Staff – Benefits

Additional benefits / Reimbursements for medical care

Below you will find all reimbursement types. By clicking the reimbursement group open, you will find more detailed instructions and rules

Doctor’s fee:

  • 75% of the doctor’s consultation fee is reimbursed when the visit is eligible for Kela reimbursement.
  • The reimbursement is calculated based on the total cost. For example, if the fee is €60, the reimbursement is €45, including the Kela reimbursement of €8.
  • 75% of the doctor’s fee for examinations performed to diagnose or treat an illness is reimbursed.
  • 75% of the cost of necessary procedures performed by the doctor is reimbursed (however, the facility fee is reimbursed up to a maximum of €100 per procedure).
    Note: Fees for major surgeries and comparable procedures are reimbursed according to section 15.1 of the rules.
  • No reimbursement is paid for infertility treatments or for dialysis or cancer treatments performed by a private service provider.
  • The administrative fee is not reimbursed

Facility fee:

  • Reimbursed up to a maximum of €100 per procedure (e.g., endoscopies, mole removal). Please note that the facility fee must first be paid by you, and then you can apply for reimbursement from the fund afterwards.
  • Important: If you are going to a private clinic for surgery or a procedure (e.g., mole removal or endoscopy), first request an itemized cost estimate. After that, you can ask the fund about the amount of reimbursement.

Instructions for claiming reimbursement:

  • If the Kela reimbursement has already been deducted from the invoice or the cost is not eligible for Kela reimbursement:
    • Apply for reimbursement primarily through Iris: Omasairauskassa
    • Alternatively, you can send the application by post to: Koneen toimihenkilöiden vakuutuskassa. P.O. Box 6, 05801 Hyvinkää
      • The application must include an itemized invoice.
    • Reimbursement must be claimed within 6 months from the date of paying the costs.
  • If the Kela reimbursement has not been deducted:
    • Apply for reimbursement via OmaKela: OmaKela
    • Alternatively, you can send the application by post to: Koneen toimihenkilöiden vakuutuskassa, P.O. Box 6, 05801 Hyvinkää
    • The application must include:
      • Your completed reimbursement application form SV 127
      • The doctor’s completed form SV 120
      • The invoice or receipt of the payment
    • Reimbursement must be claimed within 6 months from the date of paying the costs.

Medicine:

  • Medicines prescribed by a doctor and eligible for compensation under the Health Insurance Act are fully reimbursed up to the reference price. The reference price for each medicine is determined by the Pharmaceuticals Pricing Board (HILA).
  • The annual initial deductible for medicines under the Health Insurance Act is €70,33 for Kela-reimbursable medicines. The initial deductible is not reimbursed.
  • Clinical nutrition products, equivalent products, and emollient creams prescribed by a doctor are fully reimbursed when they are Kela-reimbursable.
  • Antiseptic solutions, bandages and wound dressings prescribed by a doctor are fully reimbursed.

The employee benefit fund has a nationwide pharmacy agreement. This covers all of Finland (with the exception of a few pharmacies that are not part of the agreement). You will receive direct reimbursement for your medicine purchases at the pharmacy by presenting your Kela card with the number 46303.

The annual maximum limit on out-of-pocket medicine costs:

  • The annual out-of-pocket maximum is EUR 636,12 in 2026.
    You will receive the additional reimbursement immediately at the pharmacy, and you do not need to apply for it separately from Kela.

Special reimbursement for a medicine:

  • The employee benefit fund processes applications for the right to special reimbursement for a medicine. You can apply for the right by sending via OmaKela a medical statement B that a doctor has issued for you. No separate application is required.

Instructions for claiming reimbursement:

  • If you did not receive medicine reimbursement directly at the pharmacy, the product is most likely not Kela-reimbursable, or you have not reached the initial deductible, €70,33. In these cases, the fund does not reimburse the medicine.

