As of 01.01.2019 all children up to age 18 are entitled to dental care through their HMO as part of the healthcare services basket. (In 2018 only children up to age 16 were eligible.)
Who is Eligible?
- Those who are covered by National Health Insurance who are younger than 18 years old on the day they are referred for treatment.
How to Claim It?
- All children are automatically covered by the health plan where they are registered and where they receive the healthcare basket services.
- The services are provided in health plan clinics or clinics that have an arrangement with the health plan that meet the Dental Care Division's professional standards.
- Listings of clinics that provide the services according to health plan:
- Please note: Treatments performed privately and not through the HMO will not be reimbursed.
Treatments Included in the Basket
- Treatments given free of charge:
- Annual check-up by a dentist (a second time in one year is permitted if justified by a medical opinion)
- Routine check-ups and follow-up as part of medical care
- Guidance and preparation of a treatment plan.
- X-rays as part of the treatment process
- A pair of bite wing x-rays during the routine exam.
- Instruction in oral hygiene (up to twice a year).
- Plaque removal once a year. Youth between age 17 and 18 are entitled to 2 treatments a year at no cost.
- Topical prevention treatment
- Filling of holes and cracks (preventative treatment)
- Treatments that require a co-payment (24 NIS per treatment):
- First aid
- Reconstruction with amalgam and other materials ("fillings")
- Treatment of the pulp of the tooth in baby and permanent teeth (including root canal)
- Crowns (immediate and more permanent)
- Preliminary crowns in posterior and anterior teeth
- Extractions (including surgical extractions)
- Preservation of the space after extraction
- Use of sedation/nitrous oxide
- Dental care under anesthesia for children up to age 5 with early childhood tooth decays.
- When one procedure continues over the course of a number of visits, the co-payment is one time for the procedure and covers all of the visits connected to that procedure.
Treatments Not Included in the Basket
- There are certain treatments, including straightening of teeth (orthodontic procedures) that are not included in the basket and do not appear on the listing (published by the Ministry of Health) of included dental services.
Standards According to Ministry of Health Directives
- The health plans are required to provide the dental services according to the guidelines given by law. The treatment must be done with medical discretion, and be of reasonable quality, performed within a reasonable amount of time and be reasonably located to the patient's place of residence.
- First aid - The health plans are responsible for providing a center for dental first aid available to their policyholders, which is open past normal clinic hours, and which will provide urgent procedures to policyholders and be within a reasonable distance of their place of residence.
- The wait period for a periodic examination and preparation of a treatment plan may not exceed 30 treatment days from the date of the request.
- The wait period to begin treatment according to a treatment plan prepared by a dentist on behalf of the service provider may not exceed 14 days from the date the plan was prepared.
- The wait period may exceed those indicated above with parental approval.
- All children who have requested dental treatment included in the basket before they turn 18, are entitled to have the health plan prepare a treatment plan to be performed completely even if the procedures included in it continue after the child turns 18.
- Complaints regarding treatment or non-provision of services may be submitted to the HMO Ombudsman or the National Health Insurance Law Ombudsman.
- For a comprehensive categorized listing of healthcare organizations offering assistance and support, click here.
Laws and Regulations
- The National Health Insurance Law
- Medical Administration Circular 20/2010 from 17.06.10 - Dental services for children in the The National Health Insurance Law
- Deputy Director of Supervision of Health Plans and Additional Health Services Circular 12/10 from 12.9.2010 regarding dental care for children in the The National Health Insurance Law - Guidelines for establishing standards of service
- Guidelines for the Provision of Dental Care to Students no. 8.2 from 07.07.2016
- Ministry of Health Director Circular no. 2/2017 from 24.01.2017 - Broadening the Dental Care offered in the healthcare basket.
- Ministry of Health Director Circular no. 3/2018 from 10.01.2018 - Broadening the Dental Care offered in the healthcare basket for 2018.
- The Ministry of Health's Children's Dental Care Reform Page
- Press release regarding the expansion of dental services for children up to age 15 on the Ministry of Health website.
- Original information provided by the IMA.
- English translation and maintenance by The Shira Pransky Project.