Benefits related to children

Maternity benefit

Maternity benefit is a benefit for temporary incapacity to work paid by the Health Insurance Fund to an insured person (an employee, a civil servant, a person receiving remuneration or service fees on the basis of a contract under the law of obligations, a member of the management or controlling body of a legal person, a self-employed person, a spouse participating in the activities of a self-employed person) on the basis of a maternity leave certificate in case the person does not receive income subject to individually registered social tax due to a temporary release from the their duties or economic or professional activity.

Gynaecologists, family physicians and midwives have the right to issue maternity leave certificates. A pregnant woman has the right to receive a maternity leave certificate for up to 140 calendar days when going on pregnancy and maternity leave. 

Maternity leave can commence 30 to 70 calendar days before the estimated date of delivery (at pregnancy weeks 30-36). If a pregnant woman takes the pregnancy and maternity leave at least 30 calendar days before the estimated date of delivery, she is entitled to maternity benefit for 140 calendar days. When a women chooses to go on the maternity leave later, her doctor or midwife must also respectively reduce the duration of the maternity leave certificate, so the number of the days by which the pregnancy and maternity leave of the woman commences after the said term will be deducted from the period of the maternity benefit.

If the conditions of service of a pregnant woman have been eased during her pregnancy, based on the decision of her doctor or midwife, she will have the right to receive the maternity benefit for 140 calendar days only if the pregnancy and maternity leave commences at least 70 calendar days before the estimated date of delivery. When in the above case, a women chooses to go on the maternity leave later, her doctor or midwife must also respectively reduce the duration of the maternity leave certificate, so the number of the days by which the pregnancy and maternity leave of the woman commences after the said term will be deducted from the period of the maternity benefit.

If a woman has doubts about the validity of the period of the maternity leave certificate issued to her, she should first contact the doctor who issued the maternity leave certificate.

If a woman delivers before going on the maternity leave and the pregnancy has lasted more than 28 weeks, the maternity leave certificate will be issued as of the date of delivery for 140 calendar days.

In the case of delivery before the 28th week of pregnancy, a maternity leave certificate will be issued at the 28th week, provided that the child is alive. The certificate for sick leave is discontinued on the day before the date of issue of a maternity leave certificate.

New maternity leave during the period of child care leave:

A woman who is on a child care leave and wants to take a new maternity leave and receive maternity benefits must terminate the child care leave. For this purpose, the woman should file an application for termination of the child care leave to her employer. When the woman indicates in the application the end date of the child care leave to be a day before the start date of the maternity leave, the woman does not need to return to work in the meantime. We recommend informing the employer sufficiently in advance before the start of the maternity leave, so that the employer can complete the cancellation in the employment registry in a timely manner. 

An example of calculating maternity benefits:

Mary worked on the basis of an employment contract and went on a maternity leave 30 days before the estimated date of delivery.
Since Mary is employed on the basis of an employment contract, the social tax calculated will provide the basis for the calculation of the benefit. For Mary, a social tax of 2741.81 euros was calculated in the previous year, her total taxable income was: 2741.81/0.33 = 8308.52 euros

Mary’s daily income was 8308.52/365 = 22.76 euros.
Mary will receive maternity benefit for 140 days: 140 x 22.76 = 3186.40 euros. 
Income tax is withheld from the sum 3186.40 x 0.20 = 637.28 euros

The Health Insurance Fund will pay Mary 3186.40 – 637.28 = 2549.12 euros 

Calculation of maternity benefit if a woman goes on the maternity leave later than 30 days before the estimated date of delivery:

Riina works as member of the board and goes on maternity leave 20 days before the estimated date of delivery. Therefore, her doctor or midwife must issue her a maternity leave certificate for 130 days.

Since Riina works as member of the board, the social tax paid will provide the basis for the calculation of the benefit. For Mary, a social tax of 3163.63 euros was calculated in the previous year, her total taxable income was: 3163.63/0.33 = 9 586.76 euros. 

Riina’s daily income is 9586.76/365 = 26.27 euros. 
Riina will receive maternity benefit for 130 days: 130 x 26.27 = 3415.10 euros. 
Income tax is withheld from the sum 3415.10 x 0.20 = 683.02 euros 

The Health Insurance Fund will pay Riina maternity benefit in the amount of 3415.10 – 683.02 = 2732.08 euros

NB! Social Insurance Board pays parental benefit to all persons upon the birth of a child. An employee can access the information regarding the payment of the benefit in the state portal www.eesti.ee under the service „Allowances for temporary incapacity for work".

Hambaravihüvitis rasedale ja alla üheaastase lapse emale

Alates 1. jaanuarist 2018 saavad lapseootel naised ja alla üheaastaste laste emad hambaravihüvitist kuni 85 eurot aastas, kusjuures patsient ise tasub vähemalt 15% arvest ise.

