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 20 of Regulation (EC) No. 883/2004 of the European Parliament and of the Council
This option is intended for those insured persons who have medical indication to receive a health care service that is also provided in Estonia, but cannot be provided to the patient during a medically justified period of time. This option is a non-monetary benefit. Required documents:
The Health Insurance Fund processes the application based on the content of the application, the decision of the medical council and the criteria set out in Regulation (EC) No 883/2004 of the European Parliament and of the Council.
In case of a positive decision, the Health Insurance Fund will issue a document (the S2 form) according to which the Health Insurance Fund will assume the obligation to pay for medical expenses incurred abroad (Member States of the European Union, Member States of the European Free Trade Area). The issued S2 form does not extend to possible non-medical expenses (patient’s self-liability, transportation costs, translation services, administrative or office expenses, accommodation outside the hospital, etc.). These are paid for to the foreign medical institution by the patient or the patient’s legal representative.
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B: Under Article 271(1) of the Health Insurance Act
The option is intended for insured persons for whom the indicated health care service or an alternative health care service cannot be rendered in Estonia. This option is a non-monetary benefit. Pursuant to the criteria set out by the Health Insurance Act, the health care service provided abroad must also have proven medical efficacy and the probability of achieving the aim of the service must be at least 50 per cent. Required documents:
In processing the application, the Health Insurance Fund proceeds from the person’s application, the evaluation given by the council and the criteria provided for in Subsection 27 1(1) of the Health Insurance Act.
In case of a positive decision, the Health Insurance Fund will issue a document (the S2 form) according to which the Health Insurance Fund will assume the obligation to pay for medical expenses incurred abroad. There are no restrictions on the choice of country, but the Health Insurance Fund may consider giving preference to a Member State of the European Union. The issued letter of guarantee or S2 form does not extend to possible non-medical expenses (patient’s self-liability, transportation costs, translation services, administrative or office expenses, accommodation outside the hospital, etc.). These are paid for to the foreign medical institution by the patient or the patient’s legal representative.
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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 want to receive health care services that they are entitled to receive at the expense of the Health Insurance Fund also in Estonia, in another Member State of the European Union, Norway, Iceland and Liechtenstein. In Switzerland, Directive 2011/24/EU does not apply, which means that in Switzerland, medical expenses are not reimbursed without prior authorization.
This option is a monetary benefit. Health care services that are available for Estonian insured persons only for a fee (such as adults’ laser operations to correct vision, vaccinations performed outside the national immunization plan) or are not indicated for a patient cannot be reimbursed.
Under this directive, prior authorization for treatment abroad is not required. At first the patient has to cover all the costs by themselves and after receiving the health care service and submitting all necessary documents they can apply to the Health Insurance Fund for reimbursement. The Health Insurance Fund reimburses the costs of health care services according to the Health Insurance Fund’s list of health care services, i.e. the price list, so if the services are more expensive abroad, the exceeding part of the costs is to be paid by the patient.
A referral from a family physician or medical specialist is also required when seeking treatment abroad on the same grounds as it would be when seeing a doctor in Estonia.
We wish to clarify that going abroad to receive treatment on the basis of prior authorisation or a directive does not exempt you from the requirement to take out travel insurance. The Health Insurance Fund will only cover the costs of the healthcare service requested.
Read more:
- Table comparing treatment options and benefits
- Your rights under the Directive
- Reimbursement of treatment costs in the European Union
