As I read through Leumit’s Passport to Healthcare in Israel brochure from 2010 (available for download here) I thought it was a good opportunity to highlight some points that they felt were essential information about what a Kupat Cholim has to offer its clientele. I will not be referring to anything unique to Leumit, so members of Meuhedet, Maccabi and Clalit can also follow along to learn or recall just what you are entitled to receive, and what options you have in the Israeli public health system.
You Do Not Pay The Kupah for the Basic Basket
We’ve summarized the Basket of Health Services here, but these points bear repeating:
- The Kupot Cholim provide the government’s package of basic healthcare services, which include: doctor visits, laboratory services, imaging, hospitalization, rehabilitation, paramedical (speech, occupational and other therapies), prescriptions and medical equipment.
- You do not pay your Kupat Cholim for this insurance coverage (except for co-pays). The basic coverage is automatic when you sign up as a member to any kupat cholim. The funding comes out of your payments to Bituach Leumi (National Insurance Institute), not the kupot.
You Do Pay for Supplementary Health Insurance (Shaban)
|Kupat Cholim||Level 1||Level 2|
|Clalit||Mushlam Zahav||Mushlam Platinum|
Your monthly fees to the kupah are for additional policies that add benefits on top of the basic basket entitlements. Since you are paying extra for additional coverage, you should be familiar with the added benefits and how to use them. Some supplemental benefits:
- Private doctors, or private medical procedures at hospitals or other facilities. These options can be limited in the expense covered, the number of times used in a year, or to whom or where you can go. Explore the arrangements directly with your kupah to find out how to exercise these private options, or get reimbursements.
- Additional or expanded categories of services, like genetic testing, dental treatment discounts, orthopedic products and travel vaccinations.
- Extending coverage on treatments included in the basic basket, like additional paramedical treatments in child development services.
- Some surgery, transplant or treatment abroad options.
- Additional pre- and post-natal services and tests, like fertility treatments, genetic testing, scans, private obstetrician, preparation classes and convalescence.
- Additional pediatric services, like testing for learning disabilities and bedwetting treatments.
- Discounts on drugs not included in the basic basket.
- More preventative care.
- Expansion of mental health coverage.
- Discounted alternative medicine options.
Your Kupah Has Doctor and Facility Choices Without Going Private
Your Kupah has a directory of physicians that are considered “within the kupah”. This directory is on the kupah website (in Hebrew) and is accessible through the 24-hour hotline representative, or your local branch secretary. Occasionally you may even be able to get a print version that looks like a small phone book.
You can use this directory to find a primary care physician, the center of your galaxy in the Kupah system, and to find specialists.
Many primary care physicians can see you on the same day you call, or the next.
Specialists can have longer wait times, but if you find multiple options from the kupah directory, you can “shop” for the best appointment.
- Finding a facility or clinic that is not “within the Kupah” is still an option even without using your private appointment supplemental benefits, especially if the Kupah does not have a good alternative (within a reasonable time and distance). Request a hitchayvut from the kupah, and see what happens.