- •§ 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
§ 54. Size of benefit for temporary incapacity for work
(1) The health insurance fund shall pay benefit for temporary incapacity for work to an insured person per calendar day as a percentage of his or her average income per calendar day, as follows:
1) 80 per cent in the event of receiving in-patient health services or nursing a child under 12 years of age in a hospital;
11) 80 per cent in the event of caring for a child under 3 years of age or for a disabled child under 16 years of age when the person caring for the child is himself or herself ill or is receiving obstetrical care;
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
2) 80 per cent in the event of receiving out-patient health services, nursing a family member who is ill at home, refusal to perform work not corresponding to his or her state of health, temporary release from the performance of his or her duties, or quarantine;
(17.12.08 entered into force 1.07.09 - RT I 2009, 5, 35)
3) 100 per cent in the event of nursing a child under 12 years of age at home;
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
4) 100 per cent in the event of pregnancy and maternity leave;
5) 100 per cent in the event of adoptive parents leave;
6) 100 per cent in the event of an illness or injury caused as a result of an occupational disease or an accident at work;
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
7) 100 per cent in the event of preventing a criminal offence, protecting national or public interests or saving a human life.
(2) Upon calculation of the size of a benefit, amounts of 50 cents or more shall be rounded to one kroon and amounts of less than 50 cents shall not be taken into account.
(3) The amount of a benefit paid by the health insurance fund to an employee upon grant of work to him or her that corresponds to his or her state of health, upon his or her temporary transfer to another position or upon temporary easement of his or her conditions of service shall be such that the total amount of the benefit and the salary or wages received for the period, divided by the number of calendar days in the period, is equal to the insured person’s average income per calendar day.
(17.12.08 entered into force 1.07.09 - RT I 2009, 5, 35)
§ 55. Calculation of average income per calendar day
(1) Average income per calendar day shall be calculated on the basis of the information concerning payment of social tax submitted by the Tax and Customs Board and the information certifying the right to receive a benefit as submitted by the persons specified in clause 5 (2) 1), 2), 4) or 5) or subsection 5 (3) of this Act.
(17.12.2003 entered into force 01.01.2004 - RT I 2003, 88, 591)
(2) The average income of a person insured on the basis of clause 5 (2) 1) or 2) of this Act per calendar day is deemed to be equal to the income calculated on the basis of the social tax calculated for the insured person during the calendar year preceding the calendar year of the date on which release from the performance of his or her duties commenced as specified in the certificate of incapacity for work, divided by 365. The number of the days for which the insured person was temporarily released from the performance of his or her duties or economic or professional activity on the basis of a certificate of incapacity for work shall be deducted from the figure 365.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
(3) If social tax was not paid for a person insured on the basis of clause 5 (2) 1) or 2) of this Act during the calendar year serving as the basis for calculation of his or her average income per calendar day, the average income per calendar day is deemed to be equal to the basic wages of the employee divided by 30, but not more than the amount of the minimum monthly wage established by the Government of the Republic and divided by 30. Calculation of average income per calendar day shall be based on the basic wages of the employee or the minimum monthly wage established by the Government of the Republic as applicable on the date preceding the date on which release from the performance of duties commenced as specified in the certificate of incapacity for work.
(4) If average income per calendar day calculated pursuant to the procedure provided for in subsection (2) of this section is lower than average income per calendar day calculated pursuant to the procedure provided for in subsection (3) of this section, average income per calendar day shall be calculated pursuant to the procedure provided for in subsection (3) of this section.
(5) The average income of a person insured on the basis of clause 5 (2) 4) or 5) or subsection 5 (3) of this Act per calendar day is deemed to be equal to the income calculated on the basis of the social tax paid by or for the insured person during the calendar year preceding the calendar year of the date specified in the certificate of incapacity for work as the date on which release from performance of the duties arising from a contract specified in clause 5 (2) 4) or 5) of this Act or from economic or professional activity commenced, divided by 365. The number of the days for which the insured person was temporarily released from the performance of his or her duties or economic or professional activity on the basis of a certificate of incapacity for work shall be deducted from the figure 365.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
(6) If social tax was not paid for a person insured on the basis of clause 5 (2) 4) or 5) or subsection 5 (3) of this Act during the calendar year serving as the basis for calculation of his or her average income per calendar day, the average income per calendar day is deemed to be equal to the monthly rate provided for in subsection 2 (5) of the Social Tax Act, divided by 30. Average income per calendar day shall be calculated on the basis of the monthly rate provided for in subsection 2 (5) of the Social Tax Act which was applicable on the date preceding the date on which the person was released from the performance of his or her duties or from economic or professional activity.
(7) The provisions of subsection (6) of this section do not apply if, on the date preceding the date on which release from the performance of duties commenced as specified in a certificate of incapacity for work, the insured person did not have the obligation to make advance payments of social tax.
(8) If an insured person has the right to receive benefit for temporary incapacity for work on the basis of both subsection (2) and subsection (5) of this section, his or her average income per calendar day shall be calculated on the bases which is more favourable for the insured person.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)