Benefits and reimbursement fees

Medical fees

• The Fund will compensate 75% of doctors’ fees if the treatment is also compensable according to the Health Insurance Act.
• The Fund will compensate 75% of doctors fees if the treatment is not compensable according to the Health Insurance Act, however the maximum amount of compensation is 115 euros until 31.12.2023 and 200 euros from 1.1.2024.

Medicines

●The Fund will compensate 85% 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.

●The special reimbursable medicines will be compensated entirely up to the reference price if compensation is also granted based on the Health Insurance Act and said person claiming for reimbursement has been granted the right for special reimbursement for the particular medicinal product.

●Kindly note that some of the medicines prescribed by a doctor are not compensable under the Health Insurance Act.

●Additional compensations of large medicinal costs: The fund will compensate high medicinal expenses in case the expenses exceed the annual amount of EUR 592,16 which is the threshold for high medicinal costs.

Research and Treatment

● The Fund will compensate 75 % of the costs of laboratory tests and pathology samples if they are prescribed by a doctor.

● The Fund will compensate 75 % of the costs of radiological examinations if they are prescribed by a professional doctor.

● The Fund will compensate 75 % of the costs of light treatment if they are prescribed by a professional doctor.

Physiotherapy

●The Fund will compensate 75 % of the costs of physiotherapy and physiotherapeutic examinations or massage if the prescription is written by a professional doctor.

• The Fund will compensate maximum of 10 therapy sessions annually.

Chiropractor, naprapath

●The Fund will compensate 75% of the costs of treatment given by a chiropractor and a naprapath if the prescription is written by a professional doctor.

• The Fund will compensate maximum of 5 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.

●In general the usage of cheapest mode of transportation is compensated. This means public transportation. In specific cases usage of taxi, ambulance or car is compensated if the condition of the applicant or conditions of traffic require specific mode of transportation. Usually a qualified professional of health care provides the applicant with a certificate which states the need of special transportation (Kela blank SV 67)

●The compensation is paid in accordance with the price of travel. The copayment of a travel is  EUR 25,00 and costs exceeding this sum are paid.

Fees of Public Health Care

●The Fund will compensate the fee of hospital care and hospice care at home up to 180 days 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 visits at the nurses reception

●The Fund will compensate the doctors’ medical certificate written in a public hospital or health care center.

Dental Care

● After having been a member of the Fund for one year a person is entitled to have 90% compensation from charges of dentist, dental hygienist, and dental specialist up to EUR 300, 00 annually.

●Compensable dental treatment also includes dental check-up, orthodontics, prostheses and technical dental work. On Health Insurance Act dental check-up is compensable once a year, and orthodontics, prostheses and technical dental work are compensable under special circumstances.

Glasses

●After having been a member of the Fund for one year a person is entitled to have compensation from eye glasses prescribed by an ophthalmologist or optician up to EUR 330, 00.

─The entitlement for compensation on glasses is in every three years.

Appliances

●The Fund will compensate the cost of appliances of medical purposes up to EUR 100,00, prescribed by a professional doctor. Each case is addressed separately in a board meeting.

Therapy given by a Psychologist

● The Fund will compensate 75 % of the price of therapy given by a professional Psychologist, when the therapy is recommended by a doctor.

• The maximum compensation is 5 sessions annually.

Burial Assistance

●In case of death of a member the fund will pay a funeral grant of EUR 733,00 to close relatives or the estate of the late member.