Health plan policyholders are entitled to a quarterly, per family, payment ceiling on co-payments for various medical services as outlined below.
List of Services
- Secondary Doctors: Specialty doctors, including psychiatrists that are not primary care doctors (see below) as well as dietitians and podiatrists.
- Primary doctors are general doctors (that are not specialists) and specialty doctors in family medicine, internal medicine, gynecology and pediatrics. There are no co-payments for visits to primary care doctors.
- Out-patient Clinics: Clinics run in the framework of general hospitals (including mental health clinics in general hospitals).
- Imaging institutes: x-rays, ultrasounds, nuclear medicine, CT, echocardiograms, MRI.
- Diagnostic institutes: EEG, EMG, audiometry, ergometry
- Institute for gastroenterology and the institute for sleeping problems
- For a list of medical services see the Ministry of Health website.
Who is Eligible?
- Health plan policyholders.
- The following populations are entitled to a 50% discount of the payment ceiling
- Specific populations are entitled to Exemptions and Discounts for Health Plan Medical Services.
How to Claim It?
- The payment ceiling should go into effect automatically - When the family reaches the ceiling, the computerized system should no longer require payment for relevant services beyond the established limit.
- The health plans send quarterly reports to their policyholders which detail the payments for that quarter.
Laws and Regulations
- The National Health Insurance Law
- Deputy Ministry of Health Director for Health Plan and Additional Health Services Supervision Circular 1/2015 from 15.03.2015 - Update of payments for healthcare services and medications
- English translation and maintenance by The Shira Pransky Project.