meuhedet c

April 2020

Meuhedet CSupplementary Health Insurance Program Regulations

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Chapter 1Paragraph page

1. Introduction ...................................................................................................................... 42. Definitions and interpretation ......................................................................................... 53. Legal status ....................................................................................................................... 84. Membership of “Meuhedet C” ........................................................................................ 85. Registration ....................................................................................................................... 96. Waiting periods ........................................................................................................... 107. Commencement, termination or renewal of membership .......................................... 118. Membership fees .......................................................................................................... 129. Recuperation of the Health Fund’s loss and indemnification from third parties —

“double insurance” ........................................................................................................ 1310. Eligibility restrictions ................................................................................................... 1411. General conditions ......................................................................................................... 1512. An insured who spends an extended period abroad ................................................... 1613. Commencement .............................................................................................................. 17

Chapter 2OPERATIONS1. Treatments/operations in a private hospital ................................................................ 182. Plastic surgery operations .............................................................................................. 213. Deleted ............................................................................................................................ 22

MEDICAL TREATMENT ABROAD4 Medical consultation before choosing a foreign medical center ................................ 235 Surgical operations which the insured chooses

to have performed abroad ............................................................................................. 24

INNOVATIVE TREATMENTS6. Anti-Aging Treatments ................................................................................................... 257. Shock- Wave Treatments ................................................................................................ 258. Periodic Screening .......................................................................................................... 269. Oncogenetic Tests ........................................................................................................... 2610. Laboratory Testing Services in the insured’s home ....................................................... 27

LIFE STYLE11. Nutritional Counseling ................................................................................................... 2712. Workshops and courses .................................................................................................. 2813. Rehabilitation exercise following myocardial infarction ............................................. 28

CONSULTATION14 Second opinion in Israel ................................................................................................. 28

PEDIATRIC SERVICES15 Treatment of nocturnal enuresis ................................................................................... 29

PREGNANCY AND BIRTH16 Plastic surgery operations .............................................................................................. 30

17. Early detection of congenital disorders in the fetus .................................................... 3618. Umbilical cord blood ...................................................................................................... 37

CONVALESCENCE AND RECOVERY 19. Recovery following complex surgery ............................................................................. 37

ADDITIONAL SERVICES20. Treatment of hemorrhoids and fissures ........................................................................ 3821. Treatment of sexual function disorders......................................................................... 3822. Therapeutic riding, hydrotherapy, music therapy, art therapy and therapy using animals ......................................................................... 3923. Deleted ............................................................................................................................ 3924. Food substitutes which are not included in the health basket ................................... 3925. Treatment of snoring problems and nasal congestion ................................................. 4026. Rehabilitation from sports injuries ................................................................................ 4027. Child development ......................................................................................................... 4028. Nuchal Translucency ....................................................................................................... 4029. Physician home visits ...................................................................................................... 4130. Pregnancy and birth basket ........................................................................................... 4131. Diagnosis of attention and concentration disorders .................................................... 4232. Complementary Medicine .............................................................................................. 4233. Postnatal convalescence ................................................................................................. 4334. Dental care for children, adolescents and adults ......................................................... 4335. Hearing aids .................................................................................................................... 4436. Optics for children, adolescents and adults .................................................................. 4437. Didactic and psychodidactic diagnosis .......................................................................... 4538. Financing supervision of fertility treatments at participating institutes .................... 4539. Breastfeeding counseling ............................................................................................... 45

Appendix A - Monthly Payments ............................................................................................. 47Appendix B - List of medical services provided within the framework of private hospitals/PMS for “Meuhedet C” members ............................................................................. 48 Appendix C - List of private hospitals which are contractually affiliated with the Fund for the purpose of performing operations through surgeons who have an agreement with the Fund ................................................................................................... 52Appendix D - Medications basket for “Meuhedet C” members ............................................ 54Appendix E – List of medical accessories and medical equipment for “Meuhedet Adif” and “Meuhedet C” members ................................................................................................... 59Appendix F - Hearing aids for “Meuhedet C” members ........................................................ 63Appendix G - List of dental treatments for children, adolescents and adults ....................... 64Appendix H - Foreign travel vaccinations - List of the Fund’s participating clinics and the excess payable by the insured .................................................................................... 91

Paragraph page

Contents

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Chapter 1 The Meuhedet C supplementary health services program regulations

Fund may prescribe various provisions regarding a transfer from another Fund’s program.

(d) Subject to the provisions of subsection (c), the Health Fund shall not discriminate between the program’s members, either at the time when they join it or when providing the services within the framework thereof.

(e) The price of the program shall be uniform for all age groups, irrespective of the number of years of membership in the program, the member’s state of health or his economic circumstances

(f) … (21) (a) A Health Fund shall provide anyone whom it is responsible towards as

stated in section 3(c) with all the health services which he is entitled to under this law(1), whether by itself or through service providers, without any discrimination or making provision of the services which are included in its services basket conditional upon joining or membership in a supplementary services program.(2)

(b)

2. Definitions and interpretation2.1. In these Regulations the following terms (in alphabetical order) shall have the

meanings given next to them: “Supplementary insurance” or “SHS” — Additional health services as defined in section 10 of the National Health Insurance Law, 5754-1994.“Family members” — Children under the age of 18 of anyone who is insured under the Meuhedet C program, including a step child, foster child or a child for whom a guardian has been appointed. “Age of the insured” — Shall be calculated in full years, as the difference between the insured’s date of birth and the date for determining his age under these Regulations. Should the difference, beyond full years, amount to six months or more, a full year shall be added to the insured’s age, and if less than six months, it shall be ignored. “Insurance premiums” — Sums which a member is obliged to pay to Meuhedet Health Fund once a month or once per other period which shall be determined, for himself and his family members as a condition for receiving the rights granted under these Regulations.“Registration fee” — A one-time fee which must be paid by any new member of “Meuhedet C” as specified in Appendix A to these Regulations. “The management” — The management of Meuhedet Health Fund and/or anyone authorized to act in its name.

(1) National Health Insurance Law, 5754-1994

(2) National Health Insurance Law, 5754-1994

1. Introduction1.1. “Meuhedet C” is a is a supplementary health services program (supplementary

insurance — as defined hereinafter) which constitutes an additional tier of services offered to those insured with the Meuhedet Health Fund who are “Meuhedet Adif” members. The program incorporates a broad range of medical services that are not included in “the basic health services basket” which the Fund is obliged to provide under the National Health Insurance Law (“the first tier”) or in the “Meuhedet Adif” program (“the second tier”).

1.2. As stated in the National Health Insurance Law, the right of a person insured with the Fund to receive the full range of services which he is entitled to under the National Health Insurance Law, 5754-1994 shall not be affected by his participation or nonparticipation in the supplementary health services program of the Fund or of a corporation under its control. As specified in sections 10 and 21 of the National Health Insurance Law:“(10)(a) A Health Fund may offer its members programs for supplementary health

services which are not included in the Fund’s services basket and payments (hereinafter — a supplementary services program), either by itself or through a fully controlled subsidiary (hereinafter in this section — the Fund); a supplementary services program and any change to it require the Minister of Health’s approval.

(b) A supplementary services program shall only be offered to members of the Fund as a reciprocal shared balancing arrangement, subject to the following rules:(1) Provision of the services in the program shall be exclusively financed

from funds that were collected for that purpose from those who joined the program (hereinafter — members);

(2) The Fund may from time to time change the rights of the program’s members and the members’ payments;

(c) (1) A Health Fund shall include in the program any member who wishes to join the program, regardless of his state of health or economic circumstances, and shall not make his joining or his rights upon joining subject to any condition, apart from reasonable qualification periods, which shall be prescribed for all members of the program regarding the provision of various services within the framework thereof, and provided that no qualification period as aforesaid shall be prescribed with respect to services that were included in the services basket and the payments of the Fund for a person who was a member of the Fund and joined the program within one year following the change in the Fund’s services basket and payments

