From 01.01.2022, the Health Insurance Fund took over the financing of various medical devices from the Social Insurance Board, and the possibilities of obtaining several aids at a discount changed significantly.
The aim of the change is to make several necessary devices more accessible to people, which is why 566 new devices financed by the Health Insurance Fund were added to the list of medical devices. Kärt Veliste, an expert on medicines and medical devices at the Health Insurance Fund, said that the necessity of the change was reached in cooperation with several experts in the health and social fields, who have recommended that overlapping products be reimbursed by only one institution.
The Health Insurance Fund will finance all orthoses, sole supports, urinary aids (catheters, penile covers) and urine collectors (urine collection bags and their fasteners).
Major changes
Issuance of certificates
From the new year, only doctors (both family doctors and other specialists) with a prescription for a digital medical device can prescribe these medical devices to people who meet the conditions set out in the list of medical devices. Other healthcare professionals are not allowed to do this by law. It is also not possible to purchase medical equipment on the basis of a rehabilitation plan, although the need for an aid may be indicated there. The change narrows the circle of prescribers, but the higher discount rate associated with the financing of the health insurance fund, the absence of a separate minimum co-payment and the fact that disability or reduced working capacity no longer play a role in compensation, all in all improve the availability of products to the people who need them the most. Prescriptions for medical devices prescribed by a doctor are visible on the patient portal digilugu.ee and the state portal eesti.ee. In the future, persons with severe or profound visual impairments can acquire white canes without a certificate.
Reimbursement based on evidence-based need
Medical devices will be reimbursed based on application conditions and limits coordinated with professional societies for target groups who have an evidence-based need for this. The compensation does not depend on whether the person has a disability or a reduced ability to work. The Health Insurance Fund reimburses medical devices to the extent of 90% of the limit price, if the product exceeds the limit price, the person must also pay the part that exceeds the limit price. The previous minimum deductible fee of 7 euros when purchasing a device no longer applies.
The prescription for the aid that directs the excretion of urine is renewed automatically
01.01.2021- 31.12.2021, with ISO code 09.24 (aids that direct the excretion of urine) of the transaction aid group, prescriptions for the medical device are automatically created in the prescription center, because the users’ needs do not change significantly over time. These are cards with a recurring limit period, i.e. every year on January 1 and July 1, a new prescription is automatically created for a person. This means that these people do not have to see a doctor again next year to get a medical device prescription for urinary aids and urine collectors. NB! A person who has purchased aids that direct the excretion of urine can no longer buy means for washing or scrubbing the body (wet wipes, washing gloves and head washing caps) at a discount.
New discounts and utility codes
In the future, it will be possible to purchase skin cleansers with a pH level of 5.5 for cleaning the intimate area with a state discount, and only products based on zinc oxide can be purchased as skin protection products. Persons who purchase catheters, urine bags or penis covers financed by the Estonian Health Insurance Fund have the right to purchase additional skin protection and cleaning products with the support of the Social Insurance Board discount.
Stair climbers were added to the list of aids, so that people using wheelchairs who live in a building with stairs do not have to apply for the necessary aid through a special procedure. It is an aid that a wheelchair user needs on a daily basis, the application for which was previously made through a special procedure.
Baby monitors were also added to the list as monitoring devices, which can be purchased by the parent of a child up to 3 years old who has a hearing loss of 50 dB or more.
Separate assistive device codes were created for bedsore prevention mattresses as well as standing frames and supports and children’s orthopedic shoes.
With a decrease in the reimbursement limit and excluding aids in 2022 from the list
The reimbursement threshold for wheelchairs, light filters and magnifying glasses will be lowered from 90 percent to 70 percent, as they are not first priority aids. In the future, wheelchairs can only be obtained through a special procedure. People who have started renting a wheelchair under the conditions established by the old regulation can rent the aid until the end of the usage period of the aid in hand. After the amendment enters into force on 01.01.2022, a 70% state discount will apply to them. On the basis of the special procedure of the Social Insurance Board, the discount rate given in the decision applies to renters of wheelchairs until the end of the decision.
The thresholds were increased for custom-made eye prostheses, assistant-operated manual wheelchairs, category II special seats, category II electric wheelchairs, adult hearing aids, magnifying video systems, daisy players, signaling devices and receivers.
Disinfectants are removed from the list of aids compensated by the state, because based on the definition of an aid in the Social Welfare Act, in this case it is not an aid intended for the needy, but they were intended for the protection of caregivers. Due to the COVID-19 pandemic, disinfectants have become an everyday common tool for hand disinfection.
A car adapted for a person with mobility impairments was also excluded from the list, as companies do not offer such cars. A person with a mobility disability who wears a prosthesis or uses a wheelchair can purchase car adaptations to operate the engine (manual control device).
Procedure for special procedures
The Health Insurance Act does not allow for special procedures regarding medical devices. It is not justified to apply for financing through a special procedure for products for which there is an alternative product, for example, from another manufacturer in the list of medical devices. The Health Insurance Fund works to ensure that a wide range of products is available to the insured.
Reimbursement of those products that are not (yet) in the list of medical devices in 2022 (for example, skull orthoses or very specific neuroorthoses) and for which there is no comparable alternative in the list, can continue to be requested next year through a special procedure of the Social Insurance Board. However, it is rather a very exceptional process.
Transition time
With an aid certificate issued before 01/01/2022, a person can buy the necessary medical device until the end of January, the transition period ensures that the change is smoother for people, companies and doctors.
In case of additional questions, please contact the Health Insurance Fund by phone (+372) 669 6630 or by e-mailinfo@haigekassa.ee.
Additional sources:
- List of aids and compensation conditions from 01.01.2022 (182.71 KB, XLSX). Social Insurance Board
- List of medical devices in 2022 . Estonian Health Insurance Fund
- Major changes in the conditions for reimbursement of aids. Social Insurance Board
- The list of medical devices of the Estonian Health Insurance Fund and the procedure for taking over the obligation to pay for a medical device entered in the list of medical devices. State Gazette
