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The State Council Regulation On The Implementation Of The Health Insurance Law

Original Language Title: Valtioneuvoston asetus sairausvakuutuslain täytäntöönpanosta

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Council Regulation on the implementation of the Health Insurance Act

See the copyright notice Conditions of use .

In accordance with the decision of the Government of the Ministry of Social Affairs and Health, the Health Insurance Act of 21 December 2004 provides for (1224/2004) Pursuant to:

Chapter 1

Cash benefits

ARTICLE 1
Work and working conditions as a condition of special maternity money

A chemical substance related to the work or working conditions of the insured person may be assessed by the Health Insurance Act (1224/2004) In accordance with Article 4 (1), the health of the insured person or the foetus if the chemical substance is:

(1) anaesthetic gas;

2) lead or lead;

(3) mercury or mercury compound;

(4) chemotherapy;

(5) carbon monoxide, i.e. carbon monoxide;

(6) pesticides assessed as hazardous to the health of the insured person or the foetus;

(7) organic solvent that has been assessed as hazardous to the health of the insured person or the foetus;

(8) a substance classified as a carcinogen, carcinogen or mutagen, the packaging of which becomes (2002) Or chemical law (999/2013) , including H340, H341, H350, H350i, H351, H360, H360D, H360FD, H360Fd, H360Df, H361, H361d or H361df;

(9) in the decision of the Ministry of Labour on the factors causing the risk of cancer (188/1993) Or by the Ministry of Social Affairs and Health (1232/2000) The substance that causes the risk of cancer;

(10) environmental tobacco smoke.

(21/05/2015)

Paragraph 1 shall also apply to the chemical substance:

(1) ionising radiation including radionuclides;

2) toxoplasmosis, listeriosis, rubella, herpes, chickenpox, parvorko, hepatitis B and C, cytomegaloinflammation and HIV infection as well as other infectious diseases comparable to these.

(21/05/2015)

An element related to the other equivalent, insured or working conditions may be assessed for the health of the insured person or of the foetus in the case of underground mining, working under pressurised conditions or underwater diving.

ARTICLE 2
Assessment of dangerous elements

The assessment of factors posing a risk to the health of the foetus referred to in Article 4 (1) of Chapter 9 of the Sickness Insurance Act must be carried out in the context of the work environment and in the design of working conditions. By healthcare professionals or other comparable persons.

The survey shall identify the presence of factors posing a risk to the health of the insured person or the health of the foetus in the workplace and the work tasks in which the risk is present. If necessary, work hygiene measurements, biological exposure measurements or other methods of identification commonly used in the field of occupational health care are used.

The risk assessment carried out by healthcare professionals or other comparable persons performing health care services shall take into account existing medical information on the risk and identify the potential hazard of the person causing danger, Durability and duration of action. However, in the case of environmental tobacco smoke, the decision of the Council of Ministers on the fight against environmental tobacco smoke and the related risk of cancer (1153/1999) Provides.

Health care professionals who carry out health care must inform the employer of the risk factors, as well as the risks posed by work, working methods and substances used in work, and make proposals for To remove or protect against it.

ARTICLE 3 (212.2010/1090)
Ex-post inspection

The ex-post control referred to in Article 8 (3) of Chapter 9 of the Sickness Insurance Act must carry out a necessary study to determine the state of health of the mother and to establish possible birth defects. The verifier shall also endeavour to ensure that the mother is assigned to the appropriate treatment if the examination indicates the condition of the disease or the damage to the birth.

§ 4 (21/05/2015)
Severe illness or disability

The severe diseases or injuries within the meaning of Section 2 (4) of Chapter 10 of the Sickness Insurance Act include leukaemia and other malignant tumours, severe heart defects, severe accidents and burns, diabetes mellitus at the start of treatment and hard Balanced diabetes, severe mental disorders, severe disability, severe lung asthma and severe rheumatoid arthritis, as well as other diseases, injuries and medical conditions comparable to those mentioned above.

§ 5
Pressure medical reason for granting a special care allowance

The weighty medical grounds referred to in Section 3 (3) of Chapter 10 of the Sickness Insurance Act, on the basis of which the special care allowance is paid for over 150 working days, are:

1) a life-threatening condition requiring continuous monitoring of the child, such as the immunosuppression and the risk of infection;

(2) post-treatment of severe accidents and burns;

(3) the treatment of a dying child;

(4) the treatment of a child requiring dialysis when it requires continuous supervision of the child and the presence of the parent; and

5) other similar weighty medical reason.

Chapter 2

Application and payment of benefits

ARTICLE 1
Exact statement when applying for cash benefits

In the case of sickness benefit, the insured person must present a necessary and reliable explanation of the illness and the date of incapacity for work. If the invalidity persists longer than the period of ownership referred to in Article 7 (1) and (2) of Chapter 8 of the Health Insurance Act, the insured person shall present a medical opinion on his incapacity for work.