(2) In relation to the qualification periods referred to in paragraph (1), the

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“Meuhedet Adif” — The program which constitutes the first tier of the SHS schemes, whose insured’s rights and obligations are set out in the “Meuhedet Adif” Regulations. “Insured” — A person whose entitlement to be included in the SHS program has been recognized pursuant to these Regulations. “Consumer Price Index” or “Cost of Living Index” — The Cost of Living Index which is published by the Central Bureau of Statistics or any other index which shall replace it. “Health Cost Index” — The index which reflects the cost of health services as defined in the Fifth Schedule of the National Health Insurance Law.“The services directory” — A booklet which is updated from time to time which lists Meuhedet’s contractually affiliated medical service providers. “Authorized institute” — An institute or service provider which is contractually affiliated with the Fund and listed together with its details in the Fund’s medical services guide. “Escort” — A person over the age of 22 who accompanies an insured when travelling abroad to receive medical assistance pursuant to these Regulations, subject to a professional recommendation and prior clearance from the certifying authority.“Qualifying event” — Circumstances in which an insured is eligible to receive medical help and/or assistance, subject to the conditions specified in these Regulations. “Implants” — Medical equipment which is inserted into a patient while an operation is being performed on him and which remains in the patient’s body temporarily or permanently as specified in paragraph 1 of Chapter 2 of these Regulations. “The Meuhedet C medical services basket” — The range and extent of tests, medical treatments and assistance which a member is eligible to receive pursuant to these Regulations. “The basic health services basket” — The range and extent of tests, medical treatments and assistance which a Fund member is eligible to receive pursuant to these Regulations. “Indemnification” — A pecuniary payment made to an insured which constitutes the Reserve’s contribution to the total expense incurred in purchasing a medical service which he is entitled to pursuant to these Regulations. “Membership year” — 12 consecutive months of membership in the program, the first of which began on the day on which the insured joined the program and for which the membership fee was paid. “Insurance period” or “membership period”- A period of time during which the member was insured in and fulfilled the conditions of the Meuhedet C program, either continuously or intermittently as specified in these Regulations. “The waiting period” — A continuous period of membership in the program during which the insured included in the program is obliged to pay the membership fee, but is not entitled to the rights specified in these Regulations.

“Total expenses” — The total sums actually paid by the member or by any third party to the service providers in order to cover the overall cost of an event for which the member is requesting pecuniary or other assistance. “The certifying authority” — The medical or administrative authority within the Fund which has the power to decide whether a member is eligible or ineligible to receive a medical service which is offered under these Regulations. “Agreement” — A contract made between Meuhedet Health Fund and any medical supplier for the provision of medical services to members of the SHS program. “Health declaration” — A form in which an insured reports his state of health and the state of health of his family members who are insured through him.“The Fund” — Meuhedet Health Fund or any other entity operating under its auspices, subject to the approvals required by law. “Excess” — A sum which the member is obliged to pay before receiving any of the services specified in these Regulations, as a condition for exercising his rights. “The program” or “Meuhedet C” — The “Meuhedet C” SHS Program as described in these Regulations and their Appendices. “Fund member” — A resident who is 18 or more years of age and who is registered as Meuhedet Health Fund member, provided that his name is included in the National Insurance Institute file, as required under the provisions of the National Health Insurance Law.“Month” — A month of days according to the Gregorian calendar.“Membership month” — A month for which the “Meuhedet C” membership fee was paid. “Abroad” — A country or territory in which the law of jurisdiction of the State of Israel does not apply. “The Health Law” — The Nation Health Insurance Law, 5754-1994 including the Regulations enacted and/or the orders which have been or shall be issued pursuant thereto. “Soldier” — A person serving in the regular forces of the army under the Defense Service Law (hereinafter — a conscripted soldier), or by way of a commitment to serve in the standing army.“Double insurance” — The right of an insured, due to the existence of an insurance contract or an agreement for indemnification from any third party, including from a commercial insurance company, to receive a medical service, or indemnification with respect to a medical service, which is included in the “Meuhedet C” services basket. “Waiver of medical confidentiality form” — A form in which an insured declares that he relinquishes in advance medical confidentiality regarding his state of health and the state of health of his minor family members, who are insured because of him and authorizes the Fund to obtain, inter alia, essential information for the purpose of preserving continuity of medical treatment. The waiver form shall only apply to future SHS Program claims.

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family members may register for/remain in the program, according to their choice.

4.4. Separated spouses are entitled to retain their membership in the program as individual insured, paying their insurance premiums separately.

5. Registration5.1. An insured who is over the age of 18 and wishes to be accepted in “Meuhedet C”

shall fill out and sign a “membership form”. Subject to the provisions of paragraph 5.7 below, the date on which the form was signed shall be regarded as the date on which on which he joined the program., Upon joining, the insured shall be required to sign a standing order form for bank payment or pay the first month’s insurance premium.

5.2. The insured shall sign the membership form in his own name and in the names of his children. The insured may sign on behalf of his/her spouse.

5.3. An application to join the program may be submitted in the insured’s name by another person who presents a power of attorney which was given to him by the insured.

5.4. An application to join a child or legally incompetent person shall be submitted by the person appointed to serve as their lawful guardian.

5.5. Meuhedet Health Fund shall notify the joining party that it has received the membership forms and entered in its records that he joined on the said date.

5.6. The program regulations and a copy of the signed membership form shall be attached to the Fund’s notification as aforesaid.

5.7. An insured who signed a membership form shall submit it to an authorized party in the Fund. The Fund shall inform the insured on or within 30 days at the latest from the date of his registration, of his inclusion in the program. Should he receive no notification from the Fund as aforesaid within 30 days from the date on which he submitted the membership forms, then the insured shall be regarded as having joined the program on the date on which he signed the membership form.

5.8. An insured must keep a branch of Meuhedet Health Fund in the area in which he lives continuously abreast, and inform it within 30 days, of changes to his name, address, status and family situation.

5.9. Should a parent wish to join his child to “Meuhedet C” or should the guardian of a minor who is insured with Meuhedet wish to join him to “Meuhedet C”, he shall submit a membership application for him and an undertaking to pay the insurance premiums. The membership of a minor shall be suspended for nonpayment of insurance premiums in accordance with paragraph 8.The Fund shall join the minor without age or state of health restrictions.

5.10. On the joining date the member may sign the health declaration and waiver of medical confidentiality form. This form shall only be used to process an indemnification claim submitted by the member pursuant to these Regulations.

“Regulations” — The “Meuhedet Health Fund” regulations. “These Regulations” — The version of the “Meuhedet C” Regulations which is currently in force. “Medication” — A preparation which is listed in the register of medications and preparations maintained under the Pharmacists Ordinance.

2.2. Interpretation — In these Regulations: 2.2.1. The masculine gender also includes the feminine gender and the singular

also includes the plural, except in those cases in which it is expressly stated otherwise or the context implies another meaning.

2.2.2. The division of the Regulations into parts and chapters and the names and headings of those parts and chapters, are for the reader’s convenience only and should not be used in order to interpret the Regulations.

2.2.3. Wherever the amount of an insured’s expense is stated in a foreign currency, the intention is the equivalent sum in new shekels, according to the representative exchange rate of the foreign currency on the date on which the service was paid for.

3. Legal status3.1. Meuhedet Health Fund owns, is responsible for and administers “Meuhedet C”. 3.2. Provided that the rights of “Meuhedet C” members shall not be undermined and

subject to the provisions of the National Health Insurance Law, the management may, with the approval of the Minister of Health, transfer all or some of the rights and obligations conferred and imposed on it by these Regulations to another entity/corporation, in any manner or by any method it shall see fit, including through collaboration with another corporation.

3.3. For the avoidance of doubt, it should be noted that the program is subject to the provisions of the National Health Insurance Law, 5754-1994. Should there be any variance between them, the provisions of the National Health Insurance Law shall override these Regulations and their Appendices.

4. Membership of “Meuhedet C”4.1. Subject to the provisions of these Regulations, every member of Meuhedet Health

Fund who is registered therein pursuant to the provisions of the Health Law and is insured under the “Meuhedet Adif” program, is entitled to apply for and to be granted membership of the “Meuhedet C” program without obstacles being placed before him because of his age or state of health.

4.2. An insured may add his children who are registered with the Meuhedet Health Fund to the program. The Fund shall add minors to the program, without age or state of health restrictions.

4.3. Should a family member terminate his membership in “Meuhedet C”, the other

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6.7. For the avoidance of doubt, the Fund shall only approve indemnification for those insured as stated in paragraphs 6.3, 6.4 and 6.6 above with respect to a medical service which was purchased by the member after he joined the SHS program and provided that a right to indemnification for that service exists under these Regulations.

6.8. An insured who joined the Fund within a year from the date on which he first became an immigrant and joined the program within 90 days from the date on which he joined the Fund, shall be exempt from any waiting periods.

7. Commencement, termination or renewal of membership7.1. Membership in the SHS program commences from the date of the insured’s signature on

the “Meuhedet C” membership form for the program, provided that the membership fees were paid in an orderly manner as stated in paragraph 8 below.

7.2. An insured who wishes to discontinue his membership in the program shall notify the Fund’s offices of this and sign the appropriate form. Termination of his membership and the membership of those insured under his auspices shall take effect a month thereafter. An insured who is bedridden or who for reasons beyond his control cannot go to the Fund’s offices, may terminate his membership in the program as aforesaid through an authorized representative who shall present ID.