If you had to pay the full price of the medicine yourself for any other reason:

  • Apply for reimbursement via OmaKela: Our Services | Kela
  • Alternatively, you can send your application by post to:
    Koneen toimihenkilöiden vakuutuskassa, P.O. Box 6, 05801 Hyvinkää
  • The application must include:
    • Completed claim form SV 178
    • Pharmacy’s calculation of the medicine purchase
    • Receipt
  • Reimbursement must be claimed within 6 months from the date of paying the costs

If you received a Kela reimbursement but had to pay the remaining amount yourself:

  • Apply for reimbursement primarily through Iris: Omasairauskassa
  • Alternatively, you can mail your application to: Koneen toimihenkilöiden vakuutuskassa, P.O. Box 6, 05801 Hyvinkää
  • The application must include:
    • Pharmacy’s calculation of the medicine purchase
    • Receipt
  • Reimbursement must be claimed within 6 months from the date of paying the costs

Examination prescribed by a doctor:

  • 75% of laboratory tests, pathology-related examinations, and radiological examinations prescribed by a doctor or dentist for the treatment of an illness are reimbursed.
  • The reimbursement is calculated based on the total cost. For example, if the examination costs €100, the reimbursement is €75, including the Kela reimbursement.
  • No reimbursement is paid for infertility treatment costs or for cancer and dialysis treatments performed in the private sector.
  • MRI examinations:
    • The invoicing contract does not apply to Terveystalo or Aava, as the prices for these examinations are significantly higher than those of other health care providers.
    • Please ask your doctor to print out the referral during your appointment so that you can book an appointment with a more affordable health care provider (see Contracts with health care providers – Vakuutuskassa).
    • Please note that by using a more affordable service provider, your deductible will be lower.
    • However, if you still wish to go to Terveystalo or Aava, you must first pay the full cost of the examination yourself and then apply for reimbursement from the fund afterwards.
  • Please keep in mind, that laboratory tests in Synlab are the most affordable.

Instructions for claiming reimbursement:

  • Apply for reimbursement primarily through Iris: Omasairauskassa
  • Alternatively, you can send the application by post to: Koneen toimihenkilöiden vakuutuskassa, P.O. Box 6, 05801 Hyvinkää.
    • The application must include the doctor’s referral and the invoice/receipt of the payment.
  • Reimbursement must be claimed within 6 months from the date of paying the costs.

Psychotherapy:

  • Reimbursed for up to 5 sessions per calendar year with a referral from healthcare.
    • Only treatment provided by a trained psychotherapist (not a doctor) or psychologist is reimbursed.
    • You can verify the therapist’s qualifications in Valvira’s Registers of social welfare and healthcare professionals by searching the provider’s name at: JulkiTerhikki

Instructions for claiming reimbursement:

  • Apply for reimbursement primarily through Iris: Omasairauskassa.
  • Alternatively, you can send the application by post to: Koneen toimihenkilöiden vakuutuskassa, P.O. Box 6, 05801 Hyvinkää.
    • The application must include the referral from healthcare and the invoice/receipt showing the paid amount, date of visit, given treatment, and provider.
  • Reimbursement must be claimed within 6 months from the date of paying the costs.

Physiotherapy:

  • 75% of the cost is reimbursed. No referral is required.
  • Starting from May 1, 2025, Kela will reimburse 4 physiotherapy sessions per calendar year without a doctor’s prescription. The Kela reimbursement is €15 per session. The Kela reimbursement is included in the 75% reimbursement paid by the fund.
  • Example:
    • Cost €100
      • Total reimbursement: €75 = Kela reimbursement €15 + fund’s additional benefit reimbursement €60
  • Starting from October 20, 2025, physiotherapy will be reimbursed for up to 20 sessions per calendar year.

Instructions for claiming reimbursement:

  • For the first 4 sessions, you can apply for reimbursement through the OmaKela online service.
  • The application must include the following documents:
    • Invoice or cash receipt
    • Form SV 3FS: Statement of physiotherapy provided and fees charged (completed by the provider)
    • Form SV 127: Reimbursement application – fill in sections 1, 2, and 4
  • The application will be forwarded to the employee benefit fund, which will pay you a 75% reimbursement.
  • For additional visits, reimbursement can be applied for via Iris: Omasairauskassa
  • Alternatively, you can send the application by post to: Koneen toimihenkilöiden vakuutuskassa, P.O. Box 6, 05801 Hyvinkää.
    • The application must include an itemized invoice.
  • Reimbursement must be claimed within 6 months from the date of payment.

