Clalit Platinum Plan Caps Out-of-Pocket Surgery Costs
Translated & summarized from Behadrei Haredim by baba
Clalit Mushlam Platinum members can now undergo private surgeries with out-of-pocket costs capped at NIS 2,000, a significant reduction from private market prices. The plan provides access to over 1,000 specialist surgeons for various procedures, including common surgeries like ear tube insertions and cataract operations. This benefit offers substantial savings for patients compared to the full cost of private medical care, with co-payments varying by procedure type but always within the established cap.
The story in 5 lines · by baba
- Clalit Platinum plan members face out-of-pocket surgery costs capped at NIS 2,000.
- Over 1,000 specialist surgeons are available through the Clalit Mushlam network.
- Common procedures like ear tube insertion cost hundreds of shekels under the plan.
- Laser-assisted cataract surgery may incur a co-payment up to NIS 2,000.
- Clalit Mushlam Gold members have higher co-payments than Platinum members.
Clalit Mushlam Platinum health plan members can undergo private surgeries with out-of-pocket expenses capped at NIS 2,000, significantly reducing costs compared to the full private market price, which can reach tens of thousands of shekels. The plan offers access to over 1,000 specialist surgeons across various fields, including general surgery, orthopedics, gynecology, ENT, and ophthalmology.
Patients can select their surgeon from a list of contracted specialists after receiving a medical recommendation. Common procedures like ear tube insertion for children, which can cost thousands privately, are available under the plan for a few hundred shekels. Similarly, combined tonsil and adenoid removal with tube insertion also falls under this reduced co-payment.
For cataract surgeries, procedures with standard lenses and without laser technology are covered with no co-payment. However, laser-assisted cataract surgery under the Platinum plan may incur a co-payment of up to NIS 2,000. Other covered procedures include hernia repairs, hand surgeries, and complex orthopedic operations, with co-payments generally ranging from NIS 300 to NIS 2,000, depending on the surgery type.
Clalit Mushlam Gold plan members also receive coverage for private surgeries with contracted surgeons, but their co-payments are higher. Platinum members pay approximately 25% of the Gold plan's co-payment, with the Platinum co-payment not falling below NIS 300 or exceeding NIS 2,000 per surgery. This cap provides substantial savings for individuals facing significant medical expenses.
Avraham Konsky, Director of the Haredi Department at Clalit, emphasized the importance of informing the public about these options, stating, "It is important for families facing a recommendation for surgery to know that they do not always have to pay the high prices of private medicine." He encouraged members to be aware of their rights and options to make informed medical and financial decisions. The process begins with a medical recommendation, followed by contacting Clalit to verify coverage, available surgeons, and co-payment amounts.
