The Israeli health law states:
“Health services provided here within, given upon medical opinion, shall be of adequate quality, within a reasonable time period and at a reasonable distance from the residence of the patient… and all within the financial recourses available to the HMOs (Kupat-holim)…”
The public health system in Israel is very good, compared to the western world. The basic level of coverage is identically supplied in all 4 HMOs – health maintenance organizations – designed to ensure equal treatment for all, and has many advantages:
- No resident/ Oleh can be turned down, regardless of their health, financial condition, age or any other factor. This is also true for whoever chooses to join the supplemental health coverage that each HMO offers.
- Medical centers and clinics are spread out all over the country.
- The general/daily services and treatments are adequate and uphold most expectations.
- Public hospitals provide emergency medical attention.
In order to ensure equal treatment for all (and prevent deficits), the health law includes defined budgets for every medical procedure, and terms of eligibility. Many critical situations requiring high budgets undergo approval of a regional committee, and in other situations, terms of eligibility are difficult to meet.
Supplemental Health Services (Shaban) Offered by the HMOs
It is estimated that over 70% of the population in Israel have purchased the Shabans.
All the HMOs have supplemental health coverage for additional costs. The services are designed to provide extra coverage above the budgets in the health law and after exercising the law, not instead of the law.
The Shabans focus on a wide range of general/daily services and health care, discounts on better-living treatments, and lower co-payments. They also include a choice of surgeons and hospitals in agreement with the HMO. As a Shaban member, you will be entitled to purchase long-term care coverage that each HMO has, in cooperation with certain insurance companies. Restrictions apply as the long-term policies are outsourced to private companies.
In some cases the supplements offer coverage where the basic health law is undefined. The law however prohibits the Shabans from offering certain coverage such as life saving medications, or allowing lesser demanding terms of eligibility, than those stated in the health law, such as for overseas surgery and overseas transplant surgery.
Why Private Health Coverage?
Private health exists first and foremost to provide a better solution whenever the HMOs terms of eligibility are difficult to meet:
Most transplant surgeries are performed in the country with high success rates, providing a match is found. Sometimes a live donor may help, with kidneys for example; usually the donor would be a relative. In Israel, the number of organ donors is very low, approximately 1/3 of the world average, which makes the waiting list at times, very long. Only 6% of the population has an EDI card. If a situation is life threatening, a specialist of the HMO would recommend nominating a patient for overseas transplant surgery, subject to the approval of a regional committee. The health law permits a budget of up to $250,000 towards a transplant operation overseas, providing the patient is in a life threatening situation, and the transplant cannot be done in the country. Once those terms are met, the Shabans offer extra costs coverage above that.
There are situations where a transplant is necessary but not life threatening, for example if a patient is in need of an organ donation such as a kidney, bone marrow, pancreas and more. In such cases, the patient would not be entitled to an overseas transplant operation, since the patient would receive alternate treatments such as dialysis, blood donations and medications. These treatments may go on for several months to a few years, until a matching organ is available. As the treatments are prolonged, effectiveness gradually drops to a point where the transplant is all the more necessary but with a dramatically reduced success rate.
The basic private health plans include transplant coverage nationwide and worldwide including heart, lung, liver, kidney, pancreas, bone marrow, intestines, ovaries and special treatments overseas. The immediate access to an international waiting list increases the chances to find a match sooner.
Surgery and overseas surgery
Basic private health coverage offers overseas surgery of the patient’s choice, regardless of the type of surgery and urgency. Medical flights are covered, and staying expenses of those accompanying the patient are covered when hospitalization exceeds 10 days. Full private health plans also include private surgery in the country as an alternative to the HMOs. This includes your choice of surgeons/specialists, date and hospital, with the medical equipment most suitable for the procedure. Scheduling the surgery promptly as well as choosing the right surgeon/team of surgeons and hospital, can go towards increasing the success rate of any operation and minimizing risks and recovery time.