Massage therapy:

  • 50% of the cost of treatment provided by a licensed massage therapist is reimbursed. No referral is required.
  • Note: The massage therapist/rehabilitation therapist must be properly trained, and the person providing the treatment must be listed in the central register of health care professionals maintained by Valvira (National Supervisory Authority for Welfare and Health). You can check the qualification by searching the therapist’s name at: https://julkiterhikki.valvira.fi/
  • Student massage services are not reimbursed.

Instructions for claiming reimbursement:

  • Apply for reimbursement primarily through Iris: Omasairauskassa
  • Alternatively, you can send the application by post to: Koneen toimihenkilöiden vakuutuskassa, P.O. Box 6, 05801 Hyvinkää.
    • The application must include a receipt with the following details:
      • Name of the person receiving/paying for the treatment
      • Name of the trained massage therapist/rehabilitation therapist on the receipt/invoice
      • Description of the treatment, e.g., 30 min massage
      • Date of the treatment
      • Price
      • Payment method, e.g., debit card, cash
  • Reimbursement must be claimed within 6 months from the date of payment.

Chiropractice, osteopathy and naprapathy:

  • 50% reimbursed with a doctor’s referral.

Instructions for claiming reimbursement:

  • Apply for reimbursement primarily through Iris: Omasairauskassa
  • Alternatively, you can send the application by post to: Koneen toimihenkilöiden vakuutuskassa, P.O. Box 6, 05801 Hyvinkää.
    • The application must include the doctor’s referral and an itemized invoice.
  • Reimbursement must be claimed within 6 months from the date of payment.

Starting from October 20, 2025, massage, naprapathy, osteopathy, and chiropractic treatments are reimbursed for a total of 20 sessions per calendar year.
Please note that for treatments paid in advance, reimbursement can only be claimed after the sessions have taken place.
If you pay for a series card in advance, the treatments must be provided within 6 months of the payment date. In addition, proof of visit dates is required.
Reimbursement must be applied for within 6 months of the payment date.

  • Up to €200 per calendar year is reimbursed in addition to Kela reimbursements.
  • The reimbursement covers treatments by municipal dentists and dental hygienists, as well as private dentists and dental hygienists, including treatments not reimbursed by Kela, except for aesthetic treatments (e.g., whitening).
  • Starting May 1, 2025, Kela reimburses dental hygienist treatments twice per calendar year without a dentist’s referral. After that, a dentist’s referral is required for the treatment to be Kela-reimbursable. If there is no referral, Kela reimbursement will not be granted, and the hygienist’s fee will be fully covered from the €200 dental care allowance. With a referral, the Kela reimbursement is paid in addition to the €200 allowance.
  • Bite guards or anti-snoring mouthpieces are reimbursed as medical devices, not under the dental care benefit.
  • Dental X-rays taken in the private sector are reimbursed as examinations, not under the dental care benefit. Dental X-rays taken in the public sector are reimbursed as dental care.

Instructions for claiming reimbursement:

If the Kela reimbursement has already been deducted from the invoice:

  • Apply for reimbursement primarily through Iris: Omasairauskassa
  • Alternatively, you can send the application by post to: Koneen toimihenkilöiden vakuutuskassa, P.O. Box 6, 05801 Hyvinkää.
    • The application must include an itemized invoice.
  • Reimbursement must be claimed within 6 months from the date of paying the costs.

If the Kela reimbursement has not been deducted:

  • Apply for reimbursement through OmaKela
  • Alternatively, you can send the application by post to: Koneen toimihenkilöiden vakuutuskassa, P.O. Box 6, 05801 Hyvinkää.
    • The application must include:
      • For a dentist visit: your completed reimbursement application form SV 127, the dentist’s completed form SV 126, and the itemized invoice.
      • For a dental hygienist visit: your completed reimbursement application form SV 127, the dentist’s referral to the hygienist SV 3SHM, the hygienist’s completed form SV 3SHS, and the itemized invoice.
  • Reimbursement must be claimed within 6 months from the date of paying the costs.

Eyeglasses

  • A reimbursement of up to €200 is available every other calendar year for prescription eyeglasses, contact lenses, or laser eye surgery.
  • You can apply for reimbursement in multiple installments within the same calendar year. The reimbursable costs must be from the same year. The benefit can also be used for an eyeglass leasing agreement.
  • The reimbursement requires that the lenses are corrective for vision.

