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{{זכות/תחילת טור ימני}}
 
{{זכות/תחילת טור ימני}}
 
{{דגשים  
 
{{דגשים  
| מידע = The health plans are required by law to provide the medications included in the healthcare basket to policyholders, subject to relevant [[:he:התוויה רפואית|medical indications]] and a professional medical opinion
+
| מידע = The health plans are required by law to provide the medications included in the [[The Healthcare Basket|healthcare basket]] to policyholders, subject to relevant [[:he:התוויה רפואית|medical indications]] and professional medical opinions
 
| מידע2 = The list of medications included in the basket is closed, detailed in the [[:he:צו ביטוח בריאות ממלכתי (תרופות בסל שירותי הבריאות)|National Health Insurance Order]], and updated every year  
 
| מידע2 = The list of medications included in the basket is closed, detailed in the [[:he:צו ביטוח בריאות ממלכתי (תרופות בסל שירותי הבריאות)|National Health Insurance Order]], and updated every year  
 
| איסור = <!-- דוגמה: אסור לעשות -->
 
| איסור = <!-- דוגמה: אסור לעשות -->
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| ממשל  = <!-- קישור לגורם ממשל אחראי -->
 
| ממשל  = <!-- קישור לגורם ממשל אחראי -->
 
}}<!-- פרמטרים סטנדרטיים: מידע/איסור/חשוב/פיצוי/שאלה/ממשל. ראו [[תבנית:דגשים]] למידע על אפשרויות הפרמטרים בתבנית -->
 
}}<!-- פרמטרים סטנדרטיים: מידע/איסור/חשוב/פיצוי/שאלה/ממשל. ראו [[תבנית:דגשים]] למידע על אפשרויות הפרמטרים בתבנית -->
 
+
*The list of medications included in the basket according to [[:he:חוק ביטוח בריאות ממלכתי|The National Health Insurance Law]] is detailed in the [[:he:צו ביטוח בריאות ממלכתי (תרופות בסל שירותי הבריאות)|National Health Insurance Ordinance (Medications in the Healthcare Services Basket)]].
*The list of medications included in the basket is detailed in the [[:he:צו ביטוח בריאות ממלכתי (תרופות בסל שירותי הבריאות)|National Health Insurance Order (Medications in the Healthcare Services Basket)]].
+
{{זכות/סיום הקדמה}} <!-- תבנית זו דואגת לכך שהכותרת הבאה בתור תתחיל רק מתחת לתוכן העניינים -->
*The health plans are required by law to provide the medications included in the healthcare basket to policyholders, subject to relevant [[:he:התוויה רפואית|medical indications]] and a professional medical opinion.
+
*The health plans are required by law to provide the medications included in the healthcare basket to policyholders, subject to relevant medical indications and professional medical opinions.
 
*By law, the health plans are permitted to collect a co-payment for medications included in the healthcare basket.
 
*By law, the health plans are permitted to collect a co-payment for medications included in the healthcare basket.
 
*The health plans are not required to provided medications not included in the healthcare basket, but they may do so. Accordingly, it is possible that one health plan may supply a specific medication not included in the healthcare basket, while another health plan does not do so. In such a case, a policyholder may choose to switch to a health plan that has decided to supply a specific medication.
 
*The health plans are not required to provided medications not included in the healthcare basket, but they may do so. Accordingly, it is possible that one health plan may supply a specific medication not included in the healthcare basket, while another health plan does not do so. In such a case, a policyholder may choose to switch to a health plan that has decided to supply a specific medication.
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*Policyholders may find out if a specific medication is included in the healthcare basket by reviewing the law or information published by the Ministry of Health.
 
*Policyholders may find out if a specific medication is included in the healthcare basket by reviewing the law or information published by the Ministry of Health.
 
*The list of medications included in the basket is closed and updated every year. Any public or private entity (i.e. patients, patient organizations, doctors, companies, etc.) may submit a request to add new medications to the healthcare services basket.
 
*The list of medications included in the basket is closed and updated every year. Any public or private entity (i.e. patients, patient organizations, doctors, companies, etc.) may submit a request to add new medications to the healthcare services basket.
 
