The General Directives for members of the Clerical Employee Sickness Fund Meta

Valid as of May 13^st 2024, until further notice 

These general directives are meant to briefly inform about the Clerical Employee Sickness Fund Meta and fund’s most common practices and compensations. Specific directives are found in the official rules of the Clerical Employee Sickness Fund Meta. Contact the sickness fund for more detailed information.

NB: Please notice that this is an unofficial translation.
The valid official guidelines and rules in Finnish are followed in the interpretation and decision-making. 

A person belonging to the sickness fund’s area of operation can apply for the insurance status if their employer provides their main income (work time is at least 60 hours per calendar month) for at least 6 months and the salary is paid from Finland.

The insurance must be applied for within six months from the start of employment.

Any changes in personal information e.g. bank account number, address or name must be notified to the sickness fund in writing.

An insured shall resign from the sickness fund when no longer belonging to its area of operation. An insured can resign from the sickness fund by submitting a written notification. The insurance 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 a termination of employment is not entitled to reapply for the insurance.

The insurance fee is 1,50 per cent of the monthly gross salary; however, the maximum fee from January 1^st 2024 is 52,64 € per month.

The maximum insurance fee is bound to the wage coefficient as provided in sections 96, 97, and 100 of the Employees Pensions Act (395/2006). The insurance fee is deducted directly from the salary by the employer and settled with the sickness fund. The insurance fee is not tax-deductible.

The insured must notify the sickness fund when starting an unpaid leave. The insured should also inform about the periods spent on assignments abroad in case a foreign employer pays the salary.

You are entitled to fund’s medical compensations if you are on:

• sickness leave
• parental allowances
• temporary lay-off and your monthly working hours are at least 50% from full-time working hours

You are not entitled to fund’s compensations if you are on:

• child home care allowance
• study leave
• job alternation leave
• rehabilitation allowance
• international assignment, when the salary is not being paid from Finland
• temporary lay-off and your monthly working hours are fewer than 50% from full-time working hours

A insured 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 via e-service IRIS. Applications send by e-mail won’t be accepted after May 1st 2024.

KELA-COMPENSATION

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 insured must apply for the compensation themselves. In these cases, the compensation can be applied for providing Kela’s decision within six months from its date.

EXAMINATIONS AND TREATMENTS

A doctor’s referral must be provided each time a reimbursement for examination or treatment is applied for. The referral must be acquired before entering an examination or a treatment. The referral is valid for one year. The maximum amount of visit that can be reimbursed is marked on the referral.

MEDICINES

Reimbursement for medicinal products can be applied for with the receipt and with a calculation called “Laskelma lääkeostoista”. If the calculation is unavailable, deliver print-outs from My Kanta Pages; instructions below

• Log in to My Kanta Pages: www.kanta.fi/en/citizens, select identification method
• Click Prescriptions (Reseptit) and Prescription date (Määräyspäivä)
• Take a screenshot for every medicine on your receipt. Check that your name is shown on the top and the purchase of your receipt is shown on bottom. 

PLEASE NOTICE THAT IF THE TREATMENT OR THE EXAMINATION IS KELA-REIMBURSABLE,
THE KELA-REIMBURSEMENT WILL BE SUBTRACTED FROM THE FUND’S REIMBURSEMENT.  

According to the fund rules, a prerequisite for receiving compensation is that the treatment is necessary and is due to an illness, a pregnancy or a childbirth AND that
1) the examination or the treatment is given by a doctor or other professional with appropriate professional training and who is registered by National Supervisory Authority for Welfare and Health (Valvira) in the Registers of social welfare and healthcare professionals
OR
2) the examination or the treatment is given in a private health care unit as referred to in the Law on the supervision of social and health care (Laki sosiaali- ja terveydenhuollon valvonnasta 741/2023).

Medical treatment that has general medical approval and is carried out according to good healthcare practice and is considered as medically necessary treatment or examination that should be compensated.

A doctor’s referral must be acquired before entering an examination or a treatment. The referral is valid for one year. The maximum amount of visit that can be reimbursed is marked on the referral.

• administrative fees, invoicing extras, penalty interests etc.
• parking fees
• journeys made by other means of transport than an ambulance
• non-Kela-reimbursable medicine, over-the-counter medicine, vitamins, herbal products etc.
• vaccinations
• medical certificates acquired for an insurance company, a pension, rehabilitation, taxation, a driver’s licence etc.
• optician’s fees
• detoxification
• braces, orthosis, insoles, medical aids etc.
• support person’s or family member’s fees or a family room
• cosmetic procedures
• the share of costs covered by employer (e.g. ePassi)
• artificial insemination costs
• artificial kidney or cancer treatments or examinations in private health care
• preventive vitamin-, trace substance- or health package- examinations
• pregnancy 3D- or 4D –examinations

The sickness fund Meta has agreed on discounts with the following service providers. Discounts are given by presenting your membership card.

The electronic membership card can be found in the fund’s electronic service, IRIS.
Register to IRIS at: https://meta.omasairauskassa.fi

You can request a plastic membership card by e-mail meta@toimihenkilosairauskassameta.fi
Also, provide your postal address to which the card will be send to.