Eyesight examination

  • Eyesight examination ( excluding retinal imaging) performed by an optician is fully reimbursed.

Instructions for claiming reimbursement:

  • Apply for reimbursement primarily through Iris: Omasairauskassa
  • Alternatively, you can send the application by post to: Koneen toimihenkilöiden vakuutuskassa, P.O. Box 6, 05801 Hyvinkää.
    • The application must include a receipt with your name and breakdown of costs.
  • Reimbursement must be claimed within 6 months from the date of paying the costs.

Eyeglass leasing agreements

  • Leasing agreements: The eyeglass benefit can also be used for leasing agreements.
  • Applying for reimbursement: Reimbursement must be claimed in the same year in which you are entitled to eyeglass reimbursement.

Instructions for claiming reimbursement

  • Invoice: Attach the part of the invoice showing the monthly payment period (e.g., 1.3.-31.3.2025).
  • Purchase agreement: Include the purchase with your application.

Applying for reimbursement

  • Monthly: You can apply for reimbursement on a monthly basis.
  • In one go: You can collect receipts worth €200 and apply for reimbursement at once. Note the turn of the year.

Application period

  • 6 months: The application period is 6 months from the payment date.

Turn of the year

  • Payments at the end of the year: If you enter into a leasing agreement at the end of the year, consider applying for reimbursement only at the beginning of the following year.
  • Example: The total cost of the payment installments is €90 (e.g. €45 on 30.11.2025 and €45 on 31.12.2025). It is not recommended to apply for the benefit under the 2025 eyeglass allowance.
  • Allowance for 2026: Apply for reimbursements starting from the payment period beginning 1 January 2026 to ensure you receive the full €200 benefit for 2026.
  • From the hospital serial treatment and day surgery fee, 75% is reimbursed (public sector fees).
  • From the hospital daily care fee, 75% is reimbursed, for a maximum of 150 days for the same illness.

Instructions for claiming reimbursement:

  • Apply for reimbursement primarily through Iris: Omasairauskassa
  • Alternatively, you can send the application by post to: Koneen toimihenkilöiden vakuutuskassa, P.O. Box 6, 05801 Hyvinkää.
    • The application must include the invoice.
  • Reimbursement must be claimed within 6 months from the date of paying the costs.
  • 75% of the hospital outpatient clinic fee is reimbursed.
  • 75% of the municipal health center fee and annual fee is reimbursed.

Instructions for claiming reimbursement:

  • Apply for reimbursement primarily through Iris: Omasairauskassa
  • Alternatively, you can send the application by post to: Koneen toimihenkilöiden vakuutuskassa, P.O. Box 6, 05801 Hyvinkää.
    • The application must include the invoice.
  • Reimbursement must be claimed within 6 months from the date of paying the costs.
  • Travel costs to visit a doctor or to undergo an examination or treatment in a medical examination institution or hospital are reimbursed at 100 per cent in cases where they are eligible for compensation under the Health Insurance Act, i.e. reimbursed by KELA
  • The trip is fully reimbursed when the one-way cost exceeds the €25 deductible.
    • For example, the €25 deductible for a Kela taxi and the deductible for ambulance transport are fully reimbursed.
  • Trips under €25 count towards your maximum annual limit on out-of-pocket travel costs (€300), and applications for these are submitted in OmaKela.
  • No reimbursement is paid for trips under €25 before maximum annual limit is reached.
  • You’ll find further information on travel costs in Reimbursements of travel costs | Our Services | Kela

Instructions for claiming reimbursement:

