משרד העלייה והקליטה The Ministry of Aliyah and Immigrant Absorption ENGLISH שירותי בריאות. Health Services in Israel. 5th Edition

Transcription

1 משרד העלייה והקליטה The Ministry of Aliyah and Immigrant Absorption ENGLISH שירותי בריאות Health Services in Israel 5th Edition

2 Produced by The Publications Department Ministry of Aliyah and Immigrant Absorption 15 Rehov Hillel, Jerusalem All Rights Reserved Jerusalem 2014 Ida Ben Shetreet - Director, Publications Department Laura L. Woolf - Chief Editor, English Language Publications Catalogue Number: הופק על ידי אגף מידע ופרסום משרד העלייה והקליטה רח' הלל 15, ירושלים כל הזכויות שמורות ירושלים 2014 Telephone Information Center (03) info@moia.gov.il הודפס על ידי המדפיס הממשלתי Special thanks to Dr. Yitzhak Berlovich, Director, Wolfson Hospital, for his assistance in updating this booklet. Produced by the Publications Department

3 Table of Contents Introduction The Health System in Israel The National Health Insurance Law The Ministry of Health The Basket of Health Services The Health Funds Emergency Services Dental Care Hospitals Pregnancy and Birth Child Development Senior Citizens Chronic Care Mental Health Additional Services Alternative Medicine Services of the Ministry of Health Services of the Local Authorities Services of the National Institute Insurance Private Health Care Social Services Appendix I Rights of Patients Appendix II Complaints and Legal Claims Useful Addresses מבוא - מערכת הבריאות בישראל חוק ביטוח בריאות ממלכתי משרד הבריאות סל שירותי בריאות קופות חולים שירותי חירום בריאות השן בתי חולים היריון ולידה התפתחות הילד גיל הזהב שירותי בריאות סיעודיים בריאות הנפש שירותים נוספים רפואה משלימה שירותי משרד הבריאות שירותי הרשויות המקומיות שירותי המוסד לביטוח לאומי שירותי רפואה פרטית שירותי רווחה נספח - 1 זכויות החולה נספח - 2 פניות הציבור כתובות וטלפונים Health Services in Israel 3

4 4 Health Services in Israel

5 Introduction The Health System in Israel The defining characteristic of the health system in Israel is its governance by the National Health Insurance Law (1995). This law ensures health coverage to every resident of Israel and defines the government's responsibility to provide health services to every person without discrimination. In other words, health insurance is mandatory, and all residents of Israel must be insured. This booklet presents a general outline of the health system in Israel, and the kinds of medical services to which residents of Israel are entitled. For specific questions that are not answered in this booklet, consult with a health fund or the Ministry of Health (see Useful Addresses at the back of this booklet). The Englishspeaking immigrant organizations may also be able to provide some information. NOTE: This is the fifth edition of this booklet and hereby nullifies all previous editions. The information in this booklet is based on data provided by various official sources. Details are subject to change. In case of any discrepancy, the regulations of the Ministry of Health, the health funds, the National Insurance Institute, the Ministry of Aliyah and Immigrant Absorption, and other official bodies will prevail. The information presented here does not confer eligibility for any benefit or service. Health Services in Israel 5

6 The National Health Insurance Law The following are the basic provisions of the National Health Insurance Law: Every resident of the State of Israel is entitled to health insurance. Coverage is mandatory, and every resident must be covered. The provisions of the Basket of Health Services (sal sherutei briut) are identical for each individual. Health services are provided through the health funds (kupot holim). The items included in the basic Basket of Health Services are identical for each person. Each health fund is authorized to offer its members additional services and plans not included in the Basket. There are also slight variations between the payment systems among the health funds. For details, consult with the health funds. Every resident of Israel must be a member of one of the health funds in order to receive health services. Every person is entitled to join the health fund of their choice. The funds are forbidden to reject any applicant. Any person is entitled to transfer from one health fund to another. Services included in the Basket are administered according to the judgment of medical professionals. Care must be provided at a reasonable level of quality, within a reasonable period of time, and within a reasonable distance from the patient s place of residence. The government of Israel is responsible for coverage of the costs of the Basket of Services. The National Insurance Institute collects health insurance premiums. The rate of payment is according to a progressive scale. The Law forbids employers to require employees to belong to any specific health fund. The health funds are subject to ongoing governmental supervision and inspections. 6 Health Services in Israel

