A guide for medical institutions
- The service provider assesses whether the need for medical care is medically justified. The patient's questionnaire (available in Estonian and English) helps with the assessment.
- If the need is justified, the service is provided as if the patient was insured by EHIF (visit fees and bed-day fees are the same as for a person insured by EHIF, the waiting period for receiving the service is also the same).
- The service provider provides the service during the person's expected stay in Estonia. There must be a medical indication to provide the service.
- The S2 certificate or European Health Insurance Card / replacement certificate must be valid for the entire duration of the service. The period of validity is indicated on the certificate or health insurance card.
- The service provider makes a copy of the certificate/card/replacement certificate and keeps it with the patient's medical record together with the completed questionnaire. If EHIF needs to review the data when checking treatment invoices, a copy of the certificate/card/replacement certificate and the questionnaire will be requested from the healthcare provider.
- The health care provider forwards treatment invoices of a person insured in an EU member state to EHIF as messages in XML format via X-Road (see also the guide for electronic transmission of treatment invoices). You can send one or more invoices in one message. EHIF compiles the consolidated invoices periodically itself (e.g. once a day). Personal data of an EU insured and his/her insurance document data must be entered in the treatment invoice that is submitted on the basis of funding source (National Health Accounts (RTA foreigners)).
- Treatment invoices must be submitted according to the instructions.
- You can read more about the funding of primary care here.
Please note! If a person insured in another EU country does not provide proof of insurance, the health care provider has the right to charge the patient for the service on the basis of regular price list. The patient is given a treatment invoice and a document certifying payment, if the invoice does not contain information confirming the payment. The price list of a medical institution should not include prices that discriminate against patients arriving for treatment from outside Estonia.
Contacts of EHIF:
- Issues concerning European Union law: call 603 3686 or 603 3672.
- EHIF's medical advisor: call 603 3661 (issues concerning treatment invoices of people insured in another member state).