kela, what every health care professional should know
TRANSCRIPT
With you throughout life – Supporting you through times of change
”Our mission is to secure the income and promote the health of
the entire nation and support the capacity of individual
citizens to care for themselves.”
3.6.2016 Olga Tarsalainen
Universal social protection
• Kela manages the basic social security of all
persons who are covered by the Finnish social
security system
• All residents are at some point in their lives
customers of Kela
• People living abroad may also be covered by the
Finnish social security system and be eligible for
benefits from Kela
Kela
National pension
Unemployment
Sickness and maternity
(cash benefits)
Health care
Family benefits
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Private insurance
institutions, funds,
foundations etc.
Employment pensions
Employment accidents and occupational
diseases
Municipalities
Health care
Municipal income support
Social services
Unemployment funds
Benefits based on residence
Benefits based on
employment
From pensions to comprehensive social provision
• Founded in 1937, Kela was initially responsible solely for the
provision of national pensions.
• Its scope of operations gradually broadened.
• In 1964, implementation of the new Health Insurance Act was entrusted to Kela
• In the 1980s, Kela was tasked with the provision of unemployment benefits
• Child benefit, student financial aid and housing allowance schemes were transferred to Kela in the 1990s
• In 2009, Kela took over the provision of child maintenance allowances from local authorities
• Interpreting services for the disabled have been available from Kela since 1 September 2010
• Guarantee pensions for persons with a small pension were introduced in March 2011
Original year of
introduction of
benefits subsequently
assigned to Kela is in
brackets
Benefit schemes administered by Kela: 1937 to present
From a pension institution to the Social Insurance Institution
District agent Kaijansinkko from
Kansaneläkelaitos (Kela)
making a surveillance visit to
widow Miina Eriksson’s home in
Lappee (1950).
Administration
• Kela is an institution under public law that operates
under the oversight of the Finnish Parliament.
• Its administration and operations are overseen by
12 Trustees selected by Parliament and by 8
Auditors selected by the Trustees.
• Responsibility for the management and
development of Kela’s operations is assigned to a
10-member Board selected by the Trustees to serve
a three-year term.
Kela’s operations
• Upon the proposal of the Board, the Trustees
approve the accounting principles and accounts of
the institution and release the Board from liability.
The Trustees also submit a report on their
operations to Parliament annually.
• Kela’s status, functions and administration are
defined in the Act on the Social Insurance
Institution. Kela’s social security functions are
provided for in Acts of Parliament concerning
specific benefits.
Financing of Kela’s operations 2014 (EUR, million)
1 954
1 690
10 039
704 72 Contributions from theinsured towards dailyallowances and medical care
Contributions fromemployers towards HealthInsurance
State contributions towardsbenefit expenditure
Contributions frommunicipalities
Other income
Share of expenditures in 2014
Cash benefits
Services
Sickness and health
6 %
Disability 11 %
Old age 56 %
Survivors 5 %
Family and children
8 %
Unemployment 12 %
Housing 0 %
Other social
protection 2 %
Sickness and health
53 %
Disability 11 %
Old age 10 %
Survivors 0 %
Family and children
14 %
Unemployment 3 %
Housing 5 %
Other social
protection 4 %
Convenient access to services
Our goals
• Simplifing the claiming of benefits
• Taking customers at their word
• Accepting verbal communications as equally
valid to information transmitted in writing
• Customer advocacy (leveraging available
information for the customer’s benefit)
• Wide-scale adoption of immediate, on-the-
spot reimbursements
• Automation of decision-making processes
• Making Kela easily accessible for example
through social media
Conveniently located services
• Multi-channel customer service
• Kela at home and at work = online and phone-
based service
• Office-based customer service available in major
population centres
• Joint services with other government agencies
• On-the-spot reimbursements in pharmacies,
treatment facilities and medical transport services
• Service by mail
Local offices
• Kela offers customer service through 180 dedicated
offices throughout Finland
• Customers are free to contact any office, most of
which are open Monday to Friday between 9 am
and 4 pm. Customer service is also available by
scheduled appointment if more time is needed
• Thanks to electronic document management and
information systems, applications can be handled
at any office.
