Healthcare Reimbursement in Estonia: Who Reimburses What Depending on Your Situation

CLEISS’s list of social security agreements mentions no bilateral convention between France and Estonia: the European regulations, applicable in the 27 EU States and in the States of the European Economic Area, govern the situation. They lift residence conditions, add up periods of activity and organise posting. A French national is treated in Estonia under Estonian rules, with forms issued by their French fund: EHIC, A1, S1.

The concepts of reimbursement base and out-of-pocket cost help compare contracts. How the system works is presented on the page on the healthcare system in Estonia.

The employee on a local contract is covered when their employer pays the 33% social tax, of which 13% funds health insurance (CLEISS, Tervisekassa). A new employee on a contract of at least one month waits 14 days of insurance before receiving benefits, and cover continues for two months after the contract ends. They choose a family doctor. See the glossary entry on the local contract.

The posted employee sent by a French employer stays affiliated to the French scheme for up to 24 months with the A1 form, without registering with Estonian insurance (europa.eu). If they live in Estonia, they can ask their French fund for an S1 form to register with the fund; their family members are covered without contributions if the local fund treats them as dependants under Estonian law (CLEISS). They can also ask their French fund to reimburse care on presentation of invoices with the S3125 form, at Estonian or French rates. Sick leave certified in Estonia is declared within 48 hours to the French fund and the employer. See posted worker or expatriate and the glossary entry on the posted worker.

The self-employed person pays the 33% social tax themselves on their taxable income, up to an annual ceiling, and thereby acquires their health insurance; CLEISS notes a monthly minimum, to be checked with the Estonian tax authority. They are not covered by unemployment insurance. The digital nomad who works for a foreign client without setting up comes first under the rule of the country of activity, to be confirmed with their home scheme.

The student on a temporary stay uses their EHIC with contracted providers; students are among the people covered by the Estonian scheme according to CLEISS. Before the age of 30, the Caisse des Français de l’Étranger (CFE, the voluntary social security fund for French nationals abroad) offers its youth offer. See student insurance abroad.

The retiree who receives only a French pension and settles permanently in Estonia without working there requests the S1 form from their pension fund, preferably before leaving (CLEISS). They hand two copies to Tervisekassa with their registration application, after which the fund checks that they live in Estonia and have no other Estonian insurance, then registers them (Tervisekassa). No contribution to the local scheme is withheld; a contribution of 3.2% on the basic pension and 4.2% on the supplementary pension is levied on general scheme pensions when tax residence is outside France, and 7.1% for the self-employed. The retiree stays covered in France.

The spouse and children follow the holder’s status: dependants of the employee, individual S1 of the retiree, or their own insurance. Children under 19 are insured (CLEISS). See expat family insurance and the guide on retiree health insurance abroad.

The Caisse des Français de l’Étranger lets you keep the French scheme on top of the local scheme; the member pays both the country’s mandatory scheme and the CFE, which spares them waiting periods and the loss of pension quarters on returning (ameli.fr, the website of the French Assurance Maladie, the national health insurance). The CFE’s main offer covers GP consultations, medicines, tests, hospitalisation, maternity, dental care, emergency transport and vaccines, including stays of less than three months in France (CFE).

• Waiting period: immediate cover if you join before departure or within three months of settling in; beyond that, a three-month wait for under-45s and six months for over-45s (CFE, exact age to be confirmed with the fund).
• Maternity: the date of conception must be after joining or being attached as a dependant (CFE).
• Return to France: no waiting period for the member (CFE); they open their entitlement with the S1106 form (ameli.fr). See CFE reimbursements and the page on returning to France.

International health insurance with first-euro cover reimburses actual costs within its ceilings, after any deductible, waiting periods and exclusions. It usefully complements the Estonian scheme on dentistry, dentures and optical care, and opens direct access to private providers. Contracts are compared on the annual ceiling, the coverage area and the handling of pre-existing conditions.

The tourist uses their EHIC (Euroopa ravikindlustuskaart) after checking that the provider has a contract with Tervisekassa; a non-contracted provider is paid in full (CLEISS). On return, the S3125 form lets you request reimbursement at Estonian or French rates up to actual costs. France Diplomatie also recommends an assistance contract covering hospitalisation and repatriation. See long-stay travel insurance.

• Consultation: GP free at the surgery; up to €5 for a home visit, a specialist or a dentist; exemption for under-2s and pregnant women (CLEISS).
• Hospitalisation: €2.50 per day, capped at €25 per stay, with no charge for under-18s, pregnancy and intensive care (CLEISS).
• Medicines: 50% as a rule, 75% or 100% for some, 90% for children aged 4 to 16, people with disabilities and over-63s; €2.50 per prescribed product (CLEISS).
• Dental: free for under-19s with a contracted dentist; up to €40 per year for adults, €85 for retirees and people aged 63 and over; dentures up to €260 per three years for certain insured people (CLEISS).
• Optical: the CLEISS profile does not describe its cover; a supplementary contract is worth considering.
• Maternity: leave of up to 140 days, daily allowance from the fund and a birth allowance of €320; a CFE member must have conceived after joining (CLEISS, CFE).

The reimbursement guide and the page on expat health insurance give benchmarks; Expavy helps you weigh these options against your situation.