Reimbursement scheme for cross-border healthcare to be amended
The Act on Cross-Border Health Care will be amended. The legislative amendments will enter into force on 1 May 2023. The most central amendment deals with renewing the right to reimbursement under the Directive on the Application of Patients’ Rights in Cross-Border Healthcare.
Under the legislation currently in force, patients have the right to receive reimbursement from the Social Insurance Institution of Finland (Kela) for medical costs related to treatment, medication and travel as provided in the Health Insurance Act if they seek non-urgent care in another EU Member State, Switzerland or a country belonging to the European Economic Area (EEA) under the terms of the Directive.
In future, medical costs will be reimbursed up the amount of the cost for the corresponding public healthcare service in the patients’ wellbeing services county, the City of Helsinki or the HUS Group, the joint authority for Helsinki and Uusimaa. However, the reimbursement may not exceed the costs the patients actually pay for the health services they receive.
Costs for travel and medication will be reimbursed as before as provided in the Health Insurance Act.
Treatment must correspond to treatment given in Finland
Reimbursements can be applied for from Kela as before. The right to reimbursement will exist for treatment received in EU and EEA countries, Switzerland and the United Kingdom of Great Britain and Northern Ireland.
Reimbursement of costs requires that the person has covered the costs arising from the treatment.
Another condition for reimbursement is that the healthcare service received abroad is part of the range of public healthcare services in Finland and the service would have been provided by the Finnish public healthcare in a corresponding situation in Finland.
Kela must request the relevant wellbeing services county, the City of Helsinki or the HUS Group to provide an assessment of whether the conditions for reimbursement are met.
Seeking treatment requires a referral and, in certain cases, also a prior authorisation under the Directive
To receive reimbursement for non-urgent care, patients will also need a referral if, by law, they would need one for similar treatment in the Finnish public healthcare.
In certain cases, the right to reimbursement will also require a prior authorisation under the Directive. The authorisation can be applied for from Kela. Provisions will be laid down separately by government decree on the services the costs of which can be reimbursed subject to prior authorisation.
The prior authorisation procedure under the Directive will not be introduced until the beginning of 2024.
A prior authorisation in accordance with EU Regulation 883/2004 or an international agreement is already in use in Finland, and it takes priority. This prior authorisation can be used if the person cannot be provided with the treatment that is included in the range of public healthcare services within the timeframe laid down by law.
Voluntary prior notification to be introduced in Finland
In future, people can, if they so wish, request Kela to find out beforehand whether they are entitled to reimbursement and what its maximum amount is. This is called a prior notification.
A prior notification application must include an account drawn up by a healthcare service provider operating abroad regarding a healthcare service given abroad.
The reimbursement will be paid at the amount estimated in the prior notification if the healthcare service provided in another state corresponds to the services considered in the prior notification.
However, the reimbursement may not exceed the costs the patients actually pay for the healthcare services they receive.
Marika Lahtivirta, Legal Adviser, [email protected]