FAQ

The Health Insurance Fund pays allowance for:

a) nursing a child under 12 years of age or a disabled person under 19 years of age (the start date of the certificate for care leave was before 15 May 2024) – for up to 14 consecutive days. Based on certificates for care leave, the start date of which was on or after 15 May 2024, we will pay allowance for up to 60 consecutive days.

b) nursing a child under 3 years of age or a disabled child under 16 years of age if the caregiver of the child is sick or is receiving maternity care – for up to 10 consecutive days.

The Health Insurance Fund pays the carer’s allowance from the first day of the certificate for care leave. The allowance is paid based on the daily income of the beneficiary, which is calculated based on the income subject to social tax for the previous calendar year. The allowance is paid at 80% of daily income, with income tax deducted from it.
 

If the start date of the certificate for care leave was before 1 July 2024, the Health Insurance Fund will calculate the carer’s allowance based on the minimum wage, because the parent did not have any income subject to social tax in the previous calendar year.

If the start date of the certificate for care leave was on or after 1 July 2024, the Health Insurance Fund will calculate the carer’s allowance based on either the daily rate of the allowance calculated based on the person’s income subject to social tax for the previous calendar year or the daily rate of the shared parental benefit. Allowance is paid based on the rate that is more favourable for the parent.

The certificate is issued to the parent actually nursing the child.

The large intestine is the part of the bowel that extends from the end of the small intestine to the anus, and it is divided into the cecum, the colon, and the rectum. In the large intestine, water and mineral salts are absorbed, and the digestive processes are completed. Colon cancer is a malignant tumour that most often originates from a mucosal tumour located in the large intestine. Most colon cancers develop from initially benign tumours, or polyps, as a result of a gradual process of carcinogenesis.

Colon cancer is a common disease that affects women and men almost equally. Almost 1,000 people in Estonia develop colon cancer every year.

Colon cancer is a major global health problem, ranking among the top three most common types of cancer that cause cancer death. The incidence of colon cancer has also increased year by year in Estonia: while 680 people were diagnosed with colon cancer in 2000, now almost 1,000 people are diagnosed with colon cancer each year.

It is difficult to detect colon cancer in a timely manner if people seek medical attention too late, i.e. only when they have complaints or symptoms. Nearly a third of cancer cases have already spread from the intestine to other organs by the time they are discovered. This makes treatment more complicated for both the patient and the doctor, which is why early detection of cancer and timely treatment are important.

The development of colon cancer is a gradual process that depends on the interaction of several factors. This means that the development of cancer requires the interaction of several carcinogenic factors, usually over many years. The gradual process reflects the emergence and accumulation of mutations acquired during life. Initially, it is a benign tumour in the intestinal mucosa. However, over time, the benign tumour, or polyp, may enlarge and undergo structural changes. Not all polyps develop into colon cancer. The regression of polyps is also possible, but approximately every twentieth polyp will progress and may develop into cancer.

Because colon cancer develops slowly and gradually, the risk of developing cancer increases with age. The risk of developing the disease increases significantly from the age of 50. 90% of colon cancer cases occur in people over 50 years of age.

Most colon cancer cases are first detected in people over 70 years of age. The higher the average life expectancy and the more older people there are in the population, the higher the incidence of colon cancer.

• In addition to age, important risk factors for colon cancer include dietary habits, the presence of previous benign colon tumours or polyps, the presence of colon cancer in close relatives (for example, one case of colon cancer or a significant polyp in a close relative doubles the risk), and obesity.
• Smoking also increases the risk, as does excessive consumption of red meat (the effect of the latter factor has not been conclusively proven in high-quality scientific studies). People who exercise more and eat fewer calories have a slightly lower risk of developing colon cancer.
• The risk is increased, among other things, by certain comorbidities and previous surgeries – people who have previously had surgery for either polyps or colon cancer have a slightly higher risk of developing colon cancer.
• In 75% of cases, colon cancer affects people who do not have a hereditary predisposition, meaning there is no history of cancer in the family. Approximately 25% of colon cancer cases are associated with a family history, but the exact number, location, nature, and mechanism of gene defects may not be known. About 2–5% of cases have been proven to be caused by specific gene changes.

The risk of developing colon cancer increases from the age of 50!

The process of cancer development is usually slow. It is believed that it takes at least 10–15 years from the onset of precancerous changes to the development of cancer. There are genetic syndromes characterised by an unusually rapid development of cancer – for example, Lynch syndrome, or hereditary nonpolyposis colon cancer. In this case, cancer may develop significantly faster than usual, for example, within a year or two in a previously visually healthy intestinal mucosa.

Polyps, or cancerous growths, can also occur in younger people – especially if there is a hereditary predisposition. Most often, the incidence of polyps increases in people aged 50 and older. According to various reports, about one in five people over the age of 50 have some kind of polyp in their intestines.

The likelihood of polyps occurring is somewhat lower in women than in men. The reason is probably both gender characteristics and environmental influences. Men tend to have more harmful habits, are on average less health-conscious, pay less attention to themselves, and seek medical attention later. The role of hormones is highly speculative – female hormones may offer some protection.

As polyps also develop from the accumulation of lifestyle factors, it can be speculated that they would not develop if people behaved health-consciously. However, the accumulation of genetic mutations is an inevitable process that accompanies ageing.

Factors that reduce the risk of developing colon cancer have also been studied – for example, the use of nonsteroidal anti-inflammatory drugs (NSAIDs, including aspirin, celecoxib, etc.), the use of cholesterol-lowering drugs, an active lifestyle, and a normal body weight. The use of estrogens and calcium supplements also somewhat reduces the risk of colon cancer.

The effectiveness of NSAIDs in preventing and also reducing polyps has been proven, but there is a question of side effects, for example, on the gastric mucosa and cardiovascular system. In addition, there is still limited knowledge about the exact doses and duration of treatment.

Colon cancer develops slowly and early colon cancer has no symptoms. The relatively long latency period offers a good opportunity for the early detection of the tumour. A polyp, or benign tumour, that is detected early and properly removed prevents the development of colon cancer.

Colon cancer causes complaints when the tumour is very large or has spread outside the colon. This may mean that treatment results will deteriorate and treatment will become more complicated. However, localised colon cancer, i.e. a tumour confined to the bowel wall, would be easier to treat safely and effectively.

Typical symptoms of colon cancer include rectal bleeding, altered bowel habits (constipation, occasional diarrhoea, painful/strong urges to defecate or urinate that do not necessarily lead to defecation or urination), abdominal or back pain, anaemia, and a tumour that can be felt.

The cancer may also have spread from one location to another or metastasised to other organs.

The success of colon cancer treatment is determined by the extent and complexity of the tumour, as well as the presence or absence of distant metastases, that is, cancer spread to other organs.

The general rule is that all tumours that are at least a centimetre or larger in diameter must be treated or completely removed.

Colon cancer screening is a proven effective method for detecting this form of cancer in its early stages, when the cancer has not yet spread to other organs. The development of colon cancer is slow, and identifying early changes in the bowel helps to detect the disease in time and start modern treatment, which has good results.

To diagnose colon cancer, either a stool test (faecal occult blood test) or a colonoscopy is performed.

Faecal occult blood test

Faecal occult blood tests are most commonly used because they are simple, fast, safe, painless, and more affordable. A person can take the stool sample required for a faecal occult blood test at home. The faecal occult blood test is an important screening test for the early detection of colon cancer. It allows for early detection of possible intestinal occult blood. A person can obtain the necessary materials and information for a faecal occult blood test from their family physician or nurse.

A faecal occult blood test is not a blood test! Occult bleeding is bleeding from the gastrointestinal tract that the person is unaware of (even 100 ml per day can go unnoticed). Even healthy people pass blood in their stools every day (0.5–1.5 ml in 24 hours).

Other causes of gastrointestinal bleeding may include aspirin, NSAIDs, gum disease, gastritis and oesophagitis, gastroduodenal ulcers, vascular ectasias, haemorrhoids, portal hypertensive gastropathy, and parasites in the gastrointestinal tract. Aspirin and anticoagulant therapy can cause bleeding, but usually so little that it does not cause a positive occult blood test.

Bleeding due to a tumour may be intermittent and the blood may be unevenly distributed in the stool. Therefore, it is necessary to take a stool sample from several places and sometimes several times.

If a properly performed test shows the presence of occult blood in the stool, a colonoscopy should be performed.

Colonoscopy

Colonoscopy is an examination of the large intestine that allows a doctor to examine the large intestine using a flexible, tubular examination instrument, or endoscope, equipped with a video camera. It allows the doctor to look for visible changes in the large intestine.

Colonoscopy is a painless procedure!

