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Medicinal Products

Only medicinal products included in the Health Insurance Fund’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 between 3.19 EUR and the reference price/price agreement.
 
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;
  • persons receiving pension for incapacity for work under the National Pension Insurance Act;
  • 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 Health Insurance Fund’s list of medicinal products.
 
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