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:

Medication Look-Up: Basic Basket and Supplemental Plans

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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/ 

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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

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Home Care from the Kupat Cholim

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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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Speech Therapy

The following describes eligibility for speech therapy under specific conditions as defined on the Clalit health plan website (valid as of January 1, 2011). The health basket also requires the Kupat Cholim to provide speech therapy as part of child development services. The best way to clarify the services available, and any additional entitlements included in the supplemental plans, is to ask the Kupat Cholim.

Voice disorders as the result of surgery

Up to 20 treatments in one treatment sequence, one-time diagnosis according to a speech therapist’s opinion up to two years from the day of the incident.

Language and speech disorders as the result of CVA or MS

Up to 20 treatments in one treatment sequence, one-time diagnosis according to a speech therapist’s opinion up to two years from the day of the incident.

Listening and lip reading exercises for the hard of hearing after hearing device adjustment

Up to 4 treatments only.

Cleft palate and lip

The extent of the treatment is determined by a professional certified by the health plan and is approved by a health plan speech therapist.

Teacher and kindergarten teacher hoarseness in the public education system

With occupational physician approval- Up to 15 treatments only. Treatment may be discontinued before exhausting all eligibility in the absence of a response or if treatments are no longer required.

Hoarseness lasting at least 6 months

Eligibility

Hoarseness lasting at least 6 months since the initial E.N.T. doctor examination and caused by a problem in the vocal chords after all other treatments and after changing the required habits (smoking), when it is not possible to treat using surgery to correct the problem according to the detailed findings.

Extent of treatments

Only up to 20 treatments may be approved according to the medical guidelines and with approval of a professional certified by Clalit (the health plan).

Eligible Conditions
  • Warts (papillomas) on the vocal chords (subject to changing of habits)
  • Swelling of the vocal cords (subject to changing of habits)
  • Sound chord paralysis
  • Lack of chord closure due to weakness
  • Swelling of the vocal cords due to reflux (after exhausting previous treatment)
  • Thickening of the vocal cords – according to etiology
  • Chronic laryngitis – according to etiology

 

This information was translated and adapted from content provided by The Society for Patients’ Rights in Israel.

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Kupat Cholim Services for Diabetes Patients

As detailed on the Clalit health plan health services website (January 1, 2010)

Insulin Pump

Clalit customers are entitled to receive an insulin pump free of charge under the following conditions with a referral from the treating doctor:

  1. Children and adults with diabetes who suffer from hypoglycemic attacks marked by spontaneous loss of consciousness, confusion and change in behavior without prior warning.
  2. Those who suffer from repeated attacks of ketosis, acidosis and hypoglycemia requiring hospitalization.
  3. Diabetes patients whose HgA1c level is 7.5 and more.
  4. Diabetes patients who received intensive treatment including three or more injections of insulin throughout the day; however, did not achieve the balance goals.
  5. Women who suffered from diabetes in the period before pregnancy and during pregnancy.
  6. Type 2 diabetes patients in cases of severe resistance to insulin and those treated with high doses of insulin who do not reach the recommended sugar level balance.
  7. For those who suffer from pulmonary hypertension, the service is given with a recommendation from a hospital lung disease specialist. In cases of preliminary pulmonary hypertension, please get approval from the district medical administration.

Reimbursement for a sugar level measuring device

Clalit customers who require a sugar level measuring device may purchase it in a Clalit pharmacy and receive a reimbursement. In order to receive the reimbursement, please obtain a letter from a doctor specializing in diabetes or a family health specialist. The recommendation must be approved by the clinic manager. Additionally, a tax invoice or original receipt indicating the name of the device and the customer for whom the device was purchased must be attached. Such a reimbursement may be given once every three years.

The health plans are responsible for providing device supplies

The Ministry of Health has made it obligatory for the health plans to provide patients with the supplies required to operate an appliance or device which is included in the basket without a co-payment. Click here to download the Ministry of Health notice regarding such supplies.

Syringes for personal use – Diabetes patients who require syringes for personal use may obtain them from Clalit free of charge.

