An employer calculates the sickness benefit:
EHIF calculates the benefit for incapacity to work:
on the basis of the employee's average salary for the last six months.
on the basis of the data on social tax calculated or paid for the employee for the previous calendar year, as received from the Tax and Customs Board.
After the receipt of the benefit you can view the information underlying the calculation on the state portal eesti.ee.
Calculation of average per-calendar day income by EHIF
The benefit is equal to the income calculated based on the social tax calculated or paid to the insured person during the calendar year preceding the start of the certificate of incapacity for work, divided by 365.
The benefit rate is calculated from the daily income and multiplied by the number of days to be reimbursed (see the examples of benefit calculation). Sickness benefit is subject to income tax.
If a person had no income in the previous year or their average annual income was lower than the minimum wage (584 euros per month in 2020), the daily income is calculated as follows:
- daily income = basic wage: 30, but not more than the minimum wage divided by 30.
The calculation is based on the basic monthly wage or the minimum monthly wage applicable on the day before the date of the start of the release from work specified in the certificate of incapacity to work.
If a person did not have any income in the previous year and his/her basic wage is lower than the minimum monthly wage, then daily income = basic wage: 30.
Daily income of a person receiving remuneration or service fees on the basis of a contract under the law of obligations, a member of a management body, or a self-employed person is deemed to be equal to the income calculated on the basis of the social tax paid for the insured person during the calendar year preceding the start of the certificate of incapacity to work, divided by 365.
In case there was no income, the daily income = monthly rate established in the Social Tax Act (584 euros per month in 2020). 30.
If a self-employed person was not obliged to pay advance payments of social tax and in the previous year, no social tax was paid for or by him/her, then he/she has no daily income and will not receive any benefit.
If the data serving as basis for the benefit calculation have been changed at the Tax and Customs Board, a person has the right to submit an application to the Health Insurance Fund for the recalculation of the benefit within 3 years from the date of receipt of the certificate of incapacity to work by EHIF.
Specifications for different types of insurance
If a person is insured at the same time as an employee and a self-employed person or as a member of a management body or as a person who is a contracting party under the law of obligations, the daily income is calculated on a more favourable basis for the insured (either on the basis of the amount of the social tax calculated or the amount of social tax paid).
Robert is a self-employed person. Last year, the employer paid a social tax of 894.76 euros for him, and he himself as an entrepreneur paid 442.91 euros. In total, the amount of social tax paid was 1,337.67 euros, and the income calculated on that is 4,053.55 euros.
4,053.55 : 365 = 11.11 euros of daily income.
- Old-age pensioner Karl is a self-employed person. He falls ill. No social tax was paid for him in the previous year. As an old-age pensioner, he is not obliged to pay advance payments of social tax. Therefore, he will not receive any benefits.
- Maria works under an employment contract and also operates as a self-employed person and has health insurance cover based on both.
Last year, her social tax was calculated in the amount of 3,302.95 euros, but paid in the amount of 2,292.51 euros. Since the amount of social tax calculated is higher, it is more profitable for Maria to calculate the benefit on the basis of the calculated social tax.
In the event of an illness or injury, an insured person has the right to receive sickness benefit until the date on which their capacity for work is restored as specified in the certificate for sick leave, but not for more than 240 consecutive calendar days in the event of tuberculosis or 182 consecutive calendar days in the event of any other illness.
If necessary, a doctor may issue a certificate for sick leave for a longer time than the reimbursable period. This limitation applies only to the period for which the benefit is paid, and not to the duration of the sick leave certificate.