When applying for a special care allowance, the insured person must provide a necessary and reliable statement of the loss of earnings and a medical certificate for the medical treatment or rehabilitation of the sick child's illness or disability.

In the case of an application for a special purpose grant, the insured person shall be accompanied by a certificate issued by a doctor, a nurse, a midwife or a nurse, by a doctor, a doctor or a doctor who carries out occupational health care, or any other insured person's working conditions. The doctor's opinion on the risk referred to in Section 9 of Chapter 9 of the Health Insurance Act for the health of the foetus and the employer's statement that the worker is absent from work and that the worker has not been transferred to other tasks; Under contract law (2002) As required. An equivalent explanation shall be required for its own work.

When applying for parental benefit, the insured person must present a doctor, nurse, midwife or nurse certifying that the pregnancy has lasted at least the period provided for in Article 2 (1) of Chapter 9 of the Health Insurance Act. When applying for parental leave, it is necessary to indicate how the parental allowance is distributed between the parents. When applying for a partial parental allowance, both parents are required to present an employment contract with their employer on part-time work, setting out the agreed working time arrangements and the remuneration paid for part-time work. The entrepreneur parent must provide a reliable explanation of the reduction in the work carried out in the company between 40 % and 60 % of the previous one. (211.2006/980)

In addition, when applying for paternity money, it is necessary to identify the times the father takes care of the child and is not in gainful employment or other work outside the home. The Father shall immediately inform the National Pensions Office if he no longer takes part in the child's care. (21/05/2015)

In the case of parental leave, parental allowance or partial parental allowance shall be presented by the adoptive parents to the institution of the institution of the municipality of Social Welfare or (22/2012) A certificate issued by the adoption agency referred to in Article 22 (1). In the application, the adoptive parents shall determine the periods to be treated by him and not in gainful employment or any other work, except for the work of his own household. (21/05/2015)

The infectious disease Article 27 of the 583/1986 The daily allowance referred to in paragraph 1 shall be submitted;

(1) the decision of the institution responsible for the control of communicable diseases for absence or isolation from work; or

(2) the decision of the institution of the Ministry of Social Affairs and Health, the Government of the provincial government or the institution responsible for the control of communicable diseases;

(3) a reliable explanation of the loss of earnings and of the amount.

In the absence of a reliable explanation of the amount of the loss of earnings, the benefit is determined on the basis of the working income established as the basis for the daily subsistence allowance.

(8.11.2007)

When applying for a daily subsistence allowance, the insured person must present his or her occupational health service or other insured person's working conditions for the insured person's incapacity for work, as well as the fact that he is in a position to be able to cope with his or her health. Or through recovery without jeopardising part of his work. In addition, the insured person must present an agreement with his employer on part-time work, as evidenced by the agreed working time arrangements and the remuneration paid for part-time work. The entrepreneur must provide a reliable explanation of the reduction in the work carried out in the company between 40 % and 60 % of the previous one. (211.2006/980)

ARTICLE 2
Conditions for the payment of benefits

The payment of benefits shall be subject to the condition that the insured person, on request, presents a report on his absence from work to the Social Insurance Institution.

The payment of sickness benefit is subject to the condition that the insured person presents the necessary and reliable information on the continued incapacity of work.

The payment of parental allowance and partial parental benefit is subject to the submission by the insured person of the ex-post examination of the certificate referred to in Article 8 (3) of Chapter 9 of the Health Insurance Act.

As a condition for the payment of the daily subsistence allowance for less than 12 working days, the insured person is required to provide the necessary and reliable information to show that he is unfit for part-time work or other A necessary and reliable explanation of the reason for the end of the entitlement to sickness benefit. (211.2006/980)

ARTICLE 3 (21/05/2015)
Periods of payment of benefits

Sickness benefit, medical allowance and special care allowance shall be paid retrospect in such a way that the first payment period is 6 working days and each subsequent payment period is 25 working days. In the event of incapacity for work, sickness benefit and sickness benefit are paid at the end of the daily allowance. If, for the reasons referred to in Article 11 (6) of Chapter 8 of the Health Insurance Act, the partial sickness benefit period is shorter than the period of payment, the allowance shall be paid at the end of the day.

If the sickness benefit of the worker is interrupted by the fact that the Medical Service's opinion has not been delivered within the period laid down in Article 5a of Chapter 8 of the Health Insurance Act, the daily allowance shall be paid up to 90 working days. If a worker delivers a medical opinion later, sickness benefit is paid out to the end of the period of suspension. The sickness benefit is then paid in accordance with paragraph 1.

