How does the state health insurance system work?
Healthcare in Estonia is managed by the Ministry for Social Affairs. The national insurance scheme is funded out of taxes and should be available to you wherever you are living in the country.
If you are an expat, as soon as you are registered as resident in Estonia, you will become eligible for the state health insurance system and will need to start making contributions. You can only pay quarterly or annually, not monthly. If you do not pay, EHIF will cancel your insurance.
Your employer will sign you up for health insurance, but check that this has been done and that you have been allotted an Estonian ID code. If you are self-employed, you will need to sign up yourself, and if you are not working and not a dependent of someone with medical insurance, you will also need to register with EHIF.
In Estonia, the start and end dates of your medical insurance are linked to your tax returns. After you submit your first return and pay your tax, your insurance will begin, and it will end on the day after the deadline for your next return. When you first register, your insurance will only begin a month after you sign.
If illness or accident renders you incapable of working, the national insurance scheme should also give you access to some state benefits.
When you have signed up with a GP, you will need to submit an application form (Avaldus perearsti nimistusse registreerimiseks) and this must be completed in Estonian. A practice may refuse to take you on if it is full.
There is also a telemedical service called MinuDoc, which is recommended for expats, since consultations can be held in Estonian, Russian, English, Finnish, French or Spanish. You will have to pay approximately €50 per session.
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Who is eligible for state healthcare?
Healthcare is provided for everyone in Estonia and as a resident, you will be eligible as long as you have signed up. The following groups are automatically covered:
- pregnant women
- children and young adults up to the age of 19
How do you apply to join the state health insurance system?
Your employer must sign you up. International House in Talinn gives free consultations about aspects of life in Estonia, and this includes healthcare and health insurance: they will be able to assist you.
It is also possible to sign up with EHIF directly under the “voluntary insurance contract”. You will be able to do this if you have been insured with them previously, for at least a year; or if someone who has also been insured with them registers on your behalf.
What is covered by the state health insurance system?
You will be covered for:
- GP visits
- hospital treatment
- referrals from your doctor, for instance, to a gynaecologist or a psychiatrist
However, if you are admitted to hospital, there will be a small charge: around €2.50 per day for up to 10 days. In an emergency; if you go into labour; or if one of your children has to be hospitalized, there is no fee. There is a charge of €5 when you visit your GP for the first time, and you may also have to pay the same rate for home visits.
You must take your EHIC or your insurance policy with you to all medical visits. Estonian medical insurance works on a reimbursement policy, so you might need to pay upfront and then claim the cost back from your provider.
Prescriptions will involve co-payment, but this is usually a minimal fee.
Are retirees covered by state medical insurance?
Yes, pensioners are covered. If you are British, you may also be covered if you have:
- an exportable UK State Pension
- a contribution-based Employment Support Allowance
- another exportable benefit
In this case, you are entitled to apply for an S1 certificate which will enable you to access Estonian healthcare. You may also be eligible for an S1 if you:
- receive certain UK benefits, such as a UK State Pension
- are employed by a UK body or firm
- are a dependent of someone who has an S1 certificate
Are students covered by state medical insurance?
If you are a student, you will not be covered by the state plan unless you have the right to long-term residence or are working. If you are from an EU member state, you can use your EHIC, but this is not a replacement for proper health coverage: it is only for emergencies.
You will need to take out travel insurance or private cover as well, and this is compulsory. You will need to sort this out within two months of arriving in the country.
Will your family be covered by your insurance?
Legally married dependent spouses of insured persons are entitled to state health insurance if they have less than five years to pensionable age.
The person who wishes to obtain the insurance must submit an application to the Health Insurance Fund. The insurance ends when the dependent:
- reaches pensionable age
- gets divorced
- or when the insurance of the maintenance provider ends
A legally married, dependent spouse of an insured person has the right to state health insurance coverage if they are:
- raising at least one child under 8 years of age
- raising at least three children under 16 years of age
- over the age of 58
- under the age of 19
Is dental treatment covered by state health insurance?
Some emergency dental care, such as lancing an abscess or emergency extractions, is free but in general you will need to pay for your dental treatment and this is non-refundable. Basic treatment will cost you around €30 per appointment, and you will usually have to pay for half of this: the state insurance will cover the rest. So if you have a filling for €60, for example, you will need to pay the full fee upfront, but your state insurance will reimburse €30.
Dental care for children and young adults up to the age of 19 is free.
However, this does not apply to all private clinics: it is only applicable to those dental practices that are covered by EHIF. In practice, most private dentists have an arrangement with EHIF.
What are the contribution rates for state health insurance?
This will depend on your income. The minimum threshold for contribution is around €170 per year. Your contribution rate is calculated on a percentage basis: your insurance premium equals the average gross monthly salary of the preceding calendar year, times 0.13. So you will find that your premium changes annually, depending on what your gross monthly salary is in any given year.
Why buy private health insurance?
If you are not covered by EHIF, or you would like quicker access to Estonian healthcare or better facilities, private cover is an option. International students are also likely to need private health insurance.
It is not always easy to find a state medical practice in Estonia and English-speaking medical personnel are limited, therefore many expats prefer to take out private cover. Expats are often excluded from the healthcare system by the language barrier even though they pay into the national insurance scheme.
Estonia is working to address this problem, for instance by compiling a list of medics’ language skills and encouraging expats to engage with the national language.
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What is covered by private health insurance?
Private health insurance will cover the full range of primary care and other treatments, in addition to more advanced dental care and treatments such as elective cosmetic surgery.
How much does private health insurance cost?
Check whether your employer has a contract with a private provider. Skype, which was initially set up in Estonia, has an insurance arrangement for its foreign personnel, for instance.
For those seeking international private medical insurance (iPMI) cover for multiple countries including Estonia, numerous variables can have an impact on the cost.
The most important variables are:
- age (the higher the more expensive)
- area of cover (i.e. in addition to Estonia, which other areas is coverage required in? If those other areas include any of the US, the Caribbean, Singapore, China, Hong Kong or Dubai this can significantly increase the overall price)
- product choice (higher end insurance products are more expensive)
Other variables include:
- payment frequency
- country of residence
As so many variables have an effect on the cost of international private medical insurance in Estonia it becomes very difficult to give accurate estimates without knowing the full details of the coverage required. However, as a very rough guide, using a standard profile of a 40 year old British male with no deductibles, no co-insurance, a middle tier plan/product, all modules included and worldwide coverage excluding the US, a ballpark price of around £4,000/$5,000 might be expected. Were coverage to be expanded to include the US then the premium could increase to almost double that amount.
Which companies offer private health insurance?
It is a good idea to take out insurance with those private providers who are recognized by the Estonian Police and Border Guard, including:
- Salva Kindlustuse
Some of these companies allow you to sign up online before you come into the country.
Bigger international companies such as Cigna Global also operate in the region.
Glossary of health insurance terms
Haigekassa - Estonian Health Insurance Fund (EHIF)
Mul on EHIC kaart - I have an EHIC card
Mul on riiklik tervisekindlustus - I have public health insurance
Mul on eraõiguslik tervisekindlustus - I have private health insurance