General principles of providing medical care to a person who stays in Estonia but is insured in another EU member state.
A person insured in another EU member state is entitled to necessary medical care during a temporary stay in Estonia on the same terms as a person insured in Estonia. This
means that if, for example, a person insured in Germany or Finland is on a tourist trip or business trip in Estonia and falls suddenly ill, he or she will be treated under the same terms as people insured in Estonia.
However, in order to receive medical care, the person must carry a European Health Insurance Card or a replacement certificate. Medical care must be medically justified and the need for medical care must be decided by a health care provider. The duration of the patient's stay in Estonia must be taken into account when providing assistance.
If a person insured in another member state has come to Estonia for the purpose of receiving medical treatment here, then it is deemed to be planned treatment. In such a case, she or he must have a prior authorization, i.e. an E112 form or S2 certificate. If the person does not have such prior authorization, the service provider must invoice the person, not EHIF.
Medical care is provided on the basis of following documents:
- In the case of medical care required during a temporary stay in Estonia and the person has not come to Estonia for the purpose of receiving treatment here, the basis for reimbursement of the service is the European Health Insurance Card or its replacement certificate.
- If a person has come to Estonia for the purpose of receiving treatment here, the basis for reimbursement is a certificate E112 or S2.
- If a person receives medical treatment in connection with an accident at work or an occupational disease, the basis for reimbursement is certificate E123 or DA1.
In order to be able to provide medical care on the basis of forms E106, E109 and E121 (or S1 certificate), a person must first bring the respective forms to EHIF. EHIF will register these forms and the person's data are then entered into a database and he or she receives medical treatment. These insurance forms entitle posted workers, old age
pensioners, cross-border workers and their family members to receive health insurance in Estonia.
As in Italy the European Health Insurance Card is linked to the National Health Insurance Card, they may issue European Health Insurance Cards with person’s name and competent authority data replaced by asterisks. You should not accept such card.
In addition, there are European Health Insurance Cards issued, where the country code is EU. Holders of a card with EU country code must contact their employer to get reimbursement of medical expenses.
The Netherlands issue in addition to the European Health Insurance Card, a World Health Insurance Card. However, the right to free necessary medical care is available only under the European Health Insurance Card. The World Health Insurance Card must be considered as a private insurance policy.
General terms and conditions of treatment funding and general terms and conditions of primary care funding address, inter alia, the provision of health care services to a person insured in another EU member state.
- verify the existence of a European Health Insurance Card or a replacement certificate;
- assess the need for medical care and have the patient questionnaire completed;
- make and keep copies of: the European Health Insurance Card or its replacement certificate, patient document, questionnaire;
- forward the invoice for the service provided to EHIF.
First, the physician has to check whether the person has health insurance. The existence of health insurance cover for a foreign patient is verified through the EHIF database.
If the patient is in the EHIF database, i.e. as a result of the inquiry it turns out that the person is insured, he or she must be from that on treated exactly as a person insured in Estonia.
If a person does not have health insurance according to the EHIF's database, he or she must have a European Health Insurance Card or a European Health Insurance Card replacement certificate. Please note that each member state issues the card or its replacement certificate in their official language. Thus, the patient can present, for example, a card or a replacement certificate in Finnish language. You can see the samples of cards of other countries on the European Commission's website. A sample of a European Health Insurance Card replacement certificate can be seen here.
1. The patient does not have a European Health Insurance Card or a replacement certificate. In such case, it is a paid service (except for emergency medical care) and the health care provider has the right to ask the patient to pay for the service according to the price list. The price list must not set different prices for foreigners compared to local patients.
2. The patient carries a European Health Insurance Card or a replacement certificate. In such case, he or she must be provided with necessary medical care on the same terms with people insured in Estonia. Medical care must be medically justified and the duration of the patient's stay in Estonia must be taken into account when providing care. The health care provider shall decide whether the patient needs medical care or not.
Before providing necessary medical care, the health care provider should make a copy of the European Health Insurance Card or its replacement certificate and have the patient complete the questionnaire. If the patient wants to get a certificate for temporary incapacity for work, he or she must be provided with a completed E116 form.
The patient's treatment invoice must be forwarded to EHIF. From 2020, a new system for the transmission of treatment invoices has been in place. Now, when submitting an invoice in the program, the health care provider also fills in corresponding fields for the health insurance card or its replacement certificate. You do not need to add a copy of the European Health Insurance Card or its replacement certificate, patient document, questionnaire to the invoice; However, the health care provider makes copies of these documents and keeps them, because EHIF has the right to request these documents from the medical institution, if necessary.