7 Health services are administered according to policies of respect for the patient and the patient s right to privacy and medical confidentiality. Any person who feels that their rights have been violated may file a complaint. The health funds are forbidden to deny this right to any of its members. The exceptions to this law include some of the following: Soldiers conscripted to obligatory service in the Israel Defense Forces receive medical care through the Army. Disabled IDF veterans receive medical care through the Ministry of Defense. The National Insurance Institute covers persons injured in work accidents, hospitalization of woman giving birth and their newborns, and persons injured during enemy actions. Disabled World War II veterans and victims of the Nazis may be eligible for certain types of coverage from the Ministry of Finance. Who is Eligible for Health Services? The National Health Insurance Law considers any person recognized by the National Insurance Institute as a resident of Israel to be eligible for health services. Registration in one of the four health funds is a prerequisite for receiving healthcare services (see below). The Ministry of Health The Ministry of Health is responsible for the provision of health services to all residents of Israel, and for overseeing the health system, including planning, supervision, and coordination of activities. In addition to providing public health services through the health funds and family health centers, the Ministry of Health maintains Health Services in Israel 7

8 general hospitals, psychiatric hospitals, community mental health clinics, treatment programs for substance abusers, and facilities for the chronically ill. See the sections on Mental Health Services and Services Provided by the Ministry of Health below. The Public Ombudsman (netziv kvilot hatzibur) of the Ministry of Health is responsible for public complaints, including cases of refusal to register an applicant in a health fund, limiting registration through special conditions or payments, or cases in which a health fund refuses to provide a service included within the Basket of Health Services. See Appendix II. Note: The Ministry of Health is the licensing and recognition body for medical and some paramedical professionals, including physicians, nurses, pharmacists, psychologists, and dentists. For more information on licensing and recognition procedures for health professionals, see the booklets entitled Medical Professionals, and Nurses, available from the Publications Department. See the order form at the back of this booklet. Information is also available on the Ministry website: The Basket of Health Services The Basket of Health Services (sal sherutei briut) consists of a range of essential medical services, including treatments, medications, and equipment which each health fund is obligated to provide to its members. Its contents are defined by law, but are subject to periodic revision. Therefore, a treatment or medication that was covered at one point may be discontinued, or new items may be added. 8 Health Services in Israel

9 It is important to note that only those services included in the Basket are free of charge or discounted. Patients may have to cover at least some of the cost of certain prescriptions and treatments, or fully finance items not included in the Basket. Patients can also choose to acquire supplementary coverage from their health fund. See below. Obligatory services provided by the health funds include: Visits to clinics for consultation, diagnosis, and treatment (including consultations and treatments from family doctors, specialists, and para-medical professionals). Prescriptions Hospitalization and emergency room services. Laboratory services. Certain medical equipment Certain diagnostic procedures, including x-rays and scans. Rehabilitation Also within the Basket are certain types of paramedical services such as physiotherapy. Note that most diagnostic and treatment procedures are provided only upon a physician s referral. In order to supplement those services guaranteed by law, the health funds also offer the option of supplementary insurance (bituach mashlim) for an additional fee. Patients can also supplement health-fund coverage with private medical services. In case of any discrepancy between the law and the claims of the health fund, contact the National Health Insurance Law Ombudsman (netzivut hakvilot bituach briut mamlachti). See Useful Addresses. Information about the Health Basket, fees for services, and other topics, is available on the Ministry of Health website, Health Services in Israel 9

10 The Health Funds There are four health funds: Kupat Holim Clalit, Kupat Holim Maccabi, Kupat Holim Meuhedet and Kupat Holim Leumit. Each fund has branches throughout the country. As stated above, the Law requires each health fund to provide its members with all mandated services. The differences between funds lie mainly in the location and availability of their facilities, the types of supplemental policies, and additional services offered within the framework of their facilities at a discount or no charge. It is advisable for potential members to investigate each fund individually, and choose the one that best suits their particular needs. In general, each fund allows its members to choose a primary-care physician and specialists from the list of doctors associated with the fund. Doctors accept patients either at the fund s clinics or in their own independent offices. Patients must have their healthfund membership card or booklet when visiting a doctor. In most cases, there is a fee for seeing a specialist. In addition, each fund has arrangements for the hospitalization of its members, whether in government or private hospitals. The funds also offer laboratory services, x-rays, and pharmacies, as well as paramedical services such as physiotherapy. Prescriptions Many prescriptions are included in the Basket of Services; however, others are not. Those that are included are covered at rates that vary from 50-90%. Patients must pay the full costs of prescriptions not covered by their health fund. A physician or pharmacist will often have information about the rate of coverage for a particular prescription. In some cases, the health funds dispense certain prescriptions only through their own pharmacies, or offer greater coverage on prescriptions that patients purchase from the fund s pharmacies. Check with the dispensing physician or the health fund pharmacy. 10 Health Services in Israel