  • Apply for reimbursement for the deductible (€25) primarily through Iris: Omasairauskassa
  • Alternatively, you can send the application by post to: Koneen toimihenkilöiden vakuutuskassa, P.O. Box 6, 05801 Hyvinkää
    • The application must include a receipt for the deductible amount.
  • Reimbursement must be claimed within 6 months from the date of paying the costs.
  • Trips under €25 count towards the maximum annual limit on out-of-pocket travel costs (€300). Reimbursement for these trips is applied for via OmaKela.
  • One assistive device is reimbursed per calendar year, up to a maximum of €500, but only if the device is not otherwise available free of charge (e.g., from a health center).
  • Receiving reimbursement requires a doctor’s prescription for the device.
  • Examples of assistive devices:
    • ·  Bite guard, wrist or knee support, insoles, compression socks
  • Reimbursable as assistive device:
    • ·  50% of the rental cost for a sleep apnea (CPAP) device
    •   50% of the cost of a temporary sleep mask until the device is available from the public healthcare system
  • Not reimbursed as assistive device:
    • Purchase of a CPAP device
    • Instructions provided by a nurse for using the device
  • In unclear cases, please contact the fund.

Instructions for claiming reimbursement:

  • Apply for reimbursement primarily through Iris: Omasairauskassa
  • Alternatively, you can send the application by post to: Koneen toimihenkilöiden vakuutuskassa, P.O. Box 6, 05801 Hyvinkää.
    • The application must include a doctor’s referral and an itemized invoice.
  • Reimbursement must be claimed within 6 months from the date of paying the costs.

It is possible to apply for discretionary benefit in situations where public sector treatment queues are long and where the insured person’s recovery and return to work would be significantly accelerated by an operation performed by a private service provider.

To qualify for the benefit, the following are required:

  • A referral from the treating physician to the public sector
  • A schedule estimate from the public sector. Once this is received, the insured can apply for the benefit according to the instructions below

The insured must provide the following documentation:

  • A medical statement B from the occupational health physician, including a comprehensive job description and an explanation of how the illness affects work
  • A personal application for the procedure, including a description of the illness
  • A schedule estimate from the public sector
  • A written cost estimate from the private service provider
  • A supporting statement from the manager, which must include a description of the work and working conditions, and explain how the current health condition impacts the ability to perform work tasks

Once all the above documentation has been submitted to the fund, the fund will process the application and inform the insured of the decision.
After receiving a positive decision, the insured may book an appointment for the operation. The fund will then provide a payment commitment to the service provider.

The maximum reimbursement is €5,000, of which the insured person’s share is €200 (the deductible must be paid on-site).
If the cost of the operation exceeds €5,000, the excess amount will be the responsibility of the insured.

The employee benefit fund reimburses the operation according to the fund’s rules, and the remaining costs are charged to the insured person’s unit. Therefore, approval from the budget-responsible manager is required to receive the benefit.

Forms can be downloaded from the links below:

Plan for the contingency fund 2024

Approved 15 November 2024

The purpose of the contingency fund is to supplement, at the discretion of the Board, the benefits specified in Sections 15–16 of the Fund’s rules, in accordance with a plan approved by the Board for a maximum of one year at a time. The plan is confirmed annually after the financial statements have been approved and remains in force until the next contingency fund plan is adopted following the approval of the subsequent year’s financial statements.

It is possible to apply for reimbursement from the contingency fund if the reimbursement is not available from public sources or if another party (e.g., insurance) does not cover such additional costs. A prerequisite for reimbursement is that the individual has otherwise regularly taken care of their health and utilized the annual reimbursements offered by the fund.

The maximum reimbursement payable to a member from the contingency fund is 500 euros per person per calendar year. Reimbursement from the contingency fund can be applied for as a one-time payment for the same condition only once during the membership period. The reimbursement is included in the annual reimbursement ceiling of 2,000 euros. A prerequisite for the Board’s decision on reimbursement is a diagnosis from the attending physician and a statement on the necessity of the treatment.

Discretionary benefits are not reimbursed from the contingency fund, nor can it be used to cover deductibles for the benefits mentioned in Sections 15–16 of the rules.

The reimbursement decision is based on the rules in effect at the time of the application

  • Restrictions – Additional benefits are not available during:
  • Study leave
  • Child care leave
  • International assignments
  • Temporary pension or rehabilitation allowance
  • Job alternation leave
  • Unpaid leave
  • After the €2,000 reimbursement ceiling has been reached

Appeal process for additional benefit decisions

  • An insured member who is dissatisfied with the fund’s additional benefit decision may request a recommendation for resolution from the Finnish Financial Ombudsman Bureau.
  • Instructions for filing an appeal