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Choosing a Kupat Cholim

Among the questions we are frequently asked here at SPP are: I am making Aliyah, which Kupat Cholim (health fund) do I choose? How do I know which Kupah is the best for me and my family?

We thought we’d give you the tips and tricks in how to choose your Kupat Cholim:

Israel has four health funds: ClalitLeumitMaccabi, and Meuchedet. It is important to remember that, in terms of coverage, all health funds are obligated to provide the same basic basket of health care services, and even their supplemental plans are highly comparable.  The decision criteria described here are more about convenience and experience. 

When you make Aliyah you can register for health coverage and choose your Kupat Cholim at the airport. You are not obligated to register at this time. If you are unsure for what plan to register, you can do so later at your local post office.

As far as choosing a Kupah, in every conversation about how to choose your Kupah (including one that took place a while back on our facebook page) it always comes down to the following criteria: Geography/Accessibility, Recommendations, Particular services/doctors.

Geography and Accessibility:

It is important that your local Clinic is close to, and accessible, from your home. For example, there are some towns that only have one health fund clinic within, or very close by. Even in dense cities, sometimes small details can make a difference in how easily you can show up at your clinic. You may want to find out which kupah has the absolute closest branch to your residence, or in a commercial center that you will be frequenting. 

Recommendations:

Those with personal experience in the local kupot are truly your best resource. If you have English speaking friends or family already living in a particular area, it is good to ask for recommendations on a health fund. Most Anglos living in the Jerusalem area register with Meuhedet or Maccabi, while many in Ramat Beit Shemesh sing the praises of their Leumit clinic. Clalit has the most extensive services in locales around the country. As long as there is adequate local infrastructure, some communities find that different kupot make an extra effort to cater to English speakers at times, or members find that they have many Anglo friendly doctors.

Are you involved in any community groups, even virtual? Facebook community groups are an amazing crowdsourcing resource, as well as the dedicated groups Israel Medical Inquiries and Navigate the Israeli Healthcare System. People with positive experiences in their kupah, or with particular doctors, or clinics are really the best resource for a recommendation.

Particular Services/Doctors: 

If you have been referred to a particular specialist, or have a condition that needs attention, then it’s worth exploring if they work with a specific Kupah.  It is also important to ascertain if your prospective Kupah has special arrangements with a hospital that you know will be a regular resource for you. Generally, all of the kupot offer adequate support for any condition you might need to deal with, but if you come in with specific preferences, then you can narrow down which kupah you want.

You’re Not Stuck

Remember you can always  change your Kupat Cholim if you are unhappy with your first choice. See Switching Health Plans for general instructions for how to make the switch.

More Choices

There is also the option to upgrade to supplementary insurance.  Please note that you do not need to elect to upgrade upon making aliyah. You can opt for supplementary insurance at a later date, however a wait period for some additional services may apply.

As always, The Shira Pransky Project is here to assist with your navigational questions. Depending on your prospective community, they may be able to share the reputations and personal experiences with the different kupot that they have heard from other members, or connect you directly with others.

Whether you are a new Oleh, or have been here for years, we wish you a Mazel Tov, and Labriut, to your health!

Further Reading:

To find out more about what your Kupah is offering you please read here.

For all of the most up-to-date Kupah brochures in English, check out: Forms and Files.

For other related information we have translated as part of our collaboration with Kol-Zchut: Choosing a Health Plan

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Therapy Through the Kupat Cholim

As of July 2015, the responsibility for providing mental health services to the public was transferred from the Ministry of Health to the Kupot Cholim. For the average Kupah member (in non-acute and non-critical situations) this means figuring out how to receive therapy, possibly preceded by a psychological assessment or diagnosis.

For all mental health services you should start with your primary care doctor for referral. Once you find out where you need to go, check with the Kupah secretary or information service to see if you will need a Hitchayvut

Outpatient Clinics

There are therapists available in outpatient clinics of general and psychiatric hospitals, or community clinics run by, (or by agreement with), the Kupat Cholim. These options are the cheapest (ranging from free to around 32 shekels, once per quarter), and you may be able to find one close to home. On the other hand, it may take a lot of time to get started, and your flexibility in choosing the right therapist for you may be limited.

