Overview of Lokomo's Sickness Fund: Membership, Operations, and More

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Lokomo’s
Sickness
Fund
 
 
 
 
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TAINA
TUOMINEN
 
 
What is
Lokomo’s
Sickness
Fund?
 
 
Employees’ fund
 
Established in 1917
 
Operations in compliance with the Health
Insurance Act since 1974
 
There are currently 1,883 members, 372 of
whom are retired and not in the company’s
employ
 
The sickness fund office is located in Tampere
on Lokomonkatu in Metso Outotec Finland Oy’s
factory area
 
Salaried employees
Taina Tuominen, Fund Director
Hanna Hautamäki, Insurance Secretary
Sirpa Olán, Insurance Secretary
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Sphere of
operations of
the Lokomo
Sickness Fund
 
Shareholders in the sphere of operations (employers)
John Deere Forestry Oy, Tampere
Metso Outotec Finland Oy
Valmet Occupational Health Care Tampere, which is
part of Valmet Group
Parker Hannifin Manufacturing Finland Oy, Tampere
Persons who have moved to Metso Outotec Oyj and
Valmet Oyj and have been members of the Lokomo
Sickness Fund before that.
Tevo Lokomo Oy, Tampere
Supersteel Oy, Parkano
Finla Työterveys Tampere – the fund’s sphere of
operations includes former employees of Metso
Shared Services Oy who are transferring to Finla
Työterveys Tampere and have been members of
Lokomo’s Sickness Fund before the transfer.
Lokomo’s Sickness Fund
 
The fund also includes retired and external members
(separate criteria)
 
Membership
 
All employees and salaried employees who work for
employers within the company’s sphere of operations are
members of Lokomo’s Sickness Fund.
The membership is automatic (if the employment
relationship lasts more than four months)
NOTE!
 
Personnel transferred from Outotec Finland Oy, Outotec
Filters Oy and Metso Outotec Oyj in the merger on
January 1, 2021;
 
Rules of the Sickness Fund, Section 4, Subsection 5:
 
The exception to this are persons transferred to Metso
Outotec Finland Oy from Outotec Finland Oy, Outotec
Filters Oy and Metso Outotec Oyj in the merger on
January 1, 2021, who have the opportunity to indicate
within three months (January 1–March 31, 2021) if they
do not wish to join Lokomo’s Sickness Fund by virtue of
the merger. As of April 1, 2021, the mandatory
membership will also apply to the aforementioned group
of employees. 
Persons who do not join at this time will
not be able to join the fund at a later time.
 
Membership
fees
 
 
The membership fee is 1.1% of the gross pay.
The cap for the membership fee is
€48.00/month.
 
Persons who have been members of the
Sickness Fund for 15 years before their
retirement or the end of their employment
can become retired or external members.
 
For retired members, the membership fee is
1.7% of their gross pension.
 
The membership fee for external members is
€24.00/month.
 
Employees’ fund
as a concept
 
Management
of the
sickness fund
1/2
 
Management
of the
sickness fund
2/2
 
Operational regulation and control
 
REGULATION OF THE SICKNESS
FUND’S OPERATIONS
 
 
Kela benefits
Health Insurance Act
Kela’s instructions on benefits
 
Additional sickness fund benefits
Public Insurance Funds Act
Public Insurance Funds Decree
Sickness Fund’s own rules
 
OVERSIGHT OF THE SICKNESS FUND’S
OPERATIONS
 
Financial Supervisory Authority
Kela
The Finnish Financial Ombudsman
Bureau (FINE)
Board of the Sickness Fund
 
Benefits
managed by the
employees’ fund
1/2
 
Benefits
managed by the
employees’ fund
2/2
 
 
 
 
Additional separate sickness fund benefits
Doctor’s fees (incl. office fees)
Psychologist’s and psychotherapist’s fees
Outpatient clinic, health center and hospital
fees (public health care)
Medication
Examination and treatment
(lab tests, pathological examinations and imaging)
Travel
Aids
Eyeglasses
Dental care
Physical therapy and massage
Podiatry
Burial grant
 
 
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Applying for
benefits
 
 
Members of the Sickness Fund can apply for
benefits electronically through Kela’s website
 
-> forwarded automatically to the fund for
processing
 
Direct Kela compensations from service
provides (Sickness Fund’s invoicing
agreements)
 
Additional benefits can be applied for by
mail/e-mail (please note that e-mail is not a
data secure communication channel)
 
In spring 2021, Lokomo’s Sickness Fund will
gain an electronic service channel (secured
connection) for applying for additional benefits
and checking personal information. Further
information will be provided at a later time.
 
