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Rollikka

General Brochure of Information

 
 
 

General Information

Rollikka is a sickness fund for employees and it takes care of the health insurance and supplementary benefit issues of its members.

Our headquarters is situated in Tampere, Finland, while our clientele formed by our members resides all over Finland.  We have approximately 2 000 members  from various companies within our range of services.

Kindly note that the benefits listed below are for the members of this fund in particular – other funds have their own rules and regulations concerning their benefits. In this brochure the term fund refers solely to Rollikka.

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 (http://www.kela.fi/in/internet/english.nsf). The fund offers to supplement this social security by paying reimbursement to its members.

Our members’ Kela issues concerning reimbursement on medical fees, medicines and travel 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 Rollikka

Joining the Fund

Membership in the fund is voluntary for employees. One joins the fund by filling the application blank which can be found on our web page (www.sairauskassarollikka.fi) currently the blank is in Finnish only.

All membership issues including new members are addressed in the meeting of the Board. These meetings take place once a month. The date of the next board meeting can be found on our web page. Applicants must fill and send the application to be addressed in the board meeting within 2 months of the commencement of employment.

A member cannot withdraw from the membership during the employment period, it is also 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. In general, this means the end of employment in a company whose employees are able to be members of Rollikka. The list of companies can be found on our web page.

Becoming a member

All new members will receive a letter of information with their new membership card enclosed. This card states the name and social security number of a said member.

Membership fee is 39,90 euros per month. The fee will be taken from the salary of a member by one’s employer.

During an unpaid leave (e.g. parental leave, temporary layoff) a member may pay the membership fee oneself. In such cases one must send a specific blank to fund’s office. In this blank one declares the time period during which one pays the membership fee oneself. In cases of unpaid fees one is not entitled to have the benefits and reimbursements offered by the Fund during the unpaid leave.

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 one year.

Services and Office Hours

Our office serves during office hours as follows: on Monday to Thursday between 9 AM and 12; 1 PM and 3 PM. On Fridays the office is closed. During the opening hours we are within reach at the office and via email and phone.

Personnel

Manager of the Fund: Sanna Hyry tel. +358 50 325 7362 email

sairauskassa.rollikka@kela.fi

Substitute Manager: Raija Mustalahti tel. +358 50 336 0008  email

sairauskassa.rollikka@kela.fi

                

Address

Lapintie 3, 33100 Tampere

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: maximum compensation of 80% of the price, however the maximum amount of compensation is 500 euros. 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 (40% of the price)

─ The lower special reimbursement (65% of the price)

─ The higher special reimbursement (100% of the price, a EUR  4,50 copayment is charged for each medicine)

●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 605,13 which is the threshold for high medicinal costs.

Research and Treatment

● The Fund will compensate 80 % of the costs of laboratory tests and pathology samples if they are prescribed by a professional doctor.

● The Fund will compensate 80 % of the costs of radiological examinations, though excluding other procedures made during the examination. The board can decide to compensate such costs; each case is addressed separately in a board meeting.

● The Fund will compensate 80 % of the costs of chemotherapy and artificial kidney treatment and light treatment if they are prescribed by a professional doctor and the treatment is also compensable according to the Health Insurance Act.

● The Fund will compensate 80 % of the price of chemical removal of nails, prescribed by a professional doctor.

Physiotherapy

●The Fund will compensate 80 % 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.

●The Fund will compensate 80% 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. When using a car the compensation is calculated as follows: EUR 0, 20 per kilometer. The yearly limit of copayment is 300,00  if your travel costs out-of-pocket exceed this amount, no copayment will be taken from the compensation.

Fees of Public Health Care

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

●The Fund will compensate 80% of the cost of 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.

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.

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.

Therapy given by a Psychologist

● The Fund will compensate 80 % 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.

Endoscopies

●The Fund will compensate 80% of the price of the payment. In Endoscopies the price may be in two parts, one being the fee of the doctor and the other a charge from the use of devices and appliances.

Applying for reimbursement

●Always send the invoice and a receipt which proves that the invoice is paid.

●Rollikka 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 SV127e, 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.

●Member of the Fund is entitled to compensation regarding eyeglasses and dental care when they have been a member for a one year. Requirements to the compensation are met when the member has paid the member fee for 12 months.

 

Companies which have an agreement with the Fund

The fund has made an agreement with certain health service companies, physiotherapists and pharmacies. These are listed on side sopimuslaitokset- ja apteekit. In these companies a member of the fund can pay only the copayment and the company will send the invoice directly to the fund

            ─ In these cases please have your social security card and fund membership card

                with you and present them when checking in.

            ─You can also pay the full cost yourself and afterwards apply for reimbursement

                from the fund.