European Union information medical institutions
General principles of providing medical care to a person who stays in Estonia but is insured in another EU member state.
A person insured in another EU member state is entitled to necessary medical care during a temporary stay in Estonia on the same terms as a person insured in Estonia. This means that if, for example, a person insured in Germany or Finland is on a tourist trip or business trip in Estonia and falls suddenly ill, he or she will be treated under the same terms as people insured in Estonia.
However, in order to receive medical care, the person must carry a European Health Insurance Card or a replacement certificate. Medical care must be medically justified and the need for medical care must be decided by a health care provider. The duration of the patient's stay in Estonia must be taken into account when providing assistance.
If a person insured in another member state has come to Estonia for the purpose of receiving medical treatment here, then it is deemed to be planned treatment. In such a case, she or he must have a prior authorization, i.e. an E112 form or S2 certificate. If the person does not have such prior authorization, the service provider must invoice the person, not EHIF.
Medical care is provided on the basis of following documents:
- In the case of medical care required during a temporary stay in Estonia and the person has not come to Estonia for the purpose of receiving treatment here, the basis for reimbursement of the service is the European Health Insurance Card or its replacement certificate.
- If a person has come to Estonia for the purpose of receiving treatment here, the basis for reimbursement is a certificate E112 or S2.
- If a person receives medical treatment in connection with an accident at work or an occupational disease, the basis for reimbursement is certificate E123 or DA1.
In order to be able to provide medical care on the basis of forms E106, E109 and E121 (or S1 certificate), a person must first bring the respective forms to EHIF. EHIF will register these forms and the person's data are then entered into a database and he or she receives medical treatment. These insurance forms entitle posted workers, old age
pensioners, cross-border workers and their family members to receive health insurance in Estonia.
As in Italy the European Health Insurance Card is linked to the National Health Insurance Card, they may issue European Health Insurance Cards with person’s name and competent authority data replaced by asterisks. You should not accept such card.
In addition, there are European Health Insurance Cards issued, where the country code is EU. Holders of a card with EU country code must contact their employer to get reimbursement of medical expenses.
The Netherlands issue in addition to the European Health Insurance Card, a World Health Insurance Card. However, the right to free necessary medical care is available only under the European Health Insurance Card. The World Health Insurance Card must be considered as a private insurance policy.
A guide for medical institutions
- The service provider assesses whether the need for medical care is medically justified. The patient's questionnaire (available in Estonian and English) helps with the assessment.
- If the need is justified, the service is provided as if the patient was insured by EHIF (visit fees and bed-day fees are the same as for a person insured by EHIF, the waiting period for receiving the service is also the same).
- The service provider provides the service during the person's expected stay in Estonia. There must be a medical indication to provide the service.
- The S2 certificate or European Health Insurance Card / replacement certificate must be valid for the entire duration of the service. The period of validity is indicated on the certificate or health insurance card.
- The service provider makes a copy of the certificate/card/replacement certificate and keeps it with the patient's medical record together with the completed questionnaire. If EHIF needs to review the data when checking treatment invoices, a copy of the certificate/card/replacement certificate and the questionnaire will be requested from the healthcare provider.
- The health care provider forwards treatment invoices of a person insured in an EU member state to EHIF as messages in XML format via X-Road (see also the guide for electronic transmission of treatment invoices). You can send one or more invoices in one message. EHIF compiles the consolidated invoices periodically itself (e.g. once a day). Personal data of an EU insured and his/her insurance document data must be entered in the treatment invoice that is submitted on the basis of funding source (National Health Accounts (RTA foreigners)).
- Treatment invoices must be submitted according to the instructions.
- You can read more about the funding of primary care here.
Please note! If a person insured in another EU country does not provide proof of insurance, the health care provider has the right to charge the patient for the service on the basis of regular price list. The patient is given a treatment invoice and a document certifying payment, if the invoice does not contain information confirming the payment. The price list of a medical institution should not include prices that discriminate against patients arriving for treatment from outside Estonia.
