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Check out the benefits of the compulsory health insurance

All CHI holders are entitled to treatment and health care services in Lithuania without any additional fees. This entitlement is obtained by making consistent monthly CHI payments. CHI for residents that belong to socially-vulnerable citizen groups is covered by the state. What is available to all Lithuanian residents, making consistent CHI payments or covered by the state?

1.    Each insured person can freely choose their polyclinic, medical centre or general practitioner's office (the healthcare institution must have an agreement with the territorial Health Insurance Fund), including the healthcare institution, providing primary outpatient mental health services (mental healthcare centre). The patient must register with the chosen primary personal healthcare institution (PPHI).

2.    At the chosen healthcare institution, the resident must submit an application and choose the general practitioner, also a doctor-psychiatrist (mental healthcare services may be provided at the same institution as the general practitioner). The application can also be submitted electronically, ensuring the confirmation of the identity of the applicant, by mail or via a courier (a copy of the personal identification document must be included). If a country or a municipality of the resident’s place of residence is under a declared emergency situation or a quarantine, and the resident is unable to submit the application via the means, listed above, he/she may submit a scanned copy of a photograph of the Form. No. 025-025-1/a and a copy of personal identification document by e-mail. The original copies must be submitted in 30 calendar days (but no later than at the end of the emergency situation or quarantine).

3.    If the institution chosen does not satisfy the patient’s needs, it may be replaced with another by submitting a personal identification document and an application to the new institution (minors are registered by a parent or a guardian). The same procedure applies to the general practitioner by choosing another, working at the same institution.

4.    The patient is unregistered from the previous healthcare institution automatically, while his/her medical history (patient card) is transferred to the new institution upon its request in 3 business days.

5.    Changing the healthcare institution within 6 months, the documentation and transfer of the medical documents to the chosen institution, is subject to a fee of 2.90 Eur. The fee does not apply to persons, coming to study in another city or upon returning to their permanent place of residence after graduation.

6.    A general practitioner may prescribe the examinations that are within his/her competence. In each case, in order to prescribe an examination and send the patient to hospital or for an expert consultation, the doctor must consider the condition of the patient’s health (rather than upon the patient's request).

7.    If needed, a general practitioner may prescribe the following examinations: general blood test, biochemical blood test, i.e. lipidogram, potassium, sodium, creatinine, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, bilirubin, glucose, uric acid tests. In addition to that, if needed, a general practitioner may prescribe a general urine test and a urine albumin/creatinine ratio test, i.e. C-reactive protein, erythrocyte sedimentation rate (ESR) and thyroid function tests (TFT), glucose tolerance test, coprogram, vaginal and cervical gynaecological swab, enterobiasis test, electrocardiography, spirometry for maximum exhaled air flow per second, forced lung capacity in the first second (FEV1) and forced vital lung capacity (FVC) values, pulse oximetry.

8.     In certain cases, a general practitioner may prescribe: glycosylated haemoglobin test, blood clotting tests (prothrombin time, international normalized ratio, activated partial thromboplastin time), prostate-specific antigen test (also in patients after radical prostate cancer treatment), blood type and Rh factor tests, syphilis (RPR) and specific (treponemal) test with T. pallidum antigens (TPHA) test, hepatitis B and C tests, urine culture, human immunodeficiency virus test, rapid test to detect Group A beta-haemolytic streptococci, faecal occult bleeding test, tuberculin sample or oncocytological cervical smear.

9.    Healthy patients of certain age groups can be prescribed tests, conducted under the following preventive programmes: cervical, breast, colon, or prostate cancer, and cardiovascular diseases. If a person feels unwell, but does not fall into the age group, they should immediately address their general physician. The general physician will conduct the necessary examinations and, if needed, issue a referral to a specialist physician.

10.    CHIF budget funds are used to cover vaccinations for certain age groups. Children and adults, covered by CHI can get the following vaccinations:

-    According to the terms set in the Children's Preventive Vaccination Calendar, healthcare institutions vaccinate children from the following communicable diseases free of charge: tuberculosis, hepatitis B, pertussis, diphtheria, tetanus, Haemophilus influenza type B infection, poliomyelitis, measles, mumps, rubella, pneumonia, rotavirus, type B meningococcal infections. In case of a need (upon being bitten by any animal), children can be also vaccinated from rabies (vaccine and immunoglobulin for rabies).

-    The National Health Insurance Fund uses the CHIF funds to reimburse vaccinations from influenza and pneumococcal infection for adults in risk groups. Also, in case of a need the insured persons can be vaccinated from tetanus, diphtheria, rabies and measles.

