Definitions:

necessary medical treatment – the need for medical care must occur during a stay in another country and it must be medically justified. In addition, the treating doctor must take into account the duration of the stay and the nature of the healthcare service. Necessary medical treatment also includes pregnancy-related visits and giving birth in a foreign country due to family reasons or as an emergency, as well as services necessary for chronic illnesses, such as kidney dialysis, oxygen therapy, special asthma treatment, echocardiography for chronic autoimmune diseases, chemotherapy illnesses.

planned treatment – the purpose of travelling to another country is to receive treatment, meaning that the need for treatment arises in one country and the treatment is performed in another country. Certain chronic illnesses and pregnancy are not included in this category, as it has been agreed that they are categorised as necessary medical treatment.

prior authorisation – before a healthcare service is provided, authorisation must be applied for from the Estonian Health Insurance Fund. This will ensure that the Health Insurance Fund will cover the cost of the healthcare service abroad. The following documents are issued if prior authorisation is granted: letter of guarantee, E112 form, and contract.

 

Directive on patients’ rights
2011/24/EU

Regulation (EC) No 883/2004 art 20

Regulation (EC) No
883/2004

Health Insurance Act (section 271)

Type of treatment

Planned and necessary treatment

Planned treatment only

Necessary treatment only

Planned treatment only

Which healthcare services are persons entitled to or which will be reimbursed?

Only the healthcare services that can be found on the list of healthcare services of the Health Insurance Fund and the services covered by the Health Insurance Fund in Estonia are reimbursed

Only the healthcare services that can be found on the list of healthcare services of the Health Insurance Fund and the services covered by the Health Insurance Fund but which cannot be provided during a medically justifiable period of time

Healthcare services are reimbursed in accordance with the legislation of the country that provided the services, meaning the services that are part of the social insurance reimbursements of that country

Persons are entitled to receive services in accordance with the legislation of the country that provided the services, meaning the services that are part of the social insurance reimbursements of that country

Health care services that are not provided in Estonia but are prescribed for persons, proven to be medically effective, and the probability of achieving the objective is at least 50 per cent

In which treatment facilities does this right apply?

Public and private treatment facilities

Public facilities only

Public facilities only

Public and private treatment facilities

 

Is prior authorisation by the Estonian Health Insurance Fund necessary?

 

NO

 

Pursuant to the Estonian Health Insurance Act, a referral from a family or private doctor is necessary

 

 

YES

 

If authorisation is granted, form E112/S2 is issued

 

NO

 

 

NO

 

The European health insurance card or its replacement certificate is necessary

 

YES

 

If authorisation is granted, a letter of guarantee or form E112/S2 is issued, or a contract is concluded with persons

Who is reimbursed and how?

After the healthcare service has been provided, persons are reimbursed directly

Invoicing will take place between the countries’ competent authorities (health insurance funds), meaning that there is no monetary reimbursement to persons

After the healthcare service has been provided, persons are reimbursed directly

Invoicing will take place between the countries’ competent authorities (health insurance funds), meaning that there is no monetary reimbursement to persons

Directly to the treatment facility of the foreign country or between competent authorities, in special cases, also to persons directly after healthcare services have been provided

What do persons have to pay themselves if the service is provided abroad?

Persons will pay all invoices on site and will be reimbursed later

Only co-payment according to local rates of the country that provided healthcare

Persons will pay all invoices on site and will be reimbursed later

Only co-payment according to local rates of the country that provided healthcare

Only co-payment according to local rates of the country that provided healthcare

Pursuant to which price list are reimbursements/payments made?

Reimbursements are made in accordance with the Estonian price list (co-payments, etc. are not reimbursed)

Persons are not reimbursed but invoicing is in accordance with the price list of the foreign country

Reimbursements are made according to local rates of the country that provided healthcare

Persons are not reimbursed but invoicing is in accordance with the price list of the foreign country

In accordance with the price list of the foreign country (co-payments, etc. are not reimbursed)

Where can I find more information?

Reimbursement of EU medical costs

Planned treatment abroad

Reimbursement of EU medical costs

European health insurance card

Planned treatment abroad