Medical care for people working in Europe

Arstiabi Euroopas töötajaleIf a person insured by the Estonian Health Insurance Fund works for an Estonian employer in another European country or stays there for more than six months, Estonia will still be his or her country of affiliation. This means that while living in another country, he or she will receive any medical care there on equal terms with those insured there, but as a country of affiliation, Estonia will compensate the other country for his or her medical expenses.

In order to receive medical care abroad, a person or his/her employer must apply for the S1 certificate, depending on whether he/she is a cross-border worker, an employee posted from Estonia to another EU Member State, the European Economic Area member state or Switzerland, or an employee in several countries.

  • Cross-border worker - a person insured by an Estonian employer and who works in Estonia but returns to his/her country of residence in an European Union member state, the European Economic Area member state or Switzerland at least once a week.
  • Posted worker - a person insured by an Estonian employer and who is sent on a long-term posting (more than six months) into another European Union member state, the European Economic Area member state or Switzerland.
  • Worker in several countries - a person insured by an Estonian employer and who works for his/her employer in two or more EU member states, the European Economic Area member state or Switzerland but does not work in his/her country of residence.

In order to obtain an S1 certificate, a person or his/her employer must submit an application to EHIF, the forms of which can be found on the EHIF's website

With these certificates, the worker and, if necessary, his/her family members are able to receive medical care in another country on equal terms with people living in that country.

Employees posted from Estonia to another European country

Posted worker is a person insured by an Estonian employer and sent on a long-term posting (more than six months) into another European Union member state, the European Economic Area member state or Switzerland.

Employees posted from Estonia to another European country must be registered by their employer with the Social Insurance Board in advance. The Social Insurance Board issues an A1 certificate (certificate concerning the applicable legislation) for each employee. In case of long-term postings of a worker lasting more than six months, the worker himself or his employer may apply to EHIF for an S1 certificate application forms.

This certificate provides the worker with the right to register in the health insurance system of the country of posting and, once registered, enables the posted worker to receive medical care in the country of posting on the same terms as insured persons there (the scope of medical care is wider than just emergency medical care received under the European Health Insurance Card). In this case, the person's country of affiliation is still the sending country - Estonia.

Example: An employee is sent from Estonia to work in France - his or her country of affiliation is Estonia, because the person's employer is in Estonia and the social tax paid on his or her salary is received in Estonia. A posted worker is entitled to receive medical care in France in accordance with the legislation there, but Estonia will compensate to France for his or her medical expenses.

An S1 certificate shall be sent to the address indicated in the application. S1 certificate cannot be issued for postings of less than six months. In such case, the posted worker should order a European Health Insurance Card, which entitles him/her to receive necessary medical care in the country of employment on the same terms as insured persons there (the worker must pay the deductibles him/herself). Holders of S1 certificate must also apply for a European Health Insurance Card from the Estonian Health Insurance Fund before going on a posting. By presenting the card, a person receives necessary medical care in another Member State of the European Union, a Member State of the European Economic Area or Switzerland where he/she is not posted to work with an S1 certificate, but where, for example, he or she spends his or her holiday.

Family members

If a worker on a long-term posting takes his or her dependent family members to another country, these family members are entitled to an S1 certificate. The laws of the new country of residence determine who is considered a family member and who is entitled to benefits. The competent authority of the other country shall decide whether or not to register the S1 certificate issued to the family member. Each person applies for an S1 certificate separately for him/herself and his/her family member. Once the certificate has been registered, family members residing in another Member State are also entitled to medical care under the same conditions as insured persons there.

Who pays incapacity for work benefits in case of a longer posting?

Despite the fact that a posted worker is working in another country, his or her taxes are still paid in Estonia and his or her country of affiliation is Estonia. Sickness and maternity benefits are paid to posted workers by the Estonian Health Insurance Fund in accordance with the Health Insurance Act.

Employees posted to Estonia from other European countries (S1 certificate)

People posted to Estonia for a longer period of time who live here on the basis of the right of residence are entitled to any medical care in Estonia on equal terms with those insured by the Estonian Health Insurance Fund, if they have an S1 certificate issued from their home country.

S1 certificate must be registered with the Estonian Health Insurance Fund. Bring the certificate to the EHIF's customer service office or send it by email. Please attach to the certificates the completed application "Application for registration of an insured person and/or his/her family members in another EU Member State".

Family members

According to Estonian legislation, the following are considered to be family members who receive health insurance in Estonia together with a posted worker:

  • children under the age of 19;
  • an unemployed spouse raising one child under the age of 8 or three children under the age of 16;
  • a spouse with less than 5 years to the retirement age.

After the S1 certificate is registered, the person will be notified in writing of the granting of health insurance. When visiting a doctor in Estonia, you must show your ID with Estonian personal identification code (ID card, passport). The European Health Insurance Card is issued to a person by his or her country of affiliation and with the card him or her are entitled to receive necessary medical care in another European country where he or she is not posted to work with an S1 certificate, but where he or she spends his or her holiday.