11.    For vaccinations, reimbursed from the NHIF, patients should address their general practitioner.

1.    Patients with CHI can use the CHIF funds to reimburse basic dental care services, offered by dental experts, working at the PPHI they are registered with.  

2.    If the institution does not offer primary outpatient dental care services, these services must be provided at another healthcare institution.

Important. The National Health Insurance Fund covers the physician’s work, while the patient must pay for the medicine, tooth fillings or other dental care materials, disposable tools, based on the amount of the materials used and their purchase prices.

Exceptions apply (medicine, tooth fillings or other dental care materials and disposable tools are free of charge) for children, pupils attending full-time general education schools, vocational schools, but only until they come 24 years of age, and persons that receive social support (they must provide a social support certificate, issued by the municipal administration of their place of residence).

3.    Children under 14 years are offered molar sealants, covered from the CHIF. This service is offered by dentists with assistants or dental hygienists at personal healthcare institutions that have agreements with the National Health Insurance Fund. For children’s molar sealants, address your polyclinic or dental clinic, which has an agreement with the National Health Insurance Fund. If this service is offered at an institution, which does not have an agreement with the National Health Insurance Fund, the services will be subject to a certain fee.

4.    Entitlement to dental prosthetics, reimbursed from the National Health Insurance Fund belongs to the following persons with CHI:

  • Persons that have reached retirement age;
  • Children under 18 years;
  • Persons, recognized as incapacitated to work or partially incapacitated to work in accordance with the procedure, established by the Law on the Social Integration of the Disabled of the Republic of Lithuania;
  • Individuals, who have been treated for oral cancer.

5.    Persons, wishing to get dental prosthesis services, must address the healthcare institution they are registered with (the healthcare institution must have an agreement with the National Health Insurance Fund) or another healthcare institution, which is licensed to provide dental care services and has an agreement with the National Health Insurance Fund regarding the provision and payment for dental care services.

6.    The costs of dental prosthesis services are reimbursed from the National Health Insurance Fund based on factual dental prosthesis costs, but no more than:  

-    561.35-1,727.20 Eur (determined by experts) for pensioners, persons incapacitated to work or partially incapacitated to work and persons that have undergone oral cancer treatment;       

-     286.49-1,727.20 Eur (determined by experts) for children;      

If the factual dental prosthesis costs are higher than established in the reimbursed amount, the difference must be covered by the patient.

7.      Other reimbursed dental prosthesis services will be available not earlier than in 3 years since the date of reimbursed dental prosthesis services.

1.    Patients with a referral for a specialist physician consultation can choose the healthcare institution, where they wish to have the services provided.

2.    The key is to address an institution, which has an agreement regarding the provision of services and coverage of their fees with the National Health Insurance Fund. The specialist physician services may be provided at an institution that is not the same as the one that the referral has been issued at.

3.    Patients must register an appointment with the specialist physician in 30 calendar days (60 calendar days under emergency situation and (or) quarantine) – that is the term of expiry of the referral.

A referral is not necessary in the following cases:

  • When the patient visits the same specialist physician for the same reason or is subject to follow-up care;
  • When the patient addresses a dermatovenerologist (for skin and venereal diseases), but it is important to make sure that this expert works at an institution, which has signed an agreement with the National Health Insurance Fund;
  • When the patient comes to the same specialist physician for as a follow-up procedure (i.e. if the physician instructs to as a part of the continuous treatment or examination of the patient) or if the patient has a chronic illness and is subject to long-term follow-up;
  • Patients can register an appointment with a dentist or a mental healthcare expert (primary level) at the institution that they are registered at without a referral;
  • All residents of Lithuania (both with CHI and not) receive emergency first aid immediately and free of charge.

1.    Ambulance services refer to personal healthcare services, provided:

-    by ambulance service providers 24/7 (including holidays) that have an agreement with the National Health Insurance Fund and operate in a certain territory;

-    to all persons (both with and without CHI);

-    In cases of emergency medical assistance (transporting patients that require emergency medical assistance during the transportation after acute illnesses or accidents), also in case of a need to establish the fact of birth or death.

2.    Based on its competence, the ambulance service can also offer other services, which are not covered from the National Health Insurance Fund:

-    patient transfer from one inpatient treatment institution, where the patient has been hospitalised, to another inpatient treatment institution for further treatment (the costs of the patient transfer must be covered by the sending treatment institution, based on the agreement with the ambulance services);

-    patient transfer from one treatment institution to another for diagnostic, treatment procedures or examination, if the transfer is necessary due to the patient's condition (indications must be coordinated by the sending and receiving institutions); (the costs of the patient transfer must be covered by the sending treatment institution, based on the agreement with the ambulance services);

-    patient transfer from an inpatient treatment institution home after inpatient treatment, if the transfer is necessary due to the patient's condition (indications must be coordinated by the sending institution); (the costs of the patient transfer must be covered by the sending treatment institution, based on the agreement with the ambulance services);

-    patient transportation under the request of the patient or his/her family, if it is not necessary based on the patient’s condition (the costs must be covered by the patient).

