Leaving Israel: Understanding National Insurance and Health Fees Abroad

Israeli citizens residing abroad face monthly National Insurance and Health Service fees, with the minimum payment set at 266 shekels per month for those with negligible income, totaling 3,192 shekels annually. Returning to Israel after a period abroad incurs a waiting period for health services, which can be waived by paying a lump sum of 16,860 shekels, equivalent to approximately five and a half years of regular payments. This payment secures continuity of benefits and eligibility for pensions, not direct medical treatment overseas.

For individuals residing in countries with a social security agreement with Israel, the monthly fee is reduced to a minimum of 123 shekels, covering only health insurance. This distinction, determined by the destination country, results in an annual saving of about 1,700 shekels compared to the standard rate. Failure to pay these fees while abroad can jeopardize eligibility for health services and benefits, with accumulated debts awaiting return.

Child benefits are paid for only three months after an individual leaves Israel, ceasing from the fourth month. Exceptions to these rules include individuals sent abroad by an Israeli employer who deducts insurance and taxes, those on sabbatical or employer-funded training, patients receiving medical treatment abroad not available in Israel with physician approval, employees of Israeli consulates, or remote workers for Israeli companies. Eligibility in agreement countries is governed by the specific terms of the treaty.

The waiting period for returning residents is calculated as one month for every year of absence, capped at six months. A "year of absence" is defined as at least 183 days spent outside Israel within a 12-month period. A "month of waiting" involves 25 consecutive days in Israel, with any short trips abroad resetting the count. The option to "buy back" this waiting period costs 16,860 shekels, payable in one or up to six installments, and restores medical services upon full payment, excluding foreign treatments and fertility procedures.

Certain groups are exempt from the waiting period, including minors, discharged soldiers within 24 months of release, new immigrants, and those who maintained continuous health insurance payments while abroad. For extended stays, the ongoing monthly payments can become more costly than the buy-back option, particularly when the primary goal is to maintain eligibility for benefits rather than immediate healthcare access.

Individuals sent abroad by Israeli employers have a different arrangement, where the employer continues to pay Israeli insurance fees, and the employee receives an exemption from double payments. This also allows for the continuation of child benefits beyond the initial three months. The process for re-establishing residency upon return involves a National Insurance questionnaire detailing family location, children's education, and income sources.