Persons insured by the Estonian Health Insurance Fund, who are staying temporarily in another Member State, receive required health care on equal terms to insured people living in such country.
Medical necessity must incur during a stay in another country; it should be medically justified, and the doctor has to take into account the expected duration of the stay and nature of health care.
Medical necessity also includes pregnancy-related consultations and giving birth in another state for family reasons or under extraordinary conditions and services required for chronic illnesses, such as kidney dialysis, oxygen therapy, specialized care of asthma, echocardiography in chronic autoimmune diseases, chemotherapy-related illnesses).
To receive medical treatment, a patient should provide to medical institution their European Health Insurance Card (EHIC), or a replacement certificate and an identity document. The right to receive health services on the basis of the EHIC is only in these medical institutions that belong to the public health care system (it does not include private clinics). If a person receives medical care in relation to accident at work or occupational disease, they are compensated on the basis of formal certificate E123 or DA1.
NB! Please note that the EHIC does not cover all costs that may accompany necessary medical care. The patient shall pay the self-liability fees (visitation fee, in-patient fee, co-payment, etc.) according to local rates. EHIC does not cover transnational transport costs or private doctor fees. We recommend concluding a travel insurance contract at a private insurance company. Depending on the insurance conditions, this contract will ensure the reimbursement of the patient’s personal expenses. This service is provided by private insurances and the Health Insurance Fund does not regulate this field. Using the European health insurance card or its replacement certificate is not allowed if the person does not have health insurance. In Estonia, health insurance is verified with an identification document.
Sample of the card (.jsp)
The EHIC allows receiving necessary medical treatment in the following countries:
Austria, Belgium, Bulgaria, Spain, Netherlands, Croatia, Ireland, Iceland, Italy, Greece, Cyprus, Lithuania, Liechtenstein, Luxembourg, Latvia, Malta, Norway, Poland, Portugal, France, Sweden, Romania, Germany, Slovakia, Slovenia, Finland, Great Britain, Switzerland, Denmark, Czech Republic, Hungary.
How to apply for a card?
EHIC and its replacement certificate can only be applied for by persons with valid health insurance. EHIC will be delivered within 10 days. EHIC is free of charge
The card can be applied for:
- through the citizen portal http://www.eesti.ee,
- by bringing an application personally to a customer service office,
- by sending an application to the Health Insurance Fund’s customer service office via regular mail,
- by sending a digitally signed application to the Health Insurance Fund by e-mail to firstname.lastname@example.org.
The application form in Estonian is available on the Health Insurance Fund’s website, offices of Eesti Post, and at the Health Insurance Fund’s customer service offices.
You can order EHIC via regular mail to a specified address, to your address in the population register, or have it delivered to a Health Insurance Fund’s customer service where you can collect it from. After submitting an application for a EHIC you need to confirm it. EHIC can be applied for by a person who is at least 15 years old and has a passport or an ID card. A parent or a representative can apply for the card for a child of under 19 years of age. When represented by another person, according to the law, it is possible to order the card by submitting an application on paper or a digitally signed application to the Health Insurance Fund. An application must be accompanied by a document certifying the right of representation.
EHIC is issued to persons under 19 years of age with the validity period of 5 years, but for no longer than up to becoming 19 years old. EHIC is issued to persons at least 19 years old with the validity period of 3 years, but for no longer than for the presumable duration of the person’s health insurance.
To order a new health insurance card, you must first cancel the previous one. You can do so by calling the information phone of the Health Insurance Fund at (+372) 669 6630. You can then order a new card at the state portal. You can also bring the application for the card to a client service office of the Health Insurance Fund or send it by post or e-mail, in which case it must be digitally signed. The application is available on the website of the Health Insurance Fund.
6. If the period of validity of the EHIC is expiring and I want a new card, do I have to make a new application or can it be received on the basis of an existing card?
In order to receive a new EHIC you have to submit a new application. The new card can be ordered a month before the old card expires.
7. How fast can I receive EHIC and how long will it remain valid?
If you order EHIC to a health insurance fund office, it can be obtained in 7-10 days. When ordering your card to your home it will arrive a little bit faster. EHIC is valid for three years if the person is medically insured. For children under 19 years of age the card is issued with a validity of five years.
Is necessary medical care free of charge when you are abroad and have a valid EHIC with you?
Necessary medical care is not free - the patient must pay self-liability fees (visitation fee, in-patient fee, co-payment, etc.) according to local rates. These costs are not refundable. EHIC does not cover transport costs or private doctor fees.
9. If a student goes studying for one semester through a student exchange program to another country outside of the EU, how will he/she get health insurance?
In Estonia he/she will have a valid health insurance because during the exchange program he/she will stay in his/her school list. However, EHIC does not apply outside of the EU, he/she must turn to a private insurance company and buy a travel insurance with health insurance for that period.
10. A student is starting his/her studies in an university in the EU. Will his/her health insurance be discontinued in Estonia? How could he/she receive a health insurance while studying in another country?
Students (including pupils) who go to study abroad have to submit a foreign school´s certificate to the health insurance fund in order to continue their health insurance. The certificate must contain the following information: student's personal identification number, first name and last name, the data of the university and the duration of studies.
In order to receive necessary medical care in another EU country on equal terms to the insured people living there, you have to apply for an EHIC. The health insurance is formalised for 12 months maximum, therefor we ask you to remember to send a verification of your studies to the health insurance fund on each academic year.
11. How can an Estonian citizen get health insurance when he/she is planning to start working in another EU member state?
