Specialised medical care
A person needs specialized care if the family doctor determines that their health concern requires the involvement of a more specialized doctor.
A referral is needed to turn to a specialist, which is issued by the family doctor. No referral is needed to turn to a(n):
- dermatologist or venereologist;
The insured person has the right to choose the specialist that is suitable to them and an appointment time in any health care institution which is under contract with the Health Insurance Fund. The fund’s contract partners serve all insured individuals, regardless of their place of residence.
Specialized healthcare is divided into three:
- ambulatory care- doctor visit in the course of which a person is examined, some procedures are done (blood test, EKG, etc.) and if needed, further treatment is determined. The patient does not remain in the hospital.
- outpatient care- when the patient is kept for longer than a simple visit but does not spend the night in the hospital.
- stationary care- given at a hospital and the patient must stay overnight or even longer.
When visiting a specialist, treatment facilities have the right to charge a patient up to 5 euros for a visit fee.
- for children below the age of 2,
- in cases related to pregnancy and childbirth,
- in the case of intensive care.
- if the patient is to be referred to another doctor at the same facility,
During a hospital stay, a patient may be charged €2.50 per day for their room, up to a maximum of €25 per hospital stay.
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 the Estonian Health Insurance Fund are entitled to receive health care services abroad based on certain criteria and to claim from the Health Insurance Fund for both monetary and non-monetary benefits for this.
Options for planned medical treatment abroad:
A. Under Article 20 of Regulation (EC) No. 883/2004 of the European Parliament and of the Council
This option is intended for those insured persons who have medical indication to receive a health care service that is also provided in Estonia, but cannot be provided to the patient during a medically justified period of time. This option is a non-monetary benefit. Required documents:
The Health Insurance Fund processes the application based on the content of the application, the decision of the medical council and the criteria set out in Regulation (EC) No 883/2004 of the European Parliament and of the Council.
In case of a positive decision, the Health Insurance Fund will issue a document (the S2 form) according to which the Health Insurance Fund will assume the obligation to pay for medical expenses incurred abroad (Member States of the European Union, Member States of the European Free Trade Area). The issued S2 form does 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.
B: Under Article 271(1) of the Health Insurance Act
The option is intended for insured persons for whom the indicated health care service or an alternative health care service cannot be rendered in Estonia. This option is a non-monetary benefit. Pursuant to the criteria set out by the Health Insurance Act, the health care service provided abroad must also have proven medical efficacy and the probability of achieving the aim of the service must be at least 50 per cent. Required documents:
In processing the application, the Health Insurance Fund proceeds from the person’s application, the evaluation given by the council and the criteria provided for in Subsection 27 1(1) of the Health Insurance Act.
In case of a positive decision, the Health Insurance Fund will issue a document (the S2 form) according to which the Health Insurance Fund will assume the obligation to pay for medical expenses incurred abroad. There are no restrictions on the choice of country, but the Health Insurance Fund may consider giving preference to a Member State of the European Union. The issued letter of guarantee or S2 form does 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.
C. Directive 2011/24/EU of the European Parliament and of the Council (Free Movement of Patients)
This option is intended for insured persons who want to receive health care services that they are entitled to receive at the expense of the Health Insurance Fund also in Estonia, in another Member State of the European Union, Norway, Iceland and Liechtenstein. In Switzerland, Directive 2011/24/EU does not apply, which means that in Switzerland, medical expenses are not reimbursed without prior authorization.
This option is a monetary benefit. Health care services that are available for Estonian insured persons only for a fee (such as adults’ laser operations to correct vision, vaccinations performed outside the national immunization plan) or are not indicated for a patient cannot be reimbursed.
Under this directive, prior authorization for treatment abroad is not required. At first the patient has to cover all the costs by themselves and after receiving the health care service and submitting all necessary documents they can apply to the Health Insurance Fund for reimbursement. The Health Insurance Fund reimburses the costs of health care services according to the Health Insurance Fund’s list of health care services, i.e. the price list, so if the services are more expensive abroad, the exceeding part of the costs is to be paid by the patient.
A referral from a family physician or medical specialist is also required when seeking treatment abroad on the same grounds as it would be when seeing a doctor in Estonia.
- Table comparing treatment options and benefits
- Your rights under the Directive
- Reimbursement of treatment costs in the European Union