Client fees

Free-of-charge health care services are

• services related to the promotion of health and wellbeing and the prevention of illnesses
  • health counselling and health check-ups
  • screening in accordance with the national screening programme
  • maternity and child health clinic services
  • student welfare services
  • school health care, including persons over 18 years of age
  • student health care, excluding medical care for persons over 18 years of age
• primary health care services:
  • outpatient health care services for persons under 18 years of age 
  • appointments for mental health, substance abuse, and addiction treatment in primary health care
  • appointment with a registered nurse, public health nurse, or midwife
  • rehabilitation counselling and rehabilitation guidance, rehabilitation assessment, including the following activities: assessment of the need for rehabilitation by a rehabilitation advisor, first visit by home rehabilitation and assessments carried out between rehabilitation periods by expert services, assessment of work ability
  • assistive equipment services and adaptation training
  • laboratory and imaging examinations by a referral from a physician in the wellbeing services county
• medical supplies for the treatment of long-term illness
• medical certificate or statement necessary for:
  • a free-of-charge primary health care certificate or statement in accordance with the Act on Client Fees, Section 5, Paragraph 1, Subparagraph d, required for the client to receive treatment or rehabilitation, to obtain reimbursement for medication under Chapter 5 of the Health Insurance Act (1224/2004), or to demonstrate the need for a short-term sick leave
• prevention and treatment of communicable diseases:
  • vaccinations included in the national vaccination programme, general voluntary vaccinations and other vaccinations in accordance with the Communicable Diseases Act
  • examination, treatment and prescribed medication for a generally hazardous communicable disease, as well as quarantine and isolation of the exposed person
  • medication prescribed for the treatment of a monitored communicable disease, as well as examination, treatment and medication prescribed for the treatment and prevention of HIV infection, chancroid, gonorrhoea and sexually transmitted chlamydia infection
• specialised health care:
  • examination and treatment provided by an outpatient clinic for persons under 18 years of age
  • services provided by support centres for victims of sexual abuse (Council of Europe Convention 53/2015) No client fees are charged to victims of sexual violence when the examination or treatment measures are related to the treatment of somatic or psychological problems caused by sexual violence.
  • examination, treatment, and follow-up provided by maternity outpatient clinics for pregnant 
    individuals who use substances. If a pregnant person who uses intoxicants needs health services during pregnancy that are not directly related to pregnancy, these services will be subject to normal client fees.
  • treatment provided at a unit of psychiatric outpatient care, excluding any associated partial upkeep
  • treatment and upkeep provided during institutional care, as well as care-related transportation, for a person with respiratory paralysis / a person dependent on a ventilator
  • examination and treatment of living donors of human organs, tissues or cells
  • care and upkeep for persons under 18 years of age with more than seven accumulated days of care in a calendar year
  • when provided as part of a series to persons under 18 years of age, medical rehabilitation and hyposensitisation, speech and voice disorder treatment, radiotherapy and chemotherapy, other similar treatments, and continuous dialysis treatment
  • counselling as a part of medical rehabilitation, assessment for rehabilitation needs and 
    opportunities, adaptation training and rehabilitation counselling
  • assistive equipment for medical rehabilitation, including their fitting, necessary renewal, and maintenance, excluding assistive equipment services covered under other legislation
  • prehospital care, excluding patient transport related to prehospital care
  • transportation of a registered patient to another treatment facility or home care by a patient transport vehicle.

Free-of-charge social services are

• social work
• social counselling
• assessment visits for service needs 
• social rehabilitation
• outpatient substance abuse care
• family work
• child guidance and family counselling
• supervision of meetings between a child and a parent
• supported meetings and supervised exchanges
• Services to be provided by the wellbeing services county in accordance with the Marriage Act (234/1929), Paternity Act (775/2022), Adoption Act (22/2012), Act on Child Maintenance (704/1975), Act on Child Custody and Right of Access (361/1983), Child Maintenance Allowance Act (580/2008) and the Act on the Linking of 
  Certain Maintenance Payments to the Cost-of-Living Index (583/2008); and 
• care of children and adolescents referred to in the Child Welfare Act (683/83);
• activities supporting the employment of disabled people and work activities for disabled people, excluding transportation and meals
• documents regarding an individual’s social welfare.

As the new Disability Services Act comes into force on 1 January 2025, applications submitted will be processed in accordance with the provisions of the new Act. Appeals pending upon the entry into force of the new Act shall be processed in accordance with the provisions that were in force upon its entry into force. Decisions made based on the repealed law shall remain in force for the duration specified in the decisions, but no longer than three years from the entry into force of the new Act. Decisions must, however, be brought into conformity with the new Act on the initiative of the disabled person or on the initiative of the wellbeing services county whenever the service needs of the disabled person require it.