7.3. It is hereby clarified that notwithstanding termination of his membership, the insured shall remain liable to Meuhedet Health Fund for his financial obligations with respect to the entire period during which he was a member of the program. A member who is liable for an insurance premium with respect to his membership in “Meuhedet C” and who terminated his membership in it without settling the balance of his debt, shall not be eligible to join the program or the “Meuhedet Adif” program until his debt has been paid.

7.4. The Fund may suspend or terminate the membership of an insured in “Meuhedet C” immediately due to nonpayment of the membership fees as specified in paragraph 8 below and/or in any misconduct, including the use of violence against any physician or employee of the Fund, false or partial reporting of an expense incurred by the insured or his rights under an agreement with any third party, and/or any other cause which enables the Fund to cancel the insured’s membership under the National Health Insurance Law or any other law.7.4.1. The Fund shall terminate the insured’s membership upon 60 days’ prior

written notice.7.4.2. The insured shall be granted a right to a hearing during the prior notice

period.7.5. The membership of a minor or an incompetent shall not be terminated following

termination of an insured’s membership as stated in paragraph 7.4 above. 7.6. Membership in each of the SHS programs shall be terminated immediately should

the insured cease to be a member of the Fund and the termination of an insured’s

6. Waiting periods 6.1. During the waiting periods specified in Chapter 2 of these Regulations neither the

insured nor those insured under his auspices shall be eligible to receive medical services pursuant to these Regulations or any indemnification with respect to those services.

6.2. Upon expiry of the waiting period, an insured shall be eligible under these Regulations to receive the medical services and/or indemnification which he requires.

6.3. A person joining the program shall be bound by the waiting periods as specified in every chapter of these Regulations. For the avoidance of doubt, the waiting periods specified in these Regulations shall equally apply to the insured even if for any reason he was exempted from a waiting period when he joined the “Meuhedet Adif” program.

6.4. Notwithstanding the provisions of paragraph 6.1 above, an IDF soldier who was discharged after completing his mandatory service and who had not been insured with Meuhedet Health Fund before his conscription, or who had been insured with the Fund but had not been a member of the program prior to his conscription into IDF service, shall be eligible to join the program with full rights upon being discharged from the IDF, without any waiting period, provided that he joined the program within 90 days from the date of his discharge.

6.5. An SHS program member who was imprisoned for a period of more than a year and whose membership in the Fund was frozen as a result thereof and who before his membership in the Fund was frozen had completed the waiting period required under these Regulations, or part thereof, shall be exempt upon his release and the resumption of his membership in the Fund from all or part of the waiting period which he had completed, according to the duration of the waiting period required under these Regulations, with respect to the service in question, provided that he was not removed from the program due to a debt which existed before his membership was frozen and that he renewed his payments to the SHS program within the first 90 days following cancellation of the moratorium.

6.6. A person who terminated his membership in another Fund and joined Meuhedet Health Fund for the first time after completing all or part of the required waiting period (in the other Fund) with respect to a right granted to him under that Fund’s regulations and in relation to which a right exists to receive a medical service and/or indemnification under these Regulations, shall be exempt from the entire waiting period or part thereof according to the duration of the required waiting period under these Regulations for the service in question. This right is only granted to an insured as aforesaid if he joined the program within 90 days from the date on which he joined the Fund. The foregoing is conditional upon the member proving the period during which he was a member of the other Fund’s supplementary insurance scheme.

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during which his rights were suspended the insured shall only be entitled to indemnification, should such a right exist under these Regulations.

8.9.2. Should the insured fail to fully redeem his debt during the warning period, his membership in the program shall be terminated at the end of the warning period, subject to the right to a hearing as specified in paragraph 7.4.2 above. The Fund may sue the insured for his unpaid debt, including the costs which it incurs in collecting it.

8.10. Non-collection of the monthly fees from the insured’s bank account for reasons which depend upon the bank or any third party, shall not release the insured from his responsibility to pay the monthly fees at the Fund’s offices.

8.11. Should as a result of a mistake made in good faith, the bank account of an individual insured with the Fund whose membership in the program had been cancelled on the Fund’s or on his own initiative for the reasons specified in these Regulations, continued to be debited, the full amounts which were mistakenly taken from him shall be returned to the insured, together with Cost of Living Index linkage differentials. The insured and his family members shall have no rights under these Regulations regarding the period following the date on which their membership was terminated, even if membership fees as aforesaid were paid with respect thereto.

9. Recuperation of the Health Fund’s loss and indemnification from third parties — “double insurance”

9.1. Should an obligation exist to indemnify the insured pursuant to any agreement with respect to a service which is included in these Regulations, the Fund shall be proportionately liable in accordance with the ratio between its coverage and the coverage provided by all the other programs or policies in relation to that service.

9.2. When filing a request for indemnification/a service pursuant to these Regulations, every insured must bring to the attention of the certifying authority the existence of an obligation which any third party has to indemnify him, including under a private insurance policy issued by a commercial insurance company and/or any other “supplemental insurance” program which covers all or part of the cost of the medical service in question (“double insurance”), within the framework of an affidavit which he shall sign when asking to receive the service or the indemnification. The insured is likewise obliged to point to and to give all the details which are known to him regarding the “damaging factor” (should one exist) which caused the event that resulted in him requiring the medical service.

9.3. In any case as stated in paragraphs 9.1-9.2 above, the Fund shall provide the medical service to the insured. The Fund shall, however, condition its provision of the medical service or the indemnification as stated in these Regulations on the insured signing an irrevocable power of attorney authorizing the Fund to request in his name from the insurance company and/or any other third party reimbursement of the pecuniary

membership in “Meuhedet Adif” shall automatically terminate his membership in “Meuhedet C”.

8. Membership fees 8.1. The tariffs payable for membership in the “Meuhedet C” SHS program (hereinafter:

“the monthly fees”) which are specified in Appendix “A” are prescribed by the Fund’s management subject to the clearances required by law.

8.2. The monthly fees are determined subject to the age of the insured and his family status, as they appear in the Fund’s records (single/family). A member who moves from one age group to a higher age group — shall pay according to the standard rate charged for the new age group. The Fund may set a family rate, which shall be updated from time to time. The family rate payable by the insured’s family shall be determined according to the age of the elder of the two spouses.

8.3. Subject to obtaining the clearances required under the National Health Insurance Law in order to do so, Meuhedet Health Fund may require a new program member to pay a “registration fee”. The registration fee shall not be returned to the insured should he cancel his membership in the program.

8.4. From the date on which he registered for the program, an insured must pay the monthly fees required for himself and his children once a month or once per period, as specified in the payments table in Appendix “A” to these Regulations, through a direct debit authorization. The aforementioned payments schedule shall be updated from time to time in the manner described in paragraph 8.6 below.

8.5. Systematic collection of the monthly fees in a concentrated format from the employer — constitutes compliance with the provisions of paragraph 8.4 above. However, this method of collection does not exempt the insured from personal responsibility should the membership fees not be paid by the employer.

8.6. The insured’s fees shall be updated once every 2 months, in accordance with the increase in the Consumer Price Index, or if higher, the Health Cost Index.

8.7. The Fund may, with the Minister of Health’s approval, change from time to time the insured’s rights under the SHS program and the fees payable for them.

8.8. Monthly fees which were paid in arrears for months which have passed, shall be paid together with linkage to the Cost of Living Index.

8.9. The rights of an insured who is four months in arrears with payment of the monthly fees for himself and his family members shall be suspended, and a letter shall be sent to him explaining that should he fail to pay his debt within 60 days from the date on which the letter was sent (hereinafter: “the warning period”) — his membership in the program shall be terminated. 8.9.1. Should the insured pay his entire debt during the warning period, together

with linkage differentials as aforesaid, he shall be entitled to continue his membership in the program with full rights. With respect to the period

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10.1.3. If the “qualifying event” occurred as a result of a dangerous sports activity — skydiving, sky gliding, diving, martial arts or any other sports activity of any kind for which an insurance obligation is imposed on the insured, or on any sports association but for which neither the insured nor the association took out any insurance policy, the Fund shall make provision of the assistance under these Regulations conditional upon the insured signing a power of attorney as specified in paragraph 9.3 above.

10.1.4. An insured shall not be entitled to a medical service and/or indemnification with respect to a medical service which was provided to him prior to the commencement, or following the expiry, of his entitlement period under these Regulations.

11. General conditions 11.1. All “the medical services” specified in Chapter 2 of these Regulations, are provided

to those insured under the program to the extent that they are not included in “the basic health services basket” which is binding on the Fund by virtue of the “National Health Insurance Law”. A medical service which is included in the program and which shall be added to the statutory health services basket in the future, shall automatically be removed from, and the Fund shall not be obliged to provide it within the framework of, the program.