{{זכות/סיום הקדמה}} <!-- תבנית זו דואגת לכך שהכותרת הבאה בתור תתחיל רק מתחת לתוכן העניינים -->
 
  
 
== Who is Eligible? == <!--מי זכאי-->
 
== Who is Eligible? == <!--מי זכאי-->
*Anyone [[:he:ביטוח בריאות|insured]] according to [[:he:חוק ביטוח בריאות ממלכתי|The National Health Insurance Law]].
+
*Anyone [[:he:ביטוח בריאות|insured]] according to The National Health Insurance Law.
  
 
== How to Claim It? == <!--תהליך מימוש הזכות-->
 
== How to Claim It? == <!--תהליך מימוש הזכות-->
*Information regarding the medications included in the healthcare basket can be found on the [http://www.old.health.gov.il/units/pharmacy/trufot/index.asp?safa=h Ministry of Health website] and through the health plans.  
+
* Obtaining medications included in the healthcare basket is subject to relevant [[:he:התוויה רפואית|medical indications]] and a professional medical opinion of the attending physician.
*Information is provided regarding if the medications are included in the basket, what the medical indications for its use are, if it may be acquired over the counter, and if a co-payment is required.<br />
+
 
<big>Useful Websites:</big>
+
== Medications Included in the Healthcare Basket ==
*[http://www.old.health.gov.il/units/pharmacy/trufot/index.asp?safa=h The Ministry of Health's medications database]
+
*Information regarding the medications included in the healthcare basket can be found on the Ministry of Health and health plans' websites.  
*[http://www.old.health.gov.il/Download/pages/trufotSal2011.pdf Listing of the medications included in the 2011 healthcare basket from the Ministry of Health]
+
*Information is provided on these sites regarding if a given medication is included in the basket, what the medical indications for its use are, if it may be acquired over the counter, and if a co-payment is required.  
*[http://www.health.gov.il/hozer/mk01_2012.pdf Expansion of the healthcare services basket for 2012]
+
* The Ministry of Health website:
*[http://www.old.health.gov.il/pages/default.asp?maincat=1&catId=111&PageId=827 Medications price listing on the Ministry of Health website]
+
** [http://www.old.health.gov.il/units/pharmacy/trufot/index.asp?safa=h The Ministry of Health's medications database]
*[http://www.clalit.co.il/HE-IL/Guides/medicines.htm Clalit Health Services Medications Guide]<br />
+
** [http://www.old.health.gov.il/pages/default.asp?maincat=1&catId=111&PageId=827 Medications price listing on the Ministry of Health website]
<big>Co-Payment Amounts</big>
+
* Health plan websites:
*Maccabi Health Services - [http://www.maccabi4u.co.il/13084-he/Maccabi.aspx Co-payments for medications]
+
** Maccabi Health Services - [http://www.maccabi4u.co.il/13084-he/Maccabi.aspx Co-payments for medications]
*Leumit Health Fund - [http://www.leumit.co.il/services_info.asp?pgId=1321&catID=226 Medication fees]
+
** Leumit Health Fund - [http://www.leumit.co.il/services_info.asp?pgId=1321&catID=226 Medication fees]
*Meuhedet Health Services - [https://www.meuhedet.co.il/meuhedet/views/engine?rnd=0.82017924921742&templateName=menu.txt&idorItemId=topMenu&menuBarView=menu&menuBarSubjectParam=1211196727562&menuBarStartMenuParam=subSubject&topMenuId=11&menuBarOpenCategoryParam=&mainView=article&mainId=&mainSubjectParam=1211196727562 Co-payments and exemptions]
+
** Meuhedet Health Services - [https://www.meuhedet.co.il/meuhedet/views/engine?rnd=0.82017924921742&templateName=menu.txt&idorItemId=topMenu&menuBarView=menu&menuBarSubjectParam=1211196727562&menuBarStartMenuParam=subSubject&topMenuId=11&menuBarOpenCategoryParam=&mainView=article&mainId=&mainSubjectParam=1211196727562 Co-payments and exemptions]
*Clalit Health Services - [http://www.clalit.co.il/HE-IL/fee+for+servic/ Medication fees]
+
** Clalit Health Services - [http://www.clalit.co.il/HE-IL/fee+for+servic/ Medication fees]
  
