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Conditions of and procedure for payment of benefits and for services through the Estonian Health Insurance Fund in emergency situation

Passed 23.04.2020 No. 28

This Regulation is established under § 52 (1³) of the Health Services Organisation Act.

§ 1.  Scope of application of Regulation

  This Regulation establishes the conditions of and the procedure for the payment of benefits and for services from the state budget through the Estonian Health Insurance Fund during the emergency situation declared by the Government of the Republic on 12 March 2020.

§ 2.  Conditions of and procedure for payment of sickness benefit to persons for the first three sick days

 (1) The Estonian Health Insurance Fund shall grant and pay sickness benefit to a person who is an insured person under § 5 (2) 1), 2), 4), 5) and 5¹) and § 5 (3) and (3¹) of the Health Insurance Act.

 (2) Sickness benefit shall be granted and paid for days one through three of a person’s certificate for sick leave in insured events where their release from work is based on reason 1, 3, 4, 10, 18 or 19 set out in § 10 (2) 8) of Minister of Social Affairs Regulation No. 114 “Composition of the data of the certificate of incapacity for work, the paper form of the certificate as well as the conditions and procedure for the registration and issue of the certificate and forwarding the certificate to the Health Insurance Fund” of 26 September 2002.

 (3) The amount of the sickness benefit shall be calculated on the conditions and pursuant to the procedure provided for in § 54 of the Health Insurance Act.

 (4) The average income per calendar day subject to compensation shall be calculated on the conditions and pursuant to the procedure provided for in § 55 of the Health Insurance Act.

§ 3.  Payment for services under special conditions to health care providers and owners of ambulance crews

 (1) Providers of general medical care, including primary on-call centres, shall be compensated for the following expenses:
 1) additional personnel expenses;
 2) additional expenses of providing services to patients not included in the practice list;
 3) additional expenses of acquiring personal protective equipment, disinfection and waste management;
 4) expenses of increased Internet capacity and other communications;
 5) expenses of emergency care provided to uninsured persons;
 6) expenses of additional tests and procedures arising from the patient’s condition;
 7) expenses related to the provision of remote services.

 (2) The provider of the family physician advice line service shall be compensated for additional expenses due to increased number of calls.

 (3) Providers of nursing shall be compensated for the following expenses:
 1) additional personnel expenses;
 2) additional expenses of acquiring personal protective equipment, disinfection and waste management;
 3) expenses of extended treatment arising from the emergency situation;
 4) additional expenses of patient treatment;
 5) additional expenses of readiness;
 6) expenses related to the provision of remote services.

 (4) Owners of ambulance crews shall be compensated for the following expenses:
 1) additional personnel expenses;
 2) additional expenses of acquiring personal protective equipment, disinfection and waste management;
 3) expenses of providing the service of additional ambulance crews;
 4) additional expenses of readiness.

 (5) Providers of specialised medical care, except for providers of dental care, shall be compensated for the following expenses:
 1) additional personnel expenses;
 2) additional expenses of acquiring personal protective equipment, disinfection and waste management;
 3) additional expenses of hospital medicinal products;
 4) expenses of reorganising the work of medical departments;
 5) expenses of increased intensive care capability;
 6) expenses of acquiring equipment necessary for providing quality health care services in the conditions of the emergency situation;
 7) additional IT expenses;
 8) expenses of maintaining the financial sustainability of service providers due to no scheduled treatment;
 9) additional expenses of readiness;
 10) expenses of additional tests and procedures arising from the patient’s condition;
 11) expenses related to the provision of remote services;
 12) expenses of emergency care provided to uninsured persons.

 (6) Providers of dental care services shall be compensated for the following expenses:
 1) additional expenses of acquiring personal protective equipment, disinfection and waste management;
 2) additional expenses of readiness.

§ 4.  Implementation of Regulation

 (1) The provisions of § 2 of this Regulation shall be applied to certificates for sick leave issued between 13 March 2020 and the end of the emergency situation.

 (2) The provisions of § 3 of this Regulation shall be applied to additional expense reports filed from 13 March 2020 to 60 calendar days after the end of the emergency situation by service providers who have a valid general medical care financing contract, medical treatment financing contract, emergency medical care financing contract or advice line financing contract with the Estonian Health Insurance Fund, and accepted by the Estonian Health Insurance Fund.

 (3) This Regulation takes effect on 1 May 2020.