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.

Waking Up!

I just got back from an amazing/inspiring/motivating yom iyun, focusing on the accessibility of patient rights. There were presentations from doctors, professors, administrators, social workers and government officials, all surrounding this urgent objective. 

A few important points:

Everybody knows the challenge

Only within the past few years the concept of bridging the awareness gap between patients and the help and support that they are entitled to has gained a life of its own. There are now several organizations dedicated to finding and implementing solutions, and many more institutions collaborating on these initiatives.

Personally, I’m amazed at how an idea can suddenly be “in the air”, with so many people recognizing it on their own and tackling it from different directions. At the same time that I was first formulating my concept and approach to English accessibility, the Hadassah social work department was just launching their Kivunim  information center, Amitai Korn was conceiving Kol Zchut, Bituach Leumi was revamping their website, and many more institutions were waking up!

English is a slice of the (humble) pie

Israel has much to be proud of in its institutions of public support and protection. Universal healthcare, the social safety net, and the protection of patient rights are all enshrined in law and continually maintained and improved upon. But (!), Israelis of all stripes are missing out on some or all of these entitlements. The statistics on uptake of the support programs that are in place (from Bituach Leumi and elsewhere) for all of the relevant populations are dismal.

Still, certain populations are particularly weak, foremost- immigrants. Yes, English speakers in Israel are immigrants, sharing all the challenges of integration encountered by the Russians, French, Ethiopians, etc. with a few unique hurdles of our own. Something must be done to bolster the awareness and acquisition of entitlements among immigrant communities and every participant in today’s yom iyun agrees. The Shira Pransky Project is making sure that the English speaking community specifically is recognized and addressed.

So what is being done right now?

The general director of the Misrad Habriut issued a directive to all medical service institutions in February 2011 that they must reach a certain standard of “cultural competence”. The gist- all information and services must be accessible in Hebrew, Russian, Arabic and… English! Many people and organizations, including The Shira Pransky Project, are working hard to push this objective and assist institutions scrambling to fulfill it (more about that in a moment).

Government institutions are upgrading and updating their websites, opening information centers, and even co-opting social media to inform the public, respond to inquiries and give directions. (We have direct assurance from Gov.il that they respond to English questions on facebook and twitter.)

Kol Zchut, Kivunim and other organizations, are all constantly promoting information and awareness via their programs. The Shira Pransky Project is working directly with these organizations and others to assist them in English accessibility with translations, recruiting bi-lingual volunteers, and more.

The Shira Pransky Project is also constantly engaging more organizations to advocate for the assistance non-profits to adopt, and maybe even lead the way, in meeting the Health Ministry’s standards for cultural competence, and  our website is in a constant state of evolution to better simplify and present useful information

So what can you do right now?

  1. Get Familiar

    Get to know your rights, entitlements, and avenues for information and support. You can start with our website, but also visit your Kupat Cholim’s English site, and the various English Government sites. Read your Kupat Cholim’s English brochure(s). Read the other English publications out there. Save yourself the pain and frustration of navigating the system, or worse- missed opportunity, by understanding the system you belong to right now.
  2. Speak Up!

    Your Kupat Cholim has an ombudsman’s office, and the Health ministry has an ombudsman’s office, dedicated to receiving complaints and protecting your rights. These professionals need to hear your issues about compromised service in English (or any other issues) in order to address them, and to emphasize the importance of English accessibility in their institutions. The public ombudsman from the Health Ministry spoke today specifically about how even a single complaint about an issue can help them raise flags and result in huge reforms! 

    Also, the public advocacy organization Emun Hatzibur has specifically called for complaints relating to language barriers in health service institutions. They will fight for you to address any imminent situation, and they will use your issue to bolster the Health Ministry’s directive on cultural competence. They can be contacted directly, or you can email these specific complaints to The Shira Pransky Project to be passed on to them.

