Make a claim on your health insurance

Frequently asked questions about health insurance

What expenses are covered by health insurance?

Health insurance provides compensation for the costs of examinations and treatments in Finland that are caused by an illness or accident. To be eligible for compensation, the illness must have started or the accident must have occurred during the validity of the insurance cover. 

The most common costs to be compensated are:

• doctor’s fees
• costs of X-ray and MRI procedures and laboratory tests
• costs of five physical treatment sessions prescribed by a doctor in connection with a compensable surgical operation or the treatment of a fracture
• costs of dental treatment resulting from an accident, excluding examination and treatment costs resulting from an injury caused by occlusion
• treatment costs resulting from plastic surgery after breast cancer or an accident
• daily hospital fees.

Costs of medication are not compensated.

Is there a deductible in health insurance?

Yes. The deductible in health insurance is fixed and it is 150 euros per insurance period. You will only need to pay the deductible once in an insurance period. The insurance period is one year. 

Example: You fall ill and make a claim on medical treatment expenses for the first time in the insurance period. The treatment expenses are 250 euros and your deductible is 150 euros. The compensation paid to you is 100 euros. You fall ill again and make a claim on a new treatment expense of 170 euros during the same insurance period. As you have already paid the full deductible during this insurance period, nothing is deducted from the second compensation, and you are paid 170 euros.  

You can check your insurance period and deductible in our Insurance self-service.

Do I need to deliver the receipts to the insurance company?

You don’t need to deliver the receipts from doctor’s appointments or health care facilities to us when you make a claim. You should, however, keep them for 12 months.

How does a payment commitment work?

If you need more extensive examinations or a surgery, for instance, as a result of an accident, the health care facility may request a payment commitment from the insurance company in advance. If this is needed, the health care facility will ask which insurance company you have, and then send the request for a payment commitment directly to us. We will process the request as soon as possible and get back both to the health care facility and you with our decision to either approve or reject the payment commitment. The health care facility will then usually contact you to discuss the necessary examinations and treatments. 

If you have not yet paid the deductible in the current insurance period, we will let you know how much the deductible is in connection with the payment commitment. The health care facility will then charge the deductible from you and we will pay the rest to the health care facility.