EHIF settles the treatment invoices with the health care provider. EHIF will recover the amounts paid for the invoices from the competent authority of the patient’s country of affiliation.
The European Health Insurance Card entitles patients to receive the treatment they need during their stay. Planned treatment (the patient must come to Estonia for the purpose of receiving specific treatment) is not covered by the European Health Insurance Card.
For chronically ill patients, there is a separate list of health care services (renal dialysis, oxygen therapy, special asthma treatment, echocardiography for chronic autoimmune diseases, chemotherapy) that a physician must provide to the person as part of necessary medical care and on the basis of the European Health Insurance Card. Pregnancy and maternity care, including obstetric care, must also be provided under the European Health Insurance Card.
In dental care, a person has to pay for medical care themselves, because the dental care benefit system in force in Estonia does not allow to deduct the reimbursable amount from the treatment invoice of a person insured in the European Union immediately. A person has the right to claim benefits from the country where he or she is insured on the basis of invoices for paid services.
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).
If other European Union memeber state insurance institution begins to pay sickness benefits to a patient, who has received a necessary treatment in Estonia or who has been in Estonia for planned treatment, then the insurance institution may need additional information.
From 01.01.2021, form E116 will be replaced with medical report
To obtain this document, the patient must:
• ask the doctor who treated him or her in Estonia, to fill in the Medical report, which can be found here.
• submit the Medical report and the application (Application for Incapacity for Work Benefit in EU Member State) to the Estonian Health Insurance Fund.
•The doctor must complete all the required fields in Medical report. Completion guide for Medical report can be found here.
If you have any questions about filling in the medical report, please contact the Estonian Health Insurance Fund by phone 443 0237 or by info [at] haigekassa.ee.
Incapacity for work certificate issued in a foreign country
EHIF pays temporary incapacity for work benefit to a person insured in Estonia also on the basis of a document certifying illness issued by a foreign doctor.
A document certifying illness issued by a foreign doctor must be submitted to the employer, who will attach the employer's certificate to it.
In the Health Insurance Fund, each insured person has only one bank account where benefits are deposited. You can check your bank account on the citizen portal eesti.ee or by calling the customer service 669 6630. All transfers are made to the last submitted bank account.
At the request of the Health Insurance Fund, a certified translation into Estonian by a sworn translator must be attached to the certificate issued by a foreign doctor. The costs of translating the certificate shall be borne by the insured person.
European Union digital prescription
Medicinal products for dispensation at the discount rate
The Regulation of the Minister of Social Affairs “Conditions and procedure for the issue of prescriptions for medicinal products and for the dispensation of medicinal products by pharmacies and the format of the prescription” has approved the conditions and procedure for prescribing medicinal products and dispensing medicines from pharmacies in the EU.
If a person has provided proof of their insurance cover issued by another EU member state by presenting a respective document, he or she is entitled to medicinal products at discount rate on the same terms as those insured by EHIF. Discount medicinal products are prescribed only if a person has a medically justified indication for that. When prescribing the medicinal product, a physician must decide on the amount by considering how long the patient is going to stay in Estonia.
Formal proofs are: European Health Insurance Card, European Health Insurance Card replacement certificate, Form E112, Certificate S2, Form E123, Certificate DA1.
If a person does not submit a document certifying EU health insurance or the need for providing the medical service to him or her has not become apparent while he or she is staying in Estonia, but he or she still needs medicines due to his or her health condition, the doctor will issue a prescription without a discount.
As the digital prescription information system contains accurate and full data of the insurance certificate for the calculation of discount, it must be taken into account that when issuing a prescription without a discount only the personal identification code and country of residence need to be entered into the digital prescription. No other data should be entered, as in such case the prescription center will automatically calculate the discount.
The physician who prepared the prescription shall enter the details of the patient's identity and insurance document on the prescription in order to authorize the discount and shall keep a copy of the document certifying the EU health insurance cover with the person's medical history. If the competent authority of an EU Member State does not agree to pay the invoice to EHIF and wishes to receive for additional information a copy of the document certifying the person's insurance cover, EHIF has the right to contact the physician who provided the person with medical treatment or issued the prescription.
Medicinal products may be prescribed only by physicians, dentists and midwives who have the right to provide health care services in the Republic of Estonia for outpatient treatment of their patients. Prescription of medicinal products shall be based on the regulation of the Minister of Social Affairs “Conditions and procedure for the issue of prescriptions for medicinal products and for the dispensation of medicinal products by pharmacies and the format of the prescription” (persons and conditions specified in subsection 41 (2) of the Health Insurance Act).