Navigating the Israeli Health Care System

March 2015

The Israeli Health Care System

Health insurance for all Legal Residents

Government determines the basket of services “sal habriut”

Tax based sliding scale: graduated tax on salary paid to Bituach Leumi

6-12 months free membership as an Oleh (if not in employment)

Rights to Health Care Coverage for New Immigrants

NO age limitationNO health limitation/pre-existing

illness exclusionNO waiting periodALL are covered by the Israeli

National Health Service

Israeli Health Funds

Choice of 4 Health Funds(Maccabi, Clalit, Meuhedet and Leumit)

How does one decide which health fund to join?

It is possible to change from one plan to another?

How does one choose a doctor?How to change a doctor

Services Provided by the Health Funds - Health Care BasketDoctors visits (primary care and specialists)Blood testsImaging studies (US/X-RAY/CT/MRI)Hospital admissions and surgeriesParamedical treatments

(physiotherapy/OT/ST)Medications (15% co-payment; quarterly

ceiling for patients with chronic disease; exemption from co-pay for oncological medications)

Dental care and treatments for children until aged 12

Services Not Included in the Health Care BasketDentistry (for patient aged 12+)OptometryPsychiatry - currently undergoing

reformChronic nursing care – provided

by the state not in the Health Basket

Primary Care Medicine

Family/General Medicine – emphasis on proactive preventative medicine and screening as well as reactive treatment to patient’s complaints

Choice of primary care doctor:Dependent on health fundMaccabi and Meuhedet

(free choice)Leumit and Clalit

(according to address)

Primary Care Medicine

Changing your Primary care doctor:Within a quarterBetween quartersYour primary care doctor as your case

coordinator:A liaison between specialties and health care

providers, including assistance in the case of urgent referrals

Provider of referrals to support services including:

◦ Social workers◦ Paramedical professionals◦ Home care team

Primary Care Medicine

Pediatricians – Primary care providers for the child population – function as Family physicians and refer as appropriate to the child developmental services (assessment and treatment)

Direct access to some specialties – with no need for a referral:◦Orthopedic care◦Ob/Gyn◦Ophthalmology◦Dermatology◦ENT

Referrals to Specialists in Secondary CareReferral by primary care physicianSpecialists located in community clinics,

medical centers and hospital outpatient clinics

Each Health Fund has agreements with certain local hospitals (preferred provider hospitals)

If referred to hospital – a tofes 17 / hitchayvut is necessary –

available from branch office(telephone, fax, via internet or in person)

Making an Appointment

OnlineTelephoning the 24 hour call

center with multilingual capabilityDirectly with the clinic

receptionist

Internet Site and Services

Information on rights and benefits

Health promotionPersonal Health recordPersonal remindersRequests from primary

physician:◦ Prescriptions◦ Sick notes◦ Referrals to blood tests

Ordering from pharmacyTravel insurance

M-Health

Directory with GPS service location

Lab resultsMedication listAlerts and reminders

for chronically illPregnancy

managementPhysician’s mobile

portal

Emergency and After Hours CareEach Kupah has somewhat different

arrangements24 hour help lines (staffed by

medical professionals)Emergency clinics :“Mokdim” –

including the network of 13 Nationwide Terem clinics

Home visitsEmergency rooms in

hospitals

Home Care Team

Multi-disciplinary teamReferral by primary care doctor

or Health-fund liaison nurses in hospitals

Short term support – acute injury or illness

Long term support – chronically ill patient with decreased mobility / functioning

Tipot Halav – Mother and Baby Care Clinics Provides health and medical services in the field of

health promotion for pregnant women, infants and children (from birth to age 6 years) and their families.

Tipat Halav centers are distributed throughout Israel. Objectives of the service provided at Tipat Halav

include:◦ Prevention of infections diseases my means of immunization.◦ Early detection of health problems by means of routine

examinations◦ Guidance regarding lifestyle that improves health and

prevents diseases, such as: Good nutrition

Breastfeeding Child development Dental health Hygiene Safety and more

Child Development Diagnosis until aged 9: Referral forms pre-assessment

to be filled out by parent, nursery or school teacher and pediatrician.