11 In some cases, health-fund members may receive partial coverage or discounts on such over-the-counter items as vitamins or sun protection items from the health fund pharmacy. Receiving Services from a Health Fund Following completion of registration procedures at the health fund, a new member should receive a membership card, or confirmation of registration, which serves as a temporary card until the permanent one is processed. They should also receive an explanatory booklet about the services of the health fund. Alternatively, it is possible to request information from the health fund secretariat, or visit the health fund s website (see Useful Addresses). Each fund has a list of physicians who provide care. Some physicians have practices located at health fund clinics, while others maintain independent offices. Patients can make appointments for certain types of physicians, such as family doctors, as needed, while other types of doctors, particularly many kinds of specialists, require a referral from a family doctor, or authorization from the health fund secretariat. Patients may have to pay fees for certain types of supplementary treatments and laboratory services according to the guidelines of the health fund. Patients must have their membership card or booklet whenever visiting a doctor or a clinic, or receiving any type of service associated with their health fund. General Responsibilities of the Health Funds The law requires the health funds to provide the full range of services to all of their members without discrimination. Failure to pay health insurance premiums, or delay in payment, does not release the health fund from its responsibilities, and the patient must continue to receive any necessary care that is included in the Basket of Services. Health Services in Israel 11

12 Each health fund has a charter that determines the rights of its members. Any individual has the right to request a copy of the charter (for a fee). The funds are required to make information about services available to their members, including the method in which they provide their services, and to whom. Each health fund must make provision for public inquiries (complaints). See Appendix II for details. Registration in a Health Fund One of the most important things to do following aliyah is to register with one of the health funds. New immigrants can register for health insurance at Ben Gurion Airport upon arrival in Israel, or later at a postal bank (see below). After arrival at the airport, and following receipt of the necessary documents from an absorption counselor, new immigrants can inform the counselor of the fund in which they and their spouse prefer to register (spouses are allowed to register in different funds,) and the fund in which to register children below the age of 18. Family members over the age of 18 register separately, and must present their own te udat oleh or that of their parents. It is advisable to research the various funds while still abroad. It is also possible to contact friends or relations from the airport in order to consult about the choice of a fund. Note that there is no fee for registering at the airport. Following registration at the airport, take the copy of the registration form to the office of the chosen fund in order to receive a membership card. Note that you are not considered a member of the health fund until this step has been taken. For more details, see the section about registering for health insurance below. New immigrants who do not register in a health fund at the airport following arrival, or change status in Israel, should receive 12 Health Services in Israel

13 a voucher along with their te udat oleh that entitles six months of free health insurance, provided that they are not working. It is necessary to register at a local post office branch, and present the following items: Voucher for health insurance received at the airport or from an office of the Ministry of Aliyah and Immigrant Absorption. Te udat oleh. Te udat zehut (or Authorization of Registration in the Population Registry). To locate the nearest post office, and to check opening hours, visit At the postal bank, indicate the chosen health fund, as well as the health fund in which to register any children below the age of 18. Children over the age of 18 register separately, presenting either their own or their parents te udat oleh. Note that for married couples, both spouses must be present (although spouses may register in separate funds if they wish). Each applicant over the age of 18 must pay a processing fee. After registering at the postal bank office, take the registration certificate stamped by the postal bank office (or received at the airport) to the secretariat of the health fund. At the time of registration, the health fund will issue a temporary membership card. which is used to obtain medical services until the fund issues the permanent card. Health coverage goes into effect immediately upon registration. Note that an applicant is not considered registered until this step is taken. In other words, the procedures at the airport or postal bank alone are not sufficient to insure coverage, and it is necessary to register at the health fund in order to receive any kind of medical care. A new immigrant unable to personally register at the postal bank, for health or other reasons, can send a representative Health Services in Israel 13

14 who has power-of-attorney to one of the District Health Offices of the Ministry of Health. The representing individual must have with them their own identity documents as well as those of the person they represent. Following presentation of the necessary documentation, the Ministry of Health provides the representative with an authorization to take to the postal-bank office, in order to process the registration. Health fund membership entitles a member to the basic, universal Basket of Health Services mandated by law. Members can also choose to acquire supplementary insurance, for an additional fee, known as bituach mashlim. See below. Note: Registration in a health fund is a necessary condition for receiving medical services. It is very important to register in a health fund as soon as possible after arriving in Israel, in order to be eligible for health care as soon as it is needed. Failure to register with a health fund can result in unnecessary problems and delays in receiving medical care. A new immigrant in need of health care before they have registered with a fund must apply to the National Health Insurance Law Ombudsman of the Ministry of Health. In such a situation, it is recommended to consult with a personal absorption counselor of the Ministry of Aliyah and Immigrant Absorption. Temporary residents must register with a health fund and pay according to income. Transferring from One Health Fund to Another Every person has the right to transfer from one health fund to another, provided that they are a member of their current health fund for at least one year. 14 Health Services in Israel

