Planned medical treatment abroad
Persons insured by the Estonian Health Insurance Fund are entitled to receive health care services abroad based on certain criteria and to claim from the Health Insurance Fund for both monetary and non-monetary benefits for this.
Options for planned medical treatment abroad:
A. Under Article 271(1) of the Health Insurance Act
This option is intended for insured persons for whom medically indicated healthcare services or alternative healthcare services cannot be provided in Estonia. This option constitutes non-monetary compensation. Based on the criteria of the Health Insurance Act, healthcare services provided in a foreign country must also have proven medical effectiveness, be cost-effective, and be within the budget of the health insurance system. Required documents:
When processing the application, the Health Insurance Fund bases its decision on the individual’s application, the council’s assessment, and the criteria set forth in § 271 (1) of the Health Insurance Act.
In the event of a positive decision, the Health Insurance Fund issues a document (letter of guarantee or Form S2) whereby the Health Insurance Fund assumes the obligation to pay for medical expenses incurred in a foreign country. The Health Insurance Fund may give preference to a Member State of the European Union. The issued letter of guarantee or Form S2 does not cover potential non-medical expenses (patient copayment, transportation costs, translation costs, administrative or office costs, insurance, accommodation outside the hospital, etc.). These are paid to the foreign healthcare facility by the patient or their legal representative.
B. Under Article 20 of Regulation (EC) No. 883/2004 of the European Parliament and of the Council
This option is intended for insured persons who have been medically prescribed a healthcare service that is provided in Estonia but which cannot be provided within a medically justified timeframe. This option constitutes non-monetary compensation. Required documents:
When processing the application, the Health Insurance Fund bases its decision on the individual’s application, the consilium’s assessment, and the criteria set forth in Regulation (EC) No. 883/2004 of the European Parliament and of the Council.
In the event of a positive decision, the Health Insurance Fund issues a document (letter of guarantee or Form S2) whereby the Health Insurance Fund assumes the obligation to pay for medical expenses incurred in a foreign country (European Union member states, European Free Trade Association member states). The issued letter of guarantee or Form S2 does not cover potential non-medical expenses (patient copayment, transportation costs, translation costs, administrative or office costs, accommodation outside the hospital, insurance, etc.). These costs are paid to the foreign healthcare facility by the patient or their legal representative.
Read more about applying for prior authorization for planned treatment abroad.
C. Directive 2011/24/EU of the European Parliament and of the Council (Free Movement of Patients)
This option is intended for insured persons who wish to receive healthcare services—which patients are entitled to receive at the expense of the Estonian Health Insurance Fund (EHIF)—in another European Union member state, Norway, Iceland, or Liechtenstein. Directive 2011/24/EU does not apply in Switzerland, which means that medical expenses incurred in Switzerland are not reimbursed without prior authorization.
This option involves financial reimbursement. Reimbursement is not paid for healthcare services that are subject to a fee for the insured person in Estonia (e.g., laser eye surgery for adults, vaccinations performed outside the national immunization schedule, etc.) or are not indicated for the patient based on their health condition.
No prior authorization is required when seeking treatment abroad under this directive. Initially, the patient must cover all costs for the healthcare services received themselves; financial reimbursement from the EHIF can be requested after the healthcare services have been provided and the necessary documents have been submitted. The EHIF reimburses the costs of healthcare services in accordance with the EHIF’s list of healthcare services, i.e., the price list; therefore, if services are more expensive in a foreign country, the patient must cover part of the cost.
To receive healthcare services abroad, a referral from a family doctor or specialist is required, on the same basis as when visiting a doctor in Estonia.
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