The Israeli health care system provides universal coverage to all legal residents. It is financed through taxes and administered through one of four health funds (Kupat Cholim) that are non-profit. The health funds provide a standard basket of services including primary and specialist care, hospitalization, medications, and some rehabilitative services. Supplementary private insurance can cover additional services like dental, mental health, and long term nursing care. New immigrants have immediate access to coverage without limitations. The system emphasizes preventative care through services like mother/baby clinics and relies on primary care physicians as care coordinators.

1. Navigating the Israeli
Health Care System
March 2015

2. The Israeli Health Care System
 Health insurance for all Legal
Residents
 Government determines the basket of
services “sal habriut”
 Tax based sliding scale: graduated tax
on salary paid to Bituach Leumi
 6-12 months free membership as an
Oleh (if not in employment)

3. Rights to Health Care Coverage
for New Immigrants
 NO age limitation
 NO health limitation/pre-existing
illness exclusion
 NO waiting period
 ALL are covered by the Israeli
National Health Service

4. Israeli Health Funds
 Choice of 4 Health Funds
(Maccabi, Clalit, Meuhedet and
Leumit)
 How does one decide which health
fund to join?
 It is possible to change from one plan
to another?
 How does one choose a doctor?
 How to change a doctor

5. Services Provided by the Health
Funds - Health Care Basket
 Doctors visits (primary care and specialists)
 Blood tests
 Imaging studies (US/X-RAY/CT/MRI)
 Hospital admissions and surgeries
 Paramedical treatments
(physiotherapy/OT/ST)
 Medications (15% co-payment; quarterly
ceiling for patients with chronic disease;
exemption from co-pay for oncological
medications)
 Dental care and treatments for
children until aged 12

6. Services Not Included in the
Health Care Basket
 Dentistry (for patient aged 12+)
 Optometry
 Psychiatry - currently undergoing
reform
 Chronic nursing care – provided by
the state not in the Health Basket

7. Primary Care Medicine
 Family/General Medicine – emphasis on
proactive preventative medicine and
screening as well as reactive treatment
to patient’s complaints
Choice of primary care doctor:
 Dependent on health fund
 Maccabi and Meuhedet
(free choice)
 Leumit and Clalit
(according to address)

8. Primary Care Medicine
Changing your Primary care doctor:
 Within a quarter
 Between quarters
Your primary care doctor as your case coordinator:
 A liaison between specialties and health care
providers, including assistance in the case of
urgent referrals
 Provider of referrals to support
services including:
◦ Social workers
◦ Paramedical professionals
◦ Home care team

9. Primary Care Medicine
 Pediatricians – Primary care providers
for the child population – function as
Family physicians and refer as
appropriate to the child developmental
services (assessment and treatment)
 Direct access to some specialties – with
no need for a referral:
◦ Orthopedic care
◦ Ob/Gyn
◦ Ophthalmology
◦ Dermatology
◦ ENT

10. Referrals to Specialists in
Secondary Care
 Referral by primary care physician
 Specialists located in community clinics,
medical centers and hospital outpatient
clinics
 Each Health Fund has agreements with
certain local hospitals (preferred provider
hospitals)
 If referred to hospital – a tofes 17 / hitchayvut
is necessary –
available from branch office
(telephone, fax,
via internet or in person)

11. Making an Appointment
 Online
 Telephoning the 24 hour call center
with multilingual capability
 Directly with the clinic receptionist

12. Internet Site and Services
 Information on rights and
benefits
 Health promotion
 Personal Health record
 Personal reminders
 Requests from primary
physician:
◦ Prescriptions
◦ Sick notes
◦ Referrals to blood tests
 Ordering from pharmacy
 Travel insurance

13. M-Health
 Directory with GPS
service location
 Lab results
 Medication list
 Alerts and reminders for
chronically ill
 Pregnancy management
 Physician’s mobile portal

14. Emergency and After Hours Care
 Each Kupah has somewhat different
arrangements
 24 hour help lines (staffed by medical
professionals)
 Emergency clinics :“Mokdim” – including
the network of 13 Nationwide Terem
clinics
 Home visits
 Emergency rooms in
hospitals

15. Home Care Team
 Multi-disciplinary team
 Referral by primary care doctor or
Health-fund liaison nurses in hospitals
 Short term support – acute injury or
illness
 Long term support – chronically ill
patient with decreased mobility /
functioning

16. Tipot Halav – Mother and Baby
Care Clinics
 Provides health and medical services in the field of health
promotion for pregnant women, infants and children (from
birth to age 6 years) and their families.
 Tipat Halav centers are distributed throughout Israel.
 Objectives of the service provided at Tipat Halav include:
◦ Prevention of infections diseases my means of immunization.
◦ Early detection of health problems by means of routine
examinations
◦ Guidance regarding lifestyle that improves health and prevents
diseases, such as:
Good nutrition
 Breastfeeding
 Child development
 Dental health
 Hygiene
 Safety and more

