Information about dental care compensation possibilities in Estonia

In our clinic adults covered by Tervisekassa medical insurance, can use Dental compesation for Adults, which is called Hambaravihüvits.

You can check the amount and balance of the benefit in the state portal www.eesti.ee under the service “Information on dental care and denture services”.

• The benefit applies to essential dental care services. All these services, which are not included in the list of reimbursable services, must be paid based on the price list of the medical institution.
• The reimbursable amount is deducted from the treatment invoice immediately at the time of payment, and the patient does not have to submit any application or document to the Health Insurance Fund.
• You can find information about which dental care services are reimbursed here.

Compensation is for:

1.  Adults – All insured adults can receive dental care benefit of 60 euros per year, while the patient pays at least 50% of the treatment invoice.
2. For pregnant women and mothers of children under one year of age – All women who are pregnant or mothers of children under one year of age are eligible for dental care benefit of up to 105 euros per year, with the patient paying at least 12,5% of the treatment invoice.
3. For registered unemployed persons – Unemployed persons registered with the Unemployment Insurance Fund receive dental care benefits at an increased rate. The benefit is 105 euros per year, with the patient paying at least 12,5% of the treatment invoice.
4. For persons receiving subsistence allowance – Persons who have received subsistence allowance under the Social Welfare Act during the two calendar months preceding the month in which the service was received are eligible for the dental care benefit at the increased rate. The benefit is 105 euros per year, with the patient paying at least 12,5% of the treatment invoice.
5. For the elderly, pensioners and persons with partial or no capacity for work – Old-age pensioners and persons receiving pension for incapacity for work, people with partial or no capacity for work and the elderly over the age of 63 are entitled to dental care benefit of 105 euros per year, with the patient paying at least 12,5% of the invoice.
6. Adults with increased need for dental care – All patients with an increased need for dental care are eligible for a benefit of up to 105 euros per year, with the patient paying at least 12,5% of the treatment invoice. A person is entitled to the benefit if the increased need for dental care has arisen as a result of the provision of the following health services or illnesses:

• surgical and/or radiation therapy for tumours of the head and neck (in the case of certain oncological and haematological conditions, a person is eligible to apply for free dental care);
  surgical treatment of lip, alveolar and cleft palate;
• treatment of genetic and metabolic diseases causing malformations of the dental tissue or the maxillofacial area;
• surgical treatment of trauma and inflammation of the maxillofacial area;medical procedure (endoscopy, anaesthesia, etc.) that has resulted in trauma to the maxillofacial area;
  lung, liver, heart and/or kidney, haematopoietic stem cells transplantation or preparation for their transplantation;
• included in the waiting list for endoprosthesis;
• type 1 diabetes;
• Sjögren’s syndrome.

Whether a person has an increased need for dental care is determined by their attending physician, who adds the corresponding statistical code to the treatment invoice. In this way, the necessary information reaches the dentist who is a partner to the Health Insurance Fund and proves the person’s right to a benefit of 105 euros.

How is the benefit determined?
It is important to determine which target group of the benefit you belong to. If you become eligible for different benefits during a calendar year, you are entitled to a benefit in the highest amount. For example, an adult insured person who is pregnant or a mother of a child under the age of one year is entitled to a benefit of 105 euros per year. However, if the child reaches the age of one year on the day the service is provided, the mother is eligible for a benefit of 60 euros, because at the time of receiving the service she is no longer in the target group of the 105-euro benefit.

Dental care benefit can be used in full during one calendar year and the unused portion cannot be carried over to the following year. When the year changes, a new calculation of the benefit begins. You can receive the dental care benefit in the amount of up to 105 euros a year.

Example of benefit: €60
If your dental care invoice for reimbursable services is, for example, 120 euros, you will have to pay 50% of the treatment invoice, i.e. 60 euros, and the other 50% will be reimbursed by the Health Insurance Fund. During the same calendar year, the Health Insurance Fund will not cover any more dental services for you, so next time you will have to pay the entire bill yourself.

If your treatment invoice for reimbursable services is, for example, 100 euros, the Health Insurance Fund will pay the annual benefit rate of 50 euros at a time and you will have to pay the remaining 50 euros. Therefore, you have another 10 euros dental benefit to use this calendar year.

Calculation
Dental care invoice 100 euros
50% is paid by the patient: 50 euros
50% is paid by the Health Insurance Fund: 50 euros
Balance: 60–50 = 10 euros of benefit in the same year

Example of benefit: €105
If your dental care invoice for reimbursable services is 120 euros, you will pay 15 euros and the Health Insurance Fund will reimburse 105 euros of the invoice. In the same calendar year, the Health Insurance Fund will no longer reimburse you for dental care services, i.e. the next time you will have to pay the treatment invoice in full by yourself.

For example, if your dental care invoice for reimbursable services is 80 euros, you will pay 10 euros, i.e. 12,5%, and the Health Insurance Fund will reimburse 87,5%, i.e. 70 euros. If you go to the dentist again in the same year, the Health Insurance Fund will reimburse 35 euros of your treatment invoice and your annual benefit of 105 euros will be used up.

Calculation
Dental care invoice 80 euros
12,5% is paid by the patient: 10 euros
87,5% is paid by the Health Insurance Fund: 70 euros
Balance: 105–70 = 35 euros of benefit in the same year