- •§ 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
§ 11. Duration of insurance cover of persons considered equal to insured persons
(1) The insurance cover of a person specified in subsection 5 (4) of this Act commences as of the making of an entry on commencement of the insurance cover in the health insurance database. The documents necessary for the person to be entered in the health insurance database shall be submitted to the health insurance fund by the person himself of herself or his or her legal representative or, upon agreement with his or her employer, by the employer.
(2) The documents necessary for a person specified in clause 5 (4) 3) of this Act to be entered in the health insurance database shall be submitted by the Social Insurance Board and, in the cases provided by law, by the Chancellery of the Riigikogu.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
(3) The documents necessary for a person studying in Estonia specified in clause 5 (4) 5) of this Act to be entered in the health insurance database shall be submitted by the Ministry of Education and Research. A person studying in a foreign state specified in clause 5 (4) 5) is obligated to submit the documents necessary for insurance cover to commence by himself or herself.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
(4) The insurance cover of the persons specified in clauses 5 (4) 1)–4) of this Act terminates if the person no longer meets the conditions provided for in the relevant clause of subsection 5 (4), taking account of the specifications provided for in § 12 of this Act.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
(5) A submitter of documents specified in subsection (2) or (3) of this section is required to notify the health insurance fund of termination of the insurance cover of a person specified in clause 5 (4) 3) or 5) of this Act within ten calendar days.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
§ 12. Specifications concerning duration of insurance cover of persons considered equal to insured persons
(1) The insurance cover of a person declared permanently incapacitated for work terminates three months after termination of his or her permanent incapacity for work.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
(11) The insurance cover of a person specified in clause 5 (4) 1) of this Act terminates three months after the estimated date of delivery as determined by a doctor.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
(2) The insurance cover of a person specified in clause 5 (4) 5) of this Act terminates three months after his or her graduation from the educational institution. If a student acquiring general secondary education as specified in clause 5 (4) 5) of this Act reaches 24 years of age within three consecutive academic years after commencement of acquisition of the general secondary education, his or her insurance cover terminates three months after his or her graduation from the educational institution.
(24.11.05 entered into force 1.01.06 - RT I 2005, 65, 498)
(21) If a student of at least 19 years of age acquiring general secondary education as specified in clause 5 (4) 5) of this Act is expelled from the educational institution before graduation within three consecutive academic years after commencement of acquisition of the general secondary education, his or her insurance cover terminates one month after the expulsion. If a student of at least 19 years of age acquiring vocational education as specified in clause 5 (4) 5) of this Act fails to graduate from the educational institution within the standard period of study prescribed for completion of the curriculum (except for medical reasons) or is expelled from the educational institution before graduation, his or her insurance cover terminates one month thereafter. If a student specified in clause 5 (4) 5) of this Act fails to graduate from the educational institution within one year after the end of the standard period of study prescribed for completion of the curriculum (except for medical reasons) or is expelled from the educational institution before graduation, his or her insurance cover terminates one month thereafter.
(24.11.05 entered into force 1.01.06 - RT I 2005, 65, 498)
(3) Insurance cover is suspended for any period of academic leave. The conditions under which insurance cover is not suspended for a period of academic leave shall be established by a regulation of the Minister of Social Affairs. After expiry of a period of suspension, insurance cover resumes without a waiting period.