The health plans pay medical service providers, (such as hospitals and other facilities), to provide various healthcare services to their policyholders. Health plan policyholders are entitled to choose from among the service providers with which their health plan has arrangements.
- In cases where the health plan is connected to more than one service provider, the health plans have the right to establish specific rules related to choice between their service providers.
- Choice of service providers is subject to the health plans' arrangements for choice of service providers.
- The health plans are obligated to publicize the services available to their members, where the services may be received, and which service providers offer them on behalf of the health plan, as well as provide this information to any member who requests it.
- The health plans may limit their policyholders' choice of service providers subject to a number of principles, including the Principle of Treatment Continuity (which establishes that a patient does not have to switch medical facilities during an illness or medical condition that is being treated there) , the principle of following professional opinion(s) of relevant medical specialists, and the principle of providing relevant treatment opportunities within a reasonable distance of the policyholder's home. For more information see the "Limitations" section on Health Plan Choice of Service Provider Arrangements.
Who is Eligible?
- All health plan policyholders.
Choosing Health Plan Service Providers
Choosing a family doctor
- Policyholders may choose a family doctor without restrictions related to location.
- One may switch family doctors once per calendar quarter (the year is divided into four quarters: January-March, April-June, July-September, October-December) except in situations detailed below.
- Switching a family doctor is free of charge.
Choosing a medical specialist (specialty doctor) who works in the health plan or provides services on its behalf
- A health plan doctor is a doctor employed by a health plan (a health plan employee); a doctor working on behalf of a health plan is one who is not directly employed by a health plan, but who appears on a list of doctors providing services on behalf of a health plan.
- In some cases, going to a specialty doctor requires a referral. Specific cases requiring a referral vary by health plan and policyholders should clarify specifics with their primary care clinic or when making an appointment.
- Policyholders may choose a specialty doctor without restrictions related to location.
- Switching from one specialty doctor to another within the same field of specialty may be done once per calendar quarter, except in situations detailed below.
- The first referral per quarter to a specialty doctor incurs a fee.
Switching doctors during a quarter
- As a general rule, switching doctors may only be done once a quarter is over.
- Nevertheless, the Ministry of Health circular established that the health plans must publicize guidelines for situations in which patients may switch between doctors within a quarter. (For example: emergency medical treatment, absence of the doctor, situations when a patient is in need of medical care but is far from his/her hometown.) The health plans have to specify that switches in these types of situations are done without any fees.
- For more information see the health plans websites:
Choosing Service Providers Outside the Health Plan
- When a policyholder requires a medical service from a service provider outside the health plan (i.e. in an out-patient hospital facility not owned by the health plan), s/he will be required to provide the service provider with a payment voucher (Form 17).
- Form 17 constitutes the health plan's obligation to pay for the medical service(s) provided to the policyholder, such as hospitalization, admission to another type of medical facility, emergency room care, specialty doctor visit, specific type of examination, etc.
- If the health plan does not have an agreement with the service provider to which the policyholder has been referred, or if the service provider is not included in the arrangements for the policyholder's place of residence, Form 17 will not be issued. In such cases, the policyholder will be referred to a service provider with which the health plan has an agreement or which is included in relevant arrangements.
- Switching from one external service provider to another within the same field of specialty may be done after the calendar quarter is over.
- The first referral per quarter to an external service provider incurs a fee.
How to Claim It?
- If a service is provided directly by the health plan, the policyholder may make an appointment with the health plan directly, in accordance with its established procedures.
- If a service is provided by an external service provider, the policyholder will be required to provide a payment voucher (Form 17) to the service provider.
- Policyholders must contact their primary care clinic in order to obtain such a payment voucher. For more information, see: Obtaining a Payment Voucher (Form 17) from the Health Plan.
Health Plan Choice Arrangements
- Clalit Health Services choice arrangements
- Maccabi Health Services choice arrangements
- Meuhedet Health Services choice arrangements
- Leumit Health Plan's choice arrangements- there is no document summarizing the choice arrangements (as of March 2016) though general information may be found on the Leumit website.
- Information about the health plans' service provider choice arrangements may be obtained at health plan clinics and on the health plans' websites. Moreover, every policyholder has the right to receive a copy of their health plan's service provider choice arrangements at no cost.
- The question of the scope of policyholders' right to have a choice of service providers is complicated. Accordingly, a policyholder whose request for a payment voucher (Form 17) has been denied is entitled to do the following:
- The health plan was obliged to fund catheterization for a northern resident who chose to do it in a hospital in the center of the country
- For a comprehensive categorized listing of healthcare organizations offering assistance and support, click here.
Laws and Regulations
- The National Health Insurance Law - section 23.
- National Health Insurance Regulations (Arrangements for Selection of Service Providers), 5765-2005
- Assistant Director of Health Plan and Additional Healthcare Services Supervision Circular 5-2012 from 29.02.2012 - Linking primary and secondary physicians and fees required for a repeat visit to a physician in the same field during a quarter.
- Assistant Director of Health Plan and Additional Healthcare Services Supervision Circular 06/2011 from 09.06.2011 - Implementation of National Health Insurance Regulations (Arrangements for Selection of Service Providers), 5765-2005
- "The Impact of Payment Arrangements between the Health Plans and the Public Hospitals on the Options for Service Providers Offered by the Health Plans to their Members" on the Knesset Research and Information Center website
- Choosing Medical Service Providers on the Society for Patients Rights in Israel website
- Original information provided by the Mazor Clinical Center - Providing Legal Advice Regarding Patients Rights in Israel.
- English translation and maintenance by The Shira Pransky Project.