Meuhedet See - Meuhedet.co.il

The Meuhedet C
comprehensive
supplementary health
insurance plan
BEING HEALTHY STAYING HEALTHY
Dear customers,
The comprehensive and expanded supplementary insurance plan,
Meuhedet C, is intended to provide you with the broadest possible
range of services in Israel and abroad. The plan offers a range of services
exceeding what has been available in the past – it's the perfect protective
umbrella for customers. Recently Meuhedet C has taken another step
forward – we have added new services and upgraded existing ones such
as free restorative dental care for ages 12-18, Private Medical Service
agreements in Jerusalem hospitals with a minimal co-pay, treatments
for children (therapeutic horseback riding, hydrotherapy, music therapy,
art therapy and animal-assisted therapy), and in vitro fertilization
treatments in private hospitals with a co-pay of just NIS 100 per cycle.
Meuhedet works with medical centers in Israel and around the world
to offer Meuhedet C customers extensive medical coverage. Meuhedet
thereby enables Meuhedet C customers to receive the highest quality
care in each field quickly, provided by leading professionals.
Meuhedet C is here for you in situations where special attention is
required, including surgeries and implants in the best Israeli and
international hospitals, recuperation after complex surgeries, dental
implants, and more, as well as in common situations such as: doctors'
home visits and laboratory tests at the customer's home, expanded
services for pregnancy and birth, diagnosis and treatment of infertility,
child development services, preventive care, complementary medicine
and more.
Membership in the Meuhedet C program is not limited by customer age
or health condition. All Meuhedet Adif customers may join Meuhedet C
and enjoy the range of services the program offers.
This newsletter presents a summary of the medical services included
in the Meuhedet C program. The complete list of services and binding
conditions appears in the Meuhedet C Regulations, which is available at
any Meuhedet clinic or on our website: www.meuhedet.co.il
Wishing you good health
Dr. Uzi Semani
Insurance Division Manager
*The contents of this leaflet are provided as general information
only and are subject to the Meuhedet C supplementary
insurance regulations - January 2014 / Shvat 5774 edition.
Prior to purchasing any medical services,
the policyholder is advised to clarify his or her rights.
2
January 2014 / Shvat 5774 edition
Services comparison table
Meuhedet Adif and Meuhedet C
Meuhedet
Adif
Meuhedet
Adif +
Meuhedet C
Medical assistance abroad
√
√
Virtual colonoscopy
√
√
Treatments and surgeries at private
hospitals in Israel
√
√√
Medical services within public hospitals
through Private Medical Service (PMS)
√
√√
Implants
√
√√
Service
Surgery and treatment in Israel and abroad
Medical consultation before choosing a
medical center abroad
√√
Surgery abroad selected by customer
Plastic surgery
√√
√√
Consultation, accessories and medication
Second opinion abroad
Purchase of implants and medical
accessories
√
√√
√
√√
Hearing aids
√
√√
Medication not included in Meuhedet's
medication basket
√
√
Second opinion in Israel
√
√√
Genetic testing
√
√
Diagnosis and treatment of infertility for
men and women
Monitoring for women with high-risk
pregnancies
√
√√
√
√
New mother recuperation
√
√√
Early discovery of congenital defects in the
fetus: amniocentesis and chorionic villus
sampling
√
√
Early discovery of congenital defects in the
fetus: detailed ultrasound scan
√
√√
Family expansion
Nuchal translucency
√
√√
√√
4
√√
Service offered in the Meuhedet Adif framework
Upgraded service offered in the Meuhedet C framework
Service offered only in the Meuhedet C framework
Services comparison table
Meuhedet Adif and Meuhedet C
Service
Meuhedet
Adif
Meuhedet
Adif +
Meuhedet C
Caesarean section
√√
Umbilical cord blood
√√
Children and teenagers
Visit to private pediatrician
√
Speech therapy
√
√
Child development
√
√√
Food substitutes not included in the health
basket
Bedwetting treatment
√
√√
√
√√
Therapeutic horseback riding
√√
Animal-assisted therapy
√√
Hydrotherapy (beyond what is included in
the health basket)
√√
Art therapy
√√
Music therapy
√√
Diagnosis of attention deficit disorders
(ADD)
√√
Dental and gum care
Free restorative dental treatments for
children and teenagers ages 12-18
Dental examinations and treatments
√√
√
Dental implants
√
√√