If an Estonian citizen starts working in another EU member state and the taxes will be paid there, he/she will receive health insurance from that state. However he/she cannot have a existing health insurance in Estonia at the same time.
12. If a person works in several EU countries, which country will he/she receive health insurance?
If a person works in a number of EU member states, he/she will receive health insurance from the state where he/she pays social security contributions.
13. Can a foreigner, who is working in an Estonian company under an employment contract, receive health insurance under the same conditions as a citizen of Estonia?
If a person starts working under an employment contract and his social tax will be received in Estonia, then the employer shall also enlist him in Estonian Tax and Customs Board. To do this, the person should have an Estonian identification code and he/she cannot have health insurance in another EU country at the same time. Further information can be found here: http://www.haigekassa.ee/en/people/health-insurance
14. Where should a person begin and which documents he/she has to present to EHIF if he/she wishes to go abroad for a specialist doctor consultation? Does EHIF reimburse all costs?
In such case there are several options. Table comparing treatment options and benefits can be found here. Firstly if a person chooses to go abroad under the legislation of the Directive 2011/24, then he/she needs a referral from a family or private doctor. Persons will pay all invoices themselves on site and will be reimbursed later, reimbursements are made in accordance with the Estonian price list (co-payments and other non-medical costs such as transportation and accomodation are not reimbursed). All of the documents that a person needs to submit can be found here.
Secondly a person can submit an application to the health insurance fund under the legislation of Regulation (EC) No 883/2004 art 20 and under Health Insurance Act section 271. Applications that do not come with a council decision will be processed longer, because then the health insurance fund has to request the decision themselves. Further information can be found here.
The health insurance fund covers only the costs of people who have received the prior authorization on the basis of the form E112 or the letter of guarantee. When a person goes abroad to receive planned treatment before getting the prior authorization from EHIF and submits an application and invoices for reimbursement after the treatment, the health insurance fund cannot compensate the cost of treatment in local rates of the country that provided healthcare. In this case the compensation is only possible in accordance with the Estonian price list (legislation of the Directive 2011/24).
15. A person wants to apply for a planned treatment abroad – he/she has all the necessary documents (application, decision of the council). The operation should be carried out quickly, but the average application processing time is 30 days. What to do in this situation – is there a way to process applications faster in case of an emergency?
The application should be submitted to the health insurance fund as soon as possible. The council decision speeds up the process and a decision can be made as an exception.
16. A person, who was formerly insured by the EHIF had a scheduled operation time. Now when the person is insured in another country does he/she have to pay for the operation?
In Estonia he/she will receive only necessary medical care for free, planned treatment is not free of charge. Information about reimbursement opportunities and operation time should be asked from the competent institution where he/she is insured. In this case he/she would have to go to the doctor in that country where he/she is insured.
17. If a woman has permanently registered her place of resident in another EU member state and is pregnant, does she have the right to receive health insurance there as an Estonian citizen? On the other hand, she wishes to see the doctor and give birth in Estonia.
If a person permanently starts living in another EU member state, then she should be insured by that country. While staying in Estonia she has the right to receive necessary medical care on the basis of an EHIC, issued by the state where she is insured. The person cannot be insured in both countries at the same time.
Costs related to pregnancy and childbirth shall be considered as necessary medical costs if the reason for going to another country is not solely to give birth. Exception is made when a women goes to another country to give birth for family reasons (spouse or parents are residing in another member state). In such cases, the accompanying medical care are additional to childbirth and are considered as necessary medical care, which is provided on the basis of the EHIC. The woman can give birth in Estonia on equal terms as persons insured by EHIF if she has a valid EHIC with her.
18. Can an Estonian citizen, who is living and working abroad and is pregnant, have free examinations when coming to Estonia? Her health insurance is not valid in Estonia because her taxes are received in another country.
Since planned examinations do not qualify as necessary medical care and she does not have Estonian health insurance, she cannot have them for free.
19. An Estonian citizen wishes to take his retired mother along with her to live in Finland. Does the mother have the right to a health insurance in Finland in full amount or does she have to pay some part of the treatment herself?
When an Estonian pensioner receives pension from Estonia, she must apply for the form E121 (application forms) from EHIF when she starts living in Finland. After the form is registered in the new country of residence she becomes entitled to all medical care equal to other pensioners of that country.
20. How can I receive the form E106 from EHIF?
When it comes to posted workers or if the person is working in several countries at the same time, then the person firstly has to submit an application to the Social Security Office to receive the form under the A1 certificate and after that has to make an application to the health insurance fund to receive the form E106. The health insurance fund proceeds from the information mentioned in the form A1 when issuing the form E106.
Once all the necessary information (the duration of the dispatch is not longer than 6 months) is available, the health insurance fund can issue the form E106, which gives the person the right to register him-/herself in the dispatched country´s health insurance institution. The form E106 is sent to the employer unless it is agreed otherwise.
Moreover, addition to the posted worker, the frontier worker and person raising a child under 3 years whose employment contract has been suspended, can request the form E106. They also have to submit an application to the health insurance fund.
21. How can I get the form E104 from EHIF?
The form E104 is issued to people upon request. Firstly the health insurance should be canceled in Estonia. According to the Population Law, when living in another EU member state you have to inform the population register about your new place of residence, the health insurance fund cannot end the insurance before this.
The form E104 confirms that your health insurance in Estonia has ended. The application to obtain confirmation can be found here. A completed application can be brought to a health insurance fund customer service office, you can also send it by post or by digitally signed e-mail. Contact information can be found here.