Colonoscopy is more accurate than an X-ray of the large intestine and, if necessary, allows for the taking of biopsies, or tissue samples, during the examination, which can later be examined under a microscope. It is a very important and high-quality examination that provides the most reliable answer.

Cancer screening is primarily a good opportunity to make sure you are healthy.

Screening as primary prevention helps to prevent cancer. Cancer only begins to cause complaints and symptoms when the cancer has spread to other organs in the body, and by then, it is significantly more difficult to treat. Screening helps to detect tumours at a stage when they can be treated and to prevent tumours from spreading to other parts of the body.

Research shows that colon cancer screening is effective. It allows to detect colon cancer at an earlier stage or before it develops, i.e. in a precancerous state, when a person has low- or high-risk benign tumours, or polyps. Thus, screening results in more polyps and stage I–II colon cancer being diagnosed, and fewer stage III–IV colon cancer being diagnosed.

Population-based screening programmes are used in several countries to reduce colon cancer incidence and mortality. In most countries, the faecal occult blood test is used as a screening method, with colonoscopy only being used in people with a positive test result. In addition, the occult blood test is more sensitive for large polyps and incipient cancers.

Estonia was one of the last countries in Europe where colon cancer screening was not available until 2016. However, this programme has also been introduced in other countries relatively recently.

With the aim of assessing the impact of implementing colon cancer screening on public health and the related health costs, the Health Insurance Fund commissioned the health technology assessment report ‘Cost-effectiveness of colon cancer screening’ from the Institute of Family Medicine and Public Health of University of Tartu.

The cost-effectiveness report compared different testing methods and found that the most effective is to use a faecal occult blood test first, and if faecal occult blood is found in the sample, a colonoscopy should be performed.

Therefore, the method chosen for colon cancer screening in Estonia is a faecal occult blood test, followed by colonoscopy if necessary. People aged 60–68 are invited to the screening.

Successful colon cancer screening helps to prevent a third of colon cancer deaths. By launching screening in Estonia, it is possible to prevent 33–74 deaths from colon cancer within the group of people participating in the screening within ten years and gain a total of 71–136 quality years of life for people aged 60–69.

Colon cancer screening is an effective method for detecting colon cancer at an earlier stage or before it develops, i.e. in a precancerous state, when a person has low- or high-risk benign tumours, or polyps.

Screening can reduce mortality from colon cancer by 13–33%, but screening has no effect on overall mortality. There are 750 new cases of colon cancer in Estonia each year, and although it ranks high among cancers, it still accounts for a small proportion of overall mortality.

Screening tests are generally effective when a sufficient number of people at risk participate. European quality guidelines say that the minimum participation rate should be 45% and 65% is recommended.

Screening is voluntary and the Health Insurance Fund considers it important to inform insured persons about both the positive and negative aspects of screening. Thanks to information materials, raising awareness, and explanatory work, the patient can make an informed choice.

Family physicians play a very important role in colon cancer screening. If you have any questions, contact your family physician. They will explain how important it is to participate in the screening and what will happen next, as well as advise you throughout the process and answers any questions that arise.

Men and women aged 60–68 participate in the screening every two years.

To participate in colon cancer screening, contact your family physician and register for an appointment with a family nurse.

At the appointment, you will receive the kit necessary to take a stool sample. The kit includes a sample container, information material, a questionnaire, and a postage paid envelope. The sample can be taken at home and then sent by mail to the laboratory. The postage for sending the sample is prepaid and there are no additional costs.

There is no need to wait for an invitation to participate in the screening. People in the target group can also contact their family physician and express their desire to participate in the screening.

The person takes a stool sample in accordance with the instructions and fills out the questionnaire included in the kit, where they must write their name and the date the sample was taken, and send it to the laboratory by mail in a postage paid envelope.

Please note!

You will receive the result of the occult blood test 10 working days after posting the sample from your family medicine centre or the health portal terviseportaal.ee.

Once the sample has reached the laboratory, it is analysed and the result is entered into the health information system.

If the test result is negative, you should be screened again in two years. If your health condition changes, you should definitely contact your family physician.

If the test is unsuccessful, or if there is no test result, you must return to your family medicine centre to repeat the test.

If the test result is positive, you will be sent for further tests. There is no reason to worry, because a positive result does not mean anything else besides that there is a need for additional testing. The family physician issues a referral for a colonoscopy.

The person registers for a procedure at an endoscopy clinic either by phone or through the health portal.

A medical specialist performs a colonoscopy in an endoscopy room. If necessary, a biopsy will be taken during the colonoscopy or polyps will be removed and sent for histological examination. The medical specialist will schedule an appointment in 30 days.

If the person does not come to the appointment at the agreed time, they will be contacted by the endoscopy office.

At the next appointment, the doctor performing the colonoscopy will decide, based on the histology results, what treatment the patient needs and, if necessary, issue a referral to an oncologist or surgeon.

To perform a colonoscopy, the large intestine must be clean of faeces. For this, oral lavage solutions are used. Thorough preparation is important to improve visibility for the doctor.

A low-fibre diet is recommended for 48 hours before a colonoscopy. Suitable foods include boiled or steamed white fish, boiled chicken, eggs, cheese, bread, margarine, cookies, and potatoes. It is not recommended to eat foods rich in fibre such as red meat (beef, pork, lamb), red fish (salmon, trout), fruits, vegetables, mushrooms, nuts, and whole grains.

The day before the colonoscopy, breakfast should be chosen from the foods allowed the previous day. After that, do not eat until the colonoscopy, but make sure to drink enough (for example, tea, coffee, sparkling or still water, or broth). Jellies and ice cream are also allowed. Milk can be added to coffee and tea.

When preparing for a colonoscopy, drink a bowel lavage solution in accordance with the recommended dosage and administration method of the manufacturer, and depending on whether your colonoscopy is performed in the morning or evening. It is recommended to stay near a toilet when drinking the lavage solution, as the need to use the toilet may arise quickly.

Some people may have problems with the amount of the solution (about four litres) and its salty taste, which can cause a feeling of nausea. It helps to drink the solution cold or add juice for flavour.

You also need to be careful with some medicinal products. For example, you must stop taking iron supplements one week before a colonoscopy. Aspirin up to 100 mg per day is allowed. Warfarin therapy can be safely stopped 3–4 days before colonoscopy and resumed immediately after colonoscopy.

During colonoscopy, you must lie on your back or turn to your right or left side if necessary. The colonoscope is passed through the anus into the large intestine and the colonic mucosa can be observed by dilating the large intestine with air. If necessary, a medicinal product to help you relax will be injected into a blood vessel (vein) before the procedure. You may experience some discomfort due your bowel stretching.

Colonoscopy lasts for 30–40 minutes, or sometimes longer, depending on the location of the intestinal loops in the abdominal cavity and the connections between them.

After the colonoscopy, you can return to your regular life. As the large intestine is thoroughly cleansed before the procedure, you may not feel the need to defecate the next day.

Contraindications for colonoscopy include acute heart and lung diseases, gastrointestinal perforation, bowel obstruction, severe bleeding, hernia, and the like. The decision on whether a patient can undergo a colonoscopy or whether the procedure should be postponed is made by the family physician.

Screening colonoscopy is a painless procedure with minimal risks. Bowel examinations are performed by experienced and appropriately trained doctors.

Screening always involves some risk. There is no direct health harm caused by taking a faecal occult blood test, but every screening method always carries the risk of false positive and false negative results. In the event of a false positive result, the person will proceed to a colonoscopy, which carries a risk of health damage.

Side effects associated with preparing for a colonoscopy procedure include bloating and abdominal pain. Complications from colonoscopy are rare (according to studies, they occur in up to five per cent of patients). The risk of complications is reduced by the fact that doctors with extensive colonoscopy experience are selected to perform screening tests.

The colonoscopy procedure is primarily associated with the risk of bleeding and/or gastrointestinal perforation, both during the preparation and execution phases. Bleeding that may occur after a biopsy is taken is minimal and does not require blood transfusions or surgery. However, a perforation in the colon wall, or gastrointestinal perforation, may lead to surgery.

Bleeding during colonoscopy occurs in 1.64 cases per 1,000, gastrointestinal perforation in 0.85 cases per 1,000, and death in 0.074 cases per 1,000 people.

The risk of health harm from colonoscopy is higher in patients with comorbidities and in the elderly. To mitigate the risk, a patient with a positive occult blood test result visits their family physician before undergoing a colonoscopy, who can assess their health status.

