Koneen toimihenkilöiden vakuutuskassa

Information in English

Employee Benefit Fund newsletter

Health and financial security for our employees

Membership in the employee benefit fund (EBF) brings financial security in case of illness. The benefits paid by the EBF add to those paid by the Social Insurance Institution (KELA),  which are usually only approximately 20% of laboratory tests and treatment, and approximately 30% of medication. Additional benefits are tax free for its recipient.

The financial security bestowed by the employee benefit fund enables regularity in taking care of one’s own well-being, which in turn increases one’s quality of life.

Overall, the purpose of the employee benefit fund is to grant benefits to its members according to the Finnish Health Insurance Act, as well as additional benefits.

The employee benefit fund functions as a KELA office in matters related to the Health Insurance Act:

  • Members will receive a KELA-card with the EBF identification number
    • Staff: 46303
  • Covering expenses from medication, lab tests, and treatment as per the Health Insurance Act
  • Paying maternity, paternity, and parenting benefits, as well as special treatment allowances
  • All benefits will be paid when the treatment of an illness is in question

KELA covers expenses as ordained by the Health Insurance Act. Additional benefits granted by the employee benefit fund are funded by membership payments.

Staff

Members of the employee benefit fund are staff members of any shareholder within the EBF’s range of operation, whose employment exceeds 6 months.

A membership fee is 29 EUR  per month.  The KELA card must bear the employment benefit fund identification number: 46303.

The yearly additional benefit allowance per EBF member is at most 2000 EUR. Additional benefits are benefits paid in addition to those paid by KELA for such purposes as: doctors’ fees, lab tests, dental care, glasses, et al. The deductible for doctors’ fees and lab tests is 30%.

ADDITIONAL BENEFITS

Doctors’ fees:

  • a doctor’s fee is reimbursed at 70 percent of the original cost (includes Kela reimbursement)
  • the administrative fee is not reimbursed
  • if you are considering being a private patient in a hospital or a private clinic for surgery or treatment, ask for a cost estimate for each treatment, after which you can ask the fund whether they are reimbursed

Discretionary contribution

Discretionary contribution

Examinations:

  • medical testing and examinations are reimbursed at 70 per cent of the original cost (includes Kela reimbursement)
  • the treatment fee is reimbursed by up to EUR 50 per visit
  • physiotherapy prescribed by a physician is reimbursed at 70 per cent of the fee,  treatment by a chiropractor prescribed by a physician is  reimbursed at 50 per cent, and massage provided by an authorized masseur prescribed by a physician, occupational nurse or occupational physiotherapist is reimbursed at 50 per cent of the fee (the maximum being 30 sessions per year). Reimbursement can only be claimed after the treatment, not in advance (e.g. serial cards).
  • Psychotherapy prescribed by occupational health care is reimbursed max 5 visits per year

Medication and others:

  • medication prescribed by a physician and intended for the treatment of an illness is reimbursed at 100 per cent of the reference price, after the 50 € initial deductible per year. The medication has to be eligible for compensation under the Health Insurance Act, i.e. reimbursed by KELA
  • clinical nutrients and corresponding products, and emollients are reimbursed in cases where they are eligible for compensation under the Health Insurance Act
  • disinfectants and bandages prescribed by a physician are also reimbursed

Dental care:

  • for dental care, the fund reimburses EUR 150 a year, in addition to the KELA reimbursement
  • the dates of the visits determine the year under which the costs are recorded

Eye glasses and eyesight examinations:

  • EUR 150 is reimbursed for eyeglasses every second calendar year, the reimbursement can also be used for corrective eye laser surgery. A receipt of the purchase with your name and a copy of the eyesight examination record must be sent to the fund.
  • Eyesight examination performed by an optician is reimbursed at 100 per cent (except for a driver’s license).

 Hospitalization:

  • the fund reimburses hospital day fees for 150 days for one illness according to the lowest payment class in municipal central hospital care
  • Fees: an outpatient department fee and a municipal day surgery fee are reimbursed at 100 per cent
  • health centre fee is reimbursed at 100 per cent

Travel costs:

  • travel costs to visit a doctor or to undergo an examination or treatment in a medical examination institution or hospital are reimbursed at 100 per cent in cases where they are eligible for compensation under the Health Insurance Act

Medical devices:

  • medical devices (pediatric supports, occlusal splint, etc.): one (pair) per year is reimbursed at reasonable expenses in cases where reimbursement cannot be received anywhere else, e.g. from the municipal health centre
  • the fund reimburses 50 % for the rent of a CPAP machine or for the price of a temporary sleeping mask used in the treatment of sleep apnea, until the device is available from the public sector. The purchase of a CPAP machine is not reimbursed.

How to claim:

  • if you visit a private clinic with which EBF does not have an invoicing contract, you have to pay the cost yourself.  The Kela reimbursement can be deducted from the price. Send the receipt to the EBF
    • by mail: Koneen toimihenkilöiden vakuutuskassa, PL 6, 05801 Hyvinkää
    • by e-mail: satu.penttila@kone.com

Invoicing contracts:
Sopimuskumppanit

N.B.!
File your claim within 6 months of the original expense!

Paternity allowance
Paternity allowance
Maternity allowance
Maternity allowance

RESTRICTIONS CONCERNING ADDITIONAL BENEFITS

Additional benefits are not applicable when the person is

  • on a study leave
  • on a child care leave
  • laid off
  • posted abroad
  • on a temporary pension
  • on a leave of absence
  • on job alternation leave