Preventive medicine
Vaccinations
√
√
Vaccinations and medicine for overseas
travel
Preventive tests
√
√
√
√
Urgent transport in ambulance
√
√
Cardiology transmitter subscription and
emergency heart disease care
√
√
Urgent care
√
√√
√√
Service offered in the Meuhedet Adif framework
Upgraded service offered in the Meuhedet C framework
Service offered only in the Meuhedet C framework
5
Services comparison table
Meuhedet Adif and Meuhedet C
Recuperation and recovery
Private nurse services
√
Complex long-term care
√
√
Recuperation after complex surgery
√
√√
Physical therapy after myocardial
infarction
√
√√
Sports injury rehabilitation
√
√√
Lifestyle
Psychological consultation and treatment
√
Sports medicine
√
√
Aesthetic medicine
√
√√
Laser eye surgery
√
√
Optical services
√
√√
Nutritional consultation
√
√√
Complementary medicine
√
√√
Workshops and courses
√
√√
Tests and services
At-home laboratory tests
√√
Home doctor visits
√√
Oncological tests
√√
Periodic screenings
√√
Treatments
Knee pain treatment with Apos shoes
√
√√
Shockwave therapy
√√
Hemorrhoid and anal fissure treatment
√√
Treatment for sexual dysfunction
√√
Snoring and nasal congestion treatment
√√
√
√√
√√
6
Service offered in the Meuhedet Adif framework
Upgraded service offered in the Meuhedet C framework
Service offered only in the Meuhedet C framework
Services for Meuhedet C Customers*
Surgeries and treatments – in Israel and abroad
Treatment/surgery in private hospitals
Surgeries in private hospitals in Israel and choice of surgeon.
Surgeries through Hadassah and Shaare Zedek Private Medical
Services with minimal co-pay.
Private Medical Services at public hospitals in Jerusalem.
Implants – Eligibility for reimbursement for purchase of implants
used during surgery at a private hospital.
All of the aforesaid is subject to the approved list of services.
Medical treatment abroad
Eligibility for surgery abroad at advanced medical centers that
Meuhedet has agreements with, with no co-pay.
Eligibility to locate a consultant abroad prior to selecting a
medical center for a surgery or treatment abroad.
Eligibility for medical consultation prior to selecting a medical
center for a surgery or treatment abroad.
Plastic surgery
Eligibility for plastic surgery in private hospitals that Meuhedet has
agreements with, by surgeons included in the agreement.
Consultation
Second opinion in Israel
Eligibility for an additional medical opinion in Israel.
7
Family expansion
Early discovery of congenital defects in the fetus
Ultrasound – eligibility for an early ultrasound and detailed
ultrasound at clinics that Meuhedet has agreements with or at
private clinics that Meuhedet doesn't have agreements with.
Nuchal translucency scan
Eligibility for nuchal translucency scan at a clinic that doesn't have
an agreement with Meuhedet.
Caesarian section
Eligibility for reimbursement for the cost of caesarian section
through Private Medical Services at public hospitals in Jerusalem
for women with three or more children.
Umbilical cord blood
Eligibility for partial coverage by Meuhedet for the cost of taking,
maintaining and preserving umbilical cord blood.
Postpartum convalescence
Women who have just given birth, beginning with the first child,
are eligible for three convalescence days at a postpartum
convalescence institution.
Infertility diagnosis and treatment for men and women
Eligibility for fertility treatments with minimal co-pay:
Tests and treatments to determine the causes of infertility.
Medications to treat infertility.
In vitro fertilizations – with minimal co-pay.
Freezing genetic material – freezing fertilized ova and
re-implantation.
Fertility treatments involving egg donation, conducted abroad.
Children
Child Development
Eligibility for 15 additional treatments per year (total for treatments
in all fields) beyond what is covered by Meuhedet Adif.
8
Bed-wetting
Eligibility for reimbursement for a set of 4 sessions by a practitioner
who does not have a contract with Meuhedet.
Therapeutic horseback riding, animal-assisted therapy,
hydrotherapy, music and art therapy
Eligibility for reimbursement for the costs of hydrotherapy, music
therapy and art therapy for children under age 12.
Food substitutes not covered by the health basket
Eligibility for discounts for food substitutes for babies up to
two years old (who are customers of the program) determined
by a doctor as necessary (from the list of Meuhedet-approved
substitutes).
