THE CLOCK IS TICKING – Major changes to private health policies approved for 2016

THE CLOCK IS TICKING – Major changes to private health policies approved for 2016

By Danny Newman, Branch Manager – Beit Shemesh, Goldfus Insurance

Changes that were proposed to happen over the past few months in regards to private health insurance are now scheduled to take effect as of 1^st February 2016, according to a recent release from the Ministry of Finance and the Comptroller of Insurance. These changes will impact cover for private operations, alternative procedures and consultations in Israel.

The implication to the private Israeli health system is that certain doctors, surgeons and medical procedures that are currently covered by comprehensive private health plans, will no longer be available as of 1^st February 2016.

I thought private operations were covered through the supplementary baskets of my Kupat Cholim?

Whilst it is true that the Kupot Cholim in Israel provide very good cover, there are certain elements of cover where they fall short. The private health policies fill those gaps in particular for cover related to:

• Operations
• Transplants
• Medicines not included in the government health basket

These are the three main reasons for considering private health insurance as the economic impact on a family that doesn’t have adequate cover, could be significant.

What is going to change? 

What is the advantage of purchasing a private health insurance policy before the changes come into effect?

• Cover for all private surgeons irrespective of whether or not they appear on the list of participating physicians, post February 2016.
• Policies sold through the private insurance companies are a contract as opposed to an agreement and as such, the changes will not affect policies purchased prior to February 2016.
• Private policies sold before February 2016 are based on pre-determined price schedule. Policies sold after, will be reviewed every two years and subject to increases in premium.
• A number of providers offer fixed premiums for comprehensive health insurance plans for children, saving them thousands of shekel over the lifespan of the policy. The comprehensive fixed plan policies will no longer be available as of February 2016.
• Certain plans are available that cover the cost of an operation or procedure in its entirety with no co-payment made by the insured. Plans purchased after 2016 will all be subject to a deductible/excess dependent on the type of procedure and assuming that it is covered in the first place.
• In light of the impending changes, a number of companies are offering sizable discounts to make the decision making process a little easier.

*There are a number of different types of plans with the various insurance companies. Cover is subject to terms and conditions of the policy.

What disadvantages are there to these changes?

Certain doctors/specialists who are top of their field, may decide not to be part of the closed list of “participating” surgeons, resulting in people having to pay out of pocket to see them. As such, these doctors will be able to set the price tag at whatever amount they see fit, without needing to adhere to regulations set by the changes.

The main disadvantage with the changes is that by standardising the cover for private operations, alternative procedures and consultations, there will no longer be the option to receive a higher level of care on policies as of February 2016, without dipping into your own pocket.

What if I have a collective private policy through my employer/union?

A number of large companies and unions offer collective private health insurance at discounted rates. The policies are usually designed to renew once every 5 years to allow the insurance provider to change the terms & conditions of the policy, or to allow the company or union to change the insurance provider.

At the moment the insurance providers of collective private health policies promise “Retzef Bituachi” (guaranteed insurability). This means that should the insurance company renew the policy to a different type of plan, one can continue the group plan in its new guise irrespective of pre-existing medical conditions that may have subsequently developed. Additionally, should one leave their job, the guaranteed insurability clause gives the individual a small window of opportunity to continue the policy on a private basis, according to the terms and conditions that may apply at that specific point in time. There is no guaranteed premium schedule which means that premiums may be significantly more expensive than the collective discounted rates.

The renewal and continuation of collective private health plans will become problematic after 1^st February 2016 as the only policies that will be available will be the new uniform policies.

What should be my next step?

The next step should be to contact your insurance agent or find one that you trust, and discuss the private health insurance options available to you, taking into consideration your current health status, as well as other personal particulars. There are a range of surgery plans which vary in the cost of premium and level of coverage. Those who do not purchase a private health insurance policy before the changes take effect; will not be able to purchase the more comprehensive private policies currently available as of February 2016.

For more information about private health insurance contact us today!