Health care during temporary stay in another European Union state

People insured by the Estonian Health Insurance Fund who are temporarily staying in another EU member state will receive necessary health care on equal terms with the insured residents of that state. The need for health care must have arisen during the stay in the state. The need for health services must be justified on medical grounds and the doctor must consider the presumed duration of the stay and nature of the health service. Visiting another state with the purpose of receiving treatment does not fall under this provision.

The right to receive health services on the basis of the EHIC is only in these medical institutions that belong to the public health care system (it does not include private clinics).

Which countries provide necessary health care with the European Health Insurance Card?
Austria, Belgium, Bulgaria, Spain, Netherlands, Croatia, Ireland, Iceland, Italy, Greece, Cyprus, Lithuania, Liechtenstein, Luxembourg, Latvia, Malta, Norway, Poland, Portugal, France, Sweden, Romania, Germany, Slovakia, Slovenia, Finland, Great Britain, Switzerland, Denmark, Czech Republic, Hungary.

How to get necessary health care?
To receive health care, you must present your European Health Insurance Card or its replacement certificate and your identity document at the health care institution.

Is necessary health care free of charge?
Necessary health care is not free of charge – you must pay the patient’s co-payments (e.g. visit fee, in-patient fee) according to the tariffs of the country of location. Patient’s co-payments are not reimbursed to the patient. The Health Insurance Card also does not cover transportation costs between states.

Do I need to get travel insurance in addition to the European Health Insurance Card?
It is not compulsory, but the Health Insurance Fund advises you to get additional travel insurance. Travel insurance will generally cover the costly patient’s co-payments and transportation between countries. You can find information about specific co-payments on the websites of each state. However, these do not give information about transportation costs between states. At the same time, private insurance might not always help, e.g. with chronic disease or pregnancy. This is why it is also necessary to get the European Health Insurance Card.

What to do when you have left your European Health Insurance Card at home?
If you are insured but you have forgotten to take your European Health Insurance Card, you must pay for the invoices from your own pocket and when you come back to Estonia, you have the right to file an application to the Health Insurance Fund for reimbursement of costs.

To receive reimbursement, you must keep the original invoices for health services and documents certifying the payment. To calculate the reimbursable amount, the Health Insurance Fund must send a query to the other EU state, so you need to have patience – the procedure may take some time and the transfer of the reimbursable amount to your account may take at least six months.

NB! If you are travelling outside EU borders, it is advisable to get travel insurance. The service is provided by private insurance companies and the Health Insurance Fund does not govern the domain.

Applying for prior authorization for planned treatment abroad
You need to apply for prior authorization for reimbursement of treatment abroad in two cases:

1. If you wish to travel abroad with the purpose of receiving a health service that cannot be provided in Estonia but is in your case medically indicated and with proven efficiency, then you need to file an application with the Health Insurance Fund (also available at the customer services). The Estonian Health Insurance Fund makes the decision on funding on the basis of a decision by a council of doctors. The patient shall cover the co-payments, transportation costs, accommodation outside the hospital, etc.
2. A person must also apply for prior authorization from the Health Insurance Fund to receive reimbursement for planned treatment in another EU state under Regulation (EC) 883/2004 (article20). The authorization is provided if the treatment in question is among the benefits provided for by the legislation in the Member State where the person concerned resides and where he cannot be given such treatment within a time-limit which is medically justifiable, taking into account his current state of health and the probable course of his illness.

Directive on the application of patients’ rights in cross-border healthcare

As of 25 October 2013, persons insured by the Estonian Health Insurance Fund can travel to another EU state to seek treatment and apply for reimbursement from the Health Insurance Fund afterwards. This means that you first have to cover all the costs on your own and you can apply for reimbursement of costs from the Health Insurance Fund after the provision of service and the submission of all necessary documents.

The Health Care Fund shall only reimburse the costs of the health services that the patient is also entitled to receive at the Health Insurance Fund’s expense in Estonia. Health services that are fee-charging for patients insured in Estonia (such as dental care for adults) or are not indicated for a patient on the basis of his/her state of health shall not be reimbursed for. It is also possible to apply for reimbursement for medicinal products and medical devices purchased from another state, if the purchased items are included in the list of pharmaceuticals compensated for or medical devices reimbursed for and for which the person would also have the right to receive benefits in Estonia.

If services are provided in another state (tests, analyses), which might be a part of the service package in that state but are not reimbursable for the given medical condition in Estonia, then unfortunately the Health Insurance Fund cannot reimburse for such costs. A referral from a specialist doctor is also necessary when seeking treatment abroad on the same grounds as it would be when attending a doctor’s consultation in Estonia.

The patient also has to consider that the Health Insurance Fund pays reimbursement based on the prices listed in the Health Insurance Fund’s list of health care services, not on the basis of the foreign price list. If the cost of a health service received abroad is higher than in the Health Insurance Fund’s list of health care services, then the patient shall cover the price difference. The patient shall also cover co-payments, travel costs and other costs which would not be reimbursed for on the receipt of the same health service in Estonia.

To receive reimbursement, you must submit an application (available in the customer services and the post offices of Eesti Post), as well as the original invoices for the health service, documents certifying the payment, copies of prescriptions, referral to a specialist doctor and a case summary.

To make sure people receive sufficient information on cross-border healthcare, each member state will create a contact point for sharing information. These contact points give information about treatment abroad, but also give information about local health care to citizens of other countries – conditions of receiving health care, benefits, information added to the prescriptions designated for use in another member state, etc.
Website of the Estonian contact point. It is also possible to ask questions by telephone and e-mail.

The Directive on patient rights is available on the Eurlex website.

Health care during residency in another European Union state

Estonia will remain the insuring country of pensioners living abroad, posted workers and members of their families on several occasions. This means that while living abroad, these people will gain any kind of health care on equal terms with the people insured in that state, but Estonia shall cover the health care costs of these people as the insuring country.

Information about health care in the EU on the European Commission’s website.

Everything you always wanted to know about European Union health policies but were afraid to ask

Understanding the EU role in health is especially important now, when health systems have to deal with a plethora of challenges, the European social model is confronted by the threat posed by the financial crisis, and the EU is facing increasing euro-scepticism in politics.
This short book makes EU health policy in its entirety (and complexity) accessible to political and technical debate. To this end the volume focuses on four aspects of EU health policy:
- the EU institutions, processes and powers related to health;
- the EU action taken on the basis of this health mandate;
- the non-health action affecting health and health systems;
- and, because of its growing importance, financial governance and what it means for European health systems.

This book is aimed at policymakers and students of public health and health systems in the EU who want to understand how the EU can add value in their quest improving population health and the performance of health systems in Member States.
http://www.euro.who.int/en/about-us/partners/observatory/studies/everything-you-always-wanted-to-know-about-european-union-health-policies-but-were-afraid-to-ask

Cooperation with HYKSin

HYKSin provides services of Helsinki University Hospital for international and private patients. It is specially recognized for neonatal intensive care unit and pediatric heart surgeries.

HYKSin's services can be obtained by three optional ways:

  • by receiving a guarantee letter from the Estonian Health Insurance Fund;
  • regarding services according to the cross-border directive;
  • regarding private services.

For further information about treatment at HYKSin and reimbursment system, please contact HYKSin Customer Service by e-mail info@hyksin.com or phone +358 10 328 1900. See more information about HYKSin on website www.hyksin.com.

You can also contact EHIF's International Relations Department by e-mail valissuhted@haigekassa.ee.