FAQ

First the doctor issues a prescription to the patient. If the doctor prescribing a medicine does not specify otherwise, then all prescriptions are public, i.e. everyone knowing the patient’s personal identification code can buy the drug.

Yes, drugs can be bought for someone else and you need your identity document and the identity code of the person you are buying medicines for.

The pharmacist enters the buyer’s personal identification code into the Digital Prescription Center. The buyer has to know the identification code of the patient. If the patient has more than one prescription, then it is necessary to know the name of the drug or the doctor or the date of the prescription in order to pick the right one.

The doctor can issue a paper prescription. The pharmacist can call to service desk of digital prescription and he/she will have all the information necessary to sell the drug that is needed.

In case of a home visit, the doctor writes the prescription on a paper as in the past. The buyer must give the identity document and the prescription on paper to the pharmacist. If the pharmacist has registered the prescription in the Digital Prescription Center, the patient and physicians can see it in the Health Portal.

We recommend that you actively use the Health Portal, where in addition to general health information you can monitor the information of the prescription drugs, including whether the patient has bought the drugs or for how long the prescriptions are valid.

If you can’t access the Internet, you should make notes of the prescription (in calendar or somewhere else) or ask the doctor to issue a paper with all the information needed.

Paper prescriptions can be prescribed if it is not possible or practical to issue digital prescription (for example, a patient who is planning to go abroad and needs to buy medicines abroad).
 

You can get the European health insurance card by ordering it on www.eesti.ee, by submitting an application at your local client service office of the Health Insurance Fund, or by sending an application to the Health Insurance Fund by post or by e-mail, in which case it must be digitally signed.

Persons who are at least 15 years of age can apply for the European health insurance card by presenting their passport or ID-card. A parent or representative of the child can apply for the card for the child until the child is 19 years old.

Once the European health insurance card has been ordered, it is unfortunately not possible to change the mailing address where the card is sent. If your order the card via www.eesti.ee, then you must verify your address in the portal before submitting the application. The card is sent to the address indicated in the portal. If you order the health insurance card by other means, then it is sent to the address indicated on the application.

The card is issued to persons by their country of insurance (country that receives the person’s taxes). A person can be insured in only one member state. If you work in several member states, then you should turn to the Social Insurance Board to state your country of insurance. If your taxes are received by Estonia and you are insured as an employee, then you can apply for the European health insurance card from the Estonian Health Insurance Fund. Citizenship is not a deciding factor regarding health insurance.

To order a new health insurance card, you must first cancel the previous one. You can do so by calling the information phone of the Health Insurance Fund at (+372) 669 6630. You can then order a new card at the state portal. You can also bring the application for the card to a client service office of the Health Insurance Fund or send it by post or e-mail, in which case it must be digitally signed. The application is available on the website of the Health Insurance Fund.

In order to receive a new EHIC you have to submit a new application. The new card can be ordered a month before the old card expires.

If you order EHIC to a health insurance fund office, it can be obtained in 7-10 days. When ordering your card to your home it will arrive a little bit faster. EHIC is valid for three years if the person is medically insured. For children under 19 years of age the card is issued with a validity of five years.

Necessary medical care is not free - the patient must pay self-liability fees (visitation fee, in-patient fee, co-payment, etc.) according to local rates. These costs are not refundable. EHIC does not cover transport costs or private doctor fees. 

Students (including pupils) who go to study abroad have to submit a foreign school´s certificate to the health insurance fund in order to continue their health insurance. The certificate must contain the following information: student's personal identification number, first name and last name, the data of the university and the duration of studies.

In order to receive necessary medical care in another EU country on equal terms to the insured people living there, you have to apply for an EHIC. The health insurance is formalised for 12 months maximum, therefor we ask you to remember to send a verification of your studies to the health insurance fund on each academic year.

If a person works in a number of EU member states, he/she will receive health insurance from the state where he/she pays social security contributions.

