- •§ 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
§ 69. Fee for home visit
(1) A person providing general medical care may demand a fee from an insured person for a home visit.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
(2) A fee for a home visit shall not exceed the maximum rate of visit fees set out in subsection 72 (1) of this Act, regardless of the number of insured persons per one home visit.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
(3) A fee for a home visit shall not be demanded from pregnant women from the twelfth week of pregnancy and from insured persons under 2 years of age.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
§ 70. Visit fee and additional cost-sharing upon payment for out-patient specialised medical care
(1) If out-patient specialised medical care is provided on the basis of a referral from a person providing general medical care or a person providing specialised medical care or, in the case provided for in subsection (3) of this section, without a referral, the person providing the specialised medical care has the right to demand that the insured person pay a visit fee.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
(2) If out-patient specialised medical care is provided without a referral from a person providing general medical care or a person providing specialised medical care, the health insurance fund shall not assume the obligation to pay for the health services (additional cost-sharing), except in the cases specified in subsection (3) of this section.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
(3) If out-patient specialised medical care is provided without a referral from a person providing general medical care or a person providing specialised medical care, the health insurance fund shall assume the obligation to pay for the health services if the specialised medical care is provided in connection with a trauma, a chronic illness, tuberculosis, eye disease, dermatosis or venereal disease or in the case where gynaecological or psychiatric care is provided. For the purposes of this Act, a chronic illness is an illness in the event of which it is necessary to monitor the patient continuously according to generally recognised treatment instructions and where the treatment is to be adapted by a specialist.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
(4) If an insured person is referred to a person providing out-patient specialised medical care to a health care professional working for the same health care provider but in another speciality or to a health care professional working for another health care provider but providing the same health service, the insured person shall not be required to pay a visit fee.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
(5) A visit fee shall not be required if:
1) out-patient specialised medical care is provided to pregnant women as from the twelfth week of pregnancy;
2) out-patient specialised medical care is provided to insured persons under 2 years of age;
3) provision of emergency out-patient specialised medical care is directly followed by the provision of in-patient health services.
(16.12.04 entered into force 1.01.05 - RT I 2004, 89, 614)
(6) If a patient cancels a contract for provision of health services less than 24 hours before the time agreed upon for the provision of the health service or fails to appear at the place of performance of the contract at the time agreed for the provision of the service, the provider of the health service has the right to demand a double visit fee from the patient at the time of the following performance of the contract for the health service. (20.12.07 entered into force 1.09.08 - RT I 2008, 3, 22)
§ 71. In-patient fee
(1) A person providing in-patient specialised medical care may demand an in-patient fee from an insured person for the services provided in standard conditions of accommodation. An in-patient fee may be demanded for each calendar day which has commenced during the time spent by a person in hospital, but not for more than ten calendar days for one case of disease.
(2) An in-patient fee shall not be demanded for a period when intensive care is provided, upon provision of in-patient specialised medical care in connection with pregnancy or delivery, or upon provision of in-patient specialised medical care to a minor.
(3) The supervisory board of a health care provider has the right to establish an in-patient fee.