Cheryl Burnat (talk | contribs)
Cheryl Burnat (talk | contribs)
 
(5 intermediate revisions by the same user not shown)
Line 2: Line 2:
 
{{תקציר |תוכן=
 
{{תקציר |תוכן=
 
{{דגשים  
 
{{דגשים  
| מידע = As of 08.01.2016 all children up to age 15 are entitled to dental care through their health plan as part of the [[The Healthcare Basket|healthcare services basket]].  
+
| מידע = As of January 2019, all children up to age 18 are entitled to dental care through their health plan as part of the [[The Healthcare Basket|healthcare services basket]].  
| מידע2 = Youth aged 14-15 are additionally eligible for yearly plaque removal (twice a year, free of charge).  
+
| מידע2 = Additionally, youth between age 17-18 are eligible for yearly plaque removal (twice a year, free of charge).  
 
| איסור = <!-- דוגמה: אסור לעשות -->
 
| איסור = <!-- דוגמה: אסור לעשות -->
 
| חשוב  = <!-- דוגמה: חשוב לדעת -->
 
| חשוב  = <!-- דוגמה: חשוב לדעת -->
| פיצוי = Preventative treatments are given free of charge and preservation treatments are given with a supplemental cost of NIS 23.
+
| פיצוי = Preventative treatments are given free of charge and preservation treatments are given with a supplemental cost of NIS 24.
 
| שאלה  = <!-- דוגמה: שאלה -->
 
| שאלה  = <!-- דוגמה: שאלה -->
| ממשל  = For more information see the [https://www.health.gov.il/Subjects/Dental_health/ChildrenDentalTreatmentsReform/Pages/default.aspx Ministry of Health Website].
+
| ממשל  = For additional information see [https://www.health.gov.il/English/Topics/Dental_Health/ChildrenDentalTreatmentsReform/Pages/default.aspx dental care for children and adolescents] on the Ministry of Health Website and [http://call.gov.il/infocenter/index?page=content&id=EL361 dental care for children] on the Ministry of Health's Kol HaBriut website
 
}}
 
}}
 
}}
 
}}
Line 18: Line 18:
 
{{ראו גם  
 
{{ראו גם  
 
| [[Dental Care]]
 
| [[Dental Care]]
| [[:he:טיפולי שיניים לתלמידי חטיבות הביניים|Dental Care for Middle School Children]]
+
| [[:he:טיפולי שיניים לתלמידי בית ספר שנפגעו בתאונה|Dental Care for Children in School Injured in an Accident]]
| [[:he:טיפולי שיניים לתלמידי בית ספר|Dental Care for Schoolchildren]]
 
 
| [[Child and Adolescent Health]]
 
| [[Child and Adolescent Health]]
 
}}
 
}}
 
{{עצם העניין/סיום}}
 
{{עצם העניין/סיום}}
 
+
As of 01.01.2019 all children up to age 18 are entitled to dental care through their HMO as part of the [[The Healthcare Basket|healthcare services basket]].  
As of 08.01.2016 all children up to age 15 are entitled to dental care through their health plan as part of the [[The Healthcare Basket|healthcare services basket]].  
+
(In 2018 only children up to age 16 were eligible.)
(Until 2015 eligibility was only until age 12 and as of 01.01.2016 it was extended to age 14.)
+
<!--*The age of eligibility will continue to rise gradually until it reaches age 18 such that:
 
 
*The age of eligibility will continue to rise gradually until it reaches age 18 such that:
 
 
**In January 2018 eligibility will be extended to age 16.
 
**In January 2018 eligibility will be extended to age 16.
 
**In January 2019 eligibility will be extended to age 17.
 
**In January 2019 eligibility will be extended to age 17.
**In January 2020 eligibility will be extended to age 18.
+
**In January 2020 eligibility will be extended to age 18.-->
 
 
 
== Who is Eligible? == <!--מי זכאי-->
 
== Who is Eligible? == <!--מי זכאי-->
* Those who are covered by National [[Health Insurance]] who are younger than 15 years old when treatment is requested (as of 2017).
+
* Those who are covered by National [[Health Insurance]] who are younger than 18 years old on the day they are referred for treatment.
  
