Israel's Health Ministry Set to Approve Supplemental Maccabi HMO Coverage

Deputy Health Minister Yaakov Litzman has already signed the order, despite misgivings from the ministry's professional ranks and the Finance Ministry's budget department.

Despite advocating for curtailed insurance plans in recent years, the Health Ministry is nevertheless about to give the Maccabi health maintenance organization the final go-ahead to launch a new premium supplementary plan.

Deputy Health Minister Yaakov Litzman has already signed the order to allow Maccabi to offer members the extra plan in addition to its Gold Shield plan, despite misgivings from the ministry's professional ranks and the Finance Ministry's budget department.

Maccabi's new plan, which will cost adults dozens of additional shekels a month, includes services like eyeglasses, dental work, personal fitness instruction, aesthetic treatment, and surgery overseas.

"Our new plan contains important rights for funding services that until now were too expensive for many patients, and therefore they avoided treatment," Maccabi stated.

Maccabi is careful to note that coverage under the new plan will not overlap with existing rights under Gold Shield. The only exception is one perk: two months at a health club.

Last April, with the approval of the Health Ministry, Maccabi closed its most basic supplementary plan, Silver Shield, paving the way for the new plan.

A senior Health Ministry official explained that the ministry found itself in a bind because other HMOs already offer higher-level supplementary plans – particularly Maccabi's main rival, Clalit, with its Platinum plan. If not allowed a similar opportunity, the official said, Maccabi could have claimed discrimination.

The only options then, the official said, were to permit Maccabi Gold Shield to expand its coverage and then hike the premiums paid by all 1.6 million members insured under the plan, or to allow it to offer a new plan. He concluded that the second option, while not ideal, is not as bad as the first.

The approval, however, is at odds with statements by the ministry and Litzman himself in recent months.

At the last Dead Sea Symposium dealing with health insurance, Health Ministry director general Prof. Roni Gamzu delivered a speech to the heads of the country's health system, saying: "We are the ones who are primarily responsible for the fact that nearly 6 million insured people don't know what insurance they purchased and what their rights are. Most of us aren’t capable of understanding the differences between the various insurance schemes. The ministry hasn't served the citizenry well in this regard."

Gamzu, who called the rise of private and complementary insurance a "vicious cycle," added that the ministry bears responsibility for the complex stratification of plans and the fact that each HMO has two insurance tracks.

"It is important that people understand that most health care is found in the basic public health package, whereas the marketing machine sends out the opposite message," he said. "Anything found in the more expensive plans is just crumbs."

Litzman's office did not respond to requests for comment, but issued the following statement: "The Health Ministry will promote and approve this in accordance with procedures and the law."
 

Yaron Kaminski