In the case of a false negative occult blood test, however, it may happen that a person actually needs to have a colonoscopy, but it is not performed. At the same time, the occult blood test chosen for screening is a very good method because of its sensitivity, and should provide fairly accurate answers. In addition, the medical specialist (colonoscopist) may not notice a change that is important to the patient (dangerous polyp, cancer). The causes may lie in the endoscopy, poor bowel preparation, or patient-related factors. This problem may occur in up to two cases per 100 procedures.

Theoretically, the risk increases just by going to the doctor – the anticipation and fear of the screening test, along with the possibility of an unpleasant result, can also cause worry and stress.

Polyps that are at least a centimetre in diameter must be removed when discovered. The quality of polyp removal is important – if it is removed completely, i.e. within healthy tissue, the risk of polyp recurrence is extremely low (assuming that these are benign changes). In the case of dysplasia, a precancerous condition, or cancer, the polyp may recur after removal.

Colon cancer is treated either surgically (openly through a large abdominal incision) or laparoscopically (observing the abdominal cavity with a laparoscope through a small incision made through the skin and muscles).

Radiation therapy and chemotherapy also play an important role in the comprehensive treatment of colon cancer. Together with surgical treatment, they improve the treatment outcomes of the disease. In some cases, patients have been cured without surgical treatment as a result of radiation therapy and chemotherapy.

Modern knowledge and experience make it possible to surgically treat even advanced colon cancer that has spread to other organs, such as the liver or lungs. The first successful surgical removal of liver metastases was performed as early as 1952. Surgical treatment of metastatic colon cancer has now become routine for those patients whose general condition and comorbidity profile make surgical treatment appropriate. The success of treatment has also been increased by the use of surgical treatment combined with advanced chemotherapy.

In addition, there is increasing talk of an immunological predisposition to colon cancer. Whether a tumour can be managed with immune system control or not depends largely on the immune status of the host and the nature of the tumour. This, in turn, largely determines the overall treatment outcomes of colon cancer.

Surgical techniques have become significantly more patient-friendly. The trauma of surgical treatment, including open surgical treatment, has decreased, and post-operative recovery has been significantly accelerated. Accelerated post-operative recovery programmes are available, allowing the patient to return to daily activities more quickly and safely.

In the case of rectal cancer, it is increasingly possible to restore bowel continuity and avoid the creation of a stoma (a surgically created opening in the front wall of the abdomen through which faeces or urine involuntarily pass into a collection bag attached to the abdomen for this purpose).

In the past, surgical treatment of rectal cancer meant the need for an artificial anus for up to half of patients. Today, the proportion of such cases has decreased significantly, usually reaching 10–25 per cent of all treated rectal cancer patients.

Colon cancer is becoming a chronic disease that requires treatment but can be controlled over many years.

Chemotherapy for colon cancer has developed greatly over the last 20 years. A number of new so-called precision medicines have been introduced into colon chemotherapy, which have improved the ability to control the disease. The curative effect of chemotherapy has not improved significantly, but the time to control the disease has become about four to five times longer than 20 years ago – from half a year to an average of three years.

The doctor will draw up an electronic certificate of incapacity for work for you for the period of leave and send it to the database of the Health Insurance Fund. If your doctor terminates your certificate of incapacity for work, please inform your employer!

In order for the Health Insurance Fund to assign and pay benefits on the basis of the certificate of incapacity for work, the employer must submit the details of the certificate of incapacity for work completed by the doctor to the Health Insurance Fund electronically via the state portal www.eesti.ee. Once the employer has sent the information to the Health Insurance Fund and the information on the certificate of incapacity for work does not need to be specified, the benefit will be paid into your current account within a few working days.https://www.eesti.ee/eraisik/en/artikkel/health-and-care/health-and-medical-care/temporary-incapacity-for-work#benefits-for-temporary-incapacity-for-work
 

You can find information about your certificates of incapacity for work on the state portal www.eesti.ee under ‘Certificates of temporary incapacity for work’.

Incapacity for work is reimbursed up to the date of return to work shown on the certificate of temporary incapacity for work, but no more than

• 182 consecutive calendar days or
• 240 consecutive calendar days for tuberculosis.

The doctor can also issue a certificate of incapacity for work for a longer period. In that case, the certificate of incapacity for work proves the absence from work. No benefits are paid for this period. 
 

For self-employed persons, the Health Insurance Fund pays the sickness benefit from the ninth day of absence from work. No sickness benefit is paid to self-employed persons for the first eight days of their leave.

In accordance with the Employment Contracts Act, an employee has the right to interrupt, postpone, or terminate prematurely a holiday due to significant reasons arising from the employee.

The employee has the right to claim the unused part of the holiday immediately after the impediment to using the holiday ceases to exist or, by agreement of the parties, at another time. The employee must notify the employer of an impediment to using the leave at the first opportunity.

If the employee does not interrupt their leave, they are not entitled to the benefit for incapacity for work.

In the event of sickness or injury, the certificate of incapacity for work is issued to the employee based on calendar days and is granted from the day on which the employee is unable to carry out their duties.

The certificate of incapacity for work may be opened retroactively (also starting on a holiday or public holiday) if an insured person falls ill or needs care or nursing care on a weekend, a national holiday, or a public holiday and the person informs the healthcare professional by telecommunication or by coming to the appointment on the working day immediately following the day on which the insured person falls ill, and if the insured person’s illness is recorded in the health information system.
 

The benefit for temporary incapacity for work is calculated on the basis of income taxed with social tax. The payable benefit is calculated based on the social tax for the previous calendar year, the data for which is available to the Health Insurance Fund from the Tax and Customs Board.

In accordance with subsection 55 (1) of the Health Insurance Act, when calculating the benefit for incapacity for work, doctoral student benefits, the parental benefit, and other benefits paid by the rural municipality, city, or artistic association and the social tax paid on them are not taken into account.

To obtain the amount of the benefit, the rate of the benefit is calculated from the employee’s average earnings per calendar day and multiplied by the number of days to be reimbursed. Income tax is withheld from the benefit.

The procedure for paying the benefit for temporary incapacity for work depends on the type of certificate for incapacity for work and the reason for it. For more details on the procedures for awarding and paying the benefit, see the page on benefits.
 

If there was no income subject to social tax in the previous calendar year, the benefit is calculated on the basis of the salary agreed with the person concerned and the minimum wage. More information on this can be found on the website of the Health Insurance Fund.

The Health Insurance Fund pays the benefit for temporary incapacity for work within 30 calendar days of the date on which the employer of the insured person has made the correct entries on the electronic certificate of incapacity for work or on which the additional paper documents have been received by the Health Insurance Fund.

The employer must pay the sickness benefit on pay day, but no later than 30 calendar days after the doctor has closed the sick leave, duly completed in the state portal eesti.ee.

Yes, it can. It is possible to change the name and bank account details of the beneficiary

• via the service ‘Account number and personal data in the Health Insurance Fund’ on the state portal eesti.ee;
• by sending a digitally signed application to info [at] tervisekassa.ee.
   

The certificate of incapacity for work and subsequent certificates that were issued during the period of employment are paid by the Health Insurance Fund, even if the employment relationship ends in the meantime.

Submit the paper certificate from the foreign doctor to your employer, who will forward it to the Health Insurance Fund together with the necessary supporting documents. If you need incapacity for work for a longer period than the end date specified on the foreign doctor’s certificate, contact your family physician within five days after the end date stated on the certificate. Your family physician will be able to issue you with a medical certificate after the certificate issued by the foreign doctor has been entered by the Health Insurance Fund as the primary medical certificate in the database of the Health Insurance Fund.

For an insurance company in another EU Member State to pay sickness benefits to a person who has received treatment in Estonia, the doctor must complete the document ‘Medical report’.

The doctor has to print out the document, sign it, and give it to the person. The person applies to their employer or the institution paying the benefits in their state of insurance with this document.

It is also allowed for the person to forward the original document together with the application (‘Application for the benefit for incapacity for work in an EU Member State’ at tervisekassa.ee/partner/avaldused-partnerile) to the Health Insurance Fund and for the Health Insurance Fund to forward it to the foreign insurance institution.
 

To settle labour disputes, you should contact the Labour Inspectorate. You can also turn to a court.

The Health Insurance Fund will reimburse the difference between the pregnant person’s salary and the salary before the transfer to lighter work. For more details, see this link.

Starting from the second day of the certificate for sick leave, the Health Insurance Fund pays a benefit of 70% of the average salary before the start of the initial certificate for sick leave.

 n the case of lighter work, the Health Insurance Fund will compensate the difference in average salary compared to the salary before the transfer to lighter work.

If other employers cannot offer lighter work, the pregnant person is released from work with these employers. In such cases, the Health Insurance Fund will then pay a benefit of the certificate for sick leave at 70% of the average salary paid by the employer before the initial certificate for sick leave started.

The benefits are added together and paid as a lump sum.
 