 
== How to Claim It? == <!--תהליך מימוש הזכות-->
 
== How to Claim It? == <!--תהליך מימוש הזכות-->
Line 39: Line 35:
 
*The services are provided in health plan clinics or clinics that have an arrangement with the health plan that meet the Dental Care Division's professional standards.
 
*The services are provided in health plan clinics or clinics that have an arrangement with the health plan that meet the Dental Care Division's professional standards.
 
*Listings of clinics that provide the services according to health plan:
 
*Listings of clinics that provide the services according to health plan:
:*[http://www.clalit.co.il/he/clalit_smile/Pages/default.aspx Clalit]  
+
**[http://www.clalit.co.il/he/clalit_smile/Pages/default.aspx Clalit]  
:*[http://serguide.maccabi4u.co.il/heb/DentistOffices/ Maccabi]
+
**[http://serguide.maccabi4u.co.il/heb/DentistOffices/ Maccabi]
:*[http://www.leumit.co.il/heb/servicesearch/dentics/ Leumit]
+
**[http://www.leumit.co.il/heb/servicesearch/dentics/ Leumit]
:*[https://www.meuhedet.co.il/meuhedet/views/engine?rnd=0.5899724602447313&templateName=menu.txt&idorItemId=topMenu&realSubject=995473824372&mainView=article&mainId=1277206659875&menuBarView=menu&menuBarstartmenuParam=subSubject&menuBarSubjectParam=9954738243 Meuhedet]
+
**[https://www.meuhedet.co.il/meuhedet/views/engine?rnd=0.5899724602447313&templateName=menu.txt&idorItemId=topMenu&realSubject=995473824372&mainView=article&mainId=1277206659875&menuBarView=menu&menuBarstartmenuParam=subSubject&menuBarSubjectParam=9954738243 Meuhedet]
 +
*'''Please note:''' Treatments performed privately and not through the HMO will not be reimbursed.
  
 
== Treatments Included in the Basket ==
 
== Treatments Included in the Basket ==
 
* '''Treatments given free of charge:'''
 
* '''Treatments given free of charge:'''
:*Annual check-up by a dentist (a second time in one year is permitted if justified by a medical opinion)
+
**Annual check-up by a dentist (a second time in one year is permitted if justified by a medical opinion)
:*Routine check-ups and follow-up as part of medical care
+
**Routine check-ups and follow-up as part of medical care
:*Guidance and preparation of a treatment plan.
+
**Guidance and preparation of a treatment plan.
:*X-rays as part of the treatment process
+
**X-rays as part of the treatment process
:*A pair of bite wing x-rays during the routine exam.
+
**A pair of bite wing x-rays during the routine exam.
:*Instruction in oral hygiene (up to twice a year).
+
**Instruction in oral hygiene (up to twice a year).
:*Plaque removal once a year.  As of 08.01.2017, youth aged 14-15 are eligible for 2 treatments a year at no cost.
+
**Plaque removal once a year.  Youth between age 17 and 18 are entitled to 2 treatments a year at no cost.
:*Topical prevention treatment
+
**Topical prevention treatment
:*Filling of cavities
+
**Filling of holes and cracks (preventative treatment)
*'''Treatments that require a co-payment''' (23 NIS per treatment):
+
*'''Treatments that require a co-payment''' (24 NIS per treatment):
:*First aid
+
**First aid
:*Reconstruction with amalgam and other materials
+
**Reconstruction with amalgam and other materials ("fillings")
:*Treatment of the pulp of the tooth in baby and permanent teeth (including root canal)
+
**Treatment of the pulp of the tooth in baby and permanent teeth (including root canal)
:*Crowns (immediate and more permanent)
+
**Crowns (immediate and more permanent)
:*Preliminary crowns in posterior and anterior teeth
+
**Preliminary crowns in posterior and anterior teeth
:*Extractions (including surgical extractions)
+
**Extractions (including surgical extractions)
:*Preservation of the space after extraction
+
**Preservation of the space after extraction
:*Use of sedation/nitrous oxide
+
**Use of sedation/nitrous oxide
 
:*Dental care under anesthesia for children up to age 5 with early childhood tooth decays.  
 
