“meuhedet adif” regulations - shira pransky project

“Meuhedet Adif” Regulations

The Supplementary and ComprehensiveHealth Insurance

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Chapter A

Clause Page

1. Introduction ................................................................................................................................... 52. Legal Status ..................................................................................................................................... 63. Definitions and implementations ................................................................................................ 74. Membership at “Meuhedet Adif ” ................................................................................................ 95. Registration .................................................................................................................................. 106. Waiting period ............................................................................................................................. 117. Beginning of membership, ending or renewal ......................................................................... 128. Membership fees .......................................................................................................................... 129. Damage benefit of “Meuhedet” and refund by third party — “double insurance” .............. 1410. Eligibility restrictions .................................................................................................................. 1511. Self-participation / participation of “Meuhedet” ..................................................................... 1512. Approved authority ..................................................................................................................... 1613. Committee of appeal ................................................................................................................... 1614. General conditions ...................................................................................................................... 1715. General ......................................................................................................................................... 1716. Insured who is a long period abroad ......................................................................................... 1817. Initiation .........................................................................................................................................18

Chapter B

1. Treatments / surgeries in private hospitals ............................................................................... 191.1 Definitions ............................................................................................................................ 191.2 General ................................................................................................................................. 201.3 Purchasing of medical services at private hospitals through doctors associated

by agreement to “Meuhedet” ............................................................................................. 211.4 Purchasing medical services in private hospitals and non-associated doctors

by association with “Meuhedet” ........................................................................................ 211.5 Purchasing of medical services in a public hospital through PMS ............................... 221.6 Implants ................................................................................................................................ 231.7 Restrictions .......................................................................................................................... 23

2. Diagnoses and treatment fertility disorders in man and in woman ...................................... 242.1 Definitions ............................................................................................................................ 242.2 General ................................................................................................................................. 252.3 Terms of Eligibility .............................................................................................................. 25

Contents

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2.4 Tests and treatment ............................................................................................................. 262.5 Supply of drugs .................................................................................................................... 262.6 In vitro fertilization (I.V.F.) ................................................................................................ 272.7 Freezing of genetic material ............................................................................................... 282.8 Fertility disorders and treatment, using egg donation, carried out abroad . ................. 28

3. Drugs not included in the “drugs list” of “Meuhedet” ............................................................ 293.1 Eligibility through “Adif ” ................................................................................................... 29

4. Psychological counseling ............................................................................................................ 294.1 General ................................................................................................................................. 294.2 Terms of service delivery .................................................................................................... 30

5. Medical assistance abroad .......................................................................................................... 30 General ......................................................................................................................................... 30

5.2 Additional assistance for performing transplants and life-saving surgeries abroad in those cases entitlement according the Ministry of Health Policy ................................. 31

5.3 Treatments abroad not included in the Ministry of Health Regulations ...................... 325.8 Accompanying expenses for medical assistance abroad ................................................. 345.9 Travel insurance abroad ...................................................................................................... 35

6. Second opinion ............................................................................................................................ 366.1 Second medical opinion in Israel ...................................................................................... 366.2 Additional opinion abroad ................................................................................................. 37

7. Vaccinations ................................................................................................................................. 387.1 Insured not belonging to the risk group and requests vaccination by his own initiative,

is entitled to receive the vaccinations as specified below: .............................................. 387.2 Indemnity ............................................................................................................................. 38

8. Vaccinations and drugs for travelers abroad ............................................................................ 389. Recovery after complicated surgery .......................................................................................... 3910. Monitoring high-risk pregnant women .................................................................................... 3911. Complex hospitalization and nursing ....................................................................................... 4012. Dentistry and gums ..................................................................................................................... 40

13. Alternative medicine ................................................................................................................... 4113.2 Conditions for receiving the treatment ............................................................................. 41

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14. Early detection of birth defects in fetus .................................................................................... 4214.2 Screening of the systems of the fetus ................................................................................ 4214.3 Restrictions .......................................................................................................................... 43

15. Purchasing of implants and medical accessories ..................................................................... 4316. Recovery of women after birth .................................................................................................. 4417. Subscription thoracic transmitter and emergency services for cardiac patients ................. 4518. Private Nurse ................................................................................................................................ 4519. Child development ...................................................................................................................... 4620. Treatment of speech disabilities ................................................................................................. 4721. Genetic testing ............................................................................................................................. 4722. Preventive tests ............................................................................................................................ 4823. Aesthetic medicine ...................................................................................................................... 4824. Sport medicine ............................................................................................................................. 4925. Rehabilitation exercise after myocardial infarction ................................................................. 4926. Visit to a private pediatrician ..................................................................................................... 4927. Urgent ambulance transport ...................................................................................................... 4928. Laser treatment to correct nearsightedness .............................................................................. 5029. Optical services ............................................................................................................................ 5030. Nutritional counseling ................................................................................................................ 5131. Virtual Colonoscopy ................................................................................................................... 5132. Biochemical test survey during first trimester of pregnancy ...................................................51

Appendix A of the policy “Meuhedet Adif ” monthly payments* ................................................ 51Updating insurance fee .............................................................................................................. 53Registration fee ........................................................................................................................... 53

Appendix B ......................................................................................................................................... 54List of medical services provided in the framework of private hospitals/PMS for insured “Meuhedet Adif ” .................................................................................................... 54

Appendix C ......................................................................................................................................... 59List of private hospitals associated by agreement to “Meuhedet” ......................................... 59List of medical centers abroad ................................................................................................... 61

Appendix D ......................................................................................................................................... 62List of drugs for insured ‘Meuhedet Adif ” .............................................................................. 62

Appendix E .......................................................................................................................................... 67List of implants and medical accessories ................................................................................. 67Waiting periods for the various rights in the framework of “Meuhedet Adif ” ................... 70

December 2009

Contents

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Regulations for the “Meuhedet Adif” additional health services program Chapter A

1. Introduction

1.1 “Meuhedet Adif ” is a program for additional health services (henceforth “AHS” operat-ing on mutual and voluntary basis, for providing medical services and/or assistance in purchasing medical assistance. It includes a wide variety of medical services, which are not included in the “Basic Health Services” requiring “Meuhedet” under the National Health Insurance Law. All this, under conditions, restrictions and self-participation of the insured, as mentioned and conditional in these regulations.

1.2 It is the right of the insured to receive the complete services from “Meuhedet”. He is entitled to these by virtue of the National Health Insurance Law, 1994, not influenced by joining or not-joining the additional health service program of “Meuhedet” or of any other corporate control, as specified in the paragraphs 10 and 21 of the National Health Insurance Law.

“(10) (a) “Meuhedet” may offer its insured additional health service programs, which are not included in the National services and the payments of “Meuhedet” (henceforth — additional services program). Between itself and through a full controlling subsidiary (henceforth in this paragraph — “Meuhedet”); the additional services program and any changes to it, are subject to the approval of the Minister of Health.

(b) The additional health services program will be offered to the insured of “Meuhedet” as an arrangement of shared mutual balance, only with the fol-lowing rules:(1) The services in this program will be given only in the original framework

“Meuhedet” collected for this purpose from those joining the program (henceforth — members);

(2) From time to time, “Meuhedet” may alter the rights and the payments of the members;

(c) (1) “Meuhedet” will add any member requesting to join the program, with no connection to his state of health of financial status, and will not limit the joining or the rights of the insured at the time of joining with any conditions. Except for a reasonable qualification period, this will be de-termined, for the members in general, in relevance to the provision of various services of this program in this framework. And only if there will be no qualification period, as mentioned, longer than one year for the services, after the alterations of the basic services and payments of “Meuhedet” which were included in the National services and pay-ments of “Meuhedet” in concerning those already being a member of

“Meuhedet” and joining the program;

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Chapter A Regulations for the “Meuhedet Adif” additional health services program

(2) “Meuhedet” may determine, on the issue of qualification period as men-tioned in section (1), various instructions concerning transferring from a program of another Health Insurance Organization.

(d) Subject to the mentioned in small section (c) “Meuhedet” will not discriminate between the members of the program not during joining nor during the provision of services in this framework.

(e) The price of the program will be homogenous for all age groups, not depending on the number of membership years in the program, or on the status of health or financial status of the member.

(f) …

(21) (a) “Meuhedet” will provide all those under its responsibility and mentioned in paragraph 3(c) all the health services to which they are entitled by law. By itself or by means of service providers, without discrimination and uncondi-tional, the services, included in its basic service, will be provided by joining or membership of the additional services program.

(b) Non-payment or delay in payments of the health insurances will not dismiss “Meuhedet” of his obligations of providing health services included in the ba-sic health services.

2. Legal Status

2.1 The additional health services program (AHS program) — is owned by for the responsi-bility of — and managed by “Meuhedet”.

2.2 The management may transfer the rights and the obligations bestowed upon her, with approval of the Ministry of Health, according these regulations to another body/corpora-tion, completely of partly, in any way or manner, it seems proper, including by means of sharing with another corporation. All on condition that the rights of the members on

“Meuhedet Adif ” will not be harmed, and subjected to the instruction of the National Health Insurance Law.

2.3 The AHS program operates under these policies and is subject to the authority of the lo-cal Health Insurance organization under paragraph 10 of the National Health Insurance Law.

2.4 For the avoidance of doubt, it may be said that the AHS program is subject to the in-structions of National Health Insurance Law, 1994. In any case, of conflict between these Regulations and all its appendixes and between the instructions of the National Health Insurance Law, the Law will prevail.

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3. Definitions and implementations

This Regulations will have the following terms (according ABC) de implications besides them:

“Family members” — children until the age of 18, of those insured at one of the AHS programs of “Meuhedet” include stepchildren and children under custody or trust.

“Insurance fees” — monthly payments a member needs to pay every month to “Meuhedet” or once in a determined period, for himself and the family members as condition for obtain-ing the rights granted to members under these Regulations.

“Registration fees” — one time payment fee applies to all new, requesting to join “Meuhedet Adif ” as specified in appendix A of these Regulations.

“Management”—Management of “Meuhedet”, and/or some one authorized to act in his place.“Total expenses” — Total actual payments by the member or by any third party to the service

provides for the total cost of an event for which the member seeks financial aid or other.“Approving authority” — Medical or administrative authority at “Meuhedet”, which is autho-

rized to approve whether the member is entitled or not entitled for receiving medical services as proposed in this Regulations.

“Agreement” — a connection made between “Meuhedet” and between any medical suppliers, for providing medical services to the members of the AHS program.

“Health declaration” — a form on which the insured reports on his health status and on the health status of the family members who are insured through him.

“Meuhedet” — “Meuhedet” or any other body operating in its name, subjected to the required approvals by law.

“Fund” — unit operating independently concerning financially and invoicing for operating the program. The unit is the responsibility of “Meuhedet” and is not a separate juridical en-tity.

“Self-participation” — payment the member is obliged to pay before receiving the full service as specified in these Regulations, as a condition for exercising his rights.

“Program” — the AHS program “Meuhedet Adif ” as specified in these Regulations and its ap-pendixes.

“Meuhedet Member” — citizen at the age of 18 years, who is registered as a member at the “Meuhedet”, and only if his name is included in the file of the Social Insurance Institute, everything as required by the provisions of the National Health Insurance Law.

“Month” — A Month according to the Gregorian calendar.“Monthly membership” — the month for which membership fees has been paid for

“Meuhedet Adif ”.“Abroad” — State or territory outside the jurisdiction of the State of Israel. “Health Law” — National Health Insurance Law, 1994 including the regulations and/or orders

issued or pursuant issued.

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“Soldier” — Person, belonging to the army’s regular forces, according to the Security Service Law (henceforth a soldier in compulsory service) or by way of permanent service com-mitment.

“Double insurance” — Right of the insured, the existence of an agreement for insurance or in-demnification agreement by any third party and generally this is a commercial insurance company, receive medical service or indemnity in respect of medical services, included in the basic service of “Meuhedet Adif ”.

“Waiver of medical confidentiality” — Form in which the insured declares giving up, in ad-vance, his medical confidentiality regarding his health status and the health status of the minor family members, through him insured and provisioning “Meuhedet” to receive, among other, vital information for the purpose of maintaining continuity of medical care. Disclaimer effect of future claims will be of interest only in the AHS program.

“Insured” — Person recognized his eligibility of inclusion in the AHS program pursuant to this Regulations.

“Cost of living index” — cost of living index published by the Central Bureau of Statistics.“Health cost index” — The index reflects the cost of health services as defined with additional

fifth of the National Health Insurance Law.“Directory services” — Booklet that is updated periodically and lists the providers of medical

services associated with “Meuhedet” by agreement.“Authorized institute” — institute or service provider associated with “Meuhedet” by agree-

ment whose details appear in the directory of the medical services of “Meuhedet”. “Escort” — A person over the age of 22, accompanying the insured traveling abroad to receive

medical assistance pursuant to regulations under a professional recommendation and in advance approval by the “Approving authority”

“Case eligible” — The circumstances for which insured is entitled to medical assistance and/or aid, subject to the conditions specified in this Regulations.

“Implants” — medical equipment put into the patient during surgery performed at the patient’s body staying temporarily or permanently as specified in section 1 of Chapter 2 of these Regulations.

“Medical Services” — Variety of tests, medical treatments, and scope of assistance members are entitled to receive pursuant these Regulations.

“Basic Health Services” — Variety of tests and scope of assistance “Meuhedet” insured are en-titled to receive pursuant the Health Law.

“Indemnity” — Financial payment for the insured, being a participation in the Fund of his overall expenses, for the purchase of medical services he is entitled to pursuant these Regulations.

“Membership year” — 12 months of consecutive membership in the program, the first of which starts on the day of joining the program for which the insured pays membership fees.

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“Meuhedet Adif ” — AHS program. Services offered under this program detailed in Chapter B. of this Regulations.

“AHS program” — “Meuhedet Adif ” as defined in this Regulations. “Donor” — someone who is an immediate family member of an insured who needs an organ

transplant from the living, agreeing to donate an organ from his body or tissue from his tissues to the insured needing it, voluntarily, on his full responsibility and according the law.

“Insurance period” — A period in which a member was insured in the AHS program if con-tinuously or intermittently pursuant this Regulations and conform the conditions.

“Waiting period” — A continuous period of membership in the program during which the insured is included in the program, must pay membership fees, but is not entitled to the rights pursuant this Regulations.

“Regulations” — Regulations of “Meuhedet”.“These Regulations” — The Regulations of the program for additional health services

“Meuhedet Adif ” valid at the time.

3.2 Interpretation — In these regulations:

3.2.1 The masculine form of address also includes the feminine from, and the singular also includes the plural, apart from cases in which it is particularly stated other-wise or that another meaning may be deduced from the text.

3.2.2 The division of these regulations to parts and chapters, as well as to the names and titles of the parts and chapters are for the readers’ convenience only; and they should not be taken into consideration for construing of these regulations.

3.2.3 Anytime a sum of money is stated, that the insured should pay, in foreign cur-rency; it is intended to describe an amount equal to the amount in NIS, according to the foreign Currency’s exchange rates on the day of the payment.

4. Membership at “Meuhedet Adif ”

4.1 Each member of “Meuhedet” registered pursuant the Health Law, is entitled to be ac-cepted as an insured in the AHS program, without limitations placed in front of him due to age or health status, subjected to the said in this Regulations.

4.2 The insured is entitled to bring his children, registered with “Meuhedet”, into the AHS program. “Meuhedet” will add the minor without restrictions to age or health status.

