In English

 

Cable Sickness Fund

Information sheet

 

 

 

Table of Contents

Cable Sickness Fund. 1

1.      Introduction and Contact details. 1

2.      Payments and membership. 1

3.      Reimbursements and directions for applying. 2

3.1.       Health Care Centre. 2

3.2.       Clinics, GP´s appointments and hospital costs. 3

3.3.       Private clinics & doctors, laboratory and radiological examinations. 3

3.4.       Physiotherapy and Chiropractic. 4

3.5.       Medicines and medicinal products. 4

3.6.       Eye glasses and optometry. 5

3.7.       Dental health care. 5

3.8.       Appliances. 6

3.9.       Travel costs. 6

3.10.          Home nursing. 6

4.      Contracts with service providers. 6

5.      How to Apply?. 6

 

 


 

 

Cable Sickness Fund

1.Introduction and Contact details

Cable Sickness Fund provides reimbursements to its members. The costs are covered with membership fees collected from the members of the fund. In this brochure we give you detailed information on what kinds of costs are reimbursable and how you apply for your reimbursements.

The manager of the fund is Raija Kuntonen. Do not hesitate to contact fund’s office in all matters concerning your reimbursements. Especially if you are unsure about anything related to your reimbursements.

The fund has its own board the members of which are elected annually by the general meeting of the fund. Board members must represent fund members in all participating companies. Meeting is held annually, in April every year the latest. Every member of the fund has one vote in the meeting. Should you wish to become a candidate for the election of board members, kindly contact the fund manager beforehand.

2.Payments and membership

Every member pays 1, 3 % of their salary as a payment of membership. This is looked after by one’s employer and you see the fee deducted on your payment roll monthly. Companies taking part in this sickness fund in particular are listed at our website also.

    Prysmian Finland Oy

    Grid Solutions Oy

    Maintpartner Expert Services Oy

    Oy Lival Ab / Nordic Aluminium

    Purso Oy

    Raskone Oy

    Caverion Suomi Oy

    ISS Monitaito Oy

    Maintpartner Oy

    Sigma Trukit Oy

All employees whose work contract is for three months or longer and whose salary is based on hourly working time have mandatory membership in the fund. Membership will begin simultaneously with your work contract.

 After having had a membership continuously for twenty years one can shift as a pensioner member. Their monthly membership fee is 2, 2 % of pension. Remember to contact the office within one month from the arrival of your pension decision, should you wish to remain as a member.

 

3.Reimbursements and directions for applying

In this chapter we give you information on our reimbursements.

 

3.1.Health Care Centre

Costs caused by a visit in your local Health Care Centre are reuimbursed to full. This includes doctor’s appointment (EUR 20, 90), clinic appointment (EUR 41, 70) and emergency visit (EUR 28, 70) fees.

Costs of doctor’s Medical Certificates are reimbursable in case they are meant for one’s employer as a verification of absence from work due to sickness. Certificates for special medicine reimbursement (Medical Certificate B) for Kela are reimbursable as well.

Medical certificates for other purposes, e.g. for driver’s licence are not reimbursable.

All invoices for medical certificates must include detailed information for which purpose the certificate is written.  An invoice with detailed information about the exact date of visit and the type of appointment must be provided when applying reimbursement. Invoice must also contain personal information, ergo name and personal identity code.

3.2.Clinics, GP´s appointments and hospital costs

Costs for clinical appointments in specialised public hospitals (university or central hospital) EUR 41, 70, surgical operations (EUR 136, 80) and hospital costs (EUR 49, 50 per day) in public hospitals are fully reimbursable.

Non reimbursable costs include fees for retirement housing, long-term care in hospital or rehabilitation in institutional care.

There is an annual out-of-pocket limit for public health care costs. In 2017 this limit is EUR 691. Should this limit be met the clinic appointments and surgical operations are free of charge for the rest of the calendar year. The reduced fee for hospital care is EUR 22, 20 per day, which is not reimbursed by the fund.

Remember to ask for a client charge card with your first visit from your local health care centre. Represent the card always when visiting public health care and make sure all your costs are documented to the card, this way it’ll be easier to keep track with your out-of-pocket limit.

3.3.Private clinics & doctors, laboratory and radiological examinations

Costs for necessary treatment of illness and examinations are fully reimbursed; however office work fees are not reimbursed. Appointments to both general and specialist doctors are reimbursable as well as laboratory exams, x-rays, ultrasounds and magnetic resonance images. All examinations require a prescription from a doctor; some are reimbursable when the prescription is written by a specialist doctor.

Apply by sending invoice (pay it first!) and the original documents you received. Include your application form with your signature on both the signature line and the mandate below (SV 127en). This way you ensure your both you Kela reimbursement and sickness fund reimbursement can be paid with no hindrance.

Should your visit be to a clinic that has an agreement with Kela and they can reduce your Kela reimbursement on the spot, send your paid bill with details of price and reimbursement to the fund’s office for the fund’s reimbursement.