11.2. When the need arises for a medical service which is included in these Regulations, the insured should contact his local branch of the Fund, either personally or through his representative, to clarify his rights and to provide all the medical information and documents required in order to process his request.

11.3. The Fund may conduct such checks and examinations in order to clarify its liability under these Regulations as it shall see fit, provided that the clarification process shall not delay the insured’s medical treatment in a way which may damage his health.

11.4. The Fund may condition the payment of any sum to the insured pursuant to its liability under these Regulations on the presentation of documents and evidence which prove to its satisfaction that he is entitled to it, including illness summaries, original invoices from service providers and original receipts showing every sum which the insured actually paid in purchasing the medical service in question.

11.5. Should an insured who was found to be entitled to indemnification die before he received it, without having named a beneficiary, then subject to the provisions of these Regulations, the Fund shall pay the sums which the insured had been entitled to with respect to the receipt of medical assistance to his lawful heirs or executor.

11.6. For the avoidance of doubt, the entitlement to indemnification with respect to a medical service under these Regulations only exists if the insured purchased and received a medical service which he is entitled to be indemnified for as expressly

loss which it sustained as a result of providing the medical assistance, all up to the indemnification ceilings which the member is entitled to under any agreement/contract.

9.4. Should the insured have been paid a sum directly by any third party, including an insurance company, in order to cover his expenses in relation to an “insured event” for which “double insurance” exists, the insured shall be obliged to inform the Fund of this and to transfer to the Fund immediately its share with respect to the expenses which it incurred in the case.

9.5. Should the insured and/or his spouse refuse to sign a power of attorney as stated in paragraph 9.3 above, or to reimburse the Fund, or should it be proved ex post facto that the insured concealed information as stated above, he shall not be entitled to the rights which are granted to him under these Regulations. At the same time, the Fund may take against him the legal measures which it has at its disposal, including the action stated in paragraph 7.4 above.

10. Eligibility restrictions 10.1. Without prejudice to any of the provisions of these Regulations, the program shall

not be obliged to provide medical aid/assistance and/or cover or indemnification with respect to medical expenses which the insured incurred due to the occurrence of a “qualifying event” which is included in the “services basket” of these Regulations, in one or more of the following cases:10.1.1. The service requested by the insured under these Regulations relates to an

injury for which he is also entitled to medical assistance under the Road Accident Victims Compensation Law, the Defense Service Law, the Police (Invalids and Fallen) Law, the Prison Service (Invalids and Fallen) Law, the Benefits for Victims of Hostilities Law, the National Insurance Law (Work Accident Victims), the Disability (Compensation and Rehabilitation) Law, the Disabled Victims of Nazi Persecution Law, the Persons Disabled in War against the Nazis Law, the Compensation for Prisoners of Zion and their Families Law, or any other law under which the insured is eligible to receive medical assistance in kind with respect to the injury. Should entitlement be denied under that law, the insured shall be entitled to medical services under these Regulations. Notwithstanding the foregoing, policyholders who are entitled under the Road Accident Victims Compensation Law and the National Insurance Law (Work Accident Victims), shall be entitled to the services enumerated in Chapter 2, paragraphs 1 and 14 of these Regulations.

10.1.2. The insured or anyone acting on his behalf acted with fraudulent intent, submitted erroneous facts to the Fund, concealed facts/findings concerning the medical service required and his eligibility under these Regulations.

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13. CommencementThese Regulations shall come into force on the date of their publication and shall apply to all insured persons who are entitled to medical assistance under their provisions. In this chapter the “Meuhedet C” medical services basket shall be specified, including the range of tests, treatments, operations and assistance which the insured are entitled to, and the eligibility conditions and the manner of providing the service in each of the areas included in the basket shall also be defined. In this chapter the “Meuhedet C” medical services basket shall be specified, including the range of tests, treatments, operations and assistance which the insured are entitled to, and the eligibility conditions and the manner of providing the service in each of the areas included in the basket shall also be defined.

stated in these Regulations and the insured satisfied all the requirements specified in these Regulations as a condition for receiving the indemnification.

11.7. An insured who exhausted the waiting period under this program in relation to a specific service, while in the throes of receiving a parallel service to which he was entitled under the “Meuhedet Adif” Regulations, shall be entitled to choose the indemnification/excess from the program which best suits him.

11.8. Unless expressly stipulated otherwise in these Regulations, the member’s rights pursuant to these Regulations are restricted to services provided within the State of Israel.

11.9. The Fund may update, augment or derogate from the provisions of these Regulations and/or terminate the program, on condition that the addition, derogation or termination of the program was approved as required under the provisions of the National Health Insurance Law and brought to the attention of the insured.

11.10. The members’ refund table shall be updated in accordance with the rate of increase in the Index on the dates on which the premiums are updated.

11.11. For the avoidance of doubt, it is hereby clarified and agreed that, subject to the provisions of these Regulations, should the insured select a physician or any other medical service provider on his own initiative, without receiving the Fund’s referral and prior written clearance, he shall do so on his own counsel, at his own expense and entirely at his own risk. The Fund shall not be responsible for the quality of the medical treatment and its results, nor for any physical and/or psychological damage which the insured shall sustain as a result of the aforementioned treatment or service.

11.12. The Fund shall not be bound by any assurance, advertisement, declaration or undertaking which it did not give/make on its own initiative.

11.13. A notice which was sent to the insured by the Fund at what according to the Fund’s records was his last known address, shall be deemed to have been lawfully delivered to him.

12. An insured who spends an extended period abroad12.1. An insured or any of his family members, who leave the country on their own initiative

to remain abroad, shall not be entitled to cover/indemnification by the Fund with respect to medical assistance received, when necessary, during their stay abroad.

12.2. During their stay abroad they must take out a medical insurance policy for themselves, at their own expense, with a commercial insurance company, providing the broadest cover possible, having regard to their state of health.

12.3. Retaining the insured’s rights under these Regulations is conditional upon payment of the insurance premiums when due throughout the period of their stay abroad.

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Chapter 2 The Medical Services Basket for Meuhedet C Members

Operations1. Treatments/operations in a private hospital Subject to the terms and conditions specified in these Regulations and the agreements existing between the Fund and the service provider as shall be detailed hereinafter, the insured is entitled to be admitted to a private hospital for one of the medical services enumerated in Appendix B of these Regulations and to choose for himself a “treating physician” (as defined below).

Waiting period: 12 months from the date of joining the program.Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Improved alternative

1.1. DefinitionsIn this chapter the following terms (in alphabetical order) shall have the meanings appearing next to them:

“Hospitalization” — Admission of an insured to a hospital order to receive one of the medical treatments to which he is entitled under these Regulations.“Long term care hospitalization” — Admission of an insured to a Ministry of Health licensed hospital or institution which is equipped to treat ADL-dependent patients suffering from prolonged or incurable illness and whose condition is not expected to improve as a result of medical assistance. “Complex long term care hospitalization” — Admission of an insured who suffers from a prolonged illness of any kind and whose medical condition, in the Fund’s opinion, means that he requires daily medical assistance and constant and prolonged medical supervision in a Ministry of Health licensed hospital or department which is designated for such patients.“Psychiatric hospitalization” — Inpatient treatment for mental illness of an insured in a Ministry of Health licensed psychiatric hospital. “Rehabilitative hospitalization” — Inpatient treatment of an insured in a rehabilitation department and/or a hospital which is equipped to treat patients whose medical condition may improve, and who are suitable for rehabilitation, provided that the hospital operates under a Ministry of Health license and it has an agreement with the Fund.“Hospital” — A hospital, including its medical and paramedical staff , which operates within the State of Israel under a Ministry of Health license and which the Fund is contractually affiliated to (as specified in Appendix C).“Private hospital” — A hospital (as defined above) which is privately owned or a Ministry of Health licensed surgical clinic.“Medical treatment” — A conservative inpatient examination or inpatient treatment of any kind in each of the areas specified in Appendix B of these Regulations.

