Choosing Your Estonian Health Insurance (Haigekassa)

Moving to Estonia is an adventure. You’ve likely been drawn in by the promise of a digital-first society, stunning medieval cities, and vast, serene forests. You're sorting out your ID-card, finding the perfect apartment in Tallinn or Tartu, and maybe even starting your own OÜ (the Estonian version of an LLC). But amidst all the excitement, a practical, and frankly, crucial question pops up: What happens if I get sick?

Let's be honest, navigating a new country's healthcare system can feel daunting. The terminology is new, the rules are different, and you just want the peace of mind that you’ll be taken care of. In Estonia, the conversation revolves around one key name: the Tervisekassa.

This guide is your deep dive into the Estonian health insurance system. We'll break down what the Tervisekassa is, who's eligible, how to get it, and whether you should also consider private insurance. Think of this as a chat with a fellow expat who has already navigated this process, coffee in hand.

First Things First: What is the Tervisekassa?

You might hear locals and long-time expats refer to it as the Haigekassa. That was its name for decades. In 2023, it was officially rebranded to Tervisekassa (which translates to "Health Fund"). It's the same national health insurance fund, just with a new name. So, if you see both terms, know they’re talking about the same thing.

The Tervisekassa is Estonia’s state-funded health insurance system, built on the principle of solidarity. It’s not "free" in the traditional sense; it's funded by social tax paid on income. This system provides universal healthcare coverage to insured residents, ensuring that everyone has access to medical care, regardless of their income level.

What does Tervisekassa cover?

• Family Doctor (Perearst): Your first point of contact. Consultations are free.
• Specialist Care: Referrals from your family doctor to specialists like dermatologists, cardiologists, etc. (A small visit fee, usually up to €5, may apply).
• Hospital Treatment: Comprehensive coverage for necessary in-patient care. (A small daily fee of up to €2.50 per day may apply, for a maximum of 10 days per hospital stay).
• Subsidized Prescription Drugs: Significant discounts on a wide range of medications.
• Pregnancy and Childbirth: Full coverage for maternity care.
• Preventative Care: Health screenings and vaccinations.
• Limited Dental Care: Coverage is primarily for children under 19. Adults receive a small annual benefit (around €60 as of 2024/2025), which covers only a fraction of most treatments. Emergency dental care gets a slightly higher subsidy.

Are You Eligible? The Expat's Guide to Tervisekassa Coverage

This is the most critical part for any expat. Your eligibility for state health insurance is tied directly to your legal and employment status in Estonia.

1. The Employee

This is the most straightforward path. If you have an Estonian employment contract with a local company, you are automatically covered. Here’s how it works:

• Your employer pays a 33% social tax on your gross salary.
• 13% of that social tax is allocated directly to the Tervisekassa to fund your health insurance.
• Your employer handles all the registration. Once you're registered in the Employment Register (Töötamise Register), your insurance typically becomes active after a 14-day waiting period.
• You can check your coverage status on the state portal, eesti.ee.

2. The Entrepreneur / Board Member (OÜ Owner)

Many expats move to Estonia to start their own company (OÜ). This route gives you flexibility, but you are responsible for ensuring you have health insurance.

• To get Tervisekassa coverage, you must pay yourself a salary or a board member fee from your Estonian company.
• You must pay the 33% social tax on this income.
• Crucially, there's a monthly minimum social tax obligation to maintain health insurance. For 2024, the minimum base was €725 per month, meaning a social tax payment of at least €239.25 was required. This figure is adjusted annually, so for 2025, expect a slight increase. If you pay less than this minimum, you won't be insured.

This is a non-negotiable point for self-employed expats. Simply having a company isn't enough; you must be actively paying yourself and the corresponding taxes to qualify.