Diagnosis of attention deficit disorders
Eligibility for one-time computerized diagnosis of attention deficit
disorders (TOVA and BRC method).
Dental care
Free restorative dental care for children and teenagers ages
12 to 18 at Meuhedet dental clinics.
Dental implants
Eligibility for discounts on dental implants at Meuhedet clinics.
Recovery and recuperation
Physical therapy following myocardial infarction
Eligibility for 6 additional months of partial coverage by Meuhedet
(beyond what is included in Meuhedet Adif) of the customer’s
expenses for supervised physical therapy following an acute
myocardial infarction.
Recuperation after complex surgery
Eligibility for reimbursement of expenses for recuperation
at a relevant institution for a customer who had brain or
stomach surgery, organ transplant or other surgery (excluding
cosmetic plastic surgery and obstetric surgery), which required
hospitalization for over 10 consecutive days.
Rehabilitation from sports injury
Eligibility for rehabilitation following a sports injury at an institution
approved by Meuhedet.
Lifestyle
Nutritional consultation
Eligibility for two additional treatments for nutritional consultation
(beyond what is included in Meuhedet Adif) from a consultant who
has an agreement with Meuhedet.
Workshops and courses
Eligibility for discounts on participation in weight loss and prenatal
courses.
9
Complementary medicine
Eligibility for 18 additional treatments (beyond what is included in
Meuhedet Adif) at Meuhedet complementary medicine clinics at
a significant discount from the regular price.
Tests and services
At-home laboratory testing services
Eligibility for laboratory testing by a physician or nurse at the
customer’s home.
Physician home-visit services
Eligibility for home visit services by a physician at times when the
clinics are closed.
Oncological tests
Eligibility for tests for discovery of cancer genes connected to
serious diseases.
Periodic screening tests
Eligibility for comprehensive screening tests for customers over
age 18.
Medical treatments
Discounts on medical treatments in the following fields:
Shockwave treatment for calcification and hell spurs
Treatments for hemorrhoids and anal fissures
Treatments for sexual dysfunction
Treatments for snoring and nasal congestion
*subject to the terms of the Meuhedet C Regulations
10
Waiting period table
Waiting periods for eligibility for various services under Meuhedet C
Medical consultation prior to selection of medical center abroad
Periodic screening tests
At-home lab testing service
No
waiting
period
Nutritional consultation
Nuchal translucency scan
Early discovery of congenital defects in the fetus
Attention deficit disorder diagnosis
Workshops and courses
Plastic surgery
Oncological testing
3 month
waiting
period
Bed-wetting treatments for children
Recuperation after complex surgery
Apos therapy shoes
Hearing aids
Shockwave therapy
Physical therapy after myocardial infarction
Second medical opinion in Israel
Umbilical cord blood
Postpartum convalescence
6 month
waiting
period
Hydrotherapy
Music therapy
Art therapy
Child development
Therapeutic horseback riding
Free restorative dental care for children and teenagers ages 12-18
Optical care for children, youth, and adults
Treatment/surgery at private hospitals
Utilization of Private Medical Services
Implants
Treatments for hemorrhoids and anal fissures
Treatments for sexual dysfunction
12 month
waiting
period
Caesarian section in the framework of Private Medical Services (birth of 4th child)
Partial coverage for food substitutes not covered by health basket
Treatment for snoring and nasal congestion
Sports injury rehabilitation
Physician home-visit
Dental implants
Complementary medicine
24
month
waiting
period
Surgery abroad selected by customer
Infertility diagnosis and treatment for men and women
*Subject to the terms of the Meuhedet C Regulations. Waiting period - consecutive
number of months, as detailed in the table above, from the month that the
customer signs up for Meuhedet C until the time that the customer is eligible
to utilize his/her rights under the Regulations of Meuhedet C. Please note that
customers of Meuhedet Adif who register for Meuhedet C do not lose their
eligibilities, if they registered for Meuhedet C at a later date.