In such case there are several options. Table comparing treatment options and benefits can be found here. Firstly if a person chooses to go abroad under the legislation of the Directive 2011/24, then he/she needs a referral from a family or private doctor. Persons will pay all invoices themselves on site and will be reimbursed later, reimbursements are made in accordance with the Estonian price list (co-payments and other non-medical costs such as transportation and accomodation are not reimbursed). All of the documents that a person needs to submit can be found here.

Secondly a person can submit an application to the health insurance fund under the legislation of Regulation (EC) No 883/2004 art 20 and under Health Insurance Act section 271. Applications that do not come with a council decision will be processed longer, because then the health insurance fund has to request the decision themselves. Further information can be found here.

The health insurance fund covers only the costs of people who have received the prior authorization on the basis of the form E112 or the letter of guarantee. When a person goes abroad to receive planned treatment before getting the prior authorization from EHIF and submits an application and invoices for reimbursement after the treatment, the health insurance fund cannot compensate the cost of treatment in local rates of the country that provided healthcare. In this case the compensation is only possible in accordance with the Estonian price list (legislation of the Directive 2011/24).

The application should be submitted to the health insurance fund as soon as possible. The council decision speeds up the process and a decision can be made as an exception.  

To do so, a person working in an EU member state must contact the competent authority in the country where he / she works and request the application form.

Since planned examinations do not qualify as necessary medical care and she does not have Estonian health insurance, she cannot have them for free.

When an Estonian pensioner receives pension from Estonia, she must apply for the form E121/S1 (application forms) from EHIF when she starts living in Finland. After the form is registered in the new country of residence she becomes entitled to all medical care equal to other pensioners of that country.

When it comes to posted workers or if the person is working in several countries at the same time, then the person firstly has to submit an application to the Social Security Office to receive the form under the A1 certificate and after that has to make an application to the health insurance fund to receive the form E106/S1. The health insurance fund proceeds from the information mentioned in the form A1 when issuing the form E106/S1. 

Once all the necessary information (the duration of the dispatch is not longer than 6 months) is available, the health insurance fund can issue the form E106/S1, which gives the person the right to register him-/herself in the dispatched country´s  health insurance institution. The form E106/S1 is sent to the employer unless it is agreed otherwise.

Moreover, addition to the posted worker, the frontier worker and person raising a child under 3 years whose employment contract has been suspended, can request the form E106/S1. They also have to submit an application to the health insurance fund.

The form E104 is issued to people upon request. Firstly the health insurance should be canceled in Estonia. According to the Population Law, when living in another EU member state you have to inform the population register about your new place of residence, the health insurance fund cannot end the insurance before this.

The form E104 confirms that your health insurance in Estonia has ended. The application to obtain confirmation can be found here. A completed application can be brought to a health insurance fund customer service office, you can also send it by post or by digitally signed e-mail. Contact information can be found here.

Prior authorization for planned medical treatment abroad is a decision taken by the Board of the Health Insurance Fund to assume the obligation to reimburse the applicant for their necessary health care services abroad. To apply for prior authorization, you need to submit a respective application to the Health Insurance Fund (for more details, see “Planned medical treatment abroad”).

Before applying for a prior authorization for planned medical treatment abroad, find out with your treating doctor in Estonia which health care service is required. In order to apply for a prior authorization, the patient or his/her legal representative must fill in an application form (for more details see “Applying for a prior authorization for planned treatment abroad”) and the Estonian treating doctor must fill in the council report. For faster processing, please submit your application together with the council report. In the absence of the latter, EHIF will send a request to your doctor.

The council is a team of doctors that have medical specialists’ competence, and the council works as an advisory body, making decisions to achieve the best possible treatment outcome for the patient.

A person insured by the Health Insurance Fund is entitled to receive health care services (planned treatment) abroad on the basis of certain criteria. Availability of specific health care services abroad depends on the legal basis they are applied for, such as:

1. European Parliament and of the Council Regulation (EC) No 883/2004 Article 20 or
2. Article 27¹(1) of the Health Insurance Act

(For more information see “Planned medical treatment abroad”).