  3. Unite!

    I’ve held back considerably from launching into a diatribe on the need for English speakers in Israel to come together as a community, especially over important issues. We want institutions to recognize and address the specific needs of our community, but we must also recognize ourselves as such. Whether you have been here for years or weeks you are walking in the shoes of all those ancestors that passed through Ellis Island, and all those other ports around the world, for generations. Yes, this time at least we are immigrants to our own homeland (ironically enough), but here once again, we need the support of our fellows in order to integrate and make it in our (please God) final destination.
  4. Get Involved!

    The Shira Pransky Project recruits bi-lingual volunteers to directly assist health and support organizations in English accessibility and for specific projects. We could also use some help ourselves. Of course, our efforts require financial support, so please donate to support English accessibility. And spread the word.

Congratulations!

You read the whole thing! I guess you agree that this is important stuff, so please share it with others, and leave a comment!

Rights of Patients After a Cardiac Event

After a heart attack or surgery, patients feel vulnerable and anxious and are sometimes afraid of losing their ability to function; they do not always know what action is required in their situation. To alleviate these problems, heart rehabilitation programs have been developed, which are designed for those who suffer from one of the following:

  • Patients who have had a heart attack
  • Patients who have undergone coronary artery bypass surgery
  • Patients with Class II-III heart failure and/or LVEF < 35% decrease in left ventricular functionality with intermediate severity and above
  • Patients who have undergone pacemaker/defibrillator implantation

Before Implantation or Open Heart Surgery

The Ministry of Health requires that before a transplant or open heart surgery, the patient must undergo a comprehensive dental examination and treatment of all of the infections found in the patient, as well as preventive action against infections in the patient.

Recovery and Rehabilitation in a Convalescent Home

Included in the health basket is eligibility for five days of recovery in a convalescent home that has an agreement with the kupat cholim, without any co-payment. In order to obtain the service contact a kupat cholim representative in the hospital before being released or in a kupat cholim branch within 24 hours of being released from the hospital and present a medical recommendation from a cardiologist. As part of a stay in the convalescent home, the patient is entitled to medical oversight, instruction and follow-up, nutritional lectures and supervised exercise.

Also note that every kupat cholim offers an extended stay in the convalescent home in their supplemental health services plan (Shaban). Contact a representative for the details of your plan.

Rehabilitative Exercise

Anyone is who is insured is eligible to receive rehabilitative exercise services for a period of 4 months, with a co-payment. The program includes supervised physical activity with monitoring and follow-up by a cardiologist, a Holter stress test, relaxation and anxiety reduction, plus lectures on proper nutrition and risk factors.

Also note that every kupat cholim offers  an extended program for an additional period in their supplemental health services plan (Shaban). Contact a representative for the details of your plan.

Heart Rate Monitoring/Follow-up

Included  in the health basket is eligibility for receiving a personal monitoring device (cardiobeeper)  for 6 weeks, allowing the E.K.G to be broadcast directly to the medical center which is manned at all times.

Also note that every kupat cholim offers an extension of the service for an additional period of approximately one year  in their supplemental health services plan (Shaban). Contact a representative for the details of your plan.

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

Healthcare News Roundup

Here are some news articles about Israeli healthcare that we have recently shared on our twitter feed-

Hadassah Hospital is taking health care to new heights- Haaretz 

Mortlity high in psych hospitals- Hrtz  -Would b more intrsting w/ comp 2 intrntl data, still thumbs up 4 reform

Health Ministry to probe new Meuhedet rules that dentists say endanger kids teeth- Haaretz 

Ichilov head Barbash- new emergency facility/why only central Israel hospitals get donations- Haaretz 

American CEOs Get an Israeli Medical Education 

@mominisrael Risks of Homebirth 

Turning things around at Bikur Cholim- JPost 

Public funding for updating health basket eroding-JPost 

Really interesting- Surrogacy law in Israel 

I love docs but hubris is a professional hazard-60% of docs punch in, others protest “demeaning”-JPost 

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Health Services Abroad

In principle, the obligation imposed by the law for the Kupat Cholim to provide health services to Israeli residents is limited exclusively to the territory of Israel. However, there is a defined set of cases where the insured is entitled to participation in the costs of medical treatment abroad, subject to the fulfillment of all the following conditions:

  1. The treatment is in one of the following fields: organ transplants, congenital defects, tumors, cardiovascular diseases and neurocerebral diseases.
  2. The insured is unable to receive the required treatment or an equivalent treatment in Israel (if a little experience does exist in Israel, it is considered as if the insured is able to receive the treatment in Israel).
  3. The insured is in danger of losing his life if he does not receive the specific health service.