Treatments: Until aged 3: Unlimited number of treatments(health-

basket), no co-payment Aged 3-6 years: Maximum of 54 treatments/year, 28₪

copayment, further treatments – supplementary insurance

Aged 6-9 years: Maximum of 18 treatments/year, 28₪Co-payment, further treatments – supplementary insurance

Aged 9-10 years: Treatments via supplementary insurance only

Child Development

Special Categories:1. Children with severe developmental

disabilities (CP, genetic disorders such as Down’s syndrome)

Unlimited number of treatments until aged 18 years

According to recommendation of Specialist in Child development

No co-payment2. Children with Autistic Spectrum DisorderAllowance of 156 treatments a year (3/week)Copayment – 28 . ₪

Supplementary Health InsuranceAdditional level of the basic healthcare basket

and can include three principle types of coverage:

Added Insurance - Services that are not included in the healthcare basket such as dental care and long-term care insurance.

Expanded Insurance - Expansion of the services included in the healthcare basket

Substitute Insurance - Qualitative replacement of services provided in the healthcare basket, such as compensation for hospitalization expenses incurred at a private hospital

Supplementary Health InsuranceOptionalCost varies according to patient ageCoverage varies between health fundsA choice of supplementary health plans

offeredImmediate coverage for Olim (within 3

months of Aliya)No exclusion criteriaAccess to benefits and rights via the

Health fund’s internet sites or brochures

Supplementary Health Insurance Subsidized medicines not included in the health basket* Second opinions with specialists* – ShaRaP

reimbursement with receipt and summary of visit Operations at private hospitals* Coverage of expenses for surgery and special

treatments abroad – preapproval necessary* IVF treatments* – beyond that included in the basic plan Expanded basket of prenatal testing Discounts on complementary health care treatments Discounts for a variety of medical aids and orthotics* Discounted dental care and treatments Subsidy for ambulance transportation(*Generally preapproval required)

Disability Benefit Entitlement– Bituach Leumi Age and residency - You are an Israeli resident,

aged 18 till retirement age. Income – your income as a salaried employee or a

self-employed worker is under 60% of the average wage, or under 45% of the average wage (depending on type of impairment).

Medical disability – an NII physician has determined a medical disability degree of at least 60% for you, or of at least 40% if a medical disability of at least 25% was determined for a single impairment.

Incapacity degree – It has been work, oryour capacity to earn a living has been diminished by at least 50%determined that, due to your disability, you cannot

Nursing Care PatientsA nursing care patient is someone of retirement age suffering

from a medical condition that requires assistance performing daily functions:

Getting up and lying down Getting dressed and undressed Bathing Eating and drinking Continence Independent mobility

A complex nursing care patient in addition to being unable to perform daily functions, requires constant supervision by a doctor due to:

Pressure ulcers (bedsores) Prolonged intravenous infusion Dialysis Chemotherapy and/or radiation therapy

Nursing Care Coverage What Nursing Care is an Israeli citizen entitled to?

NII will fund up to 18 hours of home care per week What do the Kupot Cholim offer you? If you have

additional coverage they will fund home care to the value of +/-4,500 NIS per month for the first 3 years and +/-2,800 NIS per month for the subsequent 2 years

What is the true cost of Nursing Care? Home care can cost +/-20,000 NIS per month. Care in a Hospital / Institution can cost 10,000 – 25,000 NIS per month, depending on the quality of care.

How to cover the shortfall? Many choose to take out a private nursing insurance policy

Accessing Medical Care for the Katin Hozer or Ezrach Oleh

Katin Hozer ?An Israeli citizen who left Israel before

the age of 14 with at least one parent.Ezrach Oleh? An Israeli citizen born abroad to at least

one parent who held transferable Israeli citizenship at the time of their birth.

Entitled to free health insurance from and eligible for health services shortly after registering with Bituach Leumi.

Accessing Medical Care for the Toshav HozerToshav Hozer ?An Israeli citizen above the age of 17 and

has resided abroad for at least two years.

The toshav hozer has 2 options for health care:

1. To pay Bituach leumi a sum of money calculated according to period of absence from Israel

2. To take out private insurance to cover the period he is without health coverage

How to register with Kupat CholimNew Olim will have the

opportunity to register for health care upon arrival at Ben Gurion Airport

Changing Kupat cholim is done:◦Via bituach leumi internet site◦At the post office

Additional Sources of Informationwww.health.gov.ilwww.btl.gov.ilwww.kolzchut.org.ilwww.shirapranskyproject.orgwww.maccabi4u.co.ilwww.clalit.co.ilwww.meuhedet.co.ilwww.leumit.co.il

Thank You