The Health Insurance Fund makes a decision on referring a person for treatment abroad based on the assessment of the Estonian Council of Medical Specialists and by checking the compliance of the application with the criteria provided by law. If the application is accompanied by an appropriately completed council report, it will take up to 30 days to process the application. If the application has reached the Health Insurance Fund without the council’s report, the fund will ask the patient's doctor to convene the council. The council helps find out whether the need for health care services abroad is justified and whether the requested health care services or alternative health care services can be provided in Estonia. If the application is submitted without the council’s report or the information in the report is incomplete, the processing can take 2-3 months (see Question 6 for more details).

If a person’s state of health requires an emergency intervention, the person’s treating physician shall send a respective confirmation to the Health Insurance Fund and the application will be processed as a matter of urgency (see Question 13 for details).

The following circumstances may prolong the processing of your application:

• incomplete application;
• incomplete council report;
• the patient refuses from additional evaluation of their state of health;
• the required documents are not received by the deadline;
• when the patient disagrees with their treating physician regarding the necessity and expediency of the health care services;
• misunderstanding of the principles of prior authorization procedure for planned medical treatment abroad.

Pursuant to Article 27¹(3) of the Health Insurance Act, at the request of the Health Insurance Fund, the insured person must undergo an additional evaluation of their state of health, which will be carried out by a doctor appointed by the Health Insurance Fund for the purpose of identifying the conformity of the state of health of the person to the criteria of planned medical treatment abroad. The Health Insurance Fund applies the requirement to undergo an additional evaluation of health, if it is not possible to provide an assessment of the compliance or non-compliance with the criteria of planned medical treatment abroad or if the assessment is in conflict with the criteria.

If the person fails to undergo additional evaluation of health, the Health Insurance Fund will make a decision on the application on the basis of the information available to us.

In processing the application, the Health Insurance Fund proceeds from the application, the evaluation given by the council and the following criteria provided for in Subsection 27 ¹(1) of the Health Insurance Act:

• the health service applied for or an alternative health service cannot be rendered to the insured person in Estonia;
   
• provision of the health service applied for is therapeutically justified with regard to the insured person;
   
• the medical efficacy of the health service applied for has been proved;
   
• the average probability of the aim of the health service applied for being achieved is at least 50 per cent.

Before making a refusal decision, the Health Insurance Fund explains in writing to the applicant why we cannot finance the health care service through the measure of planned medical treatment abroad. The Health Insurance Fund also gives the applicant the opportunity to submit his/her opinion and objections in writing. In case of a negative decision, a written notice is sent to the applicant along with the statement of grounds of denial of referral to treatment.

Treatment for which medically proved efficacy can be assessed on the basis of published clinical trials and the scientific literature.

A written hearing is communicated to the applicant before a negative decision is taken. In a written hearing the Health Insurance Fund explains in writing to the applicant why we cannot finance the health care service through the measure of planned medical treatment abroad.

A written hearing allows the applicant who has submitted an application for prior authorization of planned medical treatment abroad to submit his/her opinion and objections in writing.

Yes. The application for prior authorization for planned medical treatment abroad must be submitted before going abroad for the treatment. You can start treatment once the Health Insurance Fund has issued a prior authorization.

It takes up to 30 days to process an application submitted together with the council’s report. It takes 2 to 3 months, in some cases even longer, to process an application submitted without the council's report (see Question 6 for more details).

If a person’s state of health requires an emergency intervention, the person’s treating physician shall send a respective confirmation to the Health Insurance Fund and the application will be processed as a matter of urgency (see Question 13 for details).

Time resource for emergency cases is limited and will be allocated to the treatment cases of utmost emergency. An application is processed as a matter of urgency if treatment needs to be rendered within the hours or days. A treating doctor will send a respective confirmation to the Health Insurance Fund. The precondition for the urgent application procedure is that both, the application for prior authorization for planned medical treatment abroad and the council report have been completed and submitted correctly.

