When an emergency room visit is payment-exempt according to the State Health Insurance Law, the medical center (branch) does not need to be contacted a financial authorization. The hospital will bill Maccabi directly for the ER visit. If the hospital requests a financial authorization from Maccabi or needs to verify eligibility after the ER visit, you’ll need to provide the medical center with a doctor's referral (if available) and a discharge summary from the ER (copies are accepted). The documents will be reviewed, and based on the reason, Maccabi will issue an authorization and determine if a deductible is required. The medical center will contact you within three working days from when the documents are received If you were referred to the ER from a Maccabi center and subsequently hospitalized, you will receive a credit for the fee paid at the Maccabi center. To request a refund, submit the following documents to Maccabi: an invoice and receipt from the medical center, a summary of your visit indicating the referral to the hospital, and a hospital discharge letter.

Emergency room visits

Q: How much does it cost?

Acute dyspnea - Partial deductible approval requires oxygen saturation levels below 90 or IV treatment in the ER. For these instances, partial deductible approval requires that the ER visit fell outside Maccabi clinics' and emergency centers' operating hours : Visiting the emergency room between 11:00 p.m. and 6:00 a.m. for reasons not qualifying for full exemption. A person with known heart disease experiencing chest pains. Asthma attack (during Maccabi medical centers' operating hours). Renal colic necessitating IV treatment in the ER CT or MRI in the ER Diagnosed and symptomatic arrhythmia Second-degree burn in children up to age 3, irrespective of body area percentage Second-degree burn covering 10% of the body or more, ages 3-18, Abdominal injury during pregnancy, from week 20 onwards Under these circumstances, a deductible of NIS 249 is required, subject to Ministry of Health pricing changes Payment is made to Maccabi , for the coverage of the hospital visit If you visit the ER between 6:00 in the morning and 23:00 at night without a doctor's referral, and not for a legally exempted reason,, you’ll need to pay the full NIS 1,110 fee according to pricing set by the Ministry of Health.

Who is eligible?

Individuals who visited the emergency room in cases exempted or partially covered by the Ministry of Health and Maccabi.

What does Maccabi provide?

Partial or full coverage, based on the specific case.

How much does it cost?

Visits exempt from payment

Additional cases eligible for exemption - within Maccabi	Exemptions from payment within the health plan	Reason for visiting the ER
An individual who declined hospitalization despite the ER's decision An individual transferred from one hospital's ER to another and subsequently hospitalized, provided the transfer was based on the hospital staff's decision, not the individual's	An individual who visited the ER and was hospitalized, regardless of whether they had a prior authorization or doctor's referral	Hospitalization
A doctor’s referral from a Maccabi medical center or center affiliated with Maccabi. A telephone referral from a Maccabi doctor, issued prior to the the ER visit. A referral from a Tyto doctor. A referral from a Maccabi nurse, issued before the ER visit, in urgent cases where no doctor was available and immediate attention is needed. Referral from a nurse at the Maccabi Nonstop Call Center outside of clinic hours - valid if the individual arrives at the ER within 24 hours of the referral.	A doctor's referral and/or an authorization (within 24 hours of issuance). The exemption remains valid even if the individual was not hospitalized A doctor's referral issued at a home visit, from an entity affiliated with Maccabi.	Referrals to the ER
Applies for evacuation by intensive care ambulance only	Exemption is not granted within the health plan	Ambulance transport to the emergency room
Dislocation of any joint, excluding fingers and toes Dentoalveolar injury requiring immediate re-implanting of the tooth (e.g., dislodged or seriously displaced tooth).	Fresh fracture Acute shoulder or elbow dislocation An injury necessitating stitches, dermal adhesive, or other related methods Jaw dislocation	Fractures and injuries
Foreign object ingestion (when Maccabi's medical centers and urgent care centers are closed) Toxic substance ingestion (when Maccabi medical centers and urgent care centers are closed)	Inhalation of foreign object into respiratory tract	Foreign objects or toxins
	Third-degree burn	Burns
Chemical eye burn	Foreign object in the eye	Eyes
Lack of fetal movement from the 28th week onwards - as diagnosed by a doctor Heavy bleeding during pregnancy	Contractions	Pregnancy and childbirth
	Sudden high fever (above 38.5 °C) - infants up to two months old (60 days) Head injury - babies up to 2 years old	Babies
Acute urinary retention requiring catheterization	Medical care in the ER for the following conditions: Cancer Hemophilia Cystic fibrosis (CF) Familial dysautonomia Dialysis patients	Medical care in the ER
	Sexual violence victims Domestic violence victims	Victims of violence
	An acknowledged victim of terror or related violence, on the day of the injury and up to 72 hours from the incident	Victims of terrorism or military hostilities
	Work accident - a victim of a work accident with confirmation from their employer (Form BL 250 or BL 283), provided they visit the emergency room within 7 days of the injury. Traffic accident - ER visit within 48 hours of the accident. Exemption will be granted upon presentation of a police verification Traffic accident - ER visit within 3-7 days of the accident. Exemption will be granted if the visit is necessitated by the accident. A police verification indicating the victim's presence at the accident and a discharge sheet from the emergency room are required Traffic accidents - ER visits from 8 days after the accident onwards: Exemption will be granted if the visit is accident-related and during hours normally requiring fees (11:00 p.m. to 6:00 a.m.), or if there's medical justification for the ER visit. Student accident - injury at school or during a school trip. Exemptions are subject to a confirmation submitted by the school	Accidents
Emergency room visits at a general hospital in the following cases: Suicide/attempted suicide Psychosis/psychotic states Severe side effects of medication/suspected poisoning	Emergency room visits at a general hospital in the following cases: On the order of a district psychiatrist or according to a court order in criminal proceedings, as per the Treatment of the Mentally Ill Law. Emergency room visits at a psychiatric hospital: An individual who is referred to or refers themselves to an ER in a psychiatric hospital.	Psychiatric ER
A police officer injured while on duty A police officer referred by the police or the prison service	A detainee in detention for up to 12 months - evacuated to the emergency room from the detention center and hospitalized. A detainee in detention for up to 12 months - evacuated to the emergency room with a doctor's referral.	Police and prison service
Convulsions from high fever (when Maccabi medical centers and urgent care centers are closed) Severe allergic reaction requiring IV infusion and/or following Epipen injection	Life-threatening allergic reaction	Allergy attacks or severe allergic reactions
Asthma attack (when Maccabi medical centers and urgent care centers are closed)		Asthma attacks
	Head injury - ages 2 and under Head injury - ages 70 and up	Head injuries
Animal bite - only if a rabies vaccine was administered at the ER When the health bureau is closed: animal bite	Snake bite Scorpion bite	Snake or animal bites
Post-operative bleeding (up to 10 days after in-hospital surgery) Fixing a cast applied the previous day (when the Maccabi medical centers and urgent care centers are closed)		ER visits after medical treatment
Type 1 diabetic patient with hypoglycemia - blood sugar levels below 60 units		Diabetes
Epileptic episode when Maccabi medical centers and urgent care centers are closed	An epileptic episode in a diagnosed epilepsy patient	Epilepsy
	Emergency evacuation to the ER via Magen David Adom ambulance due to a sudden incident	Evacuation from a public area

