Section 26(a)(1) of the National Health Insurance Law requires that in their articles, every health fund establishes how complaints are submitted, looked into, and corrected if any shortcomings are discovered. As part of this arrangement, every health fund has a department responsible for handling policyholders' complaints.
- Policyholders may complain about the following things:
- Service in a clinic.
- Inappropriate conduct by the treating staff.
- Failures and shortcomings during the provision of care.
- Complaints may also be submitted regarding denied approval of a treatment or service that the policyholder claims is included in the healthcare basket.
- The health fund ombudsman must clarify all complaints and recommend a manner in which the health fund should handle each complaint, as well as provide a written response to the complainant explaining the decision.
Who is Eligible?
- All health fund policyholders.
How to Claim It?
- A detailed written complaint must be submitted describing the details of the incident and providing identifying details of the staff involved in the incident or in the refusal of services. All relevant documentation must be attached to the complaint.
- The written complaint may be sent in the mail to the health fund's ombudsman. Some of the health funds also allow complaints to be submitted online.
- Contact information for complaints at the different health funds:
- Clalit - English listing of regional complaints departments whose responses may be appealed to the general administration ombudsman
- Maccabi - Complaints may be submitted to the ombudsman online
- Leumit - Complaints may be submitted online; Click here for the English customer service page
- Meuhedet - All contact information for the customer service department; Click here to submit a comment or complaint on the English website
- Complaints regarding improper treatment in a hospital should be submitted to the ombudsman/department responsible for complaints at the hospital.
- Issues regarding medications that are not included the healthcare basket should be brought before the health fund's exceptions committee.
- In cases where the health fund has refused to provide medical services, care or medications, or if the handling of such a request is delayed, a complaint may be submitted to the Ministry of Health's National Health Insurance Law Ombudsman.
- In cases concerning provision of improper care or inappropriate conduct by the treating staff, the departments responsible for handling complaints at the health fund/hospital should be contacted. In cases concerning denial of services/care, the Ministry of Health's National Health Insurance Law Ombudsman should be contacted.
- The services included in the healthcare basket should be interpreted with flexibility, taking into account the dynamic technological advances
- For a comprehensive categorized listing of healthcare organizations offering assistance and support, click here.
Laws and Regulations
- Original information in this entry is courtesy of the Mazor Clinical Center - Providing Legal Advice Regarding Patients Rights in Israel.
- Original translation by AACI's Shira Pransky Project.