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.

1. 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.
2. 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.