15 The Transfer Procedure It is possible to transfer health funds free of charge through the website of the National Insurance Institute ( or through a Post Office branch, for a fee. The law provides six dates for transferring from one health fund to another: January 1: for applicants between Sept Nov. 15 March 1: for applicants between Nov Jan. 15 May 1: for applicants between Jan.16 - March 15 July 1: for applicants between March 16 - May 15 September 1: for applicants between May 16 - July 15 November 1: for applicants between July 16 - Sept. 15 In particular circumstances, it may be possible to submit a request to the Public Ombudsman of the Ministry of Health to cancel a request to transfer health funds, or to transfer from one fund to another earlier than the official date. For more information, see the section entitled Registering in a Health Fund, and Useful Addresses at the end of this booklet. Transferring from one health fund to another does not harm a member s rights with the health fund; they are entitled to all basic services and benefits of the Basket of Health Services as defined by law. Upon transferring health funds, the former fund should submit all medical records and information to the new fund at no cost. Health-fund members who belong to supplemental plans and who transfer from one health fund to another are no longer members of a supplemental plan. However, one who chooses to join a supplementary program in their new health fund, which takes effect within 90 days from commencement of membership in the fund, is usually entitled to an exemption or shortening of the waiting period for the supplemental insurance, provided that the new package is equivalent to that in the previous fund. Health Services in Israel 15

16 Children Children born in Israel, and entered into the Population Registry, are generally considered by the National Insurance Institute as members of the same health fund as the parent into whose bank account the National Insurance Institute pays child allowances (in most cases the mother). Parents should verify that their children are indeed registered with their health fund. Parents who belong to different health funds, and who wish to register the child in the health fund of the parent who does not receive the National Insurance Institute child allowance, must submit a request form signed by both parents. They may submit the form at any Postal Service branch office. Children who reach their 18th birthday continue to remain members of their health fund, unless they choose to switch funds. They must then follow the established procedures for transferring health funds. Soldiers Soldiers in regular, compulsory I.D.F. service (sadir,) or in the career army (keva) receive medical care within the framework of the army. Demobilized soldiers, following their army service, continue to remain members of the health fund that they joined prior to conscription. For more information, consult the booklet entitled Military Service, available from the Publications Department. See the order form at the back of this booklet. Returning Residents Israeli citizens who return to Israel following less than 2 years of residence overseas, who continue to pay health insurance fees while abroad, remain registered as members of their fund. Consult a health fund for details. The National Health Insurance Law currently obliges residents of Israel who reside abroad for two or more years, and who do not 16 Health Services in Israel

17 pay health insurance premiums, to undergo a waiting period of up to half a year before becoming eligible to receive health services. Alternatively, returning residents can redeem the waiting period with a special payment to the National Insurance Institute. Returning residents can make the payment for the entire amount at once, or in up to six installments. The amount of the payment is updated each year on the first of January. Following authorization of resident status from the National Insurance Institute, and completion of the special payment or the waiting period, returning residents are eligible for health services according to the National Health Insurance Law, and can join the health fund of their choice. It is also possible to make the payment while still overseas, from six months before returning to Israel. This enables eligibility for health insurance immediately upon arrival in Israel. More information about the special payment and waiting period, including calculating the waiting period, is available on the National Insurance Institute website: Information is also available from personal absorption counselors at the Ministry of Aliyah and Immigrant Absorption. Registration Process for the Special Payment 1. Any Israeli citizen can register using the registration form on the Ministry of Aliyah and Immigrant Absorption website. 2. Means of payment: Payment on the National Insurance Institute s internet payment site, from anywhere in the world, via credit card. Note that payments via credit cards issued abroad must be in one installment only. Israeli checks Israeli bank checks for payment for the entire amount due in (one payment only). The payment procedure is as follows: Write checks to order of the National Insurance Institute Payee only. Health Services in Israel 17

