Planned medical treatment abroad

  • Due to the spread of the Coronavirus, travelling abroad is not recommended.
  • If you are already in a European country, necessary medical care is provided to people insured in Estonia on equal terms with insured people living in that country.
  • However, patients who are planning to go abroad for treatment are asked to make sure that they can enter the country and that the foreign hospital has the capacity to provide the agreed healthcare.
  • Please assess the necessity of planned treatment abroad with your attending physician in Estonia who referred you to the treatment abroad. Whenever possible, treatment abroad should be postponed and the attending physician should be asked to make changes to the treatment.
  • Patients who have already received treatment or are still receiving treatment and who cannot return home due to lack of transport or border closures, please read the recommendations on the website of the Ministry of Foreign Affairs https://vm.ee/en/koroonaviirus-2019-ncov.
  • EHIF considers the need to extend the letters of guarantee for treatment abroad and forms E112 or S2 on a case-by-case basis. Please send an application for an extension only if you have agreed in advance with the foreign medical institution the exact time of treatment.
  • In case of an emergency treatment, the attending physician will communicate directly with the Estonian Health Insurance Fund.

Persons insured by EHIF can go to another European Union (EU) member state, as well as Norway, Iceland and Liechtenstein to receive planned treatment there and apply for reimbursement from the EHIF. In certain cases, EHIF reimburses the costs of planned treatment even if the treatment has been provided elsewhere than in the above-mentioned countries.

To receive planned treatment abroad (in the EU or elsewhere), you must first apply for prior authorisation from EHIF to fund the healthcare service (for more details, see authorization for planned treatment abroad). The prior authorization ensures that EHIF will pay for the health care service abroad. If EHIF grants prior authorization, a corresponding document is issued: either a letter of guarantee, form E112/S2 or a contract.

There are three ways to get reimbursement from EHIF for planned treatment abroad.

1. Apply for prior authorization from EHIF to cover necessary medical expenses in a medical institution of an EU member state or Norway, Switzerland, Iceland, Liechtenstein. This option is intended for those insured persons who have medical indication to receive a health care services that are also provided in Estonia, but cannot be provided to the patient during a medically justified period of time. EHIF bases its decision to grant or refuse authorization on the decision of medical council. The council consists of at least two medical specialists, one of whom is the patient's attending physician (not a family physician).

In the event of a positive decision, EHIF issues a document confirming that EHIF will assume the responsibility for payments, and will pay the medical expenses incurred abroad. The patient will bear the visit and deductible fees and travel expenses. The reimbursement terms are set out in Regulation (EC) No 883/2004 of the European Parliament and of the Council.

2. Apply for prior authorization from EHIF to cover necessary medical expenses in a EU member state, EEA member state (Norway, Liechtenstein, Iceland), Switzerland or some other country. Such medical expenses are reimbursed by EHIF only if the requested health care service (consultation, treatment, study) is not available in Estonia, there are no alternative health care services and the requested service is indicated for the patient. Also, the health care service provided abroad must have proven medical efficacy and the probability of achieving the aim of the service must be at least 50 per cent. Whether a particular patient's treatment case meets the above criteria is assessed by at least two medical specialists, one of whom is the patient's attending physician (not the family physician).

In the event of a positive decision, EHIF issues a document confirming that EHIF will assume the responsibility for payments, and will pay the medical expenses incurred abroad. The patient will bear the visit and deductible fees and travel expenses. The terms of reimbursement are set out in the Health Insurance Act (§ 271, subsection 1).

3. Get treatment under the Directive on Free Movement of Patients in the EU. This means that a patient who has been referred by a medical specialist can choose any medical institution or physician in the EU member states, Norway, Iceland and Liechtenstein, and claim reimbursement from EHIF after receiving treatment. In this case you do not need to apply for prior authorization from EHIF. For certain doctors no referral is needed. You can go to a psychiatrist, gynaecologist, dermatologist, lung doctor (in case of suspected tuberculosis), ophthalmologist and dentist without a referral. Also, a referral letter is not required in case of a trauma (during one day) when consulting a traumatologist or surgeon.

Referral letter is not required in following situations:

  • the patient is a pupil or student studying in another member state and has submitted a respective certificate to EHIF;
  • the patient has been issued one of the following forms: E112/S2, E106/S1, E109/S1 or E121/S1 (i.e. persons insured under the Regulation 883/2004 art 17, art 19, art 24, art 26);
  • the patient is referred to another medical specialist during the stay abroad and he or she does not return to Estonia in the meantime;
  • the patient needs medical care while in another country (necessary medical care under the Regulation 883/2004).

Please note that Switzerland is not covered by Directive 2011/24/EU that entitles a person to seek planned treatment in another EU Member State and to claim benefits later when they return home.

An important difference in Estonia and abroad when seeing a medical specialist on the basis of a referral or in the above-mentioned case without a referral is that you must first pay for entire treatment abroad and apply for reimbursement from EHIF when you return home.

