How Does the Health System Work for Residence Permit Holders in Estonia?
One of the most critical issues for foreigners moving to Estonia for work, family reunification, entrepreneurship, or investment is what health rights they have along with their residence permit.
Many foreigners think, “I have a residence permit, so I must have health insurance automatically”; however, the Estonian system is not that simple.
At the heart of access to health services in Estonia is the public health insurance institution, Estonian Health Insurance Fund – EHIF (Tervisekassa).
Foreigners living with a residence permit can only join the public system under certain conditions; in this process, private health insurance often becomes a mandatory or practically unavoidable tool.
Key Features of the Estonian Health System
The Estonian health system is a mixed model, primarily publicly funded, but with a significant portion of services provided by private health service providers.
The main source of funding is the social tax paid by employers and, in certain cases, individuals.
A 13% portion of this social tax is directly transferred as a health insurance contribution to Tervisekassa, and the system aims to provide universal access to basic health services for “insured residents” with this resource.
The coverage of public health insurance roughly includes the following services:
- Family doctor (primary care)
- Specialist care
- Hospital and inpatient treatment, emergency services
- Maternity care
- Reimbursement for prescription medicines
Who is Eligible for Public Health Insurance (Tervisekassa / EHIF)?
According to Estonian legislation, not everyone with a residence permit is automatically considered insured.
The key sentence of the system is:
“Everyone permanently residing in Estonia and those temporarily residing in Estonia with a temporary residence permit or right of residence, for whom social tax is paid or who pays social tax themselves, is entitled to health insurance.”
Tervisekassa clarifies this situation further:
“A person temporarily residing in Estonia is entitled to public health insurance only if they are employed and social tax is paid for them.”
Temporary Residence Permit Holders
The critical condition for temporary residence permit holders based on work, family reunification, starting a business, entrepreneurship, etc., to enter public health insurance is:
- Payment of social tax for themselves (by the employer or if self-employed, by themselves).
In other words:
- Simply having a residence permit is not sufficient for public health insurance.
- Entry into the system is possible through actual employment or paying social tax on your behalf.
Permanent Residents and Estonian Citizens
Permanent residents and Estonian citizens are generally automatically included in the system as soon as they enter the workforce.
Their employers pay social tax on their behalf, and they fall under public health insurance coverage.
Main Pathways to Health Coverage for Residence Permit Holders
1. Employer-Based Public Health Insurance
The most common model in Estonia is the employer paying social tax for salaried employees, thereby automatically including the employee in Tervisekassa coverage.
- The employer pays 33% social tax on the gross salary; 13% of this is the health insurance contribution.
- The foreign employee typically receives an Estonian personal identification code along with their residence permit.
- The employer submits the employment notification to the tax office; this information is reflected in the EHIF/Tervisekassa system.
After the first social tax payment is made, your public health insurance coverage usually becomes active within 1–2 months.
During this waiting period, it is strongly recommended to secure yourself with private health insurance.
2. Self-Employed Individuals and Freelancers
Those working in Estonia as self-employed can also join public health insurance by paying social tax on their own behalf.
- They declare their income and pay social tax themselves.
- Tervisekassa coverage continues, provided that payments are regular and sufficient.
Cash flow and tax planning are critical for this group. Especially for foreigners who establish a company in Estonia and tie themselves as a director/employee; incorrect structuring can lead to the risk of not benefiting from public health insurance.
In such cases, obtaining professional support in international tax and social security planning provides a significant advantage.
3. Voluntary Health Insurance Contract (VHI)
For those living in Estonia but not insured through an employer, Tervisekassa offers the option of a Voluntary Health Insurance Contract (VHI).
- The individual pays a premium of 13% calculated on the average salary.
- According to international sources, this premium is approximately €170 per month (the amount may vary over the years).
