- •§ 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
§ 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
A list of the documents necessary in order to receive adult dental care benefit, the composition of the information contained in the documents and the procedure for submission of the documents shall be established by a regulation of the Minister of Social Affairs.
§ 66. Connection between adult dental care benefit and specific period of time
If an insured person does not acquire the right to receive adult dental care benefit in whole or in part during one calendar year because the insured person does not incur expenses subject to compensation or incurs such expenses in an amount lower than the extent subject to compensation, the benefit subject to payment during the following calendar year shall not be increased by the amount of the benefit not received or by the part of the benefit not received during the preceding calendar year.
(16.12.04 entered into force 1.01.05 - RT I 2004, 89, 614)
Division 6
Additional Fee and Additional Cost-sharing by Insured Person
Subdivision 1
General Conditions
§ 67. Additional fee and prohibition on extension of additional fee
(1) For the purposes of this Act, an additional fee is taken to mean the expenses which are incurred by an insured person in addition to the amount of cost-sharing in order to receive health insurance benefit and with regard to which the payment obligation is not assumed by the health insurance fund. Additional fees are visit fee and in-patient fee.
(2) The health insurance fund shall not compensate for additional fees.
(3) A health care provider which has entered into a contract for financing medical treatment with the health insurance fund shall not demand that an insured person participate in paying for a health service entered in the list of health services in any other manner than on the bases and to the extent provided for in this Division in addition to the cost-sharing specified in the list of health services, the list of medicinal products or the list of medical devices. (20.12.07 entered into force 1.09.08 - RT I 2008, 3, 22)
§ 68. Obligation to provide health service in standard conditions of accommodation
(1) A health care provider with which the health insurance fund has entered into a contract for financing medical treatment is required to provide an insured person with accommodation in standard conditions for any period during which the person is receiving in-patient health services.
(2) The standard conditions of accommodation shall be established by a regulation of the Minister of Social Affairs.
(3) If health services are provided in conditions better than the standard conditions of accommodation, the health care provider may demand a fee corresponding to the value of the additional benefits from an insured person in accordance with the price list established by the health care provider. The health care provider is required to submit such price list to the health insurance fund upon entry into a contract for financing medical treatment and to make insured persons aware of the price list before health services are provided.
(4) An insured person has the right to demand that health care provider provide health services in the standard conditions of accommodation. If a health care provider which has entered into a contract for financing medical treatment with the health insurance fund is only able to provide health services in conditions better than the standard conditions of accommodation, the health care provider shall not demand the fee specified in subsection (3) of this section from an insured person.
Subdivision 2
Visit Fee, Additional Cost-sharing, In-patient Fee and Fee for Issue of Documents