Health care
compensations
 
 
ADDITIONAL BENEFITS, SECTION 14:
 
The fund compensates its members for
necessary treatment
 by a doctor or
corresponding professional due to sickness,
pregnancy or childbirth. The compensation
covers the actual cost of the treatment
excluding any unnecessary costs without
jeopardizing the health of the member in
question. In the context of these rules,
dentists are also regarded as doctors.
 
Examples of
compensations:
 
 
Doctor’s fees
Without a referral, the compensation covers
80%
With a referral from the personal
occupational health care doctor, the
compensation covers 100% of specialist’s
fees
Ophthalmologist, gynecologist, urologist: no
referral needed, compensation 100%
Example:
Cost of a specialist’s appointment €80.00
Kela compensation €13.50
Additional fund benefit with/without the occupational
health care doctor’s referral €66.50/€50.50
Excess with a referral €0, without a referral €16.00
Many private clinics also charge an office fee
Kela does not provide compensation for these
Fund compensation 80–100% (without/with a referral)
 
Examples of
compensations:
 
Examples of
compensations:
 
Examples of
compensations:
 
Examples of
compensations:
 
 
Physical treatment
Compensation for physical treatment 75%, no more than
eight treatment sessions with a single referral
An (occupational health care) doctor’s referral is required
The fund’s contractual clinics must be used in Pirkanmaa 
(in
other locations, such as the Helsinki area, customers can
choose the provider)
The contractual providers charge the fund’s share directly
from the fund; the customer only pays the excess
 
Massage
Compensation in accordance with the annual compensation
cap, which is €160/year for 2021
Doctor’s referral not required
Members can choose the treatment provider, who must be a
trained massage therapist
(the rights to use the professional title of a massage
therapist can be checked through Valvira’s JulkiTerhikki
service: 
https://julkiterhikki.valvira.fi/?lang=fi
)
The massage compensation can also be used for treatments
provided by a chiropractor, naprapath or osteopath.
No direct invoicing: members must pay the costs and then
apply for compensation from the Sickness Fund. The
documents must indicate the 
details of the member who
received the treatment, the treatment cost, the details of the
massage therapist and the bank account to which the
compensation is to be provided
.
 
Examples of
compensations:
 
 
Dental care
Kela compensation is provided for dental care costs in
accordance with the effective rates
As an added benefit, a dental care allowance of €350.00
per calendar year is available (requires a year of fund
membership)
X-rays taken in the context of dental care = examination
and treatment = compensation 80% (does not reduce
the dental care allowance); the 20% excess is deducted
from the remaining dental care allowance
A payment commitment is eligible as a payment
instrument for contractual dentists. The Sickness Fund
can provide the commitment. Request one when going
in for dental care.
You can also go to the clinic of your choice, pay the costs
or request an invoice and deliver the documents to the
Sickness Fund.
It is recommended to pay the costs in full (including the
portion of the Kela compensation). This speeds up the
processing of the total compensation (additional
benefit).
It is possible to receive a compensation for prosthetic
care, orthodontic treatment or dental occlusion
treatment: the maximum additional compensation sum
equals the dental care allowance (€350)
 
Examples of
compensations:
 
 
Eyeglass allowance
€450.00 every three years
€300.00 every two years
Requires a year’s membership in the fund
(€300.00)
A payment commitment is accepted by optical
shops. Contact the Sickness Fund to obtain
one.
You can also obtain the eyeglasses from a
provider of your choice, pay the costs and
apply for compensation from the Sickness Fund
(please ensure that the receipt indicates the
customer’s name).
A sum equal to the eyeglass allowance is also
available to be used for refractive eye surgery.
Eyeglasses are compensated if they have been
prescribed by a doctor or optician; the lenses
must also be ground for the purpose of
correcting a deficiency in eyesight.
 
 
 
Surgery at a private
hospital
 
 
On a case-by-case basis, compensation can be paid
for treatment provided by a private hospital.
 
