The Health Insurance Fund shall cover medical treatment expenses of a person with health insurance. If social tax is paid for you then you are automatically insured.
If you work, your employer pays social tax for you. If you are unemployed or if your employment contract has been suspended, as during the period you are at home with a small child, you are eligible for health insurance together with national family allowances.
The state guarantees health insurance to you when
- You raise a child under 3 years old in Estonia
- You raise seven or more children under 19 years old in Estonia
- Do not work and are raising three or more children under 19 years old in Estonia, and at least one child is younger than 8 years
- Do not work, your spouse works and the employer pays their social tax, your family has at least one child under 8, or 8 years old child until the end of the 1st grade, or at least three children under 16.
Note! The Social Insurance Board interprets work as all working activities, for example:
- a person working on the basis of an employment contract,
- member of the management or control body,
- a person working on the basis of a contract under the law of obligations (VÕS)
- elected or appointed member of local government,
- owner of an entrepreneurial account, etc.
The state guarantees health insurance and it is assigned automatically (you dont need to apply) to you when you raise a child under 3 in Estonia, you dont work and raise 3 or more children, one of which is less than 8 years old, or your raise 7 or more children. The state guarantees health insurance to one parent – in general, to the recipient of the parental benefit or later the parental leave.
In addition to a child’s parent, these conditions also apply to a guardian or a person who has concluded a written foster care contract, or to other persons who receives the parental benefit and uses the parental leave instead of the parents.
Note that if you decide to change the recipient of allowances in your family, then the right for health insurance shall also transfer to that person to whom the allowances are paid to (adoption premium, parental benefit, or an allowance for a family with many children). It is important to check that the mother, who is indeed actually at home with the child, would not lose her health insurance.
Example. A mother is at home with her 10-month-old, and receives parental benefit. The family decides to change the parental benefit recipient and the father submits the application. At the same time, the mother wishes to remain at home with the child.
As the mother will no longer be paid parental benefit for the child, nor will she return to work, she will lose the health insurance and should she need medical assistance, the Health Insurance Fund will not cover her medical treatment expenses.
When the payment period of the shared parental benefit ends, the parent who received it the last will continue being insured by the state until the child turns 3 years old. You can change the insured person until that by writing to us about it.
Insurance for a dependent spouse
You must file an application for getting health insurance if you:
- Do not work, your spouse works and the employer pays their social tax, your family has at least one child under 8, or 8 years old child until the end of the 1st grade, or at least three children under 16
It is important to know that if the family has the right to receive social tax from the state in connection with raising a child under 3 years old, in connection with raising 3-6 children or in connection with raising 7 and more children, then you cannot apply for the payment of social tax as a dependent spouse.
- If the working spouse also receives parental benefit at the same time, it is not possible for you to get health insurance through his/her employment.
- Only one parent can get health insurance from the state at the same time. For example, if there is one child under the age of 3 in the family and 3 or more children in addition, we insure the parent who receives the parental benefit. You cannot get at the same time health insurance in connection with raising a child under 3 years old, and the other parent in connection with raising 3 or more children.
If you have applied for international protection from Estonia and received international protection granting decision and Estonian residence permit from the Police and Border Guard Board, and you:
- Live in Estonia
- Are of the pensionable age
- Do not work
- Do not receive pension appointed in Estonia
then we grant you health insurance starting from the first validity date of your residence permit.
How to Apply for Health Insurance?
You do not have to file an application to get health insurance. The Police and Border Guard Board forwards information about you to us automatically.
If you do not have valid health insurance for some reason, then turn to one of our customer services and take along:
- Identity document
- Supplementary legal protection and residence permit decision
You can check the validity of the health insurance by calling our infoline at 612 1360.
We guarantee you health insurance, if you have moved to Estonia, and you are:
- an Estonian citizen, or
- a person of Estonian nationality, or
- the spouse, child, or parent of an Estonian citizen,
- you are of the pensionable age, or
- your monthly income is below the national pension rate, or
- we pay you some social benefit.
How to Apply for Health Insurance?
You do not have to file a separate application for getting health insurance. If you have filed an application to receive returnee support and we have issued a decision to you, then you have also automatically received health insurance.
Having an entrepreneurial account affects health insurance only if it has been applied for by a person who:
- does not work and is raising three or more children under the age of 19 living in Estonia, at least one of whom is under the age of 8. (§ 6 subsection 1 point 11 of the Social Tax Act (STA))
- does not work, but whose spouse works, and the employer pays social tax for them.
- whose family has at least one child under the age of 8 or at least three children under the age of 16. (STA § 6 subsection 1 point 8)
In these cases, the condition for obtaining health insurance is that the person does not work. Since having a entrepreneurial account is equated with working, you no longer have the right to health insurance from the state after opening a entrepreneurial account. In this case, you get health insurance through the social tax paid from business income.
Please note, however, that only having an entrepreneurial account does not provide health insurance!
In order to obtain health insurance, the social tax must be received through the entrepreneurial account, at least to the extent of the minimum obligation.
In 2023, the monthly rate underlying the minimum social tax obligation is 654 euros, and the minimum social tax obligation is 215.83 euros per month (654 × 33%).
For example: If a person operates only through a entrepreneurial account, then in order to obtain health insurance, they must receive at least 1,798,50 euros per calendar month in 2023 from the provision of services or the sale of goods, on which the business income tax is 359,70 euros (1, 798,50 × 20%) The income tax includes the share of social tax which is 215,83 euros (359,70 × 33/55 in the case of a person liable for funded pension). Since the minimum social tax obligation has been met, the person has the right to health insurance.
You can read more about the emergence of health insurance on the " Employer insured" website of the Health Insurance Fund.
Other possibilities of obtaining health insurance from the state are not related to working or not working, and therefore having a business account does not affect them.
Last updated: 29.11.2023