Who pays incapacity for work benefits in case of a longer posting?

The incapacity for work benefit is paid by the person's home country, i.e. the country that has issued the S1 certificate.

Worker with permanent residence in another EU Member State

Cross-border worker

A cross-border worker is a person who is employed or self-employed in a Member State of the European Union, a Member State of the European Economic Area or Switzerland and resides in another of the above countries to which he or she returns regularly every day or at least once a week.

In order for a cross-border worker to receive an S1 certificate from Estonia, he/she must submit an application to the Estonian Health Insurance Fund. When processing the application, the Estonian Health Insurance Fund may request a copy of a person's employment contract, copies of tickets, etc. in order to find out the details that may prove his or her weekly border crossing.

For example, if a person works in Estonia, but travels to Finland with his or her family at least once a week, Estonia will remain his or her country of affiliation because his or her employer is in Estonia and the social tax paid on his or her salary is paid to Estonia.

An S1 certificate issued by the Estonian Health Insurance Fund entitles a person to register with the health insurance system of the country of residence. This means that a cross-border worker is entitled t to receive medical care under the same conditions as the insured there according to the legislation of the country of residence, but Estonia will later reimburse his her medical expenses to his/her country of residence (the scope of medical care is wider than that provided under the European Health Insurance Card).

Holders of S1 certificate may apply to the Estonian Health Insurance Fund for a European Health Insurance card. The card entitles a person to receive necessary medical care in a country where he or she is not registered with an S1 certificate, but where, for example, he or she is on holiday or on a short-term posting.

Family members

If dependent family members live with the cross-border worker and do not have health insurance in the country of residence, they are entitled to an S1 certificate. A separate S1 certificate is issued to each member of the family and the competent authority of the country of residence will register it or not. The laws of the country of residence determine who is considered a family member. Once the certificate has been registered, family members residing in another member state are also entitled to medical care on the same terms as insured persons there.

Who pays incapacity benefits to a cross-border worker?

A cross-border worker who works in Estonia but lives in another member state is a member of the Estonian social security system and his country of affiliation is Estonia. Consequently, sickness and maternity benefits are paid to a cross-border worker by the Estonian Health Insurance Fund in accordance with the Health Insurance Act.

A parent on parental leave living in another European country

A person who has an employment contract with an Estonian employer, but who is on parental leave with a child under the age of three and who has settled permanently in another EU Member State, European Economic Area member state or Switzerland for family reasons, can apply for an S1 certificate from the Estonian Health Insurance Fund. For this, a person has to send an application to the Estonian Health Insurance Fund.

Example: Anna has an employment contract with an Estonian employer. After maternity leave, Anna goes on parental leave and moves permanently to live with her child's father, who works in France. In order to receive an S1 certificate from the Estonian Health Insurance Fund, Anna's permanent residence must be in another EU member state on the basis of the Estonian population register and her health insurance suspended by her employer.

An S1 certificate issued by the Estonian Health Insurance Fund entitles Anna to register with the health insurance system of the country of residence or in this case French health insurance system. This means that she is entitled t to receive medical care under the same conditions as insured people of her country of residence according to the legislation of the country of residence, but Estonia will later reimburse her medical expenses to her country of residence (the scope of medical care is wider than that provided under the European Health Insurance Card).

Holders of S1 certificate may apply to the Estonian Health Insurance Fund for a European Health Insurance card. The card entitles a person to receive necessary medical care in a country where he or she is not registered with an S1 certificate, but where, for example, he or she is on holiday.

Family members

If dependent family members live with an employed person and do not have health insurance in the country of residence, they are entitled to an S1 certificate. A separate S1 certificate is issued to each member of the family and the competent authority of the country of residence will register it or not. The laws of the country of residence determine who is considered a family member.  Once the certificate has been registered, family members residing in another member state are also entitled to medical care on the same terms as insured persons there.

 

Worker and family members living in different countries

A person living and working in Estonia has family members who live in another EU Member State

If a person starts living and working in Estonia (his/her social tax is paid in Estonia and he/she receives health insurance as an employee), but his/her dependent family members remain in another EU member state, EEA member state or Switzerland where they do not have health insurance, the employee can apply for an S1 certificate from the Estonian Health Insurance Fund for his/her family members.

For family members to receive health insurance with an S1 certificate in their country of residence, you must go through the following steps:

  1. The employee submits an application to the Estonian Health Insurance Fund for an S1 certificate. A separate application for an S1 certificate is submitted for each family member.
  2. After verifying the insurance and residence details, EHIF forwards the certificates to the employee's family members, who should register the certificates with the health insurance institution of their home country.
  3. Family members who have received an S1 certificate from the Estonian Health Insurance Fund receive a European Health Insurance Card from the Estonian Health Insurance Fund. You can read more about the benefits available under the European Health Insurance Card and how to order the card on our website.

