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Why Do I Need Private Health Insurance in a Socialized Medical System?

Israel boasts one of the world’s best socialized healthcare systems and yet, many Israelis choose to pay extra for private insurance policies to supplement the government-sponsored plans. If the quality of medical care is high, how come so many opt to spend extra?

The Israeli healthcare system works through four major insurance carriers (HMOs): Maccabi, Meuchedet, Leumit, and Clalit. When you sign up to the HMO (kupat cholim) you must join one of these four companies to receive basic medical coverage. The base insurance plan is paid to Bituach Leumi (The National Insurance Institution). The package includes many services such as doctor visits, prescription medications, preventative medicine, and prenatal care, and is offered to everyone regardless of age or pre-existing conditions.

There are some services which the basic insurance package does not cover completely. For instance, while HMOs cover emergency surgeries, elective surgeries are more complicated. Elective surgeries are based on the public system, which lead to long wait periods when they are covered. Alternatively, many elective surgeries are covered on a private basis via the Mashlim package of the HMO, where they are limited to surgeons that are a part of the HMO’s network and are not covered 100%. 

Each of the four major medical insurance companies offers optional, supplementary insurance services on top of your basic coverage. These plans include extra services such as subsidized dental care, financial assistance in receiving non-essential surgeries such as laser eye procedures, optometric coverage, and access to various therapies. There are also many reimbursement programs for privileges such as visiting a private doctor outside of the company’s network and postnatal care as well as some additional medications. While these supplemental insurance plans offer more than the basic insurance plans, they don’t cover everything.

For the most comprehensive coverage, private health insurance is a necessity. Private health insurance provides you access to a wider range of services, truly supplementing where the HMO plans are lacking, and assuring security in the event of unexpected medical eventualities. There are many different types of private health plans, but the majority offer a broader range of coverage options for: overseas treatments, organ transplants, surgeon, medications, cancer management packages, critical illness cover, ambulatory care and personal accident coverage, alternative treatments and preventative health services such as dieticians, gym memberships, tobacco and alcohol addiction programs.

The most current Health Basket was just released, and while many important medications are added every year, the limited allocated budget allows for only a fraction of the submitted treatments to be added. For medications not included in the basket, private health insurance is crucial. 

One of the most important features of private insurance is the help afforded in strenuous or emergency circumstances. People throughout the world wait for months, sometimes even a year or more, for organ transplants, but if you have private insurance in Israel, you can receive special attention during the wait period, procedures, and recovery. You may even be able to opt to use a private hospital where there is more individualized care and many more comforts and amenities.

Many insurance policies offer the option to include financial aid to families in times of medical difficulties, via a critical illness policy. For example, patrons of certain premium plans are given a financial help package when there is a critical illness diagnosis to be used to relieve the financial burden to the family. This package can cover the cost of additional caregivers for the family, travel expenses to and from the hospital, or whatever other purpose you choose to use the money for. Since it is a lump-sum payout, there is no need to submit receipts – you can use the money for whatever purpose you choose.

Looking at all the potential benefits, it is quite evident why so many Israelis choose private health insurance in addition to the kupot supplemental insurance. It is important to evaluate your specific medical and financial situation to make the best possible decision. Contact us today to schedule a consultation and let us help you pick out the best insurance plan for you.

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