Independent Therapist

The way that many people consider ideal, is choosing an independent therapist. This option is more expensive (around 55 shekels for the first visit and 132 for each subsequent session), and still does not mean unlimited choice. The Kupah has a listing of independent therapists from which to choose (links below). The listing will include location and may also include the languages in which the therapist will work. You can contact these therapists directly until you find the right one and make an appointment.  At the Kupah, you will have to pay the co-payment and get a Hitchayvut to bring to the therapists’ office.

Useful Links:

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Payment and Choice in the Kupah [Basics Review]

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
Maccabi Gold Sheli
Meuhedet Adif
Leumit Kessef Zahav

 

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, such as genetic testing, dental treatment discounts, orthopedic products and travel vaccinations.
  • Extending coverage on treatments included in the basic basket, such as additional paramedical treatments in child development services.
  • Some surgery, transplant or treatment abroad options.
  • Additional pre- and post-natal services and tests, such as fertility treatments, genetic testing, scans, private obstetrician, preparation classes and convalescence.
  • Additional pediatric services, such as 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.

Further Reading

Videos: Using Your Kupat Cholim Online

This page contains videos from two out of the four national health funds about how to use their online resources, such as scheduling appointments and finding services. Even if you are a member of one of the other kupot cholim similar tools are usually available for all.

The original videos are in Hebrew and we have added English subtitles, so please make sure that you have the captions enabled. The online tools from each kupat cholim are only available via their Hebrew websites or apps, but we hope that with familiarity and courage you will consider taking advantage of these useful tools!

(We have also added another useful English video produced independently by a Maccabi Clinic.)

Booking a Doctor’s Appointment Online – Without a Password (Maccabi)

Booking an Appointment from your Cellphone – Without a Password (Maccabi)

Ordering Prescriptions Online (Maccabi)

How To Request Prescriptions From Your Doctor Online (Maccabi)

Update Personal Details Online (Clalit)

Send Requests to Your Clinic (Clalit)

Finding Your Lab Results Online (Clalit)

Check your Kupah Entitlements Online (Clalit)

Medical Attention Any Time and in Emergencies

Your Kupat Cholim is required to have options and procedures in place for you to receive medical attention within a reasonable time 24 hours a day. Your local clinic is available daytime hours, and there are other options available during “off hours” that are subsidized by the kupat cholim. These other options include: urgent care centers, contracted private clinics and house-call companies. 

Click here for a description of alternative medical services during “off hours”.

What about the emergency room?

Even if you walk into the emergency room during off-hours, you will have to pay unless you have a referral or one of the conditions listed for exemption (see below). You should only go to the emergency room in a true emergency, not just because you need to see a doctor on short notice. 

Click here for a description and listing of exemptions from Emergency Room costs.

In contrast to the emergency room, other options are covered by the Kupat Cholim (with a co-pay) provided you use them at the correct time. If you have the time and presence of mind in your condition, you should call your kupat cholim’s 24-hour number for directions (listed below). The operator can tell you where there are urgent care centers or other clinics you can go to in the area, and you can find out the hours and cost for the house call option. If the best option is to go to an emergency room, the operator’s referral is enough to guarantee coverage by the kupat cholim.

Kupat Cholim’s 24-hour telephone information centers:

  • Clalit:          *2700
  • Maccabi:     *3555
  • Meuhedet:   *3833
  • Leumit:         1-700-507-507

 

But… Emergencies?!

Of course, if the situation is truly urgent, and wasted time contributes to the danger, then you should not pause for these preliminaries. If you need an emergency room, that is where you should go without delay. If you are hospitalized from there, or if your condition matches any of those listed for automatic exemption, all fees will be covered by the Kupat Cholim, and if not, you can establish that the visit was “medically justified” after the fact and receive at least partial coverage.

What if you need an ambulance?

It is also possible to face the expense of using an ambulance to get to the hospital, unless you are exempt. In this case too the gold standard for establishing that the ambulance evacuation was an emergency is if the patient was then hospitalized. Once again, one should not hesitate to call an ambulance when it is necessary, as an emergency situation should not be delayed. 

Click here for a description and listing of exemptions from ambulance evacuation costs.

So remember…

  • Your kupat cholim is responsible for providing medical attention at any time of day.
  • The emergency room can cost you plenty if you use it when it is not a true emergency.
  • An ambulance should not be considered a convenient form of transportation to the hospital if it is not necessary.
  • Do not hesitate to use emergency services in urgent situations!