Contacts of EHIF:
- Issues concerning European Union law: call 620 8471 or 603 3688.
- Forwarding medical bills of persons insured in a European Union member state to the Health Insurance Fund: call 4430237 or 6208321.
Medical report
If other European Union member state insurance institution begins to pay sickness benefits to a patient, who has received a necessary treatment in Estonia or who has been in Estonia for planned treatment, then the insurance institution may need additional information.
To obtain medical report document, the patient must:
- ask the doctor who treated him or her in Estonia, to fill in the Medical report, which can be found here.
- submit the Medical report and the application (Application for Incapacity for Work Benefit in EU Member State) to the Estonian Health Insurance Fund.
- The doctor must complete all the required fields in Medical report. Completion guide for Medical report can be found here.
- If you have any questions about filling in the medical report, please contact the Estonian Health Insurance Fund by phone or by info [at] tervisekassa.ee (info[at]tervisekassa[dot]ee).
Incapacity for work certificate issued in a foreign country
EHIF pays temporary incapacity for work benefit to a person insured in Estonia also on the basis of a document certifying illness issued by a foreign doctor.
A document certifying illness issued by a foreign doctor must be submitted to the employer, who will attach the employer's certificate to it.
In the Health Insurance Fund, each insured person has only one bank account where benefits are deposited. You can check your bank account on the citizen portal eesti.ee or by calling the customer service. All transfers are made to the last submitted bank account.
At the request of the Health Insurance Fund, a certified translation into Estonian by a sworn translator must be attached to the certificate issued by a foreign doctor. The costs of translating the certificate shall be borne by the insured person.
European Union digital prescription
Medicinal products for dispensation at the discount rate
The Regulation of the Minister of Social Affairs “Conditions and procedure for the issue of prescriptions for medicinal products and for the dispensation of medicinal products by pharmacies and the format of the prescription” has approved the conditions and procedure for prescribing medicinal products and dispensing medicines from pharmacies in the EU.
If a person has provided proof of their insurance cover issued by another EU member state by presenting a respective document, he or she is entitled to medicinal products at discount rate on the same terms as those insured by EHIF. Discount medicinal products are prescribed only if a person has a medically justified indication for that. When prescribing the medicinal product, a physician must decide on the amount by considering how long the patient is going to stay in Estonia.
Formal proofs are: European Health Insurance Card, European Health Insurance Card replacement certificate, Form E112, Certificate S2, Form E123, Certificate DA1.
If a person does not submit a document certifying EU health insurance or the need for providing the medical service to him or her has not become apparent while he or she is staying in Estonia, but he or she still needs medicines due to his or her health condition, the doctor will issue a prescription without a discount.
As the digital prescription information system contains accurate and full data of the insurance certificate for the calculation of discount, it must be taken into account that when issuing a prescription without a discount only the personal identification code and country of residence need to be entered into the digital prescription. No other data should be entered, as in such case the prescription center will automatically calculate the discount.
The physician who prepared the prescription shall enter the details of the patient's identity and insurance document on the prescription in order to authorize the discount and shall keep a copy of the document certifying the EU health insurance cover with the person's medical history. If the competent authority of an EU Member State does not agree to pay the invoice to EHIF and wishes to receive for additional information a copy of the document certifying the person's insurance cover, EHIF has the right to contact the physician who provided the person with medical treatment or issued the prescription.
Medicinal products may be prescribed only by physicians, dentists and midwives who have the right to provide health care services in the Republic of Estonia for outpatient treatment of their patients. Prescription of medicinal products shall be based on the regulation of the Minister of Social Affairs “Conditions and procedure for the issue of prescriptions for medicinal products and for the dispensation of medicinal products by pharmacies and the format of the prescription” (persons and conditions specified in subsection 41 (2) of the Health Insurance Act).