The Health Insurance Fund compensates for the difference in salary compared to the average salary before transferring to a lighter job.
 

In the case of an adapted job, the Health Insurance Fund will compensate the difference in pay compared to the average pay before the adaptation.

If the other employer cannot provide adapted work, the person will continue to be on sick leave there. The Health Insurance Fund pays a benefit of 70% of the avergage salary.

The employer provides the data.

Health insurance benefits are added together and paid out as a lump sum.
 

No. The law does not provide such a possibility.

The health care provider:

1. checks the validity of the insurance cover and the amount of the balance of the assumed payment obligation for the calendar year before transmitting the data via X-tee
2. only lists the services for which the Health Insurance Fund pays on the invoice sent to the Health Insurance Fund
3. submits the invoice on the day of service provision via the X-tee data exchange layer for information systems
4. ensures that the medical invoice number combination is unique for at least three calendar years
5. can view the summary invoices and their contents using their software
6. can check the dental care benefit limit, transmit data on reimbursable services, and monitor summary information on submitted invoices by using the freeware Misp portal to transmit data on reimbursable dental care services

The Health Insurance Fund:

1. settles the invoices for correctly submitted adult dental care services no less than once a week
2. makes payments on the basis of a summary invoice to the health care provider to the bank account indicated in the contract (at a credit institution in the Republic of Estonia) within 20 calendar days at the latest

We ask the health care provider to make sure that the information on the invoice is correct and in accordance with the terms and conditions of the service before submitting the invoice.
 

Amendments to incorrectly submitted invoices will only be made on the basis of a written application by the health care provider. Please send the digitally signed application by email to info [at] tervisekassa.ee.

An application for the cancellation/crediting of an invoice must include:

• the details (name, address, registration number) of the institution that submitted the invoice;
• the name and personal identification code of the person;
• invoice number;
• date of the invoice;
• the reason for the cancellation;
• the amount to be reimbursed by the Health Insurance Fund;
• a reference to the summary invoice (if the invoice was part of a summary invoice);
• confirmation that the health care provider has informed the person of the cancellation.

Application form to be submitted to the Health Insurance Fund: application for cancellation/crediting (in Estonian).

After the cancellation/crediting of the invoice by the Health Insurance Fund, the Health Insurance Fund will inform the health care provider of the possibility to submit a new invoice.
 

Contracted service providers should know the following aspects.

1. The exchange of information for and paying of the in-kind benefit is done electronically through the software used by dental care providers.
2. Before providing a service to a person, the service provider can verify whether the person has health insurance, as well as check the limit of the benefit (60 or 105 euros) and the balance of the benefit in the Health Insurance Fund system.
3. Some necessary services provided to patients are reimbursed by the Health Insurance Fund, some are not.
4. After the services have been provided, the provider submits the invoice electronically to the Health Insurance Fund via its software (the provider must be authenticated to X-tee using an ID card or similar (secure server)). If the visit includes both services reimbursed by the Health Insurance Fund and services that are fully paid, the invoice submitted to the Health Insurance Fund must include all the services for which the Health Insurance Fund will pay, indicating the full cost of each service.
5. If the benefit limit was not checked before the provision of the service, it will be checked during the payment process. The system will then display the amount paid for the person, taking into account the limit and the prices of the services in the price list of the Health Insurance Fund, as well as the number of services.
6. The invoice is then submitted to the Health Insurance Fund and the person pays the difference between the total amount of the invoice and the amount paid by the Health Insurance Fund.
7. The Health Insurance Fund will pay the service provider on the basis of the invoice submitted by the service provider and up to the amount of the reimbursable amount shown on the invoice.
    

All insured adults are entitled to up to 60 euros per year in dental care benefit (with a 50% co-payment).

A benefit of up to 105 euros per year (with a 12.5% co-payment) is available for pregnant people and mothers of children under one year of age, old-age pensioners, pensioners receiving a pension for incapacity for work, persons with partial or no work ability, persons over the age of 63, patients with an increased need for dental care, people registered as unemployed with the Unemployment Insurance Fund, and recipients of subsistence benefits who have received such benefits during the two calendar months prior to the month of receiving dental care.

The dental care benefit is an in-kind benefit, meaning the invoice is settled electronically between the dental care provider and the Health Insurance Fund.

If the service is eligible for the benefit, the reimbursable amount will be deducted from the invoice at the time of payment, and no separate reimbursement is made by the Health Insurance Fund.

The benefit applies to essential dental care services. For services that are not included in the list of reimbursable services, the full price according to the clinic's price list must be paid.

The dental care benefit can be used at dental clinics that have a contract with the Health Insurance Fund.

If the invoice is 50 euros, the person pays 50% as a co-payment – i.e., 25 euros – and the Health Insurance Fund reimburses the remaining 25 euros (50%).

As the annual benefit limit is 60 euros, the person would still have 35 euros left to use during the same calendar year.

The dental care benefit must be used within a single calendar year. Any unused amount does not carry over to the next year. When the new year begins, the benefit calculation starts anew.

A digital prescription can be used to issue a medicinal product once, twice, three times, or six times. The prescriptions are valid for 60 days, for 120 days, for 180 days, and for 540 days, respectively, unless a shorter period is indicated on the prescription. A prescription for a narcotic medicinal product is valid for 30 days, unless a shorter period is indicated on the prescription.

Medical professionals are obliged to issue prescriptions electronically. A paper prescription may be issued in exceptional circumstances: if the prescription centre cannot be used for objective reasons or if the patient needs a prescription to obtain cross-border health services in another EU Member State within the meaning of the Health Services Organisation Act. Paper prescriptions remain valid – they are used concurrently with digital prescriptions.

You can buy the medicinal product as soon as the digital prescription has been issued and approved by your doctor.

You can buy the medicinal product from a pharmacy as soon as the digital prescription has been issued and approved by your doctor. The buyer also needs to present an identity document. The pharmacist will find the right prescription in the prescription centre using the personal identification code of the person.

If the prescription is a public or authorised one, the person buying the medicinal product for someone else will have to specify the personal identification code of the patient and present their own identity document. In the case of multiple prescriptions, the buyer should also know the name of the medicinal product, the date of prescription, and the name of the doctor or their speciality.

A digital prescription can be used to buy the medicinal product only once. It is possible to buy a smaller quantity than the one specified on the prescription. The same prescription cannot be used again later. The doctor will have to issue a new prescription.

You can view all your digital prescriptions on the state portal eesti.ee and the health portal terviseportaal.ee. You can also see whether the medicinal product has already been purchased or not. If you do not have access to the internet or do not own an ID card, you can also get prescription information from your family physician or pharmacist.

You can find information about digital prescriptions for your minor child on the health portal terviseportaal.ee. To do this, the parent must log in to the portal with their ID card, click on ‘Switch roles’ on the homepage, and select their child from the list. It is then possible to view the health data of the child, including their digital prescriptions.

To view their child’s prescriptions from the state portal eesti.ee, the parent must log in to the state portal with the child’s ID card.
 

Physicians and pharmacists have access to the prescriptions that have been issued. The person can check who has looked at their data and when on the state portal www.eesti.ee.

If necessary, a physician can cancel a prescription that they or other physicians have prescribed.

The prescription benefit rate is calculated in the prescription centre and if a mistake has been made in calculating the benefit rate, you should contact the Health Insurance Fund and submit a signed application with the purchase receipt for the medicinal product. If the prescription centre has made a mistake to the detriment of the person, the Health Insurance Fund will compensate the damage incurred to the extent provided by law.

A paper prescription can be issued in exceptional circumstances, such as home visits or during power cuts, or if it is not practical to issue a digital prescription.

Purchasing medicinal products in other European countries (that have joined the service) with a digital prescription issued in Estonia became possible in 2020. The countries which have joined the service can be found here: www.tehik.ee/en/cross-border-data-exchange. More countries will join the service gradually based on their possibilities. When buying the prescribed medicinal product, a person only needs to present their ID card or passport.

The medicinal product reimbursement process is the same as for paper prescriptions. While abroad, a person insured in Estonia must first pay the full price for the medicinal product prescribed to them in Estonia. Afterwards, they can reclaim the amount paid for the medicinal product from the Estonian Health Insurance Fund on the basis of an application for reimbursement and the receipt for the purchase of the medicinal product. For prescriptions issued in Estonia, the medicinal product is reimbursed on the basis of the terms and conditions and the reference price valid in Estonia, and therefore, the medicinal product is reimbursed retrospectively.

The Health Insurance Fund reimburses the prices based on the terms and conditions and price limits of the list of medicinal products of the Health Insurance Fund and not on the basis of the price list valid in the respective foreign country.
 