On weekends or public holidays, application are not processed.

Prior authorization for medical treatment abroad is not processed or issued as a matter of urgency in the following circumstances:

• the consultation or operation time has already been booked in the hospital and the application has not been submitted with a sufficient time reserve;
• travel tickets have been booked, the application has not been submitted with sufficient time reserve;
• the state of health does not require emergency intervention.

The Health Insurance Fund does not help find a hospital, doctor or health care service necessary for medical treatment abroad. Determining the need for planned medical treatment abroad and finding a suitable medical institution abroad is the responsibility of the applicant in co-operation with his/her treatment treating doctor in Estonia.

The Health Insurance Fund does not book appointments, consultations or operation times abroad. Necessary agreements are made either by the Estonian doctor, the patient or his/her legal representative (for example, a parent).

In general, the Health Insurance Fund does not reimburse transport costs incurred with regard to planned medical treatment abroad.

In exceptional cases, the Health Insurance Fund pays for medical air transport if other means of transport are excluded due to the patient's state of health. The need for medical air transport is agreed between the foreign and Estonian medical institutions. The Estonian medical institution settles invoices directly with the Health Insurance Fund.

From 1 January 2021, the Health Insurance Fund will also pay for medical land transport by ambulance and ferry.

Patient receiving inpatient hospital treatment will have no accommodation costs. In the case of outpatient treatment, the patient or his official representative pays the accommodation costs in out-of-hospital accommodation.

Based on the S2 form or letter of guarantee issued by the Health Insurance Fund, the foreign medical institution sends the invoice(s) for medical services directly to the Health Insurance Fund and the patient does not have to worry about the payment. The patient or his/her legal representative shall pay the foreign medical institution for possible non-medical costs (transport, translation, administrative or office costs, out-of-hospital accommodation, etc.).

According to the Health Insurance Act, the visit fee limit for outpatient specialized medical care is 5 euros and the daily bed fee limit is 2.50 euros. As a result, the Health Insurance Fund assumes the obligation to pay for the part of the visit fee that exceeds 5 euros. The Health Insurance Fund assumes the obligation to pay for the entire visit fee if medical care is provided to a pregnant woman or a child under 2 years of age. The Health Insurance Fund assumes the obligation to pay the bed-day fee in standard accommodation conditions in the extent that exceeds 25 euros (i.e. 2.5 euros per day for a maximum of 10 days). The Health Insurance Fund assumes the obligation to pay the entire bed-day fee during the provision of intensive care, the provision of inpatient specialized medical care related to pregnancy and childbirth or the provision of inpatient specialized medical care to a person under 18 years of age (see Question 19 for more details).

The Health Insurance Fund does not cover the out-of-hospital accommodation costs of the family members accompanying the patient.

According to the Health Insurance Act, the visit fee limit for outpatient specialized medical care is 5 euros and the daily bed fee limit is 2.50 euros. As a result, the Health Insurance Fund assumes the obligation to pay for the part of the visit fee that exceeds 5 euros. The Health Insurance Fund assumes the obligation to pay for the entire visit fee if medical care is provided to a pregnant woman or a child under 2 years of age. The Health Insurance Fund assumes the obligation to pay the bed-day fee in standard accommodation conditions in the extent that exceeds 25 euros (i.e. 2.5 euros per day for a maximum of 10 days). The Health Insurance Fund assumes the obligation to pay the entire bed-day fee during the provision of intensive care, the provision of inpatient specialized medical care related to pregnancy and childbirth or the provision of inpatient specialized medical care to a person under 18 years of age.

The Health Insurance Fund does not cover the out-of-hospital accommodation costs of the family members accompanying the patient.

To apply for a refund, please submit the following documents:

• invoice for the visit or bed-day fee (PDF file or original invoice on paper);
• proof of payment of the invoice.

