- •§ 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
§ 61. Prohibition on permitting insured person who is temporarily incapacitated for work to assume employment or service
(1) An employer shall not permit an insured person specified in clause 5 (2) 1) or 2) of this Act to assume his or her duties at a time when he or she is released from the performance of his or her duties as specified in the certificate of incapacity for work.
(2) In the event of a violation of the prohibition specified in subsection (1) of this section, the insured person shall lose the right to receive benefit for temporary incapacity for work as of the date of the violation.
§ 62. Rights of health insurance fund upon payment of benefit for temporary incapacity for work
(1) The health insurance fund may, by a decision, extend the term for payment of a benefit for temporary incapacity for work by up to 30 calendar days if there is reasonable doubt as to the right of the person to receive the benefit. If such doubt proves to be unjustified, the health insurance fund is required to pay a fine for delay as of the expiry of the term provided for in subsection 53 (6) of this Act.
(2) Before adoption of a decision specified in subsection (1) of this section, the health insurance fund is required to grant the insured person a term of at least five calendar days to submit his or her opinion concerning and objections to the matter.
(3) The health insurance fund may issue a precept together with a warning concerning unjustified payment of a benefit for temporary incapacity for work and reclaim the benefit from the insured person or withhold the unjustified benefit from the payments of subsequent periods.
(4) If unjustified payment of a benefit for temporary incapacity for work occurs due to submission of incorrect information by the employer of the insured person or due to violation of the prohibition specified in subsection 61 (1) of this Act, the health insurance fund may issue a precept together with a warning and reclaim the unjustified benefit from the employer of the insured person.
(5) The health insurance fund shall reclaim the difference between the benefit paid at the rate of 100 per cent on the basis of clause 54 (1) 6) of this Act as a result of an accident at work or an occupational disease and the benefit calculated at the rate of 80 per cent, depending on the treatment regime, on the basis of clause 54 (1) 1) or 2) of this Act from the employer.
(6) In the event of failure to comply with a precept within the term set out in a warning specified in subsection (3) or (4) of this section, the health insurance fund has the right to issue a precept for compulsory execution pursuant to the procedure provided in the Code of Enforcement Procedure.
(15.06.05 entered into force 1.01.06 - RT I 2005, 39, 308)
Subdivision 2
Other Benefits in Cash
§ 63. Adult dental care benefit
(1) The health insurance fund shall, to the extent, under the conditions and pursuant to the procedure established by a regulation of the Minister of Social Affairs, compensate the amounts paid for dental care services during one calendar year to insured persons receiving a pension for incapacity for work or an old-age pension pursuant to the State Pension Insurance Act, insured persons of at least 63 years of age, pregnant women, mothers of children under one year of age and persons who have an increased need for dental care services as a result of health services provided to them.
(9.12.08 entered into force 1.01.09 - RT I 2008, 56, 313)
(2) A higher rate of benefit shall be established by a regulation of the Minister of Social Affairs for pregnant women, mothers of children under one year of age and persons who have an increased need for dental care services as a result of health services provided to them.
(3) The health insurance fund shall, to the extent, under the conditions and pursuant to the procedure established by a regulation of the Minister of Social Affairs, compensate a person receiving a pension for incapacity for work or an old-age pension pursuant to the State Pension Insurance Act and an insured person of at least 63 years of age for amounts paid for dentures once every three years. (19.06.08 entered into force 1.08.08 - RT I 2008, 34, 210)
(4) (Repealed - 19.06.08 entered into force 1.08.09 - RT I 2008, 34, 210)