 

Kupat Cholim Discounts on Glasses

You may be eligible to receive discounts on purchasing glasses from your kupat cholim if you are a member of their additional health service plans. All of the kupot cholim have agreements with specific stores, or their own stores, where the discounts they offer are available. Be sure to ask the secretary at your local clinic, or the information hotline to locate a participating store. You will also have to fulfill the eligibility requirements to get your discount. We have summarized the discounts and conditions below, but be sure to check your eligibility directly with the kupat cholim.

Maccabi

Gold Members

Adults with the following diagnosed vision problems are entitled to partial coverage for the cost of plastic glasses lenses or contact lenses. Children are eligible for these same benefits, or a blanket discount of up to 600 NIS for one pair of frames and lenses per year without specific diagnosis requirements.

  • Shortsightedness or farsightedness of 7 or higher (5 up to age 10): 83% discount up to a ceiling of 510 NIS on one pair of glasses lenses or one pair of contact lenses per year, or a discount of 83% up to a ceiling 225 NIS on the purchase of a single contact lens 
  • Astigmatism or a cylinder of number 7 or higher: 83% discount up to a ceiling of 1,995 NIS on one pair of glasses lenses per year
  • Keratoconus: 83% discount up to a ceiling of 1,995 NIS on one pair of glasses lenses per year, or 998 NIS off the purchase of a single lens or 1,995 NIS off the purchase of one pair of contact lenses per year
  • After a corneal transplant or corneal therapy: 83% discount up to a ceiling of 1,995 NIS on the purchase of one pair of contact lenses or an 83% discount up to a ceiling of 998 NIS on the purchase of a single lens per year

Sheli Members

Members are eligible for any discounts available to gold members. In addition, Sheli members who need glasses are entitled to a 50% discount on the purchase of eyeglasses, sunglasses and contact lenses at participating stores. This discount can be used on multiple purchases over 3 years until reaching a ceiling of 1,002 NIS discounted (total purchase cost of  2,004 NIS). The full discount credit is renewed every 3 years. This discount cannot be combined with the discount on plastic glasses lenses available for the specific conditions listed above, but the member may choose which benefit to receive. 

Click here for full details in Hebrew on the Maccabi website.

Meuhedet

Si Members

Children up to age 18 are entitled to purchase prescription glasses once a year costing up to NIS 700 with a co-payment of 10%. When the glasses cost more than NIS 700, members pay the difference plus 70 shekels.

Adults 70 years and older are eligible for the same discount as children for regular glasses or a discount on multifocal or bifocal glasses up to a ceiling of 1,200 NIS with a co-payment of 10% once every two years. When the multifocals or bifocals cost more than 1,200 NIS, members pay the difference plus 120 NIS. 

Click here for full details in Hebrew on the Meuhedet website.

Leumit

Gold and Silver Members

Adults are are eligible for up to 70% total discounts on frames and lenses on purchases made at participating stores. Prices are determined based on the specific frame and lens choice. Children are eligible for free glasses ((frame, optical lenses and anti-reflex coating) up to 650 NIS ceiling with a 21 NIS co-payment. 

Click here for full details in Hebrew on the Meuhedet website.

Clalit

Mushlam Platinum members

Children up to age 18 are entitled to a discount on glasses up to 600 NIS once per calendar year. If the cost exceeds 600 NIS the member pays the difference. The benefit includes checking eyesight and glasses (frame, optical lenses and anti-reflex coating). Alternatively, you can use this benefit for the purchase of contact lenses.

Click here for full details in Hebrew on the Clalit website.

See Also:

 

Choosing Your Kupah’s “Higher Level” Plans

Is it worth it to pay my kupat cholim for their additional “levels”? What am I getting? Which level should I choose? Is there a straightforward comparison of each kupah’s offering?

These are very common questions for anyone who makes Aliyah. The answers are extremely subjective, and many personal researchers have tried and failed to compile an objective comparison.

However, let’s review some important decision criteria and examples of benefits offered by these plans (known as Supplemental Plans, Additional Health Services or Shaban) to assist anyone taking the time to think about these choices. The following information cannot be comprehensive or account for all the variation between plans!

Firstly, know your specific needs:

Many of the benefits of the supplemental insurance from the kupot cholim is catered to specific populations. For example, there are many added benefits for expectant mother’s and the elderly population. 

