A specialized medical service is a medical service provided in a medical facility that offers a special level of medical knowledge and professional experience in treating a specific illness or medical condition.
- Policyholders with an illness or medical condition that requires medical care at a facility specializing in a specific medical service are entitled to receive that service at that facility regardless of their health plan's choice of service provider arrangements with the facility.
- If more than one such facility exists, the health plan may establish service provider choice arrangements, subject to reasonable availability and distance requirements.
- The Ministry of Health periodically updates the listing of illnesses/medical conditions requiring specialized medical services, as well as the listing of recognized facilities that provide specialized medical services. Click here to view the listings on the Ministry of Health website.
Who is Eligible?
- All health insurance policyholders.
Illnesses and Medical Conditions that have a Medical Center Specializing in them
- Ataxia-Telangiectasia (AT)
- Familial Dysautonomia (FD)
- Oculopharyngeal muscular dystrophy (OPMD) and swallowing difficulty (dysphagia)
- Ocular oncology
- Tropical diseases
- Rett syndrome
- Prader Willi syndrome (PWS)
- Polio (Poliomyelitis)
- Orthopedic oncology
- Children requiring brain or spine surgery
- Children with intestinal failure or requiring an intestinal transplant
- Children with chronic renal failure
- Machado–Joseph disease (MJD)
- Children with Osteogenesis imperfecta
- Children with Arthrogryposis
- Complex mental illness resulting from sexual abuse
- Complex mental illness resulting from various disorders, including intellectual developmental disability or from developmental psychiatric disorder (autistic spectrum)
- Mental illness for adults with a background of behavioral intellectual disabilities or developmental psychiatric disorder (autistic spectrum)
How to Claim It?
- In order that the policyholder's request be granted he/she must clarify in advance that the facility is recognized by the Ministry of Health as a specialized medical service provider - (see here for a list of specialized medical centers on the Ministry of Health website).
- Policyholders must request a payment voucher (Form 17) to the specialized medical service facility from their primary care clinic.
- If the health plan refuses to issue a payment voucher (Form 17) for a service provider offering a specific specialization, the policyholder may claim that s/he is entitled to receive the specialized medical service from the specific facility due to the fact that it is a specialized medical service.
Appealing a Health Plan Decision
- The policy may appeal the Health Fund's decision to withhold payment voucher (Form 17) for a specialized medical service provider, in one of the following ways:
- Patients being treated in a specialized medical center are entitled to continue their treatment in that facility even if their health fund does not have a specific arrangement with that facility. For more information see Maintaining Continuity of Care (Principle of Treatment Continuity).
- For a comprehensive categorized listing of healthcare organizations offering assistance and support, click here.
- The Ministry of Health
- The Ministry of Health's Health Voice Call Center: *5400
- The National Health Insurance Law Ombudsman
Laws and Regulations
- The National Health Insurance Law
- National Health Insurance Regulations (Arrangements for Selection of Service Providers), 5765-2005
- Ministry of Health Director Circular 21/07 from 22.11.2007 - Recognition of Specialized Medical Services
- Assistant Director of Health Plan and Additional Healthcare Services Supervision Circular 06/2011 from 09.06.2011 - Implementation of National Health Insurance Regulations (Arrangements for Selection of Service Providers), 5765-2005
- The Knesset Research and Information Center - "The Impact of Payment Arrangements between the Health Plans and the Public Hospitals on the Options for Service Providers Offered by the Health Plans to their Members"
- Original information provided by the Mazor Clinical Center - Providing Legal Advice Regarding Patients Rights in Israel.
- English translation and maintenance by The Shira Pransky Project.