Health Plan Fee Exemptions for the Seriously Ill (Right)

From All Rights (Kol-Zchut) (www.kolzchut.org.il)

הקדמה:

Policyholders who have a serious illnesses, detailed below, are exempt from paying the health plan's deductible for various medications and services
Those who are eligible must verify that the information regarding their illness is up-to-date in their health plan's computer system
For more information, see the Ministry of Health's English website

Patients with an illness classified by the Ministry of Health as a "serious illness" (see the list below) are exempt from paying for medications through their health fund, according to the regulations of their insurance. They are also exempt from paying for certain medical services included in the healthcare basket.

  • If Payment Form (Form 17) is necessary, the patient will be exempt from paying the deductible for issuing the form.

Medical Services for Which an Exemption is Given

  • Secondary doctor visits: Medical specialists including psychologists, that are not primary doctors (see below), including podiatrists and dietitians.
    • Primary doctors are general doctors (that are not specialists) and specialists family medicine, pediatrics, internal medicine and gynecology. There is no deductible for an appointment with a primary doctor.
  • Out-patient Clinics: Clinics that are run through general hospitals (including mental health clinics in general hospitals.
  • Institutes:
    • Imaging Institutes: x-rays, ultrasounds, nuclear medicine, CT, echo-cardiogram, MRI.
    • Diagnostic Institutes: EEG, EMG, ergometry, audiometry.
    • Gastroenterology Institute and the Institute for Sleep Disturbances.

More Information

Medications

Who is Eligible?

How to Claim It?

  • The right is granted automatically, as long as the patient is classified with the health fund as a "seriously ill patient".
  • In most cases the classification of "seriously ill patient" will be valid for 2-3 years from the day that it was originally defined as such by the health fund in accordance with the funds guidelines.
  • After those 2-3 years, the classification of "seriously ill patient" must be renewed in order to continue receiving the benefits.
  • The health fund is obligated to update the patient when the time period that he has been classified as a "seriously ill patient" is coming up so that he can request to renew it.
  • Some of the health funds have a system that automatically extends the classification based on criteria that the fund establish (diagnoses, medications and the like), but in some of the funds the patient has to request renewal of the classification. One should ask their specific health fund to clarify what the process is.
  • In all cases, if the health fund determines that the patient is not eligible for a renewal of the classification, it is obligated to notify the patient in writing and to give him a chance to go to his family doctor or the health fund clinic if he thinks that he is still eligible to be classified as a seriously ill patient.

Important: It is the responsibility of the patient to make sure that the details of his illness are found and update in the health fund's system and that he is classified there as a "seriously ill patient".

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