- •§ 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
§ 89. Transitional provisions
(1) If release from work as specified in a certificate of incapacity for work commences before 1 October 2002 but the certificate is submitted for the grant and payment of benefit for temporary incapacity for work after 1 October 2002, the provisions of this Act apply to the grant and payment of the benefit.
(2) If the pregnancy and maternity leave of a person insured on the basis of the Republic of Estonia Health Insurance Act ends after the entry into force of this Act, the insured person has the right to demand extension of the leave pursuant to this Act.
(3) Until 1 January 2003, the health insurance fund may enter into a contract with a person specified in clause 22 (1) 1) of this Act without the restriction concerning insurance by the health insurance fund.
(4) Until 1 January 2003, the dependent spouse of an insured person is also deemed to be a person considered equal to insured persons pursuant to law and social tax is not paid for him or her.
(5) Until the entry into force of subsection 30 (4) of this Act on 1 July 2003, a reference price set out in the list of health services covers all expenses necessary for the provision of a health service, except expenses on research, the training of pupils and students and the construction or renovation of buildings.
(6) The provisions of Subdivision 2 of Division 2 of Chapter 3 of this Act do not apply to contracts regulating payment for health services which have been entered into between the health insurance fund and health care providers before the entry into force of this Act.
(7) During the period between the entry into force of this Act and entry into a price agreement, the price which was applicable on 1 January 2001 is deemed to be the wholesale purchase price of all the pharmaceutical forms, strengths and packages of a medicinal product.
(8) If a pharmaceutical form, strength or package of a medicinal product was not registered with the State Agency of Medicines as at 1 January 2001, the wholesale purchase price shall be determined on the basis of the concentration of the active ingredient in the medicinal product and the nature of its pharmaceutical form.
(9) If a medicinal product was not registered with the State Agency of Medicines as at 1 January 2001, the manufacturer of the medicinal product or the holder of marketing authorisation does not have the right to demand a higher wholesale purchase price for the medicinal product than the price specified in the application for registration of the medicinal product.
(10) Until the entry into force of clause 54 (1) 1) of this Act on 1 April 2003, the health insurance fund shall pay benefit for temporary incapacity for work to an insured person per calendar day in the amount of 60 per cent of the average income per calendar day in the event of the provision of in-patient health services or caring for a child under 10 years of age in a hospital.
(11) The following students admitted to educational institutions before the academic year 2003/04 are not deemed to be persons considered equal to insured persons pursuant this Act:
1) students acquire education in the form of distance learning (except for students enrolled in this form of study for medical reasons);
2) students of at least 24 years of age acquiring vocational education on the basis of secondary education in the form of distance learning or evening courses (except for students who reach 24 years of age within the standard period of study prescribed for completion of the curriculum).
(29.01.2003 entered into force 10.03.2003 - RT I 2003, 20, 116)
(12) Subsection 57 (7) of this Act does not apply to a person whose release from his or her duties or economic or professional activity as specified in the certificate of incapacity for work commences after 31 July 2004.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
(13) After 1 January 2009, the insurance cover of a sole proprietor registered with a regional structural unit of the Tax and Customs Board shall end two months after notification of the Tax and Customs Board of the termination of the business activities of the person or deletion of a sole proprietor from the register of taxable persons after 31 December 2009 for the reason that the person has not applied for his or her entry in the commercial register as a sole proprietor or his or her application for registration in the commercial register was not satisfied. The Tax and Customs Board shall inform the health insurance fund of the termination of the business activities of a person or deletion of a person from the register within ten calendar days.
(11.12.08 entered into force 1.01.09 - RT I 2008, 60, 331)