- The coverage obtained through this contract is the same as that of those insured through employment:
- Family doctor and specialist consultations
- Hospital and inpatient treatment
- Maternity and childbirth services
- Reimbursement for prescription medicines on a designated list
This model is an important “bridge solution” for those who have settled in Estonia but have not yet found a job, relying on their savings or for flexible working residence permit holders.
Private Health Insurance for Residence Permit Holders
Many foreigners, during their initial period in Estonia when they have not yet entered Tervisekassa coverage, are effectively forced to have private health insurance.
In some types of visas and residence permits, this is already a legal requirement.
When is Private Insurance Mandatory or Necessary?
- Non-EU/EEA students: For example, Tallinn University requires students from outside the EU/EEA to have internationally valid private health insurance for long-term visa or residence permit applications.
- Estonia Digital Nomad Visa: This visa type requires comprehensive health insurance covering Estonia and the Schengen area with a minimum €30,000 coverage.
- First 1–2 months: Even if your employer has started paying social tax, the activation of your Tervisekassa coverage typically takes a few months. During this time, a private policy serves as a safety cushion for urgent or unexpected health needs.
Advantages of Private Health Insurance
Private (especially international) health insurances complement the public system for residence permit holders in the following ways:
- Reducing waiting times: Direct access to private clinics without waiting in line in the public system, especially for specialist consultations.
- Access to specialists without referrals: Some policies cover specialist appointments without requiring a referral from a family doctor.
- Dental and eye health: Additional coverage for dental treatments and items like glasses/lenses, which are limited in the public system.
- Mobility between two countries: Coverage valid in both Estonia and other countries for frequent travelers.
Therefore, many employees, entrepreneurs, or remote workers who obtain a new residence permit in Estonia prefer to hold private international health policies until public insurance kicks in – and often even afterwards.
Steps for Foreigners to Register in the Public Health System
A foreigner settling in Estonia with a residence permit typically follows these steps to join the public health system:
1. Obtain a Residence Permit or Right of Residence
First, you obtain a temporary or permanent residence permit/right of residence through the Estonian Police and Border Guard Board.
At this stage, especially for non-EU citizens, a private health insurance policy is often a mandatory part of the application file.
2. Register in the Population Register
When you settle in Estonia, you register your address in the Population Register.
With this registration, you are given a personal identification code.
This code is the key to access all Estonian e-government systems, including health services.
3. Start Paying Social Tax
- If you are a salaried employee: Your employer starts paying social tax on your behalf.
- If you are self-employed: You declare your income and pay social tax at the relevant rates yourself.
This step is a key criterion for the start of Tervisekassa coverage.
4. Activation of Tervisekassa Coverage
After social tax payments are reflected in the system, your name falls on the Tervisekassa insured list.
Different sources typically mention a 1–2 month waiting period for this process.
During this period:
- It is recommended to maintain your private health insurance without interruption.
- If your family members also came to Estonia with a residence permit, everyone’s coverage status should be checked individually.
5. Choose a Family Doctor
After your Tervisekassa coverage starts, you choose a family doctor/family medicine clinic that accepts you.
In Estonia, family doctors:
- Serve as a “gatekeeper” (referral chain to specialists).
- Are also the main actors of preventive health services (vaccination, periodic check-ups, chronic disease monitoring, etc.).
6. Use the e-Health Portal (Terviseportaal)
When your coverage becomes active, you can access:
- Digital health records
- e-prescriptions
- Past tests and reports
using your ID card, Mobile-ID, or Smart-ID.
This structure provides great practicality for frequent travelers or those living in multiple countries.
What Does Coverage Include for Insured Residence Permit Holders?
All residence permit holders under Tervisekassa benefit from the same basic health package as Estonian citizens.
Basic Services
- Primary care / Family doctor: Consultations, basic tests, preventive health services, and routine check-ups.
- Specialist care: Specialist consultations with a referral from the family doctor; usually with a low co-payment (e.g., ~€5).
- Hospital & Inpatient care: Surgeries, inpatient treatments, intensive care, etc.; although there may be a daily co-payment, a large portion is covered by the public system.
