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.
Provision of health care services to persons insured in other European Union Member States and submission of invoices to the Health Insurance Fund
Processing invoices for health care services and submitting thereof to the Health Insurance Fund
- The service provider assess whether the need for service is medically justified. The questionnaire filled in by the patient (in Estonian and in English) will help with the assessment.
- If the need is justified, the service provider will provide service as it would to a person insured by the Estonian Health Insurance Fund (visit fees, in-patient fees exactly as would apply to a person insured by the Estonian Health Insurance Fund; waiting period for receiving service will also be exactly the same).
- The service provider provides the service during the person’s estimated period of stay in Estonia (if there is a medical need to do so).
- The validity period of the authorisation specified on the standard format certificate must cover the period of providing the service.
- The service provider will make a copy of the standard format certificate/card/replacement certificate.
- A single consolidated invoice package will include medical bills for only the persons insured in another Member State.
- Upon electronic submission, the displayed department of the Estonian Health Insurance Fund must be selected and aliens (foreigners) must be selected as the type of parcel when uploading the consolidated invoice and respective medical bills as well as the appended copies. In case of submission as a paper copy, all documents must be sent to the Harju Department of the Estonian Health Insurance Fund.
- In the event that a prescription needs to be written, the data to be included in the prescription must be taken only from a standard format certificate. Estonian personal identification codes must not be specified in the prescription.
- The service provider will append a copy of the certificate/card/replacement certificate and the questionnaire filled in by the person to every medical bill upon the provision of required or scheduled medical treatment to a person insured in another EU Member State.
Electronic submission of insurance documents to the Health Insurance Fund
Medical institution can submit copies of insurance documents (European Health Insurance Card, replacement certificate, forms E112 or S2 and E123 or DA1) of insured persons from other European Union Member States as well as completed questionnaires to the Harju Department of the Estonian Health Insurance Fund electronically. In this case, medical bills and consolidated invoices do not have to be sent to the Harju Department of the Estonian Health Insurance Fund as paper copies or via e-mail.
Copies of documents certifying EU insurance must be submitted to the Health Insurance Fund in a PDF file format (PDF must be legible across all data). Each insurance document saved as a PDF file must be titled with the person’s medical bill number (for example, RH2805188). All PDF files of a single consolidated invoice must be included in one DigiDoc file. DigiDoc file must be titled with the registration number of the medical institution and the consolidated invoice number. Registration number of the medical institution and the consolidated invoice number must be separated using an underscore (for example, 90006399_35).
DigiDoc does not have to be digitally signed. Original copies of documents certifying insurance must be kept with the health care provider.
Medical bills of persons insured in the EU are submitted to the Health Insurance Fund over a secure Internet channel as a separate parcel, whereas the parcel structure must comply with the “format of an electronic parcel of medical bills”.
In the electronically submitted medical bills package, the displayed department (Harju, Pärnu, Tartu, or Viru) must be selected as the department of the Estonian Health Insurance Fund; type of parcel must be selected as alien (foreigner); data for the medical bill must be taken from the person’s standard format certificate.
DigiDoc file must be submitted to the Health Insurance Fund through Toru. The file must be uploaded to the XMLfield on the medical bills upload page.
The Estonian Health Insurance Fund will pay medical bills that are accompanied by properly formalised documents certifying insurance. A complaint will be formalised for the medical institution with regard to medical bills submitted without copies of insurance documents of persons insured in the EU, and the bill will not be paid in the respective amount.
If documents cannot be sent as PDF files, the consolidated invoice together with medical bills and copies of documents certifying insurance must be sent to the Harju Department of the Estonian Health Insurance Fund.
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.
Forms E115 and E116
In connection with paying sickness benefit for a patient insured in a European Union Member State in a foreign state, a competent authority of the European Union Member State may require additional information on forms E116 and E115.
On form E116, the person’s attending physician must fill in the boxes or fields no. 3, 4 and 5 (making sure to add their stamp to clause 4). Please fill in the form using capital letters. Once the form is completed, please mail it to Pärnu Department of the Estonian Health Insurance Fund at the address Lai 14, 80010 Pärnu. The Health Insurance Fund will then fill in the fields 1, 2 and 8 on the form E116 and complete the form E115.
If you have any questions about filling in the form, please contact the consultants of the Harju Department of the Estonian Health Insurance Fund over the phone at 443 0237 or via the e-mail address ines.kullamaa [at] haigekassa.ee, katrin.toom [at] haigekassa.ee or eve.lilienthal [at] haigekassa.ee.
Certificate of incapacity for work issued in a foreign state
The Health Insurance Fund also pays the benefit for temporary incapacity for work on the basis of a document certifying the illness issued by a doctor of a foreign state.
Document certifying the illness issued by a doctor of a foreign state must be submitted to the employer who will add the employer’s certificate (additional form in a PDF file format, Word file format) to it and submit the documents to the Health Insurance Fund together with an accompanying document.
In the Health Insurance Fund, each insured person has only one bank account on which to receive the benefit. As such, we are drawing attention to the fact that if the Health Insurance Fund has been given data regarding different bank accounts for the purpose of receiving financial benefits (benefit for incapacity for work, benefit for dental service, additional benefit for medicinal products), the transfers of all unpaid financial benefits will be made to the bank account provided last.
The beneficiary can check their bank account data using the citizen portal www.eesti.ee or over the Health Insurance Fund client information phone 669 6630.
Bank account data can be changed in the citizen portal www.eesti.ee or using the form available on the Health Insurance Fund website and submitting it to the Health Insurance Fund – either by post or via e-mail. Health Insurance Fund contacts are available here.
Upon the request of the Health Insurance Fund, a translation into Estonian certified by a sworn translator must be appended to the certificate issued by a doctor of a foreign state. The costs associated with translating the certificate are borne by the insured person.