4.3 Those who where members at “Meuhedet Adif ” before this Regulations, will be consid-ered to be insured in this program, as long as they are members of “Meuhedet” and pay the premiums regularly.

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4.4 If a family member resigns from the AHS program, other family members may sign up/stay in the program according to their choice.

4.5 Separated spouses are entitled to continue their membership in the program, as insured individual paying the premiums separately.

5. Registration

5.1 Insured over the age of 18, applying to join “Meuhedet Adif ”, will sign the “sign-up” form. Signing date will be considered as the date of joining the program, subject to clause 5.7 below. In the joining status, the insured is required to sign a direct debit or bank payment to pay the premiums for the first month of insurance.

5.2 On the sign-up form, the insured will sign in his name and in the name of his children. The insured may sign for his/her spouse.

5.3 A request for joining the program by the insured may be submitted by another person presenting a power of attorney on behalf of the insured.

5.4 Request for joining child or legally incompetent will be submitted by the appointed legal guardian.

5.5 “Meuhedet” will confirm receipt of its forms and registration to the insured before the joining date in question.

5.6 The Regulations of AHS program and the copy of the sign-up form will be attached to the above message from “Meuhedet”.

5.7 Insured who signed the sign-up form will give it to a qualified person at “Meuhedet” “Meuhedet” will notify the insured at the time of registering or at the latest within 30 days of registering, on joining the program. If within 30 days of delivery the sign-up forms, the insured has not received any messages for “Meuhedet” as mentioned above, the insured will be considered joining the program on the date of signing the sign-up form.

5.8 The insured must notify the branch of “Meuhedet” in the area of residence, on an ongoing basis and not later than 30 days, of changes that have taken place in his/her name, address, family status and condition.

5.9 A minor will be considered a program member as long as at least one parent is a member for whom premiums were paid as usual. A minor with a guardian will be considered a member if registered by the guardian. Ceasing the membership of a minor due to non-payment of premiums will be done in accordance with article 8. “Meuhedet” will join the minor without limitations of age or health status.

5.10 On the day of joining, the member may sign the health statement and the medical confi-dentiality waiver form. Usage of this form will only be handling the lawsuit for indemni-fication by the member pursuant this Regulations.

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6. Waiting period

6.1 During the waiting period, as mentioned in Chapter B of these Regulations, the insured and those insured through him/her will not have the rights to receive any medical ser-vices under these Regulations, and he/her will not be eligible to receive any indemnity in respect of those services.

6.2 The insured will be eligible to receive medical services and/or indemnification pursuant this Regulations in respect of medical service they needed after the waiting period.

6.3 Those insured in the AHS program prior the approval of the program by the Ministry of Health, will have a waiting period as stated in our program policies, which was valid at the time of joining, unless the period was reduced by this Regulations — in this case the waiting period will apply to this Regulations.

6.4 Veterans who were members of the supplemental insurance at the evening of recruiting, asking to join the insurance after their release from military service, can join the program immediately upon release and will be exempt from the waiting period.

6.5 Veterans who were not insured at “Meuhedet”, or those who were insured at “Meuhedet” but were no members of the AHS program on the evening of recruiting, will be eligible to join the AHS program with full rights of their choice upon release from the army, without any waiting period. This right is for soldiers only, provided that they join the program within 90 days of release.

6.6 Those who stopped the membership with another Health Insurance Organization and joined “Meuhedet” for the first time after completing the whole or part of the waiting period (at another Health Insurance Organization) for the rights granted to him by the Regulations of that Health Insurance Organization, and which is its right to medical ser-vices and/or indemnification pursuant this Regulations, will be exempted from the wait-ing period, at whole or partly, depending on the waiting period in these regulations in respect of that service. This right is given to the insured provided he/she will join the program within 90 days of signing the sign-up form. The above mentioned is on condition that the member will be able to prove the period of supplemental insurance at the other Health Insurance Organization.

6.7 For the avoidance of doubt, “Meuhedet” will approve indemnity by the insured as men-tioned in clauses 6.5 and 6.6, but only for a medical service that was purchase by the mem-ber after joining the AHS program and as long as there is eligibility for indemnification for that service pursuant these Regulations.

6.8 An AHS member, imprisoned for a period exceeding one year, and therefore has been subtracted from insurance list of “Meuhedet”, and freezing his membership at “Meuhedet” before completing the waiting period required pursuant these regulations, in whole or part, will be exempt from the thawing of frozen membership at “Meuhedet” upon his release, and of the waiting period, in whole of partly depending on the required waiting

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period pursuant these regulations, with respect of that service,. All this, if not removed from the program due to debt prior freezing and subject to that renewal of payments to the AHS program within the first 90 days of cancellation of freezing.

7. Beginning of membership, ending or renewal

7.1 The membership at the AHS program starts from the date of signing by the insured on the sign-up form provided that the fees are paid regularly as stated below in paragraph 8.

7.2 The insured who wants to stop the membership in this program, will so inform “Meuhedet” office and will sign there the appropriate form. The end of the membership, and of those insured through him/her, will enter into force one month after notification by the insured, as stated above. Insured who is confined to bed or for some reason, out of his/her control, is unable to come to the office of “Meuhedet”, may terminate his/her membership in the program, as stated above, by means of proxy with presentation of an i.d.

7.3 It is hereby declared that stopping the membership does not release the member of his/her financial obligations of the insured for any period of membership in the program.

7.4 The approving authority in “Meuhedet” may suspend or immediately stop the member-ship of the insured at “Meuhedet Adif ” due to non-payments of premiums as mentioned below in section 8, and/or in case of inappropriate behavior towards the doctor or any employee in name of “Meuhedet” false, or partly reporting of expenses of the insured, or of his/her rights under an agreement with any third party, and/or any other excuse that al-lows “Meuhedet” to cancel the membership according to National Health Insurance Law or any other law.

7.4.1 “Meuhedet” will notify the insured of ceasing his membership with a letter of warning that will be launched 60 days before the date of cessation of member-ship.

7.4.2 De insured will be given the right to a hearing during the alert period.

7.5 Ceasing membership of a insured at “Meuhedet”, as stated in paragraph 7.4 above, does not drag ceasing of membership of a minor or legally incompetent

7.6 Ceasing membership of the insured at “Meuhedet” will bring the membership at the AHS program to an immediate ending.

8. Membership fees

8.1. Rates of AHS program “Meuhedet Adif ” (henceforth monthly payments) are specified in appendix A, determined by the management of “Meuhedet” and subjected to approval as required by law

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8.2 The monthly payments are determined by the age of the insured and the family status listed at “Meuhedet” (single family). Member passing from one age group to a higher age group — will pay according to the customary in that new age group. “Meuhedet” may es-tablish a family rate, which will be updated from time to time. The family rate for which the insured family will be charged will be determined according to the eldest of the couple.

8.3 Meuhedet may oblige a newcomer to the program to pay a registration fee subject to ap-provals required pursuant to National Health Insurance Law. Registration fees will not be returned to the insured during cancellation of his/her membership in the program

8.4 Insured must pay the required monthly payments for him/herself as well as for his chil-dren month by month or once in a period, as specified in the payments table in appendix A of these regulations. All these of the list of the program, and by bank account debit.

8.5 Deduction of monthly payments as usual by concentrate collection through the employ-er — fulfills the mentioned above. However, this form of collection does not excuse the insured from personal responsibility in any case in which membership fees were not paid by the employer.

8.6 The insured payments will be updated once every 2- months, depending on the rise in the retail price index, or health cost index, the higher of the two.

8.7 “Meuhedet” may, with the approval of the Minister of Health, change from time to time the rights of the insured in the AHS program and the premiums

8.8 Monthly payments paid in arrears for months — will be paid linked to the cost of living index

8.9 If the insured is in debt, for not regulating the monthly payments for him/herself and fam-ily members, for a period of four months, his/her rights will be frozen and an alert will be launched explaining that if he/she does not pay the debt within 60 days after sending the letter — the membership in the program will be stopped.

8.9.1 If the insured paid all his debts during the alert period, with additional differen-tials linked to the index as stated above, he/she will be entitled to continue the membership in the program with full rights because of the freezing period the insured will be entitled to indemnification only, as this right exists pursuant these regulations.

8.9.2 If the insured did not regulate the debts in full during the alert period, the mem-bership in the program will be stopped after the alert period subjected to the right of a hearing as specified under section 7.4.2 above. The “Meuhedet” may sue the insured for the un-paid debt, including collection expenses.

8.10 Non-collection of the monthly payments from the bank account of the insured due to reasons pendant by the bank or any third party — does not relieve the insured from the responsibility to arrange the monthly payments at the offices of “Meuhedet”.

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8.11 If, due to a mistake that was made in good faith, the debiting of the bank account of in-sured by “Meuhedet” continued, while the membership in the program was cancelled at the initiative of “Meuhedet” or initiated by other reasons set forth on these regulations, the insured will receive a full refund of the amounts which were taken by mistake linked to the cost of living index. The insured and his/her family members will not have any rights pursuant these regulations, for the period after the date of cessation of membership, even the membership fees have been paid as stated above.

9. Damage benefit of “Meuhedet” and refund by third party — “double insurance”

9.1 In any case, existing mandatory indemnification towards the insured under any agree-ment, in respect of service including in these regulations, the Fund will be liable at a proportionate rate for any programs or policies applicable to the case.

9.2 All insured must, while applying for indemnification/service pursuant the policy, bring it to the attention of “approval authority” if there exists an indemnity obligation to him by any third party including the existence of private insurance at a commercial insurance company and/or the existence of “supplemental insurance” covering the medical services in whole or in part “(double insurance)”. All this in an affidavit signed by him/her when contacting for the services or indemnification. Also, the insured is committed to point out the “cause of harm” (if exists) which caused the event for which the insured needed the medical service and give all the information know to him/her about the harmer.

9.3 In any event, as stated in above sections 9.1-9.2m “Meuhedet” will provide the medical services to the insured. “Meuhedet” will provide the supply of the medical services or per-forming such indemnification pursuant these regulations so that the insured will autho-rize “Meuhedet” by signing an irrevocable power of attorney, by which “Meuhedet” may contact in the name of the insured, the insurance company and/or any third party, with the purpose of settling the financial damage caused to him/her due to providing medi-cal aid, all within a limit of indemnity is the member entitled by virtue of an agreement/contract of some sort.

9.4 If the insured received direct payment from any third party, including insurance company indemnity for his/her expenses in respect of “insurance case” for which there is a “double insurance”, the insured must notify “Meuhedet” and transfer immediately at the share of

“Meuhedet” in respect of expenses, which have been caused due to the case.9.5 Refused the insured and/or spouse to sign a power of attorney as mentioned in above

article 9.3, or did not return money “Meuhedet”, or proved in retrospect, concealed the information as mentioned above, he/she will not be entitled to the rights pursuant these regulations. Also, “Meuhedet” may take legal means standing to his disposal including the stated in above paragraph 7.4.

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10. Eligibility restrictions

Without prejudice to the provisions of these regulations, the Fund is not obliged to provide medical help/ assistance and/or coverage or indemnification for medical expenses caused by the insured in respect of “case eligible” for services included in the basic services of these regulations, in one or more of the following cases:

10.1 If the service, the insured requests based on these regulations, is connected to the ad-ditional eligibility of the member pursuant Compensation Law for Victims of Road Ac-cidents, Defense Service Law, Law Police — disabled victims, Prison Service act, Disabled Victims, Victims Compensation Act of Hostilities, National Insurance Law (victims of work), Compensation and rehabilitation of the Handicapped Law, Law disabled Nazi Per-secution, Law Disabled against the Nazis war, the law rewards Prisoners of Zion and their families are entitled of medical assistances in respect of the injury and all other law enti-tling medical assistance in respect of the injury if denied eligibility by the same law, the insured will be entitled to medical services based on these regulations.

10.2 If the insured or someone on his behalf, acted with the intention to cheat, forwarded wrong facts to “Meuhedet”, or concealed facts/evidence relating to the medical services required for eligibility of the insured pursuant these regulations.

10.3 In “case eligible” occurred as a trigger result from a dangerous sport — skydiving, soaring, diving, physical combat any other sports activity for which the obligation of insurance lies with the insured, or any sporting association and on behalf of that did not purchase any insurance program by the association of the insured “Meuhedet” will provide the offered service pursuant these regulations signed by the insured on the power of attorney as set out in above section 9.3.

10.4 The insured will not be entitled to medical services and/or indemnity in respect of medi-cal services which was served to the insured prior beginning of the period of entitlement based on these regulations or after the end of that period.

11. Self-participation / participation of “Meuhedet”

To maintain “insurance fees” relatively low, “Meuhedet” decided to take the principal of self-participation of the insured on expense.

11.1 The self-participation of the insured when purchasing medical help or assistance pursuant to these regulations is basic condition for receiving the medical services as specified in Chapter 2 of these regulations.

11.2 The insured has no right to indemnification in respect of amounts, which were paid as “self-participation”.

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11.3 Wherever in these regulations is mentioned “participation of “Meuhedet” or the Fund in expenses of the insured,” the intention is for expenses, which the insured actually carries, to purchase any medical service; he/she is entitled to receive pursuant these regulations.

11.4 Determining the height of the indemnification the insured is entitled to, the “self-partici-pation” will be considered pursuant these regulations.

11.5 For avoidance of doubt, indemnification eligibility for medical services according to these regulations only exists, if the insured purchased and received medical services belonging to the same services, which are explicitly stated in the policy that the insured is entitled to indemnification in respect of their purchase, and only if the insured was under the, in these regulations specified, circumstances as a condition for indemnification

11.6 Participation of “Meuhedet” in the expenses of the insured, which were approved by the approved authority, will be upon delivery of receipts and original tax invoices to the ap-proved authority.

12. Approved authority

12.1 The approved authority checks the joining request forms as stated in above paragraph 5.For the treatment of claim filed on behalf of the insured, the approved authority may obtain medical documentation from the insured himself, from the doctors, or any other medical facility where the insured has been treated.

12.2 The approved authority is authorized to discuss any appeal of the insured, for approval or rejection, all those subject to the conditions, restrictions, limitations and self-participa-tion of the insured as stated and conditional to these regulations.

12.3 The approved authority will consider each request of the insured based on the said in these regulations only, and will notify the insured of his/her rights accordingly within 60 days of appeal. In emergencies, an answer will be given within a shorter time and such way that it will not harm the health of the insured.

13. Committee of appeal

Insured who disagrees with a decision given in his case by the approved authority may, by choice turn in writing to the appeal committee of the AHS program.

13.1 The “appeal committee” has been nominated by the management of “Meuhedet” and will appoint three people: lawyer — chairman and two public representatives who are mem-bers of the board of “Meuhedet” and up to the inspector.

13.2 The appeal to the committee will be in writing with attachments of medical opinion and documents or others supporting request. The appeal can be delivered to each of

“Meuhedet” branch offices for submitting to the committee.

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13.3 The decision of the committee will be accepted by a majority vote of the committee mem-bers.

13.4 For the avoidance of doubt, it is hereby clarified that this stated in this section will not revoke the entitlement of the insured to prosecute at the Court of Work instead of turning the appeal to “Meuhedet” committee.

14. General conditions

14.1 When the need arises for medical service included in these regulations, the insured needs to contact “Meuhedet” branch at his place of residence, whether by himself or through his representative, for the clarifications of his rights and to give all the medical information and required documents for handling his request

14.2 “Meuhedet” may conduct any test or investigation to determine the liability according to these regulations, all as it deems necessary on condition that the test process does not delay the medical treatment of the insured in such a way that it might harm his health.

