What are the statutory health benefits in Estonia?

In Estonia, statutory health insurance is provided through the Estonian Health Insurance Fund (EHIF), locally known as Haigekassa. It is mandatory for most employees, with coverage details as follows:

• Who is Covered?

- Coverage includes all employees working under an employment agreement whose social tax is paid by the employer.

- Other covered groups include self-employed individuals, children, pensioners, students, and unemployed persons registered with the Unemployment Insurance Fund.

- Coverage begins when the employer registers the employee with the Tax and Customs Board and starts paying the social tax.

• Financing of Health Insurance:

- Health insurance is financed through the social tax, which is fully funded by the employer.

- Employees do not contribute directly to health insurance.

• Coverage Includes:

- Access to a wide range of medical services such as:

- General practitioner services

- Specialist care (with a referral from a GP)

- Hospital treatment

- Emergency medical care

- Rehabilitation services

- Prescribed medicines (with partial reimbursement)

- Maternity care

• Dental care includes limited compensation for adults, with more extensive coverage available for children.
• Medically necessary eye care services are also covered under certain conditions:

- Eye examinations are covered when referred by a general practitioner or specialist.

- Treatment of eye diseases, such as infections, glaucoma, and cataracts, is covered if deemed medically necessary.

- Surgical procedures, including cataract surgery, are covered when prescribed by a specialist.

It is important to note that routine eye examinations for vision correction, as well as the cost of eyeglasses or contact lenses, are generally not covered under the statutory health insurance. These services are usually paid out-of-pocket or through supplementary private insurance. For the most precise and up-to-date information regarding coverage and eligibility, consultation with Tervisekassa or a local healthcare provider is recommended.

For more detailed information on medical care and statutory health insurance benefits, please visit the provided link (https://www.eesti.ee/en/health-and-care/health-and-medical-care/medical-care).