Health Insurance System

Health Insurance System

Health Insurance System

Like many other European States Lithuania has put in place the compulsory health insurance system which means that residents of Lithuania are obliged to obtain health insurance coverage (i.e. to pay the compulsory health insurance contributions). With respect to the insured the State guarantees healthcare services compensated from the Compulsory Health Insurance Fund (CHIF). Statutory compulsory health insurance based on the compulsory health insurance contributions and transfers from the State budget provides a universal healthcare coverage to the residents of Lithuania.

Lithuanian health insurance system is based on the principles of solidarity and universality. The principle of universality is understood as an arrangement when all citizens of the Republic of Lithuania and foreign nationals permanently residing in Lithuania as well as foreign nationals temporarily residing and legally employed in the country are obliged to pay the compulsory health insurance contributions, and upon an occurrence of an insured event are entitled to receive healthcare services financed from the CHIF.

The principle of solidarity means that the contributions paid by all employed persons or persons otherwise engaged in active economy activities as well as the funds of the State budget contribute to the accumulation of the CHIF budget. Entitlement to healthcare covered by the Compulsory Health Insurance does not depend on the amount of contributions paid and the duration of the insurance status. The Compulsory Health Insurance provides the universal social insurance for population and covers the costs of healthcare regardless of the amount of the compulsory health insurance contributions paid by the person concerned.

People eligible for the Compulsory Health Insurance either have to pay the compulsory health insurance contributions themselves (self-employed persons, farmers) or these contributions have to be paid by their employers (employed persons) or by the State. Meanwhile, the State pays contributions for certain socially vulnerable categories of residents determined by the Law. The major part of the revenue of the CHIF is represented by the compulsory health insurance contributions paid by the insured and the contributions paid on their behalf.

Insured persons

Persons covered by the compulsory health insurance means persons eligible for the compulsory health insurance, who, in the manner prescribed by the Law on Health Insurance, pay the contributions in the amount set by the Law on Health Insurance themselves or on behalf of whom contributions in the amount set by the Law on Health Insurance are paid.

The following persons shall be eligible for the compulsory health insurance:

- citizens of the Republic of Lithuania and foreign nationals permanently residing in the Republic of Lithuania;
- foreign nationals temporarily residing in the Republic of Lithuania, if they are legally employed in the Republic of Lithuania, and minor members of their families;
- unaccompanied foreign minors;
- foreign nationals who have been granted subsidiary protection in the Republic of Lithuania;
- persons to whom the Law on Health Insurance shall be applicable under EU regulations on the coordination of social security systems;
- persons permanently or temporarily residing in the Republic of Lithuania to whom the application of legal acts of the Republic of Lithuania regulating health insurance is provided for in these international agreements;
- displaced persons.

The following persons shall be regarded as persons covered by the compulsory health insurance:

- persons for whom compulsory health insurance contributions specified in the Law on Health Insurance are paid and persons who under the Law on Health Insurance pay compulsory health insurance contributions themselves;
- persons listed belonging to the socially vulnerable groups of residents determined by the Law on Health Insurance who are insured by the State. The State pays compulsory health insurance contributions on behalf of them.

Persons insured by the means of the State are these residents of the Republic of Lithuania:

persons who receive any type of pension or relief compensation set by laws of the Republic of Lithuania;
- unemployed persons registered with the Employment Service and persons involved in vocational training measures organised by the Employment Service, unless they sign an employment contract;
- unemployed persons of working age who have statutory compulsory state social pension insurance record required for receiving the state social insurance old-age pension;
- women who are granted a maternity leave and unemployed women during the period of pregnancy 70 days before the childbirth (after 28 pregnancy weeks and over) and 56 days after the childbirth;
- one of the parents/adoptive parents raising a child under 8 years of age, one of the guardians providing guardianship for a child under 8 years of age in the family, also one of the parents/adoptive parents raising two or more minor children, one of the guardians/caretakers providing guardianship for/taking care of two or more minor children in the family;
- persons under the age of 18 years;
- pupils of general education schools, full-time students of vocational schools, post-secondary and higher education institutions of the Republic of Lithuania or of the Member States of the European Union;
- persons supported by the state and provided with a social benefit;
- one of the parents/adoptive parents, guardian or caretaker nursing at home a person for whom a disability level is established;
- persons who have been recognised as disabled in accordance with the procedure laid down by legal acts;
- persons suffering from publicly dangerous communicable diseases which are included in the list defined by the Ministry of Health;
- participants of the opposition/resistance – volunteer soldiers, participants of fights for freedom, rehabilitated political prisoners and similar persons, deportees and similar persons, also victims of the events of 13 January 1991 or other events injured while defending Lithuania's independence and statehood;
- persons who contributed to the post-accident management at the Chernobyl nuclear power plant;
- former inmates of the ghetto and juvenile prisoners kept at fascist forced confinement places;
- clergymen of traditional religious associations recognised by the state, students of clergy training schools, novices undergoing monastic formation in novitiates;
- persons for whom the legal status of participants of the war in Afghanistan is recognised in accordance with the procedure laid down by law;
- unaccompanied foreign minors;
- the spouse of the President of the Republic who has not reached the pensionable age and does not have insured income – for the duration of the term of office of the President of the Republic.
- persons engaged in voluntary hands-on training in accordance with the procedure defined by the Law on Support for Employment;
- displaced persons;
- arrested and convicted persons;
- persons permanently or temporarily residing in the Republic of Lithuania who receive any type of pension in accordance with international agreements of the Republic of Lithuania and to whom the application of legal acts of the Republic of Lithuania regulating health insurance is provided for in these international agreements.