14.3 “Meuhedet” will be entitled to stipulate execution of any payment to the insured under the liabilities of these regulations, by requiring documents and evidence to its satisfaction, including disease summaries and original invoices of service providers and original re-ceipts to prove that all the payments made by the insured are payments for actual services purchased in respect of the medical service in question.

14.4 If the insured, entitled to indemnification, dies before he received the indemnity due to him and no beneficiary is mentioned, “Meuhedet” will pay to the heirs or the legally de-termined estate administrator the amounts the insured was entitled to on behalf of the medical aid, and subjected to the stated in these regulations

14.5 The medical aid pursuant these regulations will be provided within the State of Israel only, unless explicitly determined otherwise in these regulations.

14.6 For the avoidance of doubt, it is clarified herein, that choosing a doctor or any other medi-cal service provider initiated by the insured, without receiving prior written approval or referral from “Meuhedet”, is by his own opinion, at his own expense subject to the provi-sions in these regulations and for the full responsibility of the insured “Meuhedet” is not responsible for the quality of the medical treatment and the results and for any physical and/or psychological harm, which might be caused to the insured as a result of the treat-ment or service as mentioned above.

15. General

15.1 All the medical services specified in Chapter 2 of these regulations will be provided to the insured in this program as long as they are not included in the ‘basic health services” as required “Meuhedet” by “National Health Insurance Law”.

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Chapter A

Medical service, which is included in the program that will be added to the basic services required by Law in the future, will be taken from the program and “Meuhedet” will not be obligated to provide it in the framework” of the AHS program.

15.2 “Meuhedet” may update, add or detract from the stated in these regulations and/or ter-minate the program provided that the adding, diminution or termination of the program were approved as required by the National Health Insurance Law, and has been brought to the attention of the insured.

15.3 The management will not be committed to a promise, advertising, and statement of com-mitment not issued by her and on her initiative.

15.4 Messages sent by “Meuhedet” to the last know address of the insured according to the records of “Meuhedet”, will be considered as a legally delivered messages.

16. Insured who is a long period abroad

16.1 Insured or any member of his family leaving the country on their own initiative to stay abroad is not entitled to cover/indemnity by “Meuhedet” for medical help they receive during their stay abroad, when necessary.

16.2 During their stay abroad, they need to assure to themselves health insurances on their own account through a commercial insurance company, with a broad as possible insur-ance rights subjected to their health condition.

16.3 Saving of rights of the insured pursuant these regulations is conditional on regular pay-ments of premiums throughout the period of their stay abroad.

17. Initiation

The initiation of these regulations begins on the day of publication and will apply to all insured persons entitled to medical assistance pursuant these regulations.

Regulations for the “Meuhedet Adif” additional health services program

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The medical services of “Meuhedet Adif ” come to detail the variety of tests, treatments, surgeries and the assistance to the insured and to determine the eligibility criteria and how each of the topics included provides each service.

1. Treatments / surgeries in private hospitals

The insured may be admitted at a private hospital for medical services among those listed in appendix B of these regulations, provided improved hotels and reasonable availability. Also has the right to choose himself a doctor (as defined below) all those on condition and restrictions set forth in these regulations and subjected to the existing agreements between “Meuhedet” and the service provider

Waiting period: 12 Months from the day of joining the program.

1.1 Definitions

This Chapter will have the following terms, the implications besides them:

“Hospitalization” — hospitalization of the insured in a hospital to receive medical treatment is listed as on of those he is entitled pursuant these regulations.

“Nursing hospitalization” — hospitalization of the insured in a hospital or institute for hos-pitalizing patients suffering from prolonged illness or incurable, operating on a license of the Ministry of Health, and with the main purpose of providing assistance to the ill fellowmen who is not able to function on this own and medical assistance is not expected to improve the situation.

“Hospitalization and complex nursing” — hospitalization of insured suffering from a pro-longed illness of any kind, which according to the opinion of the approved authority his medical status requires medical assistance, daily and will be under prolonged constant medical supervision, in hospital or department designated for those patients and operat-ing on a license of the Ministry of Health.

“Psychiatric Hospitalization” — hospitalization of insured in a hospital for mental illnesses operating on a license of the Ministry of Health Ministry of Health to receive medical treatment for mental illness.

“Hospitalization and Revalidation” — hospitalization of insured in a revalidation department and/or hospital designated to treat patients for the improvement of their medical condi-tion, suitable for rehabilitation only, provided that is operates under a license of Ministry of Health and has an agreement with “Meuhedet”.

“Hospital” — hospital with medical staff and para-medical operating within the State of Israel, according to a license of the Ministry of Health and has an agreement with “Meuhedet” (as defined in appendix C).

Chapter BThe Medical Services Package for “Meuhedet Adif ’s” Insured

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Chapter B The Medical Services Package for “Meuhedet Adif ’s” Insured

“A Private Hospital” — A Hospital (as afore described) under private ownership.“Medical treatment” — conservative examination or treatment of any kind performed during

hospitalization in each of the areas listen in appendix B of these regulations.“Private institute” — Institute privately owned inclusive medical and para-medical staff, legally

operated and equipped with appropriate medical equipment, aimed at providing a range of medical services only to the insured of the program, the owners of the institute have an alliance agreement with “Meuhedet” and the name of the institute appears in the medical service directory of “Meuhedet”.

“Implants” — dentures and/or medical equipment of any kind, transplanted in the body of the insured and replace organs, which have been cut away during surgery, or to improve the poor functioning of tissues and/or systems as specified in appendix E of these regula-tions.

“Surgery” — surgical action in each of the areas listed in appendix B of these regulations, car-ried out in an open invasive way or through endoscope.

“Nursing” — aid, nursing as defined by law, whose main mission is helping other sick persons at home, who are unable to function on their own.

“Physician” — a doctor who by virtue alliance by agreement with “Meuhedet”, provides medical services to the insured of the program, subject and pursuant these regulations, and only whose name is included in the list of authorized doctors listed in the medical directory of “Meuhedet”.

“List of approved medical services” — list of the services specified in appendix B of these regu-lations which includes a variety of test, treatments, surgeries and other services to which the insured is entitled pursuant these regulations..

“Rehabilitation” — medical assistance with the main objective to help improve the functional condition of the patient to as close as possible to the status prior the illness.

“PMS” (private medical service) — surgery performed privately in one of the public hospitals in Jerusalem where this service is customary as specified in section 1.5 below.

1.2 General

1.2.1 Insured will be entitled to medical treatment as described in sections 1.3-1.5 be-low, provided that completed 21 membership months in the program (“waiting period”), provided that the treatment is included in the “list of approved medical services” and subjected to the agreements between service providers, having an agreement with “Meuhedet”.

1.2.2 List of authorized doctors” — as specified in appendix B of these regulations, which is an integral part of these regulations and the sole document obligat-ing “Meuhedet” regarding the medical assistance offered to the members of “Meuhedet Adif ”, by virtue of paragraph 1 of these regulations.

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1.2.3 The coverage according chapters 1.3 and 1.4 does not include implants entered into the body of the patient during surgery, except as provided in section 1.6 below.

1.2.4 Participation in “Meuhedet Adif ” with costs as specified in sections 1.3-1.6 below, replaces the participation of “Meuhedet”, if any, in the basic services as statutory in the National Health Insurance and will not be in addition.

1.3 Purchasing of medical services at private hospitals through doctors associated by agreement to “Meuhedet”

1.3.1 Insured needing a surgery/treatment included in appendix B of these regulations, is entitled to choose by himself a private hospital and physician from the list of private hospitals and from the list of doctors having an association agreement with “Meuhedet” (doctor) The list with associated doctors is available to the in-sured at the branches of “Meuhedet”.

1.3.2 If the insured chooses hospital and doctor as mentioned in above section 1.3.1, “Meuhedet” will cover all the expenses in respect of the medical treatment, except for “self-participation” by the insured at a rate not exceed the 15% of the rate the hospital charged the patient for the medical treatment, provided the insured’s self-participation will not exceed 4.995 NIS per treatment.

1.3.3 “Meuhedet” is entitled to reduce or cancel the self-participation of the insured as long as it applied to all insured and any changes to the rate of self-participation fees will be published among all insured

1.3.4 Expenses for services provided to the insured at his request, which are not ac-cording to the existing agreements between “Meuhedet” and service providers, which were not included in the “list of approved medical services” like hospital-ization in a room or preferred class , installing a radio, telephone or television by the bed of the insured, nursing care by a private nurse and/or special surveyance (except the one listed in section 18 below) all these are on the complete account of the insured.

1.4 Purchasing medical services in private hospitals and non-associated doctors by association with “Meuhedet”

1.4.1 If the insured is hospitalized by his own initiative at a private hospital and choose a non-associated private doctor who is not connected by agreement to “Meuhedet” and without advanced coordination with “the approved authority”, he will be obliged to cover all the expenses in by himself in respect to the hospi-

22


talization and treatment. The insured may apply to indemnification in respect to the expenses as specified below.

1.4.1.1 Upon his release, the insured will appeal to the “approved authority” with request for participation of “Meuhedet” in his expenses and will attach to his request a. detailed illness summary; b. original receipts concerning the payments he made for the purchasing of the medical assistance.

1.4.1.2 The “approved authority” will check the eligibility of the insured un-der indemnification of these regulations. If the eligibility is approved, “Meuhedet” will indemnify the insured in respect of expenses for the hospitalization, including the salary of the surgeon and anesthetist, up to a maximum as specified in the refund table available to the insured at the branches of “Meuhedet”.

1.4.1.3 Table of refunds will be updated according the increase of the index on the updating dates

1.4.1.4 “Meuhedet” will not be liable for the professional medical treatment the insured purchased without prior consultation, as stated in section 14.6 Chapter A in these regulations, even if he received an indemnity from “Meuhedet” in respect of expenses for the above.

1.5 Purchasing of medical services in a public hospital through PMS (Private Medical Service)

1.5.1 Insured who was operated by PMS (Private Medical Service) in a public hospital in Jerusalem where this service is customary (Hadassah, Sha’arei Tsedek, Bikur Holim) and as long as the doctor, the surgeon and the requested treatment are included in the agreement between “Meuhedet” and hospital, will he be eligible for covering the full costs of hospitalization according to the rates based on the Ministry of Health, in addition, for the cover of the expenses for the PMS in a direct payment from “Meuhedet” to the hospital, subject to the self-participation of the insured not exceeding 60% of the cost of the surgery, which was committed by the insured hospital rate.

List of services included in each of the agreements will be brought to the insured in any case it will be not less than the list of approved services in appendix B of these regulations. The updated participation rates will be available to the insured at the branches of “Meuhedet”.

23

1.5.2 If the insured choose to purchase medical services on his initiative as part of the PMS as stated above, included in the “approved services list”, and the treatment or doctor is not included in the agreement, the Fund will cover the entire cost of hospitalization paid directly to the hospital. In addition, “Meuhedet” will in-demnify the insured at 30% of total expenses for the acquisition of PMS, but no more than excess indemnity equivalent to US$ 2,500. All subject to the exceptions specified below in section 1.7.

1.6 Implants

“Meuhedet” will indemnify the insured at the rate of 50% of his expenses for the acquisi-tion of “implants” needed during surgery performed in private hospital eligibility would be lim-ited to a maximum of $3,000 a year. All this provided that the insured will present the “approved authority” medical documentation and original receipts as required and provided that the im-plants entered into the insured during surgery are included in the approved medical services list pursuant these regulations.

1.7 Restrictions

1.7.1 If during the hospitalization of insured in a private hospital, due to changes in his medical status, further treatment in another appropriate framework, including “ hospitalization an rehabilitation, “complex nursing”, “regular nursing” or “psy-chiatry” is needed, “Meuhedet” may locate an alternative framework for treat-ments in an appropriate institute. The insured will be entitled to assistance from “Meuhedet” subject to the provisions of the National Health Insurance Law.

1.7.2 To remove any doubt, it is stated that the medical services listed below will not entitle the insured to any financial indemnity if he purchased them in the frame-work of PMS or on his initiative in a private hospital. Below the list of services:

• Normal birth • Caesarean birth • Abortion approved by the medical board for this purpose. • Diagnostic curettage • Cosmetically surgery• Circumcision • Any treatment/surgery that is not included in appendix B of these regulations.

24


2. Diagnoses and treatment fertility disorders in man and in woman

Waiting period: 24 Months from the day of joining the program.

2.1 Definitions

This chapter will have the following terms the implications besides them:

“Vitro” — fertilization (IVF) composed of the following steps:Phase A — diagnostic clarification (clinical, laboratory and by means of simulation), hormone

therapy and monitoring follicles by U.S. (Ultrasound)Phase B — extracting eggs, fertilize them with semen of partner/ donor and plant them in the

womb of insured or of “surrogate mother” (freezing of those not implanted). Also, labora-tory monitoring through U.S. on the development of the fetus, to prove clinical or chemi-cal pregnancy (as defined below).

Phase C — implantation of embryos from frozen stock (if the woman is not pregnant in stage B), including hormonal monitoring and ultrasound surveillance as mentioned in above phase B.

“Clinical pregnancy” — pregnancy, with increasing blood hormone levels and by ultra sound proven existence of pregnancy sack inside the womb.

“Chemical pregnancy” — a high level of blood hormones returning to normal, without evi-dence by ultrasound of pregnancy sack.

“Married couple” — man and woman registered as a married couple in their ID cards.“Single parent family” — a single woman (unmarried, divorced, widow) wanting to have a

child, everything according the rules, conditions and restrictions as defined in these regu-lations.

“Spontaneous genetic material” — a woman’s eggs or sperm from a man by self contribution (not from donor)

“Genetic material from donor” — a woman’s eggs or sperm from a man taken from donor.“Child” — newborn born to a married couple (living as defined in these regulations) from the

current marriage and from spontaneous genetic material (belonging to the couple) or do-nor genetic material, or a newborn born to a one parent family from spontaneous genetic material or from donor

“Recognized department” — a department in a hospital or clinic, recognized by the Director-General of the Ministry of Health, with announcements at the “Lists” and set conditions, authorized to perform medical actions related to in vitro fertilization.

“Authorized institute” — institute or service provider associated by agreement with “Meuhedet” whose details appear in the directory medical services of “Meuhedet”.

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“One attempt” — any attempt when at least completed phases A + B as described above, or any attempt made phase C only.

2.2 General

2.2.1 Those insured by program, who are a married couple or a single family-par-ent, which were found, by a professional factor at “Meuhedet”, as eligible to re-ceive fertility treatments by virtue of the National Health Insurance Law, will be eligible for these treatments in a private hospital associated by agreement to “Meuhedet”.

However, for diagnosis and treatment of existing fertility disorders, in order to achieve pregnancy, provided that the married couple have no present children. Eligibility depends on self-participation at a rate of 15% of the cost of treatment and up to limit amount of self-participation of 1,776 NIS for each attempt.2.2.2 The insured is entitled to receive conservative and/or surgical treatment, as stated above, only up to a maximum of 6 attempts of in vitro conception (IVF) for each child in order to have up to two children, For the avoidance of doubt, it should be emphasized that the eligibility is based on medical criteria by National Health Insurance Law.

2.2.3 Insured of “Meuhedet Adif ”, who are a couples or single parent family already having two healthy children, are entitled to receive 50% participation of the Fund of the cost of each treatment/IVF attempt aimed at t he birth of another child, all within 6 attempts for each child, provided that any “attempt” will be approved in advance by the approving authority of “Meuhedet”.

