Table comparing treatment options and benefits

 

Necessary medical care - the need for medical care must occur during a stay in another country and it must be medically justified. The attending physician must consider the duration of the stay and the nature of the health care service. Necessary medical care also includes pregnancy-related visits and childbirth in a foreign country due to family reasons or as an emergency, as well as procedures necessary for treating chronic illnesses, such as kidney dialysis, oxygen therapy, special asthma treatment, echocardiography for chronic autoimmune diseases, chemotherapy.

Planned treatment – the purpose of travelling to another country is to seek treatment. This means that the need for treatment arises in one country and the treatment is performed in another country. This does not include certain chronic diseases and pregnancy that are classified under necessary medical care.

Prior authorization - an authorization requested from EHIF before starting planned treatment abroad, which ensures that EHIF will cover the costs the health care service provided abroad. If EHIF grants prior authorization, a corresponding document is issued: either a letter of guarantee, form E112/S2 or a contract.  

European Economic Area (EEA) - comprises 28 EU Member States and three European Free Trade Area (EFTA) countries: Iceland, Norway and Liechtenstein.

Deductible fee - costs that may be occur with the health care service provided abroad, but are not reimbursed by EHIF. These are, for example, visit fees, bed-day fees, accommodation expenses outside the hospital, translation expenses, travel expenses.

The European Commission has established a checklist for patients to apply for access to health care services abroad.

 

Patients' Rights
Directive
2011/24/EL

Regulation (EC) No. 883/2004 Article 20

Regulation (EC) No. 
883/2004

Health Insurance Act (§271)

Type of treatment

Planned and
necessary medical care in the EU member states, EFTA member states and Switzerland (excluding planned treatment)

Only planned treatment in the EU member states, EFTA member states and Switzerland

Only necessary medical care in the EU member states, EFTA member states and Switzerland

Only planned treatment outside Estonia.

Which health care services is a person entitled to and what will be reimbursed?

Only the health care services
that are listed in the EHIF’s list of health care services
and the services covered by EHIF in Estonia
are reimbursed.

Only the health care services
that are listed in the EHIF’s list of health care services and
the services covered by EHIF in Estonia
but which cannot be provided during a medically justifiable period of time.

The reimbursement applies to health care services that belong to reimbursable services in that country

Persons are entitled
to receive health care services
that are
listed in the social insurance
reimbursements
of that
country.

The reimbursement applies to health care services
that are not provided in Estonia but are prescribed for persons,
proven to be medically effective,
and the probability of achieving the aim
is at least 50 per cent.

Which medical
institutions can I turn to?

Public and private medical institutions

Public medical institutions only

Public medical
institutions only

Public and private medical
institutions

Is prior
authorization
from EHIF
required?

NO

Pursuant to the Estonian Health Insurance Act, a referral from a family physician or private doctor is required

 

YES

If authorization is granted, form E112/S2 is issued

 

NO

NO

The European Health Insurance Card or its replacement certificate is required.

 

YES

If authorization 
is granted, 
a letter of guarantee or 
form E112/S2 is issued, 
or a contract is  
signed with persons.

 

Who is reimbursed and how?

Persons are reimbursed directly, after they have received the health care service.

Invoicing
will take place
between competent national authorities
(health insurance funds), i.e. no monetary reimbursement is made to persons.

Persons are reimbursed directly, after they have received the health care service.

 

Invoicing  
will take place 
between competent national
authorities
(health insurance funds), 
(health insurance funds), i.e. no monetary reimbursement is made to persons. 

Directly to 
the medical institution of the foreign country
or between national competent  
authorities,
in special cases,
also directly to persons
after healthcare services have been provided
the health care service.

What does a person have to pay for when receiving treatment abroad?

Persons will pay
all invoices on site
and will be reimbursed
retrospectively.

Only co-payments according to local rates of the country that provided the health care service. Deductibles may apply.

Persons will pay all invoices on site and will be reimbursed
retrospectively.

Only co-payment
according to local rates of the country that provided the health care service.

Only co-payments  according to local rates of the country that provided the health care service. Deductibles may apply.

Under which
price list
are the reimbursements/payments
made?

Persons are are made in accordance with the Estonian price list (co-payments, etc. are not reimbursed)

Persons are not reimbursed directly, are made in accordance
to the price list
of the foreign country.

Reimbursement is made according to local rates of the country that provided the health care service.

Persons are not reimbursed directly, but invoicing is made according
to the price list of the foreign country

According to the price list
of the foreign country. (co-payments, etc.
are not reimbursed)

Where can I find more information?

Reimbursement of treatment costs in the EU

Planned medical treatment abroad

Reimbursement of treatment costs in the EU

European Health Insurance Card

Planned treatment abroad