On the basis of the provisions in force upon the entry into force of the new Act, the client fee and exemption from service charges for a disabled person shall remain in effect for the duration specified in the decision on the payment or service, or until the disabled person’s decisions are brought into compliance with the Disability Services Act or the Act on Special Care for People with Intellectual Disabilities, but not more than three years after this Act’s entry into force.

Client’s free-of-charge services under the new Disability Services Act (675/2023) starting as of 1 January 2025.

• Training (Disability Services Act, Section 7), but a fee is charged for upkeep and training-related mobility support
• personal assistance (Disability Services Act, Section 9)
• special support for inclusion (Disability Services Act, Section 12)
• demanding multidisciplinary support (Disability Services Act, Section 16), but a fee is charged for upkeep
• housing support (Disability Services Act, Section 18), but a fee is charged for upkeep
• home-based support for a child's housing (Disability Services Act, Section 19)
• support for accessible housing (Disability Services Act, Section 22)
• short-term care (Disability Services Act, Section 24), but a fee is charged for upkeep
• daytime activities (Disability Services Act, Section 25), but a fee is charged for upkeep
• work activities for people with intellectual disabilities (Disability Services Act, Section 27), but a fee is charged for upkeep
• mobility support (Disability Services Act, Section 28). A maximum fee equal to the local public transport fee or other comparable and reasonable fee will be charged.
• other services necessary for fulfilling the purpose of the Disability Services Act, as referred to in Section 34 of the Act
• supported decision-making (Section 14) when the service begins to be provided as of 1 January 2025

Assistance and support related to all the aforementioned services under the Disability services Act are     free of charge. In addition, the following are free of charge:

• upkeep related to morning and afternoon activities organised as short-term care (Disability Services Act, Section 24)
• travel to daytime activities (Disability Services Act, Section 25) and work activities for people with intellectual disabilities (Disability Services Act, Section 27), provided the client meets the criteria for receiving mobility support services
• services included in housing support and home-based support for the child's housing

A fee corresponding to the compensation received will be charged for housing support and personal assistance if the person is compensated for them under an act other than the Disability Services Act.

Under the amending Act (676/2023) to the Act on Special Care for People with Intellectual Disabilities, which comes into force on 1 January 2025, the following services are free of charge:

special care and the transport between operational units of a person assigned to involuntary special care or to preliminary examinations thereof

Services supporting frontline veterans’ living at home are based on the Act on the Rehabilitation of Frontline Veterans (1184/1988), the Act amending the Act on the Rehabilitation of Frontline Veterans (54/2019), and the Decree on the Rehabilitation of Frontline Veterans (1348/1988). Services supporting war invalids’ living at home are based on the Military Injuries Act (404/1948).

According to instructions issued by the State Treasury, services (including 24-hour sheltered housing, institutional services) are granted to the client on the basis of an assessment of the need for services and are free of charge for the client.

According to the Decree on Client Fees, Section 9, frontline veterans and war invalids may not be charged fees for dental check-ups, preventive treatment or clinical work related to prosthetics.

No client fees will be charged to frontline veterans, individuals granted a Frontline Service Badge (marked ‘R’ on the Kela card), war invalids, and mine clearers awarded a badge by the Finnish War Archives, based on the Regional Council’s decision of 23 November 2022 (§ 137), for the following:

• physician’s appointment in primary outpatient health care services
• outpatient visit in specialised medical care
• nurse’s appointment in specialised medical care
• visit to emergency reception or emergency services

If the client does not have a municipality of residence in Finland or is not deemed equivalent to a resident of the wellbeing services county as stipulated in Section 56 of the Act on Organising Healthcare and Social Welfare Services, a fee corresponding to the costs incurred by the wellbeing services county for the healthcare service provided will be charged, unless otherwise stipulated by an international agreement binding on Finland or European Union legislation. The above-mentioned fee shall not be charged for the vaccinations referred to in Section 44, Subsection 1 of Section 45, and Section 47 of the Communicable  Diseases Act, for examinations to prevent the spread of a generally hazardous communicable disease, for urgent treatment referred to in Section 50 of the Health Care Act, as well as for medication prescribed for treating a generally hazardous communicable disease. Fees are also not charged for the examination, treatment, and medication prescribed for the treatment of a pregnant HIV positive person, with the exception of persons temporarily staying in Finland and those who are compensated for costs under other legislation or by insurance.

