- •§ 1. Scope of application of Act
- •§ 2. Definition, principles and form of health insurance
- •§ 3. Insurer
- •§ 4. Health promotion
- •§ 5. Insured person
- •§ 6. Duration of insurance cover of employees and public servants
- •§ 7. Duration of insurance cover of persons for whom social tax is paid by state or local government
- •§ 8. Duration of insurance cover of members of management or controlling bodies of legal persons
- •§ 9. Duration of insurance cover of persons receiving remuneration or service fees on basis of contract under law of obligations
- •§ 91. Duration of insurance cover of persons receiving unemployment insurance benefit
- •§ 10. Duration of insurance cover of sole proprietors entered in register
- •§ 11. Duration of insurance cover of persons considered equal to insured persons
- •§ 12. Specifications concerning duration of insurance cover of persons considered equal to insured persons
- •§ 13. Submission of documents and information
- •§ 14. Liability of persons obligated to submit documents
- •§ 15. Health insurance database
- •§ 16. Chief processor and authorised processor of health insurance database
- •§ 17. Information to be entered in health insurance database
- •§ 18. Right to collect information
- •§ 19. Entries in health insurance database
- •§ 20. Statutes for maintenance of health insurance database
- •§ 21. Proof of insurance cover
- •§ 22. Persons considered equal to insured persons on basis of contract
- •§ 23. Application of Acts
- •§ 24. Conditions under which person is considered equal to insured persons on basis of contract
- •§ 25. Definition and types of health insurance benefit
- •§ 26. Right of recourse of health insurance fund
- •§ 27. Territorial effect of health insurance benefits
- •16.12.04 Entered into force 1.01.05 - rt I 2004, 89, 614
- •§ 28. Restrictions on receipt of health insurance benefits
- •§ 29. Scope of insurance cover
- •§ 30. List of health services of health insurance fund
- •§ 31. Amendment of list of health services
- •§ 32. Payment to health care providers
- •§ 33. Dental care benefit for insured person under 19 years of age
- •§ 34. Disease prevention
- •§ 35. Contract for financing medical treatment
- •§ 36. Entry into contract for financing medical treatment
- •§ 37. Conditions of contract for financing medical treatment
- •§ 38. Waiting list
- •§ 39. Assumption of obligations
- •§ 40. Right to second opinion
- •§ 41. Scope of insurance cover in case of benefits for medicinal products
- •§ 42. Reference price, price agreement, basic rate of cost-sharing and maximum rate of benefit for medicinal products
- •§ 43. List of medicinal products
- •§ 44. Discount rates for medicinal products
- •§ 45. Entry into price agreement
- •§ 46. Assumption of obligations to pay for the sale of medicinal products
- •§ 47. Supplementary benefit for medicinal products.
- •§ 48. Scope of insurance cover in case of benefits for medical devices
- •§ 481. Amendment of list of medical devices
- •§ 49. Assumption of obligation to pay for medical devices and contracts with sellers
- •§ 50. Definition and types of benefit for temporary incapacity for work
- •§ 51. Insured event of temporary incapacity for work
- •§ 52. Certificate of incapacity for work
- •§ 53. Procedure for grant and payment of benefit for temporary incapacity for work
- •§ 54. Size of benefit for temporary incapacity for work
- •§ 55. Calculation of average income per calendar day
- •§ 56. Right to receive benefit for temporary incapacity for work
- •17.12.08 Entered into force 1.07.09 - rt I 2009, 5, 35
- •§ 57. Period of time serving as basis for calculation of sickness benefit
- •§ 58. Period of time serving as basis for calculation of maternity benefit or adoption benefit
- •§ 59. Period of time serving as basis for calculation of care benefit
- •§ 60. Restriction on right to receive benefit for temporary incapacity for work
- •§ 61. Prohibition on permitting insured person who is temporarily incapacitated for work to assume employment or service
- •§ 62. Rights of health insurance fund upon payment of benefit for temporary incapacity for work
- •§ 63. Adult dental care benefit
- •§ 64. (Repealed - 16.12.04 entered into force 1.01.05 - rt I 2004, 89, 614)
- •§ 65. Documents necessary for receipt of adult dental care benefit
- •§ 66. Connection between adult dental care benefit and specific period of time
- •§ 67. Additional fee and prohibition on extension of additional fee
- •§ 68. Obligation to provide health service in standard conditions of accommodation
- •§ 69. Fee for home visit
- •§ 70. Visit fee and additional cost-sharing upon payment for out-patient specialised medical care
- •§ 72. Maximum rate of visit fee and in-patient fee
- •§ 73. Fee for issue of documents
- •§ 74. Repeal of Republic of Estonia Health Insurance Act
- •§ 75. Amendment of Republic of Estonia Employment Contracts Act
- •§ 76. Amendment of Wages Act
- •§ 77. Amendment of Public Service Act
- •§ 78. Amendment of Medicinal Products Act
- •§ 79. Amendment of Mental Health Act
- •§ 80. Amendment of State Fees Act
- •§ 81. Amendment of Income Tax Act
- •§ 82. Amendment of Estonian Health Insurance Fund Act
- •§ 83. Amendment of Social Tax Act
- •§ 84. Amendment of Holidays Act
- •§ 85. Amendment of State Liability Act
- •§ 86. Amendment of Health Services Organisation Act
- •§ 87. Amendment of Value Added Tax Act
- •§ 88. Calculation of average income per calendar day until entry into force of § 55 of this Act
- •§ 89. Transitional provisions
- •§ 90. Entry into force of Act
§ 32. Payment to health care providers
The procedure for the assumption of a payment obligation of an insured person by the health insurance fund and the methods for calculation of the payments to be made to health care providers shall be established by a regulation of the Minister of Social Affairs on the proposal of the supervisory board of the health insurance fund.
