General Information
Rauten sairauskassa ( sickness fund ) has been founded in 1954.
At the Fund there have been several different names along the years ,under the present name Rauten sairauskassa has operated from the outset for the year 1999.
Rauten sairauskassa is a sickness fund for employees and it takes care of the health insurance and supplementary benefit issues of its members.
In Finland the general public organization for social security is KELA, which takes care of all people who are entitled to social security in Finland, based on either residency or work in Finland. The fund offers to supplement this social security by paying reimbursement to its members.
Our members’ KELA issues concerning reimbursement on medical fees, medicines costs are processed in the Fund. We also process applications of sickness allowance and parental allowances. However, other issues regarding social insurance issues are processed in KELA.
Membership in the Sickness Fund Rauten sairauskassa
Membership in the fund is voluntary for employees. One joins the fund by filling the application blank which can be found here.
A member is impossible to dismiss a person from the fund. The member will automatically resign from the fund when one no longer belongs to its sphere of action.
All new members will receive new KELA –card including fund number.
Membership fee is 1,80% of monthly salary, however the maximum sum of membership fee is 57,45 € per month and 689,40 € per year. The fee will be taken from the salary of a member by one’s employer.
Fund inform the membership to the payroll.
During an unpaid leave (temporary layoff) a member is not entitled to have the benefits and reimbursements offered by the Fund.
One is entitled to the fund benefits as a member, the right to claim reimbursement begins as soon as one is a listed member of the fund. Reimbursement of glasses and dental health requires a membership which has lasted for two years.
Benefits and reimbursement fees
Medical fees
The Fund will compensate 80% of doctors’ fees; in case of a non-dental disease
Private surgical operations and procedures comparable to these, all applications for compensations such as these are addressed in the board meeting and each case is addressed separately.
Medicines
There are three levels of medicinal reimbursements in Kela system:
The basic reimbursement (35% of the price)
The lower special reimbursement (65% of the price)
The higher special reimbursement (100% of the price, a EUR 3 copayment is charged for each medicine)
The Fund will compensate 100% of the cost of medicines, clinical nutritional products, corresponding products and basic ointments if they are reimbursable under the Health Insurance Act and prescribed by a professional doctor. The compensation is calculated by using the reference price, which is also the basis for the Health Insurance Act compensation.
Kindly note that some of the medicines prescribed by a doctor are not compensable under the Health Insurance Act. The Fund will compensate 100 % of the costs, if it´s also compensable according to the Health Insurance Act.
Research and Treatment
The Fund will compensate 100 % of the costs of laboratory tests and pathology samples if they are prescribed by a professional doctor.
The Fund will compensate 100 % of the costs of radiological examinations, though excluding other procedures made during the examination.
Physiotherapy
The Fund will compensate 80 % of the costs of physiotherapy and physiotherapeutic examinations if the prescription is written by a professional doctor.
The Fund will compensate maximum of 15 therapy sessions annually.
Travel Expenses
The Fund will compensate travel expenses when they have been necessary in order to obtain health or the purpose of the travel has been to claim medical appliances necessary to the applicant and reimbursement has been granted based on the Health Insurance Act.
The travel costs are usually reimbursed on the basis of the least expensive way of reaching the nearest private or public doctor or treatment provider. The least expensive way is usually public transport such as bus or train. Use of your own car is reimbursed at the rate of EUR 0.20 per kilometre travelled.
The copayment for a one-way trip is EUR 14.25. Kela reimburses the costs exceeding the copayment. If the copayments amount to EUR 242.25 within a calendar year, any exceeding costs are reimbursed in full.
The Fund will compensate 100 % of the costs of travel if the travel is also compensable according to the Health Insurance Act.
Fees of Public Health Care
The Fund will compensate the fee of hospital care up to 90 days per calendar year if the necessity for hospital care has been caused by same sickness.
The Fund will compensate the hospital outpatient charges completely.
The Fund will compensate the charges of daily surgery in public hospitals
The Fund will compensate 100% of the cost of the doctors’ medical certificate written in a public hospital or health care center, if the certificate is for sikknses or special cost medicines.
Dental Care
After having been a member of the Fund for two years a person is entitled to have compensation from charges of dentist, dental hygienist, and dental specialist up to EUR 329 € (in 2014) annually.
Glasses
After having been a member of the Fund for two years a person is entitled to have compensation from eye glasses prescribed by an ophthalmologist or optician up to EUR 269 € (in 2014).
The entitlement for compensation on glasses is in every two years.
Burial Assistance
In case of death of a member the fund will pay a funeral grant of EUR 749 € (in 2014) to close relatives or the estate of the late member.
Appliances
The Fund will compensate the cost of appliances of medical purposes, prescribed by a professional doctor. Each case is addressed separately in a board meeting.
Applying for reimbursement
Always send the invoice and a receipt which proves that the invoice is paid.
Rauten sairauskassa will process also those applications of its members where one has the right for reimbursement from Kela as well. These cases fall under the Health Insurance Act.
Fill the blank Kela SV 127e
Travel costs: fill the blank Kela SV 4
Medicinal costs: send blank Kela SV 127e, the calculation given by pharmacy and the original receipt.
Visits to public health care: send the invoice and a receipt which shows that the invoice is paid.
Application must be delivered to the fund’s office within six months from the payment of the costs.
In reimbursements where a doctor’s prescription is needed please make sure that you deliver the original prescription to the office. The prescription must be signed and dated before the treatment (e.g. physiotherapy, psychological therapy) has taken place.
An administrative fee sickness fund is not a substitute.
Companies which have an agreement with the Fund
The fund has made an agreement with certain health service companies and pharmacies. These are listed below. In these companies a member of the fund can have treatment and medicines free, the company will send the invoice directly to the fund ->If the treatment or drugs fall under the Health Insurance Act.
Please have your social security card with you and present them when checking in.
Pharmacies
- Apila apteekki (Launeen Prisma)
- Asikkalan apteekki
- Heinolan Keskusapteekki
- Hollolan apteekki
- Holman apteekki (Holman Prisma)
- Kajaanin I apteekki
- Kajaanin II Raatihuoneen apteekki
- Kausalan apteekki
- Nastolan apteekki
- Orimattilan apteekki
- Palokan apteekki
- Yliopiston Apteekin kaikki toimipisteet
The Fund has also made an agreement with Suomen Terveystalo Oy and Nastolan PlusTerveys.
Agreement covers doctor's fees and laboratory studies, and radiographic studies. Physiotherapy agreement does not apply.