1.    Coverage of the inpatient treatment services (hospitalisation) from the National Health Insurance Fund is subject to the following conditions: the patient must have a CHI and a physician’s referral, and the hospital, offering these services, must have an agreement with the National Health Insurance Fund.

2.    The physician’s referral is unnecessary if the patient addresses the hospital for emergency medical help. The scope and procedure of providing it have been approved by a separate order of the Minister of Health.

3.    The inpatient services, offered at the hospital may include: active treatment, long-term treatment, transplantation and rehabilitation.

4.    Hospitals also offer:

-    monitoring services (after examination at the emergency room, when it is impossible to evaluate the condition precisely; in case of danger to the patient’s health or life, should the patient be released from the PHI immediately after examination and (or) treatment at the emergency room; when the examination and (or) treatment can be conducted in a time period that is longer than 4 hours and shorter than 24 hours; when it is impossible to ensure safe transportation of the patient after providing emergency assistance). Monitoring services are provided at the hospital, except for institutions that provided only care and palliative care or medical rehabilitation and sanatorium (preventive) treatment services.

-    the majority of day hospital services. This refers to scheduled treatment and (or) diagnostic personal healthcare services, which ensure patient monitoring for up to 8 hours. These services (pathology of pregnancy, diagnosis and treatment of pain, cancer, internal diseases, paediatric diseases, allergic diseases, radiation therapy, psychiatry, etc.) are offered only with a physician’s referral;

-    day surgery services (scheduled personal healthcare services, which involve treatment and (or) diagnostic interventions. Day surgery services are scheduled and provided only with a physician's referral. The patient must undergo the necessary examinations before receiving these services.

5.    Important:

- hospitals perform cataract surgery, during which a cloudy lens is replaced with an artificial one, covered by the CHIF. Patients with CHI must be offered a free surgery and an eye lens. The basic price for the surgery, which includes the price of the lens is paid to the healthcare institution by the CHIF, thus the patient does not need to pay. Should the patient wish to have a lens, offered by the healthcare institution and recommended by the treating physician, which is more expensive, then the patient must cover the price difference between the chosen lens and the one, covered from the CHIF funds – not the full price of the preferred lens.

- hospitals perform joint arthroplasty using reimbursed joints. Joint arthroplasty refers to treatment services, which involve replacing the worn joint parts with prosthetics, reimbursed from the CHIF. The National Health Insurance Fund (NHIF) uses the CHIF funds to purchase knee, hip, shoulder, elbow, thumb and ankle joint endoprostheses and their accessories. The NHIF then distributes the joint prostheses to hospitals, conducts endoprostheses surgery accounting and reimburses the endoprostheses, purchased by patients that are covered by CHI. NHIF registers the applications for free endoprostheses, submitted by residents with compulsory health insurance.

1.    Patients with CHI can be prescribed medical rehabilitation by their physician (general practitioner or hospital doctor) according to legislation, the patient’s diagnosis, health condition, severity of the illness, and recommendations of the physical medicine and rehabilitation physician. The treating physician also decides whether rehabilitation services should be provided on an outpatient or inpatient basis, based on the patient's medical condition.

2.    The patient is free to choose the rehabilitation institution anywhere in Lithuania, except that the institution must have an agreement with the Territorial Health Insurance Fund.

3.    Upon prescription of rehabilitation, the referral documents must be arranged by the physician, issuing the referral. Territorial Health Insurance Fund approves the certificate to confirm the patient’s entitlement to reimbursement of medical rehabilitation, which is valid for 10 calendar days. If the patient was treated on an inpatient basis and has completed the first stage of rehabilitation, the patient must arrive at the healthcare institution, offering medical rehabilitation services no later than in 5 business days since the completion of inpatient treatment and the first stage of rehabilitation.

4.    The patient only needs to contact the chosen rehabilitation institution by phone and make the arrangements regarding the arrival. Upon arriving at the rehabilitation institution, the institution is provided with an extract of the medical documents, issued by the physician, and a personal identification document.

5.    Children under 8 years old are entitled to go to medical rehabilitation institutions accompanied by a caregiver. Children over 8 years old could be accompanied by a caregiver if the child has a disability or if the medical advisory commission has established the need for care for adaptation or due to behavioural disorders, severe central or peripheral nervous system, musculoskeletal disorders, traumas or surgeries.