Special forms of money, maternity, paternity and parental allowance and partial parental allowance shall be paid in the event of a period of up to 25 working days. However, the first payment period for the maternity allowance is 30 working days.

If, as a result of illness, the child's mother has become unable to take care of her child within the meaning of Article 13 (1) of Chapter 9 of the Health Insurance Act, or she is dead, the parental allowance shall be paid to the father after 25 working days in the event of payment. The day of sickness and the daily life of the following day or day following the day following the mother's death. If the child's father is not responsible for the custody of the child, the insured person who is responsible for the maintenance of the child shall apply mutatis mutandis the child's father.

The cashier meeting of the place of employment may, by a two-thirds majority of the votes cast, take a decision on the payment of sickness benefit from the monthly payment periods referred to in paragraph 1.

§ 4
Information to be submitted when applying for medical expenses

When applying for reimbursement of the costs of medical treatment, pregnancy or childbirth, the insured person must present:

(1) a necessary and reliable statement of illness, pregnancy or childbirth;

(2) a necessary and reliable explanation of the study or treatment carried out on the basis of paragraph 1;

(3) a payment receipt or other reliable statement of costs; and

4) any other equivalent explanation.

The insured person shall demonstrate the need for a limited medicinal product, as referred to in Section 5 of Chapter 5, and the illness referred to in Articles 6 and 7, as well as the need for special replacement medicinal products and clinical medicinal products for the examination of the specialised medical unit Or a special report by a specialist doctor or other qualified medical practitioner, or more specifically by means of a separate report prescribed by the National Pensions Committee. (29.12.2005)

§ 5
Replacement of dental treatment for veterans at the same time by the dentist

Notwithstanding the provisions of Section 5 (2) of Chapter 3 of the Health Insurance Act, the law on the organisation and replacement of dental veterans is replaced by: (1999) In the case of dental research and treatment, based on the same order of the dental practitioner based on the same prescription, if they have been carried out within two years of the medical treatment prescribed by the dentist.

Chapter 3

Workplace

ARTICLE 1
Establishment of advances at the start of cash operations

Accepting the insurance fund (16/04/1992) In accordance with the sickness insurance scheme of the insurance fund in accordance with the sickness insurance scheme of the insurance fund, the Social Insurance Institute shall determine the date on which the sickness insurance legislation in the register begins. This date shall not be subject to three months following the adoption of a decision approving the approval. However, the activity of the mass may not take place at the earliest when it is registered in the register of insurance.

Before starting an activity in accordance with the Health Insurance Act, the mass shall be handed over to the National Pensions Office for the purpose of determining the amount of the advance referred to in Article 2 (1) of this Chapter. Upon receipt of this information, the National Pensions Office shall issue a written decision on the amount of the advance to be paid to the cashier.

The performance of the advance shall apply mutatis mutandis, as provided for in Article 2 of this Chapter.

ARTICLE 2
Advances to the cash register

Before the end of November, the Social Insurance Institution shall issue a written decision on the advance payment to the office cash register in the following year. When determining the amount of the advance, the amount necessary for the payment of benefits in the form of sickness insurance in the register shall be increased by one tenth of the estimated amount of benefits in order to ensure liquidity. The mass shall disclose the information necessary to determine the amount of the advance to the National Pensions Office by the end of October.

In the course of January each calendar year, the National Pensions Office shall pay the amount of the cash register referred to in Article 1 (1) to ensure the liquidity of the register. In addition, the National Pensions Office shall, on the first working day of each month, make available to the cashier the amount that it, together with the amounts previously paid, is sufficient for benefits to be paid in the same month. If the advances received by the register are not sufficient to benefit from the benefits under the Health Insurance Act, the Social Insurance Institution shall provide the cash without delay.

If the annual amount of the advance proves to be too small or too large, the amount of the advance shall be adjusted accordingly. In addition, the National Pensions Office shall, on the first working day of each month, carry out one twelfth of the amount fixed for the administrative costs of the register.

The mass shall provide the information required for the People's Pension Fund in accordance with Article 2 (2) and for the review of the advance. In addition, the cashier shall provide the Social Insurance Fund with the necessary information.

ARTICLE 3
Statistical procedure

The place of work shall be subject to an accounting year by the end of January of the year following the end of January of the year following the date of application of Chapter 16, Section 2, of the Health Insurance Act.

If you have had too much money in the job register, you will have to repay too much by the end of February. If the funds received by the register have not been sufficient for benefits under the Health Insurance Act, the Social Insurance Institution will carry out the missing part by the end of February.

The administrative costs shall be adjusted according to the criteria laid down by the Ministry of Social Affairs and Health for that calendar year.

