What type of healthcare expenses can basic social assistance be granted for?
Numerous complaints have been submitted to the Parliamentary Ombudsman criticising National Insurance Institution Kela for refusing to grant basic social assistance to cover medications prescribed by doctors, or other healthcare expenses.
Deputy-Ombudsman Jussi Pajuoja states that the Social Assistance Act does not limit which healthcare expenses social assistance can be granted for. The Social Assistance Act does not require that medications must be covered by health insurance in order for them to be considered as expenses.
According to the Deputy-Ombudsman, matters to consider must include whether the healthcare expenses presented by the applicant are necessary for the treatment of an applicant's illness or health in the manner provided in the Social Assistance Act.
When basic social assistance is granted, expenses for medicines prescribed by both private and public doctors can be taken into consideration as can expenses for medicinal products, prostheses, mobility aids, dental healthcare and eyeglasses.
Assessment on a case-by-case basis
If requested to do so, basic social assistance applicants must supply proof of the necessity of healthcare expenses.
Kela must assess on a case-by-case basis what further information on healthcare expenses will be requested and in what scope the customer will be asked to submit these as well as what role this further information will play in making the decision to the matter.
A statement by Kela's own specialist doctor can not be the sole deciding factor for decisions.
Customers do not need to apply separately for healthcare expense vouchers
According to some complaints, Kela has required a separate application in order for a customer to be granted a so-called restricted voucher for medical expenses.
The Deputy-Ombudsman states that the Social Assistance Act does not include provisions on different types of vouchers or the special application procedure related to these vouchers.
For this reason, Kela should not require that customers apply separately for a voucher in addition to their basic social assistance application.
For more information, please contact Principal Legal Adviser Tapio Räty, tel. +358 (0)9 432 3379 and Legal Adviser Riikka Jackson tel. +358 (0)9 432 3385
Deputy-ombudsman Jussi Pajuoja's decision EOAK/2112/2017 has been published in its entirety in Finnish on the Parliamentary Ombudsman's website www.oikeusasiamies.fi/.