Private surgical operations can be reimbursable in some cases. One must have strong argumentation demonstrating the reasons for which the reimbursement should be granted. Reasons for granting could be such as long queue times to operations in public health care or significant disadvantage that affects one’s daily life and routines. Whether the reimbursement will be granted or not will be decided by the board of the fund. All applications must be posted to the fund manager.

Members who are in working life must present a recommendation from an occupational physiatrist. Retired members must fill an application form in which detailed information about the situation is given. Maximum reimbursement is EUR 500 from the surgery. Equipment and products, medicines etc. are reimbursable to maximum amount of EUR136, 80, hospital fee in private hospital is reimbursed to maximum of EUR 49, 50 per day.

3.4.Physiotherapy and Chiropractic

Physiotherapy given in public health care centre and public hospital clinics (EUR 11, 50 per appointment) is reimbursable without any limitations.

Private physiotherapist is reimbursable 75 % of the cost per session, maximum amount of appointments is 30 times annually.

Legalised chiropractor appointment costs are reimbursed 75 % of the cost.

Apply by sending all the documents and signed application blank. Should Kela reimbursement not be deducted by the service provider, send all the documents including invoice, receipt, doctor’s prescription for physiotherapy, statements indicating given treatments and application blank with your signature on both signature and power of attorney sections. This way the fund will apply your reimbursement for you.

Massage, naprapath treatments and muscle manipulation are not reimbursable.

 

3.5.Medicines and medicinal products

Medicines are fully reimbursable if the purchase is based on doctor’s prescription and it is reimbursable in Kela as well. The reimbursement includes Kela-reimbursement. Reimbursable amount is up to the reference price. Should one purchase medicine more expensive than the reference priced variant, the remainder is not reimbursable.

From the beginning of 2016 there has been an initial deductible of EUR 50, this amount is reimbursable to the members of the fund.

Costs that are not reimbursable include EUR 4,50 of co-payment cost of medicines with special reimbursement, EUR 2,50 co-payment cost after your annual out-of-pocket limit of EUR 610,37 has been exceeded by your medicine costs. Kela keeps record and sends you a letter of information after your threshold has been reached.

 

3.6.Eye glasses and optometry

Eye glasses need to be prescribed by either an ophthalmologist or an optometrist. One can apply reimbursement from either eye glasses or contact lenses. Should your purchase consist only on eye glass frames, it is not reimbursable. Reimbursement can be paid for the first time after membership of one year. After this you can apply reimbursement every two years.

Maximum amount of reimbursement is EUR 350 and it is paid after two years has passed from previous reimbursement of eye glasses. This is based on the purchase date printed on your purchase receipt.

Should you find yourself unsure of the exact date of your previous purchase, always contact the fund office to clarify this! Glasses bought before the time limit has filled are not reimbursable!

Make sure your receipt has your name printed on it.

The fund also reimburses the fee of eye sight examination executed by an optometrist or if necessary, the appointment fee of an ophthalmologist (see doctor’s appointment fee reimbursements).

Lasik-surgery is reimbursable under same conditions as eye glasses above, the amount being up to EUR 500.

 

 

3.7.Dental health care

Maximum reimbursement is EUR 350 annually, with the prerequisite of a membership of one full year in the fund. With private dental care one must make sure to apply Kela-reimbursement before sending the receipts to the fund.

Public dental care and costs excluded from Kela-reimbursement can be sent directly to the fund.

3.8.Appliances

Appliances prescribed by a doctor can have a limited reimbursement if they cannot be obtained for free from public health care (crutches etc.), leg braces, support hoses, support corsets and bodices can be reimbursed up to EUR 50 annually. Other personal appliances can be reimbursed to maximum amount of EUR 840, with the percentage of reimbursement being 50 %. Gadgets such as blood pressure meters or blood sugar meters are not reimbursable.

3.9.Travel costs

Travel costs are not included to reimbursements. See if you can apply Kela-reimbursement for your health care travel costs.

3.10.Home nursing

Being nursed in one’s own home is not reimbursable under any circumstances.

4.Contracts with service providers

The fund has several contracts with different service providers.

Only fund members in working life can have their costs charged directly from the fund. Pensioners must always first pay their costs themselves and only afterwards apply reimbursement from the fund’s office.

Contracts with Suomen Terveystalo and Pihlajalinna are only for members in working life. They must first obtain a covering letter from their own occupational health care physicist. Contracts do not include physiotherapy, surgery or costs of utensils.

 

5.How to Apply?

  1. Apply within six months from the payment date in your receipt.
  2. Send all necessary documents. If you are unsure which documents to send, always contact the fund office.
  3. Send your documents to

Kaapelin Sairauskassa

Lapintie 3

33100 TAMPERE

  1. Make sure to include your email address and the number of your bank account.
  2. Contact: Raija Mustalahti (040-592 7322), kaapelin.sairauskassa@kolumbus.fi