In order to keep your health insurance costs low in Estonia, you have two principal options: either signing up with the Estonian national health insurance scheme, the Haigekassa (also known as the Estonian Health Insurance Fund/EHIF), which is mandatory if you are working in the country, or by shopping around for the best private health insurance plan from a private provider for your own treatment needs.
State health insurance in Estonia
Everyone resident in Estonia can sign up for the Haigekassa/EHIF if they are paying national health contributions: these will normally be deducted from your salary if you are employed. You will then be eligible to access the public healthcare system. Pregnant women, children and pensioners are automatically covered by EHIF.We will take a look below at how to keep your health insurance costs as low as possible if you do opt for private cover, and how to personalize your cover so that you’re not facing high premiums.
Personalising Your Health Insurance Cover
EHIF will cover:
• GP visits
• hospital treatment
• referrals from your doctor, for instance, to a gynecologist or a psychiatrist.
If you are paying national insurance contributions, your treatment will mostly be free at the point of delivery. You might need to pay for some extra services, which are reimbursable to some extent. Pregnant women, children and pensioners are automatically covered by EHIF, so if you or your dependents fall into one of these categories, your treatment will be free.
You may, however, wish to take out private insurance as a top-up, to complete any healthcare gaps in your existing state cover under EHIF: for example, for some forms of specialist care such as advanced dental treatment.
Selectable Options
Check the small print of any private policy to see whether it covers treatments that you may want to access.
Remember to shop around and see if your private policy covers pre-existing conditions: the definition of this varies between insurers. Usually the term applies to any conditions which present symptoms or for which you’ve been treated in the last five years. This normally includes any conditions you were diagnosed with over five years ago, but some insurers have different time limits for diagnosis.
You may also want to check out whether your policy has a ‘hospitalisation’ clause covering you for occasional hospital visits. You will need to discuss this directly with your insurer.
It’s also a good idea to check for any cover relating to healthcare which does not apply to you: some policies have provision for maternity care, for instance, and if you are not intending to become pregnant (or prefer to rely on the cover provided by the Estonian maternity system), then you may wish to reduce your policy costs by having such options removed.
Cost Sharing
You may also be able to reduce the cost of your premium through ‘cost sharing’: this means that you and your insurer will share the costs of any treatment. You will pay up to an agreed limit, and your provider will cover the rest. Different insurers will have different ways of arranging cost sharing.
Co-pay is where you pay a fixed sum for your treatment and your insurer covers the rest. For instance, if the total cost of your treatment is €85, and your co-pay amount is set at €40, then you will pay €40 and your insurer will pay €45.
Co-insurance is where you pay a fixed percentage of the total cost and your insurer covers the rest. For instance, if your co-insurance is set at 20%, you will pay 20% of €85 and your insurer will cover the remaining 80%.
Deductibles are where you pay the entire amount allowed for all services provided until the deductible is met. For instance, if your policy has a €1,000 annual deductible, you would pay €85 for each visit to your private sector GP. However, you would then have to pay the entire amount for 11 such visits (€1000/€85 = 11.8) before your insurance began to pay out to the doctor directly.
You may also need to take a look at whether there is an out-of-pocket maximum that you would be expected to pay after your deductible has been met.
Let’s say that your plan above, with a €1000 deductible, also has a co-insurance option of 20% and an out-of-pocket maximum of €1500. You will thus pay €85 for 11 visits to the doctor under your deductible until it is met. You will then pay €17 for each visit as your 20% coinsurance, until you reach the co-insurance ceiling of €500 (€1,500 minus the deductible of €1,000), or about 29 more visits (€500€17 = 29.4). At that point (40 total visits in a year), you would pay nothing more for the remainder of the plan year.
It’s worth doing the maths, especially if you don’t think that you’ll need to make more than a couple of visits to your GP in any one policy period. For example, if you just want dental check-ups with an occasional filling, it might be worth working out whether one or two out-of-pocket costs might be cheaper than full dental cover.
As so many variables have an effect on the cost of international private medical insurance to cover you in Estonia it becomes very difficult to give accurate estimates without knowing the full details of the coverage required. However, as a very rough guide, using a standard profile of a 40-year-old British male with no deductibles, no co-insurance, a middle-tier plan/product, all modules included, and worldwide coverage excluding the US, a ballpark price of around £4,000/$5,000 might be expected. Were coverage to be expanded to include the US then the premium could increase to almost double that amount.
Look carefully at all your options, therefore, if you are considering private cover as a top-up or as a replacement for your existing national health insurance under EHIF.
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