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.)
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.