Please keep in mind that EHIF pays only for the health care services that a patient would be also entitled to receive at the expense of EHIF in Estonia. You can not apply for reimbursement of health care services that are not provided or reimbursed in Estonia (e.g. laser eye surgery). Also, a person is not reimbursed for services that are not medically indicated for him or her. If the price of the service received abroad is higher than the price in the EHIF’s list of health care services, the patient is obliged to pay the price difference themselves. The patient will also bear the visit and deductible fees and travel expenses. The terms for reimbursement are set out in Directive 2011/24 EU of the European Parliament and of the Council.

 

Applying for prior authorization for planned treatment

To finance planned treatment abroad, it is possible to apply for PRIOR AUTHORIZATION from EHIF based on two different principles:

1. Under §271, subsection 1 of the Health Insurance Act

2. Under article 20 of Regulation (EC) No 883/2004 of the European Parliament and of the Council

1. The health care service applied for or alternatives to such health care service cannot be provided to the insured person in Estonia.

2. The health care service applied for is indicated for the insured person;

3. The medical efficacy of the health service applied for has been proven;

4. The average probability of achieving the aim of requested health care service is at least 50 per cent.

1.     The health care service applied for is indicated for the insured person;

2.     The health care service applied for is provided in Estonia

and it is a service compensated for by EHIF (EHIF’s list of health care services).

3.      The health service applied for cannot be provided to the patient

during a medically justified period of time, considering the patient’s state of health and the probable course of his/her illness;

4.     The medical institution must be part of the national system of an EU member state.

In either case, you must submit an application for prior authorization (with all the data fields filled) to EHIF before travelling abroad for treatment or tests. An incomplete application can be processed only after you have provided all the missing information. The language of the application procedure is Estonian and EHIF has the right to request a translation of applications/statements submitted in a foreign language into Estonian.

If possible, please add the decision of a council of Estonian doctors to your application, as EHIF makes its decision on referral for treatment to another state on the basis of the decision by the council of Estonian medical specialists. To receive a decision of the council, you must contact your attending physician (a medical specialist, not your family physician) who will then prepare the decision of the council of at least two participating medical specialists, who shall evaluate the conformity of the service applied for with the criteria presented in the table above.

If EHIF receives your application without the decision of the council, EHIF will contact the attending physician of the applicant with a request to gather a council to determine the need for a health service and the possibility of receiving it in Estonia.

For faster processing of the case, we advise you to submit the application along with council’s decision. The processing of applications submitted with council’s decision takes about up to 30 days on average. The processing of applications sent without council’s decision takes 2 months on average.

Applications can be submitted:

  • at EHIF’s customer service offices 
  • by regular mail, sending them to the address of the Estonian Health Insurance Fund, Lastekodu 48, Tallinn 10144. 
  • by e-mail. Please note! As the application includes sensitive personal data, we advise you to agree on the delivery of the application via e-mail and the data necessary for encryption in advance by e-mail at valisravi [at] haigekassa.ee

In case of a positive decision

  • EHIF will issue a letter of guarantee, i.e. a document verifying that the Estonian Health Insurance Fund shall pay to the foreign medical institution after the health care service has been provided on the basis of the submitted original invoice (receipt) and the epicrisis (summary of medical history). If the medical institution does not accept the letter of guarantee, then a contract for a partial assumption of the obligation for prepayment shall be signed between the patient and EHIF. The amount of prepayment according to the contract with EHIF is agreed between the parties, but does not exceed 50% of the estimated total cost. The amount is stated in the contract on the payment for planned health care services abroad signed with EHIF.

After the contract has been signed by both parties, EHIF will transfer the agreed proportion of the estimated total costs to your bank account at the agreed time. The patient will pay the total cost of the health care services to the foreign medical institution themselves. To verify that the health services were provided and paid for, the patient must submit the original invoice (receipt) and the epicrisis (summary of medical history) to EHIF within 30 calendar days from the provision of the health care services, after which EHIF will reimburse for the remaining amount of the actual cost of health care services. If the health care service is not provided or its cost is lower than the sum transferred to the patient’s bank account by EHIF, the patient is obliged to return the remaining amount to EHIF.

  • If the medical institution of another EU member state does not accept a letter of guarantee but will accept the form E112 or S2, the patient will be provided with corresponding form. The patient must personally deliver the form E112 to the foreign medical institution. Please note! The letter of guarantee, contract and form E112 do not extend to possible non-medical expenses (patient’s self-liability, transportation costs, translation services, administrative or office expenses, accommodation outside the hospital, etc.). These are paid for to the foreign medical institution by the patient or the patient’s legal representative.

In case of a negative response 

In case of a negative response, a written notice is sent to the insured person along with the statement of grounds of denial of referral to treatment.

Please note! We recommend submitting your application as early as possible. EHIF can make a decision on the reimbursement for planned treatment abroad before the treatment takes place - we do not have the right to process applications submitted post-treatment!

For faster processing of the case, we advise you to submit the application along with council’s decision. 
The processing of applications submitted with council’s decision takes about up to 30 days on average. The processing of applications sent without council’s decision takes 2-3 months on average.