To renew your prescription, please contact your physician. Only repeat prescriptions can be renewed by telephone or email, i.e. if a person with a chronic disease or a person requiring long-term treatment has already been prescribed the medicinal product.

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).
 

Three companies offer digital service platforms that meet the requirements of the Health Insurance Fund: (1) Certific OÜ – www.perearst24.ee; (2) Terviseagentuur OÜ – www.minudoc.ee/Eelvisiit; (3) and Industry62 OÜ – www.eperearstikeskus.ee. Contact them, familiarise yourself with their products, choose the most suitable one for your family medicine centre, sign a contract, and start using it.

The contract is concluded between the family medicine centre and the company. The Health Insurance Fund does not enter into contracts with any party.

The companies providing digital service platforms provide information on the family physicians who use their product to the Health Insurance Fund on a monthly basis. Based on this information, the Health Insurance Fund makes the payments. The family medicine centre does not have to separately notify the Health Insurance Fund of the conclusion of the contract.

The purpose of the requirements is to ensure consistency and reliability among the digital platforms in use. The aim of the Health Insurance Fund is to ensure that the products in use are safe and user-friendly. The service provision contract is concluded between the health care provider and the service provider, and the Health Insurance Fund does not intervene in this process. Contractual obligations are assumed voluntarily by both parties, which means that the contract must be acceptable to both parties. Therefore, if family physicians see a need to implement additional requirements, such as E-ITS, then they have the right to ask the companies to do so.

The requirements set and audited for the digital service platforms for family physicians are not related to E-ITS or ISO/IEC 27001. E-ITS/ISO regulates the work processes of the service provider as a whole and is not regulated by the requirements of the Health Insurance Fund. The compliance assessment of the digital service platforms is primarily based on the software developed by the companies, not on their overall information security compliance with any specific information security standard. The companies must have implemented the relevant information security standard and undergone an audit. The result of the audit will prove whether the company complies with the standard or not. This responsibility lies with the company
 

No, because this is not a classic audit that validates compliance with a standard (such as E-ITS or ISO 27001). Instead, it is a verification of compliance with the requirements established by the Health Insurance Fund with the help of an external partner who has the relevant competencies to assess them. The audit result is a prerequisite for receiving funding from the Health Insurance Fund.

The retention periods for logs depend primarily on the laws, regulations, and agreements (e.g. contracts) applicable to the institution. In some cases, it may be one year, in other cases, five years. Activity logs are generally retained for a minimum of one year. Data processing (content of data processing, details of the data processor, date and time of data processing) is logged in the information system of the health care provider. The information system logs of the health care provider are retained for five years. The provision is necessary to ensure the lawfulness of data processing. The prescribed retention period is based on the Law of Obligations Act.

With the e-consultation service, a family physician can consult a medical specialist via the Health Information System to clarify the diagnosis and prescribe treatment. The family physician consults the medical specialist and prepares the appropriate digital referral for the e-consultation. The family physician sends the referral to the e-consultation provider of their choice via the Health Information System. The medical specialist examines the referral, makes a decision, draws up a proper response to the referral, and sends it to the family physician via the information system. The response must be drawn up within four working days of sending the e-consultation referral to the Health Information System. The family physician then decides on the next steps based on the response.

Funding for e-consultations and referral and response requirements have been agreed for the following specialities (links in Estonian):

1. allergology-immunology
2. endocrinology
3. gastroenterology
4. haematology
5. cardiology
6. neurology
7. oncology
8. orthopaedics
9. otorhinolaryngology
10. paediatrics
11. pulmonology
12. rheumatology
13. urology
14. nephrology
15. psychiatry
16. internal medicine
17. gynaecology
18. vascular surgery
19. pain management
20. rehabilitation
21. dermatovenerology
22. child psychiatry
23. andrology
24. general surgery
25. infectionist
26. medical genetics
27. neurosurgery
28. maxillofacial surgery
29. paediatric surgery

Once the resources have been updated in the software of the family physician, the e-consultation providers in the selected speciality will be displayed. To do this, the family physician needs to update the resources at the start of each working day.

When interfacing with the service, we recommend that you choose the software that enables the e-consultation service and contact its manufacturer.

Once a family physician has decided that a person needs an e-consultation, they must assess whether the person meets the conditions for referral to an e-consultation. Descriptions of the conditions can be found here (in Estonian): ‘Procedure for the assumption of the obligation to pay a fee by the Estonian Health Insurance Fund’.

Annexes 19–23, 27–29, 31–38, 40, 42–45, 47, 50, and 52–57.

The e-consultation referral must be completed thoroughly enough to give the medical specialist a complete picture of the health concerns of the person. The reason for the referral and the purpose of the e-consultation request should be clearly described. Information about irrelevant examinations, etc. should be avoided.

The Health Insurance Fund will pay the family physician ONLY for duly provided e-consultations. In all cases, the medical specialist must prepare a response to the referral and send it to the Health Information System within four working days. No fee is charged for e-consultations that do not receive a response.

Currently, the family physician has to request answers one by one from the medical history of the person. Unfortunately, there is no automatic query that would display all the latest responses yet.

Depending on the health problem, the family physician can select the speciality and the INSTITUTION they are requesting consultation from. It is not possible to choose a specific medical specialist by name.

If the family physician decides that they need a second opinion from a medical specialist, they will write a referral for an e-consultation. If the medical specialist decides that the person needs to be invited to an appointment, the medical specialist will contact the person to arrange an appointment and book a suitable time. The family physician must make sure that the contact details of the person in the system are correct. The family physician will then inform the person (or, if necessary, their guardian or family members) that they may be contacted within the next four working days to arrange an appointment with a medical specialist.

The Health Insurance Fund finances the service from its operational fund. The medical specialist will invoice the family physician for the e-consultation service. The family physician then submits the invoice to the Health Insurance Fund to pay for the service. The Health Insurance Fund will pay the family physician for duly provided e-consultations.

You can get more information from your Health Insurance Fund administrator or from the websites of the Health Insurance Fund and the health care provider.

Patients can see the referrals for e-consultations in the health portal under ‘Valid referrals’ and the responses under ‘Responses to referrals’.

To switch family physicians, you must submit an application to the new family physician. The application is available here (in Estonian). Some centres also offer the option of submitting the application on their own website.

 The completed application must be delivered or digitally signed and sent to the new family physician.

The family physician will inform the patient of their inclusion on the practice list or refusal to do so within seven working days of submitting the application. In case of refusal, the reason must also be stated.

The family physician may refuse to include the patient on their practise list if their list has exceeded the limit set for them (2,000 or 2,400 people) or if the residential address of the patient in the population register is not within the service area of ​​that family physician.

The family physician may include the patient on their practise list, regardless of the list size limit and the number of people included on the list, if:

1. the residential address of the patient in the population register indicated in the application is within the service area of the family physician or

2. a family member of the patient is included on their practise list. The family physician may decide to not include the patient (even if a family member of the patient is included on the practise list) on their practise list if the list limit has been reached and the residential address in the population register is not located within the service area of the family physician.

Information about the service areas of family physicians can be found on the website of the Health Board.

Patients have the right to choose their family physician. Therefore, if the patient is happy with their family physician, they do not have to find a new one in another city. However, a family physician from Tallinn cannot come to Tartu for a home visit if the need arises, and it may also be difficult for the patient to see their family physician when they have been issued a certificate of incapacity for work, so we recommend choosing a family physician close to home.

The family physician issues a referral based on speciality; a specific medical institution is not specified. The contract partners of the Health Insurance Fund help all insured patients, regardless of their residential address.

E-consultation referrals, however, are made based on the medical institution. In this case, the family physician will ask the patient about the suitability of the medical institution in terms of location so that the patient can go to a specific institution for the appointment.

A digital referral has a validity period during which it is possible to book an appointment. The appointment can also take place later (after the referral has expired), i.e. if the patient has booked an appointment based on a valid digital referral, the referral no longer needs to be valid on the day of the appointment. The default validity period in family physician programs is six months, but the person who issues the referral can change it if necessary. You can view your valid referrals and book appointments in the Health Portal. You can go to any contractual partner of the Health Insurance Fund throughout Estonia for an appointment.

Family physicians can issue a certificate for sick leave after examining the patient and identifying the illness. They can issue a certificate for work leave starting on the weekend if the illness can be proven retrospectively – the illness has been documented at another medical institution or the patient has contacted the family physician counselling line.

A family physician is not required to serve a patient on the practise list of another family physician unless it is an emergency. However, there is no legal requirement that only your personal family physician on can issue the health certificate.

In this case, the family physician sets the price of the service, as the Health Insurance Fund does not pay for the health certificate. However, the family physician must publish a price list for paid services so that every patient can get acquainted with it. The components of the price of the service are determined by the family physician.