Fees should be reviewed when

1. the income of the client or their family has changed;
2. the client's or their spouse's entitlement to the deductions provided for in Sections 10 c, 10 d or 10 g has changed;
3. the circumstances of the family have changed;
4. the fee is found to be incorrect;
5. the client plan drawn up for the client is amended in such a way that it has an impact on the amount of the client fee;
6. the criteria for the payment in the wellbeing services county is amended in such a way that it has an impact on the amount of the client fee. (8.7.2022/600) the service user’s or family’s ability to pay has changed significantly

If the decision on the payment was based on incorrect information provided by the client or their representative, the payment may be adjusted retrospectively for a period not exceeding one year when it is obvious that the family’s circumstances to be taken into account in determining the payment have changed.

Fees determined according to the client's ability to pay are imposed for an indefinite period. A significant change in the service user's or family's ability to pay is considered to be at least a 5% change in the client's income, in which case a new decision will be made. This applies to all client fees determined by the client’s ability to pay for social welfare and health care services. If the income reported as the basis for the care fee is found to be incorrect, the fee may be adjusted retroactively for up to one year. The client is liable for reporting any changes.

Act on Client fees (734/1992, Sections 2a and 2b):

The wellbeing services county shall issue the client an invoice corresponding to the decision on payment. The invoice must include at least the following information:

1. date of the invoice;
2. name of the client to be charged;
3. service for which the fee is charged;
4. amount and basis of the fee;
5. public or private service provider for whose service the fee is charged;
6. name and contact details of the entity from which the client can request further information about the invoice, if necessary;
7. information on whether the fee contributes to the payment ceiling referred to in Section 6 a; if the fee does contribute to the payment ceiling, the invoice must also include a note that the client is responsible for monitoring when their payment ceiling is exceeded.

An invoice other than the invoice concerning the decision referred to in Section 2 b shall be accompanied by instructions for claiming a revised decision. The client’s privacy and personal safety must be accounted for when collecting fees.

Decision on a fee determined by ability to pay

The client shall be provided with a decision on a fee determined by their ability to pay. The decision shall contain at least the following information: (8.7.2022/600)

1. officeholder who made the decision and the date when the decision was made;
2. client directly affected by the decision;
3. service subject to the decision;
4. amount and basis of the fee charged for the service;
5. name and contact details of the person from whom the client may request additional information about the decision, if necessary. Instructions for claiming a revised decision shall be appended to the decision.

Client fees for health care and social welfare are reduced in accordance with the provisions of Section 11 of the Act on Client Fees, as of 1 January 2023. A fee imposed for social welfare services or a fee for health care services determined based on a person’s ability to pay must be waived or reduced to the extent that collecting the fee does not jeopardise the person’s or family’s means of subsistence or the fulfilment of the person’s statutory maintenance obligation. Reducing and waiving the fee shall take precedence over social assistance referred to in the Social Assistance Act (1412/1997).

The client must be informed about the reduction or waiving of the fee before the first service event (client contact, visit, or treatment period in social and health care services) or in connection with it. If it is not possible to provide the information before or in connection with the service event, it can be provided later, but at the latest when the client fee is collected. The information must be provided in such a way that the client sufficiently understands its contents.

When providing the information, the client must be provided with the name and contact information of the entity from which the client may request additional information, if necessary. The information must be provided to the client personally, either in writing or verbally. The information may also be provided through an electronic service that identifies the client. If the information is provided in a manner other than in writing, the client shall also be provided with the information in writing upon request.

A payment ceiling of €762 per calendar year has been approved for certain social and health care client fees. During the calendar year, the client will pay social and health care fees covered by the payment ceiling only up to the payment ceiling. The fees covered by the payment ceiling are determined in Section 6 a of the Act on Client Fees. However, for clients aged 18 or older receiving short-term institutional care as referred to in Subsection 1 of Section 67 of the Health Care Act or short-term institutional services as referred to in Section 22 of the Social Welfare Act, a maximum fee of €25.10 per day may be charged for upkeep, even if the payment ceiling has been exceeded.

The following are covered by the payment ceiling:

• outpatient health care services in primary health care
• examinations and treatment in an outpatient clinic of specialised health care
• day surgical procedures
• oral and dental examinations and treatment, dental technical costs excluded
• specialised oral and maxillofacial procedures
• physiotherapy, neuropsychological rehabilitation, nutritional therapy, foot care, speech therapy, occupational therapy, and other similar treatments aimed at improving and maintaining functionality, provided by a healthcare professional
• fees for series of treatment, temporary home nursing and temporary home hospital care
• short-term institutional care (Health Care Act, Section 67)
• short-term day and night care
• short-term institutional services (Social Welfare Act, Section 22)
• period of institutional medical rehabilitation provided to a person receiving services in accordance with the Act on Special Care for People with Intellectual Disabilities or the Disability Services Act.