2.2.4 Approvals to clauses 2.2.2 and 2.2.3 above will be given up to a ceiling of 66,600 NIS for all the approved fertilization attempts.

2.3 Terms of Eligibility

2.3.1 Diagnosis and treatment of fertility problems as defined in this chapter will be given to the insured of “Meuhedet Adif ” if the following exist:

2.3.1.1 Treatment or diagnosis will be performed on the insured if he is a member of “Meuhedet”.

2.3.1.2 The waiting period has passed (24 months).2.3.1.3 Professional and detailed opinion will be given for the reasons of the

fertility disturbance and positive recommendation of a specialist in fe-male medicine or endocrinologists. The insured requires investigation and/or fertility disturbance treatment, including in vitro fertilization.

26


2.3.1.4 In advance approval will be given by the “approving authority” of “Meuhedet” based on the opinion of the consultant — in fertility dis-orders on behalf of “Meuhedet”.

2.3.1.5 Insured is entitled pursuant above section 2.2.3, prior the age of 43, concerning treatment with spontaneous genetic material or by a sperm donor, or prior the age of 48 if it concerns egg donation.

2.4 Tests and treatment

2.4.1 Tests aimed at determining the causes of fertility disorder such as clinical ex-aminations, laboratory tests, routine tests and seed, seed testing using electron microscope (with the approval of the medical ward only), sperm creation pro-cess testing, imaging tests, curettage attempts and invasive testing of abdominal cavity and uterine cavity. Also conservative or invasive treatments such as arti-ficial insemination, surgical treatments, fertility treatments, except for micro-manipulation treatments of eggs prior fertilization or of the fertilized egg, all these will be given to the members of “Meuhedet” in public hospitals funded by “Meuhedet” without self-participation, provided that a senior consultant of “Meuhedet” determined that there is medical necessity and there is a reasonable chance for success.

2.4.2 The same tests and treatments will be given to members of “Meuhedet Adif ”, as stated in above paragraph 2.4.1, also in private hospitals, with self-participation of the insured not exceeding 15% of the costs all this in the framework of the eligibility as specified in above sections 2.2 and 2.3.

2.4.3 The same tests and treatments for the purpose of having a third child and on-wards, will de given to members of “Meuhedet Adif ” only, in the framework of up to 6 attempts for each child provided that the “approving authority” approved and that the self-participation will not exceed 50% of the costs.

2.5 Supply of drugs

Member of Meuhedet Adif who are entitled to fertility treatment based on these regula-tions, are eligible to drugs as specified below:

2.5.1 Medications for fertility disorders included in the medication directory of “Meuhedet” provided to the eligible under the fertilization attempts that have been approved subject to the provision of the law.

2.5.2 Drugs not included in the medication directory will be given to the member of Meuhedet Adif as stated above with “self-participation” of 50% of the retail

27

pricelist and only that these drugs are included in appendix D of these regula-tions.

2.5.3 Drugs for I.V.F. (from phase A), for the birth of third child and onwards will be provided to the members of Meuhedet Adif with self-participation of 15% of the retail pricelist.

2.5.4 Drug entitlement as stated above, is contingent upon the recommendation of a specialist of women diseases associated to “Meuhedet” and he is authorized to prescribe the medicine on behalf of “Meuhedet” provided, that the supply of drugs will be through the pharmacies of “Meuhedet” or through its central dis-pensary.

2.6 In vitro fertilization (I.V.F.)

2.6.1 In vitro treatments are given pursuant these regulations, to all eligible mem-bers of “Meuhedet”, for having up to two children, including the members of “Meuhedet Adif ” for having a third child and onwards, all these subject to the regulations as specified below:

Number

of childrenKind of insurance Number of attempts

Self-

participation in

public hospital

Self-participation

in private hospital

For the first two

children

Meuhedet members not

insured by “Meuhedet Adif”

According determination

by specialist

None Are not eligible

for participation

of “Meuhedet”

for hospitalization

in private hospital

Insured at “Meuhedet Adif” Public hospital —

according determination

by specialist.

Private hospital —

6 attempts for each child

(from those approved

by virtue the law

by the specialist)

None Up to 15% of the cost

for each attempt

For the third

child

Insured at “Meuhedet Adif 6 attempts for each child

(according approval of

specialist)

50% of the cost for

each attempt

50% of the cost for each

attempt

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2.6.2 Since the in vitro fertilization (I.V.F.) is carried out according to the recommen-dation and invitation of “recognized department” according to the request and consent of the insured, “Meuhedet” will not be imposed with direct professional liability or responsibility for the referring of the in vitro fertilization and its out-come, including complications during pregnancy and/or birth and/or for birth defects in the fetus. Although the treatment complications as mentioned above, will be on the expense of Meuhedet according the provisions of National Health Insurance Law, but without derogating from the above Meuhedet is exempted of responsibility.

2.6.3 Meuhedet will Fund the in vitro fertilization, taking place only in a “recognized department” of a hospital within the State of Israel associated by agreement to Meuhedet and subject to the conditions set forth in these regulations.

2.7 Freezing of genetic material

2.7.1 In the framework of the fertilization attempts approved by virtue of these regula-tions, “Meuhedet” will participate in the expenses for freezing fertilized eggs and implanting back in the insured, from the frozen stock (phase C) if the insured was not pregnant in phase B of the in vitro fertilization.

2.7.2 All members of “Meuhedet” are entitled to full financial cover by “Meuhedet” for freezing fertilized eggs for one year only. Insured with “Meuhedet Adif ” are eligible for an additional period of two years with self-participation of 50% of the self-cost.

2.7.3 Insured who has an Oncology illness or suffers from fertility problems, will be entitles on the account of the Fund, to save sperm for a period of five years in the framework of public service providers associated by agreement to “Meuhedet”.

2.7.4 Participation of the Fund as stated in above sections 2.7.2 and 2.7.3 will be ex-ecuted directly to the hospital, as stated above.

2.7.5 For the avoidance of doubt, the foregoing is subject to the treatment carried out in hospitals associated to “Meuhedet”, subject to the regulations of the Ministry of Health on the matter and on the sole responsibility of the insured and the per-forming specialist.

2.8 Fertility disorders and treatment, using egg donation, carried out abroad.

2.8.1 Insured by “Meuhedet Adif ” having no more than, will be entitled to indemnity up to a ceiling of 7,777 NIS, for treatment requiring egg donation, as part of fertil-

29

ity treatment approved by “Meuhedet”, under conditions and restrictions as speci-fied in Chapter 2 of these regulations.

2.8.2 Refund of the mentioned above relating to the treatment carried out abroad, in-clude both the expenses for obtaining the eggs and implantation of the fertilized eggs in the womb

2.8.3 The mentioned assistance will be approved up to two cycles of egg donation fer-tility at the insured, and is subject to in advance approval by the department of medicine of “Meuhedet”.

3. Drugs not included in the “drugs list” of “Meuhedet”

Waiting period: 6 months from the day of joining.

3.1 Eligibility through “Adif ”

3.1.1 Insured “Meuhedet Adif ” are entitled to a discount in purchasing essential drugs which are not approved for supply in the framework of its drugs list. This by recommendation of a specialist of a public hospital or the K, on a prescription of “Meuhedet” and provided that these drugs are included in appendix D of these regulations and according to the conditions specified in the same appendix.

3.1.2 “Meuhedet” may stipulate the discount mentioned above in section 3.1.1, such that t he purchase of the drug will be performed through a pharmacy of “Meuhedet” and/or pharmacies associated by agreement and all this as specified in appendix D of these regulations.

3.1.3 Drug, limited for purchasing at a certain site acquired by the insured on another site, and a drug that was purchased by the insured on a prescription not from the K, will not be entitled for discount or any refund.

4. Psychological counseling


4.1 General “Meuhedet Adif ”’s Insured are entitled to counseling and psychological therapy by inde-

pendent psychologists associated by agreement to the Fund, subject to the below condi-tions:

4.1.1 The treatment was approved in advance by an officer of “Meuhedet” (henceforth the professional authority). The professional authority will determine the preferred type

30


of treatment and scope, and refers the insured to the therapist associated by agree-ment to “Meuhedet” and meets most suitable the needs of the treatment of the in-sured, provided that the number of treatments will not be more than 36 treatments.

4.1.2 The insured will be charged with self-participation payments as follows: • For the first 12 treatments — 110 NIS per treatment • For treatments 13-24 — 133 NIS per treatment • For treatments 25-36 — 155 NIS per treatment

4.2 Terms of service delivery

4.2.1 For each treatment, which was approved as stated in section 4.1.1, the insured pays the treating psychologist the self-participation as set out above.

4.2.2 The balance amount will be paid to the therapist by the Fund.4.2.3 Insured who wants to continue the treatment with the same therapist in excess of

the number approved by t he professional authority, will pay the therapist directly a total of 215 NIS for the treatment and for a period not exceeding one year from the approval certificated of the professional authority. If treatment continues be-yond this period, the therapy cost will be aggregated between the insured and the therapist, but for an amount not exceeding 277 NIS per session.

4.2.4 If the insured received counseling/therapy from any specialist not associated by agreement to the K, without prior coordination with the “professional authority”, he will be entitled to some indemnification for expenses by “Meuhedet”.

4.2.5 Psychological therapy provided under these regulations is not aimed at diseases and/or mental disorders because of complexity or degree of severity requiring treatment in psychiatric hospitals or mental health clinics and all according the professional discretion of the approving authority of the K.

5. Medical assistance abroad

Waiting period: 24 months from day of joining.

General5.1 “Meuhedet Adif ”’s Insured are entitled to participation of “Meuhedet” for expenses to

purchase health services abroad in cases as follows: In this chapter, medical expenses include: general hospitalization and/or ambulatory

treatment, including wages of doctors, nurses, medical examinations, laboratory services, medicines, surgical expenses, anesthesiologist, recovery room, intensive care as well as tax and levies paid in foreign currency, in the country providing medical treatment for medi-cal expenses.

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5.2 Additional assistance for performing transplants and life-saving surgeries abroad in those cases entitlement according the Ministry of Health Policy

Insured Meuhedet Adif will be entitled to participation in expenses by “Meuhedet”, to purchase health services abroad for the entitling case (including medical flying of the in-sured), in case the requested service is a life-saving service, which the insured is entitled to receive in a foreign country pursuant the provisions of National Health Insurance Law and its policy (Regulations National Health Insurance Medical Services in Foreign Countries Act — 1995) — henceforth in this chapter: “The Health Ministry Regulations”, provided that the insured received prior written approval for surgery abroad from “Meuhedet” and all as specified below:

5.2.1 If the entitling case as mentioned above in paragraph 5.2, is a transplant of liver, heart or lungs, the insured will be eligible only for transplantation in overseas medical centers associated by agreement to “Meuhedet” and all in the framework of the agreements held by “Meuhedet” at that time and within the framework of activities performed at that Medical Center. In this case, “Meuhedet” will pay the mentioned medical center directly the full cost of the transplant. List of medical centers abroad associated by agreement to “Meuhedet” will be published in ap-pendix C of these regulations and will be periodically updated.

5.2.2 If the entitling case, as mentioned above in paragraph 5.2, is a life-saving treat-ment or surgery, not done in Israel (excluding organ transplantation), the par-ticipation of “Meuhedet” will be limited to the height of its own cost of a hospi-tal with agreement and no more than the sum of US$ 100.000 beyond the basic amount of entitlement pursuant Ministry of Health Regulations.

5.2.3.1 “Meuhedet” will cover the expenses of hospitalization and medi-cal treatment of the donor (as defined in these regulations), in case of transplantation surgery as mentioned in above section 5.2.1. Also, “Meuhedet” will cover the “escort expenses” of the donor before and after the hospitalization, as required and pursuant these regulations.

5.2.3.2 For avoiding any doubt, “Meuhedet” will only cover the expenses of amputation of body parts or taking tissues from the body of the donor. This will not create any liability of “Meuhedet” on behalf of the donor and/or the successors. All this in case of complications, physical harm, or death of the donor during or after the surgery/treatment, or any other reason.

5.2.3.3 “Meuhedet” will cover the expenses of the donor and mentioned in above section 5.2.3.2 and the accompanying expenses as specified in these regulations. As long as the donor stays abroad for the relevant

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medical treatment. Upon his return in Israel, he continuing treatment (if needed) will be through “Meuhedet” of the insured and/or on the account of the donor, subject to the regulation of National Health In-surance Law.

5.3 Treatments abroad not included in the Ministry of Health Regulations

5.3.1 Insured “Meuhedet Adif ” is entitled to additional medical services abroad. Be-yond those determined by the Ministry of Health pursuant regulations of Min-istry of Health, their definitions in this chapter, and provided that they obtained prior written approval from the approving authority, after this has been convinced that the illness in question requires medical treatment which is not provided in Israel and whether there is no alternative treatment for this in Israel. “Alternative treatment” is a medical treatment performed in Israel which, according to ac-cepted medical standards, is aimed to achieve the same medical result achieved by other medical treatment not performed in Israel, and as long as that does not involve more serious physical consequences to the patient.

Treatments included in this section are designed to regulate one of these four:

5.3.1.1 Preventing total loss of sight and hearing5.3.1.2 Saving an organ5.3.1.3 Kidney transplant5.3.1.4 Special medical cases, amongst as determined by the approving au-

thority of “Meuhedet” has decided that performing the medical treat-ment abroad is necessary.

5.3.2 “Meuhedet” will cover the medical expenses of the insured for approved treat-ment as stated in above section 5.3.1.1 up to a maximum of $85,000; for approved treatment as stated in above section 5.3.1.2 up to a maximum of $35,000; for ap-proved treatment as stated in above section 5.3.1.3 up to a maximum of $90,000; and for section 5.3.1.4 insured will be eligible to indemnification for the cost of performing a similar treatment in a public hospital under the Ministry of Health rate. In this case, the insured will not be entitled to payment of expenses as speci-fied in below section 5.8.

5.4 “Meuhedet” will be entitled at its discretion when referring the insured to the medical center associated by agreement, to pay the medical expenses that were approved pursuant these regulations, in whole or partly, directly to the medical center abroad, in accordance with the approved limit of indemnity under these regulations or to pay them to the in-

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sured equivalent in NIS of the day of payment, based on the prevailing exchange rate as specified in chapter 1, section 3.2.3 of these regulations, provided the insured actually paid the medical expenses and submitted the relevant medical documents and the original receipts to “Meuhedet” confirming the actual payment by the insured.

5.4.1 In any event “Meuhedet” decided to pay its part directly to the medical center abroad, “Meuhedet” will send a message of financial commitment to the service provider as stated above, subject to the height of approved indemnification pursu-ant these regulations.

5.5 If the insured refuses to hospitalize in a “agreement hospital” as stated in above sections 5.4 and has been admitted at another hospital abroad:

5.5.1 For the event specified in sections 5.2.1, 5.2.2 the insured will not be entitled to indemnification according these regulations except entitlement fixed by law.

5.5.2 For an event as specified in above sections 5.3.1.1- 5.3.1.4, “Meuhedet” will in-demnify the insured for the expenses which were paid by him for medical treat-ment on the basis of its “self-cost” at the “hospital in the agreement” provided that the sum of indemnification will not exceed the limit of indemnity he is entitled by virtue of the stated in these regulations

5.6 If the medical center abroad, associated by agreement to “Meuhedet”, is not equipped to provide the required medical service according sections 5.2.1 and 5.3.1.1-5.3.1.4 and after the insured receive approval from the authorized person at “Meuhedet”, the insured will be entitled on hospitalization in another hospital and receive refund from “Meuhedet” for the expenses which he paid by himself for the treatment subject to the following maxi-mum indemnification:

5.6.1 For an event the insurance described in section 5.2.1 maximum indemnification will be an amount of $250,000 exceeding the basic amount of entitlement by law.

