According to The National Health Insurance Law, the state is responsible for providing paramedical treatments (child development services) to children who require them due to developmental or medical problems.
- The decision on the need for a developmental neurological medical diagnosis is a professional clinical decision unrelated to educational considerations (for information on psychological diagnosis for placement in special education, see details below).
- Psychological evaluation will be conducted for children who need it in the opinion of the attending staff. For more information about the psychological diagnosis, see the Ministry of Health website.
- A psycho-social assessment (INTAKE) will be given by a social worker to any child in need of the professional team's opinion.
- Diagnostic assessments in occupational therapy, physiotherapy and communication disorders will be given in accordance with the definitions of these fields it by the Ministry of Health.
Who is Eligible?
- Children up to age 18 are eligible for medical diagnosis, including medical diagnosis of ADHD.
- Children up to age 9 are eligible for medical diagnosis and para-medical treatment by a multidisciplinary professional staff.
- Children diagnosed as having a somatic developmental disability are entitled to unlimited Paramedical Treatments for Children (Child Development Services) until age 18 as necessary. Children on the autism spectrum are also entitled to paramedical treatments from the age of diagnosis until 18.
How to Claim It?
- Diagnostic and treatment services are only provided with health plan approval provided by a medical specialist in pediatric neurology or pediatrics with experience in the field of child development. The attending pediatric physician may provided a referral for diagnosis.
- Diagnostic services are provided at a child development center recognized by the Ministry of Health.
- The health plans must provide the healthcare services themselves or through service providers.
- Parents may choose an attending medical professional from among the service providers with whom their health plan has arrangements. If the health plan is connected to more than one service provider, the health plan will established the arrangements regarding the extent of personal choice.
- For more information about the Child Development Services see the Ministry of Health Website.
- Treatments must be provided within a reasonable amount of time and within a reasonable distance from the patient's residence.
- Children between the ages of 4 and 9 who do not suffer from a somatic developmental disorder or complex disability, may undergo diagnosis by a qualified medical professional, even if they are not in a facility or department which is recognized by the Ministry of Health.
- Children who do not suffer from a somatic developmental disability, but who do suffer from a complex developmental problem (children with a disorder/disability in more than one field of child development) will be diagnosed and treated at a facility or department recognized by the Ministry of Health.
- Depending on the outcome of the diagnosis, the child will be referred for treatment. For more information see Paramedical Treatments for Children (Child Development Services).
Wait Times for Diagnosis and Treatment
- The maximum waiting time for diagnosing and starting treatment should not exceed 3 months from the referral time.
- Wait time between appointments for a repeated service/treatment should not exceed a month.
- In a case where the wait exceeds the 3 months, one can request a referral to a private service provider that is recognized as a child development unit by the Ministry of Health (even if the unit is not connected by arrangement with the health fund and the health fund has not referred the child to that unit).
- The family is entitled to reimbursement of the payments for treatment or diagnosis, up to the Ministry of Health rates, provided that the number of treatments did not exceed the number of treatments to which they are entitled.
- The refund will be provided by the health fund.
- Priority for diagnosis and treatment in the first year following their referral is given to:
- Children with a developmental disorder requiring immediate therapeutic intervention. (For details, see Medical Administration Circular 28/2000 of 06.08.2000 regarding early referral to the Child Development Institute of children at risk of developmental disabilities).
- Immigrant children with a developmental disorder during their first year after aliyah.
- Premature infants born at a birth weight of less than 1500 grams and before week 32 of pregnancy (their wait time may not exceed one month from the date of the request). For further details, see Priority Referral of Premature Babies to the Child Development Institute.
Payment for Services
- Treatment by a multidisciplinary professional staff is provided in exchange for a co-payment from the policyholder.
- The co-payment for a child between ages 3 and 9 who does not suffer from a somatic developmental disorder for services in the field of child development is established in Section 6 of the second addendum to the National Health Insurance Law, and is updated every year according to the increase in the healthcare cost index. (29 NIS as of January 2016).
- Additional treatments provided through supplementary insurance also require a co-payment which varies by health plan. Supplementary insurance policyholders should check their arrangements according to their plan and level.
- Children up to age 3.
- Children diagnosed as having a Somatic Developmental Disorder (if they receive the treatments through the health plan).
- Health plan policyholders entitled to income support (an income supplement) (as of 01.08.2005).
Psychological Evaluation for Placement in Special Education
- Psychological diagnosis for placement in the special education system is conducted for children up to the age of 6 in the developmental services system.
- These assessments, which are not for developmental medical needs, are funded by the Ministry of Education according to Ministry of Health tariffs.
- Private psychological diagnoses for placement purposes only, and not for the purpose of developmental treatment, are not entitled to a refund from the health fund.
- Repeated psychological diagnosis will be conducted as necessary. In general, there is no need to diagnose more than twice during the six years of eligibility, in addition to the first diagnosis, and there is no need for a repeat diagnosis before one year has elapsed from the previous diagnosis.
- Those for whom a health plan has refused to provide paramedical services may contact the National Health Insurance Law Ombudsman at the Ministry of Health.
- Parents wishing to submit a claim against their health plan may do so through the regional labor courts in their area of residence.
- The fact that a child is in special education does not exempt health plans from providing paramedical treatments for that child
- The Health Plans - (Kupot Cholim)
- The National Insurance Institute
- The Ministry of Health and the "Kol Habriut" website
Laws and Regulations
- The National Health Insurance Law, Section 20 of the second addendum.
- The Rehabilitative Day Care Law
- Medical Administration Circular 19/2013 from 08.07.2013 - Health plan provision of child development services
- Deputy Director of Supervision of the Health Plans and Additional Health Services Circular 3/09 from 22.01.2009 regarding child development services.
- Deputy Director of Supervision of the Health Plans and Additional Health Services Circular 1/10 from 21.01.2010 regarding child development services.
- Deputy Director of Supervision of the Health Plans and Additional Health Services Circular 09/2016 from 21.12.2016 - child development services - updated.
- The Medical Administration circular 42/2005 from 06.11.2005 - Early referral of newborns born at a very low weight to developmental assessment.
- Circular of the Director General of the Ministry of Education תשס/8(א) from 02.04.2000 - Paramedical services for students in special education programs.
- Circular of the Ministry of Health Director 28/96 from 14.11.1996 - recognition of child development diagnostic and treatment centers.
- Clalit Health Services: Referral for child development follow-up
- Maccabi Healthcare Services: Paramedical services for child development
- Leumit Health Fund: Pediatric and child development services
- Meuhedet Health Services: Occupational therapy for children
- Ministry of Health: "Health Insurance and Medical Services for Special Populations" (in Hebrew)
- English translation and maintenance by The Shira Pransky Project.