In addition, if in the opinion of the health fund a case presents exceptional medical circumstances, it may fund the treatment abroad.
Note: If a health fund rejects the insured’s request to receive health services outside Israel, the decision may be appealed before a special appeals committee in the Ministry of Health.

For more information of Health Services Abroad click here

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Health Services: Distance, Wait, Choice and Continuity

Reasonable distance and wait time

The law requires that basket of health services be provided to the insured at a reasonable distance from his place of residence, but does not define the term “reasonable distance”. There have been conditions for which the Ministry of Health has ruled that the Kupat Cholim must reach an arrangement with an institute near the insured’s place of residence or, alternatively, it must arrange transportation for the insured to and from the institute to which he was referred. Additionally, if there is no nearby medical facility which can provide a required service within a reasonable wait time, the health plan must provide the required service at a different facility, even if it does not have an agreement or arrangements with that facility. Though, again, the law does not define what “reasonable wait time” is, so it is also open to interpretation.

 

Service in small localities

 

In localities with a population of less than 5,000 residents, not more than one health-fund clinic may operate; in localities with a population of less than 10,000 residents, not more than two health-fund clinics may operate. A health fund that operates a clinic in a locality with a population of less than 10,000 people is obligated to provide medical services, within the framework of the clinic, to members of another health fund that does not operate a clinic in the same locality, upon the same conditions at which it provides them to its own members. There is no need to receive the approval of the health fund that does not have a clinic in the locality and a member of that fund may apply directly to the clinic for services.

 

Choice of health service provider

 

A health fund provides health services through its own service providers or by arrangement with other providers. The Kupat Cholim may establish guidelines for members choosing between its service providers, and is obligated to publish its guidelines for selecting service providers and to provide them free of charge at its branches at the request of any insured individual.

However, where there is medical justification for providing the service at a specific location, the health fund must fund the treatment at that location. For example: when a disease or medical condition warrants treatment at a medical institution that possesses a special degree of knowledge and professional experience, the insured will be given the option to receive the medical service he requires in connection with that disease or medical condition at such an institution.

 

Maintaining treatment continuity

Continuity in treatment must be maintained and the insured must be allowed, when possible, to receive the entire treatment for a disease or for a defined medical condition at the same institution where the treatment was begun . Thus, even if a health fund decided to provide a certain treatment that is not included in the mandatory basket of services, once it was begun and as long as it is suitable and medically indicated, the health fund is obligated to continue providing it.

 

Prohibition on discrimination

 

A health fund is forbidden to discriminate between patients suffering from a particular disease. Thus, all members of a health fund who apply for treatment/hospitalization in a certain department/institute and meet the same conditions are entitled to receive the fund’s approval for that service.

 

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

For more information on this and related topics, see Health Plan Choice of Service Provider Arrangements and the Health Plan Portal, both of which we translated as part of our collaboration with Kol-Zchut.

 

To your health ! לבריאות

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Limits and Exceptions in the Scope of Treatment from the Kupat Cholim

Indications for treatments

For some medications, the basket of health services explicitly determines “indications” – that is, provisions that limit the insured’s right to receive the medication or the medical service to specific medical conditions. A health fund is not obligated to fund the cost of a medication for indications other than those included in the basket.

 

Treatment alternatives

The choice between treatment alternatives which are included in the basket of health services, such as different medications, is subject to the discretion of the health fund, which may determine that an insured individual will receive the cheaper of two medications that have the same medical effect. Nevertheless, when there is an indication that a certain alternative is preferable for treating the insured’s problem, the health fund is obligated to provide the preferred alternative.

