The directive establishes rules regarding patients’ right to receive healthcare services in another EU member state and for facilitating access to safe and quality cross-border healthcare services, as well as promotes healthcare-related collaboration between member states, while taking into consideration the national competency of member states in organising and providing healthcare services.
The activity of the contact point in distributing information is also based on collaboration between patient organisations and other interest groups. The participants of the collaboration network and the contact point often enter into agreements to establish the rights and obligations of the parties, as well as other conditions. The contact point also collaborates with the contact points and authorities of other European Union member states. Exact rules for the operation of the national contact point are established by the regulation of the Minister of Social Affairs. The duties of the national contact point are performed by the Estonian Health Insurance Fund in collaboration with the Ministry of Social Affairs, Health Board, and the Agency of Medicines. The work of the contact point is funded from the budget of the Ministry of Social Affairs.
Your rights: Directive 2011/24/EU
Cross-border health services are performed on the grounds of referral form by a medical specialist or family physician.
Referral form is not necessary for going to psychiatrist, gynaecologist, dermatologist and venereologist, pulmonologist (for suspected tuberculosis), ophthalmologist, dentist, and in case of trauma, to traumatologist or surgeon consultation.
The directive on patients’ rights can be found on the website of Eurlex.
Your rights: regulation 883/2004 EÜ
According to EC Regulation No 883/2004 (article 20), the compensation of regular health service costs also require a prior authorization from the health insurance office. A corresponding authorisation shall be accorded where the treatment in question is among the benefits provided for by the legislation in the Member State where the person concerned resides and where he cannot be given such treatment within a time-limit which is medically justifiable, taking into account his current state of health and the probable course of his illness.
Pursuant to EU regulation No 883/2004 (article 19), an insured person and their family members, staying in a member state other than a competent member state, have the right to nonmonetary benefits that are medically necessary during their stay, taking into consideration the nature of the benefits and the presumable length of the stay. Such benefits are provided by a facility of the member state of the visit and in the name of a competent authority in accordance with their applicable legislation, as if the persons concerned were insured pursuant to this legislation.
Regulation No 883/2004 EU can be found on the website of Eurlex.
Your rights: Health Insurance Act § 27
For the compensation of regular health service costs you also require a prior authorization from the health insurance office.
Pursuant to Health Insurance Act § 27 section 3, following criteria must be met for referral to medical treatment in a foreign state if:
1. the health service applied for or alternatives to such health service are not provided in Estonia;
2. provision of the health service applied for to the insured person is therapeutically justified;
3. the medical efficacy of the health service applied for has been proved;
4. the average probability of the aim of the health service applied for being.
Conditions and procedure established by law for receiving cross-border healthcare service benefits and prior authorisation, as well as the limits of reimbursements regarding cross-border healthcare service are highlighted in section 662–4 of the Health Insurance Act.
Section 27 of the Health Insurance Act can be found on the website of Riigiteataja.
See more: patients’ rights and appeal options; table comparing treatment options and benefits; applying for prior authorisation for planned treatment abroad.