1.    Care and palliative care services include treatment, care and other basic health condition support services/measures for people with chronic illnesses in all age groups. They are also available to people with disabilities and other patients with clear diagnosis with no need for active treatment and contraindicated medical rehabilitation.

Patients are transferred to a care hospital or a care department upon establishing a final diagnosis and there is no need for additional examinations. The National Health Insurance Fund and the CHIF cover 120 days of care and palliative treatment services in a calendar year, thus the patient does not need to make any additional payments.

Care services require a referral from the treating physician. The patient or the patient’s family can choose the hospital by themselves. The hospital must have an agreement with the Territorial Health Insurance Fund.

2.    Palliative support services refer to life quality improvement measures for patients with incurable progressive diseases, which have reached the stage incompatible with life, and their relatives. These measures alleviate physical and psychological pain, help solve other psychosocial and mental issues. These services may be offered on an inpatient, day hospital or outpatient basis. Palliative support services are subject to a treating physician’s referral. The patient or the patient’s family can choose the hospital by themselves. The hospital must have an agreement with the Territorial Health Insurance Fund.

3.    Care services at home refer to services, provided for patients at home. The purpose of these services is to ensure care service availability and continuity to satisfy the patient’s need for care services at home, also to encourage self-care and the improvement of life quality. A referral for inpatient care services at home must be issued by the patient's general physician. They are provided by community and (or) general practice, and (or) extended practice, and (or) mental health carers, care assistants and physical therapists. During the visit at the patient, receiving the services, the patient is provided with all necessary examination, treatment, care, etc. actions, which are established in the medical standards of the expert, providing these services.

1.    Expensive examinations and treatments, covered from the CHIF are conducted for patients only with a referral from a specialising physician (not general physician). These examinations include: computed tomography, magnetic resonance imaging, positron emission tomography, etc. Expensive treatments include haemodialysis, curative blood gravitational surgery, and other procedures.

2.    If the referring physician decides that he or she requires a copy of the radiological examination (such as magnetic resonance imaging), this shall be stated in the referral. Copies with the description of the radiological examination are submitted to the referring physician. The patient does not need to pay for them.

3.    If the referring physician does not indicate the need for copies of the radiological examination, the patient does not need to buy them, unless he/she wishes to. 

1.    Residents with CHI are entitled to reimbursable medicines and medicinal aid measures (MAM). Not all MAM and medicines are reimbursed from the CHIF budget – only those that are included into the lists A, B or C, approved by the Minister of Health.

- The List A contains medicines for various illnesses (e.g. Cancer, tuberculosis, diabetes, epilepsy, asthma, schizophrenia, multiple sclerosis, or blood clotting disorders). They can be prescribed for anyone insured and suffering from illnesses in this list. All basic prices of the medicines, included into the list, are reimbursed 100 per cent.

- The List B contains medicines for persons in certain social groups (e.g. children, seniors, people with disabilities, etc.), whose financial possibilities to purchase certain medicine are lower than other insured persons. The basic prices of the listed medicines for children and people with disabilities are reimbursed 100 per cent, while the medicines for seniors and people with 30-40 per cent reduced working capacity – 50 per cent.

- The List C contains MAM (care measures, various diagnostic strips, special medicinal foods, etc.). May be prescribed to all persons, covered by the insurance, based on the conditions of prescription, indicated in the list. Upon including new MAM into the list C, the price list of the reimbursed MAM is updated as needed. The need for MAM is decided by the physician, but prescriptions for the MAM already used can also be issued by a nurse. The majority of the prescribed MAM can also be prescribed by general practitioners, community nurses and nurses, specialising in diabetes.

2.    As of July 2020, the state budget also reimburses the share of the price for medicines and MAM for persons, aged 75 and older. The same procedure regarding reimbursed share of the price applies in cases, when medicines and MAM are prescribed for seniors or people with disabilities, whose pensions, benefits, reimbursement payments and allowances are smaller than 100 per cent of the minimal consumption needs of the previous year.

3.    Why some of the medicines, reimbursed 100 per cent, are subject to additional payments? 100 per cent reimbursement applies only to the basic prices.

4.    CHIF budget is used to compensate orthopaedic technical devices (OTD). These refer to measures, provided by persons, covered by the CHI, by orthopaedic companies and dental care institutions that have signed agreements with the National Health Insurance Fund. The National Health Insurance Fund covers the production and (or) adaptation of the OTD and the costs of the patients, covered with CHI, that have already purchased OTD.

