What is the National Health Insurance Law?
The National Health Insurance Law came into effect in 1995 and defines the State’s responsibility to insure all its residents
Medical Services
All Health Funds are obligated to provide a uniform basket of services, defined by law, to their members. Maccabi Healthcare Services offers its members additional healthcare services beyond the Basket defined by law (under various fee-based arrangements).
Medications and vaccinations
By law, the Ministry of Health and Ministry of Finance determine the medications covered in the basket of services, and are exclusively authorized to amend what is offered. The health funds may offer additional medications in their basket, subject to the Ministries’ approval.
Payment ceiling for patients with chronic illness
For patients with chronic illnesses (defined according to a list drafted by the Ministry of Health), there is a maximum co-payment on medications included in the basket and Maccabi’s medication list.
Health insurance contribution payments to the National Insurance Institute
Health insurance contributions are defined by law and are collected by the National Insurance Institute, without any connection to an individual’s Health Fund membership.
Medical service co-payments
Health funds may charge members co-payments on specific medical services in the basket, subject to approval by the Knesset Finance Committee. Co-payments may be paid in cash or by standing order. Co-payments apply to appointments with therapists or physicians, appointments in medical clinics, hospital out-patient departments, emergency room visits in specific circumstances, and medications.
Co-payment discounts and exemptions
The law defines several circumstances that merit exemption from co-payments, based on welfare-related criteria. The National Insurance Institute notifies Maccabi of categories eligible for discounts and exemptions. To obtain a discount or an exemption on medical grounds, apply with the relevant medical documents at your nearest Maccabi branch for further information.
Please note:
If paying by standing order, co-payments are calculated automatically, up to the payment limit. Members can make this arrangement at the physician’s office or Maccabi branches.
Members who do not have a standing order should retain their original receipts. If the amounts exceed your co-payment limit, you should submit the receipts at a branch and file for reimbursement.
