: Please notice that this is an unofficial translation.
The valid official guidelines and rules in Finnish are followed in the the interpretation and decision-making.
A person who falls within the activity area of the Clerical Employee Sickness Fund Meta AND receives her/his main income from an employer (minimum employment 4 months) AND whose salary is paid from Finland has right to join the sickness fund.
Membership must be applied for within six months from the start of employment.
The changes in personal information e.g. bank account number, address or name must be notified to sickness fund in writing.
A member shall withdraw from the sickness fund when no longer belonging to its activity area. A member can resign from the sickness fund by submitting a written notification. Membership expires at the end of the same calendar month as the notice of resignation is given.A person who has resigned from the sickness fund without termination of employment is not entitled to reapply for a membership.
The maximum amount of the membership fee is linked to the wage coefficient as provided in sections 96, 97, and 100 of the Employees Pensions Act (395/2006). The membership fee is 1,40 per cent of the salary you pay income tax on.
However, from January 1st, 2019 the maximum fee is 42,93 € per month.
The membership fee is deducted directly from the salary by the employer and settled with the sickness fund. The membership fee is not tax-deductible.
A member must notify the sickness fund when she/he starts an unpaid leave. A member should also inform about time spent on assignments abroad, if the salary is paid by the foreign employer. Since the membership fee is not deducted during unpaid leave (e.g. temporary lay-offs), a member is not entitled to any sickness fund’s compensations for the period in question.
APPLYING FOR COMPENSATION
A member must apply for the compensation in writing within six months from the date of payment. Applications are to be sent to the sickness fund either by post or by e-mail.
The Kela-compensation (compensation according to the Health Insurance Act) must be deducted before applying for the compensation from the sickness fund. If direct reimbursement method is not used members must apply for the compensation themselves.
Once the Kela-compensation has been deducted, a member can apply for the compensation from the sickness fund using the receipt of payment or Kela’s decision for compensation. Reimbursement for medicinal products can be applied for with the receipt and with either a calculation called “laskelma lääkeostoista” or print-outs from My Kanta Pages; instructions below
- Log in to My Kanta Pages: www.kanta.fi/en/citizens
- Select identification method
- Click Reseptit / Prescriptions
- Click Määräyspäivä / Prescription date
- Print the page for every medicine on your receipt. (Check that the place and date of your purchase match with your receipt; the latest one is the last one on the list.)
THE SICKNESS FUND COMPENSATIONS AND CONDITIONS BRIEFLY
Please notice that this is a summary.
The valid official guidelines and rules in Finnish are followed in the interpretation and decision-making.
|FROM THE BEGINNING OF THE MEMBERSHIP|
|Public health care e.g. Health Centre fees, day surgery / daily hospital fees, outpatient and emergency clinic fees
(NB: Not to be applied to oral / dental care)
|Medicines (Kela-reimbursable)||100 %|
|The Kela-reimbursable doctor’s fees in private health care,
However, for Kela-reimbursable surgery the maximum compensation is 900 €.
(NB: Not to be applied to a surgery performed by a dentist)
|Radiological, pathological and laboratory examinations prescribed by a doctor (Kela-reimbursable)||80 %|
|Physiotherapy (Kela-reimbursable)||75 %|
|Treatments prescribed by a doctor: massage, osteopathy, naprapathy and chiropractic treatments||75 %|
|Lymphatic draining, desensitization, cryotherapy and phototherapy treatments (Kela-reimbursable)||75 %|
|Costs for accommodation (Kela-reimbursable)||100 %|
|Procedure and institutional fees charged by a private clinic||max. 100 € / treatment|
|Funeral allowance after the death of a member||500 €|
PLEASE NOTICE THAT 80 PER CENT OR 75 PER CENT IS KELA-COMPENSATION + FUND COMPENSATION TOGETHER
|doctor’s fee||100 €||16,50 €||63,50 €|
|(100 € x 80 % – 16,50 € = 63,50 €|
|AFTER ONE YEAR OF MEMBERSHIP|
|Costs for dental care||200 € per calendar year|
|Cost for eyeglasses / contact lenses (prescribed by an ophthalmologist/optician) The compensation can be applied for again after at least two years since the previous purchase of the glasses / lenses.||200 €|
|The maximum compensation for laser eye surgery is 900 €.
NB: Does not require that the membership has lasted a year.
According to the fund rules and directives, a prerequisite for receiving compensation is that the treatment is necessary and stems from illness, pregnancy or childbirth AND that
1) the examination has been made or treatment has been given by a doctor or other person that has had proper professional training and who is registered in the Central Register of Healthcare Professionals
2) the examination has been made or treatment has been given in a private health care unit as referred to in the Health Insurance Act, Chapter 3, Section 3 and Subsection 1.
Medical treatment that has general medical approval and is carried out according to good healthcare practice is considered as medically necessary treatment or examination that should be compensated. A doctor’s referral must be obtained before the compensable event and the referral is valid for 12 months. One referral can be compensated for up to 15 examination or treatment sessions, if the examination or treatment has been provided within 12 months of when the doctor gave you the referral.
THE SICKNESS FUND DOES NOT COMPENSATE FOR EXAMPLE
- administrative fees, invoicing extras, penalty interests etc.
- parking fees
- Over-the-Counter drugs, vitamins, herbal remedies, vaccines etc.
- medical certificates acquired for an insurance company, a pension, rehabilitation, taxation, a driving licence etc.
- optician’s fees
- costs caused by various braces, orthosis, insoles, medical aids etc.
- support person or family member’s fees or family room
- cosmetic procedures
DISCOUNTS FOR THE SICKNESS FUND MEMBERS
The sickness fund Meta has agreed discounts with following health care clinics and examination or treatment clinics for the sickness fund members.
You don’t need to pay administrative fee and you will get discounts by telling being a member of the sickness fund Meta and by showing the membership card.
If necessary, please ask the membership card by e-mail (firstname.lastname@example.org).
Kindly remember to provide your postal address at the same time.
HAMMAS & HAMMAS HIETALAHTI
Discounts with Silmäasema are meant for the sickness fund members and for their family members
FYSIOTERAPIA MEDIASKEL OY
FYSIOTERAPIAKESKUS VETO JA LEPO
KUNTOUTUS- JA HYVINVOINTIKESKUS VARIAATIO OY
RAISION FYSIOTERAPIA KY
Discounts with Synsam are meant for the sickness fund members and for their family members and you will get discounts by telling firstly being a member of the sickness fund Meta.