 

Examples of offerings (remember, not comprehensive or universal!):

More personal choice of advanced medical care:

  • Additional private diagnostic consultations (second opinions) with medical specialists in Israel and abroad
  • Choice of specific surgeons and/or private healthcare facilities
  • Treatment, transplants and surgery abroad (Expanding the reimbursements and instances already established by the Health Insurance Law)

Services in fields not covered by the basic Health Basket:

  • Genetic testing
  • Kupah dental clinics
  • Kupah complementary medicine clinics
  • Orthopedic devices
  • Vaccinations for traveling abroad
  • Cosmetic treatments

Fields covered by the basic Health Basket, but expanded with additional treatments/benefits

  • Additional child development treatments in physical therapy, occupational therapy, speech therapy, psychotherapy
  • Educational or psycho-educational assessments
  • More fertility treatment benefits
  • Additional testing during pregnancy
  • Discounts on hundreds of medications not included in the “Drug Basket” or medication in the basket for indications not included in the list (Note: this benefit is commonly used by people particular about their medications and/or options in treatment, and it has the potential to cover the cost of a premium plan in savings to the consumer)

Miscelaneous bonus benefits

  • Laboratory services at home (like blood tests)
  • Private nurse during hospital stay
  • Discounted prescription glasses for children
  • Fittness and nutrition benefits
  • Subscription to Private Emergency Cardiac Services
  • All kinds of other hard-to-categorize boons.
  • Some Important Caveats

    • Most benefits offered still have associated costs, like requiring partial payment by the member, partial reimbursement for private services after the member pays in full, and/or enumerated limits to how much the kupah will pay. These co-payments are often nominal, but in certain situations can still be costly.
    • Private services offered may depend on specific agreement with specific providers, not any provider that you choose.
    • There are rules and regulations that you will have to fulfill for entitlement to many benefits, so claiming them may take further effort.
    • Besides variation in benefits offered by each kupah, within the kupah there are multiple “levels” with distinct offerings.
    • When a person first joins a supplemental plan, the specified benefits can have various waiting periods before they are available to them. Qualification periods can range up to 2 years from sign-up. (When switching kupat cholim, you retain the time you have waited with your previous kupah  if you sign up for an equivalent plan within three months.)

Conclusion

Your choice about which plan is good for you will come down to a new set of personal questions. How much do you value increased, though still limited, choices? Do you consider the “Basic Health Basket” inadequate coverage of your needs? Do you feel confident that you will make sure to know and claim your benefits? Answer those questions and the choice about your kupah plans may not be obvious, but it will be more informed.

Also See:

Switching Health Plans

People switch their kupat cholim for various reasons.

Why would I switch?

You may want to consider switching if:

  • You have moved and one kupah offers better treatment options in your new community.
  • You got married and want your new family to all have the same kupat cholim to make it more convenient.
  • You’ve done your research and found that a supplemental insurance option offered by another kupah covers services or treatments that are more relevant to your needs.

 

For some things to consider when choosing a kupat cholim or considering a switch, check out “Question: Changing Your Kupat Cholim?”.

What should I know about switching?

  • Anyone who is a member of a kupat cholim has the right to switch in accordance with the relevant procedures and regulations (see below).
  • When switching health plans, the coverage provided by an additional health services plan (supplemental insurance) is generally retained in the new health plan and at the same level without requiring a waiting period, though this should always be verified before actually making the switch.
  • Switching may be done simply by going to the post office, paying a nominal fee, filling out the required form and handing it in there. There is also an online option through the National Insurance Institute (Bituach Leumi) website.

 

As part of our on-going collaboration with Kol-Zchut, we provide you with the following essential information on switching kupot cholim. See below or click here to go to the Kol-Zchut site.

Related information:

What is the Kupat Cholim Selling Me?

We’re often asked what are the differences between the various types of insurance offered by the kupot cholim. We decided to put together the following to help make it a bit clearer what your kupat cholim is actually selling (or trying to sell you):

What_is_the_kupat_cholim_selling_me

Feel free to print it out and pass it along!

 

If this information is helpful to you, please enable us to help others: 

Medication Look-Up: Basic Basket and Supplemental Plans

pillbottle

Have you ever wondered if/to what extent your medications are covered by national health insurance or your supplemental plan?

