- •§ 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
§ 45. Entry into price agreement
(1) The interests of insured persons in obtaining necessary medicinal products at a reasonable price, the budgetary funds of the health insurance fund which are prescribed for the assumption of obligations to pay for medicinal products, and the principle provided for in subsection 25 (3) of this Act shall be taken into account upon entry into a price agreement.
(2) The following conditions shall be agreed upon in a price agreement:
1) the wholesale purchase price of a medicinal product in kroons by each pharmaceutical form, active substance content and package subject to a 100 or 75 per cent discount rate;
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
2) the estimated retail sale volume of the medicinal product during the term of validity of the price agreement if the medicinal product is the only medicinal product with a given active ingredient and route of administration entered in the list of medicinal products with a discount rate of 100 or 75 per cent;
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
3) the term during which amendment of the price agreement by the parties is prohibited;
4) the conditions under which a party has the right to demand that the price agreement be amended;
5) the due date by which the parties are required to submit requests for amendment of the price agreement in order to prevent automatic extension of the term of validity of the price agreement;
6) the term during which the manufacturer of a medicinal product is required to sell the medicinal product on the Estonian market and the health insurance fund is required to assume the obligations of insured persons to pay for the medicinal product under the currently applicable conditions if the parties do not reach an agreement concerning amendment of the price;
7) other conditions and obligations necessary for ensuring the efficient and purposeful use of health insurance funds and compliance with the conditions of the price agreement.
(3) A proposal for a price agreement to be entered into shall be made to the Ministry of Social Affairs by a manufacturer of a medicinal product or a person holding marketing authorisation for a medicinal product.
(4) The Ministry of Social Affairs may issue a precept demanding that a price agreement be entered into to a manufacturer of a medicinal product or a person holding marketing authorisation for a medicinal product if the medicinal product concerned has been entered in the list of medicinal products with a 100 or 75 per cent discount rate.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
(5) In the event of failure to comply in a timely manner with a precept demanding that a price agreement be entered into, the Ministry of Social Affairs has the right to impose a penalty payment pursuant to the procedure provided for in the Substitutive Enforcement and Penalty Payment Act. The upper limit for a penalty payment is 100 000 kroons.
(51) If no agreement is reached on the conditions for entry into or amendment of a price agreement during a reasonable period of time, the Ministry of Social Affairs may initiate proceedings for the reduction of the discount rate for the medicinal product pursuant to the procedure established pursuant to subsection 43 (3) of this Act.
(28.06.2004 entered into force 01.08.2004 - RT I 2004, 56, 400)
(6) The procedure for entry into price agreements shall be established by a regulation of the Minister of Social Affairs.