Children with medical or developmental disabilities are entitled to paramedical treatments through their HMO as part of The Healthcare Basket
Children who receive Paramedical Treatments as Part of Special Education may also be entitled to treatments that are part of the healthcare basket
The health plans are required to provide reimbursement for services that were paidd for privately in cases in where the waiting time for diagnostic and treatment services at the health plan was longer than the amount established by the Ministry of Health
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.
- Children are entitled to receive the treatment from the health plan in which they are enrolled, in accordance with a professional staff diagnosis.
- The types of paramedical treatments included in the healthcare basket are: Physical therapy, occupational therapy, speech therapy, psychological (see expanded explanation on the Ministry of Health website) and psychosocial therapy, and social work.
- The treatments are provided by a multidisciplinary professional staff, including: medical specialists in pediatric neurology or pediatrics with experience in the field of child development; psychologists; physical therapists; social workers; communications clinicians; and occupational therapists.
- The health funds have expanded, through supplementary insurance, the entitlements established by the law (detailed in this page). For further information about the arrangements in each fund, see the Kol HaBriut website.
Who is Eligible?
- Children up to age 9 are eligible for diagnosis and treatment by a multidisciplinary professional staff.
- Children diagnosed as having a somatic developmental disability are entitled to unlimited paramedical treatments until age 18 according to need.
- Children on the autism spectrum are entitled to paramedical treatments from the age of diagnosis until 18.
- Children up to age 6 are entitled to treatment for Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD).
- 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.
- Children up to age 4 who have a suspected developmental delay should be referred to a clinic recognized for child development and the diagnosis should be made in the clinic or by outside professionals that the child was referred to.
- 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.
- For more information regarding different children's populations, see the More Information section below.
Number of Treatments for Which Children are Eligible
- Children suffering from a Somatic Developmental Disorder are en.titled to treatments, without limitation, based on medical need
- Children that do not suffer a somatic developmental disorder and who are not on the autistic spectrum are entitled to the following number of treatments:
- For children ages 0 to 3: An unlimited number of treatments are provided according to need and based on the professional opinion of the health plan's medical specialist.
- For children ages 3 to 6: Up to 27 treatments per year per paramedical profession (with the total number of treatments not to exceed 54) are provided according to need and based on the professional opinion of the health plan's medical specialist.
- For children ages 6 to 9: Up to 9 treatments per year per paramedical profession (with the total number of treatments not to exceed 18) are provided according to need and based on the professional opinion of the health plan's medical specialist.
- Children diagnosed before age 6 are, in the first year of treatment, entitled to the number of treatments to which they were entitled on the day of the diagnosis. Meaning that in the first year the child is entitled to the number of treatments that a 3-6 year old receives.
- The number of treatments given to children who do not have a somatic developmental disability is based on individual need, overall goals, and the objectives set by the professional staff in accordance with that which has been established by a qualified medical or healthcare professional.
- Children requiring treatment in a field of child development due to other medical problems that are not developmental (such as recovery from a specific type of surgery or medical care after an accident) will receive services according to medical necessity, regardless of eligibility for the developmental services basket.
- For further information about additional treatments provided through the supplemental plans of the health funds, see Ministry of Health website.
How to Claim It?
- First, a diagnosis will be made for the children who according to the opinion of the treating staff, require it. For more information, see Developmental Medical Diagnosis for Children (Child Development Services).
- The child will be referred for treatment based on to the results of the diagnosis.
- 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 provide a referral for diagnosis).
- 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.
- Treatments must be provided within a reasonable amount of time and within a reasonable distance from the patient's residence.
- Each treatment session performed by a healthcare professional should be one hour long, and never less than 45 minutes. Treatments may also include instruction and guidance for parents.
- Stopping treatment - Treatment may be stopped before the full number of treatments established in the healthcare services basket are used used up, only if done with professional discretion.
Wait Times for Diagnosis and Treatment
- The maximum waiting time for diagnosing and starting treatment should not exceed 3 months from the time of referral.
- The wait between necessary appointments for treatment for the child should not be more than one month.
- In the event of delay in diagnosis and treatment beyond the 3 months from the referral, you can contact one of the child development units recognized 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).
- In these cases, 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 in the following cases:
- 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).
- New Immigrants (Olim) 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 Early Referral to Child Development Services for Premature Infants.
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.
- 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.