- Emergency care: Treatment costs for insured individuals in emergencies are covered by the public system.
- Maternity & childbirth: Follow-ups during pregnancy and childbirth services are included in the coverage.
- Prescription drugs: Reimbursement is applied to medications listed by Tervisekassa at varying rates.
Dental Health and Other Limited Areas
Dental treatment is covered to a limited extent in the public system in Estonia:
- Most dental treatments for adults require either a high co-payment or are entirely out-of-pocket.
- Therefore, private health policies often offer packages specifically for dental coverage.
Co-payments and Out-of-Pocket Payments
Although public coverage seems “free at the point of use,” there are small co-payments (co-payment) for various services:
- Specialist consultation: Approximately €5 co-payment.
- Inpatient treatment in hospital: A daily fee ranging from €2.50–25, subject to a certain upper limit.
- Dental treatment: Since it is limited under insurance, adults often use out-of-pocket payment or private insurance.
Private health insurances provide additional security for residence permit holders with designs that compensate for these co-payments and additional services not covered by Tervisekassa.
Differences Between EU/EEA Citizens and Non-EU Residence Holders
EU/EEA citizens with a residence permit in Estonia can receive emergency care through the EHIC (European Health Insurance Card) during short stays.
However, when it comes to long-term residence and residence permits, entry into Tervisekassa coverage is essential, and the social tax payment rule still applies.
For non-EU citizens:
- A private health insurance policy is almost always mandatory during the visa and residence process.
- When they legally start working in Estonia, they will be included in the public system through social tax.
Health Insurance Risks in Company Formation, Remote Work, and Cross-Border Employment
In global mobility, remote work, and “posted worker” models, which country social tax and health insurance will be paid is a critical strategic decision.
A poorly structured setup can lead to:
- A double social security burden both in Estonia and the employee’s home country.
- The employee may not be able to enter the public health system at all or may enter late while actually residing in Estonia.
- Unexpected tax and insurance risks may arise for employees who are “apparently remote workers” but actually reside in Estonia.
At this point, working with teams experienced in international payroll (payroll/EOR), posted worker, and tax optimization provides security for both employers and employees.
The Role of Corpenza in This Process
For companies and professionals opening in Estonia through business, investment, or remote work models, the triangle of residence permit – social tax – health insurance is filled with technical and legal details.
For example:
- When you establish a company in Estonia and tie yourself as a director, from which date you will enter Tervisekassa coverage.
- When sending temporary personnel from Turkey or another country to Estonia, which country you will be subject to social insurance.
- In the digital nomad or remote working model, how to structure the connections between tax residency, social security, and health insurance.
Corpenza can help optimize your structure in Estonia both legally and financially with its experience in:
- Company formation and residence permits
- International accounting and social security planning
- Payroll, EOR, and posted worker models for staff leasing
- Investment-based residence and citizenship
Thus, you can create a holistic mobility strategy that ensures both your employees and their families have seamless access to the combination of Tervisekassa and private health insurance.
Conclusion: Properly Structuring Health Insurance for Residence Permit Holders in Estonia
Having a residence permit in Estonia does not automatically mean health insurance.
Real security is formed by the correct combination of the following elements:
- Residence permit + Population register registration and personal identification code
- Payment of social tax (as an employer or self-employed)
- Registration of a family doctor under Tervisekassa
- Private health insurance for the first months and for out-of-coverage items
If you are planning to move to Estonia as an employee, entrepreneur, investor, or remote worker; establish a team in Estonia on behalf of your company, or send personnel, planning the health system aspect early will be critical for both legal compliance and cost control.
Disclaimer
This text is prepared for general informational purposes; it does not constitute legal, financial, or tax advice.
Health insurance, residence permits, and social security practices in Estonia may change over time.
Before making decisions, always check the current legislation and official information sources (such as relevant public institutions in Estonia) and obtain qualified professional advice specific to your situation.
