In the health care system, the first contact that a person with a health concern has is with their family physician or family nurse.
The family physician together with the family nurse:
- diagnoses and treats most diseases;
- monitors child’s progress and persons with chronic conditions;
- performs minor surgical procedures;
- refers patients for tests and takes analyses;
- makes home visits, if necessary;
- gives advice on care, injuries or intoxications and in terms of preventive measures to all persons included in their practice list.
Every health insured citizen of Estonia has a family physician. Insured persons can choose their own family physician, in order to do so, find a family physician you wish to start going to. Information about which family physicians closest to your place of residence is available on the website of the Health Board or the Health Insurance Fund. After that, submit an application (pdf, 113 kB, in Estonian) directly to the chosen family physician to be included in their practice list.
If there is no vacancies in the practice list of the family physician, you will receive a response within 7 days. To those who have not chosen their own family physician, one will be appointed by the Health Board on the basis of their place of residence in the population register.
The family nurse has independent appointments where they teach, advise and guide people about the promotion and maintenance of health and prevention of disease. The family nurse provides assistance in the event of illness and organises medical records; also, the role of a nurse is to monitor persons with chronic conditions. If necessary, the family nurse consults with the family physician or refers the person to an appointment with the family physician.
Primary health care is free of charge for health insured persons. Persons without health insurance have to pay for the service of the family physician. For a home visit, the family physician may charge up to 5 euros, regardless of how many patients they will check during the visit. Home visits for pregnant women and children under the age of two are free of charge.
Names of family physicians may be checked:
- at the state portal in the e-service of the Health Insurance Board under Health insurance and family physician
- by calling the customer service phone number of the Health Insurance Board at (+372) 669 6630.
Information about family physicians::
- Phone numbers and addresses are listed on the website of the Health Insurance Fund
- The size of their practice lists and their service areas are available on the website of the Health Board
- For questions, contact customer service offices and the customer service phone number at 669 6630
- Or send an e-mail to email@example.com.
In case of minor concerns, you can also contact the family physician advice line and ask for professional medical advice in Estonian or Russian 24 hours a day. The numbers for the advice line are 1220 and (+372) 634 6630.
E-service of Estonian Health Insurance Fund “My prescriptions” enables a person to see prescribed medicines and prescriptions’ validity. Also you can see information about your additional drug reimbursement. To see prescribed medicines to your underage children, please visit the patient portal digilugu.ee. In the same portal you can also see referrals issued to you and to your children, health records and results of analyses.
Specialised medical care is out-patient, day or in-patient treatment provided by a medical specialist or a dentist and the health care professionals working together with the dentist.
Out-patient treatment refers to a consultation by a physician, during which the patient is checked, some procedures (such as a blood test, cardiogram, etc.) are performed on site and, if necessary, further treatment is prescribed. The patient does stay in the hospital for any longer.
Day treatment implies that the patient stays in the hospital for longer than just the consultation time but not overnight.
In-patient treatment is provided at the hospital and the patient has to stay there for a night or longer.
Health insured persons have the right to choose their preferred medical specialist and consultation time in any of the medical institutions that have a contract with the Health Insurance Fund.
To see a medical specialist, a referral from the family physician is needed, except for a gynaecologist, dermatologist, eye specialist, pulmonologist or dentist. In the case of traumas, you can also see a surgeon or traumatologist without a referral.
Patients are no longer issued referrals on paper. Instead, the family physician shall forward a digital referral to the medical specialist through the health information system. Digital referrals issued to you are available in the patient portal digilugu.ee. All referrals issued to your children and representatives are also available there.
Read more about specialised medical care from the website of the Health Insurance Fund.
- Dental care is free of charge for persons under the age of 19. Free dental care is provided only by doctors who have concluded the contract for financing medical treatment with the Health Insurance Fund.
- The Health Insurance Fund will reimburse dental care to adults with health insurance up to 40 euro per year. The patients themselves pay at least 50% of the price of the services.
- Pregnant women, mothers with children under one-year of age, old-age pensioners, persons receiving benefits for incapacity for work and people with partial or no ability for work, people over the age of 63 and people with an increased need for dental care will receive dental care benefit up to 85 euros per the calendar year. The patients themselves pay at least 15% of the price of the services.
The benefit can only be used at the dentists who have concluded a contract with the Health Insurance Fund. The benefit applies to primary dental care services. The full price must be paid for all the services that are not included in the list of services to be compensated for. In addition, the service provider has the right to ask a patient to pay an appointment fee of up to 5 euros (except for pregnant women).
The amount of the benefit is always deducted from the medical invoice immediately upon payment to the dentist.
Once every three years the Health Insurance Fund will reimburse 260 euros for the cost of dentures to persons receiving a pension for incapacity for work or for old age pensioners, people over 63 years of age who have health insurance and people with partial or no capacity for work. NB! If you have received a compensation of EUR 255.65 for the past three years, you are entitled to an additional non-monetary benefit of EUR 4.35.
From January 1, 2018, the amount of denture benefit can only be used by those denture manufacturers who have entered into a relevant contract with the Health Insurance Fund. The list of dental care offices providing the benefit is available on the Health Insurance Fund’s website. The amount of the benefit is always deducted from the medical invoice immediately upon payment to the dentist. A person, himself/herself, does not have to fill in or submit an application or another document to the Health Insurance Fund or the dentist.
At the state portal in the e-service Dental care benefit and denture benefit information you are displayed the data related to adult dental care benefit and denture benefit (rate, remaining limit).
Both health insured and uninsured adults have no right to receive free dental care, only emergency care that is provided for them in situations where the postponement of care or failure to provide care may cause the death or permanent damage to the health of the person requiring care. Whether the services provided can be regarded as emergency care is decided by the dentist.
If you have any questions, call the client line of the Health Insurance Fund at (+372) 669 6630 or write an e-mail to firstname.lastname@example.org.