Meuhedet Adif s cost-effective supplementary health insurance program

Transcription

1 Meuhedet Adif s cost-effective supplementary health insurance program BEING HEALTHY STAYING HEALTHY

2 Dear customers, Our customers well-being is our top priority. That s why Meuhedet offers the Meuhedet Adif supplementary insurance program. This program provides a variety of medical services not included in the basic health basket of the National Health Insurance Law. The program includes medical services in various fields that provide the customer with extensive medical coverage, supplemental to the services provided under the national health basket. Meuhedet Adif customers enjoy easy access to advanced, professional, state-of-the-art medical services. Meuhedet works with various medical centers in Israel and abroad and assists and guides Meuhedet Adif customers in accessing medical services, in the best tradition of Meuhedet. All Meuhedet customers are entitled to sign up for Meuhedet Adif, with no limitations on age or health condition. This brochure summarizes the medical services included in the Meuhedet Adif program. The complete description of the services and binding conditions can be found in the Meuhedet Adif Regulations, which is available at any Meuhedet clinic and on our website: Wishing you good health, Dr. Uzi Semani Insurance Division Manager *The contents of this leaflet are provided as general information only and are subject to the Meuhedet Adif supplementary insurance regulations - January 2014 / Shvat 5774 edition. Prior to purchasing any medical services, the policyholder is advised to clarify his or her rights. 2 January 2014 / Shvat 5774 edition

3

4 Services comparison table Meuhedet Adif and Meuhedet C Service Meuhedet Adif Meuhedet Adif + Meuhedet C Surgery and treatment in Israel and abroad Medical assistance abroad Virtual colonoscopy Treatments and surgeries at private hospitals in Israel Medical services within public hospitals through Private Medical Service (PMS) Implants Medical consultation before choosing a medical center abroad Surgery abroad selected by customer Plastic surgery Consultation, accessories and medication Second opinion abroad Purchase of implants and medical accessories Hearing aids Medication not included in Meuhedet's medication basket Second opinion in Israel Family expansion Genetic testing Diagnosis and treatment of infertility for men and women Monitoring for women with high-risk pregnancies New mother recuperation Early discovery of congenital defects in the fetus: amniocentesis and chorionic villus sampling Early discovery of congenital defects in the fetus: detailed ultrasound scan Nuchal translucency Service offered in the Meuhedet Adif framework Upgraded service offered in the Meuhedet C framework Service offered only in the Meuhedet C framework 4

5 Services comparison table Meuhedet Adif and Meuhedet C Service Caesarean section Umbilical cord blood Children and teenagers Meuhedet Adif Meuhedet Adif + Meuhedet C Visit to private pediatrician Speech therapy Child development Food substitutes not included in the health basket Bedwetting treatment Therapeutic horseback riding Animal-assisted therapy Hydrotherapy (beyond what is included in the health basket) Art therapy Music therapy Diagnosis of attention deficit disorders (ADD) Dental and gum care Free restorative dental treatments for children and teenagers ages Dental examinations and treatments Dental implants Preventive medicine Vaccinations Vaccinations and medicine for overseas travel Preventive tests Urgent care Urgent transport in ambulance Cardiology transmitter subscription and emergency heart disease care Service offered in the Meuhedet Adif framework Upgraded service offered in the Meuhedet C framework Service offered only in the Meuhedet C framework 5

6 Services comparison table Meuhedet Adif and Meuhedet C Recuperation and recovery Private nurse services Complex long-term care Recuperation after complex surgery Physical therapy after myocardial infarction Sports injury rehabilitation Lifestyle Psychological consultation and treatment Sports medicine Aesthetic medicine Laser eye surgery Optical services Nutritional consultation Complementary medicine Workshops and courses Tests and services At-home laboratory tests Home doctor visits Oncological tests Periodic screenings Treatments Knee pain treatment with Apos shoes Shockwave therapy Hemorrhoid and anal fissure treatment Treatment for sexual dysfunction Snoring and nasal congestion treatment Service offered in the Meuhedet Adif framework Upgraded service offered in the Meuhedet C framework Service offered only in the Meuhedet C framework 6

7 Services for Meuhedet Adif* Customers Surgery and treatment In Israel and abroad Treatment/surgery in private hospitals Eligibility for hospitalization in private hospitals for medical services and selection of physician, including: Surgery at private hospitals in Israel and choice of surgeon. Surgery in the framework of Private Medical Services at Hadassah Medical Center and Shaare Zedek Medical Center with minimal co-pay. Private Medical Services at public hospitals in Jerusalem. Implants Eligibility for the purchase of implants used during surgery at a private hospital. All of the aforesaid is subject to the approved list of services. Medical assistance abroad Additional assistance for transplants, life-saving surgery and special medical situations abroad, including: Additional assistance in transplants and live-saving surgery abroad for those eligible according to the National Health Insurance Law. Treatment abroad which is not included in Ministry of Health regulations. Coverage for expenses associated with receiving medical assistance abroad. Virtual colonoscopy Eligibility for virtual colonoscopy test. Consultation, medical equipment and medication Second opinion Second medical opinion in Israel eligibility to receive a second medical opinion in Israel (3 times per year). Second medical opinion abroad eligibility for consultation with a senior expert at one of the medical centers abroad that Meuhedet has an agreement with, for life-threatening conditions. Medications not included in the Meuhedet medications basket eligibility for discounts on purchase of critical medications not approved for supply by Meuhedet s medication registry. Medical equipment eligibility for partial coverage by Meuhedet of expenses associated with purchase of critical medical equipment. 7

