Healthcare in the EU and elsewhere
The required medical treatment while staying temporarily in another EU country
When planning a trip to another European Union Member States it makes sense to think in advance about what you need to know, and what to take with you to reduce costs, which may be associated with an unexpected health disorder.
The most important help that must be in the wallet is the European Health Insurance Card. On this basis, the people insured by the Estonian Health Insurance Fund can receive the medical treatment during a temporary stay in another Member State and receive treatment on equal terms with the insured people living in that country. For this, the need for health care has to be incurred during the stay in the other country, and the need for health care must be medically justified. Whether the medical care is needed, will be decided by the doctor.
The European Health Insurance Card gives the right to the necessary medical care during a stay within the European Union and the European Economic Area and Switzerland. The required medical care is not free – the patient's deductible expenses (visit, hospital charges, etc.) must be paid for according to the tariffs in the country of location.
Deductible expenses shall not be compensated for the patient. Also, the card does not cover the transport costs between countries. Therefore, we recommend on traveling to a foreign country also always take the travel insurance with the protection of the health risks. In the light of the above, the hospital should issue an invoice only for the deductible, which in turn can be submitted to the private insurance provider.
Also be sure to observe that for obtaining health care service, you turn to a state health care institution, and not to private doctors, since the EHIC is accepted only in the health care institutions belonging to the state system.
- More information about the european health insurance card can be found here.
The European Commission has created a manual for patient’s right to accessing healthcare in any EU/EEA country.
European Commission has created lists of frequently asked questions for good patient information on cross-border healthcare for incoming patients and outgoing patients.
More information about healthcare in European Union can be found on the European Commission's website.
Planned medical treatment abroad
Unlike the need for medical aid caused by an emergency need for treatment in a foreign country, planned treatment represents a situation where a person goes to another country in order seek treatment there. The application form is available on the website of the Health Insurance Fund, or in customer service offices. The first option is to apply for the permission of the Health Insurance Fund for covering the cost of treatment in a foreign medical institution (for the criteria of the permission see www.tervisekassa.ee). The reimbursement is made in accordance with the rates of the state that provided the treatment. The Health Insurance Fund makes an inquiry to the state where you were treated, and according to information received, shall transfer the reimbursable amount to your bank account.
In the case of a positive decision, the Health Insurance Fund will issue a document confirming the assumption of the payment of the fee and pay the medical costs incurred from abroad.
Another possibility to receive planned medical treatment abroad is Under the European Union Directive on the free movement of patients. This means that the patient who is holding a referral to a medical specialist can choose from a health care institution or a doctor from any state system within the European Union, and after treatment to seek compensation from the Health Insurance Fund. An important difference between recourse to a medical specialist on the basis of a referral in Estonia and abroad lies in the fact that while abroad the entire medical treatment must be paid for by the patient first, and then upon returning home to apply for reimbursement of the cost from the Health Insurance Fund. It must be kept in mind that the Health Insurance Fund pays only for the health services that the patient would be entitled to receive at the expense of Health Insurance Fund also in Estonia. The reimbursement is not possible in case of health care services that are not provided in or recoverable in Estonia (e.g., dental care for adults) or the services medically not indicated for the person. If the price of the service received from abroad is higher than the price in our list of health care of the Health Insurance Fund, the patient must pay the difference in price themselves. Also, the patient has to pay for the visit, co-payment fees, and travel expenses.
For receiving the compensation, an application must be submitted, the form of which is available on the website of the Health Insurance Fund or in the customer service offices, as well as to provide original invoices of the treatment, payment records, referral of the medical specialist and the summary of the treatment protocol.
More information about the treatment abroad can be found here.
Frequently asked questions - FAQ
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 an Estonian citizen starts working in another EU member state and the taxes will be paid there, he/she will receive health insurance from that state. However he/she cannot have a existing health insurance in Estonia at the same time.
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.
