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TMH קבוצת ברן בזק בנלאומי AC נכסים

Is It Covered by My Healthcare Plan or Not? / By Nir Ron, CEO, Kali Healthcare

Following the new directives for insurance oversight, insurance companies have launched drug products for new members purchasing an insurance policy. Existing policyholders who joined previously will also be able to make requests to upgrade.

Is it covered by the plan or not? That need not make a difference to you, the customer. When you need a certain medication you can receive it, and that’s all you need to know.

The world of healthcare is headed toward a major transformation in which new drugs, chemical and biological, will replace invasive treatments, and will be delivered directly to the target organ. After all, one of the main problems with drug treatment is the widespread harm to healthy cells along with the ailing cells. Imagine past wars where in order to attack the enemy one side or the other would fire innumerable mortars and bombs in order to strike the target, thereby damaging extensive areas, uprooting whole forests and harming innocent civilians. Today there are more and more smart bombs that are amazingly accurate, reaching their target without causing peripheral harm. Like guided ballistic missiles, today there are also drugs that find their way independently to the sick or infected organ, bypassing the need for surgery or other invasive procedures.


Nir Ron, CEO of Kali Healthcare

Based on the new directives for insurance oversight, which removed medications not on the healthcare fund’s list from the healthcare funds’ supplementary insurance services, insurance companies started offering drug products to new members purchasing an insurance policy. 

The primary upgrades in the field of medical insurance come to light in the maximum insurance amount for a group of drugs, the definition of the insurance case and the addition of further coverage. For instance, if the insurance amount for a group of drugs worth half a million shekels was sufficient, with today’s development of advanced medical technology, and the discovery and development of new medications, some of which are for chronic diseases requiring long-term treatment, these amounts might not suffice, thereby imposing heavy expenses on the customer that may beyond his ability to pay. With new drug products the amount of coverage ranges from a million shekels to ten million shekels. These amounts vary from one manufacturer to another.

At Kali Healthcare we made advanced preparations and started contacting all of our customers who had purchased a healthcare product, both employers and employees, and updated them on the changes that had been implemented. We also offered them the opportunity to update their products. The upgrade involved a slight increase in the premium – about NIS 2.50 per child and NIS 7.50 per adult. 

Below is a sampling of areas that were upgraded by various manufacturers. As you’ll see the differences are substantial and could turn an event that is not covered into one that is covered and would be recognized by the insurance company.

Coverage for drugs aimed at preventing and/or controlling diseases, and not just treating the disease.
Coverage for experimental drugs – medications whose effectiveness has been proven, but are still pending approval.
Coverage for orphan drugs – medications for treatment of rare diseases.
Coverage for drugs that are listed, but are designated for specific cases – certain medications are intended for specific diseases, but have not been approved for other diseases though proven effective in treating these other diseases as well.
A dramatic increase in the level of insurance coverage – varies from one manufacturer to another.
A substantial decrease in deductible – varies from one manufacturer to another.

We warmly recommend that each of you evaluate your current plan, compare and upgrade…

May we always enjoy good health.

Nir Ron, CEO, Kali Healthcare

Send replies to: info@jobnet.co.il

For the Hebrew Article  

 
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