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.