The following information is provided by AACI’s Shira Pransky Project, Israel’s only initiative solely dedicated to helping English-speakers navigate the healthcare system.
If you need anything the Kupat Cholim offers and you want to know how to get it, ask the branch secretary. In practically every publication from the Kupah you are told to contact your local branch for clarifications about rights, permissions, required documents, payment authorizations, etc.
There are surrogates, of course. While away from home you can call the closest branch, and you can always call the Kupah’s 24 hour number. You can even directly access most of the information you need straight from the Directory of Services (Madrich Sherutim) or online. But really, learning the local secretary’s name and establishing some sort of rapport might be the most valuable investment in your wellbeing that you could make.
Also, remember you can just call to ask questions, or fax to transfer documents. You may get a small charge if the Kupah has to fax some document to or for you, but the hours saved in making the trip are probably worth it.
Finally, it’s usually not worth it to ‘sort of get’ crucial information, so if you need to, speak English. Most professionals know it, or can pass you on to someone who does. Besides, you’re about to learn the most essential vocabulary-
Always ask if you need either or both of these to get the service you need.
A Hafnaya (הפנייה) is a referral to a specialist or other medical services, sometimes necessary for internal Kupah services, and very often necessary for services from other institutions.
A Hitchayvut (התחייבות) is a payment voucher from the Kupah, usually necessary for services, including tests and hospitalization, from other institutions. This payment voucher is also referred to as Form 17 ("Tofes Shva Esrei"), or a letter of financial obligation ("Tofes Hitchayvut"). Click here to learn more about this important concept from a page we translated as part of our collaboration with Kol-Zchut.
Your primary doctor is the Kupah’s point man for your physical wellbeing. He/she should be the fount from which flows all (or most) referrals, prescriptions, and communiqués.
Got a prescription from a private specialist? Ask your doctor to reissue it as a Kupah prescription. Looking for lab results from blood work? They get sent to your doctor. Need to see a physical therapist? Ask for a referral from your doctor, etc.
It’s true that you can find your own specialists and services in the Directory of Services, and many will not require a referral. Perhaps you don’t need to check with your primary care physician every time you want to see a dermatologist, but it’s important to keep in mind the Kupah’s point-man perspective when deciding a course of action.
You might even want to consider adopting the philosophy yourself. In many health related situations it’s important to have a professional to rely on with an eye on the big picture.
Not sure if the doctor you’ve got actually fits the bill for your ideal point-man? The Kupah won’t fuss if you change doctors after one calendar quarter. If you need a more immediate change, consult the branch secretary for advice.
Finally, keep in mind that if your doctor is not available, or you just want to see someone else for some reason, there are other options-
Any time you’re in need when the Kupah is closed, or the timing is simply inconvenient, call the Kupah’s 24 hour number to check if the service can be sent to your door, or where the closest emergency medical center is that you can walk into any time.
Despite the operating hours of local branches, the Kupot have admirably committed themselves to round the clock basic medical services like diagnosis and prescriptions, and sometimes even lab tests and imaging.
The Kupah has arrangements with emergency medical centers, like Terem, as well as house-call services, though the services offered by these institutions will vary, as well as the expected co-payment.
It’s worthwhile to know the capabilities of the closest emergency medical center for times when your need is not just a matter of convenience. In certain urgent situations you should go straight to the hospital or call an ambulance. Click here for information about coverage of ambulance costs from a page we translated as part of our collaboration with Kol-Zchut.
In the USA “good health insurance” is so elusive (read: expensive) and coveted it’s almost mythical. Here it’s really quite cheap.
By law, the Kupot cover doctor visits, diagnostic and laboratory services, some paramedical services, medical equipment, rehabilitation, hospitalizations and many prescription medications. Still, what’s left out, and how these services are provided can sometimes feel restrictive.
Supplementary Insurance (Bituach Mashlim) planscost an extra monthly membership fee but offer a much wider selection of medications, more opportunity for using private doctors and specialists, and more options and benefits in general. If you already have it, review your additional benefits, and remember to check with the Kupah before paying for any medical service out of pocket.
If you don’t, consider joining immediately. The Kupah must accept anyone to their supplementary health insurance plans regardless of age or medical history, but there may be a waiting period before all the extra benefits kick in. Different benefits also may have different waiting (qualification) periods. Click here for more information about supplementary health insurance on a page we translated as part of our collaboration with Kol-Zchut.
Bonus: Long term care insurance may also be worth it, though it’s a different beast all together. Worthy of a separate post found here.
The above information may need to be updated.
