What L&T-Sairauskassa covers
- Insured members are reimbursed for the health center fee, outpatient clinic fee at public hospitals, and the fee for day surgery at public hospitals, up to the maximum healthcare payment ceiling.
- The daily fee for hospital and health center stays at public hospitals is reimbursed for a maximum of 60 days per calendar year for the same illness, up to the maximum healthcare payment ceiling.
- Prescription medications prescribed by a doctor are reimbursed when they are also covered under the Sickness Insurance Act. The reimbursement is based on the reference price used for determining the Sickness Insurance Act reimbursement. Similarly, clinical nutrition products, equivalent products, and basic ointments are also reimbursed.
- 80% coverage of the specialist physician's consultation fee, up to four visits per calendar year. Note: Fees for procedures performed by the physician, such as mole removal, are not covered.
- Laboratory tests included in the board-approved examination list, including pathological examinations, and associated sample collection are reimbursed. The examination list is approved semi-annually or as needed; laboratory tests and pathological examinations are covered.
- Ultrasound and X-ray examinations listed in the board-approved examination list, as determined semi-annually or as needed, are reimbursed when prescribed by a doctor.
- 80% of the fees for endoscopic procedures listed in the board-approved list, including the facility charges, are covered.
- For the reimbursement of magnetic resonance imaging (MRI), prior approval must be obtained from the L&T-Sairauskassa by phone or email before the procedure.
The reimbursement for magnetic resonance imaging (MRI) is provided only for examinations conducted at the contracted facility, Mehiläinen.
***After the examination, please make arrangements with Mehiläinen on how and where they will send you the MRI report (you will receive the images on a CD).
If you have not yet scheduled an appointment with a treating physician at Terveystalo, please do so.
Before contacting the treating physician at Terveystalo, ensure that both the MRI report and the CD with the images are available to the physician at your occupational health services.
*If you return to the referring physician for a follow-up appointment, make sure to bring the report and the CD with you to the doctor's office. If you have a phone appointment scheduled at Terveystalo to receive the results, submit the MRI report and CD to the Terveystalo location where the phone appointment is scheduled on the previous day. Ask your occupational health services to provide you with the correct location and schedule.*
If the visit turns out to be unnecessary because you did not have the necessary materials with you or they were not delivered to Terveystalo, you will be responsible for paying the visit yourself.
If you undergo an MRI examination elsewhere, including Terveystalo, you will have to cover the cost yourself.
- The reimbursement for prescribed physiotherapy and physiotherapeutic examinations is 80%, up to a maximum of 10 treatment sessions per calendar year.
- For prescribed massage, naprapathy, osteopathy, and chiropractic treatments, the reimbursement is 80% up to a maximum of 5 treatment sessions per calendar year if the treatment is provided for the purpose of treating an illness.
- Travel expenses are reimbursed according to the deductible for reimbursable trips under the Health Insurance Act. Travel costs are reimbursed using the cheapest means of transportation available, and local transportation expenses are not covered. Visits to the pharmacy are not reimbursed.
- Prescribed bandages, aids, and prostheses are reimbursed up to a maximum of 100 euros per reimbursement occurrence if they cannot be obtained for free otherwise. Reimbursement can be made once per calendar year.
- Prescribed treatment instruments, devices, and meters are fully or partially reimbursed at the discretion of the board.
- In private health care dental treatments and costs prescribed by a dentist, specialist dental technician, and dental hygienist are reimbursed at 80%. The reimbursement is conditional upon also receiving reimbursement according to the Health Insurance Act (SVL). In public health care dental care is reimbursed at 100 %. Additional benefits are paid to those who have been a member of the fund for at least one year. The maximum amount for dental care reimbursements is 500 euros per calendar year. Reimbursement for private dental hygienist treatment requires a private dentist's prescription obtained before the treatment is provided.
- The maximum reimbursement amount for eyeglasses and contact lenses, or alternatively, refractive eye surgery, is a one-time payment of 400 euros after one year of membership in the L&T Health Fund. The reimbursement is conditional upon the lenses being optically ground for vision correction. Reimbursement can be made every third calendar year.
- According to Section 14a of the L&T Health Fund's rules, reimbursement for eligible surgeries and special procedures is subject to the provision of a B-certification obtained from the shareholder's occupational health care. The applicant must complete a separate application form, including the necessary documentation. Additionally, the fund will seek the opinion of the fund's expert physician regarding the application.
More detailed instructions and the application form can be obtained from the fund.