Your Insurance

Transplants and / or special medical treatments abroad

Qualifying period

Medical expenses for transplant with service providers (within the agreement) – full coverage
Medical expenses for transplantation with service providers (who are not in the agreement) up to NIS 4,000,000
Intestinal or ovarian transplant up to NIS 1,600,000

Animal transplant up to NIS 2,400,000
Or compensation of NIS 240,000 if performed the transplant abroad & the company did not participate in financing (except for a bone marrow transplant, stem cells from peripheral and / or umbilical blood cord)

Benefit after performing a heart, liver, kidney, vision, heart-lung or pancreas transplant in the amount of NIS 5,000 for a period of 24 months or NIS 3,000 for a kidney, bowel, ovarian or bone marrow transplant from another donor for a maximum period of up to 24 months

Special treatment abroad

Special treatment abroad up to an indemnity ceiling of NIS 700,000

Out of Basket medicine

Insurance event - the medical condition of the insured that requires medical treatment, in accordance with the following sections

Medicines not included in the health services basket – any medicine not included in the health services basket, which has been approved for use according to the medical indication for the treatment of the insured's medical condition by the competent authority in one of the following countries (hereinafter recognized countries; Switzerland, Norway, Iceland) One of the member states of the European Union before May 2004, or in the main registration track of the European Union (EMEA)
Medicines included in the basket – Any medicine included in the basket, which is not defined according to the medical indication in the health services basket to treat the insured's medical condition and provided that the medicine is approved for treatment by the insured's medical authority in Israel or the US or In one of the member states of the EU before May 2004 or in the registration track of the EU EMEA, or in Canada, or Australia, or New Zealand, or Switzerland, or Norway, or Iceland a drug that is not defined according to the medical indication in the health care basket will not be considered an experimental drug.
A medicine defined as OFF LABEL – Coverage include any drug approved for use in one of the recognized countries, but not for the medical indication to treat the insured's medical condition, provided that the drug has been recognized as effective in treating the insured's medical condition by at least one recognized scientific publications.

Insurance coverage

Up to NIS 1,500,000 (renewed every 3 years)
Deductible – 200 NIS per prescription, per month and up to 400 NIS per prescription, per month in the case of several prescriptions
Drugs that cost more than 10,000 NIS per month without deductible

Coverage for surgeries in Israel and replacement surgeries in Israel through a service provider in the arrangement

Insurer obligations

3 consultations in each insurance year; In this regard it will be clarified that a consultation will be covered even if in the end the surgery or treatment replaces the surgery for which the consultation was conducted.
Remuneration of an arrangement surgeon, for the avoidance of doubt there is no coverage for a service provider for whom there is no arrangement with an insurer
Coverage of surgical expenses in a private hospital or private surgical clinic: anesthesiologist's salary, operating room expenses, consumables, implants, hospitalization expenses up to the ceiling of 30 days of hospitalization for surgery (including pre-surgical hospitalization)
Surgery replacement treatment: This coverage will not deprive the insured of the right to surgery if after the replacement treatment, the insured will need additional treatment.

Supplementary coverage for surgeries - for owners of those who got additional HMO coverage (Mashlim Shaban - Kupat Holim)

You shall be entitled according to this appendix to the insurance benefits listed, after the entitlement has been exhausted up to the top coverage appearing in the policy.

Surgeries abroad

Insurer will participate in financing medical expenses for surgeries in a private hospital outside of Israel.

Full coverage will be given, subject to pre-approval of the insurer, and having the service provider contacted, and the coordination of the surgery will be done directly by the company. If the insured applies to the insurance company for approval of the claim retroactively, the insurance payments will be limited to the ceiling of the insurance amount stated in the agreement.

In the case of surgery involving hospitalization for more than 10 days, the company will reimburse the expenses of one companion, for each period of hospitalization (maximum insurance amount NIS 450 per day up to 30 days), in case the insured under 18 will be covered by two companion's (up to NIS 900 per day).

Ambulatory coverage

- Consultation with a specialist doctor: Up to NIS 800 per consultations with a deductible of 20% and up to 3 consultations per year
- Second opinion abroad: reimbursement up to NIS 4,000 per case
- Diagnostic medical checkups:
Up to NIS 2,500 per checkup, and up to NIS 4,000 for MRI, subject to 20% deductible. With the mentioned here, the coverage will include X-Ray such as:
Laboratory tests
X-rays
Imaging tests (excluding MRI)MRI examination – reimbursement of NIS 4,000 per insurance year
- Physiotherapy – according to the doctor's instructions, up to 12 treatments per year for one medical condition and up to NIS 2,000 per year
- Radiotherapy – up to NIS 8,500 per insured for an insurance year
- In Vitro Fertilization Treatments – Participation in insured fertilization (IVF) that requires IVF treatment, according to a referral from a gynecologist who specializes in the treatment of fertility problems, who has at least two children before the treatment, will be entitled to coverage of NIS 8,000 per child, for the entire Insurance period.
- Preventive medicine – Preventive medicine checkups for the insured over the age of 50, which include: Mammography, Pap smear test, bone density test, PSA test, intraocular pressure test, reimbursement of 80% of the actual expense and up to 330 NIS per test, once every 3 years (per examination)
- Dentist Treatments –
  Surgical extraction: Reimbursement of 80% of the actual expense and up to the amount of 280 NIS for performing a surgical extraction (tooth extraction that has suffered a periodontal or caries, and which cannot be treated with regular treatment).
Gum surgery: Reimbursement of 80% of the actual expense for the surgery but no more than the following:
Perio examination up to the amount of 280 NIS
Root planing up to a total of 140 NIS (1/6 mouth)
Gingival resection up to the amount of 1,500 NIS (1/6 mouth)
Cloth surgery (including bone surgery and gum transplant) up to a total of 1,500 per sextant (1/6 mouth)
- Pregnancy:
Reimbursement for one scan per pregnancy, up to 75% of the actual cost of this test. The insurer will also participate in the costs of amniocentesis or placental abruption for insured women up to the age of 35 and tests to detect genes that carry cystic fibrosis, fragile X syndrome, and Gaucher. The participation will be 75% of the actual expense. The reimbursement ceiling for the above coverages for the insured in this policy will be NIS 1,500 per pregnancy, and if both spouses are insured with this insurance, the ceiling for the coverages for both will be NIS 3,000 per pregnancy. This coverage will be provided beyond the coverage provided under the National Health Insurance Act.