- •§ 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
§ 18. Right to collect information
(1) In the cases provided by legislation, the health insurance fund has the right to demand that insured persons and persons applying for insurance cover submit information, including sensitive personal data, in so far as such information is necessary for performance of the functions assigned to the health insurance fund by law.
(2) In the cases provided by legislation, the health insurance fund has the right to demand that persons who have entered into a contract with the fund, and other persons and state and local government agencies submit information concerning insured persons, including sensitive personal data and other information, in so far as such information is necessary for performance of the functions assigned to the health insurance fund by law.
(3) The persons specified in subsections (1) and (2) of this section shall not demand remuneration for releasing information to the health insurance fund.
(4) Information may be released to the health insurance fund without the knowledge and consent of the insured person.
(5) A person obligated to release information shall perform the obligation immediately or not later than within the term granted by the health insurance fund when demanding the information, or shall provide written justification to the health insurance fund as to why the obligation cannot be performed as required.
(6) A person obligated to release information may refuse to release the information and contest the demand to submit the information in court or initiate challenge proceedings pursuant to the Administrative Procedure Act (RT I 2001, 58, 354; 2002, 53, 336; 61, 375).
§ 19. Entries in health insurance database
(1) If the documents on the basis of which an entry is to be made in the health insurance database are in compliance with the requirements, the entry shall be made within five calendar days after the documents arrive with the health insurance fund.
(2) The facts contained in an entry in the health insurance database acquire legal effect as of the making of the entry unless a different date is prescribed by law.
(21) The health insurance fund shall make an entry on the creation of insurance cover for the persons specified in clauses 5 (2) 1) and 2) of this Act if the Tax and Customs Board has submitted the data concerning payment of social tax for the person to the health insurance fund. The health insurance fund is required to inform the person and his or her employer of making the entry within the term and pursuant to the procedure provided in subsection (3) of this section.
(19.06.08 entered into force 1.08.08 - RT I 2008, 34, 210)
(3) The health insurance fund may make an entry on termination or suspension of the insurance cover of a person on its own initiative if the fund has sufficient information that the conditions of insurance of the person are not complied with and the fund has, if possible, previously ascertained the insured person’s opinion. The health insurance fund is required to notify the insured person of the making of the entry on the same day in writing. The insured person has the right to present objections against the making of the entry within ten days after the receipt of the notice.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)