5.6.2 For an event the insurance described in section 5.2.2. Maximum indemnification will be an amount of $100,000 exceeding the basic amount.

5.6.3 For an event the insurance described in sections 5.3.1.1. — 5.3.1.4 the maximum amount of indemnification as mentioned in section 5.5.2.

This indemnification provision is conditional to obtaining prior approval before the hospi-talization or treatment by the authorized person at “Meuhedet”.

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5.7 For the avoidance of doubt, the mere payment by “Meuhedet” for treatment abroad, if by issuing a commitment or indemnity, by itself does not imply taking responsibility for professional treatment performed abroad.

5.8 Accompanying expenses for medical assistance abroad

5.8.1 Indemnification height

5.8.1.1 Insured “Meuhedet Adif ” who’s request for medical treatment abroad has been approved pursuant Ministry of Health Regulations or by virtue of these regulations, will be entitle to indemnification for the eligible case (except in the event included in section 5.31.4) up to a maximum of $10,000 for each eligible case of “accompanying ex-penses” as defined below and according the conditions stated below and provided that the total accompanying and medical expenses for the same eligible case, will not exceed the maximum as determined in these regulations.

5.8.1.2 The above mentioned amount is for the maximum indemnification for the accompanying expenses the insured had for each eligible case approved pursuant the regulations of chapter 5 of these regulations. If the insured has exhausted the full amount of the above indemnity, whether during one trip abroad, or several trips for the same eligible case (returning medical care, follow-up tests, etc.) he will not be en-titled to indemnification in respect of that same eligible case, even if his expenses were higher that the approved maximum.

5.8.2 “Accompanying expenses” — definitions: Actual expenses for purchasing non-medical test treatments or medication, the

insured paid for receiving medical treatment abroad, this after the approval pur-suant these regulations by the authorized person at “Meuhedet” for receiving medical treatment a broad, subject to the provisions of below section 5.8.3

5.8.3 Accompanying expenses eligible indemnity.

5.8.3.1 Flight expenses from Israel to the country of treatment and back on a commercial regular flight of a civilian airline, in tourist class of one escort and if there is medical necessity approved by “approving author-ity” also a donor and/or accompanying doctor (henceforth “escorts”). For the avoidance of doubt, “Meuhedet” will not be liable for payment

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for additional expenses resulting from excess cargo of the insured and/or escorts.

5.8.3.2 Expenses for transportation by land of the insured by the cheapest public transportation appropriate to the medical condition of the in-sured (including transport by local ambulance if required) from the airport of the country of treatment to the hospital and back.

5.8.3.3 Only essential living expenses according the opinion of “Meuhedet”, of the insured and escorts approved by “Meuhedet”, during their stay abroad (before, during and after hospitalization) as required by the medical condition of the insured according the discretion of “Meuhedet”, provided that the total expenses, according this section, will not exceed 30% of the maximum indemnity as specified in above section 5.8.1.1.

5.8.3.4 Indemnity of “Meuhedet” in respect the salary of an escorting doctor will be calculated on daily wage basis, as is customary for a senior doc-tor at a public hospital in that country up to 4 days of stay abroad.

5.8.3.5 In case of death of the insured or the donor as a result of the treat-ment received for “eligible cases” “Meuhedet” will cover the costs of flying the body to Israel, subject to the limit of indemnity set forth in these regulations, provided that the indemnity in this paragraph will not exceed 30% of the balance of indemnification as set forth in above section 5.8.1.1 which has not been exploited to that date. It is hereby declared that “Meuhedet” does not cover any expenses of transporta-tion or treatment of the body in Israel.

5.8.3.6 The indemnification amounts for “accompanying expenses” as men-tioned above will be paid in NIS in Israel to the insured and the escort-ing doctor, worth the value of foreign currency paid abroad, based on the representative exchange rate on the day of payment.

5.9 Travel insurance abroad

5.9.1 It is hereby declared that the insured and the escorts themselves are obliged to purchase a travel insurance policy covering the full period of their stay abroad, in order to insure their own health and luggage insurance which are not included in the obligations of “Meuhedet” according these regulations.

5.9.2 The insurances premiums of the above are for the account of the insured and escorts, and the “Meuhedet” is not obligated to cover any part of these expenses.

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6. Second opinion


6.1 Second medical opinion in Israel.

6.1.1 Insured is entitled to a second medical opinion with the State of Israel.6.1.2 Insured requesting an additional medical opinion in Israel is entitled as follows:

6.1.2.1 If the consulting doctor is not associated by agreement to the “Meuhedet” as specified below, and the insured turned to him on his own initiative and account, the insured will be indemnified 85% of the expenses for purchasing an “additional opinion” and provided that the indemnification will not exceed 509 NIS and provided opinions are given by a “medical expert”.

In this section, “medical expert” — someone included in the list of consulting specialist.

This list includes doctors recognized until 28.6.09 to which medical experts will be added depending the decision of the commission for recognizing medical experts for this section, in accordance with the procedure of the committee as approved by the Ministry of Health.

The committee is also authorized to strike doctors from the list. The list does not include physicians associated by agreement to Meuhe-

det to supply medical services offered to all insured according the basis defined by the National Health Insurance Law, except for senior–con-sultants of the medical department of “Meuhedet”. The contents of the list will be available to the insured at the branches of “Meuhedet”.

6.1.2.2 All the mentioned above will be performed by approval of the “ap-proving authority” in exchange for providing the original receipts and medical documents.

6.1.3 Restrictions.

6.1.3.1 Insured is entitled to receive service/indemnification as set forth in the above section 6.1.2.1 for three additional medical opinions in total during one calendar year.

6.1.3.2 The medical treatment advised by the consulting person as set forth in above section 6.1.2.1 will be provided subject to the approval from the approving authority of “Meuhedet”.

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6.1.3.3 If the insured received opinion and treatment recommendation, which is not approved by the senior professional authority in that area of “Meuhedet” and decides to perform the treatment in spite of that, the responsibility and expenses of the treatment will be on the insured.

6.2 Additional opinion abroad.

6.2.1 The insured is entitle to consult a senior specialist abroad — from one of the medical centers abroad associated by agreement to “Meuhedet”, provided that he first consulted with a senior specialist in the area in question from “Meuhedet” and received in advanced approval from the approving authority of “Meuhedet”. All this provided that the need for consult result from one of the following:

6.2.1.1 There is a recommendation of an oncologist consultant on behalf of “Meuhedet”.

6.2.1.2 There is an apprehension for the necessity of open-heart surgery or brain surgery.

6.2.1.3 There is need for implantation of one of the following organs: heart, liver, bone marrow, or lungs.

6.2.1.4 Illness (not through accident) requiring limp amputation.

6.2.2 Insured recognized of being entitled for receiving additional opinion abroad pur-suant these regulations, will be entitled to receive an additional opinion from one of the medical centers abroad associated by agreement to “Meuhedet”, with self-participation not exceeding $50. The right is for one opinion per year.

6.2.3 If in the area in question, no medical opinion can be obtained from one of the medical centers abroad associated by agreement to the “Meuhedet”, and the insured has been recognized to be entitled for receiving an additional opinion abroad pursuant these regulations, the insured is eligible to indemnification at the rate of 75% of his actual expenses for receiving additional opinion from another medical center abroad up to a maximum of $800.

6.2.4 Indemnification will be given for expenses charged by a consulting doctor and for the expenses of sending medical material abroad.

6.2.5 The above mentioned will be given provided that the person given the additional opinion is a senior specialist and known in the requested area and subject to the approval received from the approving authority of “Meuhedet”.

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7. Vaccinations

Waiting period: 6 months from the day on joining.

7.1 Insured not belonging to the risk group and requests vaccination by his own initiative, is entitled to receive the vaccinations as specified below:

7.1.1 Vaccination against inflammatory disease of the liver type A or B.7.1.2 Vaccination against influenza7.1.3 Vaccination against pheumovax

7.2 Indemnity.

7.2.1 The immunization vaccine as specified in above sections 7.1.1 — 7.1.3 will be pro-vided to the insured “Meuhedet Adif ”, through the pharmacies of “Meuhedet” by payment of a minimum fee as defined below in this section. “Minimum fee” is a self-participation amount customary at Meuhedet for purchasing drugs included at the services and drugs list as defined by National Health Insurance Law, and as periodically updated. The self-participation will de determined according regula-tions of the collection program of “Meuhedet” as they apply in relation to basic drugs. The above-mentioned vaccines will be supplied through the pharmacies of “Meuhedet” only.

7.2.2 If the vaccine is one of those listed in above section 7.1.1, and cannot be supplied through the pharmacies of “Meuhedet”, the insured is entitled to indemnification up to 40% of the retail price.

8. Vaccinations and drugs for travelers abroad

Waiting period: Not required.

8.1 Insured is entitled to participation of the Fund for preventive vaccinations and drugs needed when traveling abroad to those territories requiring vaccination under the provi-sions of the Health Ministry, to prevent infection from diseases existing in those foreign countries.

8.2 Recipients of vaccines before a trip abroad as stated in above paragraph 8.1 are entitled to indemnification at a rate of 75% of the vaccine.

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8.3 The insured is also entitled to refund of such expenses for medical consultations provided in the framework of a clinic for travelers prior receiving the mentioned vaccinations and not more than the sum of $35.

9. Recovery after complicated surgery

Waiting period: 3 months from day of joining.

9.1 Insured who did under go brain surgery, abdominal surgery, organ transplantation or other surgery (except for cosmetic plastic surgery and surgeries in the obstetrics area) requiring hospitalization of more than 10 days, will be entitled to indemnification to the full expense up to a maximum of US$65 per recovery day at an institution designated for that purpose, for a period not exceeding 7 consecutive days after surgery.

9.2 After acute myocardial infarction, the insured is entitled to 7 days of recovery (including days of recovery, which were approved by National Health Insurance Law) in as insti-tution associated by agreement to “Meuhedet” and is designated for rehabilitation and recovery of heart patients. Participation will be limited to a maximum of 222 NIS per day for each additional recovery day beyond the eligibility of the basis.

9.3 Eligibility of the insured as stated in above sections 9.1 and 9.2, is conditioned on the need for recovery has been recognized in advance by the approving authority of “Meuhedet”, and that the insured will leave for recovery upon his discharge from the hospital or adja-cent to his release (up to 14 days from his discharge).

9.4 Insured is obliged to present to the approving authority, a letter of discharge from the hospital and original receipts, specifying the name of the person staying at the hospital, days of recovery and cost of t he insured.

10. Monitoring high-risk pregnant women


10.1 Insured during advanced pregnancy, according the treating physician of the “Meuhedet” or of the public hospital, is at high risk in respect to the state of health and/or the state of health of the fetus, is entitled to receive a home monitor for monitoring the pregnancy.

10.2 Duration of connection time of the insured to the monitor will be determined by a profes-sional on behalf of “Meuhedet” and this for per period not exceeding three months.

10.3 The insured needs to pay self-participation of 50 NIS per month. For avoidance of doubt, “month” for this purpose of this section shall be deemed part pf any month in which the monitor device in question was in the possession of the insured.

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10.4 If the insured purchased a home monitor, without prior approval of the “approving au-thority”, the insured will entitled to indemnification for the expenses at the self-cost of “Meuhedet” if the “approving authority” will be convinced that this acquisition was justi-fied.

11. Complex hospitalization and nursing

Waiting period: 12 months from the day of joining

11.1 Insured, who is hospitalized and the hospitalization is defined as complex nursing, will be exempt for 60 days from the first hospitalization of self-participation, and the Fund will bear the full cost of hospitalization expenses.

11.2 From the 61st day of hospitalization, the insured will be charged with self-participation subject to the regulation of National Health Insurance Law.

11.3 Became the insured from state “complex nursing” to “standard nursing”, “Meuhedet” shall be exempt from participating in any hospitalization.

12. Dentistry and gums

Waiting period: not required.

12.1 Insured “Meuhedet Adif ” are entitled to service in the area of dentistry as specified below”.

12.1.1 Free dental check once a year at the dental clinic of “Meuhedet”.12.1.2 First aid and emergency treatment for free, including: testing and photographing

the painful tooth, temporary filling, prescribing appropriate pain relief, emergen-cy tooth extraction, drainage boils infected tooth and pasting temporary crowns of fallen ones, all this preformed at the dental clinics of “Meuhedet”

12.1.3 Stone removal and oral hygiene training at 50% discount and not more than twice a year only and al this at the dental clinics of “Meuhedet”.

12.1.4 Another discount of up to 20% (depending on the type of treatment) on the rate of “Meuhedet” for insured for conservative dental treatment ( fillings and root ca-nal treatment), regular and surgical extractions, curettage of gums and gum sur-gery, periodontal crown evaluation, teeth alignment (crown and bridges — not including laboratory expenses) provided that the dental treatment is carries out at the dental clinics of “Meuhedet”. Treatment rates will be available for members a the dental clinics of “Meuhedet”.

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12.1.5 Supply of medication on the account of “Meuhedet” related to dental treatment under the terms of supply and specified in appendix D of these regulations.

13. Alternative medicine

Waiting period: not required

13.1 Insured suffering from a medical problem for which is no cure by customary methods “conventional medicine”, will be entitled to a discount of between 25-40% of the standard rate at the complementary medicine clinics of “Meuhedet” in respect of treatment (in this section — “treatment” is an active therapy resolving an acute problem and ongoing main-tenance treatment). The height of the discount depends on the type of treatment — the fee will be made available to the insured at those clinics. All this, subject to the terms of Ministry of Health.

13.2 Conditions for receiving the treatment.

13.2.1 The screening doctor at the complementary medical clinics of “Meuhedet” is of the opinion that the insured can be helped and determines the type of treatment and scope. Choose the insured to continue the treatment beyond the scope of the screening doctor as mentioned above, or beyond the quota which includes 36 treatment per year (the higher between the two), the insured will be charged with the customary treatment rate for members of “Meuhedet” not insured in the program.

13.2.2 For the avoidance of doubt, it is hereby clarified that the insured is not entitled to indemnification in respect of treatment received in “alternative medicine” outside the clinics of “Meuhedet”.

13.2.3 “Meuhedet” will provide each of the designated clinics, arrange of existing treat-ments at a clinic and is committed to supply each of its clinics with treatments of all areas existing in complementary medicine.

13.2.4 Professional authority of “Meuhedet” may refer the insured to another clinic of “Meuhedet” required for receiving treatment, if treatment is not provided at the referred regional clinic.

13.2.5 Beyond the biofeedback treatment for training the pelvic floor muscles covered by the basis, the insured will be entitled to receive at the health clinics of “Meuhedet” dealing with that, up to 15 additional biofeedback therapies, and this with maxi-mum self-participation of 50 NIS per meeting.

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13.3 Below the customary treatment methods at the complementary clinics of “Meuhedet” Acupuncture, shiatsu, reflexology, tuina, chiropractic, osteopathy, biofeedback, hypnosis,

homeopathy, Paula method, Alexander technique, Feldenkrais method, bedwetting treat-ment.