Services excluded from the payment ceiling:

• social welfare services
• income-related fees
• personal liability for service vouchers or transportation services
• temporary home care
• fees to be charged from the care recipient for the duration of the informal carer’s statutory leave
• health care certificate fees
• fees for unused and uncancelled services
• patient transport
• laboratory and imaging examinations carried out under a referral from a private physician
• wholly private services not provided by the wellbeing services county
• fees that have been reimbursed to the client, for example, on the basis of an occupational accident insurance.
• fees collected from individuals who do not have a municipality of residence in Finland, with the exception of fees charged to individuals who, under European Union legislation or an international agreement binding on Finland, are entitled to health services under the same conditions as persons residing in Finland, or individuals who, under Section 56 of the Act on Organising Healthcare and Social Welfare Services (612/2021), are considered equivalent to residents of the wellbeing services county. (8.7.2022/600) 

The fee for unused services is €56.70 / appointment.

The fee is charged if the client or their representative has booked an appointment for health care services or a short-term care or housing service placement in social or health care services and fails to attend the booked appointment or placement at the designated time without a valid reason and without cancelling the booking in advance. A fee may be charged even if the service itself is free of charge.

However, the fee is collected only if collecting the fee is not deemed unreasonable, and the client was informed at the time of booking about the possibility of such a fee being collected and provided with instructions on how to cancel the appointment in advance. The fee will not be collected if the appointment is cancelled by 3 PM on the previous working day or if there is an acceptable or unavoidable reason for failing to attend without prior cancellation. The fee is collected only if collecting the fee is not deemed unreasonable. No fee may be collected from persons under 18 years of age. Information regarding the collection of the fee and the cancellation of the appointment or placement must be provided in such a way that the client sufficiently understands its content.

The fee may also be collected when the Wellbeing Services County, at the initiative of the client or their representative, has booked an appointment for the client (e.g., a call for a periodic check-up), and the client has been informed of the booking.

No fee shall be collected from persons under 18 years of age, in units specialising in substance abuse services, or for services aimed at pregnant individuals who use intoxicants.

The fee for long-term 24-hour sheltered housing, long-term family care, long-term institutional care, continuous regular home services and long-term housing services, i.e. communal housing, is charged even if the service is temporarily interrupted due to a reason caused by the client.

If the service is interrupted for more than five days, no fee will be charged for the period exceeding five days. If the service is interrupted due to a reason attributable to the Wellbeing Services County or because the client is in institutional care, no fee shall be charged even for the abovementioned five days.

If the interruption continues for the whole month, no fee will be charged at all.

Social and health care services can be provided as regular in-person visits or as digital services/electronic interactions. A paid digital service/remote visit replaces the traditional service based on in-person visitation and corresponds in content to a conventional in-person care or service interaction.

A remote visit offered as a digital service is conducted interactively using a two-way telecommunications connection, for example, via a computer, smartphone, or tablet. A digital service replacing an in-person visit, for which a client fee is charged, is primarily interactive and tailored individually for the client.

If the service provided as a digital service does not have a separately defined fee in the price list, the service provided as a digital service will be subject to a client fee for a physical visit in accordance with the price list. If the service is free of charge according to the price list, the service provided as a digital service is also free of charge for the client.

Digital/electronic health care services contribute to the payment ceiling in the same way as traditional in-person services.

A paid digital service/remote visit in health care always requires identification and is based on an entry made in the patient information system. Health guidance and counselling provided anonymously is not a paid service that replaces an in-person visit.

The digital services used in services for the elderly are implemented through terminal devices or sensor technology set out in the agreement of the Wellbeing Services County. The Wellbeing Services County will make the terminal device and/or sensors available to the home care client for the duration of remote visits or remote group activities recorded in the client's implementation plan. A remote home visit and remote group activities are included in the client fees for home care.

Rehabilitative daytime activities can also be organised as remote group activities, in which case the Wellbeing Services County will hand over the terminal equipment to the client for the duration of the service. In remote group activities, there is a client fee for each session. Digital services provided for the elderly are social services that do not accrue toward the payment ceiling.

In the case of family care, 24-hour sheltered housing, and institutional care, the service is considered long-term when it is estimated to last at least three months from its beginning, or if the service has actually lasted for at least three months (Act, Section 7b).

For home-based services (home nursing, home hospital care, home services for families with children, home care), the requirement for long-term nature is that the client receives the service at least once a week and that the service is expected to last at least 2 months, or the service has actually lasted for at least 2 months.