- •§ 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
§ 56. Right to receive benefit for temporary incapacity for work
(1) The right to receive sickness benefit arises as of the second day of release from the performance of duties as specified in the certificate of incapacity for work.
(2) If an obligation to pay sickness benefit is based on the grant of work to an employee that corresponds to his or her state of health, the temporary transfer of an employee to another position or the temporary easement of his or her conditions of service, the benefit is calculated as of the first day on which the employee assumes the new job or position or the job or position with eased conditions of service.
17.12.08 Entered into force 1.07.09 - rt I 2009, 5, 35
(3) The right to receive care benefit, maternity benefit or adoption benefit arises as of the first day of release from the performance of duties as specified in the certificate of incapacity for work.
§ 57. Period of time serving as basis for calculation of sickness benefit
(1) In the event of a disease or injury, an insured person has the right to receive sickness benefit until the date on which his or her capacity for work is restored as specified in the certificate for sick leave or until the date on which of his or her permanent incapacity for work is declared, but not for more than 240 consecutive calendar days in the case of tuberculosis or 182 consecutive calendar days in the case of any other disease.
(2) In the event of long-term temporary incapacity for work, the doctor treating the insured person shall send the documents necessary for expert assessment to the medical assessment committee not later than by the 121st day or, in the case of tuberculosis, not later than by the 178th day as of the date of release from the performance of duties as specified in the certificate of incapacity for work, and the certificate for sick leave extended on the basis of a decision of the Social Insurance Board shall serve as the basis for continuing payment of sickness benefit after expiry of the term provided for in this subsection. (19.12.07 entered into force 1.10.08 - RT I 2007, 71, 437)
(3) In the event of quarantine, an insured person has the right to receive sickness benefit until the date of termination of the quarantine as established by the county governor, but not for more than seven calendar days.
(4) (Repealed - 17.12.08 entered into force 1.07.09 - RT I 2009, 5, 35)
(5) An insured person has the right to receive sickness benefit for not more than a total of 250 calendar days per calendar year.
(6) Insured persons receiving a pension for incapacity for work pursuant to the State Pension Insurance Act or insured persons who are at least 65 years of age have the right to receive sickness benefit in the event of an illness and injury for up to 60 consecutive calendar days for one illness but not for more than a total of 90 calendar days per calendar year.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
(7) If the reason for the temporary incapacity for work of an insured person receiving a state pension for incapacity for work is an illness or injury which is not the reason for the grant of the pension for incapacity for work to him or her, the provisions of subsections (2) and (6) of this section do not apply upon grant of the sickness benefit to him or her.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)