Exemption from Emergency Room Costs (Right)

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

Introduction:

In certain cases, patients are entitled to full or partial exemption from paying emergency room costs
In cases where some form of documentation is required in order to receive the exemption, the patient must provide the required documentation immediately after being released from the hospital
For more information, see the Ministry of Health's English website

Medical care provided in an emergency room is subject to payment according to the Ministry of Health’s price list, based on the various services provided.

  1. An emergency room fee.
  2. Costs of treatment provided in the emergency room.
  • There are cases in which someone who comes to the emergency room is exempt from paying anything or will only be required to pay the emergency room fee..

Who is Eligible?

Entitled to a Full Exemption - both from the emergency room costs and from the costs of treatments provided

  • Those covered by national health insurance who come to the emergency room and one of the following applies are entitled to a full exemption from paying the emergency room fee and treatment costs:
  1. Those who come to the emergency room with a doctor's referral or a payment voucher (Form 17), and are not hospitalized.
  2. Those who are hospitalized even if they did not have a doctor's referral and/or a payment voucher (Form 17).
  3. Work injury victims with documentation of a work injury from the employer (Form 250).
  4. Road accident victims with a police report of the accident.
  5. Students injured at school or on a school trip who have proper documentation to that effect; for more information, see: Reimbursement for Schoolchildren Treated in the Emergency Room.
  6. Those covered by national health insurance who go the emergency room due to one of the following:
    • New break/fracture.
    • Acute shoulder or joint dislocation.
    • Injury requiring stitches or another form of surgical suture.
    • Inhalation of a foreign body into the respiratory tract.
    • Penetration of a foreign body to the eye.
    • Treatment for cancer related diseases.
    • Treatment for hemophilia.
    • Treatment for cystic fibrosis (CF)
    • Women in labor
  7. Those who are taken to the hospital by a Magen David Adom (MDA) ambulance from the street or other public place following a sudden occurrence.
  8. Infants under two months old taken to the hospital as the result of a sudden fever higher than 38.5 degrees celsius (101.3 degrees fahrenheit).
  9. Dialysis patients.
  10. Victims of domestic violence or sexual assault.

Entitled to a Partial Exemption - Must Pay Emergency Room Fee; Exempt from Paying Treatment Costs

  • Those covered by national health insurance who come to the emergency room and one of the following applies are entitled to an exemption from treatment costs but are still required to pay the emergency room fee:
  1. Those who come to the emergency room between 01:00am and 06:00am except if they are entitled to a full exemption as detailed above.
  2. Cases in which it became clear after the fact that coming to the emergency room was medically justified.

Additional Entitlements According to Health Plan

How to Claim It?

  • The exemption should be provided automatically.
  • In cases where some form of documentation showing approval is required in order to receive the exemption (such as a police report for road accident victims, documentation regarding a work accident, etc.), the patient must provide the required approval to the hospital. (The payment exemption is contingent on the provision of the approval; If required documentation is not provided, the patient will owe the hospital any relevant costs and fees.)
  • Those who are exempt from treatment costs but required to pay the emergency room fee must do so upon release from the hospital or as soon as possible thereafter.

Please Note

  • Several of the Health Funds have expanded the eligibility criteria,it is recommended to review the fund which you belong to,if the eligibility criteria were expanded.
  • Often the hospital will have a patient sign an "IOU" or other promissory note regarding payment of the emergency room fee and/or treatment costs.
  • If the patient is exempt from treatment costs but not the emergency room fee must pay the fee immediately after release from the hospital so that no legal actions will be taken. Such actions may include beginning writ of execution or claims court proceedings, which are liable to entail additional costs.
  • Those exempt from treatment costs and the emergency room fee but for whom this exemption is conditional on presenting relevant documentation (such as a police report for road accident victims, documentation regarding a work accident, etc.) must submit the relevant documentation immediately after release from the hospital so that no legal actions such as those explained above will be taken. Not submitting necessary documentation is considered to be the same as non-payment.
  • According to Ministry of Health Director Circular 7/11, financial obligation forms (such as promissory notes or a patient's obligation to pay for medical services) must be available in four languages: Hebrew, Arabic, Russian and English. For more information, see: Translation and Interpreting Services for Patients in the Healthcare System.
  • Urgent evacuation of a policyholder to an emergency room in a general hospital is not limited to specific hospitals, meaning that it is not subject to any service provider agreements or arrangements between the hospital and the health plans.
  • The health plans are not responsible for covering lawyer fees or any costs associated with a writ of execution for policyholders who do not handle arrangement of payment for emergency room fees or costs in a timely manner.
  • Health insurance policyholders who decided on their own to go to the emergency room must bring their emergency room illness summary to the health plan secretariat, along with a receipt indicating payment (if applicable). If the emergency room visit is found to be justified, the health plan will send a payment voucher to the hospital and the policyholder will only be required to pay the emergency room fee in accordance with the law. It is recommended that the policyholder verify with the hospital that the payment voucher has been received and that there are no other outstanding costs or fees.
  • If a policyholder goes to the emergency room without a payment voucher and it is not an emergency, the health plan will not issue a retroactive payment voucher and the policyholder may be required to cover all hospital costs out of pocket in accordance with Ministry of Health Director Circular 33/2006.

Aid Organizations

Government Agencies

Laws and Regulations

Additional Publications

Credits