Government reforms are going to change your Kupat Holim coverage; are you prepared?
By Danny Newman, Branch Manager – Ramat Beit Shemesh, Goldfus Insurance & Investment
In recent months, there has been a push by the Minister for Health, Yael German, to implement reforms that will affect both the public and private health insurance systems in Israel. In order for the reforms to take effect, the recommendations created by the German Committee must first be accepted by the government. The implementation of these reforms is gathering pace and appears to be imminent. Should they go through, it would be the biggest revolution to the Israeli health system in 20 years.
What are the reforms and how does it affect you?
The German Committee’s recommendations are as follows:
- Separating the supplementary cover offered by the Kupot Cholim (HMOs) into 3 separate elements:
- Surgeries and consultations – selecting a surgeon of your choice and having a private consultation.
- Expanding the treatments included in the Health Basket to include more medications, broader pregnancy and dental cover, as well as more extensive cover for child development, etc.
- All other “non-essential” treatments such as cosmetic and aesthetic treatments and surgeries.
- Create a uniform surgeries / health policy that would apply to both the Kupot Cholim (HMOs) as well as the private insurance companies. By doing so, the cover will be simpler. However, the following would apply:
- Deductibles / excesses to be paid at the time of surgery
- Prohibition on the sale of alternative policies that would remove or lower the deductible
- Being limited to a surgeon from a closed list of participating surgeons only
- Regulations on the discounts provided
- Variable premiums that will fluctuate based on age brackets, as well as other factors.
What disadvantages are there to these reforms?
The main disadvantage with the reforms is that by standardising the cover for both the public and private companies, there will be limited options that will enable an individual to receive a higher level of care, should they wish.
One of the biggest drawbacks is that 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 kupot cholim or private insurance companies.
Is there a solution?
The solution is simple if you take advantage of the available products before the reforms take effect. Since current private health insurance policies are a contract that cannot be changed irrespective of future reforms that come into effect, by purchasing a policy before the reforms come into place, you will be able to enjoy a comprehensive cover without the limitations that the reforms will impose on new plans sold, once the changes come into effect.
Here is a simple comparison:
|German Committee Reforms||Current private health insurance policies that provide cover for surgeries and consultations|
|Closed plan – the surgeries cover is pre-defined, standardised and subject to limitations||Cover for surgeries for any medical procedure (subject to underwriting conditions for a specific individual, and terms and conditions of the specific policy chosen)|
|Pre-determined and standard deductible on private surgeries||Coverage from the first Shekel without a deductible (according to the surgeries policy selected)|
|Changes in premiums without prior warning and without the need for your approval||Pre-determined premiums based according to age and linked to the CPI|
|Option to choose a surgeon from a closed list of participating surgeons only||Freedom to select a surgeon of your choice|
|Consultations limited to specialists from a closed list only||Freedom to consult with a specialist of your choice|
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 reforms take effect, will not be able to purchase the private policies currently available once the implementation of the reforms begin. It is important to act before the reforms take effect and research what is in your best interest, so that you don’t find yourself caught up in a system where you have little say about the extent of whom you can see and what services you can utilize.