:*Dental care under anesthesia for children up to age 5 with early childhood tooth decays.  
 
*When one procedure continues over the course of a number of visits, the co-payment is one time for the procedure and covers all of the visits connected to that procedure.
 
*When one procedure continues over the course of a number of visits, the co-payment is one time for the procedure and covers all of the visits connected to that procedure.
{{דוגמה | A root canal requiring 2 visits requires a total co-payment of 23 NIS for the procedure}}
+
{{דוגמה | A root canal requiring 2 visits requires a total co-payment of 24 NIS for the procedure}}
  
 
=== Treatments Not Included in the Basket ===
 
=== Treatments Not Included in the Basket ===
*There are certain treatments, including orthodontic procedures that are not included in the basket and do not appear on the listing (published by the Ministry of Health) of included dental services.
+
*There are certain treatments, including straightening of teeth (orthodontic procedures) that are not included in the basket and do not appear on the listing (published by the Ministry of Health) of included dental services.
 
 
  
 
==Standards According to Ministry of Health Directives==
 
==Standards According to Ministry of Health Directives==
Line 78: Line 74:
 
*'''The wait period to begin treatment''' according to a treatment plan prepared by a dentist on behalf of the service provider may not exceed 14 days from the date the plan was prepared.
 
*'''The wait period to begin treatment''' according to a treatment plan prepared by a dentist on behalf of the service provider may not exceed 14 days from the date the plan was prepared.
 
*The wait period may exceed those indicated above with parental approval.
 
*The wait period may exceed those indicated above with parental approval.
*All children who have requested dental treatment included in the basket before they turn 15, are entitled to have the health plan prepare a treatment plan to be performed completely even if the procedures included in it continue after the child turns 15.
+
*All children who have requested dental treatment included in the basket before they turn 18, are entitled to have the health plan prepare a treatment plan to be performed completely even if the procedures included in it continue after the child turns 18.
  
 
==Complaints==
 
==Complaints==
* Complaints regarding treatment or non-provision of services may be submitted to the [[Submitting a Complaint to the Health Fund|health plans]] or the [[Submitting a Complaint to the National Health Insurance Law Ombudsman|National Health Insurance Law Ombudsman]].
+
* Complaints regarding treatment or non-provision of services may be submitted to the [[Submitting a Complaint to the Health Fund|HMO Ombudsman]] or the [[Submitting a Complaint to the National Health Insurance Law Ombudsman|National Health Insurance Law Ombudsman]].
 
<!--== Please Note ==--> <!--חשוב לדעת--><!--== Court Rulings ==--> <!--פסקי דין-->
 
<!--== Please Note ==--> <!--חשוב לדעת--><!--== Court Rulings ==--> <!--פסקי דין-->
  
Line 96: Line 92:
 
*[https://www.health.gov.il/hozer/DT08_02_29672312.pdf Guidelines for the Provision of Dental Care to Students no. 8.2 from 07.07.2016]
 
*[https://www.health.gov.il/hozer/DT08_02_29672312.pdf Guidelines for the Provision of Dental Care to Students no. 8.2 from 07.07.2016]
 
*[https://www.health.gov.il/hozer/mk02_2017.pdf Ministry of Health Director Circular no. 2/2017 from 24.01.2017] - Broadening the Dental Care offered in the healthcare basket.
 
*[https://www.health.gov.il/hozer/mk02_2017.pdf Ministry of Health Director Circular no. 2/2017 from 24.01.2017] - Broadening the Dental Care offered in the healthcare basket.
 +
*[https://www.health.gov.il/hozer/mk03_2018.pdf Ministry of Health Director Circular no. 3/2018 from 10.01.2018] - Broadening the Dental Care offered in the healthcare basket for 2018.
  