 
==Administrative Approval for Treatment with a Medication Included in the Healthcare Basket==
 
==Administrative Approval for Treatment with a Medication Included in the Healthcare Basket==
*The health plans sometimes make provision of treatment with specific medications contingent on prior administrative approval (approval that is not from the attending physician). Due to the fact that this approval process is liable to delay provision of essential treatment, the Ministry of Health has determined that health plans requesting to make provision of medications conditional may do so according to the following conditions:
+
*The health plans sometimes make provision of treatment with specific medications contingent on prior administrative approval (approval that is not from the attending physician).
 +
*Due to the fact that this approval process is liable to delay provision of essential treatment, the Ministry of Health has determined that health plans requesting to make provision of medications conditional may do so according to the following conditions:
 
:*The approval is limited to a reduced number of medications for '''non-urgent''' treatments.
 
:*The approval is limited to a reduced number of medications for '''non-urgent''' treatments.
 
:*A listing of the medications is published on the health plan's website.
 
:*A listing of the medications is published on the health plan's website.
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*The attending physician is responsible for making sure approval is obtained.
 
*The attending physician is responsible for making sure approval is obtained.
 
*Any refusal of administrative approval must be explained and sent to the patient in writing.
 
*Any refusal of administrative approval must be explained and sent to the patient in writing.
 +
 +
== Supply of Medications Not in the Healthcare Basket ==
 +
* The health plans are not required to supply medications not included in the healthcare services basket to policyholders, but they may choose to do so.
 +
* Accordingly, it is possible that one health plan may supply a certain medication even if it is not included in basket, while another health plan may not do so.
 +
* In such a case, a policyholder desiring a specific medication not included in the basket but offered by another health plan may switch to that particular health plan.
 +
 +
== Submitting a Complaint regarding Non-Provision of a Medication ==
 +
* Policyholders wishing to complain regarding non-provision of a medication included in the healthcare basket may submit a complaint to the [[:he:נציבות קבילות הציבור לחוק ביטוח בריאות ממלכתי|National Health Insurance Law Ombudsman]]. For more information, see: [[new:Submitting a Complaint to the National Health Insurance Law Ombudsman|Submitting a Complaint to the National Health Insurance Law Ombudsman]].
  
 
== Please Note == <!--חשוב לדעת-->
 
== Please Note == <!--חשוב לדעת-->
 
*The list of medications included in the basket is detailed in the [[:he:צו ביטוח בריאות ממלכתי (תרופות בסל שירותי הבריאות)|National Health Insurance Order (Medications in the Healthcare Services Basket)]]. In most cases, the medications appear by their generic name (according to the active ingredient). Accordingly, under the generic name, there may be a number of commercial names for the drug, even if they do not explicitly appear in the Order.
 
*The list of medications included in the basket is detailed in the [[:he:צו ביטוח בריאות ממלכתי (תרופות בסל שירותי הבריאות)|National Health Insurance Order (Medications in the Healthcare Services Basket)]]. In most cases, the medications appear by their generic name (according to the active ingredient). Accordingly, under the generic name, there may be a number of commercial names for the drug, even if they do not explicitly appear in the Order.
 
*All medications marketed in Israel must appear in the "Registry of Medical Products in Israel" (פנקס התכשירים הרפואיים בישראל) before being marketed. Registration and approval of a specification medication and its medical indications does not mean that it is included in the healthcare services basket.
 