  • Hüvitist saab kasutada ainult haigekassaga lepingu sõlminud hambaarstide juures.

  • Hüvitis kehtib esmavajalikele hambaraviteenustele. Kõigi nende teenuste eest, mis ei kuulu hüvitatavate teenuste nimekirja, tuleb tasuda täishinda vastavalt hambaarsti hinnakirjale. Lisaks on teenuseosutajal õigus patsiendilt küsida visiiditasu kuni 5 eurot (v.a rasedad).
  • Soodustuse summa arvestatakse raviarvelt maha kohe maksmise hetkel ning tagantjärele ei pea esitama ühtegi avaldust ega dokumenti.
  • Hüvitise suurust ja jääki saab kontrollida riigiportaalist www.eesti.ee teenuse alt „Hambaravi- ja proteesiteenuste info“.

Ema

Hambaarst kontrollib inimese hüvitise summat haigekassa andmebaasist ning 85-eurose hüvitise saamiseks peab rasedus olema kinnitatud arsti juures, kes on haigekassa lepingupartner. Juhul, kui lapseootel naine kasutab erakliiniku teenuseid, tuleb 85-eurose hüvitise saamiseks esitada haigekassale rasedust kinnitav tõend.
Hambaravihüvitist saab kasutada täies mahus ühe kalendriaasta jooksul ning selle kasutamata osa ei kandu üle järgmisesse aastasse. Kui aasta vahetub, algab uus hüvitise arvestus. Iga aasta on võimalik hüvitist saada kuni 85 eurot.

Hüvitise näidis

  • Kui Teie hambaravi arve hüvitatavate teenuste eest on 100 eurot, siis tasute ise 15 eurot ning haigekassa hüvitab raviarvest 85 eurot. Samal kalendriaastal haigekassa Teie eest hambaraviteenuseid rohkem ei hüvita ehk järgmisel korral tasute täies ulatuses raviarve ise.

  • Kui Teie üks hambaravi arve hüvitatavate teenuse eest on näiteks 60 eurot, siis tasute teie sellest ise 9 eurot ehk 15% ja haigekassa hüvitab 85% ehk 51 eurot. Kui lähete samal aastal veel hambaarsti juurde, hüvitab haigekassa raviarvest 34 eurot ja sellega on Teie aastane 85-eurone hüvitis kasutatud.

  • Arvutamine

    Hambaravi arve 60 eurot
    15% tasub patsient: 9 eurot
    85% tasub haigekassa: 51 eurot
    Hüvitise jääk: 85– 51 = 34 eurot hüvitist veel samal aastal

Oluline on tähele panna, millisesse hüvitise sihtgruppi kuulute. Kui Teil tekib kalendriaasta jooksul õigus erinevatele hüvitistele, on Teil õigus saada hüvitist kõige suurema summa ulatuses. Näiteks täiskasvanud ravikindlustatud inimesel, kes on lapseootel või alla üheaastase lapse ema, on õigus saada hüvitist 85 eurot aastas. Kui aga teenuse osutamise päeval saab laps üheaastaseks, kehtib emale 40-eurone hüvitis, sest teenuse saamise hetkel ei kuulu ta enam 85-eurose hüvitise sihtgruppi.

Milliseid hambaraviteenuseid hüvitatakse?

Hüvitis kehtib esmavajalikele hambaraviteenustele Eesti Haigekassa on koostöös Eesti Hambaarstide Liiduga koostanud patsientide jaoks esmavajalike hambaraviteenuste paketi, mille eest hüvitist tasutakse.

Esmavajalike hambaraviteenuste hulka kuuluvad:

  • hambaarsti esmane või korduv vastuvõtt;
  • diagnostika (sh röntgenülesvõtted);
  • ravimi asetamine ja ajutise täidise paigaldamine;
  • püsiva täidise paigaldamine;
  • hamba eemaldamine;
  • mädakolde avamine ja ravimine;
  • juureravi;
  • igemealuse hambakivi eemaldamine kirurgiliselt;
  • tuimestus.

Reimbursement of pharmaceuticals related to artificial insemination

From 2018, in vitro fertilization (IVF) and embryo transfer services and pharmaceuticals are fully financed by EHIF. Previously, the Ministry of Social Affairs paid for these pharmaceuticals and services. In addition, from 2018, you do not have to apply for reimbursement for IVF pharmaceuticals after you have purchased them.

Women up to the age of 40 (incl.) are entitled to a 100% discount on the pharmaceuticals necessary for in vitro fertilization immediately at a pharmacy when buying them. At the pharmacy, they only have to pay the prescription fee, which is 2.5 euros, and the part exceeding the maximum price of the reimbursable pharmaceutical, provided that the pharmaceutical is more expensive than the reference price listed by EHIF. Ask your doctor for more information about different pharmaceuticals and in vitro fertilization.

