Medications in the Healthcare Basket (Right)

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

Introduction:

The health plans are required by law to provide the medications included in the healthcare basket to policyholders, subject to relevant medical indications and professional medical opinions
Chronically Ill Patients, are exempt from paying a co-payment for medications included in the Healthcare basket, on amounts exceeding the payment ceiling
If a medication is not included in the health basket, it may be obtained in other ways. For more information see the Guide for obtaining medications not included in the Healthcare basket
The list of medications included in the health care basket is a closed list, detailed in the ordinance and is updated each year

The list of medications included in the basket according to The National Health Insurance Law is detailed in the National Health Insurance Ordinance (Medications in the Healthcare Services Basket).

  • The health plans are required by law to provide the medications included in the healthcare basket to policyholders, subject to relevant medical indications and professional medical opinions.
  • By law, the health plans are permitted to collect a co-payment for medications included in the healthcare basket.
  • The co-payments required for specific services and medications are not the same in all health plans, so one health plan may take a larger or smaller co-payment for an identical service or medication than a different health plan.
  • Chronically Ill Patients, are exempt from paying a co-payment for medications included in the Healthcare basket, on amounts exceeding the payment ceiling.
  • Policyholders may find out if a specific medication is included in the healthcare basket by reviewing the law or information published by the Ministry of Health.
  • The list of medications included in the basket is closed and is updated every year. Any public or private entity (i.e. patients, patient organizations, doctors, companies, etc.) may submit a request to add new medications to the healthcare services basket.

Who is Eligible?

  • Anyone insured according to The National Health Insurance Law.

How to Claim It?

  • Obtaining medications included in the healthcare basket is subject to relevant medical indications and a professional medical opinion of the attending physician.

Medications Included in the Healthcare Basket

Administrative Approval for Treatment with a Medication Included in the Healthcare Basket

  • The health plans sometimes make provision of treatment with specific medications contingent on prior administrative approval (approval that is not from the attending physician).
  • Due to the fact that this approval process is liable to delay provision of essential treatment, the Ministry of Health has determined that health plans requesting to make provision of medications conditional may do so according to the following conditions:
  • The approval is limited to a reduced number of medications for non-urgent treatments.
  • A listing of the medications is published on the health plan's website.
  • The conditional administrative approval is only for the the drug treatment's initial prescription.
  • A response will be provided to the patient no more than four days from the date the request was submitted by the attending physician. If a response is not received in this period of time, it will be considered to be approval of the request.
  • The attending physician is responsible for making sure approval is obtained.
  • Any refusal of administrative approval must be explained and sent to the patient in writing.

Supply of Medications Not in the Healthcare Basket

  • The health plans are not required to supply medications not included in the healthcare services basket to policyholders, but they may choose to do so.
  • Accordingly, it is possible that one health plan may supply a certain medication even if it is not included in basket, while another health plan may choose not to.
  • In such a case, a policyholder desiring a specific medication not included in the basket but offered by one health plan and not another may switch to a health plan offering the desired medication.
  • If a medication is not included in the health care basket, it maybe be obtained by other means. For more information see the guide to obtaining medications not included in the healthcare basket.

Submitting a Complaint regarding Non-Provision of a Medication

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

Additional Publications

Credits