THE COMPENSATION APPLICATION MUST ALWAYS
BE SUBMITTED TO THE SICKNESS FUND BOARD 
IN
ADVANCE
.
 
Private clinics include Pihlajalinna, Mehiläinen and
Suomen Terveystalo.
 
THE COMPENSATION APPLICATION MUST DETAIL
THE PROCEDURE, COST ESTIMATE AND PUBLIC
HEALTH CARE OPTIONS.
 
An 80% compensation can be provided for the
service fee portion of a private hospital (procedural
fee) up to a maximum of €1,500.00.
 
Additional information and support for lodging an
application is available from the Sickness Fund.
 
 
More
information:
 
 
www.lokomonsairauskassa.fi
 
www.kela.fi
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Lokomo's Sickness Fund, established in 1917, serves 1,883 members, including retired individuals. The fund operates in compliance with the Health Insurance Act and is located in Tampere. Employees within the fund's sphere of operations are automatically enrolled, with exceptions outlined for specific groups. Shareholders in the fund's operations include notable employers like John Deere Forestry Oy and Valmet Group. Membership details, including fees and eligibility criteria, are highlighted.

  • Sickness Fund
  • Lokomo
  • Membership
  • Tampere
  • Health Insurance

Uploaded on Sep 18, 2024 | 1 Views


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  1. Lokomos Sickness Fund WELCOMING WELCOMING EVENT 2021 EVENT 2021 TAINA TUOMINEN

  2. Employees fund Established in 1917 Operations in compliance with the Health Insurance Act since 1974 There are currently 1,883 members, 372 of whom are retired and not in the company s employ What is Lokomo s Sickness Fund? The sickness fund office is located in Tampere on Lokomonkatu in Metso Outotec Finland Oy s factory area Salaried employees Taina Tuominen, Fund Director Hanna Hautam ki, Insurance Secretary Sirpa Ol n, Insurance Secretary

  3. Shareholders in the sphere of operations (employers) John Deere Forestry Oy, Tampere Metso Outotec Finland Oy Valmet Occupational Health Care Tampere, which is part of Valmet Group Parker Hannifin Manufacturing Finland Oy, Tampere Persons who have moved to Metso Outotec Oyj and Valmet Oyj and have been members of the Lokomo Sickness Fund before that. Tevo Lokomo Oy, Tampere Supersteel Oy, Parkano Finla Ty terveys Tampere the fund s sphere of operations includes former employees of Metso Shared Services Oy who are transferring to Finla Ty terveys Tampere and have been members of Lokomo s Sickness Fund before the transfer. Lokomo s Sickness Fund Sphere of operations of the Lokomo Sickness Fund The fund also includes retired and external members (separate criteria)

  4. All employees and salaried employees who work for employers within the company s sphere of operations are members of Lokomo s Sickness Fund. The membership is automatic (if the employment relationship lasts more than four months) NOTE! Personnel transferred from Outotec Finland Oy, Outotec Filters Oy and Metso Outotec Oyj in the merger on January 1, 2021; Rules of the Sickness Fund, Section 4, Subsection 5: Membership The exception to this are persons transferred to Metso Outotec Finland Oy from Outotec Finland Oy, Outotec Filters Oy and Metso Outotec Oyj in the merger on January 1, 2021, who have the opportunity to indicate within three months (January 1 March 31, 2021) if they do not wish to join Lokomo s Sickness Fund by virtue of the merger. As of April 1, 2021, the mandatory membership will also apply to the aforementioned group of employees. Persons who do not join at this time will not be able to join the fund at a later time.

  5. The membership fee is 1.1% of the gross pay. The cap for the membership fee is 48.00/month. Persons who have been members of the Sickness Fund for 15 years before their retirement or the end of their employment can become retired or external members. Membership fees For retired members, the membership fee is 1.7% of their gross pension. The membership fee for external members is 24.00/month.

