There are several options to get specific treatment in some other Member State or foreign country. In addition to those options, a patient has also a right to obtain necessary treatment in case of an accident or emergency during a temporary stay in another Member State.
View more information about necessary health care in EU here.
Prior authorization for planned treatment abroad
Health Insurance Act § 271 subsection 1
Before going abroad (applicable to both EU and other countries) for treatment or examination, the patient is required to submit an application to the Estonian Health Insurance Fund. The application can be found here .
Regulation (EC) No 883/2004 of the European Parliament and of the Council article 20
Compensation for health services that are provided for the patient in Estonia also requires a prior authorization if the treatment in question cannot be given within a time-limit which is medically justifiable, regarding patients current state of health and the probable course of their illness.
In case of negative response the written notice is sent to the insured person together with the statement of grounds of denial of referral to treatment.
The application for exceptional referral to treatment to the foreign country should be submitted as early as possible – 30 days before the planned treatment at the latest leaving the Health Insurance Fund enough time for processing the documents.
Reimbursement according to EU cross-border directive 2011/24 (Patients’ Rights Directive)
In this case, the patients are entitled to travelling to another Member State with the purpose of receiving treatment just like visiting a medical specialist in Estonia. For that, no permit must be claimed from the EHIF. After having received a service, a financial benefit can be claimed from the EHIF to pay for the service. However, it is important to keep in mind that all expenses related to the service must first be paid to the healthcare provider by the patient or their close ones. An application for reimbursement to the EHIF can only be submitted retrospectively.
The EHIF only reimburses the healthcare services which the patient also has the right to receive at the expense of the EHIF in Estonia. The healthcare services that are provided in Estonia for a charge (e.g. dental care for adults) or that are not indicated to the patient on the basis of his or her health condition are not reimbursed.
For reimbursement, an application must be submitted to the EHIF along with
- the original invoices issued for the medical service, the documents verifying payment of the invoice,
- the referral issued by a medical specialist,
- patient’s medical report/summary of the treatment.
Insured persons can also apply for reimbursement of the pharmaceuticals and medical equipment purchased in a foreign country, which are included to the list of reimbursed pharmaceuticals or reimbursed medical equipment in Estonia.