In what situation can I claim?
All permanent residents are entitled to receive emergency medical assistance. Insured persons have access to other health services, with the costs being borne by compulsory health insurance. Those who have not paid compulsory health contributions (or have not had them paid on their behalf) must cover the cost of their treatment. There is also an option of choosing voluntary health insurance to supplement compulsory health insurance.
Every insured person at all levels is free to choose a doctor and healthcare institution. They should choose a family doctor and be included on the primary healthcare institution’s patient list. When necessary, the doctors will refer a patient to a specialist.
If a patient is referred by a family doctor to a specialist in an establishment that has an agreement with the Territorial Health Insurance Fund, consultations are free of charge; only consultations with a dermatologist and venereal disease specialist can occur without a referral.
Family doctors, together with specialists if necessary, may recommend in-patient treatment. The system of referrals does not apply in emergency cases.
Those not paying compulsory health insurance contributions and who are not covered by compulsory health insurance must cover their own treatment costs. Medical rehabilitation costs are covered by Territorial Health Insurance Funds from the Compulsory Health Insurance funds. Patients who receive rehabilitation and convalescence services without a doctor's referral need to pay for them at officially approved prices.
Children under 7 and those under 18 with a disability have 90% of their convalescence costs covered.
Children under 18, and those who are disabled whose capacity for work is reduced by 60-100%, or those who are recovering from a serious illness (included on the official list) have their medical rehabilitation costs paid if a doctor has referred them.
What conditions do I need to meet?
Automatically insured under the compulsory health insurance scheme are:
- those with a contract of employment;
- those who pay contributions for themselves (those receiving remuneration under copyright agreements, farmers and other self-employed persons);
- those with compulsory health insurance where their contributions are paid by the State:
- those under 18;
- pensioners and recipients of social assistance;
- unemployed person with a sufficient employment record to quality for an old-age pension;
- those registered as unemployed and those undergoing professional training organised by territorial labour exchange offices if they are not employed within the framework of this training;
- women on maternity leave and unemployed women 70 days before and 56 days after giving birth;
- a parent (step-parent, foster parent) raising or caring for a child under 8, or for two children or more, or those caring for a disabled child;
- those with a disability;
- those receiving social benefits;
- students permanently residing in Lithuania in secondary education, vocational training, higher or university education, even when studying in another EU Member State;
- others in special circumstances (the clergy, war and resistance veterans, former prisoners, unaccompanied foreign minors etc. - see the Law on Health Insurance).
The self-employed persons need to make their own health insurance payments.
Dental care for adults is covered in part from Territorial Health Insurance Funds. Someone covered by primary healthcare institution is entitled to dental care. All insured (except children and those in daytime secondary education and vocational schools up to their 24th birthday and those receiving social support) need to pay for fillings and other dental needs.
The cost of dental prosthesis is reimbursed for the following categories of insured:
- those who have reached retirement age;
- children up to the age of 18;
- those with disabilities and those with reduced capacity for work.
The cost e of pharmaceuticals , medical instruments and aids t included in the positive list is wholly covered for:
- children under 18;
- those with a recognised incapacity for work and those of pensionable age with identified special needs.
Those suffering from specific ailments have 100%, 90%, 80% or 50% of the reference price of medicines covered (in accordance with the Compensated Medicines List). Those in receipt of an old-age pension, those with Category II disabilities, those with an incapacity to work of 60-70% or those on social assistance receive compensation of 50% of the basic price of medicines. For someone insured undergoing treatment in hospital, the cost of drugs and appliances is included in the reference price of hospital treatment.
In addition, there is a list of services for which all patients are obliged to pay. Examples include: abortion at a patient's request, hormonal therapy, acupuncture and manual therapy, health checks before a foreign trip, before acquiring a weapon, for the issue of a driving licence or a private pilot's licence, additional individual patient and nursing care, cosmetic surgery and dental prostheses (except for certain categories of people) and implants.
What am I entitled to and how can I claim?
Compulsory health insurance payments under the terms of a contract of employment or a copyright agreement are deducted automatically. If you are on the state insured persons' list, you also do not need to bother about additional health insurance. If you fall into none of these groups, you must acquire compulsory health insurance privately.
The Territorial Health Insurance Funds partly reimburses the cost of cochlear implants, hearing aids and prostheses (patients have to cover the difference between the price of the Territorial Health Insurance Fund paid and the actual price).
The Territorial Health Insurance Funds reimburses 100% of rent costs of medical devices that are used for healthcare at home.
Prostheses and other orthopaedic aids are reimbursed at 50%, 80%, 95% or 100% for those insured suffering from illnesses included in special lists approved by the Ministry of Health.
People patient can obtain hearing aids on a doctor’s prescription from the companies contracted to the National Health Insurance Fund. The Fund reimburses the cots according to the reference price, the individual paying the difference if they want more expensive hearing aid.
Compulsory health insurance is administered by the National Health Insurance Fund under the auspices of the Ministry of Health and Territorial Health Insurance Funds.
- Compulsory health insurance -the state insurance system that guarantees healthcare services and reimbursement of healthcare costs, costs of acquiring medicines and medical devices and rent costs of medical devices that are used for healthcare at home;
- Self-employment– independent activities undertaken by someone who is not attached to any particular employer(s), as defined in Lithuanian Income Tax legislation;
- Basic (reference) price – part of the price of healthcare services, pharmaceuticals or medical appliances compensated by the Compulsory Health Insurance Fund.
Know your rights
These links will help you find out what your rights are. These are not European Commission websites and may not necessarily reflect the views of the Commission:
Who do you need to contact?
The National Health Insurance Fund under the Ministry of Health