The required medical treatment while staying temporarily in another EU country
When planning a trip to another European Union Member States it makes sense to think in advance about what you need to know, and what to take with you to reduce costs, which may be associated with an unexpected health disorder.
The most important help that must be in the wallet is the European Health Insurance Card. On this basis, the people insured by the Estonian Health Insurance Fund can receive the medical treatment during a temporary stay in another Member State and receive treatment on equal terms with the insured people living in that country. For this, the need for health care has to be incurred during the stay in the other country, and the need for health care must be medically justified. Whether the medical care is needed, will be decided by the doctor.
The European Health Insurance Card gives the right to the necessary medical care during a stay within the European Union and the European Economic Area and Switzerland. The required medical care is not free – the patient's deductible expenses (visit, hospital charges, etc.) must be paid for according to the tariffs in the country of location.
Deductible expenses shall not be compensated for the patient. Also, the card does not cover the transport costs between countries. Therefore, we recommend on traveling to a foreign country also always take the travel insurance with the protection of the health risks. In the light of the above, the hospital should issue an invoice only for the deductible, which in turn can be submitted to the private insurance provider.
Also be sure to observe that for obtaining health care service, you turn to a state health care institution, and not to private doctors, since the EHIC is accepted only in the health care institutions belonging to the state system.
More information about the european health insurance card can be found here.
Planned medical treatment abroad
Unlike the need for medical aid caused by an emergency need for treatment in a foreign country, planned treatment represents a situation where a person goes to another country in order seek treatment there. The application form is available on the website of the Health Insurance Fund, or in customer service offices. The first option is to apply for the permission of the Health Insurance Fund for covering the cost of treatment in a foreign medical institution (for the criteria of the permission see www.haigekassa.ee). The reimbursement is made in accordance with the rates of the state that provided the treatment. The Health Insurance Fund makes an inquiry to the state where you were treated, and according to information received, shall transfer the reimbursable amount to your bank account.
In the case of a positive decision, the Health Insurance Fund will issue a document confirming the assumption of the payment of the fee and pay the medical costs incurred from abroad.
Another possibility to receive planned medical treatment abroad is Under the European Union Directive on the free movement of patients. This means that the patient who is holding a referral to a medical specialist can choose from a health care institution or a doctor from any state system within the European Union, and after treatment to seek compensation from the Health Insurance Fund. An important difference between recourse to a medical specialist on the basis of a referral in Estonia and abroad lies in the fact that while abroad the entire medical treatment must be paid for by the patient first, and then upon returning home to apply for reimbursement of the cost from the Health Insurance Fund. It must be kept in mind that the Health Insurance Fund pays only for the health services that the patient would be entitled to receive at the expense of Health Insurance Fund also in Estonia. The reimbursement is not possible in case of health care services that are not provided in or recoverable in Estonia (e.g., dental care for adults) or the services medically not indicated for the person. If the price of the service received from abroad is higher than the price in our list of health care of the Health Insurance Fund, the patient must pay the difference in price themselves. Also, the patient has to pay for the visit, co-payment fees, and travel expenses.
For receiving the compensation, an application must be submitted, the form of which is available on the website of the Health Insurance Fund or in the customer service offices, as well as to provide original invoices of the treatment, payment records, referral of the medical specialist and the summary of the treatment protocol.
More informartion about the treatment abroad can be found here.