Overview of Lokomo's Sickness Fund: Membership, Operations, and More
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.
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Lokomos Sickness Fund WELCOMING WELCOMING EVENT 2021 EVENT 2021 TAINA TUOMINEN
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
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)
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.
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.
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
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
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
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
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
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
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.
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
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:
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:
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.
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
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.
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. Examples of compensations:
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.
www.lokomonsairauskassa.fi More information: www.kela.fi
