Contracts for financing medical treatment
A contract for financing medical treatment is an administrative contract, with which the Health Insurance Fund assumes the obligation from the insured person to pay a fee for the provision of a health care service in accordance with the conditions provided in the contract and legislation. The contracts for financing medical treatment shall be entered into by the Health Insurance Fund with the provider(s) of the health service.
Upon deciding the conclusion of the contracts for financing medical treatment and the contract period, the Health Insurance Fund takes into account the following factors:
1) The need of the insured persons for the service, and the availability of the service;
2) The quality and conditions of the service;
3) The cost of the service;
4) The possibility of the provision of the service in accordance with the standard conditions of accommodation;
5) The maximum number of health care providers;
6) The indicators of the average load for the provision of health care services;
7) The development trend of public health policy;
8) Proper compliance with past agreements for financing of treatments or similar agreements by health care providers;
9) The presence or absence of tax arrears, and the overall economic situation of the health care provider;
10) Proper compliance with the legislation governing health insurance and health care by the health care provider or by a person employing him or her.
The Health Insurance Fund enters into contracts with medical care institutions providing specialized healthcare and Network Development Plan Hospitals for five years, and with the partners of choice for four years. Contract conditions are the same for everyone.
Detailed information about the conditions of the agreement for financing of treatment is available at https://www.riigiteataja.ee/en/eli/502042015016/consolide
The following contract contains the general terms of a medical care funding contract. This includes information and terms of agreement on topics such as family physicians, treatment invoice data, guidelines on the completion of different health care forms, and terms of the funding of school health services.
Lepingute mahud ja täitmine
Tervisekassa tasub kindlustatu tervishoiuteenuste eest ainult siis, kui raviasutusel on olemas leping Tervisekassaga. Tervisekassa tasub ainult nende tervishoiuteenuste eest, mis on Tervisekassa tervishoiuteenuste loetelus ning mille osutamiseks on meditsiiniline näidustus.
Eriarstiabi, hambaravi ja hooldusravi osutavad tervishoiuasutused sõlmivad lepingu küll oma piirkonnas, aga teenindavad kõiki ravikindlustatud inimesi olenemata nende elukohast. See tähendab, et näiteks Tallinnas elav inimene võib minna eriarsti või hambaarsti juurde Tartusse või Pärnusse ja saada hooldusravi Märjamaal.
Eriarstile pöördumisel kehtib saatekirja nõue (välja arvatud trauma, kroonilise haiguse, tuberkuloosi, silmahaiguse, naha- või suguhaiguse või laste hambaravi korral, või kui arstile pöördutakse günekoloogilise või psühhiaatrilise abi saamiseks).