What's the Most Claimed Insurance Coverage in Israel?

The Answer: Ambulatory Care Appendix

A private or group health insurance that offers protection to the insured in cases of 'medical catastrophe' that can cause 'financial catastrophe' due to heavy expenses of hundreds of thousands or millions of NIS on medication, treatments and surgery.

I always suggest that even individuals with average income purchase coverage for medications, transplants and specialized treatments abroad (relatively reasonable costs). Once you purchase any basic coverage in your health insurance, including compensation in case of discovery of a serious illness or cancer, you can purchase add-ons and supplements that complement the basic coverage.

The appendix used daily by people around the world is the ambulatory care appendix.

This coverage renews every year or two, and covers about 11-13K NIS.

The coverage offers a wide range of cases in which you can consult with medical specialists and receive 80% or up to 750NIS (the lower of the two) back.

For example, a client that needs an eye doctor, rheumatologist, orthopedist or another appointment, and sees that the waiting time for an appointment through the Kupat Cholim is very long, decides to go to a private consultation and pays 1000-1200NIS to a private specialist.

If that client has an active ambulatory care appendix (following a qualification period), they can receive a refund.

Another example is physical therapy treatments. Some companies offer 12-16 treatments per year, with up to 120-150NIS per treatment. A client who wishes to choose a private physical therapist, and not be limited to a number of treatments or specific therapists via the Kupat Cholim can utilize this service.

Diagnostic tests are another perk of the ambulatory care appendix. Instead of waiting for months at a time for an MRI or PET-CT scan, you can find a quick solution privately and receive financing of about 5000-6000NIS for the expensive testing.

For the young couples reading this – there are different pregnancy tests you can get, in addition to those provided by the Kupat Cholim.

Women over 40 with two kids, who want another child, may be eligible for fertility treatments ranging from 11-20K NIS, depending on the coverage.

And, as promised – a great tip:

There are several insurance companies and agencies in the market that offer ambulatory care coverage without a health declaration or underwriting. This means that also individuals with medical problems can receive all the aforementioned services despite their medical condition. You can check out the options in companies like Ayalon, Mediwho, MyDoctor and more (make sure to check the policy conditions first).

In conclusion, the ambulatory care appendix has and will probably always be the reason people understand the importance of having health insurance. Since cancer, serious health problems and complicated surgeries aren't common occurrences for now thank God (might change in the future), oftentimes clients ask 'why do I need the insurance if I don't use it?' and then comes the day the ambulatory care appendix allows them to receive financial refunds.

It is not millions of shekels, not even hundreds of thousands, but it justifies the cost which ranges between 20-45NIS monthly for adults.

Contact your insurance agent today and check if you have an ambulatory care appendix.