Health Insurance

Estonia has solidary health insurance system. Solidarity in health insurance means that someone's health insurance payments or contribution to the system or access to the necessary assistance does not depend on age, income or health risks. All the medically insured people in Estonia are entitled to the same quality health care, regardless of whether or not they pay the health insurance tax.

Health insurance payments are made by the majority of the working age population, and from the social tax payable from the gross salary of a working person the treatment services also to the population groups in society who currently are not making insurance payments are compensated for. This group includes children, seniors and mothers raising small children at home, also the unemployed and pregnant women. Mutual solidarity includes the young and the old, the rich and the poor and the sicker and the healthier people. Today's working age people use the services relatively little, but health insurance payments paid from their gross wages also cover the health care costs of children and the elderly family members of the taxpayers. Also, today's working-age people will use health care services in the future when they can no longer contribute to the system. The existing funds are used on an ongoing basis to treat all people in need; no one has a personal account. 

How does Estonia’s health insurance work?

Funding for Estonia’s unified health insurance comes from the 13% insurance tax which is paid on the income of the workforce. In addition to the working people, many others are covered who are not themselves employed – children, pensioners, seniors and others. Everyone covered by health insurance in Estonia has the right to receive quality health care, regardless of whether they themselves pay the insurance tax or not.

An insured person’s medical expenses are covered by the Health Insurance Fund. Coverage extends to persons whose social tax is paid either by their employer or by themselves. In addition, the right to health care also belongs to children under the age of 19, university students, pupils, pregnant women, unemployed persons, those on maternity leave, dependant spouses, pensioners, caretakers of disabled persons, recipients of doctoral stipends, recipients of creative grants, nuns and monks who are on the national registry of faith-based organizations, and those who have entered into a voluntary contract with the Health Insurance Fund.

By its very nature, health insurance is similar to any other type of insurance. In the case of home or motor insurance, a person pays the insurance premium, so that in the event of an accident, they would be covered financially against unexpected and often considerable expenses.

Health insurance works similarly, but with the difference that the person’s contribution to the system does not depend on his or her assessed health risk but on whether he or she will pay social security contributions and the size of his or her income. Health insurance payments are made from the social tax paid by the working person and if the need arises the cost of health care is covered by the insurance.

An insured person is a permanent resident of the Republic of Estonia or a person living in Estonia by virtue of a temporary residence permit or by the right of permanent residence, who pays the social tax for himself/herself or for whom the payer of social tax is required to pay social tax. Insured persons are:

  • a person working on the basis of an employment contract;
  • a public servant;
  • a member of the management or supervisory board of a legal entity;
  • a person employed on the basis of a contract under the law of obligations;
  • a person registred at Estonian Unemployment Insurance Fund;
  • a person, who participated in the elimination of the consequences of a nuclear disaster:
  • a conscript;
  • the non-working spouse of a diplomat or a public servant;
  • the curator of a disabled person;
  • a person receiving child care allowance;
  • a dependant spouse, for whom the government pays social tax;
  • a person receiving social allowance.
According to the Health Insurance Act persons for whom no social tax is paid are considered as having equal status to the insured person.
The persons having equal status are:
  • a pregnant woman;
  • a person under 19 years of age;
  • a person receiving state pension granted in Estonia;
  • an insured person’s dependent spouse, who is no more than 5 years away from attaining the age limit for old-age pension;
  • pupils (there are age limits);
  • a student, who is permanent resident;
  • a person joining with the scheme voluntarily.

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Kui inimene on kaotanud nii töö kui ka ravikindlustuse, kuid soovib leida uut tööd ja säilitada ravikindlustuse, siis on tal võimalik ennast töötukassas töötuks registreerida. Töötu saab ravikindlustuse, kui ta on töötuna arvel olnud kuu aega.

Kui lapseootele jäänud naisel on kehtiv ravikindlustus mingil muul alusel, nt töölepingu alusel või töötuna, ei pea ta end haigekassas rasedana arvele võtma. Küll aga peab ta seda tegema juhul, kui tal ei ole kehtivat ravikindlustust. Sellisel juhul tuleb haigekassasse esitada arsti või ämmaemanda väljastatud raseda tõend, mille alusel vormistatakse ravikindlustus.

Lapsele ravikindlustuse saamiseks ei pea haigekassale avaldust esitama. Oluline on märkida lapse elukoht rahvastikuregistris, kuna haigekassas jõustub kindlustus automaatselt kõigile alaliselt Eestis elavatele rahvastikuregistris registreeritud lastele.

Kui pärast sünnitunnistuse väljastamist ei ole lapse andmed paari tööpäeva jooksul haigekassa andmebaasi jõudnud, tuleb pöörduda haigekassa klienditeenindusbüroosse või helistada klienditelefonile (+372) 669 6630. 

Eestis elaval mittetöötaval vanemal, kes kasvatab kolme või enamat alla 19-aastast last, kellest vähemalt üks on alla 8-aastane, on õigus saada ravikindlustus riigilt. Ravikindlustuse saamiseks tuleb pöörduda sotsiaalkindlustusametisse, mis edastab vajalikud andmed haigekassasse ning ravikindlustus tekib inimesele viie päeva jooksul.

/inimesele/kindlustus/vabatahtlik-kindlustusÜks võimalus on registreerida end ülalpeetavaks abikaasaks. Ravikindlustus tekib ülalpeetavale abikaasale, kellel on vanaduspensionieani aega vähem kui viis aastat. Ravikindlustuse saamiseks tuleb tal esitada taotlus haigekassa klienditeenindusbüroosse.

Teine võimalus on jääda eelpensionile ehk ennetähtaegsele vanaduspensionile. Selleks on õigus kuni kolm aastat enne vanaduspensioniikka jõudmist, kui Eestis on omandatud vähemalt 15 aastat pensionistaaži. Eelpensionile jääda soovijal tuleb pöörduda sotsiaalkindlustusametisse, mis edastab andmed kindlustuse saamiseks haigekassale.

Vabatahtliku kindlustuslepingu saab haigekassas sõlmida eelneval kahel aastal vähemalt 12 kuud kindlustatud olnud isik või tema ülalpidamisel olev isik või välisriigist pensioni saav Eesti elanik, kes ei kuulu ühtegi kindlustatud inimeste grupp

Ravikindlustuse kehtivust saab kontrollida riigiportaalist eesti.ee või helistades haigekassa klienditelefonile (+372) 669 6630.

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