Compulsory health insurance contributions

Main tariffs of contributions of economically active population

Category

Tariff

Legal basis

Persons with employment contract

6,98% of income

 

paragraph 1-2 of Article 17 of the Law on Health Insurance

Persons with copyright agreement, sportsmen, etc.

6,98% of income, on the basis of which social insurance contributions are calculated*

paragraph 3 of Article 17 of the Law on Health Insurance

Self-employed without business license

6,98% of income, on the basis of which social insurance contributions are calculated*

paragraph 4 of Article 17 of the Law on Health Insurance

Self-employed with business license

6,98% of the minimum monthly earnings

paragraph 5 of Article 17 of the Law on Health Insurance

Owners of individual companies, members of agriculture communities

6,98% of the sum on the basis of which their social insurance contributions are calculated *

paragraph 6 of Article 17 of the Law on Health Insurance

Other persons paying contributions by themselves

6,98% of the minimum monthly earnings

paragraph 11 of Article 17 of the Law on Health Insurance

* But not less than 6,98% of 12 minimum monthly earnings valid on the last day of each appropriate month of that year. Since 1st January 2021 the minimum months gross salary has been increased to EUR 642 and the compulsory health insurance contribution was set at EUR 44,81 per month.

Funding of healthcare

The Law on Health Insurance defines the scope of healthcare covered from the CHIF budget. It determines that the healthcare services the costs whereof are covered from the CHI budget shall be specified in the list approved by the Ministry of Health. This list also may be detailed by indicating specific healthcare services in contracts between the Territorial Health Insurance Funds (THIFs) and healthcare providers.

The scope of healthcare provided for the people insured by the CHI and covered from the CHIF:
- The primary, secondary and tertiary level healthcare services;
- Compensation of costs of the replacement of limbs, joints, organs and costs related to the acquisition of prostheses;
- Reimbursement of costs for subsidized medicines and medical aids, orthopaedic equipment, spectacles and hearing aids;
- Preventive medical care;
- Medical rehabilitation services;
- Long-term care (nursing and maintenance treatment) services at patient’s home or in the hospitals of nursing and maintenance treatment;
- Reimbursement of costs of renting medical equipment (devices) necessary for the provision of care services at patient’s home.

Most of the healthcare services are free for the insured people. Cost-sharing applies to some kinds of healthcare: for instance, dental services and pharmaceuticals for out-patient treatment. Minister of Health approves the negative list of healthcare services. These services are financed entirely from the patient's own resources according to a set price list.

In order to get free healthcare services, please, choose a primary healthcare institution and register to the list to the family doctor. The insured person is entitled to choose a primary healthcare institution and a practitioner as well as a secondary and tertiary healthcare institution and a practitioner. Services provided by family doctor are free of charge. If family doctor decides that you need specialised out-patient services or hospitalisation, he will issue you the referral. With that referral services will be provided to you in institutions having contracts with the THIF free of charge. In case of emergency, in-patient and specialised out-patient healthcare services are provided free of charge without the referral.

More information about your social security rights in Lithuania are provided on the web page of the European Commission: https://ec.europa.eu/social/main.jsp?catId=1119&langId=en

Information for EU insured residing in Lithuania

If you are an EU posted worker or pensioner living in Lithuania, you are entitled to receive free healthcare services in the member state of residence under the conditions established by the EU regulations on the coordination of social security systems. In order to exercise your right, you have to present the portable document S1 issued by your competent institution (the social security institution of the country where you are insured) to one of the THIF. If you already have the portable document S1 (or one of the forms E106, E109 E120, E121), please, take the following steps:
- Go to one of the THIF offices to register that document. Please, present your document S1 (or two copies of your E-form) and prove your identity;
- If there are other members of your family living with you in Lithuania, show copies of the documents proving their identity as well;
- After the Customer Services Department of the THIF has received the document S1 or E-form, you and your family members will be registered in the database of insured persons. You will have the same rights to medical treatment and compensation as people insured by the compulsory health insurance in Lithuania.

Contact information of THIFs

Vilnius Territorial Health Insurance Fund
Ž. Liauksmino str. 6, 01101 Vilnius,
Lithuania Phone: (+370 5) 266 1364

Fax: (+370 5) 279 1424
E-mail: vitlk@vlk.lt


 

Kaunas Territorial Health Insurance Fund
Aukštaičių str. 10, 44147 Kaunas,
Lithuania Phone: (+370 37) 300578

Fax: (+370 37) 320636
E-mail: kainf@vlk.lt
  

Klaipeda Territorial Health Insurance Fund
Pievų Tako str. 38, 92236 Klaipėda,
Lithuania Phone: (+370 46) 380473

Fax: (+370 46) 381481
E-mail: kltlk@vlk.lt


 

Siauliai Territorial Health Insurance Fund
Vilniaus str. 273, 76332 Šiauliai,
Lithuania Phone: (+370 41) 520346

Fax: (+370 41) 526528
E-mail: sitlk@vlk.lt


 

Panevezys Territorial Health Insurance Fund
Respublikos str. 66, 35158 Panevėžys,
Lithuania Phone: (+370 45) 596192

Fax: (+370 45) 583789
E-mail: patlk@vlk.lt