There is only one insurance provider covering the healthcare service provider sector, PZU Insurance, meaning prices have surged and waiting times for agreements have risen.

According to the Health Board, approximately 1,700 healthcare service providers must comply with the requirement. By Monday afternoon, 1,200 had signed contracts, including about half of family doctor centers.

While numbers are steadily increasing, key sectors like ambulance services and family doctors continue to face significant challenges as the deadline approaches.

Ambulance services, comprising 104 teams across 10 providers, are particularly burdened by the costs.

Taavet Reimers, chairman of the Estonian Ambulance Association, highlighted the financial strain, saying: "Initial offers suggest an average cost of €7,500 per ambulance team annually, amounting to €750,000 for the entire system. Ambulance providers consider this too high."

Negotiations with PZU Insurance have proven time-consuming.

Reimers warned that meeting the deadline remains uncertain: "Contracts should be finalized by December 1, but these negotiations are inherently time-consuming, and we cannot be sure that all ambulance service providers will have been able to secure contracts by then."

This financial burden is already affecting operations. Tallinn's ambulance service received a quote from the insurer just a week before the insurance mandate takes effect.

"When we issued the tender, we estimated a cost of €70,000, but the offer came in at €170,000," Raul Adlas, head of Tallinn's ambulance service (Tallinna kiirabi), said. "We do not have funds like that in the budget," Adlas added.

Adlas said that operational constraints make cost-cutting impossible.

"We cannot reduce wages or shorten the workday. Our contract stipulates that we can only be out of service for 60 minutes per day," he went on.

Family doctors are finding themselves similarly under the strain.

Elle-Mall Sadrak, head of the national family doctors association (Eesti perearstide selts), criticized the lack of competition in the healthcare provider insurance cover market.

She said: "We have never had room for negotiation with PZU. Their terms are take-it-or-leave-it. We are essentially in a monopoly situation, for which the state has no funding."

As for the impact on the healthcare budget, Sadrak said: "This means €1.3–€1.5 million from the Health Insurance Fund's budget will go to one company, reducing funds for treatment."

State agency the Health Board (Terviseamet) has suggested flexibility during the transition.

Health Board spokesperson Külli Friedemann said: "If the reasons for the delays are known, these will be taken into account, and no service provider's operating license will be immediately targeted."

Reimers acknowledged progress but warned of inevitable consequences for non-compliance, saying: "Naturally, those who fail to secure contracts will eventually face the revocation of their operating licenses."

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