“Private institute” — A lawfully run privately owned institute equipped with appropriate medical instrumentation and listed in the Fund’s medical services directories, the proprietors of which have a contractual agreement with the Fund to provide those insured under the program with a range of medical services. “Operation” — An open and invasive or endoscopic surgical procedure performed in each of the areas specified in Appendix B to these Regulations. “Nursing” — Assistance, as defined in the Nursing Law, the main purpose of which is to provide care to a person at his home who is unable to function on his own. “Treating physician” — A physician whose name appears in the list of authorized physicians specified in the Fund’s medical services directories and who pursuant to an agreement which he entered into with the Fund, and subject to and in accordance with these Regulations, provides medical services to those insured under the program.“List of approved medical services” — The list of services specified in Appendix B to these Regulation and which encompasses a range of tests, treatments, operations and other services which an insured is entitled to under these Regulations. “Rehabilitation” — Medical assistance which is primarily intended to improve the functional condition of the patient and to return him as close as possible to the condition he was in prior to his illness. “PMS (private medical service)” — An operation carried out privately in one of the public hospitals in Jerusalem in which this service is customarily provided, excluding medical services provided to a patient who was transferred from the casualty department.

1.2. General 1.2.1. An insured shall be entitled to the medical treatment specified in paragraphs

1.3-1.4 below, provided that he has completed 12 months’ membership in the program “the wailing period”) and that the treatment is included in the “list of approved medical services”, and subject to the agreements between the Fund and the service providers who have an agreement with the Fund.

1.2.2. “The list of approved medical services” specified in Appendix B to these Regulations, constitutes an integral part of these Regulations, and the only document which is binding on the Fund regarding the medical assistance offered to members of “Meuhedet C” pursuant to paragraph 1 of these Regulations.

1.2.3. The contribution of Meuhedet C to the costs specified in paragraphs 1.3-1.4 below replaces the Fund’s contribution, if any, in the services basket as defined in the National Health Insurance Law, and does not add to it.

1.3. Purchase of a medical service at a private hospital through the Fund’s affiliated physicians

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B. Original receipts for the sums which he paid in order to purchase the medical assistance.

1.4.1.2. The certifying authority shall check whether the operation is included in the list of operations set out in Appendix B to the “Meuhedet Adif” Regulations and the insured’s entitlement to indemnification pursuant to these Regulations. If his entitlement is confirmed, the Fund shall indemnify the insured against the costs of his hospitalization, including the surgeon’s and anesthetist’s fees, the price of implants, etc. up to the ceiling specified in the refund table which the insured can check at the Fund’s branches. The refund under this paragraph shall be 20% higher than the refund which the insured is entitled to for the identical service under the “Meuhedet Adif” Regulations. The Fund shall reimburse the insured for 85% of the purchase price of the “implants” which he required during the operation. The entitlement shall be limited to a ceiling of NIS 22,318 per year.

1.4.1.3. The refund table shall be updated in accordance with the rate of increase in the index on the date of the insurance premiums update.

1.4.1.4. The Fund shall not bear professional liability for medical treatment which the insured purchased without consulting it in advance as stated in paragraph 11.12 of Chapter 1 of these Regulations, notwithstanding that the Fund indemnified him with respect to his expenses for the aforementioned treatment. The list of physicians shall be available on the Meuhedet Health Fund’s website and at the Fund’s branches.

1.5. Caveats1.5.1. If due to changes in his medical condition during his stay in a private hospital

the insured should require treatment in another appropriate framework, including “rehabilitative hospitalization”, “complex long term care”, “ordinary long term care” or “psychiatric” care, the Fund may find for him an alternative treatment framework in a suitable institution. The insured shall be entitled to assistance from the Fund, subject to the provisions of the National Health Insurance Law.

2. Plastic surgery operationsWaiting Period: 3 months from the date of joining the program.Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Additional.

2.1. A “Meuhedet C” insured shall be entitled to undergo a plastic surgery operation

1.3.1. An insured who requires an operation/treatment which is included in the list of approved operations, may choose for himself a private hospital (including PMS) and treating physician from the list of private hospitals and the list of physicians who have a contractual agreement with the Fund (“treating physician”). The insured can view the list of participating surgeons, participating hospitals and operations for which Meuhedet has an agreement on the Fund’s website and at the Fund’s branches.

1.3.2. An insured who requires an operation or treatment as aforesaid, must verify with the Fund and the treating physician before proceeding with the operation that the physician is authorized by the Fund to perform the operation in question.

1.3.3. Should the insured choose a hospital and a physician as stated in paragraph 1.3.1 above, the Fund shall cover the full cost of the operation, including the surgeon’s services, use of the operating theatre, hospitalization services, the services provided by the hospital’s anesthetist, laboratory tests, imaging tests and implants, in so far as they shall be required during the hospitalization, excluding the insured’s excess in the amount of NIS 300, or if higher, 70% of the excess required under paragraph 1.3 of the Meuhedet Adif Regulations.

1.3.4. The insured shall pay the entire cost of the following services which were provided to the insured at his request and which are not covered by the existing agreements between the Fund and the service providers: hospitalization in a room in a preferred ward, installation of a radio, telephone or television adjacent to the insured’s bed, ADL assistance by a private nurse and/or special supervision. The provisions of paragraph 17 of the “Meuhedet Adif” Regulations shall apply to private nursing services.

1.4. Purchase of medical services at private hospitals and through physicians which/who are not contractually affiliated with the Fund 1.4.1. Expenses for a medical service which was provided at a nonparticipating

private hospital or through a nonparticipating physician, shall not be covered by the Fund, unless the surgeon is included in the Ministry of Health approved list of physicians for which, subject to the certifying authority’s endorsement, reimbursement is provided. The insured may request indemnification with respect to the following expenses:1.4.1.1. Upon his discharge the insured shall submit a request to the

certifying authority for the Fund to participate in his expenses, and shall attach thereto:

A. a detailed illness summary.

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Medical treatment abroad4. Medical consultation before choosing a foreign medical centerWaiting period: No waiting period is required.Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Additional.

Locating a consultant abroad4.1. A “Meuhedet C” insured who believes he requires treatment or a consultation abroad

due to his medical condition shall be entitled to receive from the Fund a list of three foreign medical centers abroad which treat his medical condition, and the names and contact details of three foreign specialists who treat his medical condition.

4.2. The insured shall not be required to pay any excess with respect to the service stated in paragraph 4.1 above.

Receiving the consultation4.3. An insured who satisfies the conditions of paragraph 4.4 below, and who chooses

to consult with one of the foreign medical centers or physicians with which/whom the Fund is contractually affiliated, shall be entitled to receive from the Fund the consultation abroad subject to payment of an excess in the sum of NIS 139 per consultation. The entitlement shall be limited to three consultations throughout the entire membership period.

4.4. The foregoing entitlement shall only apply where the need for the consultation is based on one of the following:4.4.1. A recommendation from an oncological consultant on behalf of the Fund.4.4.2. A concern regarding the need for open heart surgery or brain surgery.4.4.3. A need for a transplant of one of the following organs: heart, liver, bone

marrow, lungs.4.4.4. An illness (not resulting from an accident) which requires the amputation

of a limb. 4.5. Should it not be possible to receive a medical opinion in the area in question from

one of the foreign medical centers which the Fund is contractually affiliated with, and the insured is recognized as being entitled to receive an additional opinion abroad under these Regulations, then the insured shall be entitled to a reimbursement of NIS 6,974, or if less, 85% of the actual expenses incurred in obtaining an opinion from another medical center. The reimbursement shall be given with respect to the consultant’s fees and the cost of sending the medical material abroad.

4.6. The provisions of paragraph 4.5 above shall only apply if the physician giving the opinion is a senior specialist in the requested area and that approval was obtained from the Fund’s professional authority.

from amongst those listed hereinafter in paragraph 2.2 at a private hospital which is contractually affiliated with the Fund performed by a participating surgeon. The insured shall pay an excess in accordance with the type of operation and the hospital selected by him, as a condition for receipt of the service.

2.2. The types of operations and the excess payable for each of them are as follows:2.2.1. Nasal operation — NIS 8,5092.2.2. Small liposuction — NIS 5,5792.2.3. Large liposuction — NIS 17,8542.2.4. Breast lift/reduction — NIS 14,5072.2.5. Breast enlargement — NIS 13,1752.2.6. Blepharoplasty — NIS10,0432.2.7. Face and neck lift — NIS 17,4362.2.8. Laser hair removal — NIS 5,579“From 2.1.2020, the SHS program shall not include “laser hair removal services”.A. Those members whose insurance under the “Meuhedet C” SHS Program shall

commence after 1.1.2020 shall not be entitled to the laser hair removal service as specified in paragraph 2.2.8. For the avoidance of doubt, this provision shall also apply to new Meuhedet Health Fund members who before they moved to the Fund were insured under a similar SHS plan with their previous Health Fund and in this regard they shall be deemed to have joined on 1.1.2020.

B. Those members whose insurance under the “Meuhedet C” SHS Program shall commence by 1.1.2020 (inclusive) shall be entitled to the “laser hair removal” service as specified in paragraph 2.2.8 until 31.12.2020 (hereinafter: “the transitional period”).

