The Estonian Health Insurance Act adopted on 19.06.2002 (RT I 2002, 62, 377), regulates joint health insurance (hereinafter health insurance). This act defines that health insurance is “a system of covering health care costs for the prevention and treatment of illnesses of the insured person, for financing the purchase of medicines and medical equipment, and for the payment of temporary incapacity benefits and other benefits under the conditions and procedure provided for in this Act.” The principles of health insurance are listed as follows: “solidarity and limited co-payment of the insured persons and is based on the principle of provision of services that meet the needs of the insured persons, regional equal access to treatment and the expedient use of health insurance funds”. The Act also defines that health insurance is compulsory insurance, with the exception of health insurance provided for in §§ 22–24 of this Act.
Estonian Health Insurance Act is structured into several key sections, each addressing critical aspects of health insurance. One major focus is on temporary incapacity for work, where compensation begins on the 9th day of illness, except for cases like pregnancy, accidents, or occupational diseases, where payments start from the 2nd day. The maximum payment duration is set at 182 days, with exceptions such as tuberculosis allowing up to 240 days. These provisions encourage a timely return to work while providing additional protections for vulnerable groups, such as pregnant individuals and those injured at work.
Another significant section deals with the reimbursement for medications and medical devices. Up to 90% of costs for specific devices and medications are covered, and individuals with annual medication expenses exceeding €300 receive additional benefits. The Act also includes provisions for renegotiating price agreements with pharmaceutical manufacturers to control public healthcare spending. These mechanisms ensure financial sustainability while maintaining accessibility to essential treatments.
The Act addresses cross-border healthcare services, allowing insured individuals to receive treatment in other EU countries with reimbursement based on Estonia’s pricing conditions. However, high-cost or specialized services require prior authorization. This aligns Estonia’s health insurance framework with European Union directives, promoting the country’s integration into the broader European healthcare network.
The Act also outlines restrictions and exceptions to prevent misuse of benefits. For instance, no reimbursement is provided for self-inflicted harm or cases where prescribed treatments are ignored. Individuals actively engaged in employment or business during temporary incapacity are also ineligible for compensation. These restrictions reinforce accountability while minimizing potential abuse of the system.
The Act’s transitional provisions ensure a smooth shift to new regulations, safeguarding the rights of individuals who began utilizing earlier provisions before amendments. Patients who received treatment prior to the Act’s enforcement are also protected, demonstrating a commitment to continuity and fairness.