Patient's Transfer from the EU to Estonia
The current scheme addresses the situation where a Health Insurance Fund-insured person experiences a sudden health issue while in the EU (or in the United Kingdom, Liechtenstein, Norway, Iceland, Switzerland) and how their transportation to an Estonian hospital is arranged. It is crucial to consider Health Insurance Fund coverage and the assessed need for further hospital treatment and medical transport in the EU hospital.
Patsiendi EL-ist Eestisse toomine
Provision of medical assistance to a person insured in the European Union
The general terms of the agreement on the financing of medical services and the general terms of the agreement on the financing of general medical services also apply, among other things, to the provision of medical services to a person insured in another participating country of the European Union.
The healthcare provider in Estonia must:
- Check the patient's possession of the European Health Insurance Card or a replacement certificate.
- Assess the need for medical assistance and complete the patient questionnaire.
- Make and retain copies of the European Health Insurance Card or its replacement certificate, the patient's document, and the completed questionnaire.
- Provide the invoice for the service rendered to the Health Fund.
The doctor must first verify whether the person has valid health insurance. The presence of health insurance for a foreign patient is checked through the Health Fund's database.
If the patient is in the Health Fund's database, meaning that the person is insured, they can be treated just like a person insured in Estonia.
If, according to the Health Fund's database, the person does not have health insurance, they must present the European Health Insurance Card or a replacement certificate for the European Health Insurance Card. It should be noted that each EU member state issues the card or its replacement certificate in its own language. Thus, the patient may present, for example, a card or its replacement certificate in Finnish. Samples of cards issued in other countries can be checked on the European Commission's website. An example of a certificate replacing the European Health Insurance Card can be found here.
- The patient does not have the European Health Insurance Card or its replacement certificate. In this case, it is a paid service (excluding emergency medical care), for which the healthcare provider has the right to request payment from the patient according to their price list. Prices for foreigners in the price list should not differ from prices for local patients.
- The patient has the European Health Insurance Card or its replacement certificate. In this case, they should be provided with the necessary medical assistance on par with insured individuals in Estonia. The provision of medical assistance must be justified from a medical point of view, taking into account the duration of the patient's stay in Estonia. The decision on the need for medical assistance is made by the healthcare provider.
Before providing the necessary medical assistance, the healthcare provider makes a copy of the European Health Insurance Card or its replacement certificate and asks the patient to fill out a questionnaire. If the patient wishes to receive a certificate of temporary incapacity, they must provide a completed E116 form.
The patient's invoice must be submitted to the Health Fund. Since 2020, a new system for submitting invoices has been introduced. Now, when issuing an invoice in their program, the healthcare provider also fills in the relevant fields for the European Health Insurance Card or its replacement certificate. It is no longer necessary to attach a copy of the European Health Insurance Card or its replacement certificate to the invoice and the patient's questionnaire. However, the healthcare provider must make copies of these documents and keep them because the Health Fund has the right to request these documents from the medical institution if necessary.
The Health Fund pays the medical bills to the healthcare provider. After that, the Health Fund recovers the amounts paid for the settled medical bills from the competent institution of the EU member state that insured the patient.
Remember!
Based on the European Health Insurance Card, patients have the right to receive treatment they need during their stay. Planned treatment (i.e., a patient comes to Estonia specifically for treatment) is not covered by the European Health Insurance Card.
There is a separate list of medical services for chronic patients (renal dialysis, oxygen therapy, special treatment for asthma, echocardiography for chronic autoimmune diseases, chemotherapy) that the doctor must provide to individuals as part of necessary medical assistance and within the authority of the European Health Insurance Card. Medical services related to pregnancy and childbirth, including care for pregnant women, must also be provided under the European Health Insurance Card.
The person must personally pay the medical bill for the provision of necessary dental care because the existing compensation system for dental care in Estonia does not allow the reimbursable amount to be deducted immediately from the medical bill of a person insured in the European Union. The person has the right to demand reimbursement of expenses from the country in which they are insured, based on the paid invoices for services.
