It's important to understand payments within the healthcare system, and what you are entitled to, in order to best access your benefits and make the best healthcare, and financial decisions for your family. Below is an overview of payments and some choices available to you within the Kupot Cholim.
You Do Not Pay The Kupah for the Basic Basket
We've summarized the Basket of Health Services here, but it is important to remember:
1. The Kupot Cholim provide the government's package of basic healthcare services, which include: doctor visits, laboratory services, imaging, hospitalization, rehabilitation, paramedical (speech, occupational and other therapies), prescriptions, and medical equipment.
2. You do not pay your Kupat Cholim for this insurance coverage (except for co-pays). The basic coverage is automatic when you sign up as a member to any Kupat Cholim. The funding comes out of your payments to Bituach Leumi (National Insurance Institute).
You Do Pay for Supplementary Health Insurance (SHABAN)
Each Kupat Cholim offers 2 levels or tiers of supplemental insurance (see below), which you can acquire by paying a monthly fee. The cost of supplemental insurance is based on your age bracket, ranging from just 10 NIS per month for young children, and up to 200 NIS per month for those over 80. These additional benefits are regulated by The Ministry of Health, and can not deny for pre-existing conditions. There are many additional and worthwhile benefits you can receive with supplemental insurance. For an extensive list read our article all about supplemental insurance.
Level 1 - Gold
Level 2- Platinum
Level 1 - Gold
Level 2 - Sheli
Level 1 - Adif
Level 2 - C
Level 1 - Silver
Level 2 - Gold
It is important to note that when one purchases the higher level (Level 2), it includes all the benefits of the lower level (Level 1) of supplemental insurance. You can not exclude the cost or benefits of Level 1 when acquiring Level 2 of supplemental insurance.
Your Kupah Has Doctor and Facility Choices Without Going Private
- Your Kupah has a directory of physicians that are considered "within the kupah". This directory is on the kupah website or app (in Hebrew) and is accessible through the 24-hour hotline representative, or your local branch secretary.
- You can use this directory to find doctors or specialists.
- Many family doctors can see you within a day or 2, sometimes on the same day.
- Specialists can have longer wait times, but if you find multiple options from the kupah directory, you can "shop" for the best appointment.
- Finding a facility or clinic that is not "within the Kupah" is still an option even without using your private appointment supplemental benefits, especially if the Kupah does not have a good alternative (within a reasonable time and distance). Request a Hitchayvut from your kupah.