Medical expenses of an insured person are paid by the Health Insurance Fund. Without insurance, people would also not be able to receive a discount on medicinal products, or financial compensation and payment for medical services, which can be very expensive. Every permanent resident of Estonia as well as all who stay here on the basis of a temporary residence permit or right of residence, if the social is paid for them, have the right for health insurance.

In addition, the state guarantees the right to health insurance for:

Working adults

In Estonia, all the insured employees paying the social tax have health insurance. An employee working under an employment contract, recipient of employment or the service fees under the contract of the Law of Obligations Act, a member of the directing body and the controlling body of a legal person, a sole proprietor and their spouses participating in the activities are entitled to health insurance. Health insurance is valid for working people, whose social tax is paid for, or who pay social tax for themselves.

These are:

• Employees working under an employment contract;
• Recipients of employment or service fees under the contract of the Law of Obligations Act;
• Members of the directing body and the controlling body of a legal person;
• Sole proprietors and their spouses participating in their activities.
 

Employees with at least a one-month contract are legally entitled to health insurance. The validity of the employee’s health insurance must be cared for by the employer. As of 1 July 2014, an employment register was established by the Tax and Customs Board in which the employer is required to register the working data (the start, pause, and termination of employment) of all of their employees. The data for the health insurance of the employees or for termination of the insurance shall be communicated to the Health Insurance Fund by the Tax and Customs Board. However, it may happen that in the event of exchanging a job, the employer forgets to communicate the information of the employee to the register. The fact that the employer has failed to submit the necessary data to the insurance fund may become evident unexpectedly, for instance at the doctor’s office when extending one’s usual prescription. Thus, when taking up a new position, it makes sense after some time of working to check the validity of the insurance on one’s own. This can be done in the state portal at www.eesti.ee or by calling the Health Insurance Fund information line 16363. Health insurance is valid for two months after the termination of the employment contract.

The unemployed

All unemployed people registered in the Unemployment Insurance Fund also have health insurance:

• Unemployment insurance recipients are covered from the date on which entitlement to the benefit arises;
• Unemployment supports the beneficiaries from the date on which entitlement to the benefit arises;
• Unemployed people who do not receive unemployment support, from the 31st day of registration as unemployed;
• Unemployed people who participate in practical training, work practice, or at least 80 hours in employment training and do not receive the unemployment support from the first day of participation;
• Non-employed persons who have participated in nuclear disaster relief, from the day the application is filed.

A person does not have to submit documents themselves to the Health Insurance Fund for obtaining health insurance. The data for the start, pause, and stop of the insurance shall be provided by the Unemployment Insurance Fund. If the period of registration at the Unemployment Insurance Fund has expired, the health insurance is valid for another month. The exception is the recipients of the unemployment benefit whose health insurance will expire in two months. Information on the registration as unemployed, about unemployment support and benefits and on the applications and the necessary forms can be obtained from the website of the Unemployment Insurance Fund at www.tootukassa.ee or from their offices.

Children

All children up to 19 years of age, with their principal place of residence in Estonia, according to the population register, have health insurance. The insurance is valid until the day of their 19th birthday.

Pupils and students While studying in Estonia, the following persons receive health insurance from the state:

• Pupils acquiring basic education;
• Pupils acquiring general secondary education;
• Students acquiring formal vocational education, and higher education students who are permanent residents of Estonia and study in an educational institution in Estonia founded and operated on the basis of legislation or in an equivalent educational institution abroad.
• People without basic education who exceed the age of compulsory school attendance and who are acquiring vocational education or the pupils receiving vocational education on the basis of basic or secondary education;
• Students who are permanent residents of Estonia. When the schooling is finished and if the young person just stays home, his or her health insurance ends. If, after graduating from secondary school the young person does not continue their studies, does not go into conscript service nor goes to work, he or she should register as unemployed to continue their health insurance. For the young person who at the completion of upper secondary school are younger than 19 years of age, the health insurance is valid up to 19 years of age. For those who at the completion of upper secondary school are at least 19 years of age and a graduate from a secondary school within the standard period of studies, the insurance is valid for a further 3 months after graduation. For the health insurance not to be interrupted, they should continue their education or go to work no later than three months after graduating from secondary school.
 

For the young person who immediately after graduating from secondary school continues their studies in a vocational school or at a university, the state provides health insurance coverage for the entire standard period of 10 studies, and a further three months after graduation. If a student does not graduate from the school within the standard period of study (except for medical reasons), or he or she will be expelled from school, the health insurance ends one month after the end of the standard period of study or after ex-matriculation.