Chapter 4 (29.12.2005)

Financing

ARTICLE 1 (29.12.2005)
Execution of the State contribution to the costs of the declaration of income insurance

On the basis of the institution's estimate, the Ministry of Social Affairs and Health pays the National Pensions Office an estimate of the amount of the costs referred to in Article 13 (1) of Chapter 18 of Chapter 18 of the Health Insurance Act. (30.12.2008/1132)

The Ministry of Social Affairs and Health must carry out the advance payments referred to in paragraph 1 to the Fund for the health insurance fund on the first working day of each month.

The Social Insurance Institution shall inform the Ministry of Social Affairs and Health of the expenditure referred to in Article 13 (1) of Chapter 18 of the Health Insurance Act for each month at the latest on the 15th day of the second month following the month of payment. The difference between these costs and advances shall be taken into account in the performance of advances in anticipation of the third month following the month of payment. (30.12.2008/1132)

ARTICLE 2 (29.12.2005)
Execution of State contributions to medical insurance expenses

On the basis of the calculations provided for in Chapter 18, Section 28 of the Health Insurance Act, which is provided by the Ministry of Social Affairs and Health of the National Pensions Office, the Ministry of Social Affairs and Health shall fund the Social Insurance Fund in accordance with Chapter 18 of the Health Insurance Act. State contributions referred to in Article 10 so that, in January, at least one sixth of the annual percentage is paid monthly and monthly thereafter. In order to safeguard financing or substantially change the state's share, monthly payments can be differentiated by way of derogation from the above provisions. (30.12.2008/1132)

The health insurance fund referred to in paragraph 1 shall be carried out by the Ministry of Social Affairs and Health on the first working day of each month.

The amount of the State contributions under Sections 2 and 10 of Chapter 18 of the Sickness Insurance Act shall be fixed in the context of the accounts of the National Pensions Office.

ARTICLE 3 (29.12.2005)
Execution of the State contribution to medical care received abroad

According to Article 18 (1) of Chapter 18 of Chapter 18 of the Health Insurance Act, the Ministry of Social Affairs and Health pays the National Pensions Fund to cover the costs of medical care referred to in Article 8 (1) (5) of Chapter 18.

The National Pensions Office shall provide the Ministry of Social Affairs and Health with a calculation of the expenditure referred to in paragraph 1 at the latest 10 working days before the State's contribution is made.

Chapter 5

Negotiations

ARTICLE 1
Sickness Insurance Advisory Board

The Sickness Insurance Advisory Board is responsible for:

(1) promote and develop mutual cooperation between participants in the implementation of health insurance;

(2) make proposals to the Government of the National Pensions Office and deliver opinions to it in order to carry out surveys and studies on health insurance; and

(3) submit proposals to the Government of the People's Pensions Office and deliver opinions on the application of the Health Insurance Act and on matters relating to the development of sickness insurance.

The Advisory Board shall have the right to take a secretary and consult experts. The Government of the Social Insurance Institution shall confirm the fees payable to the Secretary and the experts on a proposal from the Advisory Board.

Costs arising from the activities of the Advisory Board shall be made from the funds of the Fund.

ARTICLE 2
Social advisory council

The role of the Social Advisory Board is to deal with medical issues related to health insurance.

The Social Advisory Board may be divided into sections.

The Advisory Board shall have the right to appoint a secretary and consult experts. The Government of the Social Insurance Institution shall establish a fee to be paid to the President, members, secretaries and experts of the Advisory Board.

Chapter 6

Entry into force

ARTICLE 1
Entry into force

This Regulation shall enter into force on 1 January 2005.

Before the entry into force of this Regulation, measures may be taken to implement it.

Entry into force and application of amending acts:

29.12.2005/1267:

This Regulation shall enter into force on 1 January 2006.

Before the entry into force of this Regulation, measures may be taken to implement it.

2.11.2006/980:

This Regulation shall enter into force on 1 January 2007.

Before the entry into force of the regulation, measures may be taken to implement the Regulation.

8.11.2007/997:

This Regulation shall enter into force on 15 November 2007.

The State contribution referred to in Article 13 (1) (3) of Chapter 18 of the Sickness Insurance Act from January to October 2007 and the advance of the State contribution referred to in Article 1 (1) (3) of this Regulation for November and December 2007 Shall be entered into the health insurance fund on the first working day of December 2007.

30.12.2008/1132:

This Regulation shall enter into force on 1 January 2009.

Before the entry into force of this Regulation, measures may be adopted for the implementation of the Regulation.

17.12.2009/1083:

This Regulation shall enter into force on 1 January 2010.

Before the entry into force of this Regulation, measures may be adopted for the implementation of the Regulation.

2.12.2010/1090:

This Regulation shall enter into force on 1 January 2011.

21/05/2015:

This Regulation shall enter into force on 1 June 2015.