Benefit for temporary incapacity for work

Benefit for temporary incapacity for work is a financial compensation paid by the Health Insurance Fund or the employer on the basis of a incapacity for work certificate to an insured person (an employee, a civil servant, a person receiving remuneration or service fees on the basis of a contract under the law of obligations, a member of the management or controlling body of a legal person, a self-employed person, a spouse participating in the activities of a self-employed person) who does not receive income due to a temporary release from their work duties. Benefit for temporary incapacity for work is paid to persons for whom social security tax has been paid.

There are more than ten types of temporary incapacity for work benefits and they depend on the reason for the leave, for example, illness, maternity leave, taking care of a sick child, etc.

For EHIF to be able to pay the incapacity for work benefit, the employer must submit the data of the beneficiary to EHIF within seven calendar days after the closure of the incapacity for work certificate. EHIF will pay the incapacity for work benefit within 30 days of the date when the employer submitted the information. Normally, the Health Insurance Fund transfers the benefit money to the employee's current account within a few working days after the employer has submitted the data.

Estonia uses an electronic incapacity for work certificate system (E-TVL), which enables the physician and the employer submit the data to the EHIF database electronically. To use the E-TVL service, the employer has to join the service on the state portal eesti.ee.  Read more about the transfer of incapacity for work data here.

Calculation of benefit for incapacity for work

 

An employer calculates the sickness benefit:

EHIF calculates the benefit for incapacity to work:

on the basis of the employee's average salary for the last six months.

on the basis of the data on social tax calculated or paid for the employee for the previous calendar year, as received from the Tax and Customs Board.

After the receipt of the benefit you can view the information underlying the calculation on the  state portal eesti.ee

Calculation of average per-calendar day income by EHIF

The benefit is equal to the income calculated based on the social tax calculated or paid to the insured person during the calendar year preceding the start of the certificate of incapacity for work, divided by 365.

The benefit rate is calculated from the daily income and multiplied by the number of days to be reimbursed (see the examples of benefit calculation). Sickness benefit is subject to income tax.

If a person had no income in the previous year or their average annual income was lower than the minimum wage (584 euros per month in 2020), the daily income is calculated as follows:

  • daily income = basic wage: 30, but not more than the minimum wage divided by 30.

The calculation is based on the basic monthly wage or the minimum monthly wage applicable on the day before the date of the start of the release from work specified in the certificate of incapacity to work.

If a person did not have any income in the previous year and his/her basic wage is lower than the minimum monthly wage, then daily income = basic wage: 30.

Daily income of a person receiving remuneration or service fees on the basis of a contract under the law of obligations, a member of a management body, or a self-employed person is deemed to be equal to the income calculated on the basis of the social tax paid for the insured person during the calendar year preceding the start of the certificate of incapacity to work, divided by 365.

In case there was no income, the daily income = monthly rate established in the Social Tax Act (584 euros per month in 2020). 30.

If a self-employed person was not obliged to pay advance payments of social tax and in the previous year, no social tax was paid for or by him/her, then he/she has no daily income and will not receive any benefit.

If the data serving as basis for the benefit calculation have been changed at the Tax and Customs Board, a person has the right to submit an application to the Health Insurance Fund for the recalculation of the benefit within 3 years from the date of receipt of the certificate of incapacity to work by EHIF.

Specifications for different types of insurance

If a person is insured at the same time as an employee and a self-employed person or as a member of a management body or as a person who is a contracting party under the law of obligations, the daily income is calculated on a more favourable basis for the insured (either on the basis of the amount of the social tax calculated or the amount of social tax paid).

Examples

Robert is a self-employed person.  Last year, the employer paid a social tax of 894.76 euros for him, and he himself as an entrepreneur paid 442.91 euros. In total, the amount of social tax paid was 1,337.67 euros, and the income calculated on that is 4,053.55 euros.
4,053.55 : 365 = 11.11 euros of daily income.

