As a rule, health services provided by the HMOs under the national health insurance law, are provided within the medical services network within Israel.
The national health insurance law enables, under special circumstances, members of the HMOs in Israel to receive health services outside Israel, up to a value of US$250,000, without member copay.
In spite of the above, where the cost of the requested service exceeds US$250,000, the director general of the Ministry of Health, or whoever has been authorized by the director general (hereinafter – the director), is authorized to waive the member’s copay for the services beyond the above amount, subject to the conditions that will be listed below.
The conditions and procedures for obtaining health services outside Israel are regulated within the national medical insurance regulations (health services abroad) – 1995.
What does a “Health Service” mean?
In order for a health service to be considered a health service that may be obtained abroad, the two following conditions must both apply:
- The requested health service – is included in the basic medical services basket* under the national health insurance law.
* The basic medical services basket, as provided by the HMOs, is a list of medical services such as: examinations, treatments, medical equipment and drugs, which the HMOs are legally required to deliver to their insureds. The list of medical services is included in the second addendum to the national health insurance law – 1994 and in the national health insurance directive (drugs included in the medical services basket) – 1995.
- And it also falls under one of the following medical specializations:
- Cerebral and nervous system
- Cardiovascular diseases
- Organ transplants
- Congenital defects
In which cases can the health services be provided abroad?
If the health service you need meets the two conditions above, you have a right to approach your HMO and request to obtain the service abroad, on condition that one of the two following additional conditions applies:
- Condition A:
For this condition to apply, the following two conditions must exist:
- It is not possible to obtain the health service you need in Israel, nor is an alternative service available.
- If the requested service will not be provided, your life will be put at risk.
- Condition B:
Even if the conditions specified in Condition A do not apply, you have a right to obtain the service abroad if there is an unusual medical circumstance.
As a rule, an unusual medical circumstance will apply in a case where there is a risk that an organ or a sense will be damaged, even if this does not amount to a life-threatening situation, should the requested service will not be delivered, and if the medical service you need, or the alternative service, cannot be provided in Israel.
It is hereby emphasized that scarcity of experience in Israel at providing a specific medical health service does not amount to an unusual medical circumstance justifying the obtaining of the service abroad.