*All medications marketed in Israel must appear in the "Registry of Medical Products in Israel" (פנקס התכשירים הרפואיים בישראל) before being marketed. Registration and approval of a specification medication and its medical indications does not mean that it is included in the healthcare services basket.
*Hospitals are required to supply all necessary medications to hospitalized patients according to the attending physician's professional opinion, even if the medications are not included in the healthcare basket. For hospitalization, policyholders receive a letter of financial obligation/payment voucher (Form 17, also know as התחייבות) from their health plan, which covers all medications and services they may require during hospitalization according to the relevant medical opinions, whether they are included in the healthcare basket or not.
+
*Hospitals are required to supply all necessary medications to hospitalized patients according to the attending physician's professional opinion, even if the medications are not included in the healthcare basket. For hospitalization, policyholders receive a [[:he:קבלת טופס התחייבות (טופס 17) מקופת החולים|letter of financial obligation/payment voucher (Form 17, also know as התחייבות) from their health plan]], which covers all medications and services they may require during hospitalization according to the relevant medical opinions, whether they are included in the healthcare basket or not.
  
 
== Legal Precedents == <!--תקדימים משפטיים-->
 
== Legal Precedents == <!--תקדימים משפטיים-->
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* [http://www.health.gov.il/hozer/sbn03_10.pdf Health Plan and Additional Health Services Supervision Division Circular 3/2010 from 16.3.2010] - Prior approval processes for the provision of treatment with medications included in the healthcare basket
 
* [http://www.health.gov.il/hozer/sbn03_10.pdf Health Plan and Additional Health Services Supervision Division Circular 3/2010 from 16.3.2010] - Prior approval processes for the provision of treatment with medications included in the healthcare basket
 
* [http://www.patients-rights.org/medicins.html Medications] on [[:he:האגודה לזכויות החולה בישראל|The Society for Patients Rights in Israel]]'s website
 
* [http://www.patients-rights.org/medicins.html Medications] on [[:he:האגודה לזכויות החולה בישראל|The Society for Patients Rights in Israel]]'s website
 +
* [http://www.old.health.gov.il/Download/pages/trufotSal2011.pdf Listing of medications included in the 2011 healthcare basket] on the Ministry of Health website
 +
* [http://www.health.gov.il/hozer/mk01_2012.pdf Ministry of Health Director Circular 1/12 from 10.01.2012] - Expansion of the healthcare services basket for 2012
 +
* [http://www.clalit.co.il/HE-IL/Guides/medicines.htm Clalit Health Services Medications Guide]
  
 
== Sources == <!--מקורות-->
 
== Sources == <!--מקורות-->
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{{זכות/ראו גם  
 
{{זכות/ראו גם  
 
| [[The Healthcare Basket]]
 
| [[The Healthcare Basket]]
 +
| [[Health and Illness]]
 
| [[new:Submitting a Request to Include Treatments or Medications in the Healthcare Basket|Submitting a Request to Include Treatments or Medications in the Healthcare Basket]]
 
| [[new:Submitting a Request to Include Treatments or Medications in the Healthcare Basket|Submitting a Request to Include Treatments or Medications in the Healthcare Basket]]
 
| [[:he:קבלת תרופה אתית מסוימת (תרופת מקור)|Obtaining a Specific Name-Brand Medication]]
 
| [[:he:קבלת תרופה אתית מסוימת (תרופת מקור)|Obtaining a Specific Name-Brand Medication]]
 
| [[:he:קבלת תרופה גנרית מסוימת|Obtaining a Specific Generic Medication]]
 
| [[:he:קבלת תרופה גנרית מסוימת|Obtaining a Specific Generic Medication]]
| [[Health and Illness]]
 
 
}}
 
}}
 
{{זכות/חדשות  
 
{{זכות/חדשות  

Revision as of 13:29, 9 June 2013

Template:זכות/תחילת טור ימני

The health plans are required by law to provide the medications included in the healthcare basket to policyholders, subject to relevant medical indications and professional medical opinions
The list of medications included in the basket is closed, detailed in the National Health Insurance Order, and updated every year
Hospitals are required to supply all necessary medications to hospitalized patients according to the attending physician's professional opinion, even if the medications are not included in the healthcare basket
By law, the health plans are permitted to collect a co-payment for medications included in the healthcare basket