During the academic leave the health insurance stops, except in the case when the leave has been taken for medical reasons. The details of pupils and students shall be submitted to the Health Insurance Fund by the Ministry of Education and Research. The pupils and the students bound for study abroad must, in order for the Estonian health insurance to continue, submit to the Health Insurance Fund a document certifying the studies abroad. On the basis thereof, health insurance shall be formalized for up to 12 months. Therefore, the certificate of the studies shall be delivered to the Health Insurance Fund in each academic year.

Conscripts

For receiving health insurance, the data of the conscript shall be submitted to the Health Insurance Fund by the Defence Resources Agency. The health insurance is still valid for one month after completing military service.

Pregnant women

If a pregnant woman does not have health insurance, to obtain health insurance she must submit to the customer service office of the Health Insurance Fund a certificate issued by the doctor or midwife about the establishment of pregnancy. The insurance ends three months after the expected date of childbirth established by the doctor.

Parents

The insured is a person on parental leave raising a child who is less than three years of age, whether it be a mother, father or guardian. Also is insured:
 
• One non-working parent living in Estonia, who is raising three or more children under the age of 19 living in Estonia, of whom at least one is under 8 years of age;
• One parent, guardian or caregiver residing in Estonia with who has been concluded an agreement for care in the family and who is raising seven or more children under the age of 19 living in Estonia;
The data for receiving health insurance shall be submitted to the Health Insurance Fund by the National Social Insurance Board.
 

Dependent spouses

A legally married dependent spouse of the insured person who has less than five years to the pensionable age has the right for state health insurance coverage.

For receiving the insurance, the person who wishes to obtain the insurance must submit an application to the Health Insurance Fund. The insurance ends when the dependent reaches the pensionable age, gets divorced, or the insurance of the maintenance provider ends. If the dependent reaches the pensionable age, generally the insurance continues as the insurance of the old-age pensioner.

A dependent spouse who is raising children

A legally married dependent spouse of the insured person has the right for state health insurance coverage if he or she is raising:

• At least one child under 8 years;
• A child of 8 years of age until the completion of the 1st grade;
• At least three children under 16 years of age. 
 

In this case the provider of the maintenance must be insured as an employee, a person receiving employment or service fees under the contract of the Law of Obligations Act, a member of a directing or controlling body of a legal person or as a sole proprietor. For receiving health insurance, the documents shall be submitted to the Estonian Social Insurance Board, who will communicate the data necessary to formalize insurance coverage to the Health Insurance Fund. More detailed information on the documents can be obtained from the National Social Insurance Board phone 16106 or at the address www. sotsiaalkindlustusamet.ee. If the conditions giving the right for health insurance are no longer met, the National Social Insurance Board shall communicate to the Health Insurance Fund the data for termination of the insurance.

Pensioners 

 

The people for whom the municipal government or the city government pays the social tax for the support of caring for a disabled person also have the right to state health insurance. Their data for receiving health insurance is communicated from the local government and shall be submitted to the Health Insurance Fund by the National Social Insurance Board.

Caregivers of disabled persons 

The people for whom the municipal government or the city government pays the social tax for the support of caring for a disabled person also have the right to state health insurance. Their data for receiving health insurance is communicated from the local government and shall be submitted to the Health Insurance Fund by the National Social Insurance Board.

Voluntary insurance

If a person does not belong to any of the above groups, it is possible to enter into a voluntary insurance contract with the Health Insurance Fund. Upon entering into a contract, insurance premiums must be paid to the Health Insurance Fund.

The following persons are entitled to enter into a contract:

• People, who in two months prior to entering into a contract, have been insured at least 12 months through an employer, as a recipient of employment or service fees under a contract of the Law of Obligations Act, a member of a directing or a controlling body of a legal person, a sole proprietor, a pupil or a student;

• A person who has paid for insurance himself or herself, or for whom social tax has been paid while employed under a contract, under the law of obligations with a contract of employment or contract of service, under the law of obligations while under contract of management or a controlling body, as a sole proprietor or a spouse of a sole proprietor in the calendar year preceding conclusion of the contract at least twelve times calculated from the monthly rate established by the state budget for the fiscal year. These people may enter into a contract to insure either themselves or their dependents. Typically, a voluntary insurance contract is concluded for one year.