Clalit Health Plan Details Private Surgery Arrangements for Platinum Members
Translated & summarized from Kikar HaShabbat by baba
Clalit Health Services has outlined its private surgery arrangements for "Perfect Platinum" members, allowing them to undergo covered procedures with specialist surgeons for a co-payment of NIS 300 to NIS 2,000. The plan covers a wide range of surgeries, including orthopedic and general procedures, performed in private hospitals or designated hospital units. Members can select their surgeon from a network of over 1,000 specialists. The co-payment includes surgeon fees, hospital charges, and necessary medical devices, potentially saving members thousands of shekels compared to full private costs.
The story in 6 lines · by baba
- Clalit's Perfect Platinum plan offers private surgeries with co-payments from NIS 300 to NIS 2,000.
- The plan covers a wide range of surgeries, including orthopedic, general, and ENT procedures.
- Members can choose their surgeon from a network of over 1,000 specialists.
- Surgeries are conducted in private hospitals or designated hospital units.
- The co-payment covers surgeon fees, hospital charges, and implanted medical devices.
- Perfect Gold members also have access to private surgery funding with different co-payment terms.
Clalit Health Services is clarifying the details of its private surgery arrangements for members of its "Perfect Platinum" supplementary insurance plan. The plan allows eligible individuals to undergo various surgical procedures with specialist surgeons at a significantly reduced out-of-pocket cost compared to standard private surgery fees.
Under the Perfect Platinum plan, members can expect to pay between NIS 300 and NIS 2,000 for a private surgery, depending on the procedure and plan terms. This co-payment is capped, even when the full cost of the surgery is substantially higher. "Perfect Gold" plan members also have access to private surgery funding, but their co-payment structure differs, with Platinum members typically paying 25% of the Gold plan's co-payment, subject to the NIS 300 to NIS 2,000 range.
The covered procedures include a wide range of surgeries listed in the national health basket, such as hernia repairs, hand surgeries, complex orthopedic procedures, and operations in general surgery, orthopedics, gynecology, ENT, and ophthalmology. Members can choose their surgeon from a network of over 1,000 specialists affiliated with Clalit Perfect. Patients are entitled to a pre-operative consultation with the surgeon to discuss the procedure.
Surgeries are performed in private hospitals or through the private medical services (SHARAP) at Hadassah and Shaare Zedek hospitals. Examples of cost savings include ear tube insertion, which might cost thousands privately but only hundreds under the plan. A hernia repair, potentially costing NIS 10,000 privately, could be covered with a co-payment of up to NIS 2,000. Cataract surgery with a standard lens and no laser technology is covered with no co-payment, while laser-assisted cataract surgery may incur up to a NIS 2,000 co-payment.
The co-payment typically covers the surgeon's fee, hospital charges, and any necessary implanted medical devices. To utilize the benefit, members must first obtain a medical recommendation for surgery, then contact Clalit to verify coverage, available surgeons, and the exact co-payment amount before scheduling the procedure. This process can result in savings of thousands of shekels for families facing significant medical expenses.
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