  6. An employees fund is an insurance fund compliant with the Public Insurance Funds Act which has received permission from Kela to provide its members with benefits in accordance with the Health Insurance Act. Some Finnish sickness funds are supplementary funds that do not grant Kela benefits. In addition to its own operations, Lokomo s Sickness Fund manages two supplementary funds: - UTC s Sickness Fund Employees fund as a concept - Tamfelt s Sickness Fund Finland currently has a total of 56 employees funds and 60 supplementary funds The operations of the employees fund are guided by the instructions applied at Kela and they use the same systems

  7. Legally independent units Separate management The Board of Lokomo s Sickness Fund has nine (9) members with representatives of employees, salaried employees and senior salaried employees. Shareholders are represented in the Board by Metso Outotec Finland Oy s Riina Ainasvuori Board members are elected in a regular fund meeting held in November Management of the sickness fund 1/2 The fund employs a fund director and two insurance secretaries Taina Tuominen, Fund Director, tel. +358 (0)50 317 3884, taina.tuominen@mogrouppartners.com Hanna Hautam ki, Insurance Secretary, tel. +358 (0)50 505 6394, hanna.hautamaki@mogrouppartners.com Sirpa Ol n, Insurance Secretary, tel. +358 (0)50 317 1668, sirpa.olan@mogrouppartners.com Lokomo s Sickness Fund has the following specialist doctors: Aulikki Juntunen, Pihlajalinna, Occupational Health Care, Tampere Matti Raittinen, Kela, Tampere office

  8. The members are primarily insured employees The highest decision-making power is held by the fund meeting, which any fund member can attend Management of the sickness fund 2/2 The regular fund meetings are held twice a year (April and November) Financial statement meeting in April Board member election in November The fund meeting decides on the rule changes proposed by the Board

  9. Operational regulation and control REGULATION OF THE SICKNESS FUND S OPERATIONS OVERSIGHT OF THE SICKNESS FUND S OPERATIONS Kela benefits Health Insurance Act Kela s instructions on benefits Financial Supervisory Authority Kela The Finnish Financial Ombudsman Bureau (FINE) Additional sickness fund benefits Public Insurance Funds Act Public Insurance Funds Decree Sickness Fund s own rules Board of the Sickness Fund

  10. Kela benefits Health care compensations: doctor s fees, dentist s fees, examination and treatment, physical therapy, travel, overnight accommodation allowance Medication compensations Sickness allowances Special care allowance Parental allowances Benefits managed by the employees fund 1/2 Kela handles member benefits other than those listed above

  11. Additional separate sickness fund benefits Doctor s fees (incl. office fees) Psychologist s and psychotherapist s fees Outpatient clinic, health center and hospital fees (public health care) Medication Examination and treatment (lab tests, pathological examinations and imaging) Travel Aids Eyeglasses Dental care Physical therapy and massage Podiatry Burial grant Benefits managed by the employees fund 2/2

  12. Members of the Sickness Fund can apply for benefits electronically through Kela s website -> forwarded automatically to the fund for processing Direct Kela compensations from service provides (Sickness Fund s invoicing agreements) Applying for benefits Additional benefits can be applied for by mail/e-mail (please note that e-mail is not a data secure communication channel) In spring 2021, Lokomo s Sickness Fund will gain an electronic service channel (secured connection) for applying for additional benefits and checking personal information. Further information will be provided at a later time.

  13. ADDITIONAL BENEFITS, SECTION 14: The fund compensates its members for necessary treatment by a doctor or corresponding professional due to sickness, pregnancy or childbirth. The compensation covers the actual cost of the treatment excluding any unnecessary costs without jeopardizing the health of the member in question. In the context of these rules, dentists are also regarded as doctors. Health care compensations

  14. Doctors fees Without a referral, the compensation covers 80% With a referral from the personal occupational health care doctor, the compensation covers 100% of specialist s fees Ophthalmologist, gynecologist, urologist: no referral needed, compensation 100% Example: Cost of a specialist s appointment 80.00 Kela compensation 13.50 Additional fund benefit with/without the occupational health care doctor s referral 66.50/ 50.50 Excess with a referral 0, without a referral 16.00 Many private clinics also charge an office fee Kela does not provide compensation for these Fund compensation 80 100% (without/with a referral) Examples of compensations:

  15. Lokomos Sickness Fund compensates 80% of examination and treatment costs This includes the Kela compensation and additional sickness fund benefit, which means that the customer s excess is 20% What are regarded as examinations and treatments? laboratory tests endoscopy through natural orifices (esophagoscopy, gastroscopy, duodenoscopy, colonoscopy, sigmoidoscopy) pathological examinations imaging (e.g. ultrasound, x-ray and magnetic resonance imaging) minor procedures during a doctor s appointment, e.g. mole removal As an example, a knee MRI at Terveystalo costs 412: Kela compensates 93.00, the fund compensates 236.60 and the customer must pay 20%, i.e. 82.40. Examples of compensations:

  16. Public health care is covered in full: Outpatient clinic fees Health center fees Hospital fees Aid compensations 300.00 for obtaining the first aids, 150 every three years thereafter Doctor s referral required Typical aid equipment includes various supports and insoles Examples of compensations: Travel compensations Travel and accommodation costs required for treatment; the most affordable mode of transportation must be used, unless some other mode is necessitated due to the nature of the sickness or traffic conditions.