An individual who declined hospitalization despite the ER's decision
An individual transferred from one hospital's ER to another and subsequently hospitalized, provided the transfer was based on the hospital staff's decision, not the individual's

An individual who visited the ER and was hospitalized, regardless of whether they had a prior authorization or doctor's referral

Hospitalization

A doctor’s referral from a Maccabi medical center or center affiliated with Maccabi.
A telephone referral from a Maccabi doctor, issued prior to the the ER visit.
A referral from a Tyto doctor.
A referral from a Maccabi nurse, issued before the ER visit, in urgent cases where no doctor was available and immediate attention is needed.
Referral from a nurse at the Maccabi Nonstop Call Center outside of clinic hours - valid if the individual arrives at the ER within 24 hours of the referral.

A doctor's referral and/or an authorization (within 24 hours of issuance). The exemption remains valid even if the individual was not hospitalized

A doctor's referral issued at a home visit, from an entity affiliated with Maccabi.

Referrals to the ER

Applies for evacuation by intensive care ambulance only

Exemption is not granted within the health plan

Ambulance transport to the emergency room

Dislocation of any joint, excluding fingers and toes
Dentoalveolar injury requiring immediate re-implanting of the tooth (e.g., dislodged or seriously displaced tooth).

Fresh fracture
Acute shoulder or elbow dislocation
An injury necessitating stitches, dermal adhesive, or other related methods
Jaw dislocation

Fractures and injuries

Foreign object ingestion (when Maccabi's medical centers and urgent care centers are closed)
Toxic substance ingestion (when Maccabi medical centers and urgent care centers are closed)

Inhalation of foreign object into respiratory tract

Foreign objects or toxins

Third-degree burn

Burns

Chemical eye burn

Foreign object in the eye

Eyes

Lack of fetal movement from the 28th week onwards - as diagnosed by a doctor
Heavy bleeding during pregnancy

Contractions

Pregnancy and childbirth

Sudden high fever (above 38.5 °C) - infants up to two months old (60 days)
Head injury - babies up to 2 years old

Babies

Acute urinary retention requiring catheterization

Medical care in the ER for the following conditions:

Cancer
Hemophilia
Cystic fibrosis (CF)
Familial dysautonomia
Dialysis patients

Medical care in the ER

Sexual violence victims
Domestic violence victims

Victims of violence

An acknowledged victim of terror or related violence, on the day of the injury and up to 72 hours from the incident