Needles for diabetes patient self-examinations – Diabetes patients who require needles for self-examinations are entitled to a 90% discount in Clalit pharmacies.

Strips for checking blood sugar – Diabetes patients who require strips for checking their own blood sugar are entitled to a 90% discount in Clalit pharmacies.

Nocturnal erection testing, such as RigiScan

The service is provided to the patient in his home using a designated device in the following cases:

  1. The patient suffers from impotence and is a prosthesis transplant candidate.
  2. The patient suffers from impotence due to diabetes and/or high blood pressure.

Laparoscopic surgery without a band

The service is provided in the following cases according to a referral from the treating doctor:

  • BMI above 40.
  • BMI above 35 with one of the following risk factors
  • Moderate to severe sleep apnea.
  • Right heart failure.
  • Diabetes which is unbalanced under insulin treatment of 100 units per day and more.
  • High blood pressure that cannot be balanced using the best pharmaceutical treatment (make sure to obtain approval from a district-certified doctor).
  • Gallbladder stones (when operating on the gallbladder).
  • Joint replacement due to obesity.
  • Cicatricial hernia or major hiatal hernia.

General Rights for the Chronically Ill and/or Disabled

Medication Co-Payment Ceiling

Diabetes patients are chronically ill and it is their responsibility to ensure that they are considered as such by their health plan. Being defined as chronically ill is primarily important because it entitles the insured to pay less for medications, up to the ceiling which changes every year. 

Please note: When calculating the cumulative cost of co-payments, purchases of supplies (syringes, bandages, etc.) must also be included.

Bituach Leumi Rights

General Disability

Anyone who is ill and above the age of 18 is entitled to submit a disability claim to the National Insurance Institute.

The disability rating is defined in proportion to the medical problem, its severity or complications connected to it. Attention must be paid to the existence of complications which raise the disability rating, even if they are not treated on a daily basis.

If the claimant has been defined as at least 40% medically disabled and he/she lost the ability to earn a living, either fully or partially, he/she will be eligible for a disability allowance from the National Insurance Institute.

Click here to see more information about general National Insurance and disability rights.

Income Tax and Municipal Tax Benefits

Income Tax

Parents of children with diabetes are entitled to income tax and municipal tax benefits. Diabetes patients do not generally receive income tax benefits. Those whose disability has been defined as above 90% are entitled to an income tax exemption.

Municipal Tax

The discounts depend on the municipal authority and should be checked on a case by case basis.

Other Rights

Insurance companies – Additional rights to which diabetes patients are entitled are rooted in claims against insurance companies for those with policies including coverage for loss of work capacity if their earning was damaged as the result of diabetes or the detection of serious illness.

Click here to visit the Juvenile Diabetes Research Foundation website.

This information was translated and adapted from content provided by The Society for Patients’ Rights in Israel.

 

 

 

English Websites and Publications for Each Kupat Cholim

It’s important to understand your kupat cholim. Getting familiar with your kupat cholim’s services and how to use them can save you time and money, or possibly make a difference in more important ways. Below are the links to the English sites for each Kupat Cholim, and you can also see our “Forms and Files” page to browse and download the English brochures and regulations that they have produced. Take a few moments to browse, and don’t stop until you’ve found out something you didn’t know:

Meuhedet- lang.meuhedet.co.il

Very simple sidebar navigation for English descriptions of all Meuhedet’s services, including PDF versions of their English pamphlets on supplemental insurance services and regulations.

Maccabi- maccabi4u.co.il/1781-he/Maccabi.aspx

Also simple navigation for good English descriptions, and downloadable PDFs. Plus, a handy summary of major points in the National Health Law.

Clalit- clalit-global.co.il/en/

Top navigation bar with drop down menus so it’s easy to navigate to very specific descriptions of services.

Leumit- leumit.co.il/eng/homepage.asp

Definitely the weakest English portal of the pack. Short lackluster descriptions and summaries of services. Tip- If you don’t see the sidebar navigation, try a different browser.