14. Early detection of birth defects in fetus


14.1 Amniocentesis for pregnant women.

14.1.1 Insured pregnant women at “Meuhedet Adif ” when entering pregnancy was less than 35 years, are entitled to perform amniocentesis or CT of the placenta, only one of there two tests, according to the choice to the insured; at the expense of the Fund at one of the institutes associated by agreement to “Meuhedet”, even when lacking the circumstances that constitute risk factors, as detailed in the National Health Insurance Law, provided that the recommendation has been given by the obstetrician of “Meuhedet”.

14.1.2. The above-mentioned tests are carried out in self-participation of the insured at a maximum of 555 NIS per test. Insured referred by “Meuhedet” to perform the examination at an external clinic, will be entitled to indemnification at 75% of the cost up to a maximum of 1,130 NIS.

14.1.3 The above mentioned test will also be performed on the expense of “Meuhedet” at married couples where the husband is a member of another Health Insurance Organization. except in cases where reason for performing the test is a hereditary disease or defect structure of chromosomes found in the husband member of oth-er Health Insurance Organization. In these cases the test will not be performed at the expense of the Fund.

14.2 Screening of the systems of the fetus.

14.2.1 Insured member of “Meuhedet Adif ” is entitled, on request, of extended screen-ing the systems instead of the basic screening approved for all the members of “Meuhedet”, during the second trimester of pregnancy (week 20-25). The screen-ing will be given once every pregnancy in clinics and institutes associated by agree-ment to “Meuhedet” with self-participation of the insured of 110 NIS per test, provided t hat there is a recommendation from the obstetrician of “Meuhedet”.

14.2.2 Insured member of “Meuhedet Adif ” is entitled to early system screening at the institutes of “Meuhedet”, during the first trimester of pregnancy, with self-partic-

43

ipation of the insured of 110 NIS only. Fulfilling the eligibility under this section will cancel the insured’s rights to receive service under rules stated in section 14.2.1.

14.3 Restrictions.

14.3.1 “Meuhedet” is not responsible for any early non-detection of birth defects fol-lowing test, which were specified in above sections 14.1 and 14.2, due to existing limitations of early detection of some birth defects in the fetus using the equip-ment existing in the health system.

14.3.2 If the pregnant insured choose to receive medical assistance as stated in above sections 14.1 and 14.2 and has done so on her own initiative, by her responsibility and expense, without obtaining prior approval of the approving authority, will not be entitled to indemnification for any expenses incurred.

15. Purchasing of implants and medical accessories

Waiting period: for “implants” — 12 months, for other “medical accessories” as specified below — 3 months from the day of joining the program.

15.1 Insured “Meuhedet Adif ” is entitled to participation for the acquisition of “implants” and/or medical equipment as specified in appendix E, provided that there is recommendation from doctors of “Meuhedet”

15.2 Insured “Meuhedet Adif ” is entitled to indemnification for the acquisition of “implants” when admitted at a private hospital to perform surgery, requiring transplantation of im-plants as stated in section 1.6 of chapter 2 of these regulations.

15.2.1 For the avoidance of doubt, it is stated that the supply of implants for transplanta-tion during hospitalization of an insured in a private hospital, is not included in the rate agreed between “Meuhedet” and the admitting hospital.

15.2 In any case, the acquisition will be at the expense of the insured. The Fund will indemnify the insured according these regulations/

15.3 “Meuhedet” will indemnify the insured only for the acquisition of implants an d/or essen-tial medical accessory, which are included in the “approved list of medical accessories” as specified in appendix E of these regulations and according to the model of the accessory/implant approved by the medical department of “Meuhedet”.

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15.4 Meuhedet may refer the insured to purchase the implant/ accessory in the framework or supplier associated by agreement to “Meuhedet”. “Meuhedet” will participated in t he overall expenses of the member at a rate of 50%-85% of the device cost to an extent and conditions as will be updated from time to time and published at “list of approved acces-sories” in appendix E of these regulations. All these against presentation of the relevant medical documents and original receipts.

15.5 The maximum refund amount to the insured for the purchase of medical equipment, non-implant, is $750 per year. The maximum refund amount to the insured fo the purchase of implants is $3,000 per year.

15.6 “Meuhedet” may lend medical device/accessory to the insured for a period determined by the approved authority of “Meuhedet”. In this case, the member will be obliged to deposit a deposit check of 20% of the cost of the device. The check will be returned to the insured upon return of the device to “Meuhedet” in a good condition on the set date. In addition, the insured will be charged with monthly fees as specified in appendix E of these regula-tions.

15.7 “Meuhedet” is not responsible for the proper functioning of equipment and/or accessories purchase by the insured not within the framework. In this case, the responsibility of the purchase will apply to the insured. For the avoidance of doubt, the said is not supposed the harm anyone responsible for normal functioning of the device or accessory under any law or case.

15.8 Insured “Meuhedet Adif ” will also be entitled to increase indemnification or to reduce the self-participation for the accessories and implants supplied to them by the provisions of National Health Insurance Law, as specified in appendix E of these regulations.

16. Recovery of women after birth


16.1 Women after birth are entitles to recovery at an institute designed for recovery after birth, provided that she has three children or more. All this on condition that, the leave of re-covery took place within one month from the day of discharge of mother/child (the later of the two) from the hospital.

16.2 The mother will be entitled to indemnification at a rate of 75% of actual expenses for each full day of recovery, up to t he amount of 222 NIS per day. All this, for a maximum period of three days and presenting of certificate discharge from the maternity ward and original receipts indicating the amounts paid to the recovery house or motel.

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17. Subscription thoracic transmitter and emergency services for cardiac patients

Waiting period: 6 months from the day of joining the program

17.1 Insured who suffers from heart disease and according the opinion of a cardiac special-ist of “Meuhedet” or of a public hospital, his condition requires monitoring by thoracic transmitter, will be entitles to indemnification for the purchase of a subscription for a transmitter and emergency services, provided the medical condition results from one or more of the following situations:

17.1.1 Insured is shortly after myocardial infarction.17.1.2 Insured is a candidate for heart surgery.17.1.3 Insured underwent heart surgery17.1.4 Insured suffers from a hearth rhythm disorder17.1.5 Insured suffers from a unstable angina pectoris

17.2 Height of indemnity.

17.2.1 First 3 months of subscription — on the expense of “Meuhedet”.17.2.2 Additional 9 months — based on 75% indemnification of the subscription cost up

to am maximum of US$25 per month17.2.3 Continuation of above indemnification for the period an additional year be-

yond the above mention, provided recommendation of cardiologic doctor from “Meuhedet”.

17.3 The approval by the “approving authority” for the subscription of the thoracic transmitter will be given in name of the institutes under agreement with “Meuhedet”.

18. Private Nurse


18.1 Insured “Meuhedet Adif ” is entitled to indemnification for the acquisition of services of a private nurse after surgery for which he was recommended by a doctor in the hospital. Hiring the services of a private nurse attached to the patient during hospitalization.

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18.1.1 Indemnification. Insured will be entitled to indemnification by “Meuhedet” up to 75% of actual

expenses in respect of hiring a private nurse, up to a limit indemnity of US$100 per day, for a period not exceeding 8 days after surgery.

18.1.2 Indemnity to the insured for the purchase of services of a private nurse contin-gent that he is admitted at a public hospital or private hospital with an agreement with “Meuhedet”.

19. Child development


Insured children in “Meuhedet Adif ”, who are eligible for treatment under the National Health Insurance Law and are recognized for their needs by a professional of “Meuhedet”, for treatment in the area of child development by a multidisciplinary team — beyond the treatment quota defined in the National Health Insurance Law, will be entitled according to the following conditions:

19.1 Children at the age 3-6 years:

19.1.1 Children as mentioned above will be entitled to receive up to 36 treatments per year (in all fields together) in addition to the treatment quota eligible by provi-sions of the National Health Insurance Law.

19.1.2 The treatment will be given in the framework of one of the institutes of “Meuhedet” or in the framework of an external institute associated by agreement to “Meuhedet” to which the insured was referred by a professional of “Meuhedet”. The insured pays 24 NIS self-participation per treatment.

19.2 Children over the age of 6 and up to 9 years are eligible to receive up to 18 treatments (in all fields together) in addition to the quota treatments they are entitles by virtue of Nation-al Health Insurance Law. Terms of service provision as specified in above section 19.2.

19.3 “Meuhedet” has no responsibility or obligation of professional indemnity pursuant these regulations for treatment not approved in advance by the professional authority of “Meuhedet” and purchased on initiative of the insured.

47

20. Treatment of speech disabilities


20.1 Stuttering therapy courses — insured up to the age of 18 years is entitled to participation of “Meuhedet” in one course of stuttering treatment, beyond the existing entitlement by law. Participation of t he “Meuhedet” — 50% of the cost of the course up to a maximum of 848 NIS.

20.2 Speech therapist — insured is entitled to a course of 12 treatments of the speech therapist, including learning disabilities with background of organic languages, with self-participa-tion up to 50% of the rate as customary at “Meuhedet”.

20.3 The above sections 20.1 — 20.2 are conditional of approval of “Meuhedet” and a profes-sional of “Meuhedet” and thus that the treatments will be provided by “Meuhedet” or by a service provided associated with “Meuhedet”.

21. Genetic testing


Insured “Meuhedet Adif ” will be entitled to a one-time trial discovery of carried diseases from the following list, provided he is not entitled to such testing services under the National Health Insurance Law. The test will be performed in public hospitals or at an institute associated by agreement to “Meuhedet”, provided that there is a recommendation of a physician geneticist from Meuhedet.

21.1 Genetic tests to detect one or more of the following disease: fragile X, CF, Familial dysau-tonomia, CANAVAN, USHER syndrome type GCDI, ML4, I-Type I Glycogen Accumulat-ing, Neiman Pick, lacking alpha-antitrypsin deficiency, Fynconi, Bloom, Myopathy lind Nemaline, MSUD disease, Ataxia Talangiatic, Kustoff disease, myopathy kind Dysferin, and Metachromatic MLD (leukodystrophy).

21.2 The self-participation of the insured will be limited to a maximum of 100 NIS per test. Participation of insured performing several tests together will be limited as follows:

21.2.1 Series of 6 tests: maximum total participation of insured 444 NIS.21.2.2 Series of 8 tests: maximum total participation of insured 638 NIS.21.2.3 For each additional test of the above list, the insured will pay self-participation

not more than 139 NIS per test.

48


21.3 Insured will be entitled to, by choice, genetic testing from the above list in an institute not associated by agreement to “Meuhedet” or performing other genetic testing. Eligibility is limited to 4 tests during the period of insurance. As stated, the insured will be entitled to a refund at a rate of 80% of the expenses up to an overall maximum for all the tests accord-ing the regulations on this section, for the amount of 722 NIS.

21.4 For the avoidance of doubt, participation of “Meuhedet” for each of the above tests as mentioned in sections 21.1 — 21.3is limited to one time during the period of insurance.

21.5 Choose the insured to perform tests for hereditary diseases discovery at the “Dor Yesha-rim” institutes, the insured will be entitled to perform the test according the agreement with these institutes, with self-participation of 30% of the test retail price, provided the insured participation limits will not exceed the amount of 222 NIS per test, The above refers to the tests as mentioned in above section 21.1.

21.6 Participation of “Meuhedet” in the expenses for each of the said genetic tests in this chap-ter, whether this will be given to the insured as discount or refund, it is limited to only once per period of insurance.

22. Preventive tests


22.1 Insured by Fund are entitled, on the recommendation of a doctor from “Meuhedet”, to preventive tests at a licensed institute associated by agreement to “Meuhedet” as specified below: • Fecal occult blood test of insured under the age of 50 • Cervix smear test (PAP) for women under age 34 or over age 55 — self-partici-

pation of 27 NIS per test. • Mammography testing and bone density test beyond the tests provided by

“Meuhedet” by virtue of the National Health Insurance Law, with self-participa-tion of 26 NIS and 122 NIS respectively.

22.2 Eligibility is frequently of one test of any type from those listed above, each two calendar years.

23. Aesthetic medicine


23.1 Insured will be entitled to 25% discount of “Meuhedet” rate for vein treatment for cosmet-ic purposes. All this on condition that the treatment was carried out in clinics designated

49

to this purpose and that the treatment and scope have been approved in advance by the approving authority of “Meuhedet”.

24. Sport medicine


Insured will be entitled to 33% discount of “Meuhedet” rate for treatment and tests sup-plied in framework of a sports clinic of “Meuhedet”: fat ratio check, spirometry, argometry and lactic acid threshold, all in accordance with the existing list of sports clinics at “Meuhedet” which is updated periodically. The list will be available to t he insured at the sports clinics.

25. Rehabilitation exercise after myocardial infarction

Waiting period: 6 months from the day of joining the program and up to the eligible event.

Insured who had an acute myocardial infarction, requiring according recommendation of a specialist, supervised physical activity at a licenses institute under medical supervision, will be entitled to participation of “Meuhedet” of 152 NIS per month in respect of this issue for three months (beyond their eligibility under the National Health Insurance Law) and provided that physical activity, as stated above, began within 6 months from the event.

26. Visit to a private pediatrician

Waiting period: not required.

“Meuhedet” will cover the expenses of the insured initiating a visit for the purpose of test-ing a child, up to t he age of four years insured in the program, with a pediatrician who is nor associated by agreement to “Meuhedet”. Participation of “Meuhedet” is limited up to 282 NIS per visit and up to two visits per child per year.

27. Urgent ambulance transport


Insured will be entitles to participation of “Meuhedet” at a rate of 50% of emergency am-bulance transport which did not result in hospitalization. Participation is limited to 50% of the rate of Magen David Adom.

50


28. Laser treatment to correct nearsightedness


28.1 Insured will be eligible to undergo surgery to correct nearsightedness, which will be car-ried out using laser (Lasik), provided at the institute/hospital associated by agreement to “Meuhedet”, and subject to self-participation of $850-$1,000 per eye, depending on the medical center selected by him from those associated by agreement to “Meuhedet”.

28.2 List of medical centers associated by agreement to “Meuhedet” on this matter, will be available to the insured at branches of “Meuhedet”.

28.3 For the avoidance of doubt, “Meuhedet” will not be liable for any damages or other harm to the insured, which may be caused directly or indirectly as result of the treatment in question.

29. Optical services


29.1 It is hereby declared that this chapter is valid as long as the service provider in optical services (henceforth: “Supplier”) is associated by agreement to “Meuhedet” and subject to the provision of the agreement (henceforth: “Agreement”) valid at the time.

29.2 Insured will be entitled to purchase for the supplier associated by agreement to “Meuhedet”, as stated above, glasses (frame + standard plastic lenses), sunglasses on condition that the item which was selected by him is of those listed above, include selected models provided by agreement between “Meuhedet” and supplier. List of suppliers will be available to the public at the branches of “Meuhedet”.

29.3 Will insured choose an item as stated in above section 29.2, he will pay self-participation, which will be updated periodically in accordance with that stated in the agreement. In-formation about the height of self-participation will be available to the insured at the supplier.

29.4 Insured who purchased an item from those listed above will be entitled also to an eye test by an optometrist associated by agreement to the suppliers at no additional charge.

29.5 Insured who choose glasses or sunglasses that are not included on selected models as stated above, will be entitled to a discount of not less than 20% of the normal price list of the same provides, for purchase which cost is higher than 49 NIS per family.

29.6 For the avoidance of doubt, an insured who purchased eyeglasses in accordance with this section shall not be entitle in addition to the assumption by the provisions of section 15 of these regulations (medical accessories).

