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Annual payment ceiling for social welfare and health care client fees

A payment ceiling of €692 per year has been specified for certain client fees charged for municipal social and health care services. When this sum has been exceeded, the client has the right to apply for a certificate of the annual payment ceiling having been exceeded.

More information about the annual payment ceiling is available on the website of the Social Services and Health Care Division. Below are some frequently asked questions about the annual payment ceiling.

What is the annual payment ceiling?

The annual payment ceiling is the amount beyond which you will no longer pay for the services covered by the payment ceiling, except for the so-called maintenance fee for short-term institutional care. The current annual payment ceiling is €692. The amount is tied to the National Pensions Index and reviewed every two years. The monitoring period for the payment ceiling is the calendar year.  The annual payment ceiling is governed by the Act on Client Charges in Healthcare and Social Welfare.

You must monitor the exceeding of the payment ceiling yourself. When your payment ceiling has been reached, the services covered by the payment ceiling will be partially free of charge for you until the end of the year. For this purpose, you must apply for a certificate of the payment ceiling having been exceeded. The certificate is issued by the operator/municipality/joint municipality where your payment ceiling is exceeded.

Which fees count towards the payment ceiling and which do not?

If the fee is covered by the payment ceiling, this is indicated on the invoice.

The following fees, for example, count towards the payment ceiling:

  • health centre fees (not charged in Helsinki)
  • fees for outpatient clinics
  • day surgery fees

The following fees, for example, do not count towards the payment ceiling:

  • fees for a doctor’s certificate
  • fees for ambulance transport
  • fees for unused or uncancelled services

 A more detailed list is available at https://www.hel.fi/sote/fi/palvelut/maksut/maksukatto

What has changed and what new services will be covered by the annual payment ceiling as of 1 January 2022?

Starting from 1 January 2022, more fees will be counted towards the annual payment ceiling. The following fees, for example, will count towards the payment ceiling:

The following fees, for example, count towards the payment ceiling:

  • oral and dental examination and treatment (excl. dental technical costs)
  • specialised health care treatment for the mouth and jaw area
  • temporary home nursing
  • temporary home hospital care

In addition, client fees covered by social assistance will count towards the payment ceiling as of 1 January 2022.

My annual payment ceiling is about to be reached; what should I do?

Keep your invoices for fees that count towards the annual payment ceiling in the order of visit/treatment times. The payment ceiling calculations are carried out in the order of the services received, which means the following:

  • If your payment ceiling is exceeded based on an invoice sent by the City of Helsinki Financial Management Services, you should contact the Financial Management Services customer service, tel. 09 310 25300 (Mon–Fri 9:00–15:00), email: talpa.maksukatto(at)hel.fi
  • If your payment ceiling is reached based on an invoice sent by the Hospital District of Helsinki and Uusimaa (HUS), you can contact the HUS telephone number on the invoice. You can contact the  patient invoicing customer service of HUS hospitals on weekdays at 9:00–12:00 by calling 09 471 785 50 or by email:  potilaslaskutus(at)hus.fi

Why did I receive mail from the Financial Management Services?

When a client has contacted the financial management services and the payment ceiling calculation has been made, the client will be sent a certificate indicating that their payment ceiling has been exceeded. In addition to this, the client will receive information about the basis of the calculation and, if necessary, additional instructions: whether the client has paid too much, whether any invoices have been reimbursed or whether a replacement invoice has been made for the maintenance fee incurred by short-term institutional care, as well as instructions on how to act if the client is dissatisfied with the payment ceiling scheme. Any credit notes and new replacement invoices will be sent as soon as possible, and the date on the invoice may differ slightly from the date of sending the certificate.

Which fees count towards the payment ceiling?

Health centre visit fees (please note: not charged in Helsinki), fees for outpatient clinics, fees for day surgery treatment, serial treatment fees, personal physiotherapy fees, night and day care fees, daily fees for short-term institutional care, psychiatric day hospital fees, as well as fees for rehabilitation for disabled patients provided as medical rehabilitation or fees for rehabilitation provided as special care to people with intellectual disabilities.

Why do I continue to receive invoices from social welfare and health care even after the payment ceiling has been reached?

After the payment ceiling is reached, a maintenance fee of €17.90 is charged for short-term institutional care, which equals roughly half of the daily fee for institutional care. The fee is also charged for short-term psychiatric institutional care and night and day care. According to Section 6a of the Act on Client Charges in Healthcare and Social Welfare, after the payment ceiling has been exceeded, no more than €22.50 per day of care may be charged for short-term institutional care. The fee is not charged for persons under 18 years of age.

After the payment ceiling has been reached, some services will be free of charge – which services/fees?

For example, the following services/fees:

  • health centre fees (not charged in Helsinki)
  • fees for outpatient clinics
  • day surgery fees
  • personal physiotherapy fees

I have reached my payment ceiling at the Hospital District of Helsinki and Uusimaa (HUS), but I still received an invoice from the Financial Management Services. Why?