 

Limits on the scope of treatment

The fact that a certain service or medication is included in the basket of health services does not mean that that service or medication will be provided free of charge and without any limit. For example: physiotherapy for chronic patients may be limited to 12 treatments per year, and may require reasonable co-payment.

 

Receipt of Services Not Included in the Basket From a Health Fund

The basket of health services describes a minimum, and the health fund is authorized to provide additional medical services or medications determined by a committee that considers exceptional cases. The committee’s approval will apply to all patients who meet the criteria that were set. The committee must conduct an orderly proceeding, including the hearing of arguments, keeping of minutes, etc. and an insured is entitled to receive a copy of the minutes and any information on the hearing in his case.

 

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

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What is the Healthcare Basket?

The following page gives a general explanation of the most basic Israeli healthcare rights, including the National Health Insurance Law, the “Healthcare Basket” concept, and which healthcare services are provided by whom.

For more detailed information about specific rights and services, please visit The Healthcare Basket Portal we translated as part of our collaboration with Kol-Zchut.

The Law: Why the system is what it is

In 1994, the Knesset passed the National Health Insurance Law which basically put into place the current Israeli healthcare system based on the following principles:

  • Application to all residents: Every resident of Israel is entitled to health services under the National Health Insurance Law.
  • Provision of service is not connected to the ability to pay: A resident pays for health insurance according to his means, and is treated according to his needs. The state is responsible for providing funding, while the health fund in which the insured is registered is responsible for providing the service.
  • Choice of a fund without limitations: Every resident is entitled to be registered as a member of one health fund chosen by him, unconditionally and without any limitations due to age or state of health.
  • Provision of service: The fund is responsible for providing all the services included in the healthcare basket, based on medical discretion, with reasonable quality, within a reasonable time, and within a reasonable distance.
  • Maintaining dignity and privacy: Every insured individual is entitled to receive health services while maintaining his dignity, privacy and medical secrecy.
  • Switching health funds: Every resident is entitled to switch from one health fund to another.
  • Selection of service providers: Every insured individual is entitled to choose service providers, such as doctors, caregivers, hospitals and institutes, from a list of service providers who are affiliated with the health fund in which he is a member and according to the arrangements for selecting service providers as published by the fund from time to time.
  • Complaints by the insured: Every insured individual is entitled to submit a complaint to the officer in charge of public inquiries at the medical institution that treated him, to the officer responsible for investigating members’ complaints at the health fund in which he is a member, or to the ombudsman under the National Health Insurance Law in the Ministry of Health.
  • Application to the court: Every insured individual is entitled to submit a claim to the Regional Labor Court.

The Healthcare Basket: What you’re entitled to

The healthcare basket includes all the services, medications, supplies and medical equipment that the insured is entitled to receive according to the National Health Insurance Law. It was originally determined based on the health services that were provided by the Ministry of Health and the Clalit health fund as of January 1, 1994 and has been regularly updated by the Ministry of Health, on the basis of recommendations by a public committee.

The healthcare basket is provided to the insured

  • based on medical discretion,
  • at reasonable quality,
  • within a reasonable time, and
  • at a reasonable distance from his place of residence

subject to the conditions set forth in the law and its regulations.

Which services are provided by the Kupat Cholim?

The National Health Insurance Law describes the following fields of service to be included in the healthcare basket for which the health funds are responsible:

  • Diagnosis, consultation and medical treatment.
  • Medications according to a list, some of which are provided only for a particular indication.
  • Hospitalization in a general hospital.
  • Rehabilitation, including hospitalization.
  • Accessories and medical supplies.
  • Medical services in the work place. 

Which services are provided by the Ministry of Health?

There are several health services that, as of now, have not been transferred to the health funds and remain the responsibility of the state:

  • Preventive medicine – well-baby clinics and inoculations.
  • Certain general rehabilitation devices, walking and other mobility devices, for which the Ministry of Health participates in the cost.
  • Health services for schoolchildren.
  • Nursing home stay.

 See Also: Ministry of Health Responsibilities for Providing the Health Basket

This information was translated and adapted as part of a collaboration with The Society for Patients’ Rights in Israel.