- •§ 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
§ 83. Amendment of Social Tax Act
The Social Tax Act (RT I 2000, 102, 675; 2001, 50, 285; 59, 359; 79, 480; 91, 544; 95, 587; 2002, 44, 284; 62, 377; 111, 662) is amended as follows:
1) clauses 8) and 9) are added to subsection 6 (1) worded as follows:
“8) dependent spouses of persons specified in clause 5 (2) 1), 2), 4) or 5) or subsection 5 (3) of the Health Insurance Act (RT I 2002, 62, 377), who are raising at least one child under 8 years of age or at least one child of 8 years of age until the child completes year one at school or at least three children under 16 years of age and for whom the state does not pay social tax on the basis of clause 1) of this subsection;
9) persons receiving social benefits granted on the basis of § 231 the Social Welfare Act (RT I 1995, 21, 323; 2001, 98, 617).”;
2) subsection 7 (3) is amended and worded as follows:
“(3) In the cases provided for in clauses 6 (1) 6), 8) and 9) of this Act and in the case of the unemployment insurance benefits provided for in the Unemployment Insurance Act, the rate of social tax is 13 per cent of the taxable amount.”
§ 84. Amendment of Holidays Act
The Holidays Act (RT I 2001, 42, 233; 2002, 61, 375; 62, 377) is amended as follows:
1) section 27 is amended and worded as follows:
Ҥ 27. Pregnancy and maternity leave
(1) Pregnancy and maternity leave of 140 calendar days shall be granted to a woman on the basis of a certificate for maternity leave.
(2) In the case of a multiple birth or a delivery with complications, pregnancy and maternity leave of 154 calendar days shall be granted.
(3) A woman has the right to commence pregnancy and maternity leave at least 70 calendar days before the estimated date of delivery as determined by a doctor.
(4) Benefit shall be paid for the period of pregnancy and maternity leave pursuant to the Health Insurance Act (RT I 2002, 62, 377).”;
2) section 28 is amended and worded as follows:
Ҥ 28. Adoptive parents leave
Adoptive parents leave of 70 calendar days as of the date of entry into force of the adoption judgment shall be granted to a person adopting a child under 10 years of age who does not descend from the adoptive parent and for whom the adoptive parent is not a step-parent. Benefit shall be paid for such period pursuant to the Health Insurance Act.”
§ 85. Amendment of State Liability Act
Subsection 21 (3) of the State Liability Act (RT I 2001, 47, 260; 2002, 62, 377; 2003, 15, 86) is amended and worded as follows:
“(3) The Estonian Health Insurance Fund has the right of recourse to the extent of health insurance benefit paid by the Fund in the case of loss caused to an insured person by a public authority through health damage or bodily injury. The claim shall be submitted pursuant to the procedure provided for in §§ 17 and 18 of this Act.”
§ 86. Amendment of Health Services Organisation Act
The Health Services Organisation Act (RT I 2001, 50, 284; 2002, 57, 360; 61, 375; 62, 377; 110, 661) is amended as follows:
1) 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;
2) subsection 6 (4) is amended and worded as follows:
“(4) Emergency care provided to a person not covered by health insurance shall be paid for out of the funds prescribed for such purpose in the state budget, on the basis of a contract entered into between the Minister of Social Affairs and the Estonian Health Insurance Fund and pursuant to the Health Insurance Act (RT I 2002, 62, 377).”;
3) subsection 55 (2) is amended and worded as follows:
“(2) The Estonian Health Insurance Fund shall enter into a contract with a term of at least five years with a person operating a hospital specified in the list of hospitals and the contract shall set out the general conditions for financing health services provided in that hospital. The Estonian Health Insurance Fund shall enter into a contract with a term of up to three years with a person operating a hospital not specified in the list of hospitals and the contract shall set out the general conditions for financing health services provided in that hospital.”;
4) clause 9) is added to subsection 56 (1) in the following wording:
“9) the procedure for conducting an expert assessment of the quality of the provision of health services.”;
5) the existing text of § 58 is considered subsection (1), and the section is amended by adding subsection (2) in the following wording:
“(2) The county governor of Harjumaa county has the right to delegate performance of the duties assigned to him or her by this Act as regards the family physicians operating in the city of Tallinn to the city of Tallinn on the basis of a contract under public law, except performance of the duties provided for in §§ 60–62 of this Act.”