- •§ 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
§ 13. Submission of documents and information
(1) Information necessary for insurance cover to commence, to be suspended or to terminate shall be submitted in unattested written form or in an electronic form which is considered equal thereto.
(2) Documents and information necessary for insurance cover to commence, to be suspended or to terminate may, in addition to the person obligated to submit the documents or information, also be submitted by the person applying for insurance cover or by the insured person.
(3) A person obligated to submit documents or information necessary for insurance cover to commence shall perform the obligation within seven calendar days as of the creation of the obligation.
(4) The health insurance fund need not be notified of the termination of insurance cover for a specified term if the insurance cover terminates due to expiry of the term. If a person employed on the basis of a contract for a specified term or employed in the service for a specified period of time continues the employment or public service with the same employer or a state or local government agency after the expiry of the contract for a specified term or the term of service, the payer of social tax is required to inform the health insurance fund of the continuance of the employment or service within ten calendar days.
(19.06.08 entered into force 1.08.08 - RT I 2008, 34, 210)
(5) The health insurance fund shall issue a certificate concerning the receipt of documents or information at the request of the person submitting the documents or information.
(6) The following shall be established by a regulation of the Minister of Social Affairs:
1) a list of the documents necessary for insurance cover to commence, to terminate and to be suspended, and the composition of the information contained in such documents;
2) if necessary, the procedure for recognition of documents issued in foreign states.
§ 14. Liability of persons obligated to submit documents
(1) If a person applying for insurance cover would have had the right to receive health insurance benefits if a person obligated to submit documents necessary for insurance cover to commence had performed such obligation as required, the person who violated the obligation shall compensate the person applying for insurance cover for the loss incurred due to the failure to receive the health insurance benefits.
(2)–(3) (Repealed - 15.06.05 entered into force 1.01.06 - RT I 2005, 39, 308)
Division 3
Health Insurance Database and Data Protection
§ 15. Health insurance database
(1) The health insurance fund shall establish a database for the purpose of performing functions relating to health insurance.
(2) The official name of the database shall be “Ravikindlustuse andmekogu” [Health Insurance Database].
§ 16. Chief processor and authorised processor of health insurance database
(1) The chief processor of the health insurance database is the health insurance fund.
(2) The authorised processor of the health insurance database is the health insurance fund.
§ 17. Information to be entered in health insurance database
(1) The following information shall be entered in the health insurance database:
1) personal data;
2) information which is the basis for the commencement, termination or suspension of insurance cover;
3) information which is the basis for payment for health insurance benefits in kind;
4) information which is the basis for payment of health insurance benefits in cash.
(2) The detailed composition of the information to be entered in the health insurance database shall be provided by the statutes for the maintenance of the database.
(3) Courts and bailiffs have the right to use the health insurance database in the part of personal data.
(15.06.05 entered into force 1.01.06 - RT I 2005, 39, 308)