Citizen Rights

Citizen/Patient’s Rights
 

 

 

Every citizen or resident in the country is entitled to receive the health service (tests, treatments and medications) via one of the four Health Maintenance Organizations (HMOs or kupot holim) (Meuhedet, Clalit, Maccabi, and Leumit) in order to get primary health care services, hospitalization and medicines.

After selecting one Health Maintenance Organization (HMO), registration in one of the medical centers affiliated to the HMO should be done to get the primary health care services such as: emergency, clinics, specialized clinics, laboratory and X-ray tests, diagnostic tests, complementary therapies, medicines and nursing services.
 

Emergency Rooms Law:

The insured member is entitled to go to the emergency room of the hospital directly in urgent cases only or according to a referral from the following parties:

- The treating physician in the Health Maintenance Organization/fund
 

- A night medical center related to the Health Maintenance Organization or a center under a contract with the HMO.
 

- A referral from «Bekor Rofah» company after a home visit to the patient.
 

 

Full Exemption from Referral to the Emergency Room Payment is granted to the following cases:

- An insured member who comes to the emergency room with a medical referral letter and/or with a financial commitment from a health maintenance organization /fund

- An insured member who was hospitalized due to an emergency referral letter/report.

- A work accident with permission from the employer.

- A road accident victim who presents a police certificate confirming the accident (also after the accident).

- Schoolchild who was injured at school or on a school and who presents a certificate from the school.

 

 

Referrals in the following cases:

- Any new fracture / severe dislocation of shoulder or elbow / penetration of a foreign body into the eye / treatment for cancer diseases.

- The treatment of cystic fibrosis disease (CF) / Aspiration of a foreign body into the respiratory tract / treatment of hemophilia.
 

- Patients under dialysis treatment / a woman who started labor pain / a wound requiring suturing or other sterilization.

- A person who was evacuated to the hospital by a MDA ambulance, from the street or another public area, following a sudden medical event.

- Infants up to the age of two months with a sudden rise in temperature.

 A financial commitment is not issued for contrived cases and the member shall bear the full cost.

 

 

Who is Obliged to Pay the Emergency Room Fees:

* Anyone coming to the emergency room at night, between 1:00 am and 6:00 am except for persons who are entitled to a full exemption as detailed in the aforementioned section.

* In case the doctor in charge finds that the case coming to the emergency room is not from a medical point of view.
 

* The member who goes to the emergency room without prior approval from one of the bodies in charge, and brings a medical report from the emergency room to center’s secretarial section and the billing for payment, an obligation is sent from the center’s to the hospital (to get a reimbursement), the insured member shall pay the emergency room fees only according to the General Health Insurance Law.

*The Health Maintenance Organization/fund does not bear the burden of attorneys' fees or any other expenses in case a member does not turn to the HMO and did not follow up his case in a timely manner. Transport expenses to the emergency room in a regular ambulance or another ambulance (Nathan, Shahal, Nathalie ..) and if the member is not hospitalized, the expenses shall be paid by the member according to directives of the General Health Insurance Law.