 
== Additional Publications == <!--הרחבות ופרסומים-->
 
== Additional Publications == <!--הרחבות ופרסומים-->

Latest revision as of 19:34, 2 December 2019

Introduction:

As of January 2019, all children up to age 18 are entitled to dental care through their health plan as part of the healthcare services basket.
Additionally, youth between age 17-18 are eligible for yearly plaque removal (twice a year, free of charge).
Preventative treatments are given free of charge and preservation treatments are given with a supplemental cost of NIS 24.
For additional information see dental care for children and adolescents on the Ministry of Health Website and dental care for children on the Ministry of Health's Kol HaBriut website


As of 01.01.2019 all children up to age 18 are entitled to dental care through their HMO as part of the healthcare services basket. (In 2018 only children up to age 16 were eligible.)

Who is Eligible?

  • Those who are covered by National Health Insurance who are younger than 18 years old on the day they are referred for treatment.

How to Claim It?

  • All children are automatically covered by the health plan where they are registered and where they receive the healthcare basket services.
  • The services are provided in health plan clinics or clinics that have an arrangement with the health plan that meet the Dental Care Division's professional standards.
  • Listings of clinics that provide the services according to health plan:
  • Please note: Treatments performed privately and not through the HMO will not be reimbursed.

Treatments Included in the Basket

  • Treatments given free of charge:
    • Annual check-up by a dentist (a second time in one year is permitted if justified by a medical opinion)
    • Routine check-ups and follow-up as part of medical care
    • Guidance and preparation of a treatment plan.
    • X-rays as part of the treatment process
    • A pair of bite wing x-rays during the routine exam.
    • Instruction in oral hygiene (up to twice a year).
    • Plaque removal once a year. Youth between age 17 and 18 are entitled to 2 treatments a year at no cost.
    • Topical prevention treatment
    • Filling of holes and cracks (preventative treatment)
  • Treatments that require a co-payment (24 NIS per treatment):
    • First aid
    • Reconstruction with amalgam and other materials ("fillings")
    • Treatment of the pulp of the tooth in baby and permanent teeth (including root canal)
    • Crowns (immediate and more permanent)
    • Preliminary crowns in posterior and anterior teeth
    • Extractions (including surgical extractions)
    • Preservation of the space after extraction
    • Use of sedation/nitrous oxide
  • Dental care under anesthesia for children up to age 5 with early childhood tooth decays.
  • When one procedure continues over the course of a number of visits, the co-payment is one time for the procedure and covers all of the visits connected to that procedure.
Example
A root canal requiring 2 visits requires a total co-payment of 24 NIS for the procedure

Treatments Not Included in the Basket

  • There are certain treatments, including straightening of teeth (orthodontic procedures) that are not included in the basket and do not appear on the listing (published by the Ministry of Health) of included dental services.

Standards According to Ministry of Health Directives

  • The health plans are required to provide the dental services according to the guidelines given by law. The treatment must be done with medical discretion, and be of reasonable quality, performed within a reasonable amount of time and be reasonably located to the patient's place of residence.
  • First aid - The health plans are responsible for providing a center for dental first aid available to their policyholders, which is open past normal clinic hours, and which will provide urgent procedures to policyholders and be within a reasonable distance of their place of residence.
  • The wait period for a periodic examination and preparation of a treatment plan may not exceed 30 treatment days from the date of the request.
  • The wait period to begin treatment according to a treatment plan prepared by a dentist on behalf of the service provider may not exceed 14 days from the date the plan was prepared.
  • The wait period may exceed those indicated above with parental approval.
  • All children who have requested dental treatment included in the basket before they turn 18, are entitled to have the health plan prepare a treatment plan to be performed completely even if the procedures included in it continue after the child turns 18.

Complaints

Aid Organizations

  • For a comprehensive categorized listing of healthcare organizations offering assistance and support, click here.

Government Agencies

Laws and Regulations

Additional Publications

Credits