§ 33. Dental care benefit for insured person under 19 years of age
(1) The health insurance fund shall assume a payment obligation arising from a contract for the provision of dental care services entered into by or for the benefit of an insured person under 19 years of age, on the condition that the dental care service provided is entered in the list of health services.
(2) Subsection (1) of this section applies to an insured person under 19 years of age and the provider of the dental care service is required to enter into a contract for the provision of dental care services with the insured person if:
1) provision of the dental care service to the insured person within one year after the person attains 19 years of age is based on therapeutic indications and if such indications were or should have been evident at the time of the insured person’s last visit to the provider of the dental care service before the person attained 19 years of age;
(19.06.08 entered into force 1.08.08 - RT I 2008, 34, 210)
2) provision of the dental care service to the insured person is based on therapeutic indications and if such indications have arisen from the need to treat the effects of dental care services provided to the person before he or she attained 19 years of age or due to the fact that the expected recovery did not occur within one year after he or she attained 19 years of age.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
§ 34. Disease prevention
The health insurance fund shall participate in financing projects specifically aimed at disease prevention to the extent of the amounts prescribed for such purpose in the budget of the health insurance fund and with approval of the Ministry of Social Affairs.
Subdivision 2
Contract for Financing Medical Treatment
§ 35. Contract for financing medical treatment
(1) By a contract for financing medical treatment, the health insurance fund assumes the obligation of an insured person to pay for the provision of health services under the conditions provided for in the contract and in legislation.
(2) A contract for financing medical treatment is a contract under public law. The provisions of Chapter 7 of the Administrative Procedure Act together with the specifications provided by this Act apply to contracts for financing medical treatment.
§ 36. Entry into contract for financing medical treatment
(1) The health insurance fund enters into a contract for financing medical treatment with a health care provider or providers.
(2) The health insurance fund is not required to enter into a contract for financing medical treatment with all health care providers.
(3) The health insurance fund has the right to enter into a contract for financing medical treatment with health care providers located in foreign states. The reference prices and limits provided for in the list of health services apply to a contract for financing medical treatment which is entered into with a health care provider located in a foreign state if the health insurance fund undertakes to assume the obligation to pay for the provision of a health service entered in the list of health services.
(4) In order for a decision to be made on entry into a contract for financing medical treatment and on the term of the contract, the health insurance fund shall take into account the following circumstances:
1) the need of the insured persons for the service, and the availability of the service;
2) the quality of and conditions for the provision of the service;
3) the price of the service;
4) the possibility of the service being provided in accordance with the standard conditions of accommodation;
5) the maximum number of health care providers providing the health service;
6) figures regarding the average density of provision of the health service;
7) developments in national health policy;
8) whether the health care provider has performed previous contracts for financing medical treatment or other similar contracts as required;
9) the existence or absence of tax arrears and the general financial situation of the health care provider;
10) compliance with legislation regulating health insurance and health by the health care provider or the employer thereof.
(41) The health insurance fund shall enter into contracts for financing medical treatment, taking account of the circumstances specified in subsection (4) of this section, with a term of at least three years.
(28.06.2004 entered into force 01.04.2005 - RT I 2004, 56, 400)
(42) If the health insurance fund, taking account of the circumstances specified in subsection (4) of this section, enters into a contract for financing medical treatment with a health care provider for the first time, the contract shall be entered into for a term of at least three years.
(28.06.2004 entered into force 01.04.2005 - RT I 2004, 56, 400)
(5) The health insurance fund shall enter into a contract for financing medical treatment for a term of at least five years with a person who owns a hospital specified in the development plan of the hospital network established by a regulation of the Government of the Republic pursuant to subsection 55 (1) of the Health Services Organisation Act.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
(6) (Repealed - 28.06.2004 entered into force 01.04.2005 - RT I 2004, 56, 400)