What are choice of service provider arrangements?

HMO choice of service provider arrangements allow patients to choose their medical service provider. By law, clients of all HMOs may choose who treats them or their children from a list of service providers under contract with their HMO.

Every resident of the State of Israel has the right to receive medical services according to the National Health Services Law. Meuhedet provides health services to its client both through doctors at its clinics and through private clinics located in the community. Meuhedet also provides specific services through medical institutes specializing in fields such as cardiology, physiotherapy, and child development, as well as laboratory and imaging services. Clients who need specific services Meuhedet is unable to provide may access them through external service providers.

Clients may find a detailed list of service providers working with Meuhedet is available in the guide to services. A specific service guide for each district details the network of medical service providers serving that district.

The principle that clients have free choice applies both to primary medicine (family medicine, pediatrics) and to specialty medicine. Before consulting a specialist, we recommend visiting your family (or pediatric) doctor for a letter of referral and help finding the most appropriate service provider. We also recommend maintaining contact with the same doctor who is familiar with you and your medical history.

Services at Meuhedet

Doctors and nurses
Clients who require a medical service have the right to apply directly to a doctor of their choice appearing in the list of doctors in the book of services. To see a doctor, clients must present their magnetic card and an identifying document. Each communication with a doctor is for a period of one quarter at least.  Patients wishing to transfer to another doctor in the same specialty during that quarter will be required to pay a quarterly fee for their visit, except in specific circumstances:

• Referral to another doctor in the same specialty in the same quarter in cases where the client lives further than 30 km from the clinic of the original doctor
• Referral to another doctor in the same specialty in the same quarter for medical emergencies requiring immediate treatment
• Referral to a substitute doctor who works in the same clinic as the original doctor in the same quarter

In these cases, clients will be refunded the costs of the copays. To receive the refund, contact the closest Meuhedet clinic to your residence and submit the original receipt.

Doctors receive clients at the addresses and times shown next to their names in the Meuhedet service guide. Generally, you will be required to schedule an appointment ahead of time. If the doctor is unavailable, you can receive information about alternatives here, in a chat with a representative, at the *3833 hotline, or at your clinic.

At Meuhedet, senior advisors specialized in all fields provide advice to doctors. A letter of referral from your treating doctor is necessary in order to contact a senior advisor.

Nursing services given at clinics

Meuhedet clients can receive medical assistance at every clinic in Israel. Present your magnetic card with an identifying document to receive the help you need. You can find a list of Meuhedet clinics here.

Medical institutes
Imaging and medical tests are administered at Meuhedet facilities, as detailed here. Before you visit a medical institute or laboratory, we recommend preparing a letter of referral from your Meuhedet doctor and a payment guarantee from the office at your clinic.

 Outpatient clinics
Meuhedet operates clinics specialized in a variety of medical and paramedical fields throughout Israel. Services at these clinics are provided by specialists, some of them senior hospital staff, who are available and approachable. According to Meuhedet policy, consultations at these clinics are given preferential treatment in order to save patients from having to visit hospital clinics.

Patients who are nonetheless select or are referred by their Meuhedet doctors to outpatient clinics at hospitals must present a medical letter to the medical office at their clinic to receive authorization for the visit.  Without this authorization, patients will not be eligible for refunds or copays from the HMO. If the HMO authorizes a referral to an outpatient clinic at a hospital, patients must receive a Meuhedet payment guarantee to bring to the hospital.

 Laboratory services
Laboratory services are provided to Meuhedet clients through its clinics’ laboratories. Meuhedet’s integrated, computerized system includes advanced diagnostic instruments.

Pharmacies and medications
Meuhedet operates pharmacies at our medical centers throughout Israel. For our clients’ convenience and as a result of the principle of free choice, Meuhedet also allows clients to frequent hundreds of external and private pharmacies. These pharmacies, which parallel clinic pharmacies, honor prescriptions from Meuhedet doctors and serve all Meuhedet clients.

