The Health Insurance Fund benefit: how it works

It is not a payout, it covers part of the treatment

Tervisekassa does not transfer money to the patient. If a service is on the list of those covered, the benefit is deducted from the bill directly at the clinic. You pay your share, and the settlement with Tervisekassa happens between the clinic and the Fund. There is no separate application to submit.

The benefit can only be used at a dental clinic that holds the relevant contract with Tervisekassa. Services that are not on the covered list are paid for by the patient according to the clinic's price list.

How much Tervisekassa covers

For an insured adult the standard benefit is up to 60 € per calendar year. The patient pays at least 50% of the cost of the covered services.

For example, on a bill of 60 € the patient pays 30 € and Tervisekassa pays 30 €. To use the full 60 € of benefit, the covered services must come to at least 120 €.

Who is entitled to the higher benefit

Some groups of patients are entitled to a higher benefit — up to 105 € a year, with the patient paying at least 12.5%. These include, among others:

• old-age pensioners;
• people over 63;
• pregnant women;
• mothers of children under one year old;
• and certain other groups.

The benefit does not carry over to the next year

The benefit is granted for each calendar year. If you have not used it in full, the remaining sum does not carry over to the next year. When the new year begins, the limit is calculated afresh.

So if you have been putting off a check-up or treatment, it is worth looking up what is left of your benefit and using it before the year is out. Depending on your category, the annual limit is 60 € or 105 €.

How to check what is left

The amount of benefit available and what remains of it can be checked on the state portal eesti.ee under “Hambaravi- ja proteesiteenuste info”. A clinic with a Tervisekassa contract can also check your entitlement and remaining balance in the system.

The benefit can be used over the course of the year across several visits and at different clinics — the annual limit stays shared between them.

And children?

For insured children under 19 the arrangement is different: dental treatment at a Tervisekassa contract partner is paid for by the Fund, so the adult annual limit of 60/105 € does not apply. Some services, such as orthodontic treatment, have separate conditions.

Dental care for children under 19: what the state pays for →