The system of the therapy fund changed on 1 July 2024. The therapy fund, through which family physicians have been able to refer their patients to a clinical psychologist, speech therapist, and physiotherapist, is now managed by the Health Insurance Fund.

Family physicians used to be able to refer a patient to any clinical psychologist, speech therapist, or physiotherapist, and depending on the service provider, the Health Insurance Fund paid for the service either in part or in full. As of July, family physicians or doctors providing treatment can only refer people to a service provider who is a partner of the Health Insurance Fund.

The change will eliminate co-payments for patients and create a fixed list of providers who offer services funded by the Health Insurance Fund. 
 

All treatments or therapies for which a patient has an appointment booked or where their treatment is in progress as at 1 July 2024 will be completed and covered through the previous funds until the end of September 2025.

If the patient is unable to go to their appointment before the end of September and the service provider does not have a valid contract with the Health Insurance Fund as of 1 July, they must pay for the service themselves or contact their doctor again, who will assess the medical need and, if necessary, issue a new referral to see a suitable service provider.

The main goal of the change is to create clarity about which institutions provide what services that are covered by the Health Insurance Fund.

The main advantage for patients is that the service becomes more affordable as the contractual partner may not ask the patient for a co-payment for a service reimbursed by the Health Insurance Fund. The service provider does, however, have the right to charge the patient a visit fee.

The therapy fund system will become clearer because there will be a list of service providers, or contractual partners of the Health Insurance Fund, so the family physician or patient will not have to search for the service provider with the help of Google, for example.It also provided an opportunity to significantly free up the schedules of family physicians, 

who previously had to be responsible for invoices, documentation, and encrypted data exchange for patients referred to the service within the framework of the therapy fund.
 

The contacts, locations, and services offered by current partners can be found on the website of the Health Insurance Fund (in Estonian).

As at September 2024, the Health Insurance Fund has a total of 108 contractual partners for the provision of independent physiotherapy in 100 locations across Estonia, for the provision of speech therapy services in 46 locations, and for the provision of psychology services in 42 locations.

The number of partners is growing, as new service providers will be added to the list at the beginning of 2025, which should also ensure better availability of the service.
 

Women have the right to book a screening appointment at any medical institution, regardless of where they live. When registering for a screening, the medical institution will check your year of birth and the validity of your health insurance. Be sure to bring an identification document.

This usually happens because the reception desk is very busy or there are disruptions in communication lines. We recommend trying again in a few days. You can also try calling the medical institution at its general telephone number, but you can also notify the Health Insurance Fund.

It is not necessary to notify the Health Insurance Fund, but you must definitely notify the population register, because the addresses of women invited for screening tests are taken from the population register. Pursuant to section 391 of the Population Register Act, a person must ensure that their residential address is correct in the population register. The population register must be notified if you move to a new address, as well as if the register contains incorrect data or no data at all.

You can check the accuracy of your residence data on the state portal using the e-services of the population register by selecting the tab for citizens and entering the portal using either an ID card or Mobile-ID.

To enter or change your residence data in the register, you must submit a notice of residence to the rural municipality or city government of your place of residence. You can do this by visiting the local government, sending it by mail or email with a digital signature, or using the population register e-services on the state portal. The notice of residence can also be submitted with a digital signature. Additional information about registering your place of residence can be found on the website of the Ministry of the Interior. Correcting your address over the phone is not possible because the caller cannot be identified over the phone.

If a woman is on the list (this can be checked by calling the Health Insurance Fund at 16363), but has not received the invitation due to a change of residential address or for another reason, if she has lost the invitation, or if the invitation has been damaged, she can also register for the screening test and participate in the study based on an identity document. A repeat invitation will be sent to women who did not participate in the study, using the addresses in the population register. We definitely recommend correcting your data in the population register.

If the registration deadline specified in the invitation (recommended within one month) has passed, but you have not yet registered for the screening test, you can still register throughout the calendar year using an identity document. The Health Insurance Fund will also send a repeat invitation to participate in the study to women who did not participate in the study in November or December of the study year. The repeat invitation will be sent to the address in the population register.

All medical institutions listed on the invitation have a contract to provide preventive tests to women with health insurance. In these cases, the invoice for the test should be submitted to the Health Insurance Fund and you do not have to pay for the test yourself. If you have been charged for a breast or a cervical cancer screening test, please notify the Health Insurance Fund (info [at] tervisekassa.ee (info[at]tervisekassa[dot]ee)). In such cases, be sure you have a receipt proving payment for the service.

The patient will receive the results of a breast cancer screening test in writing within two weeks from the medical institution that performed the test. The method of sending the test results (by mail or email and to which address) is agreed upon between the medical institution and the patient after the test. The test result does not contain sensitive personal data, it only contains information about whether the woman needs further testing or not.

The method of receiving the results of a PAP test will also be agreed upon after the test. Usually, the patient calls at a specific time and on a specific phone number. The test result does not contain sensitive personal data, it only contains information about whether or not the woman needs further testing or when it is recommended to have the next PAP test.

If a screening invitation is sent to your address for a woman who does not live there, we ask that you return the invitation to the Health Insurance Fund, if possible, with a note that the person does not live at that address. The Health Insurance Fund can forward the invitation to them at another address with a recommendation to check their data in the population register and update it if necessary.

The Health Insurance Fund bases its preventive activities on proven medical effectiveness. The incidence of breast cancer is highest among women aged 50–64. This also applies to Estonia, with the peak of incidence being in the 50s and 60s. Mammography is an X-ray examination of the breast, which is used both as a screening method and in clinical diagnostics. The sensitivity of mammography (the likelihood that the test will detect the disease) is higher in women aged 50 and older and lower in women under 50, who typically have denser breast tissue. Breasts are denser before menopause, as well as in women on hormone replacement therapy and in women with a lower body mass index. Mammograms for healthy women aged 40–49 are not more effective in reducing mortality than self-examination or clinical examination. Additionally, the negative aspects of screening can cause harm to health instead of benefit (radiation, psychological stress, unclear test results, invasive additional tests, etc.). Breast examination in healthy women before the age of 40 is not medically justified. In case of problems, women have the option of going for an examination with a referral from their family physician or medical specialist.

If a woman does not have a medical indication for a breast examination (either belonging to a risk group or complaints), payment for the examination by the Health Insurance Fund is not justified (subsection 29 (1) of the Health Insurance Act). A healthy woman can have the examination if she wishes, paying for it herself. The price of paid health care services is set by the medical institution.

Yes – many gynaecologists perform PAP tests outside of screening. You have to book an appointment with your gynaecologist. You can get an appointment much faster with a trained midwife. The Health Insurance Fund will only pay for the screening (PAP test) at those institutions who have a contract with the Health Insurance Fund. If you prefer to have your health checked in a private practice, you will have to pay for the tests performed there yourself. However, be sure to inform your gynaecologist during your visit that you received an invitation from the Health Insurance Fund to participate in the screening so that they will perform the PAP test.

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.

A medicinal product consists of the active substance(s) and excipients. The active substance treats or alleviates the disease, while excipients are necessary in the medicinal product to enable the active substance to be administered in the desired form (e.g. tablet, ointment, aerosol). As it is the active substance that affects the body, the adverse reactions of a medicinal product are also caused by the active substance. Excipients do not cause adverse reactions, except in very exceptional cases where a person is hypersensitive to a particular excipient (lactose, nut oils, various sugars). As a rule, manufacturers of both the originator and generic medicinal products use the same or similar excipients. Excipients authorised for use in the formulation of medicinal products must be of high quality and must be shown to be safe for the intended route of administration. An excipient authorised in a medicinal product must not adversely affect the properties of the medicinal product.

A generic medicinal product (alternatively also known as an analogue medicinal product) is a medicinal product that contains the same active substance as the originator medicinal product and is meant for the treatment of the same diseases. A generic medicinal product is as effective and safe as the originator medicinal product, and of the same quality. Generic medicinal products are placed on the market after the patent protection of the originator medicinal product expires. This means that a medicinal product with the same active ingredient can also be produced by other manufacturers. The manufacturer of a generic medicinal product has to demonstrate that the medicinal product contains the same active substance in exactly the same amount as the originator medicinal product and has an identical effect on the organism as the originator medicinal product. The latter is demonstrated using bioequivalence studies, i.e. studies carried out to determine whether the same amount of the active substance is taken up by the organism from both the originator and the generic medicinal product, and whether the concentration of the active substance in the organism changes in an identical manner over time in both cases.

Bioequivalent medicinal products provide an identical concentration of the active substance in the organism as the originator medicinal products when administered in identical doses. The manufacturer of the generic medicinal product also has to demonstrate that the manufacturing process of the medicinal product meets the established criteria.

