Clalit Health Plan Details Private Surgery Costs for Members
Translated & summarized from Behadrei Haredim by baba
Clalit Health Plan's "Platinum" insurance offers private surgeries with specialist doctors for a co-payment between 300 and 2,000 shekels. This covers procedures within the national health basket, allowing patient choice of surgeon and location. Significant cost reductions are available for procedures like hernia repair and ear tube insertion compared to private market rates. Some surgeries, like standard cataract procedures, are covered with no co-payment.
The story in 6 lines · by baba
- Clalit Platinum insurance offers private surgeries with specialist doctors for 300-2,000 shekel co-payments.
- The co-payment is capped, significantly reducing costs compared to full private market prices.
- The plan covers a wide range of surgeries in general surgery, orthopedics, and other specialties.
- Members can choose their surgeon from a network of over 1,000 specialists.
- Certain procedures, like standard cataract surgery, are available with no co-payment.
- Surgeries are performed in private hospitals or private services within public hospitals.
Clalit Health Plan's "Platinum" supplementary insurance plan allows members to undergo private surgeries with specialist surgeons for a co-payment ranging from 300 to 2,000 shekels, depending on the procedure and plan terms. This co-payment is capped, even if the full cost of the surgery is significantly higher.
The arrangement is available to Clalit Mushlam Platinum members, and also to Gold members, though Gold members have a different co-payment structure. Platinum members generally pay 25% of the co-payment applicable to Gold members, with the Platinum co-payment not falling below 300 shekels or exceeding 2,000 shekels per surgery.
Surgeries covered under this arrangement are those included in the national health basket. The supplementary insurance enables members to choose their surgeon and have the procedure performed privately within the network. This includes a wide array of general surgery, orthopedic, gynecology, ENT, and ophthalmology procedures, such as hernia repairs, hand surgeries, and complex orthopedic operations.
Members can select their surgeon from a network of over 1,000 specialists, after receiving a medical recommendation and verifying eligibility and costs. Surgeries take place in private hospitals or through private medical services at Hadassah and Shaare Zedek hospitals. Patients are entitled to a pre-operative consultation with the surgeon.
Examples of cost savings include ear tube insertion, which can cost thousands of shekels privately but hundreds within the Platinum plan. Hernia repair, potentially costing around 10,000 shekels privately, also falls within the 300 to 2,000 shekel co-payment range. 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 2,000 shekel co-payment. Other procedures like diagnostic or therapeutic cardiac catheterization and bariatric surgery may also be performed with no co-payment, subject to plan terms.
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