The first time I was offered to buy health insurance in Israel, I pushed it aside. Isn’t everyone covered for everything here? Well, kind of, but not exactly. This post seeks to explain the different levels of insurance in the country and what kind of coverage each layer provides.
Level One: Bituach Leumi (through your Kupat Cholim): Thank God, Israel is a first rate western country that provides an extraordinary level of medical care for all of its citizens. If an emergency comes up, you can go to the hospital and pay nothing. When you need to see a doctor, you can just sign up online and the cost is very small co-pay. Most medicines are subsidized, as are surgeries and other treatments. But there are still some things that aren’t covered. Instead, they are covered by the next two layers:
Level Two: Additional Health Insurance through Kuppat Cholim: If you have something like Magen Zahav of Meuhedet Adif, you have what is called shaban (שב”ן – שירותי בריאות נוספים). Shaban covers you for additional medicines that affect quality of life (ie treating a kidney stones in a way that hurts much less). Shaban cannot offer any additional protection for anything that can save your life. For that, you’ll have to turn to…
Level Three: Private Health Insurance: Almost all the insurance companies in Israel (not kuppot cholim) offer private health insurance. There are usually three levels: The lowest level of this insurance covers you for a certain amount towards transplants and surgeries abroad in the case of emergency. The next level offers a slightly higher level that covers a wider range of emergencies not covered by kupat cholim, as well as certain quality of life treatments as well. This level is usually called something like mashlim shaban – since it complements (להשלים) the insurance offered by the shaban – where the shaban pays for a part, the private insurance picks up the rest of the tab. The highest level covers a large plethora of emergencies and illnesses and pays you irrespective of whatever is covered by kupat cholim and the shaban (in fact, sometimes it will pay you extra for having gone through something, even if the shaban paid for it as well). Just to be clear, while almost all insurance company have the three kinds of programs above laid out above, there are variations; some cover more of X, some exclude Y, but the structure still holds.
In addition to the basic insurance laid out above, there are several kinds of “riders” or mini-policies which you can stick on your medical policy. Below is an outline of the five most common types and which ones I think are worthwhile:
1) Ambulatory – this covers preventative medicine, including check-ups, CTs and MRI. Of all the riders, I consider this to be the most worthwhile. It does cost a bit more, it does not cost nearly as much as…
2) Alternative medicines – if you’re a naturalist or hippy, go for it. If not, you can skip it. Of all the riders, this is usually one of the most expensive (because the client will probably use it for every sickness).
3) Personal doctor – this means that if you are suffering an illness, you have a personal case file and a doctor from the insurance company who monitors the progress so you know where you stand day or night. Some people consider this worthwhile, while others do not. It is a fairly inexpensive rider.
4) Expedited medicine – this rider is a hypochondriac’s dream. In the event of something wrong, you get to go to some facility or specific hospital where a team headed by someone like House MD finds what’s wrong with you and gets back to you within a few days. This rider isn’t so expensive, but most people opt to skip it.
5) A lump sum in case of contracting a specific kind of sickness (ie NIS 100,000 in case of cancer). The cost depends on how much you want the sum to be. When opting for this, and I recommend you do, opt for a sum that will allow you to get yourself and your family in order as the chaos of a sickness begins. For example, NIS 100,000 is a good amount for making sure that you are covered until disability insurance kicks in and for your family to adjust as you go through a crisis. To be clear, this money will not cover the cost of treatments abroad, as they usually cost much more than what is provided by these policies; you need to make sure the insurance covers the medical need and that this ride only covers the transition period for you and your family. If you’re wondering, this is a kind of teunot ishiyot – personal injury – insurance. In fact, the reason I am very critical of personal injury insurance generally (see last post) is that I think it should be bought in a policy like this rather than as a standalone. Buying it with this puts it in the specific context which helps the client choose the proper coverage he or she needs and doesn’t buy any unnecessary insurance.
There are dozens of other riders. Some are simple add ons, like a rider that provides a personal doctor for cancer, or a rider that ensures that all of your medical files are on a disc-on-key for immediate use when going to the hospital. There are also elaborate riders such as one that pay for a TV in the hospital, allows the sick person to order take away once a day, have his or her spouse stay at a nearby hotel and even pay for a temporary secretary to reschedule all of the person’s meeting while he or she is in the hospital. Every insurance company has its own specific riders and can choose to only allow certain riders with certain policies.
A final word on this subject. Some of you have the option of opting for additional health coverage through your work. This is usually a great idea and the cheapest way to get a good policy at a fraction of the price. A group policy includes at least 50 people at a single workplace – so you can’t just make a group out of you and your neighbours. The only downside to a group insurance policy is that you can’t add any riders that aren’t in it – you either take or leave the package.
If you have any questions about the various policies or are interested in getting some insurance for your family or a group policy for your business, feel free to contact me at firstname.lastname@example.org.