Estonian health insurance is a social insurance and it relies on the principle of solidarity: the Health Insurance Fund covers the cost of health services required by the person in case of illness regardless of the amount of social tax paid for the person concerned. The Fund uses the social tax paid for the working population also for covering the cost of health services provided to persons who have no income with regard to work activities.
The purpose of health insurance in Estonia is to cover the costs of health services provided to insured persons, prevent and cure diseases, finance the purchase of medicinal products and medical technical aids, and provide the benefit for temporary incapacity for work and other benefits.
Health insurance is applicable since January 1, 1992. As of January 01, 2013 altogether 1 237 104 insured persons were registered by the Health Insurance Fund.
Health insurance in Estonia is organised by the Estonian Health Insurance Fund (hereinafter the EHIF) and its 4 local departments. The Estonian Health Insurance Fund is the only organisation in Estonia dealing with compulsory health insurance.
Where to get information?
Information on how to obtain the required medical benefits in Estonia is provided by the officials of Estonian Health Insurance Fund. Please see the contacts page.
Only medicinal products included in the EHIF’s list of medicinal products and registered in Estonia shall be compensated for. Medicinal products shall be compensated for according to the reference prices and price agreements in case they exist; in other cases the refund will be based on the product’s retail price. Medicinal products shall be compensated for on the basis of the diagnosis. Discount rates for medicinal products:
100% discount - Patient shall make an own contribution of 1.27 EUR and in case there is a reference price or a price agreement pay the sum that exceeds that price. Health Insurance Fund will cover 100% of the sum that exceeds 1.27 EUR and is below reference price or price agreement.
90% discount - Patient makes an own contribution of 1.27 EUR per prescription, pays 10% of the sum between 1.27 EUR and the price agreement/reference price, and everything exceeding the reference price/price agreement. The Health Insurance Fund shall pay 90% of the sum between 1.27 EUR and the reference price/price agreement.
75% discount - The patient makes an own contribution of 1.27 EUR per prescription, pays 25% of the sum remaining between 1.27 EUR and the reference price/price agreement and everything exceeding the reference price/price agreement. The Health Insurance Fund shall pay 75% of the amount between 1.27 EUR and the reference price/price agreement.
50% discount - The patient shall make an own contribution of 3.19 EUR, pay 50% of the sum between 3.19 EUR and the reference price/price agreement and everything exceeding the reference price/price agreement. The Health Insurance Fund shall pay 50% of the amount exceeding 3.19 EUR, but not more than 12.79 EUR per prescription.
As an exception, a compensation rate of 90% shall apply to medicinal products with a discount rate of 75% in case of the following patient groups:
- children aged 4 to 16 years;
- insured persons over 63 years of age, in addition, all persons who have been granted pension under State Pension Insurance Act.
For children under 4 years old, compensation rate of 100% is applied on all medicinal products included in the EHIF list of medicinal products.
Adults pay the full amount for dental treatment.
Children below the age of 19 receive dental treatment free of charge by the dentists who have a valid contract with EHIF. The rule applies also to persons, who have submitted a valid European Health Insurance Card, portable document S2 or DA1 to the health service provider or registered their E106, E109 or E121 forms or the portable document S1 in the EHIF.
There is no refund system in Estonia. Where the health service provider has a contract with the EHIF, all costs are directly reimbursed to it by the Fund. The patient shall pay only the amount of own contribution. If the health service provider does not have a contract, the patient must pay for the health service.
For receiving health care services please show your ID card to the health care provider. Insurance is checked on the basis of ID code. If you are not insured in EHIF, and you are not registered on the basis of form E106, E109, E121 or portable document S1 please show your European Health Insurance Card or portable document S2 or DA1.