EU information for partners
General principle regarding the provision of medical care to a person insured in another Member State during their stay in Estonia
A person insured in another EU Member State has the right to receive required medical care during their stay in Estonia, whereas the need for health care service must be medically justified, and the estimated duration when a person insured in another EU Member State is to stay in Estonia as well as the nature of health care service must be taken into consideration. The scope of providing medical care arises from the Regulation no. 987/2009 of the European Parliament and of the Council coordinating the social security schemes of different states and laying down the procedure for implementing Regulation no. 883/2004 (on the coordination of social security systems). Pursuant to the specified Regulation, Estonia is obligated to treat persons insured in another EU Member State who require medical care during their temporary stay in Estonia on equal terms with persons insured by the Estonian Health Insurance Fund.
If a person insured in another EU Member State has come to Estonia with the intention of receiving medical care, it is deemed to be a scheduled treatment and requires a prior authorisation, i.e. form E112, or a portable document S2. If the person does not have such a prior authorisation, the health care provider should issue an invoice to the person rather than to the Health Insurance Fund.
The following documents serve as a basis for providing required medical care:
- If medical care is required during a temporary stay and the person hasn’t come to Estonia with the intention of receiving treatment, the basis for compensation for the service is the European Health Insurance Card or a replacement certificate.
- If the person has come to Estonia with the purpose of receiving treatment, the basis for compensation is a standard format certificate E112 or S2.
- If a person receives medical care in connection with an accident at work or an occupational disease, the basis for compensation is a standard format certificate E123 or DA1.
Forms E106 or E121 (S1) do not serve as a basis for the provision of medical care. This form must be previously registered with the Health Insurance Board so that the person could be entered in the health insurance database.
Due to the fact that in Italy, the European Health Insurance Card is combined with the national health insurance card, it may occur that they issue European Health Insurance Cards where the data of the person and the competent authority are replaced with asterisks. This type of card must not be accepted.
In the Netherlands, World Health Insurance Cards valid all over the world are also issued alongside the European Health Insurance Card. However, only the European Health Insurance Card gives the right to receive the required medical care for free. The World Health Insurance Card must be treated as a private insurance policy.
Teises Euroopa Liidu liikmesriigis kindlustatud isikutele tervishoiuteenuste osutamine ja arvete edastamine haigekassale
- Teenuseosutaja hindab, kas arstiabi vajadus on meditsiiniliselt põhjendatud. Hindamisel on abiks patsiendi poolt täidetav küsimustik (see on saadaval eesti ja inglise keeles).
- Kui vajadus on põhjendatud, osutatakse raviteenust nii, nagu oleks tegemist Eesti Haigekassas kindlustatuga (visiiditasud ja voodipäevatasud on samasugused nagu Eesti Haigekassa kindlustatulgi, ka teenuse saamise ooteperiood on samasugune).
- Teenuseosutaja osutab teenust inimese eeldatava Eestis viibimise aja jooksul. Teenuse osutamiseks peab olema meditsiiniline vajadus.
- Tõendid S2, E112, E123, DA1 või Euroopa ravikindlustuskaart/asendussertifikaat peab olema kehtiv kogu teenuse osutamise aja jooksul. Kehtivusaeg on märgitud tõendile või ravikindlustuskaardile.
- Teenuseosutaja teeb tõendist/kaardist/asendussertifikaadist koopia ja säilitab selle koos patsiendi poolt täidetud küsimustikuga patsiendi haigusloo juures. Kui haigekassal tekib raviarvete kontrollimisel vajadus andmeid üle vaadata, siis küsitakse tõendi/kaardi/asendussertifikaadi koopiat ja küsimustikku tervishoiuteenuse osutajalt.
- Tervishoiuteenuse osutaja edastab EL liikmesriigis kindlustatud isiku raviarved haigekassale sõnumitena XML formaadis X-tee kaudu (vt ka raviarvete elektroonilise edastamise juhendit). Ühes sõnumis võib edastada nii ühte kui ka mitut arvet. Koondarved moodustab Haigekassa perioodiliselt ise (nt kord ööpäevas).
- Rahastamise allika (RTA välismaalased) alusel esitatavale raviarvele tuleb sisestada EL kindlustatu isiku- ja tema kindlustust tõendava dokumendi andmed.
- Raviarvete edastamise juhend.
