the meuhedet c comprehensive supplementary health...

The Meuhedet C comprehensive supplementary health insurance plan

BEING HEALTHY STAYING HEALTHY

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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 healthDr. Uzi SemaniInsurance Division Manager

January 2014 / Shvat 5774 edition

*The contents of this leaflet are provided as general informationonly and are subject to the Meuhedet C supplementaryinsurance regulations - January 2014 / Shvat 5774 edition.Prior to purchasing any medical services, the policyholder is advised to clarify his or her rights.

Services comparison tableMeuhedet Adif and Meuhedet C

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Service offered in the Meuhedet Adif framework Upgraded service offered in the Meuhedet C frameworkService offered only in the Meuhedet C framework

√ √ √

√ √

Service Meuhedet Adif

Meuhedet Adif +

Meuhedet C

Surgery and treatment in Israel and abroad

Medical assistance abroad √ √

Virtual colonoscopy √ √

Treatments and surgeries at private hospitals in Israel √ √√

Medical services within public hospitals through Private Medical Service (PMS) √ √√

Implants √ √√

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 √ √√

Family expansion

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 √ √√

Nuchal translucency √√

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√ √ √

√ √

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 care

Urgent transport in ambulance √ √

Cardiology transmitter subscription and emergency heart disease care √ √


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√ √ √

√ √

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 √√


Services for Meuhedet C Customers*

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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 surgeryEligibility for plastic surgery in private hospitals that Meuhedet has agreements with, by surgeons included in the agreement.

Consultation

Second opinion in IsraelEligibility for an additional medical opinion in Israel.

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Family expansion

Early discovery of congenital defects in the fetusUltrasound – 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 scanEligibility for nuchal translucency scan at a clinic that doesn't have an agreement with Meuhedet.

Caesarian sectionEligibility 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 bloodEligibility 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 womenEligibility 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 DevelopmentEligibility for 15 additional treatments per year (total for treatments in all fields) beyond what is covered by Meuhedet Adif.

Bed-wettingEligibility 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 therapyEligibility for reimbursement for the costs of hydrotherapy, music therapy and art therapy for children under age 12.

Food substitutes not covered by the health basketEligibility 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 disordersEligibility 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 implantsEligibility for discounts on dental implants at Meuhedet clinics.

Recovery and recuperation

Physical therapy following myocardial infarctionEligibility 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 surgeryEligibility 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 injuryEligibility for rehabilitation following a sports injury at an institution approved by Meuhedet.

Lifestyle

Nutritional consultationEligibility 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 coursesEligibility for discounts on participation in weight loss and prenatal courses.

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Complementary medicineEligibility 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 servicesEligibility for laboratory testing by a physician or nurse at the customer’s home.

Physician home-visit servicesEligibility for home visit services by a physician at times when the clinics are closed.

Oncological testsEligibility for tests for discovery of cancer genes connected to serious diseases.

Periodic screening testsEligibility 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

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Waiting periods for eligibility for various services under Meuhedet C

No waiting period

Medical consultation prior to selection of medical center abroad

Periodic screening tests

At-home lab testing service

Nutritional consultation

Nuchal translucency scan

Early discovery of congenital defects in the fetus

Attention deficit disorder diagnosis

Workshops and courses

3 month waiting period

Plastic surgery

Oncological testing

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

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

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


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.

Waiting period table

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GENERAL INFORMATION

1. Insurance Fees

Detailed by customer age

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. The 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. Regular 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. Tardiness 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.

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

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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.

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Signing up for Meuhedet C

*The contents of this leaflet are provided as general informationonly and are subject to the Meuhedet C supplementaryinsurance regulations - January 2014 / Shvat 5774 edition.Prior to purchasing any medical services, the policyholder is advised to clarify his or her rights.

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 1-700-706-706Or 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 clinicthroughout the country

January 2014 / Shvat 5774 edition

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