C. An insured who began a series of treatments on a certain organ within the framework of the cover specified in paragraph 2.2.8 before or during the transitional period, shall be entitled to finish his course of treatments (for the specific organ in question only) even after that period ends”.

2.2.9. Vein removal treatment — NIS 7,672 per leg.2.2.10. Treatment to prevent hyperhidrosis of the arms and legs — NIS 6,695

2.3. The insured’s method of payment shall be in accordance with the prevailing agreement between the Fund and the service provider. A list of the Fund’s contractually affiliated service providers who provide the services enumerated in this paragraph shall be placed at the insured members’ disposal.

2.4. For the avoidance of doubt, an insured shall not be entitled to indemnification for a plastic surgery operation as aforesaid, if it was performed at another medical center, which is not contractually affiliated with the Fund.

3. Deleted

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5.4.3.2. “Organ transplant” operations:A. Those members whose insurance under the “Meuhedet C” SHS Program shall commence after 1.4.2020 shall not be entitled to undergo an organ transplant operation as specified in paragraph 5.1 above. For the avoidance of doubt, this provision shall also apply to new Meuhedet Health Fund members who before they moved to the Fund were insured under a similar SHS plan with their previous Health Fund and in this regard they shall be deemed to have joined after 1.4.2020. B. Those members whose insurance under the “Meuhedet C” SHS Program shall commence by 1.4.2020 (inclusive) shall be entitled to undergo an organ transplant operation as specified in paragraph 5.1 above until 31.12.2020. Those members whose insurance under the “Meuhedet C” SHS Program shall commence by 1.4.2020 and who shall be included until that date in the Ministry of Health’s transplant waiting list, shall be entitled to undergo organ transplant operations as stated in paragraph 5.1 until the end of the transitional period. C. An insured who began the process of undergoing an organ transplant operation within the framework of the cover specified in paragraph 5.1 and within the framework of his entitlement as specified in the transitional provision before or during the transitional period, shall be entitled to complete that process even after that period ends”.

Innovative treatments6. Anti-Aging TreatmentsWaiting period: 6 months from the date of joining the program.Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Additional.

A “Meuhedet C” insured shall be entitled to a discount on anti-aging treatments provided at a medical center which specializes in this field and which is contractually affiliated with the Fund. The insured shall be eligible for the full range of treatments specified in the agreement between the Fund and the institute. The insured can check the list of treatments and the list of the Fund’s affiliated institutes at the Fund’s branches. The discount shall be 2,000 dollars, or if less, 30% off the supplier’s regular listed price, for one annual series of treatments throughout the insurance period.

7. Shock- Wave TreatmentsWaiting period: 6 months from the date of joining the program.Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Additional.

4.7. The rights of the insured under this paragraph are in addition to his entitlement under paragraph 6.2 of Chapter 2 of the “Meuhedet Adif” Regulations, although an insured shall not be entitled to utilize his rights under both programs with respect to the same consultation.

5. Surgical operations which the insured chooses to have performed abroad

Waiting period: 24 months from the date of joining the program.Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Additional.

5.1. A “Meuhedet C” insured who, in the opinion of a professional employed by the Fund, requires one of the operations enumerated in the National Health Insurance Law, and which is routinely performed in Israel, shall be entitled to undergo the operation abroad with a contribution of up to 250% of the cost of the same operation performed in Israel according to the latest figure given in the Ministry of Health’s pricelist on the date of the operation. The Fund’s contribution shall be by way of giving a refund. For the purposes of this paragraph an “operation” shall not include the performance of organ transplants. Subject to the transitional provisions below.

5.2. The insured’s aforementioned entitlement is limited to one operation during the insurance period.

5.3. For the avoidance of doubt, it is clarified that approval of the insured’s eligibility to undergo the operation abroad under this paragraph, does not entitle him to the ancillary expenses referred to in paragraph 5.8 of the “Meuhedet Adif” Regulations.

5.4. Foreign travel insurance5.4.1. It is hereby clarified that the insured and his escorts who are travelling

abroad pursuant to paragraph 5 above shall be obliged to purchase for themselves a travel insurance policy which shall be in force throughout the period of their stay abroad and shall cover the health and luggage risks which are not included in the Fund’s liabilities under these Regulations.

5.4.2. The insured and his escorts shall be liable for the premium payable on the aforementioned policy, without the Fund being obliged to fully or partially reimburse them in this regard.

5.4.3. Transitional provision regarding this paragraph: “transitional period”- the period from 1.4.2020 to 31.3.2022. 5.4.3.1. Extent of contribution to financing the operation abroad:

During the transitional period, the entitlement to a refund for an operation performed abroad shall be up to 200% of the cost of performing the same operation in Israel according to the Ministry of Health’s pricelist.

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ovarian cancer genes, which is not included in the services basket under the National Health Insurance Law. The test shall be carried out at public hospitals or at the Fund’s participating institutes upon the recommendation of the insured’s attending Meuhedet physician.

9.2. The excess payable by the insured shall be NIS 251 per test.9.3. Women who are not entitled to them as part of the existing national health basket,

shall be eligible to undergo tests for the gene types BRCA1/BRCA2.

10. Laboratory Testing Services in the insured’s homeWaiting period: No waiting period is required. Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Additional.

10.1. Should the Fund’s professional determine that a “Meuhedet C” insured must take a blood test, he shall be entitled to have that blood test carried out through participating suppliers who in response to a telephone request shall visit the insured at any place in Israel of his choosing. The insured may receive the results of the laboratory test at the branch’s computerized information station or from its medical secretariat.

10.2. The supplier shall carry out the blood tests, with the exception of those which must be performed under special conditions which require attendance at a designated clinic.

10.3. For a blood test performed at a site chosen by the insured as aforesaid, the insured shall be charged an excess in the amount of NIS 63, which he shall pay directly to the supplier at the time when the blood sample is taken.The service shall be provided to insured members who are more than 5 years old.

Life Style11. Nutritional CounselingWaiting period: No waiting period required. Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Improved alternative

11.1. An insured shall be entitled to receive nutritional counseling from a consultant who is contractually affiliated with the Fund, even if he is not entitled to such counseling under the National Health Insurance Law.

11.2. The insured shall be entitled to receive counseling as aforesaid during two meetings per year, in return for payment of an excess in the amount of NIS 28 per meeting. The meetings quota as stated in this paragraph shall be in addition to the insured’s entitlement under paragraph 29 in Chapter 2 of the “Meuhedet Adif” Regulations.

7.1 Shock wave treatment is designed to pulverize calcifications in the joints (shoulder, elbow) and treat cases of bone spur formation in the feet and calcification of tendons.

7.2 The insured shall be entitled to a series of up to four treatment sessions throughout the insurance period as determined by the attending physician in one of the centers specializing in this treatment method with which the Fund is contractually affiliated. The members can check the list of the Fund’s participating institutes at the Fund’s branches.

7.3 An insured, as stated in the foregoing paragraph, shall be eligible to receive the treatment in question subject to paying an excess according to the type of treatment required but which shall be no more than 50% of the supplier’s regular listed price, or if less, NIS 628 per treatment.

8. Periodic ScreeningWaiting period: no waiting period is required.Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Additional.

8.1 An Insured who is over the age of 18 shall be entitled, should he decide to do so, to undergo a series of screening tests once every two years, even if there are no medical circumstances requiring such tests to be carried out under the National Health Insurance Law.

8.2 The tests shall be performed at one of the following:8.2.1 The Fund’s designated clinics.8.2.2 The Fund’s participating clinics.

8.3 Performance of the tests at the Fund’s clinics is conditional upon payment by the insured of an excess in the amount of NIS 279 per series of tests. The Fund shall bring to the insured’s attention a list of the clinics which provide the service in question.

8.4 Should the insured be referred to one of its participating institutes, the Fund may require him to pay the full cost directly to the service provider, in which case the insured shall be entitled to a refund of NIS 558, or if less, 75% of the cost for each series of tests.

8.5 The series of tests shall consist of: a physician’s examination, a general urinalysis, blood tests (hematology + chemistry), lung function and ergometric stress test.

9. Oncogenetic TestsWaiting period: 3 months from the date of joining the program.Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Additional.

9.1. A “Meuhedet C” insured shall be entitled upon the recommendation of a geneticist, to take a one-time test for the discovery of breast cancer, colon cancer and/or

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indemnification of 85% of the cost of obtaining a “second opinion” only, or if less, NIS 639, and on condition that the opinion was given by a “specialist”.In this paragraph, “consultant” shall mean — a physician whose name appears in the list of specialist consultants. With the exception of its Medical Division’s senior consultants, the list shall not include physicians who have entered into an agreement with Meuhedet Health Fund to provide medical consulting services to all those insured within the framework of the basket as defined in the National Health Insurance Law. The insured can check the composition of the list at the Fund’s branches and on its website.