Given that it is produced by another pharmaceutical manufacturer, the appearance of the medicinal product is not required to be identical to the original medicinal product. The generic medicinal product may thus differ from the originator medicinal product in terms of excipients and appearance, but must be identical to the originator in terms of efficacy, quality, and safety.

Estonian pharmacies only sell medicinal products that have passed the strict control of the Estonian State Agency of Medicines.

When the patent period of the originator medicinal product expires, other pharmaceutical companies will start producing a medicinal product with the same active substance, and the price of the medicinal product will be determined by competition between pharmaceutical companies. However, the manufacturer of the originator medicinal product can recoup the money spent on developing the medicinal product during the validity of the patent and thus maintain interest in further development. It may happen that, after the end of the patent period, the manufacturer of the medicinal product lowers the price of the medicinal product to the same level as those of generic medicinal products.

In the pharmaceutical world, more expensive does not always mean better when it comes to the quality of medicinal products containing the same active substance. Generic medicinal products are of the same quality, efficacy, and safety as originator medicinal products, so it makes economic sense to choose the cheapest products. In Estonia, a pharmacist is obliged to offer the person the most favourable alternative in the case of equal choices, provided that the doctor has not ordered the person to buy the medicinal product from a specific manufacturer. If the doctor has written the active substance on the prescription (an ‘active substance based-prescription’), the person can choose the medicinal product that best suits their needs from a range of equivalent alternatives. There is no medical reason to prefer a more expensive medicinal product.

No. In the pharmaceutical world, more expensive does not always mean better when it comes to the quality of medicinal products containing the same active substance. Generic medicinal products are of the same quality, efficacy, and safety as originator medicinal products. Preference for or exclusion of a particular manufacturer for medical reasons is rare (e.g. hypersensitivity to a particular excipient, see also question 1). People usually prefer a particular manufacturer due to psychological reasons or the marketing strategies of that manufacturer.

There is no reason to assume that pregnant people should use originator medicinal products instead of generic medicinal products. The choice of medicinal products should be based on the active substance (whether the pregnant person is indicated to use one active substance or another), rather than on the basis of a specific manufacturer.

No, definitely not. The dosage of a medicinal product is determined independently of whether it is a generic or originator medicinal product. Generic medicinal products are of the same quality, efficacy, and safety as originator medicinal products. The dose of the medicinal product is determined by the disease, the active substance used, and the patient. In addition to the doctor and pharmacist, the patient can also get information on the dosage of a particular medicinal product from the patient information leaflet.

Yes. In medical terms, a generic medicinal product is exactly the same as the originator medicinal product. Generic medicinal products are of the same quality, efficacy, and safety as originator medicinal products, so there is no need to change the dose of the medicinal product or the treatment regimen if you have switched from one medicinal product to another containing the same active substance.

Regardless of whether the person buys a generic or an originator medicinal product, the reimbursement rate of the Health Insurance Fund (50%, 75%, 90%, or 100%) remains the same. As Estonia has a limit price system for medicinal products containing the same active substance, the choice of medicinal product only affects the co-payment a person has to pay.

For example, if a pharmacy has a selection of medicinal products with the same active substance at a price of 6.39 euros, 9.59 euros, 11.19 euros, and 12.78 euros, then the limit price will generally be the price of the second most affordable medicinal product (9.59 euros in this example) and the benefit percentage of the Health Insurance Fund will be calculated from this amount. If the person prefers a more expensive medicinal product, in addition to the co-payment (3.5 euros), they will also have to pay the excess amount in terms of the price limit. It is therefore worth asking your pharmacist for advice on which medicinal product with the same active substance is cheaper.

The price the person has to pay depends on which medicinal product they buy.

For example, with a 75% benefit, the person pays:

• 4.22 euros for the purchase of a medicinal product costing 6.39 euros (3.5-euro co-payment for each prescription + 0.72 euros, i.e. 25% of 2.89 euros*).
• 5.02 euros for the purchase of a medicinal product costing 9.59 euros (3.5-euro co-payment for each prescription + 1.52 euros, i.e. 25% of 6.09 euros*).
• 6.62 euros for the purchase of a medicinal product costing 11.19 euros (3.5-euro co-payment for each prescription + 1.52 euros, i.e. 25% of 6.09 euros** + 1.6 euros (amount exceeding the price limit)).
• 8.21 euros for the purchase of a medicinal product costing 12.78 euros (3.5-euro co-payment for each prescription + 1.52 euros, i.e. 25% of 6.09 euros** + 3.19 euros (amount exceeding the price limit)).

100% benefit – the person pays a co-payment of 3.5 euros and the amount exceeding the price limit or the price in the price agreement. The Health Insurance Fund will reimburse 100% of the difference between the price limit or the price agreement and the co-payment.

• Example 1:

the person was given a reimbursable prescription for a medicinal product which costs 10 euros. The price limit of the active substance is set at 8 euros. The discounted price for the person consists of:

- the person’s co-payment: 3.5 euros

- the amount exceeding the price limit: 10 euros – 8 euros = 2 euros

- the Health Insurance Fund reimburses 100% of the difference between the price limit or the price agreement and the co-payment.

The person has to pay 3.5 euros + 2 euros = 5.5 euros for the medicinal product.

90% benefit – the person pays a co-payment of 3.5 euros, 10% of the difference between the price limit or the price agreement and the co-payment, and the amount exceeding the price limit or the price agreement. The Health Insurance Fund will reimburse 90% of the difference between the price limit or the price agreement and the co-payment.

• Example 2:

the person was given a reimbursable prescription for two medicinal products which cost 10 euros. The price limit of the active substance is set at 8 euros.

The discounted price for the person consists of:

- the person’s co-payment: 3.5 euros

- the amount exceeding the price limit: 10 euros – 8 euros = 2 euros, 2 euros × 2 products = 4 euros

- the Health Insurance Fund reimburses 90% of the difference between the price limit or the price agreement and the co-payment, so the person’s share (10%) is (8 euros × 2 products – 3.5 euros) × 10% = 1.25 euros

The person has to pay 3.5+ 4 euros + 1.25 euros = 8.75 euros for the medicinal products.

75% benefit – the person pays a co-payment of 3.5 euros, 25% of the difference between the price limit or the price agreement and the co-payment, and the amount exceeding the price limit or the price agreement. The Health Insurance Fund will reimburse 75% of the difference between the price limit or the price agreement and the co-payment.

• Example 3:

the person was given a reimbursable prescription for a medicinal product which costs 10 euros. The price limit of the active substance is set at 8 euros. The discounted price for the person consists of:

- the person’s co-payment: 3.5 euros

- the amount exceeding the price limit: 10 euros – 8 euros = 2 euros

- the Health Insurance Fund reimburses 75% of the difference between the price limit or the price agreement and the co-payment, so the person’s share (25%) is (8 euros – 3.5 euros) × 25% = 1.13 euros.

The person has to pay 3.5 euros + 2 euros + 1.12 euros = 6.63 euros for the medicinal product.

50% benefit – the person pays a co-payment of 3.5 euros, 50% of the difference between the price limit or the price agreement and the co-payment, and the amount exceeding the price limit or the price agreement. The Health Insurance Fund will reimburse 50% of the difference between the price limit or the price agreement and the co-payment.

• Example 4:

the person was given a reimbursable prescription for a medicinal product which costs 40 euros. The price limit of the active substance is set at 35 euros. The discounted price for the person consists of:

- the person’s co-payment: 3.5 euros

- the amount exceeding the price limit: 40 euros – 35 euros = 5 euros

- the Health Insurance Fund reimburses 50% of the difference between the price limit or the price agreement and the co-payment, so the person’s share (50%) is (35 euros – 3.5 euros) × 50% = 15.75 euros.

Yes, people who do not have health insurance have to pay the full price of the prescribed medicinal products.

For the exceptional reimbursement of medicinal products, the insured person or their legal representative must submit a free-form application to the Health Insurance Fund, which must contain the following information about the applicant:

1. First and last name.

2. Personal identification code.

3. Contact information (residential address, phone number, email residential address).

The application must be accompanied by the justification from the doctor. These documents must be submitted to the Health Insurance Fund by email (info [at] tervisekassa.ee (info[at]tervisekassa[dot]ee)), by post, or by submitting them in person.

The decision on exceptional compensation is taken by the management of the Health Insurance Fund. An extract from the decision will be sent to the patient and their doctor. The person can buy the medicinal product from a pharmacy on the basis of a prescription written by the doctor after a positive decision by the board of the Health Insurance Fund to exceptionally reimburse the medicinal product.