Use the links listed below to search listings of  the medications covered by the basic Healthcare Basket or by the supplemental insurance plans from each kupat cholim.

co-payment is often required for all medications, and coverage may be dependent on meeting diagnostic criteria and/or other clinical factors specified in the listings (in Hebrew). 

 

Medications in the Healthcare Basket

Medications included in the Healthcare Basket are provided to anyone covered by national insurance (anyone entitled to national insurance/paying Bituach Leumi contributions).

 

Medications Covered by Supplemental Health Plans

Those who have a supplemental health plan are entitled to full or partial coverage of some medications which are not included in the Healthcare Basket.

  • Clalit (Mushlam Platinum, Mushlam Zahav) – PDF document – as of January 2016
  • Leumit (Silver, Gold) – Database search – click the letter or enter the English first letters into the search box
  • Meuhedet (Adif, C) – Database search – enter the English first letters into the search box
  • Maccabi (Sheli, Magen Kesef, Magen Zahav) – Database search – click the letter or enter the English first letters into the search box

 

Please note: Websites and listings may change or be updated over time so please leave a comment below if a link doesn’t work or is outdated.

 

If this information was helpful to you, please enable us to help others by supporting the project:
 www.shirapranskyproject.org/donate/ 

Kupat Cholim Co-payments, Limits and Exceptions

Even though your Kupat Cholim is obligated to provide medical services they are allowed to charge co-payment for services. The following are listings of services and payments, as well as exceptions and limits, published by the kupot. As always, you should double check any specifics you see published directly with a Kupat Cholim representative.

For more details about Co-payments, discounts and exemptions  see the following pages on the Ministry of Health English website:

Maccabi’s Co-payment listing is the only one we have found in English to add to our collection of English Kupat Cholim publications and embed below. Even if you are not a Maccabi member, you may want to refer to their listing for a general idea and then follow up with your kupah directly.

Maccabi Members Co-payments, limits and exceptions

Home Care from the Kupat Cholim

home_heart

About this Benefit

All of the kupot cholim (health plans) offer home care services to patients who can’t get all of the medical services they need due to difficulty leaving the home. A full range of medical services are provided with home visits from doctors, nurses, and social workers, as well as paramedical providers, like physiotherapists, occupational therapists, speech therapists, and others.

Who is Entitled

Home care services are intended for patients who are confined to their homes temporarily or permanently due to their medical/physical condition and are not able to receive services in the kupat cholim branches.  For Example: 

  • Patients with chronic illness
  • Patients returning home after hospitalization
  • Oncology patients
  • The elderly

How to Get it

Individuals may be referred to the Home Care Unit (יחידה לטיפול בית or יחידה להמשך טיפול)  by hospital staff, a family doctor, local social services or by contacting the unit directly. Contact information can be obtained from your local branch secretary or your kupat cholim’s information hotline.

Cancer patients may be entitled to additional home care through the Israel Cancer Association. Click here for more information.

Resources

 

If this information was helpful to you, please enable us to help others by supporting the project:
 www.shirapranskyproject.org/donate/ 

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Long Term Care Insurance

What is Long-term Care Insurance?

Long-term care insurance is meant to cover financial support and/or assistance services for a person who cannot carry out Activities of Daily Living (ADL) and needs continual care. ADLs are six basic daily activities: 

  • standing up and lying down
  • dressing and undressing
  • bathing
  • eating and drinking
  • walking
  • continence

The inability to perform several of these activities usually constitutes a long-term care insurance event. 

These policies are most commonly associated with fulfilling the needs of the elderly, but it is important to remember that they can be just as applicable to a younger person that encounters disabling conditions. 

Through the Kupat Cholim

Long-term care insurance offered through the Kupat Cholim is a group insurance plan provided by the health fund in association with a private insurance company.

The policy is not like the other supplemental insurance plans offered by the Kupah in the following ways:

  • There is no obligation to accept every applicant to this plan.
  • The group insurance is for a limited period, and the insurance company is entitled not to renew it at the end of the period.
  • This insurance has no connection to the Health Basket and should be regarded the same as any group health insurance policy.

Comparison

Since Long Term Care Insurance is a private insurance policy, you can compare the terms of the proposed policy from the Kupat Cholim to any other policy offered by a private insurance company. A registered insurance agent can help you determine which policy is suitable and purchase it directly from the insurance company.