51

30. Nutritional counseling


30.1 Insured will be entitled, whether or not entitled according to National Health Insurance Law, to nutritional advice by a consultant associated by agreement to “Meuhedet”.

30.2 Insured will be entitled to counseling as mentioned at scope not exceeding 4 meetings per year and paying self-participation of 22 NIS per meeting.

31. Virtual Colonoscopy


Insured “Meuhedet Adif ” will be entitled to a virtual colonoscopy examination even in cases where “Meuhedet” is not obligated to providing this service as part of services defined in National Health Insurance Law, and in hospitals associated by agreement to “Meuhedet” and on basis of a form of commitment from “Meuhedet”. The services require the approval of the medi-cal department and conditioned with self-participation of 555 NIS per examination.

32. Biochemical test survey during first trimester of pregnancy

Pregnant insured “Meuhedet Adif ” with a single fetus are entitled to the biochemical test survey during the first trimester of pregnancy, provided that it will be carried out at the laborato-ries of “Meuhedet” or at laboratories associated by agreement to “Meuhedet”, with self-participa-tion of 110 NIS, conditional to reference by obstetrician/family doctor on behalf of “Meuhedet”.

52

Appendix A

Monthly payments*

Age group Monthly premium in NIS

Family (without relevance to the number of children under

18 years)

89

Family (of which the head of the family is older than

55 years)

96

Single insured (who is no part of insured family)

age 18-24 years

34


age 24-30 years

42


above 30 up to 55 years

56


above 55 years

67

• Until 1.5.2009• For those paying a year in advance a discount of 10% will be given (ten percent).

Remark:a. Monthly payments (insurance fees) as listed above are after the discount rate of 5% paying

“debit”. Permanent provision accounts of insured “Meuhedet Adif ” and “Adifut Eliyona” will be charged accordingly.

b. Those paying through payment vouchers — payment is made at any post bank branches across the country or at the offices of “Meuhedet”.

c. Regular payment of premiums is the condition for realizing all rights reserved for the insured AHS program subject the what has be mentioned in these regulations.

d. Delay in the insurance fee as mentioned above, will result in harming the rights of the insured up to cancellation of membership in the program as specified in section 8 of these regulations.

53

Updating insurance fee

Insurance fee of “Meuhedet Adif ” are updated depending on the rate of increase in the Consumer Price Index published by the Central Bureau of Statistics or health cost index, the highest of the two. The premiums are updated depending on the composition of t he services and the actual raise of the various medical services included in the basis services of the Fund and based on actuarial calculations performed once in a while and subject to the approval of the Ministry of Health.

Registration fee

The registration fee of the program is 15 NIS.

54

Appendix B

List of medical services provided in the framework of private hospitals/PMS for insured “Meuhedet Adif ”

Orthopedics

• Fibula Tibia Reconst. Osteotomy• Osteotomy + Fixation• Fushion between joints of fingers• Exostoses bone growth — Exostectomy• Exostoses of the meniscus• Exostoses of head of radius• Acromioplasty (shoulder)• Diagnostic arthroscopy• Treating arthoscopy• Arthroplasty — shoulder• Bone biopsy• Open biopsy — bone• Open biopsy — femur/soft tissues• Knee — arthrotomy• Knee — reconstruction ligaments• Debridement of joint + synovectomy• Dyslocation finger — correction• Discectomy — disc extracting• Lumbar disectomy • Neck discectomy• Lengthening of tendons• Extracting screw wire• Extracting spine tumor• Extracting bone fixation

• Hallux Valgus unilaterally• Hallux Valgus bilaterally• Transplantation of knee joint without

cement• Transplantation hip joint without cement• Finger amputation• Laminosectomy• Joint/wrist — synovectomy• Drainage touched foot or angle• Hand surgery• Foot surgery• Spinal surgery no discectomy• Corrective surgery — Hammer toe• Scoliosis back — rectification• Fixation vertebrae — sacrolumbar• Ankle arthrosis• Release tendons — trigger finger• Release tendons joint• Relase spinalic narrowing• Release nerve• Release carpel tunnel (CTS)• Amendment ganglion — anesthesiology• Amendment tennis elbow

55

Eyes

• Astigmatism (relaxing incisions)• Exchange eye fluids (vitrectomy)• Cornea transplant /+ extracting cataract

+ lens• Laser treatment (Yag post capsulotomy)• Trabeculectomy — laser treatment• Iridectomy — laser treatment• Iridectomy (glaucoma)• Onuclation with/without implantation• Exstoses pterygium

• Cornea transplant• Inferior cataract (local or general

anesthesia)• Chalazion• Laser break treatment (Lasic or Acsimer

only in case of clear anisometropia)• Eyelid surgery to correct ptosis• Removel touched- veroca/papilloma• Posterior vitrectomy• Repair extraocular muscles

Nose Ear Throat

• Drainage sinuses — endoscopic + spetum FESS

• Drainage sinuses—double sided endoscope –FESS

• Adenoids + buttons double sides• Extracting adenoids• Adenoids for children• Ears — drainage abscesses or hematoma• Exostoses/biopsy• Biopsy of ear receiver• Bronchoscopic• Neck dissection• Extraction touched from mouth and/or

frinks• Turbinectomy — amputating tonsils• Turibinectomy — nose caves + spetum• Turibinectomy/conectomy• Tympanoplasty

• Buttons• Buttons + tonsils + adenoids• Cutting parotid glands• Cutting saliva gland under jaw• Laryngoscopy• Laryngoscopy — general anesthesia• Laryngoscopy — biopsy• Miringotomy — francesty of timpani

membrane• Maistodectomy• Caves — nose — Coldwell — Lock• drainage abscesses/cyste floor of the

mouth• tonsils and adenoids surgery• Stepdactomy, ocecolplasty• Polecptomy nose/ outer ear• Release tong tie• Tonsils cutting

56

Surgery

• Large exsotoses• Exsotoses rectal polyp• Exsotoses/demolition touched skin/

underskin• Artery — Venus (A-V) fistula — dialyse• Biopsy lymph vessels and gland• Amputating ecsailair gland• Amputating lymph glands• Extracting foreign item generel

anesthesia• Amputating lymph/cyste• Lowering testikels• Hemeocolectomy• Reducing size stomach• Abdominalhernia incisional POVH• Double sided hernia• Hernia diaphragm• Navel hernia• Navel hernia — child• Hernia crotch — famural• Hernia crotch day hospitalization• Hernia crotch at children• Surgery — extracting veins from legs —

varicosis

• Cutting hemorrhoids — anesthesia• Cutting — gallbladder• Cutting gallbladder through laproscopy• Left hemycolectomy• Cutting stomach• Cutting appendix• Complete cutting thyroid• Laproscopy — diagnostic• Colon surgery• Stomach and small intestines surgery• Closing fistula A-V (diabetic patients)• Removal cyste• Symptomatic• Pilonydel sinus — cutting• Pilonydel cyste (exsotoses) removal• Fiss. Ani• Fistolectomy anus• Parianeli abscesses opening• Corrective laproscopy — hernia

femur/Hingu• Corrective laproscopy — hernia

femur/ Hingu Du

Chest surgery

• Amputating lung lobe or lump• Amputating lung

• Mediastinoscopy• Exploring chest opening

Neurosurgery

• Creaniotomy• Streotcasis diagnostic/surgical

• Head surgery for entering valve into the brain rooms

57

Vascular surgery

• Angioplastic — catheterization PTA endoretractomy — crotis vein

• Artery — Venus (A-V) fistula• Bypasses (medium vessles and/or large)

Breast surgery

• Amputation lump in breast (Lumpectomy)

• Amputation breast double sided• Reconstruction breast double sided• Amputation beast and lymph notes

• Amputation breast + reconstruction one side

• Geneacosmetic surgery (subject approval medical department)

• Reconstruction breast after amputation due cancer one sides

Urology

• Correction — hypospadium + advancement

• High ligation hydraucel/varicucel• Amputation prostate Retro/supra pubic• Orthrotomy• Biopsy testicles• Increasing urethra / myatotomy• Lowering testicle• Alignment bent penis — baby• Radical amputation prostate• Testicle amputation• Testicles amputation

• Amputation whole kidney (nephrectomy)• Amputation prostate through testicle —

TURP• Removal stone +/crushing by

orthroscopy• Removal urethra tissue/lump• Cystoscopy• Tying seed vein• Mincing stone through lithotripter• TURT• Correction hypospedias/afisped simple

Gynecology

• Orthropacy retrophoby• Histroscopy diagnostic• Histroscopy treatment• Histroscopy correction ligaments• Enlarging vagina• Endometrial destruction • vestibulectomy• Laser treatment full anesthesia

• Partial amputation vagina• Amputation external tumor/

condiloma — general• Amputation external tumor/

condiloma — local• Amputation putty laprascopic surgery• Amputation innate myoma —

through vagina

58

Gynecology

• Amputation polyp cervix• Amputation uterus through vagina• Amputation uterus abdominal• Amputation uterus + correction tearing• Amputation uterus + ovaries• Amputation ovaries• Diagnostic laprascopy• Laprascopy and histoscopy• Myomactomy • Laproscopic surgeries

• Correction trumpets• Cystocel/rectocel• Colfory posterior/anterior• Ovary — gouging cyste• Correction urine leakage at women

(lifting bladder)• Correction urine leakage through tape —

TVT• Cerclage• Sawing tear cervix uterus

Skin

• Excosis by name of Mohs

Heart

• Bypass surgery• Valve changing• Catheterization diagnostic• Catheterization treatment

Neurology

• Decompression periphery nerve (neurolosis)

Plastic

• Plastic — correction

The insured has the obligation to inquire at the secretariat of “Meuhedet” prior the surgery, which surgeons and private hospitals are associated by agreement to the “Meuhedet” for performing the requested surgical activities and what are the

conditions required for reFund/participation from “Meuhedet”.

59

Appendix C

List of private hospitals associated by agreement to “Meuhedet” To perform surgery by a surgeon in an agreement with “Meuhedet”

Name hospital City Address Telephone Fax

Eliysha Haifa Yair Cats 12, Har HaCarmel

Zipcode 34636

04-8389121 04-8389121

Asuta Ashdod Ashdod Sd. Menahem Begin

(Calaniot center)

08-8677122 08-8677200

Asuta Ashkelon Askelon HaGvura 3 08-6738725 08-6747625

Asuta Be’er Sheva Be'er Sheva Herzel 91, Bat Etzion 08-6279911 08-6291426

Asuta Haifa Haifa Canyon Lev HaMifratz, 3rd floor 04-8810600 04-8810631

Asuta Petah Tikwah Petah Tikwah Shpigel 3, bldg Mercaz Ha’ir 03-9053535 03-90535305

Asuta Rishon LeZion Rishon Lezion Mazal Eliezer 13, new ind. Area 03-9631631 03-9631666

Asuta Tel Aviv Tel Aviv HaBarzel 20, Ramat HaHayal

Zipcode 69710

03-7644000

Surgical center

Jerusalem Mishgav

Ledech

Jerusalem Hazkiyehu HaMelech 27 02-5637684

Herliya Medical center

HMC

Herzliya Pituah Ramot Yam 7,

Zipcode 46100

09-9592555 09-9592919

Horev Haifa Horev 15, Zipcode 41600 04-8305222 04-8341279

M.R.B. Bat Yam Sd. Ha’atsmeout 67,

Zipcode 59315

03-500888 03-5075764

Medli Rechovot Yehuda HaLevi 36,

Zipcode 76534

08-9415268 08-9416891

Medica Be’er Sheva Be’er Sheva

Medic Center Be’er

Sheva

Be’er Sheva

60

Name hospital City Address Telephone Fax

Medical center Ramat

Aviv

Tel Aviv Brodetsky 43,

canyon Ramat Aviv

03-6421511 03-6401284

NERA Ramat Gan Ramat Gan

Natanya Medical

center

Natanya Haim Levanon 1 Nave Itamar 09-8848444 08-8841224

Senist Tel Aviv Reiness 18,

Zipcode 64381

03-5225171 03-5239821

Important note: Not all hospitals are licensed to perform all operations from the list specified in appendix B of these regulations. A situation is possible where a hospital is not authorized to perform any operations except in certain limited areas. “Meuhedet” reserves the right to periodically update the agreement with the hospitals. The insured has the duty to inquire with the secretariat of “Meuhedet” before surgery, which of these private hospitals are under agreement with “Meuhedet” required to perform surgical operation by surgeons in an agreement with “Meuhedet” and what are the conditions of participation of “Meuhedet”.

61

List of medical centers abroad

Bad Trussel Oncology Center Munchen University — GermanyBaylor University Medical Center Dallas TexasBochum University Medical CenterColumbia Presbyterian Medical Center New YorkEssen Duisburg University Klinikum — GermanyGermany Essen University Medical CenterHannover University Medical Center — GermanyHeidelberg University Medical Center — GermanyHerman Memorial Hospital Houston TexasKlinikum Grosharden Munchen University — GermanyThe Leonardis Onchology Clinic Munchen GermanyThe Mayo Clinic MinnesotaMemorial Sloane Kettering New York*Montefiore Albert Einstein Medical Center New YorkMount Sinai Hospital New YorkMount Sinai Medical Center MiamiNew York University Medical CenterThe Ochsner Foundation New OrleansSick Children Hospital Toronto — CanadaStanford University Medical Center CaliforniaTemple University Medical Center PhiladelphiaTexas Heart Institute-Saint Luke EpiscopalThe Cleveland Clinic FoundationThe Gamma Knife Center KerfeldTulane Medical Center New OrleansUniversity of Riga Medical Center — LatviaUniversity of Palermo Medical Center — Italy

• Hospital licensed under the agreement for a second opinion only (section 6.2 in chapter AHS regulations).