14.1.3. All of the foregoing shall be carried out with the certifying authority’s approval, in return for submission of original receipts and medical documents.

14.2. Caveats14.2.1. An insured shall only be entitled to receive the service/indemnity as

stated in paragraphs 14.1.1-14.1.2 above, in relation to a maximum of 4 second medical opinions per calendar year.

14.2.2. The recommended medical treatment as stated in paragraphs 14.1.1-14.1.2 above shall not be provided without the approval of the Fund’s professional authority.

14.2.3. An insured who obtained an opinion and treatment recommendation and despite the fact that it is unacceptable to the Fund’s senior professional authority in the relevant field decided to follow that recommendation, shall be liable for the costs of the treatment and its results.

14.2.4. Upon expiry of the waiting period, the insured’s entitlement under this paragraph shall replace his entitlement under paragraph 5 of the “Meuhedet Adif” Regulations, provided that if during the same calendar year, the insured utilized his entitlement under the “Meuhedet Adif” Regulations the consultations which he received within the framework of “Meuhedet Adif” shall count as part of the quota stated in this paragraph.

Pediatric services15. Treatment of nocturnal enurisisWaiting period: 3 months from the date of joining the program.Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Additional

12. Workshops and coursesWaiting period: No waiting period is required Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Additional.

The insured shall be entitled to a discount of 50% off the regular rate, or if less, NIS 488 per course (the lower of the two) for attending weight loss and preparation for childbirth courses and workshops provided by the Fund and/or its participating suppliers. The discount provided by the Fund as aforesaid, shall be limited to 2 courses per calendar year. The price list shall be published at the Fund’s clinics.

13. Rehabilitation exercise following myocardial infarctionWaiting period: 6 months from the date of joining the program.Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Improved alternative

13.1. An insured who following an acute myocardial infarction is required on the instructions of a specialist to engage in controlled and medically supervised physical activity at a licensed institute, shall be entitled to a contribution from the Fund of NIS 191 per month towards the cost of doing so for a period of 9 months (in addition to his eligibility under the National Health Insurance Law), provided that he began the said physical activity within 6 months from the date of the incident.

13.2. From the date on which the waiting period expires, the entitlement under paragraph 13.1 above shall replace the eligibility which exists under paragraph 25 of the “Meuhedet Adif” Regulations.

Consultation14. Second Opinion in IsraelWaiting period: 6 months from the date of joining the program.Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Improved alternative

14.1. An insured who requests it shall be entitled to receive a second medical opinion in Israel from one of the following:14.1.1. A surgeon who is contractually tied to the Fund, subject to payment

of the excess as published on the Fund’s website.14.1.2. A consultant who is recognized by the Recognition of Specialists

Committee for the purpose of this paragraph:14.1.2.1. A consultant who is contractually tied to the Fund, subject

to payment of the excess as published on the Fund’s website.14.1.2.2. A consultant who is not contractually tied to the Fund —

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“Donated genetic material” — A woman’s eggs or a man’s sperm taken from a donor. “Child” — A living infant born to a married couple (as defined in these Regulations) from the current marriage and from spontaneous genetic material (belonging to both spouses) or from donated genetic material, or a living infant born to a one parent family from spontaneous or donated genetic material. “Recognized department” — A department in a hospital or clinic, which subject to such conditions as he prescribed, the Director General of the Ministry of Health has recognized by an announcement in the Official Gazette as authorized to engage in medical activities relating to in vitro fertilization.“Authorized institute” — An institute or service provider which is contractually affiliated with the Fund and whose details appear in the Fund’s medical services directory. “One attempt” — Any attempt in which at least Stages A + B as described above were completed, or any attempt in which Stage C only was implemented.

16.2. General 16.2.1. A married couple or a single parent family insured under the program

who were deemed eligible by the Fund’s professional advisor to receive fertility treatments under the National Health Insurance Law, shall be entitled to have their existing infertility disorders diagnosed and treated at a private hospital which is contractually affiliated with the Fund with the object of achieving pregnancy, provided that, in the case of a married couple, they have no children from their current marriage. Eligibility is subject to payment of an excess of NIS 1,952 per attempt or, if less, a sum equivalent to 15% of the cost of the treatment.

16.2.2. The insured is only entitled to receive conservative and/or surgical treatments at a private hospital as aforesaid for up to a maximum of 10 attempts at in vitro fertilization (IVF) per child with the aim of having up to two children, For the avoidance of doubt, it should be emphasized that eligibility is based on the medical criteria prescribed under the National Health Insurance Law.

16.2.3. A couple or single parent family insured under the “Meuhedet Adif” program who already have two healthy children but who wish to give birth to another child, are entitled to a financial contribution from the program amounting to 50% of the cost of up to 10 IVF treatments/attempts, provided that each “attempt” shall be approved in advance by the Fund’s certifying authority.

16.2.4. The total contribution towards the cost of all the approved IVF attempts referred to in paragraphs 16.2.2 and 16.2.3 above shall be NIS 121,969.

15.1. A “Meuhedet C” Insured who according to the determination of the Fund’s physician requires treatment for enurisis, shall be entitled to receive such treatment at the Fund’s alternative medicine clinics as stated in the “Meuhedet Adif” Regulations; however, if within the framework of solving the said problem behavioral therapy was provided by a therapist who has no contractual affiliation with the Fund , then the insured shall be entitled to a refund of NIS 727, or if less, 85% of the cost, for one series of up to 4 sessions throughout the insurance period.

15.2. The rights under this paragraph shall supplement the insured’s rights under paragraph 12 of the “Meuhedet Adif” Regulations, although an insured shall not be entitled to aggregate his rights under the two programs with respect to the same treatment.

Pregnancy and birth

16. Diagnosis and treatment of male and female fertility disordersWaiting period: 24 months from the date of joining the program.

16.1. DefinitionsIn this chapter the following terms shall have the meanings appearing next to them:“In vitro fertilization (IVF)”, which is comprised of the following stages:Stage 1 — Diagnostic clarification (clinical, laboratorial and through imaging), hormonal treatment and ultrasonic follicular monitoring.Stage 2 — Oocyte retrieval, fertilization of the eggs with the partner’s/donor’s sperm and their implantation in the insured’s or the surrogate mother’s uterus (or the freezing of those fertilized eggs which were not implanted). Additionally, laboratorial and U.S. monitoring of fetal development until proof of clinical or chemical pregnancy (as defined hereinafter).Stage 3 — Implantation of embryos from frozen stock (if the woman did not become pregnant in Stage 2), including hormonal and U.S. monitoring as stated in Stage 2 above. “Clinical pregnancy” — Pregnancy, with increasing blood hormone levels and ultrasound evidence that a gestational sac exists in the uterus.“Chemical pregnancy” — A high blood hormone level which returns to normal, without ultrasound evidence that a gestational sac exists in the uterus.“Married couple” — A man and woman who are described as a married couple in their identity cards.“Single parent family” — An unmarried woman (single, divorced, widowed) who wishes to have a child in accordance with the rules, terms and conditions specified in these Regulations.“Spontaneous genetic material” — A woman’s own eggs or a man’s own sperm (not from a donor).

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16.5. Supply of medications “Meuhedet C” members who are eligible for fertility treatment under these Regulations, shall be entitled to the following medications:16.5.1. The fertility drugs included in the Fund’s medications list, which subject

to the relevant statutory provisions shall be supplied to them within the framework of approved conception attempts.

16.5.2. Drugs which are not included in the medications list but are included in Appendix D of these Regulations, subject to an excess of up to 15% of their retail price.

16.5.3. IVF (Stage 2) medications for the conception of a third child onwards, subject to an excess of up to 15% of their retail price.

16.5.4. Entitlement to the medications as aforesaid, is contingent upon a recommendation from a specialist in female diseases who is affiliated to and authorized to prescribe the medications on behalf of the Fund, and obtaining them from the Fund’s pharmacies or its central dispensary.

16.6. In vitro fertilization (IVF) 16.6.1. Subject to the following terms and conditions, in vitro fertilization treatments

shall be provided pursuant to these Regulations to all members of the Fund who are eligible to receive them, in order to enable them to have up to two children inclusive, and to members of “Meuhedet C” to have a third child onwards:

16.3. Eligibility requirements 16.3.1. Persons insured under the “Meuhedet C” program shall be eligible

for the diagnosis and treatment of fertility disorders as defined in this chapter provided that all of the following requirements are satisfied: 16.3.1.1. The insured is a member of Meuhedet Health Fund.16.3.1.2. The waiting period has elapsed (24 months).16.3.1.3. A detailed professional opinion was given regarding the

reasons for the insured’s fertility disorder and a gynecologist or endocrinologist positively recommended that the insured’s infertility be clarified and/or treated, including through in vitro fertilization.

