- •§ 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
§ 44. Discount rates for medicinal products
(1) A list of the diseases in the case of which a medicinal product intended for the treatment or alleviation of the disease is, upon the existence of a valid reference price or price agreement, subject to entry in the list of medicinal products with a 100 per cent discount rate shall be established by a regulation of the Government of the Republic on the proposal of the Minister of Social Affairs.
(2) A list of the diseases in the case of which a medicinal product intended for the treatment or alleviation of the disease is, upon the existence of a valid reference price or price agreement, subject to entry in the list of medicinal products with a 75 per cent discount rate shall be established by a regulation of the Government of the Republic on the proposal of the Minister of Social Affairs. Upon sale of medicinal products entered in the list of medicinal products with a discount rate of 75 per cent, the 90 per cent discount rate applies to children between 4 and 16 years of age and persons receiving a pension for incapacity for work or an old-age pension on the basis of the State Pension Insurance Act (RT I 2001, 100, 648; 2002, 53, 336 and 338; 61, 375; 2003, 20, 116; 48, 343; 82, 549; 88, 589; 2004, 16, 120) and insured persons over 63 years of age.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
(3) Medicinal products which are not intended for the treatment or alleviation of diseases specified in a list of diseases established on the basis of subsection (1) or (2) of this section shall be entered in the list of medicinal products with a 50 per cent discount rate.
(4) If a medicinal product which is entered in the list of medicinal products with a discount rate of 100 or 75 per cent is not used for the treatment or alleviation of diseases specified in a list of diseases established on the basis of subsection (1) or (2) of this section, a 50 per cent discount rate shall be deemed to be applicable to the medicinal product.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
(41) In the case of medicinal products entered in the list of medicinal products, the 100 per cent discount rate applies to children under 4 years of age.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
(5) The Government of the Republic shall establish the list of diseases specified in subsection (1) of this section on the basis of the following criteria:
1) the gravity and life-threatening nature of a disease;
2) the possibility of a disease spreading epidemically;
3) the need to alleviate pain caused by a disease, and other humane considerations;
4) conformity with the financial resources of health insurance and with the principle provided for in subsection 25 (3) of this Act.
(6) Upon establishment of the list of diseases specified in subsection (2) of this section, the Government of the Republic shall, in addition to the criteria provided for in subsection (5) of this section, take into consideration the objective to ensure the treatment or alleviation of chronic diseases which severely impair the quality of life.
(7) A disease shall not be entered in a list of diseases specified in subsection (1) or (2) of this section if the disease can be treated by other, cheaper methods which do not involve significantly greater risks or have any other significant adverse effects on the situation of the insured person.
(8) A disease may be entered in the list of diseases with a condition the objective of which is to take into account the needs arising from gender, age or medical reasons.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)