8 Family expansion Genetic testing Eligibility for testing for genetic diseases - from an extensive list of approved tests. Infertility diagnosis and treatment for men and women Those eligible to receive fertility treatments under the National Health Insurance Law are eligible to receive fertility treatments in a private hospital that has an agreement with Meuhedet, including: Tests and treatments to determine the causes of infertility. Medications to treat infertility. In-vitro fertilizations with minimal co-pay. Freezing genetic material freezing fertilized ova and re-implantation. Fertility treatments involving egg donation, conducted abroad. Early discovery of congenital defects in the fetus Amniocentesis eligibility for amniocentesis or chorionic villus sampling, according to the customer s preference. Ultrasound eligibility for early ultrasound or detailed ultrasound instead of basic screening (approved for all Meuhedet customers by the National Health Insurance Law) during the second trimester of pregnancy (between weeks 20-25). 8

9 Monitoring for women with high-risk pregnancies Women with high-risk pregnancies are eligible for a home pregnancy monitor. Postpartum convalescence Women who have just given birth (who already have three children) are eligible for three convalescence days at a postpartum convalescence institution. Children Private pediatrician visit Eligibility for coverage of a visit to a private pediatrician who does not have an agreement with Meuhedet. Child development Eligibility for child development treatment up to 36 treatments per year beyond what is provided by the National Health Insurance Law. Speech therapy Eligibility for partial coverage by Meuhedet of the cost of one course of treatment for stuttering or a course which includes treatment for a learning disability based on an organic language problem (by a speech therapist), beyond what is provided under the National Health Insurance Law. Dental and gum care Eligibility to receive various dental services at Meuhedet dental clinics, including: Dental check-up once a year, free emergency treatments and first-aid. Special prices for plaque removal and counseling in oral hygiene. Discounts on Meuhedet prices for dental treatment. Provision of medication connected to dental treatment. Preventive medicine Vaccinations Vaccinations eligibility for vaccinations at the initiative of the customer hepatitis A and B, flu vaccine and Pneumovax. Vaccinations and medications for travelers to locations abroad which require vaccinations according to Ministry of Health regulations. Preventive testing Eligibility for preventive testing, as detailed below: Fecal occult blood test PAP test Mammograms and bone mineral density tests beyond what is provided under the National Health Insurance Law. 9

10 Urgent care Emergency transport by ambulance Eligibility for partial coverage by Meuhedet of the cost of an urgent ambulance ride which did not result in hospitalization. Cardiology transmitter subscription and emergency services for heart patients Eligibility for reimbursement for cardiology transmitter subscription and emergency services for heart patients. Physical therapy following myocardial infarction Eligibility for partial coverage by Meuhedet for supervised physical therapy after an acute myocardial infarction. Recuperation and rehabilitation Private nurse Eligibility for reimbursement for payment of private nurse services following surgery which requires close supervision. Recovery from complex surgery Eligibility for reimbursement for the cost of recuperation at a relevant institution after brain or stomach surgery, organ implants or other surgery (excluding cosmetic plastic surgery and obstetric surgery), which requires hospitalization for over ten consecutive days. Complex long term care hospitalization Eligibility for coverage of the costs of hospitalization for customers defined as complex long term care (for a period of 60 days). 10

11 Comprehensive mental and physical health Psychological consultation and treatment Eligibility for psychological consultation and treatment by independent psychologists who have an agreement with Meuhedet. Sports medicine Eligibility for discounts on Meuhedet s prices for treatments and tests provided by the Meuhedet sports medicine clinic. Complementary medicine Eligibility for discounts at Meuhedet s complementary medicine clinics. Nutritional consultation Eligibility for nutritional consultation from a consultant who has an agreement with Meuhedet. Esthetic medicine Eligibility for discounts on Meuhedet s prices for cosmetic vein treatments. Laser eye surgery to correct nearsightedness Eligibility for laser eye surgery to correct nearsightedness. Optical services Eligibility for discounts on glasses and sunglasses at suppliers who have an agreement with Meuhedet. *subject to the terms of the Meuhedet Adif Regulations. 11

