Treatment expenses for illness and accidents
Medical expenses insurance covers, to the extent stated in the insurance terms and conditions, the medical expenses that are not compensated under another act and which the insured must pay themself in order to receive treatment. First apply for compensation from Kela based on the Finnish Health Insurance Act.
If compensation from Kela has not been applied for within six months from when the expenses were incurred, our company shall have the right to deduct the share of Kela’s compensation that was not applied for from the amount of compensation.
Several private medical service providers apply for compensation from Kela on their customers’ behalf. In this case, Kela’s share of the compensation is deducted directly from your invoice, and you can file an insurance claim with us immediately.
The claim for compensation must be filed within one year of when the expenses arose. Our company is not obligated to compensate expenses that date back more than one year.
Please note that the insurance does not cover, e.g. physiotherapy and other forms of rehabilitation. Dental care is also not covered, except in the case of a dental injury caused by an accident.
Making a claim for a commitment to pay or a preliminary decision
We also grant commitments to pay for more costly examinations and procedures. Usually, the healthcare facility will send the physician’s request for a commitment to pay related to the examination or procedure directly to Mandatum. You can also send us the physician’s account of the treatment yourself as an attachment to a message in the Web Service. The physician’s statement that is drawn up for the commitment to pay must state the reason and need for the procedure, as well as a cost estimate. Once you receive the commitment to pay, the healthcare facility will directly invoice the insurance company for the costs of the examination or procedure.
If you are to undergo a costly examination or procedure, we recommend that you make sure in advance that it is covered by the insurance. We issue preliminary decisions, i.e., a commitment to compensate, on costly examinations or procedures.
You can enquire about whether an examination or specific treatment that has been recommended for you is covered by the insurance from our claims service at the number 0200 31100. In many cases, the claims handler can issue a preliminary decision on whether the expenses will be compensated over the phone. When you receive a preliminary decision, first pay the expenses yourself and then apply for compensation from Kela. Thereafter, you can file a claim for compensation based on your insurance.