62

Appendix D

List of drugs for insured ‘Meuhedet Adif ”

Drugs with discount up to 85% of the consumer’s drug price:

ACAMOLI COLD SYR*AKNE MYCIN PLUS SOL*ALENDRONATE TEVA 70 MG*BUSPIROL TAB*CELCOX 100 MG*CELCOX 200 MG TAB*CICLODERM CR SOL*CICLODERM C CREAM*CODIVIS CAP*DURACEF SUSP CAP*EAR CLEAR*ELOCOM CR*ELOCOM OINT*ELOCOM LOT*ESKAZOLE 400 MG*ESTELLE 1,2*FML DROP*FUCICORT CREAM*FUCITHALMIC*FUNGIMON PWD*GARGOL SOL*GINGISAN LIQ*GINGISAN OINT*HAFIF 10 LOT*HAVRIX 1440 VIAL*

HAVRIX 720 JN*HEMO OINT*HEMO SUPP*LIPANOR CAP*LOGIMAX TAB*LUSTRAL TAB*NAROCIN TAB*NERVEN DRG*OKACIN SOL*OPTIMA TAB*OPTIMA BEST*PEVISONE CREAM*PROCTOFOAM FOAM*RHINOLAST SPRAY*ROACCUTANE CAP*SALIKAREN OINT*SIMICOL TIPTIPOT*SORBON 5 MG 10 MG 15 MG*SUPRAN SUSP*TILAVIST DROP*VALTREX 500 MG TAB*VARILRIX*VENORUTON GEL*VITA MERFEN OIN 20 GR*VITAMIN B12 1 MG 100 TAB*

63

Drugs with insured discount of 50% of the consumer’s drug price:

ACAMOL TSIN CLAS.D21+N13CACAMOL TSINUN 35 DAY+NIG14ACTIVELLE 28 TAB*ACTONEL ONCE 35 MG 4 TABADAFERIN GEL 30 GRADVIL 200 MG 20 CAPADVIL 200 MG 40 CAPADVIL 200 MG 80 CAPADVIL CHIL FRUIT 100 MG/5ADVIL CHIL GRAPE 100 MG/5AERIUS 5 MG 15 TAB*AERIUS SYRUP SYR 0.5 MG/ML*AGISPOR 1% 100 MLAGISPOR ONYCHOSET OINALDARA CRM 5% 12 SACHETS 1AMARYL 1 MG 30 TAB 1AMARYL 2 MG 30 TAB 1AMARYL 3 MG 30 TAB 1ANDROGEL 50 MG SACARTHREASE 10 MG/2 ML 3 PR 1AURICULARUM PWD 300 MG*AVODART SOFT 0.5 MG 30 CAPBABYZIM DROBATRAFEN NAIL LACQUER 80BENZAC-AC GEL 2.5% 60 GRBENZAMYCIN GEL 20.3 GRCARBOSYLAN (24+24) 48 CAP*CILOXAN DRO 0.35% 5 ML* 1CIPRALEX 10 MG 28 TABCLEAREX 10% COLORLESS 1CLEAREX 2% LOTIONCLEAREX 5% COLORLESS 1COMAGIS 15 CRM 15 GR*COMAGIS 7 CRM 7 GR*CONCERTA 18 MG 30 TAB 1CONCERTA 36 MG 30 TAB 1CRINONE 8% 15 APPLIC 1

CURATODERM OIN 4 MCG/GR 20CYCLOMED 5% CRMDAIVOBET OIN 30 GRDAIVONEX CRM 50 MCG/GR 30 G*1DAIVONEX OIN 50 MCG/GR 100*1DAIVONEX OIN 50 MCG/GR 30 G*1DETRUSITOL 1 MG 56 TAB 1DETRUSITOL 2 MG 28 TAB 1DETRUSITOL 3 MG 56 TAB 1EFEXOR XR 150 MG 28 CAP 1EFEXOR XR 75 MG 28 CAP 1ELIDEL CRM 1% 15 GRELIDEL CRM 1% 30 GREVOREL CONTI 8X1 PATCHEVOREL SEQUI 4X2 PATCHEYECON EYE DROPS (20)FEMINET 21T 1,2FEMINET 63 T 1,2FELDENE GEL 0.5% 50 GR*FEMINET 21 TAB2FEMINET 63 TABFOSALAN ONCE WEEKLY 70 MGGYNO-TERAZOL 0.8% CRMIMITREX NASAL SPR 0.5% 2L1IMITREX REFILL PACK 6 MG1IMITREX STARTER PACK INJ 1INSU NOVOMIX 30INSULIN HUMALOG MX25/751KALGARON CHERRY LEM SPR 6KALGARON FORTE 24 TABKELO-COTELAMISIL 250 MG 14 TAB1LAMISIL CRM 1% 15 GRLANACORT 1% CRMLARIAM 250 MG 8 TABLIVIAL 2.5 MG 28 TABMENCEVAX ACWY 1DX 1

64



MERFEN SPRAY NCHMIDRO TEANARAMIG 2.5 MG 4 TAB 1NASCOBAL FOR 2MONTH SPR 2NOVONORM 0.5 MG 90 TAB1NOVONORM 1 MG 90 TAB 1NOVONORM 2 MG 90 TAB 1OMNIC 0.4 MG 30 CAP 1ORTHOVISC 30 MG/2 ML PRS 1OXY 10 LOT 10% 29 MLOXY 5 LOT 5% 29 MLOXY 5 TINTED LOT 5% 20 MLOXY COVER LOT 10OZPERMIXON 160 MG 60 CAP 1PINK BISMUTH 30 TABPRIODERM 1% 40 GRNCH — PROCTO WIPESNCH — PROCTO WIPESPROCURE 5 MG 28 TAB 1REDUCTIL 10 MG 28 CAPREDUCTIL 15 MG 28 CAP

RELENZA 5 MG 20 DISRUBLEX D SPR 180 ML*RUBLEX MASSAGE CRM 80 GR*SPORANOX 100 MG 14 CAP 1TAMIFLU 75 MG 10 CAPTERBINAFINE 250 MG 14 CPS 1TIGER BALM OINT-WHITE 1TIGER BALM OINT STRTILOPTIC XE 0.25% GEL 1TILOPTIC XE 0.5% DRO 1URIKAL. SAC 1*VAGIFEM 0.025 MG 15 VATVENORUTON 500 MG 30 TABXANAX XR 0.5 MG 30 TABXANAX XR 1 MG 30 TABXANAX XR 2 MG 30 TABZIDOVAL 0.75 % GEL 1ZORAC GEL 0.05% 15 GR 1ZORAC GEL 0.1% 15 GR 1ZOSTRIX 0.025 % CRMZOSTRIX HP 0.075 % CRM

ACAMOL TSI LIQ 30+10 40CAFALPI TIPTIPOT 15 MG/MLALDOLOR TIPTIPOT DRO 100MALRIN KIDS 0.025 % SPRALRIN SPRAY 15 CCANTISTIN PRIV EYE DROPSARCOXIA 120 MG 7 TABARCOXIA 60 MG 10 TABARCOXIA 90 MG 10 TABBECOZYM FORTE 20 TABBEN GAY 4 OZ OINTBEN GAY OINT 1.25 OZBEN GAY OINT 2 OZ

BEN GAY ULTR.STR.4OZ OINTBEN GAY ULTRASTRENGTH CRMBEPANTHEN LOT 200 MLBEPANTHEN PLUS CRM 30 GRCALAMANERVIN TAB 20CIALIS 10 MG 4 TABCIALIS 20 MG 4 TABCIALIS 20 MG 8 TABDESITIN 2 OZ OINTDESITIN OINT 1.25 OZDESITIN OINT. 4 OZEBIXA 10 MG 56 TABEVISTA 60 MG 28 TAB

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EVRA 1X3 PATEZETROL 10 MG 30 TABFEMULEN 84 TABFUNGIMON POWDER 30 GMGENTEAL EYE DROGYNERA 21 TABGYNERA 3 X 21 TABHARMONET (NEO) 21 TABHARMONET 3X21 (NEO) 63 TABHYPOTEARS E 30X0.4ML SOLIOPIDINE 0.5 % SOL 1KALGARON FRUIT MIX 24 TABKALGARON LEMON 24 TABKALGARON MINT 24 TABKALGARON ORANGE 24 TABKALGARON STRAWBERRY 24 TABKIDDI SYRLEVITRA 10 MG 4 TABLEVITRA 20 MG 4 TABLEVITRA 5 MG 4 TABMEDIJEL GEL 15GRMERCILON 21 TABMERCILON 3X21 TABMICRODIOL 1 STRIP X 21 T. 2MICRODIOL 3 STRUPS X 21 TMICROGYNON 63 TABMINESSE 28 TAB (NEO) 28TAMINESSE 84 TAB (NEO) 84TMINOXI 2 2 % SPRMINOXI 2 WOMEN 80 MLMINOXI 2 WOMEN X 2 BOXESMINOXI 5 5 % SPRMINOXI 5 X 2 BOXESMINULET (NEO) 21 TAB 2MINULET 3X21 (NEO) 63 TABMUCOLIT TIPTIPOT 75 MG/MLNEOGYNON 21 TAB

NICORETTE 18 10 MG/DOSE INICORETTE MINT 2 MG 30 TANICORETTE MINT 2 MG 90 TANICORETTE MINT 4 MG 30 TANICORETTE MINT 4 MG 30 TABNORDETTE TAB 38 X 3NUROFEN COLD & FLU 24 TABNUROFEN LIQUID 20 CAPNUROFEN LIQUID 40 CAPOKACIN. SOL 3 MG/ML 5 ML 1ORTHO-CYCLEN 21 TAB 2ORTHO-CYCLEN 63 TABOXY PADS MAXIMUM 1OXY PADS SENSITIVE 1POLYTAR LIQ 150 MLPROTOPIC OIN 0.03% 30 GRPROTOPIC OIN 0.1% 30 GRREDOXON 1GR 10 TABREFRESH 30X0.4 MLREGAINE FEMALEREGAINE FEMALE X 2REGAINE FORTE SOL 5% 60 MLREGAINE FORTE X 2RENNIE DIGESTIF 48 TABRENNIE DIGESTIF 96 TABRITALIN LA 40 MG TAB 1RITALIN LA 20 MG TAB 1RITALIN LA 30 MG TAB 1SONGHA NIGHT 30 TABSTREPSILS HONEY LEMON 24TSTREPSILS LEMON&HERB TABSTREPSILS PLUS 24 TABSTREPSILS VIT CSUPRADYN — N 10 TABTHYROGEN INJECTION 1.1MGTRIDERM CRM 15 GRTRINORDIOL 28 28 TAB

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Remarks:Drugs included in this Annex shall be provided in the pharmacy of Meuhedet.Drugs which are marked with an asterisk) * (, discount available for purchase in the pharmacy of the “Meuhedet” and in private pharmacies associated with Meuhedet by agreement.Drugs which are marked in 1 — require approval of a specialist.Drugs which are marked in 2 — approved for women age 20 and over only.

TRINORDIOL 28 X 3 84 TABUNISOM 25 MG 8 TABVIAGRA 100 MG 4 TABVIAGRA 100 MG 8 TABVIAGRA 25 MG 4 TABVIAGRA 25 MG 8 TABVIAGRA 50 MG 4 TABVIAGRA 50 MG 8 TABVISCOTEARS GELVSL3. LACTIC ACID BACTERIAXENICAL 120 MG 84 CAPYASMIN 21 TABZOVIRAX CREAM DMC 2G P CR

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Appendix E

List of implants and medical accessories

List of implants and medical accessories for the insured “Meuhedet Adif ”

The participation of “Meuhedet” is limited to a yearly maximum as follows:A maximum of $3,000 for implants.A maximum of $750 per year for accessories (non-implants).

Accessories Participation rate of insured

Prosthesis

External breast prosthesis

(in case there is no coverage from the Ministry of Health)

50%

Prosthesis sex organ — in case of “impotence”

(through its medical instructions and approval of the medical

department only) Maximum participation of t he insured — $75

50%

Eye ball (in case there is no coverage from the Ministry of Health) 50%

Scleral lenses for the eye 50%

Implants*

Artificial joints 50%

Valves 50%

Pacemaker 50%

Implanted breast prosthesis 50%

Artificial blood vessels 50%

Ligaments for joints 50%

Internal eye lens for cataract surgery 50%

Middle ear implants 50%

Plates and screws to mend fractured bones 50%

Plates and screws for fixation/stabilization of the spine 50%

Electrodes implants in the spinal canal for reducing pain 50%

Testicle implants 50%

Stands for heart surgery, for catheterization and urological surgery 50%

Knee and/or hip implant 50%

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Essential medical accessoriesParticipation

rate of insuredSupplier

Maximum

participation

of “Meuhedet”

Belts for use of crotch crack in abdominal wall*

(one a year)

50% Internal pharmacy only

Orthopedic foot support by size

and by special ordering (twice a year)

50% Agreement supplier 452 NIS

Elastic stockings for pregnant women

and those suffering from blood vessel diseases (by

prescription) VARILIND


Orthopedic equipment for stabilization joints/

fractures/fractures prevention treading/partial

treading (once a year)

50% Agreement supplier $600

Contact lenses, only in case of disease

of the front chamber

50% Internal pharmacy only $600

inhalator for asthma or C.F. patients including

humidifiers (recommendation of lung physician)


Wig (after chemotherapy/oncology 50% Agreement supplier 1,357 NIS

Glucometer or piercer* 50% Internal pharmacy only

Device for measuring blood pressure* 50% Internal pharmacy only

Sunglasses for albinos (once a year) and glasses

not included frame for suffering of astigmatism

higher than 7


Orthopedic shoes, special order, aimed

for equivalent lower extremities or height

adjustments


Voice amplifiers for larynx victims 50% Agreement supplier $750

Earplugs after transplantation drum buttons 50% Agreement supplier $80

Telescopic glasses for adults

(above 18 years)


Feeding button for babies 50% Agreement supplier $175

Strip or abduction device for babies 50% Agreement supplier $100

Hearing device (above 18 years) For insured “Meuhedet Adif” maximum participation for eligible

member by law up to 2,270 NIS per ear

Any kind of orthopedic belts not restricted by age

(once a year)

50% Agreement supplier

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* Will not be given if purchased at private pharmacy.** The refund amounts mentioned in NIS will be periodically updated according the raise of the index on the date of updating of premiums.

* Participation of “Meuhedet” beyond the entitlement by law is limited up to 1,778 NIS

Remark: For the avoidance of doubt, the discount rate on the list of this appendix is the maxi-mum participation of “Meuhedet” by law, the insured is not entitled to cumulative discount — discount “Meuhedet Adif ” is also embodied in the discount by law.

Essential medical accessoriesParticipation

rate of insuredSupplier

Maximum

participation

of “Meuhedet”

Milwaukee/Boston belts and/or other treatment

for scoliosis up to 18 years


Pressure bandage 15% Agreement supplier/

central warehouse

$750

AccessoriesParticipation rate

of insuredSupplier

CPAP device* (not included in cases in which

the indication is snoring problems)


Oxygen supply, including balloons and/or oxygen

generator


Facility to create oxygen will be purchased by

“Meuhedet”/Fund (with the approval of the medical

department) and will be given for usage to the

patient. The device will be returned to “Meuhedet”

after usage


Paragon pump bags and bags for KANGURO 15% Internal pharmacy

Urine bags 0% Internal pharmacy

Phanurose (accessory to transport urine into a

collection for men)

0% Internal pharmacy

Purchase of bladder catheter for emptying

the urine — poli.

Catheter silicone catheter

0%

50%

Internal pharmacy

Accessory used by patients with Penile barrel

to ensure proper airflow to the lungs

15% Central warehouse

Accessories for inhalers (once a year) 15% Internal pharmacy

Accessories for sprinkling insulin pumps 15% Internal pharmacy or agreement

supplier

Plugs for tear pipes 50% Agreement supplier

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Waiting periods for the various rights in the framework of “Meuhedet Adif ”

Without waiting period • Vaccinations and drugs for travelers abroad• Dentistry and gums• Alternative medicine• Sports medicine• Visitation private pediatrician• Emergency ambulance transportation• Laser treatment to correct nearsightedness• Optical services• Nutritional consultation

3 Months waiting period • Revalidation after complex surgery• Medical accessories• Early detection of birth defects in fetus• Genetic testing• Virtual colonoscopy

6 Months waiting period • Drugs not included in the basic services of “Meuhedet”• Psychological consultation and treatment• Additional opinion• Vaccinations• Monitoring pregnant high-risk women• Revalidation for women after birth• Subscription for thoracic transmitter and emergency service for cardiac patients• Private Nurse• Child development• Speech disorder treatment• Aesthetic medicine• Exercise rehabilitation after myocardial infarction

12 Months waiting period • Treatment/surgery in private hospitals• Hospitalization complex nursing• Purchasing of implants

24 Months waiting period • Diagnosis and treatment fertility disorders in man and woman• Medical services abroad

• Waiting period — A continuous period of membership in the program during which the insured is included in the program, must pay membership fees, but is not entitled to the rights pursuant these regulations.Soldiers after release joining “Meuhedet Adif ” program are exempted from waiting period.

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For Notes

“meuhedet adif” regulations - shira pransky project

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