Drugs & medicine
Most of the medication and drugs a patient may need are included within the drug & medication basket, as part of national health care. Every year a committee of doctors is assembled to discuss the addition of new medications to be added to the basket, taking into account the demand/necessity for each drug, its cost, the state budget, prices, alternative medications and the side effects of the alternatives.
Every year 400 new breakthrough drugs are introduced to the market on average. Most of these drugs will not be included in the list, mainly due to high costs. For certain patient groups, this could mean a significant increase in quality of life, or even the gift of life itself, yet the budget is not unlimited, and often there is pressure to include medications targeting larger patient groups. Purchasing these life saving drugs privately may cost thousands or even tens of thousands of dollars every month.
Each medication included in the basket is intended for a specific medical condition. The HMOs can subsidize a listed drug, providing that it is prescribed for a condition that is labeled. If a certain drug has been found and proven effective for other purposes, even if prescribed by the house doctor of the HMO, it cannot be subsidized by law.
The basic level of private health coverage offers full access to any medication that is not on the list of drugs subsidized by the HMOs, including drugs that are on the list, labeled differently to the patient’s needs, and “Orphan drugs”, for rare illnesses.
With medication coverage included in the basic private health plan, you will never need to fund critical and expensive drugs costing thousands to tens of thousands of dollars every month, or compromise on drug treatment.
Innovative medical treatments and technologies available in the country and abroad that replace the need for an invasive operation, aimed at giving identical results as a surgical procedure but with greatly reducing risks, trauma, pain & suffering as well as recovery time.
Private health care offers coverage of non-invasive treatments including future technologies and treatments, always allowing access to the leading medical treatment available.
Additional coverage options within private health
- Compensation due to severe illness- Coverage providing compensation in the event a patient is found to be suffering from a severe medical condition or illnesses, providing financial security during challenging times of treatment and healing.
- Long term care- Coverage that provides a monthly sum set in advance, in the event that a patient can no longer conduct normal daily activities, without the help of an aid, in order to cover expenses of nursing and special needs.
- Ambulatory services and advanced medicine- Preventative healthcare tests and check-ups, private imaging, diagnostics and lab work, M.D. accompaniment, specialist consultations, House calls, emergency dental first aid, psychological consultation and assistance, and much more. These services are available through the HMOs, although having the private option offers quick response times, often contributing to better end results.
Did you know?
All government workers (IDF – standing army, Bituach Leumi, universities, institutes & authorities, government departments, tax authorities, police, fire dep., teachers, Electric co., post office, port authorities ) and even the staff of the four HMOs (Clalit, Maccabi, Leumit, Meuhedet) and public hospital staff benefit from private health plans, offered through the work place. Major private companies such as ELAL, Intel, Banks and hundreds of medium to large entities also provide private health plans for their workers.
Israel has leading specialists and among the most advanced medical technology in the western world, with excellent capabilities. Private health care provides access to the best medical treatment available with minimal waiting times and peace of mind. Very few can pay hundreds of thousands of dollars out of pocket should a medical crisis occur to them or their loved ones. Therefore, the only real alternative is to get private health insurance with the promise that they will get their best shot at any medical crisis that may happen in the future.
What are the costs?
Depending on the chosen plan, there may be fixed and/or variable premiums for different elements of coverage. The premiums in Israel are far less expensive than those in the U.S. for similar coverage.
Nonprofits helping patients not eligible for treatment through the HMOs:
These are some examples of non-affiliated nonprofit organizations collecting donations for patients that cannot afford needed treatment that is not covered by their HMO:
*(The writer is not responsible for the contents and/or activities of these websites, and is not implying or recommending donations to these websites. Any and all responsibility of use of these websites is on the visitor solely).
About the writer: A native English speaking insurance agent specializing in insurance for recent immigrants to Israel, Guy Lane works at the Gabay Insurance Agency representing Harel Insurance Group. For more information about private health insurance plans and special benefits for Olim, contact Guy at firstname.lastname@example.org or call 054-7997918.