- Täpsemalt saab lugeda üldarstiabi rahastamise kohta siit.
- Euroopa Liidu seadusi puudutavad küsimused: tel 603 3686 ja 603 3672.
- Haigekassa usaldusarst: tel 603 3661 (teises liikmesriigis kindlustatud inimeste raviarvete küsimused).
Certificate of incapacity for work - E115 and E116
In relation with payments of sickness benefits in another state to patients insured in a European Union member state, a competent authority of a European Union member state may ask for additional information on forms E116 and E115.
The patient’s doctor must fill in fields 3, 4 and 5 on the form E116 (and not to forget to add a stamp to item no. 4). Please fill in the form in block letters. Once the form has been filled in, please send it to the Estonian Health Insurance Fund’s Pärnu Department on the address Lai 14, 80010 Pärnu. The Health Insurance Fund will then fill in fields 1, 2 and 8 on the form E116 and prepare the form E115.
If you have any questions about filling in the form, please contact the specialists of the Estonian Health Insurance Fund’s Pärnu Department by phone at 443 0237 or by e-mail at anne.heinsoo [at] haigekassa.ee or eve.lilienthal [at] haigekassa.ee.
Certificate of incapacity for work issued abroad
The Health Insurance Fund also pays the benefit for temporary incapacity for work to an insured person on the basis of a document confirming illness issued by a doctor of another state.
The document confirming illness must be forwarded to the employer who will add a certificate of the employer (executable form in .pdf format, .doc format) and submit it to the Health Insurance Fund.
For the payment of benefits, the Health Insurance Fund records only one account number for every insured person. Regarding this, remember that if several account numbers of different banks are submitted to the Health Insurance Fund for the payment of benefits (e.g. benefit for incapacity for work, benefit for dental care, supplementary reimbursement of medicinal products, etc.), then the most recent account number is used for the payment of monetary benefits.
The receiver of the benefit can check the information regarding their account number at the citizens’ portal www.eesti.ee or by calling the customer phone of the Health Insurance Fund at 669 6630.
Information regarding account numbers can be changed at www.eesti.ee or by using the application form available on the website of the Health Insurance Fund and sending it to the Health Insurance Fund via post or e-mail. Contact information of the Health Insurance Fund can be found here.
At the request of the Health Insurance Fund, an Estonian translation certified by a sworn translator must be added to the document provided by the doctor of another state. The translation costs of the document are covered by the insured person.
European Union digital prescription
Issuing medicinal products at a discount
If a person has proven the validity of their insurance cover in another EU Member State with a standard format certificate, they have the right to receive prescription medicinal products at a discount on exactly the same grounds as a person insured by the EHIF. Prescription medicinal products at a discount are prescribed in the event that the person has a medically justified need for them. The quantity of a required medicinal product prescribed by the doctor must depend on the person’s period of stay in Estonia.
Standard format certificates are: European Health Insurance Card, replacement certificate for the European Health Insurance Card, form E112, certificate S2, form E123, certificate DA1.
If the person fails to submit a document certifying EU insurance or if the need for medical service provided to them has not emerged during their stay in Estonia but they still require medicinal products due to their health status, the doctor has the right to issue a prescription without a discount.
Because the digital prescription information system has accurate data of the document certifying insurance with regard to calculating the discount, it must be taken into account that only the personal identification code and country of residence must be taken from the insurance certificate and specified in the prescription upon drawing up and digitalising a prescription without a discount, i.e. a full-price prescription. Other data must not be specified, because in this case, the Digital Prescription Centre will automatically calculate a discount.
Prescriptions may be issued only by the doctors, dentists and midwives holding an activity licence for providing health services in the Republic of Estonia and for the purpose of out-patient treatment of persons treated by them and pursuant to the Ministry of Social Affairs Regulation “Terms and conditions and the procedure for prescribing medicinal products and issuing medicinal products at pharmacies” (persons and terms and conditions specified in subclause 41 (2) of the Health Insurance Act).
The doctor who drew up a prescription with a discount will preserve a copy of the document certifying EU insurance with the person’s medical history. If a competent authority of an EU Member State does not agree to pay the bill to the Health Insurance Fund and requests a copy of the person’s document certifying insurance as additional information, the Estonian Health Insurance Fund will have the right to turn to the doctor who provided the medical service or issued a prescription for the person in order to obtain the respective copy.