Ravikindlustus

Ravikindlustus on kindlustus ravikulude katmiseks. Ravikindlustus võib olla nii riikliku sotsiaalkindlustuse kui ka kohustusliku või vabatahtliku erakindlustuse vormis.

Eestis on ravikindlustus korraldatud riikliku sotsiaalkindlustusena. Ravikindlustust korraldab Tervisekassa. Ravikindlustuse seaduse järgi katab haigekassa kindlustatud isikute haiguste ennetamise ja ravi, ravimite ja meditsiiniseadmete ostmise kulud seaduses sätestatud piirides, samuti maksab ajutise töövõimetuse hüvitisi ja muid rahalisi hüvitisi [1].

Eesti ravikindlustuse põhimõteteks on kindlustatud isikute solidaarsus, piiratud omaosalus ravikulude katmisel, teenuste osutamine vastavalt kindlustatute vajadustele ja ravikindlustuse vahendite otstarbekas kasutamine.

Ravikindlustuskaitse võib tekkida kolmel erineval alusel:

  • töötajad ja füüsilisest isikust ettevõtjad, kes on kindlustatud töötamise, täpsemalt sotsiaalmaksu maksmise alusel
  • riigi poolt kindlustatud isikud, kelle eest maksab riik sotsiaalmaksu (nt alla 3-aastast last kasvatavad vanemad, töötutoetuse saajad, kaitsejõudude ajateenijad)
  • seaduse alusel kindlustatuga võrdsustatud isikud, kelle eest sotsiaalmaksu ei maksta – lapsed kuni 19-aastaseks saamiseni, riikliku pensioni saajad, rasedad.

Eesti Haigekassa andmetel oli 2014. aastal ravikindlustus umbes 93,5 protsendil Eesti elanikest, seega kindlustamata isikuid oli umbes 6,5% rahvastikust. [2]

Haigekassa poolt kaetavad hüvitised jagunevad mitterahalisteks (tervishoiuteenused, ravimid ja meditsiinilised abivahendid) ja rahalisteks hüvitisteks (ajutise töövõimetuse hüvitis, täiskasvanute hambaravihüvitis, täiendav ravimihüvitis, väljaspool ravijärjekorda osutatud tervishoiuteenuse hüvitis, piiriülese tervishoiuteenuse hüvitis). Mitterahalise hüvitise korral katab haigekassa ravikulud otse teenuseosutajale (perearst, haigla jm) ja kompenseerib retseptiravimi või meditsiinilise abivahendi väljastanud apteegile osa vastava ravimi või abivahendi hinnast. Rahalised hüvitised maksab haigekassa kindlustatud isikule otse välja.

Haigekassa hüvitab vaid need raviteenused, mis on kantud Eesti Haigekassa tervishoiuteenuste loetellu.

Eesti riiklikku ravikindlustust rahastatakse sotsiaalmaksu ravikindlustuse osast laekuvatest vahenditest.

Eraravikindlustus ei ole Eestis levinud. Eraravikindlustuse õiguslik regulatsioon on antud võlaõigusseaduses, kuid sellist kindlustust pakuvad vaid üksikud kindlustusseltsid.

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