  • Old-age pensioner Karl is a self-employed person. He falls ill. No social tax was paid for him in the previous year. As an old-age pensioner, he is not obliged to pay advance payments of social tax. Therefore, he will not receive any benefits.
  • Maria works under an employment contract and also operates as a self-employed person and has health insurance cover based on both.
    Last year, her social tax was calculated in the amount of 3,302.95 euros, but paid in the amount of 2,292.51 euros. Since the amount of social tax calculated is higher, it is more profitable for Maria to calculate the benefit on the basis of the calculated social tax.
  • In the event of an illness or injury, an insured person has the right to receive sickness benefit until the date on which their capacity for work is restored as specified in the certificate for sick leave, but not for more than 240 consecutive calendar days in the event of tuberculosis or 182 consecutive calendar days in the event of any other illness.

    If necessary, a doctor may issue a certificate for sick leave for a longer time than the reimbursable period. This limitation applies only to the period for which the benefit is paid, and not to the duration of the sick leave certificate.

 

Comparison of benefits

Comparison of benefits for incapacity for work

Reason for release from work

Number of the reason

Type of certificate

Reimbursement procedure

Duration of payment for an insured event

Illness

1

Certificate for sick leave

The employer pays the benefit from day 4 to day 8 of the illness. EHIF pays from day 9, the benefit rate is 70%.

Up to 182 days (up to 240 days in case of tuberculosis)

Domestic injury

3

Certificate for sick leave

The employer pays the benefit from day 4 to day 8 of the illness. EHIF pays from day 9, the benefit rate is 70%.

Up to 182 days

Traffic injury

Complication/illness as a result of a traffic injury

4

 

18

Certificate for sick leave

The employer pays the benefit from day 4 to day 8 of the illness. EHIF pays from day 9, the benefit rate is 70%.

Up to 182 days

Quarantine

10

Certificate for sick leave

Based on the certificate issued due to quarantine, the employer pays the benefit from day 4 to day 8. EHIF pays from day 9, the benefit rate is 70%.

Up to 7 days

Occupational diseases

2

Certificate for sick leave

EHIF pays the benefit from day 2, the benefit rate is 100%.

Up to 182 days

Occupational injury

Occupational injury in traffic

Complication/illness as a result of an occupational injury

5

6

 

7

Certificate for sick leave

EHIF pays the benefit from day 2, the benefit rate is 100%.

Up to 182 days

Injury received while preventing a criminal offence, protecting national or public interests

8

Certificate for sick leave

EHIF pays the benefit from day 2, the benefit rate is 100%.

Up to 182 days

Transfer to easier work

17

Certificate for sick leave

EHIF compensates for the difference in wages caused by the transfer to an easier work, if the person's salary at the time of the transfer to an easier work is lower than his or her average income for the previous calendar year.

If a person is released from work due to lack of easier work, the benefit is paid from day 2 at the rate of 70%. The benefit can only be claimed during pregnancy until maternity leave.
Read more here.

Until maternity leave

Illness or injury during pregnancy

19

Certificate for sick leave

EHIF pays the benefit from day 2, the benefit rate is 70%.

Up to 182 days

Nursing a child under the age of 12 or a disabled insured person under the age of 19.

14

Certificate for care leave

EHIF pays the benefit from the first day of release, the benefit rate is 80%.

Please note! An insured person is entitled to a care benefit on the basis of a certificate for care leave for nursing a child under the age of 12 for up to 60 calendar days, if the illness is caused by a malignant tumor and the child's treatment begins in a hospital.

Up to 14 days

Nursing a sick family member who is ill at home

12

Certificate for care leave

EHIF pays the benefit from the first day of release, the benefit rate is 80%.

Up to 7 days

Caring for a child of under 3 years of age or for a disabled child of under 16 years of age when the child’s mother is ill or is receiving obstetrical care

13

Certificate for care leave

EHIF pays the benefit from the first day of release, the benefit rate is 80%.

Up to 10 days

Maternity leave

15

Certificate for maternity leave

EHIF pays the benefit from the first day of release from work, the benefit rate is 100%.

140 days

Adoptive parents leave for a child under 10 years of age

16

Certificate for adoption leave

EHIF pays the benefit from the first day of release from work, the benefit rate is 100%.

70 days

Organ or haematopoietic stem cell donation

20

Certificate for sick leave

EHIF pays from day 1, the benefit rate is 100%.

Up to 182 days