Template:זכות/סיום הקדמה

  • The health plans are required by law to provide the medications included in the healthcare basket to policyholders, subject to relevant medical indications and professional medical opinions.
  • By law, the health plans are permitted to collect a co-payment for medications included in the healthcare basket.
  • The health plans are not required to provided medications not included in the healthcare basket, but they may do so. Accordingly, it is possible that one health plan may supply a specific medication not included in the healthcare basket, while another health plan does not do so. In such a case, a policyholder may choose to switch to a health plan that has decided to supply a specific medication.
  • The co-payments required for specific services and medications are not the same in all health plans, so one health plan may take a larger or smaller co-payment for an identical service or medication than a different health plan.
  • Policyholders may find out if a specific medication is included in the healthcare basket by reviewing the law or information published by the Ministry of Health.
  • The list of medications included in the basket is closed and updated every year. Any public or private entity (i.e. patients, patient organizations, doctors, companies, etc.) may submit a request to add new medications to the healthcare services basket.

Who is Eligible?

  • Anyone insured according to The National Health Insurance Law.

How to Claim It?

  • Obtaining medications included in the healthcare basket is subject to relevant medical indications and a professional medical opinion of the attending physician.

Medications Included in the Healthcare Basket

Administrative Approval for Treatment with a Medication Included in the Healthcare Basket

  • The health plans sometimes make provision of treatment with specific medications contingent on prior administrative approval (approval that is not from the attending physician).
  • Due to the fact that this approval process is liable to delay provision of essential treatment, the Ministry of Health has determined that health plans requesting to make provision of medications conditional may do so according to the following conditions:
  • The approval is limited to a reduced number of medications for non-urgent treatments.
  • A listing of the medications is published on the health plan's website.
  • The conditional administrative approval is only for the the drug treatment's initial prescription.
  • A response will be provided to the patient no more than four days from the date the request was submitted by the attending physician. If a response is not received in this period of time, it will be considered to be approval of the request.
  • The attending physician is responsible for making sure approval is obtained.
  • Any refusal of administrative approval must be explained and sent to the patient in writing.

Supply of Medications Not in the Healthcare Basket

  • The health plans are not required to supply medications not included in the healthcare services basket to policyholders, but they may choose to do so.
  • Accordingly, it is possible that one health plan may supply a certain medication even if it is not included in basket, while another health plan may not do so.
  • In such a case, a policyholder desiring a specific medication not included in the basket but offered by another health plan may switch to that particular health plan.

Submitting a Complaint regarding Non-Provision of a Medication

  • Policyholders wishing to complain regarding non-provision of a medication included in the healthcare basket may submit a complaint to the National Health Insurance Law Ombudsman. For more information, see: Submitting a Complaint to the National Health Insurance Law Ombudsman.

Please Note

  • The list of medications included in the basket is detailed in the National Health Insurance Order (Medications in the Healthcare Services Basket). In most cases, the medications appear by their generic name (according to the active ingredient). Accordingly, under the generic name, there may be a number of commercial names for the drug, even if they do not explicitly appear in the Order.
  • All medications marketed in Israel must appear in the "Registry of Medical Products in Israel" (פנקס התכשירים הרפואיים בישראל) before being marketed. Registration and approval of a specification medication and its medical indications does not mean that it is included in the healthcare services basket.
  • Hospitals are required to supply all necessary medications to hospitalized patients according to the attending physician's professional opinion, even if the medications are not included in the healthcare basket. For hospitalization, policyholders receive a letter of financial obligation/payment voucher (Form 17, also know as התחייבות) from their health plan, which covers all medications and services they may require during hospitalization according to the relevant medical opinions, whether they are included in the healthcare basket or not.

Legal Precedents

Aid Organizations

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

Government Agencies

Laws and Regulations

The National Health Insurance Law National Health Insurance Order (Medications in the Healthcare Services Basket)

Additional Publications

* Ministry of Health Director Circular 1/12 from 10.01.2012 - Expansion of the healthcare services basket for 2012

Sources

Template:זכות/סיום טור ימני

Template:זכות/תחילת טור שמאלי Template:זכות/ראו גם

Template:זכות/טפסים

Template:זכות/סיום טור שמאלי