11
GENERAL INFORMATION
1. Insurance Fees
Detailed by customer age
Age group
Rate*
0-25
12.5 NIS
25-30
32.5 NIS
30-40
40 NIS
40-50
57.5 NIS
50-60
72.5 NIS
60-70
90 NIS
70-80
112.5 NIS
80 and up
121 NIS
*Price as of 1.1.2014
Please note:
a.Insurance fees detailed in the table apply to each person in accordance
with their age. The charge for children up to age 18 in a family is for the
first three children – no additional charge for fourth child and beyond.
b. T
he monthly fees detailed above are after a 5% discount for those
paying via standing order direct debit, credit card, or centralized
payment (this amount includes an additional discount from the rate
approved by the Ministry of Health, which is higher).
c. For those paying via payment vouchers – payment can be made at any
post office bank branch throughout the country or at Meuhedet offices.
d.Meuhedet C is in addition to Meuhedet Adif. Therefore, the rates detailed
above are in addition to payments for Meuhedet Adif.
e. R
egular payment of insurance fees ensures full utilization of the rights
that supplementary health insurance program customers are eligible
for, subject to the program Regulations.
f. T
ardiness in insurance fee payment undermines the customer’s
eligibilities up to and including cancellation of membership in the
program, as detailed in section 8 of the Regulations.
Revisions to insurance fees
*Meuhedet C insurance fees are revised in accordance with rises in the
consumer price index published by the Israeli Central Bureau of Statistics
or the Health Cost Index (basic index – the index from April 2004). In
addition, the insurance fees are updated in accordance with changes to
the composition of the health services basket and the real cost of the
various medical services included in the Meuhedet C basket and based
on the actuarial calculations conducted periodically and subject to the
approval of the Ministry of Health.
12
2. Signing up for supplementary insurance
and waiting periods
a.A resident who has been accepted as a Meuhedet customer and
has signed up for Meuhedet C will be permitted to utilize his/her
eligibilities under the supplementary insurance following a waiting
period beginning on the day the customer signed up for the program.
Some of the medical services included in Meuhedet C do not require
a waiting period at all, while others require a waiting period of between
3 and 24 months, as detailed in the Regulations and the waiting period
table in this brochure (page 11).
b.Discharged soldiers who sign up for the program within 90 days of
their discharge date from the IDF are exempt from the waiting periods
required by the Regulations.
c.New immigrants (olim) who sign up for the program no later than 90
days from the date they signed up for Meuhedet are exempt from the
waiting periods required by the Regulations.
d.Customers who transferred from a different health service in which they
were customers of the second level of supplementary insurance and
had completed the waiting period required by Meuhedet’s Regulations
are exempt from the waiting period required by Meuhedet C (subject
to the Meuhedet C Regulations).
e.Customers can cancel their membership in the program and the
membership of customers in their account at any time by signing a
Cancellation Statement.
f.Customers of Meuhedet C who decide to cancel their membership
in the program or had their membership cancelled due to failure to
pay insurance fees on time, who later decide to re-join the insurance
program are considered new customers, and the Regulations which are
applicable at that date, including regulations regarding waiting periods,
shall apply to them.
3. Co-pays / partial coverage by Meuhedet
a.Most of the medical services included in the Meuhedet C services
basket are provided through private service providers (hospitals,
physicians, institutions and para-medical employees), and considering
the expensive private market purchasing conditions, some of the
medical services included in the service basket require a customer
co-pay.
b.Other services included in the basket are provided on the basis of
Meuhedet’s partial coverage of the entire expense that the customer
paid to acquire them (reimbursement). The co-pay rate of Meuhedet
customers and the level of Meuhedet coverage for acquiring such
services are revised from time to time as detailed in the Regulations.
13
Signing up for Meuhedet C
For your convenience, there are four different ways to register for
Meuhedet C:
Register on the phone using your credit card
Please call the Meuhedet C hotline at 1-700-706-706
Or the Direct Meuhedet hotline at *3833 or 1-222-3833 from a land line.
Register using your credit card
Please fill out the registration form with your credit card details and
provide it to the front desk of your Meuhedet clinic or send it by mail to
the clinic.
Register with a standing order direct debit payment
Please fill out the registration form with the details of the standing order
direct debit and provide it to the front desk of your Meuhedet clinic or
send it by mail to the clinic.
Register at the front desk of any Meuhedet clinic
throughout the country
*The contents of this leaflet are provided as general information
only and are subject to the Meuhedet C supplementary
insurance regulations - January 2014 / Shvat 5774 edition.
Prior to purchasing any medical services,
the policyholder is advised to clarify his or her rights.
14
January 2014 / Shvat 5774 edition
‫מק"ט ‪ ,430203‬דפוס האוגדים‬