Health insurance in the EU

On several occasions, Estonia will remain the insuring country of a person working abroad. It is possible to apply for forms E106 or S1 for health care abroad, depending on whether you are a frontier worker, a worker assigned from Estonia to work in another EU state, or a worker assigned to Estonia. These forms allow the worker and if necessary, members of his/her family, to receive health care on equal terms with the residents of the given state.

NB! If you travel outside the European Union, then it is advisable to get travel insurance. This service is offered by private insurance companies and the Estonian Health Insurance Fund does not govern the domain.

Dispatched employee

Employees dispatched from Estonia to another EU member state must be registered by the employer in the Estonian National Social Insurance Board. The Social Insurance Board will issue a separate A1 certificate for every employee (a certificate regarding the applicable legislation). In the case of long-term assignments that last more than 6 (six) months, the employee or their employer can apply for form E106/S1 from the Health Insurance Fund – application forms.

This form gives the employee the right to register in the health insurance system of the country of the assignment and after registering the form, the dispatched employee is entitled to receive healthcare in the country of the assignment on the same conditions as local insured persons (the extent of healthcare is broader than simply necessary medical treatment, which is provided on the basis of the European health insurance card).

In this case, the country of insurance is still the country of dispatch – Estonia.

For example, an employee is dispatched from Estonia to France – the country of insurance will still be Estonia, as their employer is based in Estonia and the social tax paid from their salary is received by Estonia. The dispatched employee has the right to receive medical services in France in accordance with the local legislation but their medical costs will later be paid by Estonia to France.

Form E106/S1 will be sent to the address indicated in the application. In the case of assignments that last less than 6 (six) months, form E106/S1 is not issued. In this case, the dispatched employee should order the European health insurance card, which is used for receiving necessary medical treatment in the assignment country that is equal to the medical treatment received by locals (i.e. co-payments must be paid by persons themselves). Persons with form E106/S1 must also apply for the European health insurance card from the Health Insurance Fund prior to being dispatched. The card entitles persons to necessary medical treatment in EU member states where they have not been dispatched with form E106/S1 but where they are, for example, vacationing.
NB! The European health insurance card is not an identification document and is valid only if presented with an identification document.

Family members

If an employee on a long-term assignment takes dependent family members with them to the other country, then a competent authority of the country of dispatch will include their names in form E106/S1. After the form is registered, while living there, the employee’s family members are also entitled to healthcare equal to the healthcare provided to the locals who are insured.

Who pays the incapacity for work benefit in the case of long-term assignments?

A dispatched employee is employed in another country but their taxes are still received by Estonia and their country of insurance is Estonia. Sickness and maternity benefits are paid to the dispatched employee by the Estonian Health Insurance Fund in accordance with the Health Insurance Act.

 

Employee with permanent residence in another EU member state

Frontier worker

A frontier worker is a person who works or acts as a self-employed person in one member state and lives in another member state to which he/she regularly returns every day or at least once a week.

In order to receive a standard form E106/S1 in Estonia, the frontier worker must submit an application to the Estonian Health Insurance Fund. When processing the application, the Estonian Health Insurance Fund may request a copy of the worker’s employment contract, tickets, etc. for clarification and for verifying that the worker crosses the border every week.

For example, if the person works in Estonia but travels to his/her family in Finland at least once a week, then Estonia shall be that person’s insuring country, as the employer of the worker is located in Estonia and the social tax on the worker’s salary is paid to Estonia.

A form E106/S1 issued by the Estonian Health Insurance Fund grants the person the right to register as a member of the health insurance system of his/her state of residence. This means that a frontier worker has the right to receive medical care on equal terms with persons insured in that state on the basis of local legislation, but the medical treatment expenses are later reimbursed to state of residence by Estonia (the extent of health care is broader than necessary health care received on the basis of the European Health Insurance Card).