Victims of terrorism or military hostilities

Work accident - a victim of a work accident with confirmation from their employer (Form BL 250 or BL 283), provided they visit the emergency room within 7 days of the injury.
Traffic accident - ER visit within 48 hours of the accident. Exemption will be granted upon presentation of a police verification
Traffic accident - ER visit within 3-7 days of the accident. Exemption will be granted if the visit is necessitated by the accident. A police verification indicating the victim's presence at the accident and a discharge sheet from the emergency room are required
Traffic accidents - ER visits from 8 days after the accident onwards: Exemption will be granted if the visit is accident-related and during hours normally requiring fees (11:00 p.m. to 6:00 a.m.), or if there's medical justification for the ER visit.
Student accident - injury at school or during a school trip. Exemptions are subject to a confirmation submitted by the school

Accidents

Emergency room visits at a general hospital in the following cases:

Suicide/attempted suicide
Psychosis/psychotic states
Severe side effects of medication/suspected poisoning

Emergency room visits at a general hospital in the following cases:
On the order of a district psychiatrist or according to a court order in criminal proceedings, as per the Treatment of the Mentally Ill Law.
Emergency room visits at a psychiatric hospital:
An individual who is referred to or refers themselves to an ER in a psychiatric hospital.

Psychiatric ER

A police officer injured while on duty
A police officer referred by the police or the prison service

A detainee in detention for up to 12 months - evacuated to the emergency room from the detention center and hospitalized.
A detainee in detention for up to 12 months - evacuated to the emergency room with a doctor's referral.

Police and prison service

Convulsions from high fever (when Maccabi medical centers and urgent care centers are closed)
Severe allergic reaction requiring IV infusion and/or following Epipen injection

Life-threatening allergic reaction

Allergy attacks or severe allergic reactions

Asthma attack (when Maccabi medical centers and urgent care centers are closed)

Asthma attacks

Head injury - ages 2 and under
Head injury - ages 70 and up

Head injuries

Animal bite - only if a rabies vaccine was administered at the ER
When the health bureau is closed: animal bite

Snake bite
Scorpion bite

Snake or animal bites

Post-operative bleeding (up to 10 days after in-hospital surgery)
Fixing a cast applied the previous day (when the Maccabi medical centers and urgent care centers are closed)

ER visits after medical treatment

Type 1 diabetic patient with hypoglycemia - blood sugar levels below 60 units

Diabetes

Epileptic episode when Maccabi medical centers and urgent care centers are closed

An epileptic episode in a diagnosed epilepsy patient

Epilepsy

Emergency evacuation to the ER via Magen David Adom ambulance due to a sudden incident

Evacuation from a public area

Visits with reduced fees

Acute dyspnea - Partial deductible approval requires oxygen saturation levels below 90 or IV treatment in the ER.

For these instances, partial deductible approval requires that the ER visit fell outside Maccabi clinics' and emergency centers' operating hours:

Visiting the emergency room between 11:00 p.m. and 6:00 a.m. for reasons not qualifying for full exemption.
A person with known heart disease experiencing chest pains.
Asthma attack (during Maccabi medical centers' operating hours).
Renal colic necessitating IV treatment in the ER
CT or MRI in the ER
Diagnosed and symptomatic arrhythmia
Second-degree burn in children up to age 3, irrespective of body area percentage
Second-degree burn covering 10% of the body or more, ages 3-18,
Abdominal injury during pregnancy, from week 20 onwards

Under these circumstances, a deductible of NIS 249 is required, subject to Ministry of Health pricing changes Payment is made to Maccabi, for the coverage of the hospital visit

Visits requiring full payment

If you visit the ER between 6:00 in the morning and 23:00 at night without a doctor's referral, and not for a legally exempted reason,, you’ll need to pay the full NIS 1,110 fee according to pricing set by the Ministry of Health.

Where is the service provided?

At all emergency rooms.

Next steps

Financial authorization

When an emergency room visit is payment-exempt according to the State Health Insurance Law, the medical center (branch) does not need to be contacted a financial authorization. The hospital will bill Maccabi directly for the ER visit.
If the hospital requests a financial authorization from Maccabi or needs to verify eligibility after the ER visit, you’ll need to provide the medical center with a doctor's referral (if available) and a discharge summary from the ER (copies are accepted). The documents will be reviewed, and based on the reason, Maccabi will issue an authorization and determine if a deductible is required. The medical center will contact you within three working days from when the documents are received

Refunds

If you were referred to the ER from a Maccabi center and subsequently hospitalized, you will receive a credit for the fee paid at the Maccabi center. To request a refund, submit the following documents to Maccabi: an invoice and receipt from the medical center, a summary of your visit indicating the referral to the hospital, and a hospital discharge letter.

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Additional information

Medical treatment provided in emergency rooms incurs a fee based on pricing set by the Ministry of Health. The Ministry of Health has specified cases that are fully or partially exempt from payment.
Before visiting the emergency room, it's recommended to seek treatment at Maccabi's emergency care centers or consult a Maccabi Nonstop Call Center nurse via phone at *3555.
If the hospital visit is not due to an emergency, there is no requirement to go through the emergency room.