Dental care benefit
The benefit can be used only at dental care institutions that have entered into a contract with the Health Insurance Fund.
You can check the amount and balance of the benefit in the state portal www.eesti.ee under the service “Information on dental care and denture services”.
- The benefit applies to essential dental care services. All these services, which are not included in the list of reimbursable services, must be paid based on the price list of the medical institution. In addition, the service provider has the right to charge the patient an appointment fee of up to 5 euros (except for pregnant women).
- The reimbursable amount is deducted from the treatment invoice immediately at the time of payment, and the patient does not have to submit any application or document to the Health Insurance Fund.
- You can find information about which dental care services are reimbursed here.
All insured adults can receive dental care benefit of 40 euros per year, while the patient pays at least 50% of the treatment invoice.
All insured women who are pregnant or mothers of children under one year of age are eligible for dental care benefit of up to 85 euros per year, with the patient paying at least 15% of the treatment invoice.
Please check the amount and balance of the benefit in the state portal www.eesti.ee under the service “Information on dental care and denture services” before your visit to the dentist. If a pregnant woman has not acquired the right to dental care benefit in the higher amount, she should submit a maternity certificate or proof to the Health Insurance Fund to receive the benefit at the higher rate.
The dentist checks the amount of the person’s benefit in the Health Insurance Fund’s database. The right to the benefit in the higher amount is displayed after the treatment invoice verifying the pregnancy and issued by a gynaecologist/midwife who is a contract partner of the Health Insurance Fund has been received. If a pregnant woman uses the services of a private clinic, proof of pregnancy must be submitted to the Health Insurance Fund in order to receive the 85-euro benefit.
Unemployed persons registered with the Unemployment Insurance Fund receive dental care benefits at an increased rate. The benefit is 85 euros per year, with the patient paying at least 15% of the treatment invoice.
Please check the amount and balance of the benefit in the state portal www.eesti.ee under the service “Information on dental care and denture services” before your visit to the dentist.
Persons who have received subsistence allowance under the Social Welfare Act during the two calendar months preceding the month in which the service was received are eligible for the dental care benefit at the increased rate. The benefit is 85 euros per year, with the patient paying at least 15% of the treatment invoice.
Please check the amount and balance of the benefit in the state portal www.eesti.ee under the service “Information on dental care and denture services” before your visit to the dentist.
Old-age pensioners and persons receiving pension for incapacity for work, people with partial or no capacity for work and the elderly over the age of 63 are entitled to dental care benefit of 85 euros per year, with the patient paying at least 15% of the invoice.
All patients with an increased need for dental care are eligible for a benefit of up to 85 euros per year, with the patient paying at least 15% of the treatment invoice. A person is entitled to the benefit if the increased need for dental care has arisen as a result of the provision of the following health services or illnesses:
- surgical and/or radiation therapy for tumours of the head and neck (in the case of certain oncological and haematological conditions, a person is eligible to apply for free dental care);
- surgical treatment of lip, alveolar and cleft palate;
- treatment of genetic and metabolic diseases causing malformations of the dental tissue or the maxillofacial area;
- surgical treatment of trauma and inflammation of the maxillofacial area;
- medical procedure (endoscopy, anaesthesia, etc.) that has resulted in trauma to the maxillofacial area;
- lung, liver, heart and/or kidney, haematopoietic stem cells transplantation or preparation for their transplantation;
- included in the waiting list for endoprosthesis;
- type 1 diabetes;
- Sjögren’s syndrome.
Whether a person has an increased need for dental care is determined by their attending physician, who adds the corresponding statistical code to the treatment invoice. In this way, the necessary information reaches the dentist who is a partner to the Health Insurance Fund and proves the person’s right to a benefit of 85 euros.
How is the benefit determined?
It is important to determine which target group of the benefit you belong to. If you become eligible for different benefits during a calendar year, you are entitled to a benefit in the highest amount. For example, an adult insured person who is pregnant or a mother of a child under the age of one year is entitled to a benefit of 85 euros per year. However, if the child reaches the age of one year on the day the service is provided, the mother is eligible for a benefit of 40 euros, because at the time of receiving the service she is no longer in the target group of the 85-euro benefit.
Dental care benefit can be used in full during one calendar year and the unused portion cannot be carried over to the following year. When the year changes, a new calculation of the benefit begins. You can receive the dental care benefit in the amount of up to 85 euros a year.
Example of benefit: €40
If your dental care invoice for reimbursable services is, for example, 60 euros, you will have to pay 50% of the treatment invoice, i.e. 30 euros, and the other 50% will be reimbursed by the Health Insurance Fund. If you visit a dentist again during the same year, the Health Insurance Fund will reimburse another €10 of your treatment invoice, as the annual benefit is €40.
If your treatment invoice for reimbursable services is, for example, 85 euros, the Health Insurance Fund will pay the annual benefit rate of 40 euros at a time and you will have to pay the remaining 45 euros.
Calculation
Dental care invoice 60 euros
50% is paid by the patient: 30 euros
50% is paid by the Health Insurance Fund: 30 euros
Balance: 40–30 = 10 euros of benefit in the same year
Example of benefit: €85
If your dental care invoice for reimbursable services is 100 euros, you will pay 15 euros and the Health Insurance Fund will reimburse 85 euros of the invoice. In the same calendar year, the Health Insurance Fund will no longer reimburse you for dental care services, i.e. the next time you will have to pay the treatment invoice in full by yourself.
For example, if your dental care invoice for reimbursable services is 60 euros, you will pay 9 euros, i.e. 15%, and the Health Insurance Fund will reimburse 85%, i.e. 51 euros. If you go to the dentist again in the same year, the Health Insurance Fund will reimburse 34 euros of your treatment invoice and your annual benefit of 85 euros will be used up.
Calculation
Dental care invoice 60 euros
15% is paid by the patient: 9 euros
85% is paid by the Health Insurance Fund: 51 euros
Balance: 85–51 = 34 euros of benefit in the same year