Holders of the form E106/S1 can apply for the European Health Insurance Card from the Estonian Health Insurance Fund. By presenting the card, the person will get any necessary health care in the country whereto he/she was not assigned with the form E106/S1 but where he/she for example spends his/her holidays or is on short-term assignment.

Family members

If dependent family members live with the frontier worker but have no health insurance in their state of residence, then their names are added to the form E106/S1 by a competent authority of the state of residence. After the registration of the form, other family members also gain the right to health care while residing in another member state on equal terms with local insured persons.

Who pays the benefit for incapacity for work to frontier workers?

A frontier worker working in Estonia but living in another member state is part of the Estonian social security system and his/her insuring country is Estonia; as a result, the Estonian Health Insurance Fund pays sickness and maternity benefits to the frontier worker on the basis of the Health Insurance Act.

Employee and family members in different countries

Family members of a person living and working in Estonia who live in another EU member state

If a person comes to live and work in Estonia (his/her social tax is received and he/she is provided health insurance by Estonia) but that person’s dependent family members remain living in another EU member state where they have no health insurance, then this worker can apply for a form E109/S1 from the Estonian Health Insurance Fund for the members of his/her family.

In order to grant health insurance to family members in their state of residence on the basis of the form E109/S1, the following steps must be taken:

1. The worker submits an application available on our website to the Estonian Health Insurance Fund, listing the family members who need the form.
2. After checking the existence of health insurance and residence data, the Health Insurance Fund forwards the forms to the family members who should then submit these to the health insurance establishment of their state of residence, where the forms will be registered.
3. The family members who have received the form E109/S1 from the Estonian Health Insurance Fund will also be issued the European Health Insurance Card by the Estonian Health Insurance Fund. More about European Health Insurance Card.

Example: Pawel from Poland started working in Estonia and also has health insurance here, but his family stayed in Poland. His wife Marta lives in Poland, but does not work there. If Pawel worked in Poland, then Marta would be entitled to health insurance there; as a result, Marta has the right to get health insurance on the basis of the European Union regulation No 883/2004 as a dependent spouse of a person working in a European Union member state. For this, Pawel must turn to the Estonian Health Insurance Fund and apply for a form E109/S1. The form E109/S1will be sent to Marta who must submit it to the Polish health insurance establishment, who will then register the form. If Marta wants to travel to another EU member state, she must carry the European health insurance with her in proof of her right to receive necessary health care there; she can order it from the Estonian Health Insurance Fund.

Family members of a person working in another EU member state living in Estonia

If a person goes to work in another EU member state (his/her social insurance contributions will be paid to the other country and he/she will receive health insurance from another EU country) but his/her dependent family members stay in Estonia, then the family members are provided insurance by the Estonian Health Insurance Fund after the registration of a standard certificate issued by the new state of employment. For this, the worker must apply for a form E109 or S1 from a competent authority of the state of employment, which must then be delivered to the Estonian Health Insurance Fund. The family members are provided with insurance cover after the registration of the form. The Estonian Health Insurance Fund also sends a written notification about this to the family members.

According to the Health Insurance Act, the following persons are considered dependent family members:

·         Persons with up to five years left until attaining retirement age who are maintained by their spouses who are insured persons;

·         Spouse of an insured person caring for at least one child of under the age of 8 or an 8-year-old child until his/her graduation from the first year of school, or at least three children under the age of 16, and whose spouse is insured as a worker in a EU member state.

Persons insured on the basis of the form E109 or S1 shall get a European Health Insurance Card from the establishment where the working person is insured at. You can read more on the benefits received on the basis of the European Health Insurance Card on our website.

Example: Toomas started working in Finland and has health insurance there. His wife, Maarika, lives in Estonia. Maarika is not working, but she is caring for a couple of children under 5 years of age. As a result, she is entitled to get health insurance pursuant to the European Union regulation no 883/2004 as a dependent spouse of a person working in a European Union member state. For this, Toomas must contact the competent authority in Finland KELA, and apply for either a form E109 or S1. The form E109 or S1 must be delivered to the Estonian Health Insurance Fund along with the application available at our website.