Meuhedet offers a broad portfolio of medications, suitable for both clinical and home care. Our clients receive the required medications for their diseases at all Meuhedet pharmacies, as well as at pharmacies under agreement with Meuhedet, at prices that are constantly being updated and according to the required legal authorizations.

Medications listed by the Ministry of Health

Medications approved by the Ministry of Health for sale and supply in Israel; there is no connection between a medication being registered and its inclusion in the medications basket. Clients who require a medication not in the registry may submit an authorized 29 G form to receive it. The 29 G form may also be used to import a required medication unavailable in Israel. The treating physician fills out form 29 G and forwards it to the district or regional medication center to the medical department which will assess the request. A professional committee is responsible for approving or denying these applications based on their medical and economic judgment. To receive the committee’s appraisal, forward the application with a detailed and substantiated medical letter. Medications on this track are not included in the rights in the health basket. As a result, the committee will decide whether to authorize a complete exemption from payment, to charge the client a 15% copay, or to charge the entire copay (100%).

If you applied for medications in the restricted section of the health basket and your request was assessed and denied by the national center for medications, the treating doctor may forward the application for review by the exceptional committee at the regional medication center. These applications must, again, be accompanied by a detailed and substantiated medical letter.   The committee will assess the situation and confirm or deny the request. If it authorizes the request, it will set the percentage of the cost contributed by the client (0% copay, 15% copay, or 100% copay).

Committees will send their decisions to the client and the treating doctor. The decisions will be viewable to all doctors who see the client’s medical records.

Hospitals

Meuhedet clients may have surgeries performed at by surgeons included in the basket private hospitals who have signed agreements with Meuhedet, as described here.  In addition, Si and Adif clients may have surgeries performed at private hospitals which have agreements with Meuhedet, as described here and depending on the terms of their enhanced insurance.

A list of services offered by hospitals who have agreements with Meuhedet is available here. 

Hospitals with agreements with Meuhedet

Meuhedet offers clients a wide range of medical services over the broadest geographical distribution in Israel. Meuhedet also offers the widest range of coverage at hospitals under agreement with Meuhedet. Referral to hospitals is provided after service providers are located at Meuhedet community clinics or institutes. Referral to hospitals outside the framework of choice agreements will be provided after service providers are located at Meuhedet clinics or at institutes or hospitals under agreement with Meuhedet.

Services will be allocated according to medical judgment*, according to the place of residence of the client and with a referral letter from the treating doctor and/or after a consultation with an additional specialist and with a payment guarantee form.

*Medical judgment: based on a number of technical parameters, including: the treating physician’s assessment of how urgently the patient requires hospitalization, the different morbidity rates, reasonable appointment times at Meuhedet, reasonable appointment times at external service providers, the need to ensure continuity of care, the justification for medical care, and alternatives to choice agreements based on medical judgment

The following is a list of hospitals under agreement with Meuhedet, according to region, which may be chosen by clients:

*For patients insured in Kfar Saba **For patients insured in Ashdod

Oncological patients

Meuhedet enables oncological patients receiving complex therapies to receive care at any of the participating hospitals. Each hospital offers the complete suite of treatments of the other hospitals included in the health basket and authorized by the Ministry of Health for in-patient or outpatient procedures.  Meuhedet ensures continuity of care for cancer patients based on medical judgment even at hospitals not included in service provider choice arrangements.

Specialty medical services

Specialty medical services provide inclusive care tailored specifically for patients with “unique” diseases - diseases or syndromes with particular symptoms or characteristics (for example, familial dysautonomia, Rett syndrome, and more).

This service is intended for uncommon diseases (with a small number of patients in Israel) whose treatment requires particular skills or experience, whether specific staff certification or unique infrastructure.

This service center hosts a multidisciplinary team with vast medical experience and skills in treating these specific diseases. The center also provides relevant, up-to-date information to patients, their families, and the medical team.
Every person suffering from a “unique” disease with a special treatment service has the right to receive treatment through this service.

Extended hospitalization: Skilled nursing, intubation, and rehabilitation