- For updated information on the rates of co-payment, see the Ministry of Health website and the Ministry of Health price list.
Exemptions from Co-Payments
- 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).
Premature Infants, Babies and Children at Risk for Developmental Disorders
- Special newborn care units must refer any newborn weighing less than 1500 grams for a developmental examination and assessment at a recognized facility for child development and rehabilitation, and the wait time may not exceed 2 weeks from the date of the request. For more information, see: Early Referral to Child Development Services for Premature Infants.
- Additionally, there is a list of cases for which the Ministry of Health recommends early referral of newborns, infants and children at risk for developmental disorders to child development centers. For more information, see: Medical Administration Circular 28/2000 from 06.08.2000 - early referral of children at risk for developmental disorders to child development centers.
Children in Rehabilitative Day Care
- According to the law, all children in rehabilitative daycare are entitled to receive paramedical treatments as part of the day care.
- These treatments are funded by the health plan to which the toddler belongs, and there is no eligibility for treatments beyond them.
Children Receiving Paramedical Treatments as Part of Special Education
- Receiving treatments from the health plan is not conditional on the school in which the child learns or the basket of services to which he/she is entitled.
- The treatments provided as part of a special education framework in a special education school or as part of an integrated framework in a regular school do not replace the treatments to which a child is entitled from the health plan.
- The treating professional at the health plan receives the child's personalized curriculum (TALA) established by the education system, which includes the type and number of paramedical treatments a child receives at school.
- When making professional decisions, the treating professional at the health plan may take into account the fact that a child receives treatments at school.
- Until the educational plan is put in place, the kupat cholim can not stop providing, or change the existing treatments the child is receiving.
- When making professional decisions, the treating professional at the health plan may take into account the fact that a child is not receiving necessary treatments at school.
Children with Somatic Disorders
- The basket of services for children under the age of 3 who have somatic disorders is generally provided in the framework of rehabilitative daycare in accordance with each child's specific needs.
- Children of this age who are not in rehabilitative daycare are entitled to receive the services through their health plan.
- From age 3 and up, the services are provided through the health plan to which they are members of.
- There is no annual or other form of restriction or limitation placed on the number of treatment sessions children are entitled to through this framework.
- The number of treatment sessions and their frequency should be in accordance with each child's specific needs, according to the decision of the health plan's treating professional (this is generally up to 3 treatments per week total in all fields of treatment).
- Parents of children with somatic disorders are exempt from co-payments for treatments provided through the health plan.
- Children with ADHD:
- Paramedical Treatments for Children with Autism
- Communication Therapy Services for Children with Hearing Impairment
- Children with speech disorder (stuttering)
- 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.
- The health funds are obligated to maintain continuity in the provision of services in the area of child development, even in the event of changes in the agreements or arrangements of the health fund with the service provider. For more information, see Maintaining Continuity of Care (Principle of Treatment Continuity).
- 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 Israeli Association for Child Development and Rehabilitation
- For a comprehensive categorized listing of healthcare organizations offering assistance and support for people with special needs and their families, click here.
- Click here for a general list of organizations that provide assistance for medical related issues
- The Ministry of Health
- Kol Habriut - The Ministry of Health's call center
- The Ombudsman under the National Health Insurance Law
- The Health Plans - (Kupot Cholim)
Laws and Regulations
- The National Health Insurance Law
- The Rehabilitative Day Care Law
- Circular of the Deputy Director General for Supervision of the Health Funds and Additional Health Services 09/2016 from 21.12.2016 - Services in the field of child development - updated.
- The Medical Administration circular 19/2013 from 08.07.2013 - the provision of services in the field of child development by the health funds.
- Circular of the Deputy Director General for Supervision of the Health Funds and Additional Health Services 1/10 from 21.1.2010 - Services in the field of child development.
- Circular of the Deputy Director General for Supervision of the Health Funds and Additional Health Services 4/10 from 22.3.2010 - provision of child development services for children in the special education system.
- Circular of the Deputy Director General for Supervision of the Health Funds and Additional Health Services 3/09 from 22.1.2009 - Services in the field of child development.
- 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, and updates found in the standing order circular 62/8(a) and the messages and information circular 66/4.
- Circular of the Director General of the Ministry of Health 28/96 from 14.11.1996 - recognition of clinics for diagnosis and treatment of child development issues.
- 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.