Benefits related to children

Dental care benefit

From January 1, 2024, the compensation for dental treatment for insured adults increases to 60 euros (with a 50% personal contribution). This compensation also rises for individuals with increased dental care needs, such as pregnant women, mothers of children under 1 year old, individuals with partial or no work capacity, elderly pensioners, etc. The payment amount increases from 85 euros to 105 euros, while the personal contribution decreases from 15% to 12.5%.

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 60 euros per year, while the patient pays at least 50% of the treatment invoice.

ema ja laps

All insured women who are pregnant or mothers of children under one year of age are eligible for dental care benefit of up to 105 euros per year, with the patient paying at least 12,5% 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 105-euro benefit.

Unemployed persons registered with the Unemployment Insurance Fund receive dental care benefits at an increased rate. The benefit is 105 euros per year, with the patient paying at least 12,5% 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 105 euros per year, with the patient paying at least 12,5% 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. 

vanurid

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 105 euros per year, with the patient paying at least 12,5% of the invoice.

 

 

 

 

 

 

 

 

All patients with an increased need for dental care are eligible for a benefit of up to 105 euros per year, with the patient paying at least 12,5% 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: 

  1. 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);
  2. surgical treatment of lip, alveolar and cleft palate;
  3. treatment of genetic and metabolic diseases causing malformations of the dental tissue or the maxillofacial area;
  4. surgical treatment of trauma and inflammation of the maxillofacial area;
  5. medical procedure (endoscopy, anaesthesia, etc.) that has resulted in trauma to the maxillofacial area;
  6. lung, liver, heart and/or kidney, haematopoietic stem cells transplantation or preparation for their transplantation;
  7. included in the waiting list for endoprosthesis;
  8. type 1 diabetes;
  9. 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 105 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 105 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 60 euros, because at the time of receiving the service she is no longer in the target group of the 105-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 105 euros a year.

Example of benefit: €60

If your dental care invoice for reimbursable services is, for example, 120 euros, you will have to pay 50% of the treatment invoice, i.e. 60 euros, and the other 50% will be reimbursed by the Health Insurance Fund. During the same calendar year, the Health Insurance Fund will not cover any more dental services for you, so next time you will have to pay the entire bill yourself.

If your treatment invoice for reimbursable services is, for example, 100 euros, the Health Insurance Fund will pay the annual benefit rate of 50 euros at a time and you will have to pay the remaining 50 euros. Therefore, you have another 10 euros dental benefit to use this calendar year.

Calculation

Dental care invoice 100 euros
50% is paid by the patient: 50 euros
50% is paid by the Health Insurance Fund: 50 euros
Balance: 60–50 = 10 euros of benefit in the same year

Example of benefit: €105

If your dental care invoice for reimbursable services is 120 euros, you will pay 15 euros and the Health Insurance Fund will reimburse 105 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 80 euros, you will pay 10 euros, i.e. 12,5%, and the Health Insurance Fund will reimburse 87,5%, i.e. 70 euros. If you go to the dentist again in the same year, the Health Insurance Fund will reimburse 35 euros of your treatment invoice and your annual benefit of 105 euros will be used up.

Calculation

Dental care invoice 80 euros
12,5% is paid by the patient: 10 euros
87,5% is paid by the Health Insurance Fund: 70 euros
Balance: 105–70 = 35 euros of benefit in the same year

Reimbursement of pharmaceuticals related to artificial insemination

From 2018, in vitro fertilization (IVF) and embryo transfer services and pharmaceuticals are fully financed by EHIF. Previously, the Ministry of Social Affairs paid for these pharmaceuticals and services. In addition, from 2018, you do not have to apply for reimbursement for IVF pharmaceuticals after you have purchased them.