17. Child Development
 Diagnosis until aged 9: Referral forms pre-assessment
to be filled out by parent, nursery or school teacher and
pediatrician.
Treatments:
 Until aged 3: Unlimited number of treatments(health-
basket), no co-payment
 Aged 3-6 years: Maximum of 54 treatments/year, 28₪
copayment, further treatments – supplementary
insurance
 Aged 6-9 years: Maximum of 18 treatments/year, 28₪
Co-payment, further treatments – supplementary
insurance
 Aged 9-10 years: Treatments via supplementary
insurance only

18. Child Development
Special Categories:
1. Children with severe developmental
disabilities (CP, genetic disorders such as
Down’s syndrome)
 Unlimited number of treatments until aged 18
years
 According to recommendation of Specialist in
Child development
 No co-payment
2. Children with Autistic Spectrum Disorder
 Allowance of 156 treatments a year (3/week)
 Copayment – 28 . ₪

19. Supplementary Health Insurance
Additional level of the basic healthcare basket
and can include three principle types of
coverage:
 Added Insurance - Services that are not
included in the healthcare basket such as
dental care and long-term care insurance.
 Expanded Insurance - Expansion of the
services included in the healthcare basket
 Substitute Insurance - Qualitative
replacement of services provided in the
healthcare basket, such as compensation for
hospitalization expenses incurred at a private
hospital

20. Supplementary Health Insurance
 Optional
 Cost varies according to patient age
 Coverage varies between health funds
 A choice of supplementary health plans
offered
 Immediate coverage for Olim (within 3
months of Aliya)
 No exclusion criteria
 Access to benefits and rights via the
Health fund’s internet sites or brochures

21. Supplementary Health Insurance
 Subsidized medicines not included in the health basket*
 Second opinions with specialists* – ShaRaP
reimbursement with receipt and summary of visit
 Operations at private hospitals*
 Coverage of expenses for surgery and special
treatments abroad – preapproval necessary*
 IVF treatments* – beyond that included in the basic plan
 Expanded basket of prenatal testing
 Discounts on complementary health care treatments
 Discounts for a variety of medical aids and orthotics*
 Discounted dental care and treatments
 Subsidy for ambulance transportation
(*Generally preapproval required)

22. Disability Benefit Entitlement–
Bituach Leumi
 Age and residency - You are an Israeli resident, aged
18 till retirement age.
 Income – your income as a salaried employee or a self-
employed worker is under 60% of the average wage, or
under 45% of the average wage (depending on type of
impairment).
 Medical disability – an NII physician has determined a
medical disability degree of at least 60% for you, or of
at least 40% if a medical disability of at least 25% was
determined for a single impairment.
 Incapacity degree – It has been work, or
your capacity to earn a living has been diminished
by at least 50%determined that, due to your disability,
you cannot

23. Nursing Care Patients
A nursing care patient is someone of retirement age suffering from a
medical condition that requires assistance performing daily
functions:
 Getting up and lying down
 Getting dressed and undressed
 Bathing
 Eating and drinking
 Continence
 Independent mobility
A complex nursing care patient in addition to being unable to perform
daily functions, requires constant supervision by a doctor due to:
 Pressure ulcers (bedsores)
 Prolonged intravenous infusion
 Dialysis
 Chemotherapy and/or radiation therapy

24. Nursing Care Coverage
 What Nursing Care is an Israeli citizen entitled to? NII
will fund up to 18 hours of home care per week
 What do the Kupot Cholim offer you? If you have
additional coverage they will fund home care to the
value of +/-4,500 NIS per month for the first 3 years and
+/-2,800 NIS per month for the subsequent 2 years
 What is the true cost of Nursing Care? Home care can
cost +/-20,000 NIS per month. Care in a Hospital /
Institution can cost 10,000 – 25,000 NIS per month,
depending on the quality of care.
 How to cover the shortfall?
Many choose to take out a private nursing insurance
policy

25. Accessing Medical Care for the
Katin Hozer or Ezrach Oleh
Katin Hozer ?
 An Israeli citizen who left Israel before
the age of 14 with at least one parent.
Ezrach Oleh?
 An Israeli citizen born abroad to at least
one parent who held transferable Israeli
citizenship at the time of their birth.
Entitled to free health insurance from and
eligible for health services shortly after
registering with Bituach Leumi.

26. Accessing Medical Care for the
Toshav Hozer
Toshav Hozer ?
 An Israeli citizen above the age of 17 and has
resided abroad for at least two years.
The toshav hozer has 2 options for health care:
1. To pay Bituach leumi a sum of money
calculated according to period of absence
from Israel
2. To take out private insurance to
cover the period he is without health
coverage

27. How to register with Kupat
Cholim
 New Olim will have the opportunity to
register for health care upon arrival at
Ben Gurion Airport
 Changing Kupat cholim is done:
◦ Via bituach leumi internet site
◦ At the post office

28. Additional Sources of Information
 www.health.gov.il
 www.btl.gov.il
 www.kolzchut.org.il
 www.shirapranskyproject.org
 www.maccabi4u.co.il
 www.clalit.co.il
 www.meuhedet.co.il
 www.leumit.co.il

29. Thank You