Introduction:

In certain cases, health plan policyholders are entitled to receive medical treatments included in the healthcare basket abroad
If a health plan has rejected a request for funding medical treatment abroad, the applicant is entitled to appeal the decision to a Ministry of Health appeals committee
Services costing up to $250,000 are provided without a co-payment from the policyholder
Even if the services cost more than $250,000, it is possible to be granted a co-payment exemption
For more information, see the "Eligibility to Receive Health Services Abroad" on the Ministry of Health's English website

According to Section 11 of The National Health Insurance Law, in specific cases, certain healthcare services included in the healthcare basket may be provided abroad.

  • Health plan policyholders requiring treatment which meets the criteria detailed below are entitled to funding of treatment abroad up to the shekel equivalent of $250,000.
  • Even if the services cost more than $250,000, it is possible to submit a co-payment exemption request.

Who is Eligible?

  • Health plan policyholders who meet all of the following criteria:
  1. The medical service/treatment is of one of the types of treatment that is eligible for funding (see below).
  2. One of the following is applicable:
  • It is not possible to obtain the required health service or an alternative in Israel, and if the service is not provided, the patient's life will be put at risk.
  • There are exceptional medical circumstances - It is not possible to obtain the required health service or an alternative in Israel, and there is concern that without the treatment, damage to an organ or a sense will be caused, even if it is not life-threatening situation.

Types of Eligible Medical Services

  • The funding is provided for medical services meeting both of the following conditions:
  1. The services are included in the healthcare basket.
  2. The services are in one of the following medical fields:
  • Cerebral and nervous system
  • Cardiovascular diseases
  • Tumors
  • Organ transplants
  • Congenital defects

How to Claim It?

  • Applicants must submit a request to receive medical treatment abroad to the person responsible for such requests at their health plan. Click here for information for all health plans on the Ministry of Health's English website.
  • All relevant documents must be included with each request in accordance with each health plan's specific requirements; these may change depending on the circumstances of each request.
  • For details on the conditions of the different health funds for reimbursements if treatments abroad see the Kol HaBriut website.

Co-Payment Exemption for Medical Services Over $250,000

  • If the cost of the requested health service exceeds $250,000, it is possible to receive exemption from paying a co-payment.
  • The Ministry of Health director (or someone authorized to make the decision in his/her place) may exempt policyholders from the requirement to contribute a co-payment if after consulting with an appellate committee for overseas medical services, it has been determined that both of the following conditions apply:
  1. The patient is in immediate mortal danger if the medical service is not provided.
  2. There is a good chance that the results of the medical treatment will be successful.
  • A formal request for co-payment exemption must be submitted in order to receive the exemption.
  • After receiving the committee recommendation concerning the validity of the two cumulative preconditions, the Ministry of Health director will decide whether to accept or reject the committee's recommendation.
  • Decisions regarding co-payment exemption must be explained in writing.
  • The health plans are bound to decisions regarding co-payment exemptions.

Submitting a Co-Payment Exemption Request

  • The request must be mailed to the Ministry of Health's Medical Administration secretariat.
  • Five copies of the request must be sent.
  • Mailing Address: Medical Administration, Ministry of Health, P.O.Box 1176, Jerusalem 9101002
  • For more information, an appellate committee for overseas medical services coordinator may be contacted at the following phone numbers:

02-5681279 or 02-5681280/1/2/3/4/5

Appeals

  • If a health plan has rejected a request for funding medical treatment abroad, the applicant is entitled to appeal the decision to the Ministry of Health's appeals committee responsible for issues regarding medical services abroad (appellate committee for overseas medical services).
  • The appeals committee only decides regarding cases in which the health plan refused to provide a service included in the basic healthcare basket. The committee does not make decisions regarding health plan decisions made in the framework of the additional health services plans (SHABANs).
  • An Appeals Committee Application Form must first be filled out and faxed (just the form itself) to an appellate committee for overseas medical services coordinator: 02-5655954.
  • At the same time, 6 copies of the appeal letter including the following information must be submitted by mail:
    • Description of the condition from which the patient suffers
    • Description of the treatment abroad being requested
    • Name of the medical facility providing the requested treatment
    • Explanation of why the patient's situation justifies approval of receiving the treatment abroad according to the relevant regulations
  • The following documents must be attached to the written appeal:
    • The health plan's written response refusing funding of the medical treatment abroad
    • Relevant medical materials (including medical opinions, imaging results including six DVDs containing echocardiogram, CT, MRI, etc.)
    • Medical recommendation given to the patient regarding the necessity of performing the treatment abroad
    • Medical confidentiality waiver (for more information, see: Waiving Medical Confidentiality)
  • Mailing Address for appeals: Medical Administration, Ministry of Health, PO Box 1176, Jerusalem 9101002
  • For more information, contact an appellate committee for overseas medical services by telephone: 02-5681280/1/2/3/4/5, 02-5080725, 02-5080729 or fax: 02-5655954
  • For more information, see: File an Appeal after HMO Rejection from the Ministry of Health's English website.
  • An appeals committee coordinator in the Medical Administration will send the appeals letter to the health plan for a response.
  • The health plan response will be sent for the policyholder's consideration and response through an appeals committee coordinator.
  • After receiving the responses from the health plan and the policyholders, the material in the file will be sent to the Ministry of Health director (or someone authorized to act on his/her behalf) in order to examine whether or not the conditions required to provide medical care abroad have been met.
  • If it has been determined that the conditions have been met, the director will submit the appeal to an appellate committee for overseas medical services (composed of three doctors who are active in the medical field which is relevant to the request).

Appellate Committee for Overseas Medical Services

  • The committee meets without any other parties being present and makes decisions based on the written material that has been submitted.
  • No doctor who has treated the patient may participate in the discussions, and neither may any doctors who have given a second medical opinion to the patient or the health plan regarding the requested treatment.
  • The committee discusses the patient's eligibility to receive funding for required medical services abroad.
  • The committee is authorized to require the health plan to fund healthcare services abroad up to $250,000.
  • The committee's decision of whether to accept or reject the appeal must be explained in writing.

Please Note

Court Rulings

Aid Organizations

  • For a comprehensive categorized listing of healthcare organizations offering assistance and support, click here.

Government Agencies

Laws and Regulations

Credits