One who considers buying long-term care insurance should look into the following details:

Claims and Benefits
  • How is the insurance event defined?
    • How many ADLs does it take to define the insurance event? (In most cases, the qualifying situation is the inability to perform three or four ADLs)
    • Are mental frailty and Alzheimer’s included in the definition of the insurance event?
  • How long can benefits be paid? (Possible periods are three years, five years, and unlimited. The duration has an effect on the level of premium.)
  • What is the level of the monthly benefit? 
    • Can the monthly benefit be enlarged?
    • Does the level of insurance benefits depend on the insured’s age?
  • Are the insurance benefits given in the form of indemnification (against actual expenses) or of compensation?
  • Does the policy cover nursing care in the insured’s home?
    • Are receipts required in the case of at-home care?
  • Does the policy have a nonforfeiture benefit, i.e., an entitlement to partial benefits even if the insurance is terminated? 
Costs
  • Is the insurer allowed to change the premium for insureds at large (in contrast to a declared change in premium that is adjusted to the age of each insured), and under what conditions?
  • Is it possible to buy a policy in which the premium does not change as the insured ages?
  • What rights does the insured have in the event of an increase in premiums? (According to some policies, if the premium scale is raised the insured may pay the old price for reduced benefits and/or become eligible for a nonforfeiture benefit.)
  • Is the insured excused from paying premiums while receiving monthly benefits?
  • Are the premiums for at-home care different from those upon admission to a nursing institution?

 

Related pages:

Private Insurance Consumer Guide

Unlike national health insurance  delivered by the health funds and Misrad Habriut, insurance companies sell policies expanding the basic package of services, offering additional layers, and providing a level of service that the basic package omits, including private health services such as long-term care. These policies can be examined independently via registered insurance agents, as well as compared to the supplemental plans offered by your Kupat Cholim.

The private insurance companies are regulated by the Finance Ministry, and in the year 2000 they released the following aid to the consumer, explaining the types of policies available and offering advice and tools for comparison:

Supplemental Insurance

The Kupat Cholim is permitted to offer supplemental health service plans (“Shaban” – Sherutei Briut Nosafim, which literally means “Additional Health Services”) that offer additional medical services beyond those included in the Health Basket. These plans are optional and require additional payment to the Kupat Cholim beyond the basic health insurance contributions that all residents pay to Bituach Leumi.

A health fund is forbidden to make the provision of services included in the basket of services conditional on enrollment or membership in its supplementary health services plan, and they are not permitted to include components related to those that are in the basic healthcare basket, such as a discount on co-payments for medications included in the healthcare basket, or shortened waiting periods for specific services.

The price for joining an additional health services plan is the same for all policyholders in the same age group in the same plan. 

Differences between Kupot

There are differences in the supplementary plans offered by the different health funds. Each fund is free to choose which services it will offer its members under its supplementary plan, providing that these services are not included in the basic “basket of services.”  All policyholders are entitled to receive a copy of the additional health services plan offered by the health plan to which they belong. For information in English on your specific plan, check out English Websites and Publications for Each Kupat Cholim and Form and Files.

Waiting period

The health fund may set a reasonable “qualification period” (waiting period), i.e. a certain period between the date when the member joined the supplementary plan and the date when he will be entitled to rights under the plan. When switching health plans, the rights provided by an additional health services plan, including waiting period requirements, are retained in the new health plan and at the same level.

Comparison to Private Insurance Policies

The supplemental plans can be compared to private insurance policies that also cover additional medical services beyond those included in the Health Basket, but with some important differences, including:

  • The health fund is obligated to accept any member requesting to join the plan, regardless of his state of health, and the rights of an enrolling member may not be made conditional or restricted in any way.
  • The price of the plan must be uniform for each age group, regardless of the number of years of membership in the plan or the member’s state of health or finances.

 

In addition, a health fund may introduce changes in its supplementary plan (e.g. payments, addition or removal of medical services, etc.) only after it received the approval of the Ministry of Health. Private insurance policies, on the other hand, are regulated by the Finance Ministry. It is important to understand that the only truly private insurance options offered by the kupot (meaning those in which pre-existing conditions and other personal and medical information may impact premiums) are travel insurance and long-term care insurance.

Click here for more information on the “Additional Health Services (Supplementary Insurance)” page we translated as part of our collaboration with Kol-Zchut.