As detailed on the Clalit health plan health services website (January 1, 2010)
Clalit customers are entitled to receive an insulin pump free of charge under the following conditions with a referral from the treating doctor:
- Children and adults with diabetes who suffer from hypoglycemic attacks marked by spontaneous loss of consciousness, confusion and change in behavior without prior warning.
- Those who suffer from repeated attacks of ketosis, acidosis and hypoglycemia requiring hospitalization.
- Diabetes patients whose HgA1c level is 7.5 and more.
- Diabetes patients who received intensive treatment including three or more injections of insulin throughout the day; however, did not achieve the balance goals.
- Women who suffered from diabetes in the period before pregnancy and during pregnancy.
- 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.
- 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:
- The patient suffers from impotence and is a prosthesis transplant candidate.
- 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. Currently, the payment ceiling is 265 NIS per month.
Please note: When calculating the cumulative cost of co-payments, purchases of supplies (syringes, bandages, etc.) must also be included.
Bituach Leumi Rights
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
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.
The discounts depend on the municipal authority and should be checked on a case by case basis.
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.