Necessary medical treatment
The extent of provided medical care proceeds from the European Parliament and Council Regulation No 987/2009 on the regulation coordinating the social security systems of different states, which lays down detailed rules for the implementation of Regulation No 883/2004 (on the coordination of social security systems). Under this regulation, Estonia is obligated to treat persons insured in another EU Member State equally to persons insured by the Estonian Health Insurance Fund, should they need required medical care during their temporary stay in Estonia.
According to the Health Services Organisation Act, every person in the territory of the Republic of Estonia has the right to receive emergency care, which the health care professionals are required to provide within the limits of their competence and with the means available. To receive medical treatment, a patient should provide to medical institution their European Health Insurance Card, or a replacement certificate and an identity document.
Emergency care is provided on outpatient basis (by the emergency medical care) and in specialized care by departments of emergency medicine (visitation fee up to 5 EUR). Family physicians also provide emergency care to persons who live or are temporarily staying in their service area, but are not registered in the practice list of family physician.
Planned health service in Estonia
Starting from 25 October 2013, all European Union (hereinafter EU) Member States had to transpose the directive on patients' rights in cross-border healthcare into their legal system.
The Directive has three main objectives: to clarify the right of patients to receive healthcare in another EU Member State, to ensure the safety and quality of cross-border health services, and to encourage cross-border cooperation on health care.
Each member state shall establish the reimbursement regulations for their insured persons. For more information, please contact your National Contact Point.
Regulation 883/2004 EC
An insured person who has been authorized to go to another EU Member State to receive treatment appropriate to his or her condition, receives non-cash benefits provided by the authority of the place of state on behalf of competent institution in accordance with the latest applicable provisions of law, as if he or she were insured under the said legislation. Permission is granted if the treatment in question falls under the health care services covered by legislation in his or her place of residence, and such health service cannot be provided within a medically justifiable time, taking into account his or her state of health and the probable course of the illness.
If a person insured in another EU Member State has come to Estonia for the purpose of medical care, it is a regular treatment and they need a prior authorization, i.e. form E112 or a portable document S2. If they do not have such prior authorization, the health service provider should submit the invoice to that person rather than the health insurance fund.
The forms E 106 and E 121 (S1) are not grounds for the provision of medical care. Provided form must be pre-registered in the Health Insurance Fund, in which case the person is included in the health insurance database.
In 2019, the Estonian Health Insurance Fund joined the electronic exchange of social security information (EESSI) as one of the first member states of the European Union. EESSI helps social security institutions across the EU to exchange information about applicable legislation, illness, occupational diseases and accidents at work more quickly and securely, as required by EU social security coordination rules. More information about EESSI can be found on the European Commission's website.