Healthcare in the EU and elsewhere
The required medical treatment while staying temporarily in another EU country
When planning a trip to another European Union Member States it makes sense to think in advance about what you need to know, and what to take with you to reduce costs, which may be associated with an unexpected health disorder.
The most important help that must be in the wallet is the European Health Insurance Card. On this basis, the people insured by the Estonian Health Insurance Fund can receive the medical treatment during a temporary stay in another Member State and receive treatment on equal terms with the insured people living in that country. For this, the need for health care has to be incurred during the stay in the other country, and the need for health care must be medically justified. Whether the medical care is needed, will be decided by the doctor.
The European Health Insurance Card gives the right to the necessary medical care during a stay within the European Union and the European Economic Area and Switzerland. The required medical care is not free – the patient's deductible expenses (visit, hospital charges, etc.) must be paid for according to the tariffs in the country of location.
Deductible expenses shall not be compensated for the patient. Also, the card does not cover the transport costs between countries. Therefore, we recommend on traveling to a foreign country also always take the travel insurance with the protection of the health risks. In the light of the above, the hospital should issue an invoice only for the deductible, which in turn can be submitted to the private insurance provider.
Also be sure to observe that for obtaining health care service, you turn to a state health care institution, and not to private doctors, since the EHIC is accepted only in the health care institutions belonging to the state system.
More information about the european health insurance card can be found here.
Planned medical treatment abroad
Unlike the need for medical aid caused by an emergency need for treatment in a foreign country, planned treatment represents a situation where a person goes to another country in order seek treatment there. The application form is available on the website of the Health Insurance Fund, or in customer service offices. The first option is to apply for the permission of the Health Insurance Fund for covering the cost of treatment in a foreign medical institution (for the criteria of the permission see www.haigekassa.ee). The reimbursement is made in accordance with the rates of the state that provided the treatment. The Health Insurance Fund makes an inquiry to the state where you were treated, and according to information received, shall transfer the reimbursable amount to your bank account.
In the case of a positive decision, the Health Insurance Fund will issue a document confirming the assumption of the payment of the fee and pay the medical costs incurred from abroad.
Another possibility to receive planned medical treatment abroad is Under the European Union Directive on the free movement of patients. This means that the patient who is holding a referral to a medical specialist can choose from a health care institution or a doctor from any state system within the European Union, and after treatment to seek compensation from the Health Insurance Fund. An important difference between recourse to a medical specialist on the basis of a referral in Estonia and abroad lies in the fact that while abroad the entire medical treatment must be paid for by the patient first, and then upon returning home to apply for reimbursement of the cost from the Health Insurance Fund. It must be kept in mind that the Health Insurance Fund pays only for the health services that the patient would be entitled to receive at the expense of Health Insurance Fund also in Estonia. The reimbursement is not possible in case of health care services that are not provided in or recoverable in Estonia (e.g., dental care for adults) or the services medically not indicated for the person. If the price of the service received from abroad is higher than the price in our list of health care of the Health Insurance Fund, the patient must pay the difference in price themselves. Also, the patient has to pay for the visit, co-payment fees, and travel expenses.
For receiving the compensation, an application must be submitted, the form of which is available on the website of the Health Insurance Fund or in the customer service offices, as well as to provide original invoices of the treatment, payment records, referral of the medical specialist and the summary of the treatment protocol.
More informartion about the treatment abroad can be found here.
In order to receive necessary medical care in another EU country on equal terms to the insured people living there, you have to apply for an EHIC. The health insurance is formalised for 12 months maximum, therefor we ask you to remember to send a verification of your studies to the health insurance fund on each academic year.
Secondly a person can submit an application to the health insurance fund under the legislation of Regulation (EC) No 883/2004 art 20 and under Health Insurance Act section 271. Applications that do not come with a council decision will be processed longer, because then the health insurance fund has to request the decision themselves. Further information can be found here.
The health insurance fund covers only the costs of people who have received the prior authorization on the basis of the form E112 or the letter of guarantee. When a person goes abroad to receive planned treatment before getting the prior authorization from EHIF and submits an application and invoices for reimbursement after the treatment, the health insurance fund cannot compensate the cost of treatment in local rates of the country that provided healthcare. In this case the compensation is only possible in accordance with the Estonian price list (legislation of the Directive 2011/24).
Costs related to pregnancy and childbirth shall be considered as necessary medical costs if the reason for going to another country is not solely to give birth. Exception is made when a women goes to another country to give birth for family reasons (spouse or parents are residing in another member state). In such cases, the accompanying medical care are additional to childbirth and are considered as necessary medical care, which is provided on the basis of the EHIC. The woman can give birth in Estonia on equal terms as persons insured by EHIF if she has a valid EHIC with her.
Once all the necessary information (the duration of the dispatch is not longer than 6 months) is available, the health insurance fund can issue the form E106, which gives the person the right to register him-/herself in the dispatched country´s health insurance institution. The form E106 is sent to the employer unless it is agreed otherwise.
Moreover, addition to the posted worker, the frontier worker and person raising a child under 3 years whose employment contract has been suspended, can request the form E106. They also have to submit an application to the health insurance fund.
The form E104 confirms that your health insurance in Estonia has ended. The application to obtain confirmation can be found here. A completed application can be brought to a health insurance fund customer service office, you can also send it by post or by digitally signed e-mail. Contact information can be found here.