In what situation can I claim?
The right to health insurance (ravikindlustus) is created through employment. An employee does not have to present information in order to receive health insurance. In accordance with the legislation, all natural and legal persons offering employment must register information on their employees (start, suspension and end of the employment relationship) in the employment register of the Estonian Tax and Customs Board.
What conditions do I need to meet?
The Health Insurance Act provides insurance protection:
- to employees who work on the basis of an employment contract concluded for a term exceeding 1 month or for an unspecified term;
- to officials;
- to persons receiving remuneration or service fees on the basis of a contract under the law of obligations, which is concluded for a term exceeding 1 month or for an unspecified term, who are not entered in the commercial register as self-employed persons and for whom the other party to the contract must pay social tax each month on the basis of clause 9 (1) 2) of the Social Tax Act in the amount calculated on the basis of at least the monthly rate established in the state budget for the given budgetary year;
- to members of the management or controlling bodies of legal persons within the meaning of § 9 of the Income Tax Act for whom the legal persons must pay social tax each month on the basis of clause 9 (1) 2) of the Social Tax Act in the amount calculated on the basis of at least the monthly rate established in the state budget for the given budgetary year.
The person supplying the work must register the start of employment by the time the employed person starts work at the latest.
Insurance cover begins after the 14-day waiting period calculated from the date of start of employment entered in the employment register has passed. If the start of employment date remains within the applicable insurance protection period, the insurance protection will resume on new grounds without interruptions.
The insurance protection ends when 2 months have passed since the end of the employment relationship.
The insurance protection does not stop in the event of unpaid leave provided under an agreement between the parties, if social tax is paid for the person in accordance with the Social Tax Act.
The suspension and end of employment must be registered in the employment register within 10 days of the suspension or end of employment.
What am I entitled to and how can I claim?
Working insured persons have the right to a health insurance benefit in the form of a high-quality and timely healthcare service, necessary medicines or medicinal devices which are provided to the insured person under the terms stated in the Health Insurance Act by the Health Insurance Fund, and the persons that have entered into a corresponding contract with it (benefit in kind), and to a sum of money that the Health Insurance Fund is required to pay under the terms of the Health Insurance Act to the insured person to cover healthcare-related expenses, and in the event of temporary incapacity for work (cash benefit).
A health insurance benefit in kind is partially or completely funded by the Health Insurance Fund as:
- a healthcare service provided for the prevention or treatment of illnesses (healthcare service benefit);
- a medicine or medicinal device (medicine and medicinal device benefits).
The insured person has no right to demand the reimbursement of the cash or other assets spent on services or medicines or medicinal devices included in the health insurance benefits in kind from the Health Insurance Fund.
A health insurance cash benefit is paid to an insured person by the Health Insurance Fund in the form of:
- a temporary incapacity for work benefit (ajutise töövõimetuse hüvitis);
- an adult dental care benefit (täiskasvanute hambaraviteenuse hüvitis);
- a supplementary benefit for medicinal products (täiendav ravimihüvitis);
- a benefit for a cross-border healthcare service (piiriülese tervishoiuteenuse hüvitis);
- benefit for medicinal products related to artificial insemination (kunstliku viljastamisega seotud ravimihüvitis).
The benefit and fee rates are on the homepage of the Estonian Health Insurance Fund.
A health insurance cash benefit is paid to the account of the benefit recipient by the Health Insurance Fund or, on the basis of a written application from the benefit recipient, to the account of a third person in Estonia. When paying health insurance benefits in cash to the benefit recipient's account in a foreign state, additional costs must be covered by the benefit recipient.
If the employer or the other party to the contract does not have insurance for their employee, and the employee would have been entitled to a health insurance benefit, the employer must reimburse the employee for damages resulting from the employee not receiving the health insurance benefit.
Forms you may need to fill in
All natural and legal persons offering employment must register information on their employees (start, suspension and end of the employment relationship) with the Estonian Tax and Customs Board. Information received from employers for insuring the employees and suspending or ending the insurance is forwarded to the Health Insurance Fund from the employment register http://www.emta.ee/eng/business-client/registration-business/registration-employment.
A list of documents that you need to submit to claim health insurance benefits and information about forwarding them can be obtained from the addresses on the homepage of the Estonian Health Insurance Fund referred to above.
Know your rights
- Health insurance for people insured by their employer;
- Frequently asked questions on health insurance;
- Estonian National Social Insurance Board;
- Estonian Health Insurance Fund.
Publications and webpage of the European Commission
Who do you need to contact?
For more information, please contact the Estonian Health Insurance Fund.
More information and contacts on the website https://www.haigekassa.ee/en.
Helpline (in Estonia): 16 363
When calling from a foreign state: +372 6696630
The calls are answered on working days from 8:30-16:30.
Health insurance validity can be checked on the State portal or via the helpline of the Health Insurance Fund at 16363 (+372 6696630 when telephoning from a foreign State).