The Health Insurance Fund registers the form and sends a written notification about it to the person. If Maarika wishes to travel to another EU member state, then she should carry the European Health Insurance Card with her in proof of her right to receive necessary medical care while being in another member state. She can order the card from KELA.

Certificate of incapacity for work - E115 and E116

In relation with payments of sickness benefits in another state to patients insured in a European Union member state, a competent authority of a European Union member state may ask for additional information on forms E116 and E115.

To receive these forms, a patient must ask his/her doctor to fill in the form E116 and submit it to the Health Insurance Fund along with an application.

The patient’s doctor must fill in fields 3, 4 and 5 on the form E116 (and not to forget to add a stamp to item no. 4). Please fill in the form in block letters. Once the form has been filled in, please send it to the Estonian Health Insurance Fund’s Pärnu Department on the address Lai 14, 80010 Pärnu. The Health Insurance Fund will then fill in fields 1, 2 and 8 on the form E116 and prepare the form E115.

If you have any questions about filling in the form, please contact the specialists of the Estonian Health Insurance Fund’s Pärnu Department by phone at 443 0237 or by e-mail at anne.heinsoo [at] haigekassa.ee or eve.lilienthal [at] haigekassa.ee.

Certificate of incapacity for work issued abroad

The Health Insurance Fund also pays the benefit for temporary incapacity for work to an insured person on the basis of a document confirming illness issued by a doctor of another state.

The document confirming illness must be forwarded to the employer who will add a certificate of the employer (executable form in .pdf format, .doc format) and submit it to the Health Insurance Fund.

For the payment of benefits, the Health Insurance Fund records only one account number for every insured person. Regarding this, remember that if several account numbers of different banks are submitted to the Health Insurance Fund for the payment of benefits (e.g. benefit for incapacity for work, benefit for dental care, supplementary reimbursement of medicinal products, etc.), then the most recent account number is used for the payment of monetary benefits.

The receiver of the benefit can check the information regarding their account number at the citizens’ portal www.eesti.ee or by calling the customer phone of the Health Insurance Fund at 669 6630.

Information regarding account numbers can be changed at www.eesti.ee or by using the application form available on the website of the Health Insurance Fund and sending it to the Health Insurance Fund via post or e-mail. Contact information of the Health Insurance Fund can be found here.

At the request of the Health Insurance Fund, an Estonian translation certified by a sworn translator must be added to the document provided by the doctor of another state. The translation costs of the document are covered by the insured person.

Certification of insurance periods – form E104

Form E104  is issued to persons based on an application.

1. The application entitles persons to apply for certifications of insurance periods valid in the Health Insurance Fund.
2. The application entitles persons to apply for certifications of insurance periods expired in the Health Insurance Fund.

Attention!

Upon submitting the application, termination of certain insurance covers can be applied for by a:
● child
● retiree
● dependent spouse
● pregnant woman
● foreign student

The Health Insurance Fund does not terminate insurance covers on other bases (e.g. employee, person receiving childcare allowance). In this case, a person must first turn to their insurance company and apply for the termination of the insurance cover. For example, an employee to their employer, a caregiver of a person with a disability to a local government, a person receiving childcare allowance to the Social Insurance Board.

Send or take the application to a client service office where the insurance cover of persons indicated on the application is terminated if necessary. Pursuant to the Population Register Act, the population register must be notified of your new residence if you are moving to another EU member state.

The Health Insurance Fund cannot terminate the abovementioned insurance cover until a corresponding note has been made in the population register!

Client service offices will send form E104 to the address indicated on the application.

You can check the validity of your health insurance cover by calling the information phone of the Health Insurance Fund at 669 6630 (Mon – Fri 8.30 a.m. – 4.30 p.m.).