- •§ 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
§ 46. Assumption of obligations to pay for the sale of medicinal products
(1) The health insurance fund is deemed to have assumed an obligation to pay for the sale of a medicinal product to the extent and under the conditions provided for in this Act if, within thirty calendar days after the receipt of the documents on which the assumption of the obligation is based through the prescription centre specified § 81 of the Medicinal Products Act the health insurance fund has not notified the retailer of the medicinal product of its refusal to assume the obligation.
(2) The health insurance fund may refuse to assume an obligation to pay for the sale of a medicinal product if upon the sale of the medicinal product, the requirements for the sale of the medicinal product were violated.
(20.12.07 entered into force 1.09.08 - RT I 2008, 3, 22)
4) the circumstances under which assumption of an obligation is contingent upon prior written approval from the health insurance fund;
5) the scope of the reporting obligation of the retailer of medicinal products and the obligation to submit information concerning insured persons to the health insurance fund, and the composition of the information to be submitted;
6) other conditions necessary for ensuring the efficient and purposeful use of health insurance funds.
(3) Assumption of an obligation to pay for the sale of a medicinal product may be refused if the sale of the medicinal product is not in conformity with the provisions of legislation or of a contract entered into with the health insurance fund.
§ 47. Supplementary benefit for medicinal products.
(1) The health insurance fund shall additionally compensate for justified and certified amounts ranging from 6000 to 20 000 kroons which are paid during a calendar year for medicinal products which are entered in the list of medicinal products and are necessary for the out-patient treatment of an insured person (supplementary benefit for medicinal products).
(2) The size of supplementary benefit for medicinal products shall be calculated by the health insurance fund on the basis of an application by an insured person or his or her legal representative according to the information in the health insurance database.
(3) The amounts paid by the health insurance fund, the basic rate of cost-sharing and the amounts exceeding a reference price or a price established in a price agreement shall not be taken into account upon calculation of supplementary benefit for medicinal products.
(4) If an amount calculated pursuant to subsection (3) of this section is 6000 to 10 000 kroons, the health insurance fund shall compensate 50 per cent of the share exceeding 6000 kroons.
(5) If an amount calculated pursuant to subsection (3) of this section is 10 000 to 20 000 kroons, the health insurance fund shall, in addition to the amount calculated pursuant to subsection (4) of this section, compensate 75 per cent of the share exceeding 10 000 kroons.
(6) The health insurance fund shall not additionally compensate for shares of amounts calculated pursuant to subsection (3) of this section which exceed 20 000 kroons.
(7) The detailed procedure for application for and payment of supplementary benefits for medicinal products shall be established by a regulation of the Minister of Social Affairs.