Annual payment ceiling

You are responsible for keeping track of the fees that contribute to the annual ceiling and for knowing when you have reached it. You should keep all relevant invoices and receipts, because you may need to present them if requested. Fees paid on behalf of minors are combined with those of their guardian for ceiling calculations.

If you reach the ceiling after using services in the Western Uusimaa Wellbeing Services County, please fill in the online form(external link). Your payment ceiling matters will be centrally managed by the Economic Management Unit. If you reach the ceiling after using another healthcare provider, payment ceiling matters will be processed by that specific healthcare unit (e.g. HUS, you can find contact details on your HUS invoice).

Once your annual payment ceiling application has been processed, you will receive a notification. If you have overpaid client fees after reaching the ceiling, you will be reimbursed for the amount exceeding the limit. 

Services included in the payment ceiling are generally free of charge for you until the end of the calendar year. An exception to this is short-term institutional care, where over 18-year-olds are charged a maintenance fee of €25.10 (in 2024) after the payment ceiling has been reached.

It is indicated in your invoice if the fee counts towards the annual payment ceiling. Fees for the following services are included in the payment ceiling:

• outpatient care at health centres
• examinations and care provided at an outpatient clinic
• day surgery treatment
• fees for examinations and treatment in oral healthcare, excluding dental technology costs
• treatment of the mouth and jaw in specialised healthcare
• physiotherapy, neuropsychological rehabilitation, nutritional therapy, speech therapy, occupational therapy and other comparable treatment that improves and maintains the functional ability
• serial treatment
• day and night care
• temporary home hospital care and temporary home hospital nursing
• short-term institutional care provided under the Health Care Act and short-term institutional services provided under the Social Welfare Act
• medical rehabilitation period in institutional rehabilitation provided to a person who receives services under the Act on Special Care for People with Intellectual Disabilities or the Act on Disability Services and Assistance
• the above-mentioned payments covered by social assistance

Outsourced services are also included in the payment ceiling if the wellbeing services county is responsible for organising them.

• fees for patient transport
• fees for medical certificates
• fees for missed and uncancelled services
• laboratory and imaging examinations based on a private doctor’s referral
• home care
• out-of-pocket amounts for service voucher users
• home help services for families with children
• income-based fees, such as fees for long-term institutional care, long-term housing services and regular home care,
• fees for which the client has received compensation under the Employment Accidents Insurance Act, the Farmers’ Accidents Insurance Act, the Military Injuries Act, the Motor Liability Insurance Act, the Patient Injuries Act or any other comparable act.

Please note that the annual maximum limit on medicine expenses(external link) and reimbursements of travel costs(external link) are applied for through Kela.