  17. Medication compensations The initial excess will not be compensated Excess 5.00/medication Medications that are eligible for Kela compensation and have been prescribed by a doctor are covered Reference price system Members rights to special medication compensations are processed by the fund Invoicing directly from contract pharmacies Examples of compensations: Podiatry Compensation 75% The need for treatment must be ascertained at a practice; an occupational health care doctor s referral is required Three (3) treatment sessions in a series are eligible for compensation with a single referral The treatment must be provided by a trained podiatrist

  18. Physical treatment Compensation for physical treatment 75%, no more than eight treatment sessions with a single referral An (occupational health care) doctor s referral is required The fund s contractual clinics must be used in Pirkanmaa (in other locations, such as the Helsinki area, customers can choose the provider) The contractual providers charge the fund s share directly from the fund; the customer only pays the excess Massage Compensation in accordance with the annual compensation cap, which is 160/year for 2021 Examples of compensations: Doctor s referral not required Members can choose the treatment provider, who must be a trained massage therapist (the rights to use the professional title of a massage therapist can be checked through Valvira s JulkiTerhikki service: https://julkiterhikki.valvira.fi/?lang=fi) The massage compensation can also be used for treatments provided by a chiropractor, naprapath or osteopath. No direct invoicing: members must pay the costs and then apply for compensation from the Sickness Fund. The documents must indicate the details of the member who received the treatment, the treatment cost, the details of the massage therapist and the bank account to which the compensation is to be provided.

  19. Dental care Kela compensation is provided for dental care costs in accordance with the effective rates As an added benefit, a dental care allowance of 350.00 per calendar year is available (requires a year of fund membership) X-rays taken in the context of dental care = examination and treatment = compensation 80% (does not reduce the dental care allowance); the 20% excess is deducted from the remaining dental care allowance A payment commitment is eligible as a payment instrument for contractual dentists. The Sickness Fund can provide the commitment. Request one when going in for dental care. You can also go to the clinic of your choice, pay the costs or request an invoice and deliver the documents to the Sickness Fund. It is recommended to pay the costs in full (including the portion of the Kela compensation). This speeds up the processing of the total compensation (additional benefit). It is possible to receive a compensation for prosthetic care, orthodontic treatment or dental occlusion treatment: the maximum additional compensation sum equals the dental care allowance ( 350) Examples of compensations:

  20. Eyeglass allowance 450.00 every three years 300.00 every two years Requires a year s membership in the fund ( 300.00) A payment commitment is accepted by optical shops. Contact the Sickness Fund to obtain one. You can also obtain the eyeglasses from a provider of your choice, pay the costs and apply for compensation from the Sickness Fund (please ensure that the receipt indicates the customer s name). A sum equal to the eyeglass allowance is also available to be used for refractive eye surgery. Eyeglasses are compensated if they have been prescribed by a doctor or optician; the lenses must also be ground for the purpose of correcting a deficiency in eyesight. Examples of compensations:

  21. On a case-by-case basis, compensation can be paid for treatment provided by a private hospital. THE COMPENSATION APPLICATION MUST ALWAYS BE SUBMITTED TO THE SICKNESS FUND BOARD IN ADVANCE. Private clinics include Pihlajalinna, Mehil inen and Suomen Terveystalo. THE COMPENSATION APPLICATION MUST DETAIL THE PROCEDURE, COST ESTIMATE AND PUBLIC HEALTH CARE OPTIONS. Surgery at a private hospital An 80% compensation can be provided for the service fee portion of a private hospital (procedural fee) up to a maximum of 1,500.00. Additional information and support for lodging an application is available from the Sickness Fund.

  22. www.lokomonsairauskassa.fi More information: www.kela.fi

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