THE CLOCK IS TICKING – Major changes to private health policies in 2015

THE CLOCK IS TICKING – Major changes to private health policies in 2015

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

On the 24th November 2014, Dorit Salinger, the Comptroller of Capital Markets, Insurance & Savings in Israel, publicised proposed changes that will significantly impact cover for private operations, alternative procedures and consultations in Israel as of 1st May 2015.

In 2014, there was a push by then Minister for Health, Yael German, to implement reforms that would have affected both the public and private health insurance systems in Israel. With the collapse of the 19th Knesset, these proposed health reforms were put on hold. During this time, Salinger, drafted changes of her own to create a uniform policy to cover private operations, alternative procedures and consultations in Israel. As the changes that are proposed by Salinger do not need formal ministerial approval, the implementation of these reforms that will impact the private sector will take effect irrespective of the makeup of any future coalition. These drastic changes to the private Israeli health system mean that certain doctors, surgeons and medical procedures that are currently covered by comprehensive private health plans, will no longer be available as of May 2015. Some have coined this unexpected move by the Comptroller of Capital Markets, Insurance & Savings in Israel as the “socialisation of private health insurances”.

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 potential economic impact on a family not having 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 May 2015.
• 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 May 2015.
• Private policies sold before May 2015 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 May 2015.
• 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 2015 will all be subject to a deductible/excess of between 500 N.I.S – 5000 N.I.S 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 Salinger 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 May 2015, 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 May 2015 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 May 2015.

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