Yes. If the patient has no contraindications to childbirth, the benefit rate for the pills is 50%.

If an insured person has bought more than 100 euros’ worth of medicinal products (with the benefit) in a year, they will receive an supplementary benefit for medicinal products. The supplementary benefit will be applied automatically, meaning that the person does not have to submit an application to the Health Insurance Fund.

If a person has bought medicinal products (with the benefit):

- for 100–300 euros per year, the Health Insurance Fund will reimburse 50% of the amount exceeding 100 euros (maximum 100 euros per year).

- for more than 300 euros a year, the Health Insurance Fund will reimburse 90% of the amount exceeding 300 euros.

The Health Insurance Fund reimburses the cost of prescription medicinal products purchased in the European Union. First, you have to buy the medicinal product and then you can apply for a refund from the Health Insurance Fund. To do this, you must fill in the application (Application for reimbursement of the cost of healthcare in the European Union, in Estonian) on the website of the Health Insurance Fund and attach the original prescriptions and the receipts proving payment. The documents can be sent to the Health Insurance Fund by post or taken to its client service offices.

The Health Insurance Fund will make an inquiry in the foreign country and, based on the information received, transfer the amount to be reimbursed in euros to the bank account of the person.

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.

A visit fee is an additional fee charged from the insured person when providing a health service that is covered by the Health Insurance Fund. It is the right of the health care provider to charge a visit fee. Restrictions on charging visit fees are established in the Health Insurance Act.

You can find information about visit fees on the website of the Health Insurance Fund. Information about current visit fees must be available and visible to patients in every medical institution.

The Health Insurance Fund will not reimburse a paid visit to a specialist if an appointment is chosen outside the waiting list. In this case, the patient waives services funded by the Health Insurance Fund and pays the full amount for both the visit and their treatment to the medical institution themselves.

If a person does not have health insurance, they must pay for health services themselves. Each medical institution has established its own price list. Therefore, they should ask the specific medical institution for more information.

The availability of a family physician is considered the most important, which is why patients do not have to pay a visit fee when visiting a family physician. An appointment with a specialist is more expensive, and the visit fee has been set so that people do not go to a specialist unnecessarily, but instead start solving their health concerns with their family physician.

A family physician may not charge a visit fee, except in the case of home visits (up to 5 euros). Read more about the service fees applicable to the provision of health services on the website of the Health Insurance Fund.

No. The visit fee for one home visit may not exceed 5 euros, regardless of the number of insured persons per home visit.

If the family physician charged more than 5 euros, please provide the details of the physician and a receipt proving payment along with an application to the Health Insurance Fund.
 

The aim of the Health Insurance Fund is to improve the availability and quality of nursing care. Funding nursing services in general care homes also brings other health services closer to the person, as the nurse can monitor the health needs of the residents in a systematic way and address their health concerns in a more coordinated manner.

Residents of a general care home have the option of receiving nursing care on site. Nursing care in a care home is free of charge for the person, i.e. it will be paid for by the Health Insurance Fund.

The nurse assesses the health of the residents by monitoring vital signs such as body temperature, respiratory rate, blood pressure, and blood sugar. The nurse also performs urine and blood analyses and other necessary nursing procedures as needed. The nurse additionally helps to monitor and implement the treatment plan and the treatment procedures prescribed by the doctor. With the permission of the doctor, a nurse can independently treat a person with, for example, painkillers, administer medication, or remove sutures.

The nurse is also involved in counselling and disease prevention. For example, the nurse monitors for signs of mood disorders and dementia in care home residents.

The service is intended for people with mild or moderate health problems. This means that a nurse cannot solve serious 

health problems or treat a seriously ill person.The costs of care services, medicinal products, and technical aids are borne by the person or their relative.
 

There are several ways in which care homes can provide this service. A care home with a home nursing activity licence can employ a nurse and provide the service, or it can work in partnership with a family physician or a health centre that provides nursing care in the home. The care home may also work with a home nursing service provider to provide nursing services in the care home.

In order for nursing services to be provided by care homes, the licensed health care provider (care home or nurse) must submit an application to the Health Insurance Fund and enter into a contract for the provision of health services.
 

The provision of nursing care is an option for care homes, not an obligation. We added all care homes providing nursing services to the Health Insurance Fund’s map application (in Estonian) in early 2020. Select the ‘Nursing care’ (Õendusabi) view and from there, in the ‘B services’ (B teenused) filter, select ‘Nursing care in a nursing home’ (Õendusteenus hooldekodus).

Care homes must ensure that their residents have access to health services. Pursuant to the Social Welfare Act, a care home must ensure that a care plan is drawn up, including an assessment of health service needs.
 

The nursing service provided in a care home is provided by the contractual partner of the Health Insurance Fund, i.e. the health care provider, who is responsible for the quality of the service and compliance with the conditions set out in the contract.
 

If a care home resident is unable to independently visit a health care provider, it is the responsibility of the owner of the care home to provide the necessary services, including transport to the doctor.

The care home must provide the care procedures and other support services specified in the care plan.
If the person is unable to buy personal aids, their family has to provide them. Technical aids are reimbursed by the Social Insurance Board (e.g. rollator, sheets to prevent bedsores) and medical devices by the Health Insurance Fund (e.g. bandages, urinary catheters, orthoses, glucometer test strips and lancets, etc.).

The discount of the Social Insurance Board is available for the purchase of aids if the person has been issued with a technical aid certificate and a personal technical aid card. You can find more information on this on the website of the Social Insurance Board.

The Health Insurance Fund reimburses medical devices that are included in the list of medical devices and for which a digital medical device card has been issued by the treating doctor for the purchase under preferential conditions. For more information on the reimbursement of medical devices by the Health Insurance Fund, see the website of the Health Insurance Fund.
 

The costs of care services, medicinal products, and technical aids are borne by the person or their relative performing the maintenance obligation. Close family members of the care home resident need to familiarise themselves with how services are organised in the care home (care services, health services, counselling, information, transport, etc.).

They must also monitor the health and well-being of the care home resident and inform the care worker, nurse, or doctor of any health problems.

The nurse will inform and advise them as necessary.

There are several similarities in the provision of different nursing services. Nurses working in care homes deal with persons who have a low or moderate need for health services compared to persons in independent in-person nursing care. In a care home, the nurse monitors the health of the residents on a regular basis. The home nursing service is visit-based, and a family nurse only makes a home visit on the order of the family physician (e.g. to take a blood sample).

Home nursing services cannot be provided at that time.

The Health Insurance Fund has set a minimum for the provision of the service, i.e. that the service is provided on working days and during the day. The provision of nursing care at other times is agreed between the care home and the nursing care provider.

There are a variety of software programmes, and each nursing service provider can choose the one that suits them best.

Not all nursing activities performed are recorded under the capitation fee codes. Under the capitation fee codes, the most important activities with indicative content are grouped together to provide the Health Insurance Fund with input for the further development of the service.

The provision of nursing care in general care homes funded by the Health Insurance Fund is an option. We recommend implementing nursing services in a general care home as soon as possible.

Yes – if the care home and the nursing care provider enter into a cooperation agreement and the family nurse does not provide nursing care in the care home during the time they should be working at the family physician’s practice. Therefore, a full-time family nurse working in a family physician’s practice cannot provide nursing services in a care home at the same time.

No. A home nursing service provider needs an activity licence, but it is not linked to the place of establishment.

The care home must provide the care procedures and other support services and procedures specified in the care plan.

The care home and the home nursing service provider agree on how the work is organised.

If you become entitled to different dental care benefits during the calendar year, you will receive the benefit in the highest amount. For example, an insured adult who is also pregnant or the mother of a child under one year old is entitled to a benefit of 85 euros per calendar year.

All residents in the care home must be assessed using the assessment tool. A nursing plan must be drawn up for those residents for whom the assessment shows that health services are needed.

There is no fixed frequency: it is important to upload the final summary, but if it is a long case, intermediate summary should also be uploaded, in particular to keep the family physician informed about the health of their patient.

No. Only a doctor’s prescription/order/treatment regimen is required.

The nurse must be registered as a nurse/midwife with the National Register of Health Care Professionals of the Health Board.

The care home and the home nursing service provider agree on how the work is organised.

1. The nurse in the care home registers the death and draws up a death notice in the IT program, which is then transmitted to the Health Information System. The nurse will then notify the family physician by telephone (within 24 hours).
2. The family physician draws up a notice of cause of death and forwards it to the Health Information System.

3. After the cause of death has been established (by the family physician), a death certificate can be downloaded from the Health Information System and issued (by the care home) to the people close to the deceased so that they can take further action.

   Please note! More information on this can be found on the website of the Health and Welfare Information Systems Centre.