Health insurance – three types of insurance
The first type of medical insurance is the basic health insurance that every person is entitled to in accordance with the National Health Law. The second type of health insurance is the supplementary insurance of the health funds, and the third type is private health insurance.
The State Health Law allows every member of one of the health funds to receive health services through the public health system at no financial cost in accordance with the medical services defined in the Health Insurance Law. Health services in the health funds are provided according to medical discretion, of reasonable quality and within a reasonable period of time.
Health funds offer additional supplementary services to members of the fund, such as Shaban, a monthly premium contribution. Shaban is not an insurance plan. Every member of a health fund, regardless of their medical condition, is entitled to be accepted into the health services provided by the fund. On the other hand, the health fund cannot require members to join Shaban services.
Main coverages of the Shaban
- Tests and medications that are not included in the health basket.
- A visit to a specialist.
- Surgeries in a private hospital.
- Possibility to choose the surgeon and anesthesiologist.
- Rehabilitation treatments.
- Transplants, surgeries and treatments abroad.
- Alternative treatments such as shiatsu, acupuncture, and more.
Private health insurance provides more extensive coverage than the supplementary insurance provided by health insurance funds. Purchasing a private insurance policy ensures that in the event of illness or any other medical treatment, you will have all the financial resources required to carry out the treatment.
The price of the policy is determined by the insured’s age, health status, and family situation. The product basket provided by the policy differs, although, from one insurance company to another, but the main coverages are similar in the companies’ various plans and include: transplants, surgeries, and special treatments abroad, medications that are not included in the health basket, outpatient services other than during hospitalization, consultations with specialist doctors, insurance to finance dental treatments, insurance for medical coverage in the event of serious illnesses, insurance for nursing care coverage, physiotherapy treatments, and more.
Things you need to know before you buy private health insurance
To properly understand the insurance policy you are about to purchase, you must understand the following concepts:
- Double insurance is a situation in which the insured has several coverages for the same insurance event, such as coverage under the Shaban, coverage under private insurance, or coverage with different providers of several insurance companies.
- Medical Underwriting – Medical underwriting is the process of performing a risk assessment on an insurance candidate and determining the level of risk that the insurance company will take. The underwriting process consists of two stages, the stage of receiving information about the candidate’s medical condition and weighing the information to determine and assess the risk inherent in each medical condition.
- An exclusion is the removal of a section from coverage in a health policy based on a pre-existing medical condition. These are sections under which the insured will not receive coverage for certain situations arising from the insured’s health condition.
- A qualifying period is a period that must elapse from the date of joining the insurance until entitlement to insurance benefits is achieved. During the qualifying period, the insured will not be entitled to insurance benefits. The qualifying period is a tool through which insurance companies can avoid paying insurance benefits when the insured event occurred close to the date of commencement of the insurance.
- A health declaration is a statement in which the insured must report their medical condition to allow the insurance company to assess the medical risk. It is important to provide reliable and up-to-date information, as incomplete information may prevent you from receiving compensation in the future in the event of illness or any medical treatment.
There are three types of coverage in private health insurance:
- Supplementary coverage – coverage that supplements the coverage provided under the Health Insurance Plan. When the insured requires medical treatment that is included under the Health Insurance Plan or under the basic medical insurance, the insurance company will offset the payments the insured received from the health insurance fund and will pay only for the services and the portion that the health insurance fund did not pay.
- Replacement coverage – coverage that replaces the coverage provided in the general insurance basket or the Shaban. Replacement coverage expands the services included in the basic basket or the Shaban.
- Additional coverage – coverage that is not included in the basic health basket or the health insurance plan.
The type of coverage is determined within the framework of the contract between the insured and the insurance company and is conditional on the payment of a medical premium and medical underwriting. Unlike health funds, insurance companies are not required to insure people with complex and problematic medical histories.
There are two types of health insurance policy, a private insurance policy and a group insurance policy.
- The private insurance policy – this is a policy signed between the insurance company and each insured person individually.
- Group health insurance is a contract concluded between the insurance company and a group of insured persons. The agreement is for a fixed period of time, usually between three and five years.
How to choose a private health insurance policy?
It is important to check what your needs are and what coverages you require depending on the health condition of each insured. The insurance policy is structured in a modular manner and each insured can choose the coverages they wish to insure.
It is worth knowing that premium payments for health insurance are long-term payments, as soon as you stop them, you will lose all your medical rights. Check the amount of the required premium, compare the different insurance companies, based on equal data, and make a financial calculation of what premium price you can afford in the long term. Also check the amount of the deductible when activating the insurance.
If you have Shaban insurance, check what coverage it provides and avoid double coverage so as not to pay twice.
When you purchase a private health insurance policy, pay attention to the product basket that the policy contains. You should also carefully read the fine print, such as whether the insurance includes coverage for the cost of a private surgeon, the cost of hospital coverage, a private operating room, private anesthesiologists, medications and medical tests not included in the health basket, transplants abroad, treatments that cannot be performed in Israel, emergencies and serious medical events, and more. Pay attention to the maximum amount of coverage.
It is important to check the professional level of the hospital and clinics included in the arrangement with the insured. Carefully review the list of doctors and check whether the list includes senior and well-known doctors.
It is important to read the exclusions section carefully. This section is usually written in small print, but its importance is great.
An important item is long-term care insurance. In addition to the existing long-term care insurance within the Shaban framework, it is also worth purchasing long-term care insurance within the framework of private insurance to enable the best care in long-term care situations.
In conclusion,
Private health insurance often proves to be a life-saving medical insurance. It comes into play when basic insurance is insufficient and when the client is required to incur high expenses for medications, treatments, diagnostics, etc. The insurance guarantees professional, fast, and effective medical care in complex and difficult health situations. It is a worthwhile investment in both the long and short term.
The importance of mental health
Mental health is an integral part of our overall health. In the modern era, when pressures and challenges are increasing, it is important to also emphasize mental health. Mental problems can affect our quality of life, our social relationships, and our physical health.
How to maintain mental health?
- Maintain a healthy routine: exercise, proper nutrition, and sufficient sleep.
- Find time for fun activities: hobbies, sports, trips with family and friends.
- Develop social connections: conversations with friends, family, or support groups.
- Learn relaxation techniques: meditation, yoga, deep breathing.
- Seek professional help if necessary: psychologists, psychiatrists or counselors.
summary
Good health is not just the absence of disease, but also mental well-being. Investing in mental health is an investment in our future, and it can significantly improve our quality of life.
The future of healthcare in Israel
Healthcare in Israel faces many challenges, such as population growth, technological advancements, and the need for more advanced medical services. In order to ensure the quality of services, continuous investment in healthcare systems is necessary.
Technological innovation
Technology plays a central role in improving healthcare. Advanced medical devices, personal health management apps, and information technologies enable doctors and patients to better manage their health.
Remote medical services
One of the most significant developments is telemedicine, which allows patients to receive medical care without leaving their homes. This is a great solution for people with mobility issues or those living in remote areas.
summary
Healthcare in Israel is in a constant process of change and improvement. With the right investment and innovation, it is possible to ensure that the system will continue to provide quality services to the entire population.