If your payment ceiling has been reached in HUS and you have received an invoice from the City of Helsinki Financial Management Services that does not observe the payment ceiling, please contact the Financial Management Services, tel. 09 310 25300 (Mon–Fri 9:00–15:00), email: talpa.maksukatto(at)hel.fi.

Do invoices paid using social assistance count towards the payment ceiling?

As of 1 January 2022, client fees covered by social assistance will count towards the payment ceiling.

Fees for treatment reimbursed on the basis of the Workers’ Compensation Act, Agricultural Entrepreneurs’ Accidents Act, Military Injuries Act, Traffic Insurance Act, Patient Injury Act or similar legislation do not count towards the payment ceiling.

Who is responsible for monitoring the payment ceiling?

Monitoring the amount of payments made is the responsibility of the client or their representative (Section 6a of the Act on Client Charges in Healthcare and Social Welfare). The calculation of the payment ceiling starts when the client makes first contact.

The certificate is issued by the operator/municipality/joint municipality where the payment ceiling is reached. The payment ceiling calculations are carried out in the order of the services received.

What is the period for calculating the payment ceiling?

The payment ceiling is in effect from the date of the ceiling being reached until the end of the same calendar year. The monitoring of fees/services covered by the payment ceiling starts from the first care visit/day of care subject to a fee. The monitoring period for the payment ceiling is the calendar year (1 January–31 December).

What if the fees counting towards the payment ceiling are spread over two years?

If the treatment/services received by the client are spread over two calendar years, the treatment sessions that count towards the payment ceiling and the fees charged for them are recorded for the year in which the treatment took place. The period of validity of the payment ceiling always ends on the last day of the year, 31 December.

I have reached my payment ceiling, but I have been charged after this. Why?

If, when determining whether the payment ceiling has been reached/exceeded, it is found that fees have been charged in excess after the payment ceiling was reached/exceeded, any excess payments will be returned to the client. For this, the service recipient is always asked to provide their bank details in writing. We will send a separate form for this purpose.

Fees contributing to the payment ceiling are observed in the order in which the services were used, and any payments exceeding the payment ceiling are returned in the same order. This rule is applied even if the fees were invoiced and/or paid in a different order.

If the client has unpaid due invoices, instead of returning the payments, the excess payments are allocated towards the open invoice(s).

Credit notes

Any excess payments are reimbursed in connection with the payment ceiling calculation, and new invoices in accordance with the payment ceiling scheme are created to replace the old ones. Credit notes and invoices (new replacement invoices in accordance with the payment ceiling scheme) are sent to the client/service recipient by mail.

Excess payments

In the event that excess payments are returned, the client must provide their bank details to the Financial Management Services by email talpa.asiakasrekisteri(at)hel.fi or by mail to Financial Management Services, Registers, P.O. Box 247, 00099 CITY OF HELSINKI.

The message must contain the client’s customer number, name, date of birth, bank account number and the name of the account holder.

Do I need to keep the original invoices/receipts?

It is advisable to keep the original invoices/receipts, preferably in chronological order because, in order to receive the certificate, you may need to present the original invoices/receipts for the payments made.

Which hospitals are managed by the City of Helsinki?

Malmi Hospital (with the exception of the on-call services, which are managed by HUS), Laakso Hospital, Suursuo Hospital and Aurora Hospital.

How long is the processing time for payment ceiling applications?

The processing time for payment ceiling applications is 2–3 months starting from the time that the client/service recipient makes first contact.

Are services organised or fees paid during an informal carer’s leave covered by the payment ceiling?

Fees charged for services organised during an informal carer’s statutory leave do not count towards the payment ceiling, and the fees are not observed in the calculations.

Are services purchased from private service providers or fees paid to them covered by the payment ceiling?

Fees for services purchased by the client/service recipient from private service providers independently do not count towards the payment ceiling, and the fees are not observed in the calculations.

Fees charged for private services only count towards the payment ceiling if the service recipient/client is referred to the said services by the municipality/joint municipality and pays the same fee for the said services as they would for municipal services.

Are services purchased/paid for with a service voucher covered by the payment ceiling?

In the case of services purchased with a service voucher, the client’s deductible shares do not count towards the payment ceiling. A service voucher is not an outsourced service provided or purchased by the municipality. A service voucher is an alternative to these.

Please note that client fees that are not covered by the payment ceiling will be charged in full even if the client’s payment ceiling has been exceeded.

Payment ceiling for medical expenses

The payment ceiling for medical expenses is handled via Kela. Please contact Kela. More information: https://www.kela.fi/web/en/sickness

Payment ceiling for travel expenses

The payment ceiling for travel expenses is handled via Kela. Please contact Kela. More information: https://www.kela.fi/web/en/sickness