- •§ 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
§ 58. Period of time serving as basis for calculation of maternity benefit or adoption benefit
(1) A pregnant woman has the right to receive maternity benefit on the basis of a certificate for maternity leave for 140 calendar days if the pregnancy and maternity leave of the woman commences at least 30 calendar days before the estimated date of delivery as determined by a doctor. The number of the days by which the pregnancy and maternity leave of the woman commences later than the term provided for in this subsection shall be deducted from the period for which the woman has the right to receive maternity benefit.
(17.12.08 entered into force 1.07.09 - RT I 2009, 5, 35)
(2) If a pregnant woman has been granted work that correspond to her state of health or if the conditions of employment or service of a pregnant woman have been eased during her pregnancy, the woman has the right to receive maternity benefit for 140 calendar days if the pregnancy and maternity leave of the woman commences at least 70 calendar days before the estimated date of delivery as determined by a doctor. The number of the days by which the pregnancy and maternity leave of the woman commences later than the term provided for in this subsection shall be deducted from the period for which the woman has the right to receive maternity benefit.
(17.12.08 entered into force 1.07.09 - RT I 2009, 5, 35)
(3) The persons specified in clause 5 (2) 4) or 5) or subsection 5 (3) of this Act have the right to receive maternity benefit for 140 calendar days. The number of the days by which the certificate for maternity leave is issued later than the term provided for in subsection (1) of this section shall be deducted from the period for which the woman has the right to receive maternity benefit.
(17.12.08 entered into force 1.07.09 - RT I 2009, 5, 35)
(4) One person adopting a child under 10 years of age has the right to receive adoption benefit for 70 calendar days on the basis of a certificate for adoption leave.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
§ 59. Period of time serving as basis for calculation of care benefit
(1) An insured person has the right to receive care benefit on the basis of a certificate for care leave for up to 14 calendar days in the event of nursing a child under 12 years of age or for up to seven calendar days in the event of nursing another family member at home.
(2) On the basis of a certificate for care leave, an insured person has the right to receive care benefit for up to ten calendar days in the event of caring for a child under 3 years of age or for a disabled child under 16 years of age if the person caring for the child is himself or herself ill or is receiving obstetrical care.
(3) If a certificate for care leave is issued to several persons caring for one and the same person, the persons have the right to receive care benefit for not more than the total number of the calendar days specified in subsections (1) and (2) of this section.
§ 60. Restriction on right to receive benefit for temporary incapacity for work
(1) An insured person does not have the right to receive benefit for temporary incapacity for work if:
1) the illness or injury of the insured person or the person being nursed is caused by the intent of the person;
2) the illness or injury of the insured person or the person being nursed is caused by a state of intoxication ascertained pursuant to the procedure established on the basis of the Traffic Act (RT I 2001, 3, 6; 2002, 90, 521; 92, 531; 105, 613; 110, 654 and 655; 2003, 26, 156; 32, correction notice; 78, 522; 2004, 30, 208; 46, 329) or by an examination conducted by a doctor;
3) the insured person or the person being nursed fails to comply with the medically justified treatment prescribed by a doctor, as a result of which the recovery of the person is hindered;
4) the insured person fails to appear at a doctor's consultation at the prescribed time without good reason;
5) the insured person receives income subject to social tax specified in clause 2 (1) 1) or 3) of the Social Tax Act for the period of the temporary incapacity for work;
6) (Repealed - 16.12.04 entered into force 1.01.05 - RT I 2004, 89, 614)
(2) If an insured person or a person being cared for performs his or her duties or is engaged in business during his or her temporary incapacity for work, the person loses the right to receive benefit for temporary incapacity for work as of the date on which he or she commenced performing the duties or engaging in business.
(3) If an insured person or a person being cared for fails to appear at a doctor's consultation at the prescribed time without good reason, the person shall lose the right to receive benefit for temporary incapacity for work as of the date of his or her failure to appear at the consultation.
(4) An insured person does not have the right to receive benefit for temporary incapacity for work if the temporary incapacity for work commences at a time when the insured person is:
1) on holiday;
2) on care leave during a holiday.
(17.12.08 entered into force 1.07.09 - RT I 2009, 5, 35)
3) on parental leave;
4) on holiday with partial pay;
5) on adoptive parents leave.
(5) In the cases listed in subsection (4) of this section, the insured person acquires the right to receive benefit as of the day when he or she assumes or is required to assume his or her duties.
(17.12.08 entered into force 1.07.09 - RT I 2009, 5, 35)
(6) An insured person who has the right to receive maternity benefit or adoption benefit does not have the right to receive sickness benefit or care benefit for the same period. An insured person who has the right to receive sickness benefit does not have the right to receive care benefit for the same period.