Introduction:

All insurance policyholders are entitled to enroll, with payment, in their HMOs additional health services plan receive all services offered as part of it, regardless of medical condition, age, or financial status
Joining or not joining an additional health services plan does not impact the entitlement of a policyholder to fully receive all healthcare services included in the basic healthcare basket
Some of the services are contingent on a mandatory qualification (waiting) period during which the policy holder pays for the SHABAN policy but is not yet entitled to receive all of the services included in the policy
For additional information see the Ministry of Health website]


According to the National Health Insurance Law, HMOs are permitted to offer plans including additional health services (SHABAN) beyond those included in the basic healthcare basket.

  • This supplementary insurance constitutes an additional level of the basic healthcare basket and can include three principle types of coverage:
  1. Additional Insurance - Services that are not included in the healthcare basket such as dental care and long-term care insurance.
  2. Expanded Insurance - Expansion of the services included in the healthcare basket such as increased financial health plan coverage of transplants in Israel and abroad.
  3. Alternative Insurance - Qualitative replacement of services provided in the healthcare basket, such as compensation for hospitalization expenses incurred at a private hospital.
  • The HMOs may not deny any policyholders from enrolling in a supplementary insurance plan and they may not perform any tests as a prerequisite to enrollment. This is in contrast to Private Health Insurance policies offered by insurance companies and include a screening process and the companies are able to deny applicants based on age or medical condition.
  • The cost of joining a supplementary services program is the same for all policyholders of the same age and the same plan but may change over time. In contrast, private health insurance policies have rates that remain the same during the policyholder's life time.

Who is Eligible?

  • HMO policy holders.

How to Claim It?

  • The SHABAN (additional health services) policies vary between the different HMOs and every policy holder is entitled to receive a copy of his HMO's SHABAN policy.
  • Those interested in joining an additional health services plan may do so by signing an enrollment form in accordance with each health plan's specific policies.
  • Enrollment forms may be signed and submitted at any HMO branch.
  • HMOs must inform policyholders within 30 days of receiving an enrollment form that they have been added to the additional health services plan. The notification will include the additional health services plan's regulations, a copy of the enrollment form and signed payment instructions.
  • For all intents and purposes, the signing date is considered the date of enrollment.
  • The health plans may include a health declaration and waiver of medical confidentiality with the enrollment form on the condition that the signature on these forms is considered only to be a optional and not required.
  • To clarify details about the supplementary insurance program, see Contact Details for HMOs on the Ministry of Health's website.
Tip
  • Most of the HMOs have different levels of supplemental insurance which vary in the extent of the services they provide as well as their cost.
  • Before enrolling into a SHABAN plan it is recommended to evaluate your medical need, existing insurance coverage (such as Private Health Insurance), and financial capabilities in order to choose the appropriate insurance level.

Waiting Periods

  • The sole condition for receiving services as part of an additional health services plan is the qualification (waiting) period which is determined by the health plan and is different for every service.
  • During this period, policyholders are paying the HMO for the SHABAN policy but are not are not eligible to receive a specific service as long as they are in its waiting period.
  • The waiting periods also differ according to health plan and are detailed according to each medical service in the health plan's regulations. Some medical services are exempt from having a qualification period, and in no case may a waiting period be longer than 24 months.
  • There are medical services that are exempt from qualification periods.
Example
  • The SHABAN regulations in a specific HMO states that in this policy there is a waiting period of 9 months for pregnancy related services, such as tests.
  • A woman who enrolls in this SHABAN policy will pay for the policy from the time she registers but will not benefit from the services given to pregnant women until 9 months have passed.
  • Once 9 months from her enrollment date have passed she is entitled to receive the services.

Services not included in SHABAN policies

  • Additional health service policies 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 appointments.
  • Additional health service policies may not include life saving or life prolonging medications that are not included in the healthcare basket for their patients.
  • Additional health service policies may not offer financial compensation but they may offer the necessary treatments or reimbursements for policyholders on what they spent on treatments
  • Long-term care insurance policies for HMO policyholders are different then the additional health service (SHABAN) policies even though they are sometimes grouped together. It is commercial insurance with separate terms and conditions which must be clarified with the health plan.
  • Some of these services may be available by purchasing a Private Health Insurance policy.

Please note

  • Due to the fact that additional health services plans are required to cover their own costs, most of the services included in them require a co-payment from the policyholder.
  • The health plans are permitted to discontinue a policyholder's membership in an additional health services plan due to non-payment. In such a case, the health plan is required to give the policyholder at least two months advance warning, provided that the policyholder is given an opportunity for a hearing.
  • A person can not be a policyholder in one health plan and join the additional health services plan of a different one.
  • When switching health plans, the rights provided by an additional health services plan are retained in the new health plan at the same level but there may be an additional waiting period. The conditions of the transfer period should be clarified with the new HMO.


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