Pawel, who is from Poland and whose family stayed there, started working in Estonia and he has health insurance here. Her husband, Marta, lives in Poland but does not work there. If Pawel worked in Poland, Marta would be entitled to health insurance there. Consequently, in accordance with Regulation 883/2004 in force in the European Union, Marta is entitled to health insurance in Poland as a dependent spouse of a person working in a EU member state. For this, Pawel must contact the Estonian Health Insurance Fund and apply for an S1 certificate. The S1 certificate will be sent to Marta, who must contact the Polish health insurance institution and register the certificate there. If Marta wants to travel to another EU member state, then in order to prove her right to receive necessary medical care during her stay, Marta must bring a European Health Insurance Card, which she can order from the Estonian Health Insurance Fund. 

If a person goes to work in another EU member state, European Economic Area member state or Switzerland (his/her social tax is paid in another country and he/she receives insurance from another country), but his/her dependent family members stay in Estonia then the family members will be granted health insurance by the Estonian Health Insurance Fund after registering the certificate issued by the new country of employment. For this, the employee must apply to the competent authority of his/her country of employment for an S1 certificate for family members who have remained in Estonia, which must be then sent to the Estonian Health Insurance Fund for registration. After registering the certificate, family members will be granted health insurance. EHIF also sends family members a respective notice.

For the purposes of the Health Insurance Act, the following persons are deemed to be dependent family member:

  • persons with up to five years left until attaining the retirement age who are maintained by their spouses who are insured persons;
  • a dependent spouse of an insured person who is raising at least one child under the age of 8 or an 8-year-old child until the end of grade I or at least three children under the age of 16 and whose spouse is an insured person of a EU member state, EEA member state or Switzerland.

People insured under a S1 certificate receive a European Health Insurance Card from the institution where the employed person is insured. You can read more about the benefits available under the European Health Insurance Card on our website.

Example

Toomas started working in Finland and has health insurance there. Her wife, Maarika, lives in Estonia. Maarika does not work, but raises their five-year-old child. Thus, in accordance with Regulation 883/2004 in force in the European Union, Marta is entitled to health insurance in Finland as a dependent spouse of a person working in a EU member state. For this, Toomas must contact the Finnish competent authority Kansaneläkelaitos (hereinafter KELA) and apply for an S1 certificate. The S1 certificate must be submitted to the Estonian Health Insurance Fund together with the application available on the EHIF's website.

EHIF registers the certificate and notifies Toomas thereof in writing. If Maarika wants to travel to another EU member state, then in order to prove her right to receive necessary medical care during her stay, Maarika must present a European Health Insurance Card. Maarika can order it from KELA.

Incapacity for work certificate forms E115 and E116

When a relevant institution of a EU member state pays sickness benefit to a patient who is insured in a EU member state and has received necessary medical care or planned treatment in Estonia, the institution may need additional information on forms E116 and E115. 

To obtain these forms, the patient must:

  • ask the doctor who treated him/her in Estonia to fill in form E116, which can be found here.
  • submit the E116 form together with the application (application for incapacity for work benefit forms E115 and E116) to the Estonian Health Insurance Fund.
  • On form E116, the attending doctor must complete fields 3, 4, and 5 (the doctor must add his/her stamp to field 4). Please send the completed form by mail to the Estonian Health Insurance Fund in Pärnu at Suur-Jõe 63, Pärnu 80042. EHIF then fills in fields 1, 2 and 8 on form E116 and adds form E115.


If you have any questions about how to fill in the form, please contact the Estonian Health Insurance Fund by phone 443 0237 or e-mail 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.

Certification of insurance periods - Form E104

Form E104 is issued to a person based on an application.
1. The application entitles persons to apply for certification of insurance periods valid in the Health Insurance Fund.
2. The application entitles persons to apply for certification of insurance periods expired in the Health Insurance Fund.

Attention!

By submitting the application you can request EHIF to terminate your insurances. Termination of insurance in one country is necessary for the insurance period to start in another country. A person can only have one country of affiliation.

  • child
  • old age pensioner
  • dependent spouse
  • pregnant woman
  • foreign student

EHIF does not terminate insurance covers on other bases (e.g. employee, person receiving childcare allowance). In such case, a person must first turn to the company that provided them insurance and apply there for the termination of insurance cover. For example, an employee should apply to their employer, a caregiver of a person with a disability to a local government, a person receiving childcare allowance to the Social Insurance Board.

Send or take the application to a customer service office where the insurance cover of persons indicated on the application is terminated, if necessary. Pursuant to the Population Register Act, the population register must be notified of your new residence if you are moving to another EU member state.

EHIF cannot terminate the abovementioned insurance cover until a corresponding note has been made in the population register!

The customer service offices will send form E104 to the address indicated on the application.

You can check the validity of your health insurance cover by calling the EHIF's customer service +669 6630 (Mon-Fri 8:30am to 4:30pm).

Application for obtaining certificate E104.