Online Customer Service
• Customers can access Kela’s online custormer
service when convenient
• Using the online service (www.kela.fi/asiointi)
requires that the customer logs in using his or her
online banking code or a mobile certificate
• Calculator applications allow customers to check
their entitlement to benefits and the amount that
might be due to them at their current income level
Online customer service
Online customers can
• fill out benefit claims and notifications
• send attachments
• check their benefit information to see
− whether a claim has been decided and a benefit
awarded
− when they can expect the next payment
− what benefits they have been paid in the current
and previous two years
− the decision notices and letters they have been
sent by Kela
Customer service by phone
• Kela’s goal is to develop its phone service further to allow an increasing share of customer contacts to be resolved over the phone
• The customer contact centre takes care of the majority of phone calls from customers.
• Customers calling the customer contact centre are helped by a customer service specialist familiar with the benefits appropriate to each customer’s circumstances.
Customer service by mail
• Customers can submit their applications or
supporting documentation by mail to a local office of
Kela
• Kela sends customers a total of 19 million letters
yearly, most of them from a centralised mailroom.
On-the-spot reimbursements
• Certain benefits can be paid to the customers
directly, with no separate application necessary.
The reimbursement is deducted from the bill by the
pharmacy, medical clinic or transport operator.
Our goal is to increase the share of on-the-spot
reimbursements.
• On-the-spot reimbursements are the easiest way
for customers to interact with Kela. They also
reduce workload at local offices.
Kela card
• Customer ID card (with or
without the bearer’s
photograph – former is
no longer being issued)
• Issued to everyone covered by
the Finnish social security system
• Health insurance data can be integrated
into the ID card issued by police, which
will then serve a dual function as a Kela
card
• Recipients of a national pension will
receive a pensioner card from Kela if they
do not have an equivalent card from their
earnings-related pension provider
From maternity grants to pensions
• Moving to/from Finland
• Home and family
• Families with children
• Assistance with housing
costs
• Education
• School transport subsidy
• Financial aid for students
• Conscript’s allowance
• Health
• Sickness
• Rehabilitation
• Occupational health
• Disability benefits and
services
• Retirement
• Pensions
• Benefits for surviving
family members
• Unemployment
– Benefits during unemployment
National Health Insurance (NHI)
• The National Health Insurance (NHI) scheme is a part of the Finnish social
security system. The benefits require an application or a certificate made
by the caretaking physician
• The NHI scheme provides sickness allowances, partial sickness
allowances and parental allowances (compensation for loss of income
during incapacity for work)
• The NHI covers for rehabilitation that has been defined by law
• National Health Insurance also covers a share of
private doctors‘ and dentists fees
the costs for examinations and treatments prescribed by a private doctor or a
dentist
medication costs
illness-related transportation costs
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The role of the Social Insurance Institution (SII) in RTW
• The SII pays sickness allowance after 1+9 days to
maximum 300 days
• Up to 60 days: a medical certificate with diagnosis
(with exceptions esp mental health)
• From 60 days: a detailed description
• The SII requests a medical assessment from the OH
on the working ability well in advance of reaching the
limit of 90 days of sickness allowance
• The SII organizes vocational oriented rehabilitation
including psychoterapy, multiprofessional
rehabilitation, vocational education and medical
rehabilitation
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Reduced work capacity and benefits provided by Kela
Work capacity Benefits
60 %
100 % Reimbursement for occupational
health
Rehabilitation allowance for
preventive rehabilitation
Sickness allowance and discretionary
medical rehabilitation by Kela that is
vocationally orientated medical rehabilitation
Statutory vocational rehabilitation
and rehabilitation allowance : aimed
at the maintenance and improvement of
work ability
Medical rehabilitation for persons with
severe disabilities and on disability
pension Severe disability
Risk of disability
Long-run risk of disability
Early signs of problems
Healthy
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Our values
Our operations are founded on the following values:
• Respect for the individual
• Expertise
• Cooperation
• Renewal
Our mission
• Kela is active in the development of social security
and its implementation.
• The social security available from Kela is clearly
defined, of high quality and reasonable in amount.
Our mission
…is also to
• inform the public about benefits and services
• carry out research in support of the development
of social provision
• prepare statistics, estimates and projections
needed to anticipate and monitor trends in benefit
provision and other operations
• submit proposals for the development of social
security legislation
Thank you for listening!
See www.kela.fi for more information
Olga Tarsalainen
+358 50 551 72 63
Twitter: @OlgaTars
16.9.2013