18 It is advisable to send the checks by registered mail. Send the following information: identity card number, first name, last name, address, postal address for sending the receipt. Mail checks to: The National Insurance Institute, Health Division, 13 Sd. Weizmann, Jerusalem, The National Insurance Institute sends confirmation of receipt of the check directly to the indicated address. In order to ensure health insurance coverage, it is necessary to return to Israel by the end of 18 months from the date of the first payment of the redemption fee. For more information, consult the National Insurance Institute Insurance and Health Division, 13 Sd. Weizmann, Jerusalem , (02) ; Fax: (02) For information about National Health Insurance fees and eligibility for health insurance (redeeming the waiting period,) contact: (02) , Fax: (02) Tourists Tourists are not eligible for coverage by the National Health Insurance Law. A tourist in need of medical treatment in Israel must pay privately for care, arrange for coverage through their overseas insurance company, or plan for coverage by a private insurer in Israel. Tourists who change their status in Israel to new immigrant or temporary resident through the Ministry of the Interior (Misrad HaPnim) can arrange for coverage through one of the health funds upon presentation of their te udat oleh or te udat zehut. Note: For more information on status, and assistance to new immigrants, consult the Guide for the New Immigrant, available from the Publications Department (see the order form at the back of this booklet). 18 Health Services in Israel

19 Individuals Not Registered with a Health Fund Those who do not register with a health fund, and are in need of immediate medical care, are assigned to a health fund by the Director General of the Ministry of Health, or by an appointee of the Director General. Payment of Health Insurance Premiums According to law, payment of Health Insurance premiums is mandatory for every person over the age of 18. The rate of payment is on a progressive scale according to income, up to a certain limit. Persons who work for an employer have their Health Insurance premiums deducted by the employer at the same time as National Insurance premiums. The self-employed or unemployed must make arrangements directly with the National Insurance Institute. Certain categories of individuals are exempt from paying premiums, or pay premiums at a minimal rate. These include, in most cases, married women (housewives) who do not work outside their home, soldiers in regular, compulsory service, and recipients of specific types of National Insurance Institute allowances. For details, consult with the National Insurance Institute. Those who receive National Insurance Institute old-age pensions pay a standard, minimal health insurance fee, which is deducted from their pension. For more information, contact the National Insurance Institute, or consult with one of the English-speaking immigrant associations. See Useful Addresses. Information is also available from the National Insurance Institute website: Consult also the booklets entitled Pensioners, and the National Insurance Institute, available from the Publications Department. See the order form at the back of this brochure. Health Services in Israel 19

20 Note: in most cases, non-payment, or delay in payment, of Health Insurance premiums, do not affect eligibility to receive health services from a health fund according to the list of items included in the Basket of Health Services. Programs for Additional Health Services The National Health Insurance Law enables each of the four health funds to present supplementary insurance plans to their members, which offer items that are not included in the basic Basket of Services. Any member of the health fund may join a supplementary plan, regardless of age or state of health. The fees are uniform according to age group and not related to health conditions. Some plans have lower rates for families. The Law forbids the health funds to require their members to join the supplementary plan, and the funds are equally forbidden to link eligibility for services from the basic Basket of Health Services to membership in a supplementary plan. Eligibility to receive services through a supplementary health insurance plan is subject to a waiting period; at the end of the waiting period, members can receive all services included in the plan. Every health fund member is entitled to receive a copy of the fund s supplementary insurance plan. Consult with the health funds for details of their plans. Information is also on the health fund s websites. See Useful Addresses. The health funds currently offer two different plans that provide varying levels of coverage basic and comprehensive. Membership in the more comprehensive plan involves membership in the basic plan, and fees are for both. The fees for items covered by the plans generally involve a degree of participation by the member. Note that the law does not require the health funds to cover the cost of chronic-care hospitalization. 20 Health Services in Israel

21 The Ministry of Health funds chronic-care hospitalization on a limited basis, which requires some participation by the patient or their family. Some of the health funds offer chronic-care insurance plans for an additional fee, but in many cases, insurance for chronic-care is usually through private companies. The Ministry of Finance, and not the Ministry of Health, supervises these plans. Emergency Services During an emergency, there are a number of options, including: The Health-Fund Information Lines: each health fund has a 24- hour information line that members can call for advice. The health fund can recommend options such as a house-call from a doctor or a visit to an emergency room. The information line can also advise callers about the costs of treatment and refer them to the appropriate source of assistance. Emergency Clinics - emergency clinics such as Magen David Adom (MDA) stations or Terem receive patients for a fee, and generally operate during hours in which regular health-fund clinics are closed. The telephone information lines of the health funds, and the health-fund websites, provide information about the clinics associated with the fund. The local municipal information line (105/6/7) should also have information about the nearest emergency clinic. Magen David Adom clinics are located throughout the country, and provide around-the-clock first aid and emergency services, seven days a week. Their telephone number is 101 in most cities and towns. For the address of the nearest station, contact your local municipal information line or visit the MDA website: United Hatzala ( provides first-response emergency medical care, at no charge, by trained volunteer Health Services in Israel 21