The pharmacy offers a 100% discount for pharmaceuticals that contain the following active ingredients:

  • follitropin alpha;
  • follitropin beta;
  • ganirelix;
  • goserelin;
  • triptorelin;
  • cetrorelix;
  • lutropin;
  • corifollitropin;
  • chorionic gonadotropin alpha.

Reimbursable medicines

Reimbursable medicines

ATC code

Active substance

PREGNYL inj subst 5000 IU vial 1 ml solvent N1

G03GA01

chorionic gonadotropin

BEMFOLA 150 IU/0.25 ml solution for injection in a pre-filled pen N1

G03GA05

follitropin alpha

BEMFOLA 225 IU/0.375ml solution for injection in a pre-filled pen N1

G03GA05

follitropin alpha

BEMFOLA 300 IU/0.5 ml solution for injection in a pre-filled pen N1

G03GA05

follitropin alpha

BEMFOLA 450 IU/0.75 ml solution for injection in a pre-filled pen N1

G03GA05

follitropin alpha

BEMFOLA 75 IU/0.125 ml solution for injection in a pre-filled pen N1

G03GA05

follitropin alpha

BEMFOLA 300 IU/0.5 ml solution for injection in a pre-filled pen N1

G03GA05

follitropin alpha

BEMFOLA 450 IU/0.75 ml solution for injection in a pre-filled pen N1

G03GA05

follitropin alpha

BEMFOLA 900 IU/1.5 ml solution for injection in a pre-filled pen N1

G03GA05

follitropin alpha

GONAL-F powder and solvent for solution for injection 75 IU N1

G03GA05

follitropin alpha

OVALEAP 300 IU/0.5 ml solution for injection N1

G03GA05

follitropin alpha

OVALEAP 450 IU/ 0.75 ml solution for injection N1

G03GA05

follitropin alpha

OVALEAP 900 IU/1.5 ml solution for injection N1

G03GA05

follitropin alpha

PUREGON solution for injection 300 IU 0.36 ml N1

G03GA06

follitropin beta

PUREGON solution for injection 50 IU 0.5 ml N5

G03GA06

follitropin beta

PUREGON solution for injection 900 IU 1.23 ml N1

G03GA06

follitropin beta

LUVERIS powder and solvent for solution for injection 75 IU N1

G03GA07

lutropin alpha

OVITRELLE solution for injection in a pre-filled pen 250mcg/0.5ml N1

G03GA08

chorionic gonadotropin alpha

ELONVA solution for injection 100mcg/0.5ml N2

G03GA09

corifollitropin alpha

ELONVA solution for injection 150mcg/0.5ml N1

G03GA09

corifollitropin alpha

ORGALUTRAN solution for injection 0.25 mg/0.5 ml 0.5 ml N1

H01CC01

ganirelix

CETROTIDE powder and solvent for solution for injection 0.25 mg N1

H01CC02

cetrorelix

RESELIGO implant in a pre-filled syringe 10.8 mg N1

L02AE03

goserelin

RESELIGO implant in a pre-filled syringe 3.6 mg N1

L02AE03

goserelin

ZOLADEX implant 3.6mg N1

L02AE03

goserelin

DIPHERELINE 11.25 MG prolonged suspension powder 11.25mg N1 and solvent N1

L02AE04

triptorelin

DIPHERELINE 3.75 MG prolonged suspension powder 3.75mg N1 and solvent N1

L02AE04

triptorelin

*When calculating the benefit, the patient's own contribution of 2.50 euros of the discount prescription is not taken into account.

 

Adoption benefit

Adoption benefit is a benefit for temporary incapacity for work paid by EHIF to an insured person (employee, civil servant, person receiving remuneration or service fees on the basis of a contract under the law of obligations, member of a management or control body of a legal person, self-employed person, spouse participating in the activities of a self-employed person) on the basis of a certificate for adoption leave when a person does not receive income subject to individually registered social tax due to adopting a child.

Adoption benefit is paid for the adoption of a child under the age of 10. 

A certificate for adoption leave is issued as of the date of entry into force of judgment order for adoption. The certificate is issued by the family physician of the adopted child.

Example

  • Mary adopts 8-year old Linda. The judgment order for adoption enters into force on 1 February.  As of the same date, the child’s family physician issues Mary a certificate for adoption leave for 70 days.
    The benefit is calculated based on social tax paid for Mary in the previous year – 2,952.72 euros.
    Thus, Mary’s  income subject to individually registered social tax for the previous year is 2,952.72 : 0.33 = 8,947.64 euros.
    Mary 's average income for a calendar day is 8,947.64/365 = 24.51 euros.

  • Calculation

    Mary is entitled to adoption benefit for 70 days: 70 x 24.51 = 1,715.70 euros. 
    Income tax is withheld from the amount 1,715.70 x 0.20 = 343.14 euros. 
    Thus, Mary receives adoption benefit in the amount of 1,715.70 – 343.14 = 1,372.56 euros.