Women up to the age of 40 (incl.) are entitled to a 100% discount on the pharmaceuticals necessary for in vitro fertilization immediately at a pharmacy when buying them. At the pharmacy, they only have to pay the prescription fee, which is 2.5 euros, and the part exceeding the maximum price of the reimbursable pharmaceutical, provided that the pharmaceutical is more expensive than the reference price listed by EHIF. Ask your doctor for more information about different pharmaceuticals and in vitro fertilization.

 

The pharmacy offers a 100% discount for pharmaceuticals that contain the following active ingredients:

  • follitropin alpha;
  • follitropin beta;
  • ganirelix;
  • goserelin;
  • triptorelin;
  • cetrorelix;
  • lutropin;
  • corifollitropin;
  • chorionic gonadotropin alpha.

Reimbursable medicines

ATC code

Active substance

PREGNYL inj subst 5000 IU vial 1 ml solvent N1

G03GA01

chorionic gonadotropin

BEMFOLA 150 IU/0.25 ml solution for injection in a pre-filled pen N1

G03GA05

follitropin alpha

BEMFOLA 225 IU/0.375ml solution for injection in a pre-filled pen N1

G03GA05

follitropin alpha

BEMFOLA 300 IU/0.5 ml solution for injection in a pre-filled pen N1

G03GA05

follitropin alpha

BEMFOLA 450 IU/0.75 ml solution for injection in a pre-filled pen N1

G03GA05

follitropin alpha

BEMFOLA 75 IU/0.125 ml solution for injection in a pre-filled pen N1

G03GA05

follitropin alpha

BEMFOLA 300 IU/0.5 ml solution for injection in a pre-filled pen N1

G03GA05

follitropin alpha

BEMFOLA 450 IU/0.75 ml solution for injection in a pre-filled pen N1

G03GA05

follitropin alpha

BEMFOLA 900 IU/1.5 ml solution for injection in a pre-filled pen N1

G03GA05

follitropin alpha

GONAL-F powder and solvent for solution for injection 75 IU N1

G03GA05

follitropin alpha

OVALEAP 300 IU/0.5 ml solution for injection N1

G03GA05

follitropin alpha

OVALEAP 450 IU/ 0.75 ml solution for injection N1

G03GA05

follitropin alpha

OVALEAP 900 IU/1.5 ml solution for injection N1

G03GA05

follitropin alpha

PUREGON solution for injection 300 IU 0.36 ml N1

G03GA06

follitropin beta

PUREGON solution for injection 50 IU 0.5 ml N5

G03GA06

follitropin beta

PUREGON solution for injection 900 IU 1.23 ml N1

G03GA06

follitropin beta

LUVERIS powder and solvent for solution for injection 75 IU N1

G03GA07

lutropin alpha

OVITRELLE solution for injection in a pre-filled pen 250mcg/0.5ml N1

G03GA08

chorionic gonadotropin alpha

ELONVA solution for injection 100mcg/0.5ml N2

G03GA09

corifollitropin alpha

ELONVA solution for injection 150mcg/0.5ml N1

G03GA09

corifollitropin alpha

ORGALUTRAN solution for injection 0.25 mg/0.5 ml 0.5 ml N1

H01CC01

ganirelix

CETROTIDE powder and solvent for solution for injection 0.25 mg N1

H01CC02

cetrorelix

RESELIGO implant in a pre-filled syringe 10.8 mg N1

L02AE03

goserelin

RESELIGO implant in a pre-filled syringe 3.6 mg N1

L02AE03

goserelin

ZOLADEX implant 3.6mg N1

L02AE03

goserelin

DIPHERELINE 11.25 MG prolonged suspension powder 11.25mg N1 and solvent N1

L02AE04

triptorelin

DIPHERELINE 3.75 MG prolonged suspension powder 3.75mg N1 and solvent N1

L02AE04

triptorelin

*When calculating the benefit, the patient's own contribution of 2.50 euros of the discount prescription is not taken into account.

Did you find what you were looking for?

Did you find what you were looking for?

If you have any questions, please write to our client service info@haigekassa.ee. Thank you!