Please send the application together with required documents to the e-mail address of the specialist on medical treatment abroad who processed your case or mail it to the Tervisekassa, with the keyword "Medical treatment abroad".

It is possible to apply for reimbursement from the Health Insurance Fund for unauthorized and already provided health care services on two different grounds:

1. Reimbursement based on the rates valid in Estonia, as set out in Article 662 of the Health Insurance Act (Patient’s Rights Directive 2011/24/EU)

Entitlement to reimbursement for planned medical care in the Member States of the European Union and the EEA, in both public and private medical institutions (see Questions 24 and 26 for details). Only those services that are also available and reimbursable by the Health Insurance Fund in Estonia are reimbursed on the same grounds as they would be in Estonia (for more details see “Planned medical treatment abroad”).

Please note that Switzerland is not covered by Directive 2011/24/EU that entitles a person to seek planned treatment in another EU Member State and to claim reimbursement later when they return home.

2. Reimbursement based on the rates of the country where treatment was provided in case of medical necessity (Regulation (EC) No 883/2004)

This right can be exercised only in case of necessary medical care during a temporary stay in another member state (in the Member Sates of the European Union and EFTA), i.e. in a situation where the necessity arose while the person was already in another member state. The medical institution must be included in a national system (see Questions 24 and 25 for details).

The Health Insurance Fund does not reimburse:

• experimental treatment;
• participation in clinical trials;
• services that is available in Estonia but is not included in the list of health care services (paid service);
• non-medical expenses (deductibles, translation service, accommodation, travel expenses). Special conditions apply to accommodation, deductibles and travel expenses (see Questions 16, 17, 18 and 19 for details).

S2 form is a document that is valid in the Member States of the European Union and the European Free Trade Association (EFTA ) (see Questions 24 and 25 for details) and is issued by the Health Insurance Fund, provided that the applicant is insured in Estonia. When submitting the S2 form, the insured person is treated as an insured person in the respective Member State (country providing the health care service). This means that in some cases the patient has to pay certain costs related to the health care services provided in another country (e.g. country-specific deductibles, transport costs, translation costs, administrative or office costs, out-of-hospital accommodation, etc.).

A S2 form is issued only if the patient has been granted a prior authorization for planned medical treatment abroad.

See more https://europa.eu/youreurope/citizens/work/social-security-forms/index_en.htm

A letter of guarantee is a document confirming that the Health Insurance Fund will cover the patient's health care costs abroad. The letter of guarantee does not cover possible non-medical costs (transport, translation, administrative or office costs, out-of-hospital accommodation, etc.) which will be paid to the foreign medical institution by the patient of his/her legal representative 

The letter of guarantee is issued by the Health Insurance Fund to the foreign medical institution providing the requested health care service. The precondition for issuing a letter of guarantee is that the patient has been granted a prior authorization of planned medical treatment abroad.

Austria, Belgium, Bulgaria, Cyprus, Czech Republic, Denmark, Finland, France, Germany, Greece, Hungary, Ireland, Ireland, Liechtenstein, Lithuania, Liechtenstein, Luxembourg, Latvia, Malta, Norway, Poland, Portugal, Slovenia, Spain, Sweden, Switzerland, the United Kingdom*.

There are four EFTA members: Norway, Switzerland, Iceland and Liechtenstein.

The European Union's relations with the EFTA countries can be divided into two. Relations with three EFTA countries - Norway, Liechtenstein and Iceland - are regulated within the European Economic Area (EEA). However, as Switzerland is not a member of the EEA, the European Union's relations with Switzerland are governed by separate bilateral agreements between the European Union and Switzerland.

There are four EFTA member states: Norway, Liechtenstein, Iceland.

If the S2 form or the letter of guarantee is about to expire but the treatment is still ongoing, you have to apply for extension. For that, please send a respective request at least two weeks before the expiry date to the e-mail address of the specialist of treatment abroad who processed your case.

Yes. There is no difference whether the student is studying full-time or part-time.