12 Waiting period table Waiting periods for various eligibilities under Meuhedet Adif No waiting period 3 month waiting period 6 month waiting period 12 month waiting period 24 month waiting period Vaccinations and medication for travelers abroad Dental services Complementary medicine Sport medicine Visit to private pediatrician Urgent transport in ambulance Laser eye surgery Optical services Genetic testing Nutritional consultation Recuperation following complex surgery Medical equipment Hearing aids Early discovery of birth defects in the fetus Virtual colonoscopy Apos therapy shoes Medication not included in Meuhedet s medication basket Psychological consultation and treatment Additional medical opinions Vaccinations Monitoring for women with high-risk pregnancies Postpartum convalescence Cardiology transmitter subscription and emergency services for heart patients Private nurse Child development Speech therapy Preventive tests Aesthetic medicine Physical therapy following myocardial infarction Treatment/surgery at private hospitals Complex long-term care hospitalization Acquisition of implants Diagnosis and treatment of infertility for men and women Medical assistance abroad *Waiting period consecutive number of months, as detailed in the table above, from the month that the customer signs up for Meuhedet Adif until the time that the customer is eligible to utilize his/her rights under the Regulations. 12

13 GENERAL INFORMATION 1. Insurance Fees Details by customer age Age group *Prices as of Monthly Rate NIS NIS NIS 55 and up 76 NIS Family 101 NIS Family (where the head of the family is over age 55) NIS Please Note: A. Insurance fees detailed above are after a 5% discount for those paying via standing order direct debit. The bank accounts of Meuhedet Adif customers paying via standing order direct debit will be charged once a month accordingly. B.For those paying via payment vouchers payment can be made at any post office bank branch throughout the country or at Meuhedet offices. C. Regular payment of insurance fees ensures full utilization of the rights for which supplementary health insurance program customers are eligible, subject to the program regulations. D. Tardiness in insurance fee payment may undermine the customer s eligibilities up to and including cancellation of membership in the Meuhedet Adif program. Revisions to insurance fees *Meuhedet Adif insurance fees are revised in accordance with rises in the Consumer Price Index published by the Israeli Central Bureau of Statistics or the Health Cost Index (the higher of the two). In addition, the insurance fees are revised in accordance with changes to the composition of the services basket and the real cost of the various medical services included in it, and based on actuarial calculations conducted periodically and subject to the approval of the Ministry of Health. 13

14 2. Signing up for supplementary insurance and waiting periods A. A resident who has been accepted as a Meuhedet Adif customer and has signed up for Meuhedet Adif will be permitted to utilize his/her eligibilities under the supplementary insurance following a waiting period beginning on the day the customer signed up for the program. Some of the medical services included in Meuhedet Adif do not require a waiting period at all, while others require a waiting period of between 3 and 24 months, as detailed in the Regulations and the waiting period table in this brochure (page 13). B. Discharged soldiers who sign up for the program within 90 days of their discharge date from the IDF are exempt from the waiting period required by the Regulations. C. New immigrants (olim) who sign up for the program no later than 90 days from the date they signed up for Meuhedet are exempt from the waiting period required by the Regulations. D. Customers who transferred from a different health service in which they were customers of a supplementary insurance program and had completed the waiting period required by Meuhedet s Regulations are exempt from the waiting period required by Meuhedet Adif (subject to the Meuhedet Adif Regulations). E. Customers can cancel their membership in the program as well as the membership of customers in their account at any time by signing a Cancellation Statement. F. Customers of Meuhedet Adif who decide to cancel their membership in the program or had their membership cancelled due to failure to pay insurance fees on time, who later decide to re-join the insurance program are considered new customers, and the Regulations which are applicable at that date will apply to them. Co-pays / partial coverage by Meuhedet A. Most of the medical services included in the Meuhedet Adif services basket are provided through private service providers (hospitals, physicians, institutions and para-medical employees), and in light of the expensive private market purchasing conditions, some of the medical services included in the service basket require a customer co-pay. B. Other services included in the basket are provided on the basis of Meuhedet s partial coverage of the total expense that the customer paid to acquire them (reimbursement). The co-pay of Meuhedet customers and the level of Meuhedet coverage for acquiring such services are revised from time to time as detailed in the Regulations. 14

15 Signing up for Meuhedet Adif For your convenience, there are four different ways to register for Meuhedet Adif: Register on the phone using your credit card Please call the Meuhedet Adif hotline at Or the Direct Meuhedet hotline at *3833 or from a land line. Register using your credit card Please fill out the registration form with your credit card details and submit it to the front desk of your Meuhedet clinic or send it by mail to the clinic. Register with a standing order direct debit payment Please fill out the registration form with the details of the standing order direct debit and provide it to the front desk of your Meuhedet clinic or send it by mail to the clinic. Register at the front desk of any Meuhedet clinic throughout the country *The contents of this leaflet are provided as general information only and are subject to the Meuhedet Adif supplementary insurance regulations - January 2014 / Shvat 5774 edition. Prior to purchasing any medical services, the policyholder is advised to clarify his or her rights. January 2014 / Shvat 5774 edition 15

16 מק"ט , דפוס האוגדים