3. The Digital Nomad Visa Holder

This is a common point of confusion. The Estonian Digital Nomad Visa (DNV) is fantastic, but it does not grant you access to the Tervisekassa. A mandatory requirement for obtaining and holding a DNV is to have private health insurance that covers you for your entire stay in Estonia. The policy must cover medical expenses of at least €30,000.

4. Spouses and Dependents

If you are covered by Tervisekassa (e.g., as an employee), you can often extend that coverage to your dependents.

• A non-working spouse can be insured by you if they are raising at least one child under 8 years old, or are within five years of retirement age.
• Children under 19 are automatically insured if one of their parents is a legal resident of Estonia covered by Tervisekassa.

5. Long-term Residents (Voluntary Contract)

If you have a long-term residence permit but don't fall into the categories above (e.g., you're living off savings or foreign income), you might be able to sign a voluntary insurance contract with the Tervisekassa. This is an expensive option, with quarterly payments based on the previous year's average salary. There are also significant waiting periods for planned treatments after signing up, so it's more of a long-term solution than a quick fix.

The Practical Steps: From Eligible to Insured

Okay, so you've confirmed you're eligible. What now?

1. Get Your Estonian ID Card: This is your key to everything in Estonia. You cannot proceed without it.
2. Find a Family Doctor (Perearst): The family doctor is the gatekeeper of the Estonian healthcare system. You can't just walk into a specialist's office. You need to register with a general practitioner.
   • How to find one: Go to the Tervisekassa website, where they have a map and list of family doctors. Crucially, you need to find a doctor whose patient list (nimistu) is open.
   • Registration: You'll need to fill out an application form (available on the Tervisekassa site) and submit it to the doctor's clinic, either in person or digitally signed with your ID card.
   • The doctor has seven working days to accept or decline your application (they can only decline if their list is full or you don't live in their service area).
3. Booking Appointments: Once registered, you can call or use the clinic's online system to book an appointment. For specialist care, you'll discuss your issue with your family doctor, who will then provide a digital referral (saatekiri) to the appropriate specialist.

Tervisekassa vs. Private Insurance: The Great Debate

While the Tervisekassa is robust, it's not without its drawbacks. This leads many expats to ask: should I also get private health insurance?

The honest answer: it depends on your needs, patience, and budget. Many expats use a hybrid model, relying on the state system for serious issues and using private insurance for convenience.

Here’s a breakdown to help you decide:

Who benefits most from private insurance?

• Those who want speed and convenience: If the thought of waiting six weeks to see a dermatologist is unacceptable, private insurance is your friend.
• Those needing extensive dental work: Private plans offer far superior dental coverage.
• Digital Nomad Visa holders: It's a legal requirement for you.
• Expats who prefer English-language services: Private clinics are more likely to have a fully English-speaking patient journey.

Popular private insurance providers in Estonia include ERGO, If, and Salva. For more comprehensive international plans, expats often look at Bupa Global or Cigna.

The Bottom Line: Your Health Insurance Strategy in Estonia

Navigating Estonian health insurance doesn't have to be a headache. It's a logical, well-structured system once you understand the rules of entry.

Here are your key takeaways:

1. Check Your Status: Your path to insurance is defined by your visa and employment. If you're an employee or a tax-paying board member, you're on track for the state system (Tervisekassa). If you're a Digital Nomad, private insurance is your only route.
2. Embrace the Family Doctor: The perearst is central to the state system. Register with one as soon as you are eligible. Don't wait until you're sick.
3. Understand the Trade-Offs: The Tervisekassa provides a fantastic safety net for serious medical issues at a low out-of-pocket cost. Its main drawback is waiting times for non-urgent care.
4. Consider a Hybrid Approach: For the best of both worlds, rely on Tervisekassa for your core coverage and use a supplementary private plan to bypass queues for specialists, get better dental care, and ensure a seamless English-speaking experience.

Welcome to Estonia! Taking the time to sort out your health coverage now will give you the ultimate peace of mind, letting you focus on all the incredible experiences this unique Baltic nation has to offer.