General outline of health care system
Health insurance in Estonia is organised by the Estonian Health Insurance Fund (hereinafter the EHIF) and its 4 local departments. The Estonian Health Insurance Fund is the only organisation in Estonia dealing with compulsory health insurance.
1. Where to get information?
Information on how to obtain the required medical benefits in Estonia is provided by the officials of:
- Estonian Health Insurance Fund
Lembitu 10, Tallinn
Phone: + 372 620 8430
Information is also available at the local departments:
- Harju Department
Lastekodu 48, Tallinn
Phone: + 372 603 3600; + 372 603 3601
- Tartu Department
Põllu 1a, Tartu
Phone: + 372 744 7430
- Viru Department
Nooruse 5, Jõhvi
Phone: + 372 335 4470
- Pärnu Department
Lai 14, Pärnu
Phone: + 372 447 7666
2. Health care services
All persons insured with the EHIF have a family practitioner. A person not residing in Estonia may also visit a family practitioner. A person needs a referral from the family practitioner to visit a medical specialist. No referral is needed to visit a psychiatrist, gynaecologist, dermatovenerologist, ophthalmologist, dentist, pulmonologist (for tuberculosis treatment), infection specialist (for HIV/AIDS treatment), surgeon or orthopaedist (for traumatology).
In the case of emergency treatment, a person may always go to the emergency reception or call an ambulance on no 112. The attending physician decides whether the patient needs in-patient treatment.
The amount of the patient’s financial participation in the following cases:
- out-patient examination – a family practitioner can charge a visit fee of up to 5 EUR, when making a home visit;
- specialised medical care – a visit fee up to 5 EUR;
- transportation by ambulance in the case of emergency – free of charge;
- hospitalisation – an in-patient fee of up to 2.50 EUR per day for up to 10 days per hospitalisation.
There is no visit fee for:
- pregnant women;
- children below the age of 2;
- in case of immediate hospitalisation.
There is no in-patient fee:
- for children below the age of 18;
- in cases related to pregnancy and childbirth;
- in the case of intensive care.
3. Medicinal products
Only medicinal products included in the EHIF’s list of medicinal products and registered in Estonia shall be compensated for. Medicinal products shall be compensated for according to the reference prices and price agreements in case they exist; in other cases the refund will be based on the product’s retail price. Medicinal products shall be compensated for on the basis of the diagnosis. Discount rates for medicinal products:
100% discount - Patient shall make an own contribution of 1.27 EUR and in case there is a reference price or a price agreement pay the sum that exceeds that price. Health Insurance Fund will cover 100% of the sum that exceeds 1.27 EUR and is below reference price or price agreement.
90% discount - Patient makes an own contribution of 1.27 EUR per prescription, pays 10% of the sum between 1.27 EUR and the price agreement/reference price, and everything exceeding the reference price/price agreement. The Health Insurance Fund shall pay 90% of the sum between 1.27 EUR and the reference price/price agreement.
75% discount - The patient makes an own contribution of 1.27 EUR per prescription, pays 25% of the sum remaining between 1.27 EUR and the reference price/price agreement and everything exceeding the reference price/price agreement. The Health Insurance Fund shall pay 75% of the amount between 1.27 EUR and the reference price/price agreement.
50% discount - The patient shall make an own contribution of 3.19 EUR, pay 50% of the sum between 3.19 EUR and the reference price/price agreement and everything exceeding the reference price/price agreement. The Health Insurance Fund shall pay 50% of the amount exceeding 3.19 EUR, but not more than 12.79 EUR per prescription.
As an exception, a compensation rate of 90% shall apply to medicinal products with a discount rate of 75% in case of the following patient groups:
- children aged 4 to 16 years;
- insured persons over 63 years of age, in addition, all persons who have been granted pension under State Pension Insurance Act.
For children under 4 years old, compensation rate of 100% is applied on all medicinal products included in the EHIF list of medicinal products.
4. Dental treatment
Children below the age of 19 receive dental treatment free of charge by the dentists who have a valid contract with EHIF.
Adults pay the full amount for dental treatment (except for two emergency cases: the removal of a tooth and the lancing of an abscess).
The above rules apply also to persons, who have submitted a valid European Health Insurance Card, portable document S2 or DA1 to the health service provider or registered their E106, E109 or E121 forms or the portable document S1 in the EHIF.
There is no refund system in Estonia. Where the health service provider has a contract with the EHIF, all costs are directly reimbursed to it by the Fund. The patient shall pay only the amount of own contribution. If the health service provider does not have a contract, the patient must pay for the health service.
For receiving health care services please show your ID card to the health care provider. Insurance is checked on the basis of ID code. If you are not insured in EHIF, and you are not registered on the basis of form E106, E109, E121 or portable document S1 please show your European Health Insurance Card or portable document S2 or DA1.
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