Health insurance in Israel and the need for a private health care policy in brief

An informational article by Shmuel Weinstein.
Please note: This article is for informational purposes only. All coverages are solely according to the insurance companies policy conditions.

How the health system works in Israel

The Israeli medical system is governed by the National Health Law and the Ministry of Health is granted a budget each year by the Knesset to provide what is commonly known as “the basket of medical services” to all Israeli citizens.

Even non-citizens who have been accepted as residents by the National Insurance Institute (Bituach Leumi) are eligible to receive these services.

The “basket” includes doctors’ visits, medications, lab work, hospitalization, and surgery.

The various hospitals and Kupot Cholim (literally “sick funds”- but I will refer to them as “health funds”) are authorized by the government to administer this basket of services to the Israeli populace.

The Kupot Cholim receive a fixed NIS amount from the government for each member in their fund. The hospitals receive a fixed “per day” amount from the government for hospital admissions and fixed amounts for each operation performed.

The Kupot Cholim also market their own private health “upgrade” products (called ShaBaN – שב”ן – שרותי בריאות נוספים) to their members and the private hospitals all have a “private care” department (called “ShaRaP” – ש.ר.פ – שרות רפואה פרטית) where the top surgeons and specialists work . More on this later.

The problem with this system

While the National Health Care Law achieves its goal of giving every citizen and resident access to some level of health care, there are some serious drawbacks to the system. Here are some examples:

  • Inability to chose the top doctor or surgeon (the top doctors and surgeons only work privately through ShaRaP)
  • Resistance on the part of the Kupat Cholim to authorize expensive tests, such as MRI’s
  • Long waiting times to receive surgeries
  • Many important (and expensive) medications are not included in the “basket of medical services”
  • Transplants abroad are rarely authorized, and there are very few organs in Israel. This will be discussed more in depth later on.

Do not rely solely on the Kupat Cholim’s “upgrade plan” (ShaBaN) for your family’s health

The Kupot Cholim are actively promoting their products through what many consider to be false advertising techniques. A number of years ago their deceptive tactics were aired on Channel 10’s Zeh HaZman investigative reporting show

The average person is not aware of what he’s not covered for. The Kupot Cholim would have you believe that if you purchase their “extra coverage” plan (Meuchedt Adif/See, Maccabi Magen, Leumit Zahav, or Clalit Mushlam) you and your family are fully covered no matter what happens. This is far from true!

An example of how these “upgrade plans work”

As an example to clarify this point I will use Meuchedet (although the same is true more or less for all the Kupot) as most Anglos living in the Jerusalem area belong to the Meuchedet health fund. A few years ago they came out with a plan called “Meuchedet See” which would have you believe from their advertising materials that they fully cover private surgery both in Israel and abroad. This is far from true!

Regrettably, almost all the top surgeons in Israel who work in ShaRaP will not perform the surgery in exchange for the amount that Meuchedet See pays them. In the case that you want to use such a surgeon in Israel, you will have to front the money and Meuchedet See will pay you back up to 36% of the cost of the surgery and no more than $3000.

Private health insurance policies will normally pay 100% of the cost of the surgery with no limit. If in the unlikely event the surgeon that you want does not work with your private insurance company (and in all honesty there are some surgeons who don’t work at all with any insurance companies – very few, but some) – then the private insurance policy will pay the amount that they normally pay for the head of that particular department to perform the surgery.

Regarding surgery abroad, Meuchedet See will only pay for only one surgery per lifetime and only after all of the following conditions are fulfilled: the “medical approval committee” of Meuchedet approves it, the surgery is “regularly” performed in Israel (which is illogical, as one normally goes abroad when the operation is complicated and not regularly performed in Israel), and the surgery is performed in a hospital abroad that Meuchedet is contracted with.

Private health insurance has no limit on the number of surgeries performed abroad. Most policies have no limit on which hospital or surgeon to use. All medically necessary surgeries are covered (not just those “regularly” performed in Israel), and there is no “approval committee”. All surgeries are covered 100% with no maximum limit. You must, however, inform the insurance company in advance and allow them to negotiate the price with the hospital abroad.

Transplants and medications not covered in the “basket of services”

Not only in the area of private surgery are there serious deficiencies with the socialized system. Also in the areas of transplants abroad and medications that are not covered by the government “basket of services” there are similar shortcomings.

The Kupat cholim system, no matter which “extra coverage” plan you’re on will give you absolutely nothing if you need medications that are not covered by the government “basket of services”.

Regarding transplants, the situation is a little more complicated. There is a tiny budget allocated by the Ministry of Health for transplants abroad. It is not nearly enough and over 100 people in Israel per year die while waiting for “approval” to do their transplant abroad.

Each Kupat Cholim gets a percentage of this inadequate budget proportional to the amount of members in their fund. Then, within each Kupat Cholim there is a committee which evaluates each application that it receives and approves who it wants based on unknown criteria. Basically, the people with the influence, or “proteksia” as it’s called in Israel, are the ones who get approved.

These flaws are all corrected with a private health insurance plan.

In conclusion

What this all means is that thousands of Anglos like yourself who are used to obtaining top health care from their home country are under the impression that they have top care here, since they purchased the Kupat Cholim best upgrade available. Unfortunately, they may be in for a serious shock if something serious happens, G-d forbid.

By purchasing private supplementary health insurance you will get the following benefits at a very reasonable price:

  • Full coverage for Private surgery with the surgeon of your choice both in Israel and abroad.
  • Full coverage for Transplants abroad
  • Full coverage for Medications not covered in the Ministry of Health’s “basket of medical services”. A small monthly co-payment may apply.
  • Private testing and diagnostics.
  • The ability to see private specialists