- •§ 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
§ 20. Statutes for maintenance of health insurance database
(1) The statutes for the maintenance of the health insurance database shall be established by the supervisory board of the health insurance fund.
(2) The statutes for the maintenance of the health insurance database shall set out:
1) the structure and organisational structure of the database;
2) the term for storing information in the database;
3) a list of the source documents necessary for information to be entered in the database;
4) the procedure for maintaining records on the receipt and release of information;
5) the procedure for access to and release of information and the fee payable for the release pursuant to § 22 of the Personal Data Protection Act and other legislation;
(15.02.07 entered into force 1.01.08 - RT I 2007, 24, 127)
6) the procedure for the correction of inaccurate information and for giving notice of the correction;
7) the conditions and procedure for closure of access to information;
8) the bases and procedure for expansion and liquidation of the database and for combination of the database with other databases;
9) other conditions necessary for the maintenance of the database.
§ 21. Proof of insurance cover
(1) A person who is entered in the health insurance database shall present an identity document in order to prove his or her insurance cover in Estonia. In order to prove insurance cover in other member states of the European Union, a person who is entered in the health insurance database shall present the European health insurance card or the provisional replacement certificate of the European health insurance card (hereinafter provisional replacement certificate).
(2) In order to prove insurance cover, a person under 15 years of age who is entered in the health insurance database may present, instead of the identity document, the European health insurance card or the health insurance card until the issue of the European health insurance card.
(3) The conditions and procedure for the issue of European health insurance cards and provisional replacement certificates shall be established by a regulation of the Minister of Social Affairs.
(4) If a person's insurance cover is suspended or terminated, he or she shall not use the European health insurance card or provisional replacement certificate.
(19.06.08 entered into force 1.08.08 - RT I 2008, 34, 210)
Division 4
Persons Considered Equal to Insured Persons on Basis of Contract
§ 22. Persons considered equal to insured persons on basis of contract
(1) The following persons shall be considered equal to insured persons on the basis of a contract:
1) persons who during the two years prior to the month of entry into the contract had been ensured for at least twelve months on the bases provided for in subsection 5 (2) or (3) or clause 5 (4) 5) of this Act, and persons maintained by such persons;
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
2) persons receiving a pension from a foreign state unless otherwise provided by an international agreement.
(2) The health insurance fund enters into a contract specified in subsection (1) of this section with or for the benefit of a person or persons specified in clause (1) 1) or 2) of this section.
(3) The health insurance fund has the right, if it provides a reasoned explanation, to refuse to enter into a contract specified in subsection (1) of this section if the person has failed to perform contracts previously entered into with the health insurance fund as required or to comply with legislation regulating health insurance or if he or she has knowingly submitted false information to the health insurance fund.