An additional benefit for pharmaceuticals is monetary compensation payable to an insured person as monetary compensation in addition to the drug discount received from the pharmacy. This can be paid if the conditions for payment of compensation are fulfilled.

The Health Insurance Fund makes the payments of this benefit four times a year: in January (for the previous calendar year), April, July and October.

In particular, the supplementary benefit for medicinal products helps to compensate the cost of pharmaceuticals for persons:

• whose treatment plans include expensive medicinal products;
• who suffer from chronic conditions and, consequently, need to use medicinal products for a long period of time;
• who have to use several medicinal products at a given time.

NB! The procedure for calculation of discount prescriptions changes as of 01.01.2015.

How is the additional benefit for medicinal products calculated?

1) First, the base amount of the additional benefit for medicinal products is calculated for a calendar year:

The base amount of the additional benefit for medicinal products

N.B.:

This amount is always lower

than the amount spent on discount prescriptions

 

=

The amount spent on discount prescriptions

The expenditure made on the over-the-counter medicines, and non-discount prescription

medicines are not taken into account.

Mandatory co-payment per prescription.

Per one prescription:

- in case of 100%, 90% and 75% discount EUR 1.27;

- in case of 50%  discount EUR 3.19 per one prescription;

+

The share of the price of medicines, which is higher than the limit price or the agreed price.

2) If the base amount of the additional benefit for medicinal products is known, the additional benefit for medicinal products will be taken into account as follows: (select the appropriate period)

In case of discounted prescriptions purchased before 01.01.2015 the following calculation principles apply:

Base Amount (See poin 1)

The Health Insurance Fund will compensate...

Example

Less than 384 euro

Additional benefit for medicinal products will not be paid

Additional benefit for medicinal product will not be paid

384 - 640 euro

From the part exceeding 384 euro 50%

 

E.g., base amount 500 euro - the amount of compensatio is (500 - 384) x 50% = 58 euros

640 - 1300 euro

For the range of 384 - 640 euro 50% or 128 euro and in addition from the amount exceeding 640 euro 75%

E.g., base amount 1000 euro - the amount of compensation is 128 + (1000­ 640) x 75% = 398 euro

More than 1300 euro

Additional compensation will not be paid for the amounts exceeding EUR 1,300 - in such a case, the rate of additional benefit of medicinal products will remain 623 euro

E.g., base amount 1500 euro - will be compensated for to the maximum extent 623 euro

In case of discounted prescriptions purchased after 01.01.2015 the following calculation principles apply:

 

Base Amount (See point 1)

The Health Insuranc Fund will compensate...

Example

 

Less than 300 euro

Additional benefit for medicinal products will not be paid

Additional benefi fo medicinal products will not be paid

300 – 500 euro

50% from the part exceeding 300 euro

E.g., base amount 400 euro - the amount of compensation is (400­300) x 50% = 100 x 50% = 50 euro

More than 500 euro

90% from the part exceeding 500 euro, there is no rates per calendar year anymore.

E.g., the basic amount 1000 euro - the amount of compensation is ((500- 300) x 50%) + ((1000 – 500) x 90%) = 100 + 450 = 550 euro

For information about calculating your additional benefit for medicinal products check the State Portal at eesti.ee

Submission of an application for additional benefit for medicinal products

For the entitlement of the annual benefit, it is sufficient if the insured person or his or her legal representative has submitted a relevant application to the Health Insurance Fund.

You can submit the application:

● Via the service of the State Portal

● submit the application to the Health Insurance Fund: bring or send by mail to the customer service office, or digitally signed to the address info@haigekassa.ee