5.    The 3 types of cochlear implants (cochlear implants, BAHA threaded bone implants, middle ear hearing systems, and backup processors for these medical aids (MAM)), reimbursed by the CHIF budget, are a form of hearing rehabilitation that enables hearing. These implants are prescribed for children and adults that have lost the hearing ability in both of their ears, when the hearing damage is severe or very severe, while the usual hearing aids are ineffective.

6.    The CHIF budget reimburses the rent of medicinal measures (devices). The rent costs are reimbursed for the patients, covered with the insurance, who need the medicinal measures to ensure health care at home, based on the opinion of the medical advisory commission's opinion. The list of devices that can be rented and used at home include artificial lung ventilation and oxygen devices, ordinary or smart insulin pumps and infusion pumps (the so-called-pain pumps).

1.    Residents, covered with CHI can apply to the Territorial Health Insurance Fund for a free European health insurance card – a document to confirm the insured person's entitlement for emergency medicine support services, covered from the CHIF, during their temporary stay in the European Union, European Economic Area, Switzerland and the United Kingdom.

2.    Patients can choose a health care service provider in another EU country (regardless if the institution is private or public), pay for the services and then apply for reimbursement of the costs to the Territorial Health Insurance Fund upon returning to Lithuania.

3.    There is a possibility for scheduled treatment in another EU country, Iceland, Norway, Lichtenstein or Switzerland upon obtaining a permission from a competent institution – the S2 document. This document is issued to persons, covered by CHI, who are unable to receive the necessary health care services in Lithuania because of certain circumstances (considering the condition of their health and the course of illness).

4.    A person, covered with a Lithuanian CHI and residing in another EU state, is entitled to the necessary healthcare services in the country of residence, if they have registered the S1 document, issued by the Lithuanian National Health Insurance Fund, at the healthcare insurance institution of the country of residence.

All healthcare services must be paid for if the person:

  • Is not covered by the CHI;
  • Addresses a treatment institution, which has not signed an agreement with the National Health Insurance Fund;
  • Wishes to consult with an expert physician, but has no referral;
  • Wishes to receive a scheduled service without waiting in line;
  • Decides to choose additional services or treatments at their own initiative;
  • Chooses paid services, included into the list of paid healthcare services, approved by the Minister of Health. For example, cosmetic surgery and treatments, termination of pregnancy, dental prosthesis, acupuncture and manual therapy, health check before going abroad, acquiring a weapon, obtaining a driver’s or a pilot’s license, etc.
  • Chooses more expensive services, materials, treatments than reimbursed by the Territorial Health Insurance Fund: in such case they will need to cover the factual price difference between these services, materials, or treatments and the ones reimbursed (for example, if the treating physician recommends using newer, more expensive medicine or treatment technology and the patient agrees).

Important: upon signing the consent to pay for treatment services or purchase medicines or medical aid measures at their own cost, patients cannot use their entitlement for the costs, incurred at the medical institution, later.

1.    One additional month doesn't sound bad. What do we mean? Sometimes someone stops making their CHI payments. It may seem that nothing has changed and that they still use the same CHI benefits, but later get unpleasantly surprised, when they have to pay for everything themselves. Why? Because the situation is the opposite: people receive services, reimbursed from the CHIF, only for one month since the terminated payments. Failure to make the CHI payment until the end of the additional month means that they would have to pay for the services, provided to them in that additional month.

2.    CHI payments credited from a banking account automatically doesn’t sound that bad. Imagine a situation: someone has been late with their CHI payment. Later they see that the debt has been credited from their personal banking account to Sodra by Sodra itself. The person then assumes that it’s all good. The debt may be gone, but the bad news is that the insurance is gone too. Having the CHI debt credited from the personal account by Sodra itself is a red warning of no compulsory health insurance coverage.

3.    Someone with no Lithuania CHI coverage using the European Health Insurance Card doesn't sound that bad. Sometimes someone holds a European Health Insurance Card, but has no compulsory health insurance coverage in Lithuania. They show the card in European Union to use the necessary medical support for free. What does this mean? This means, that they would not be reimbursed for the costs in Lithuania and would have to pay for themselves. While the costs could amount to thousands. You cannot evade them without a compulsory health insurance.  

4.    Having a return of the CHI payments doesn’t sound that bad. Another myth. Imagine a situation: A citizen of Lithuania works in another European Union country, while the CHI payments were made in Lithuania and they have received treatment in Lithuania. Later they provide Sodra with documents to show that they have made healthcare insurance payments in Lithuania, while working in another European Union country. In that case Sodra returns the CHI payments made in Lithuania. Upon receiving the return, the person automatically loses the coverage for the past period and thus must pay for the treatment received during that period on their own.

Last updated: 16-09-2021