- •§ 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
§ 72. Maximum rate of visit fee and in-patient fee
(1) A fee for a home visit or for a visit for out-patient specialised medical care to be provided shall not exceed 50 kroons.
(2) An in-patient fee shall not exceed 25 kroons.
(3) By 1 March of each calendar year, the maximum rates of visit fees and in-patient fees shall be multiplied by an index the value of which is the yearly change in the consumer price index.
(4) The yearly change in the consumer price index shall be calculated by dividing the value of the consumer price index of the previous calendar year by the value of the consumer price index of the year preceding the previous calendar year, proceeding from the value of the consumer price index officially published by the Statistical Office.
(5) The maximum rate of visit fees and in-patient fees shall be approved by a regulation of the Minister of Social Affairs by 20 February of the given year at the latest.
§ 73. Fee for issue of documents
(1) A health care provider may demand a reasonable fee from an insured person for the documents issued.
(11) The procedure for payment to the health care provider for the issue of a document necessary for assessment whether the health of a person eligible to be drafted renders him fit to serve in the Defence Forces and the maximum rate of the fee shall be established by the Government of the Republic.
(02.06.2004 entered into force 01.07.2004 - RT I 2004, 49, 342)
(2) A health care provider shall not demand a fee from an insured person for the issue of a certificate of incapacity for work or a prescription.
(3) A health care provider shall not demand a fee from an insured person for the issue of a document which is necessary for the health insurance fund, a law enforcement authority, another health care provider in connection with the performance of a contract for the provision of health services, expert assessment concerning incapacity for work, or determination of the degree of severity of a disability, or in any other cases provided by law.
(4) A health care provider has the right to demand a fee for the issue of a document concerning a patient who is a minor if the size of the fee does not exceed the average expenses incurred upon the issue of the document.
Chapter 4
Amendment of Acts
§ 74. Repeal of Republic of Estonia Health Insurance Act
The Republic of Estonia Health Insurance Act (RT 1991, 23, 272; RT I 1999, 7, 113; 29, 397; 2000, 57, 374; 84, 536; 102, 675; 2001, 42, 233; 47, 260) is repealed.
§ 75. Amendment of Republic of Estonia Employment Contracts Act
In subsection 62 (2) of the Republic of Estonia Employment Contracts Act (RT 1992, 15/16, 241; 1993, 10, 150; RT I 1993, 26, 441; 1995, 14, 170; 16, 228; 1996, 3, 57; 40, 773; 45, 850; 49, 953; 1997, 5/6, 32; 1998, 111, 1829; 1999, 16, 276; 60, 616; 2000, 25, 144; 51, 327; 57, 370; 102, 669; 2001, 17, 78; 42, 233; 53, 311; 2002, 61, 375; 62, 377; 110, 656; 111, 663; 2003, 4, 22; 13, 69), the words “Republic of Estonia Health Insurance Act (RT 1991, 23, 272; 1992, 19, 276; RT I 1994, 23, 387; 1997, 28, 425)” are substituted by the words “Health Insurance Act (RT I 2002, 62, 377)”, and in the entire text of the Act, the words “Republic of Estonia Health Insurance Act” are substituted by the words “Health Insurance Act” in the appropriate case form.