16.3.1.4. The Fund’s certifying authority gave prior approval based on the opinion of the Fund’s senior consultant in the field of infertility disorders.

16.3.1.5. In the case of treatment using spontaneous genetic material or donated sperm, the insured who is eligible under paragraph 16.2.3 above is less than 43 years old, and less than 48 years old in the case of treatment involving the use of donated eggs.

16.4. Tests and treatments16.4.1. Provided that the Fund’s senior consultant determined that a medical

need exists and that there is a reasonable chance that treatment shall be successful, tests carried out at public hospitals to determine the cause of a fertility disorder such as: clinical tests, laboratory tests, routine sperm tests, sperm evaluation through scanning electron microscopy (subject to the Medical Division’s approval), testing the sperm creation process, imaging tests, diagnostic curettage and invasive tests of the abdominal and uterine cavities, as well as conservative or invasive treatments, such as artificial insemination, surgical treatments, in vitro fertilization and oocyte or zygote micromanipulation, shall be provided to the Fund’s members at the Fund’s expense without an “excess”.

16.4.2. The aforementioned tests and treatments shall also be provided to members of “Meuhedet C”, as stated in paragraph 16.4.1 above, at private hospitals, subject to the insured paying an excess of up to 15% of their cost and the eligibility requirements as specified in paragraphs 16.2 and 16.3 above.

16.4.3. Subject to the certifying authority’s approval and the insured’s excess of up to 15% of the cost, the aforementioned tests and treatments shall be provided exclusively to “Meuhedet C” members for the purpose of having a third child onwards on the basis of up to 10 attempts per child.

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defects in the fetus. While the Fund shall pay the treatment costs of the aforementioned complications in accordance with its obligations under the National Health Insurance Law, this shall not derogate from the foregoing provisions regarding the Fund’s exemption from liability.

16.6.3. The Fund shall only finance in vitro fertilization performed in a “recognized department” of a hospital within the State of Israel which the Fund is contractually affiliated with and subject to the conditions specified in these Regulations.

16.7. Freezing of genetic material16.7.1. Within the framework of the fertilization attempts approved under

these Regulations, the Fund shall contribute towards the cost of freezing embryos, and if she did not become pregnant in Stage 2 of the in vitro fertilization, reimplanting them in the insured from the frozen stock (Stage 3).

16.7.2. All members of the Fund are entitled to full pecuniary cover with respect to the freezing of embryos for one year, while those insured with “Meuhedet C” are entitled to a further two years of financial assistance subject to an excess of 15% of the “self-cost”.

16.7.3. An insured who is an oncology patient or who suffers from fertility problems, shall be entitled to preserve sperm for a period of five years with the Fund’s contractually affiliated public service providers at the program’s expense.

16.7.4. The financial assistance provided by the program as stated in paragraphs 16.7.2 and 16.7.3 above shall be paid directly to the hospital as aforesaid.

16.7.5. For the avoidance of doubt, the foregoing shall only apply where the treatment is provided at the Fund’s affiliated hospitals, subject to the Ministry of Health’s regulations in this regard, and at the sole risk of the insured and the professionals administering it.

16.8. Treatment of fertility disorders through egg donation performed abroad16.8.1. Those insured with “Meuhedet C” who have no more than one child,

shall be entitled to a refund of up to NIS 12,197 of the cost of egg donation required within the framework of fertility treatment approved by the Fund, subject to the terms and conditions specified in Chapter 16 of the Regulations.

16.8.2. The aforementioned refund shall relate to the treatment performed abroad, including the cost of obtaining the eggs and implanting the embryos in the uterus.

16.8.3. The said assistance to the insured shall be approved for up to two egg donation cycles, and is conditional upon prior approval from the Fund’s Medical Division.

Number of children

Type of insurance

Number of attempts

Public hospi-tal excess

Private hospi-tal excess

For the first 2 children

Fund members who are not insured under “Meuhedet Adif”

According to the profes-sional advisor’s determination

None Ineligible for a contribution from the Fund for inpatient care at a pri-vate hospital

Insured under “Meuhedet Adif”

In a public hospital — as determina-tion by the professional advisor. Private hospital — 10 attempts per child (from those ap-proved by the professional advisor pursu-ant to the law)

None Up to 15% of the cost for each attempt

For the third child onwards

Insured under “Meuhedet Adif”

10 attempts per child (in ac-cordance with the profes-sional advisor’s approval)

Up to 15% of the cost for each attempt

Up to 15% of the cost for each attempt

16.6.2. Since it is performed upon the recommendation and at the bidding of a “recognized department”, at the request and with the consent of the insured, no direct professional or vicarious liability shall be imposed on the Fund for undertaking the in vitro fertilization (IVF) or for its results, including pregnancy and/or birth complications and/or congenital

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17.3. Caveats 17.3.1. Due to prevailing limitations in the early detection of some congenital

disorders in the fetus through the tools which exist in the health system and/or the current technologic limitations which exist, including the limitations of the various tests in multifetal pregnancy situations, the Fund shall not be responsible for early detection of congenital disorders as a result of carrying out the tests specified in paragraphs 17.1 and 17.2 above.

17.3.2. Upon expiry of the waiting period, the insured’s rights under paragraphs 17.1 and 17.2 above shall supplement her entitlement under paragraph 13.2 of the “Meuhedet Adif” Regulations.

18. Umbilical cord bloodWaiting period: 6 months from the date of joining the program.Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Additional

The Fund shall cover part of the cost of taking, maintaining and preserving umbilical cord blood for a mother who is insured under the “Meuhedet C” program through one of its participating suppliers. The insured’s excess shall not exceed 50% of the ser-vice provider’s standard price, up to a ceiling of NIS 2,340 in total, for the entire period of the insurance, provided it does not exceed 15 years.

Convalescence and recovery

19. Recovery following complex surgeryWaiting period: 3 months from the date of joining the program.Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Improved alternative

19.1. An insured who has undergone brain surgery, abdominal surgery, a heart transplant or other surgery (excluding cosmetic plastic and obstetric surgery) which requires more than 10 consecutive days of hospitalization, shall be entitled to a full reimbursement of, or if less, a contribution of NIS 453 per day towards, the cost of his stay at a convalescent institution for a period of up to 7 consecutive days following the operation.

19.2. Following an acute myocardial infarction and his discharge from hospital, an insured shall be entitled to up to 12 consecutive days of convalescence (including those approved under the National Health Insurance Law) in as institution which is contractually affiliated with the Fund and which specializes in the rehabilitation and recovery of cardiac patients following heart transplant surgery. The aforementioned insured’s

16.9. Fertility preservation for women for nonmedical reasons16.9.1. A woman aged 30-40 who is insured under the program shall be entitled

to preserve her eggs at a participating institute, provided that she is not entitled to preserve them within the framework of the health basket. The entitlement under this paragraph is for up to 4 aspirations and/or (should it happen earlier) the retrieval of up to 20 eggs.

16.9.2. The insured shall pay an excess in the sum of NIS 4,000 per treatment cycle. A “treatment cycle” includes preparation for aspiration, aspiration of the eggs and their preservation for 5 years. The insured shall pay the excess before commencement of the treatment cycle and regardless of its results.

16.9.3. For the avoidance of doubt, there is no entitlement under this program to the drug therapy involved in Stage 1 of the fertility process (preparation for aspiration). The “excess” payable for provision of the medications required in order to preserve fertility within the framework of this process shall be 50% of the maximum retail price.

16.9.4. An insured who began the process before reaching the age of 41, shall be entitled to continue the process (provided that it shall proceed unabated, and with the approval of a Meuhedet gynecologist) until the maximum number of treatments have been utilized, or if earlier, until 20 eggs have been retrieved.

17. Early detection of congenital disorders in the fetusWaiting period: No waiting period is required.Genetic abnormality tests: one year.Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Additional

17.1. Antenatal screening for detection of fetal abnormalitiesA woman who is insured under the “Meuhedet C” program shall be entitled should she so choose to undergo fetal abnormality screening which is not included in the health basket entitlement. The screening, as aforesaid, shall be provided once per pregnancy at the Fund’s participating institutes and subject to payment of an excess in the amount of NIS 139 per test.

17.2. NIPT Genetic tests to detect abnormalities during the pregnancy17.2.1. An insured shall be entitled to have one test to detect congenital

disorders (trisomies) during each pregnancy through an examination of the fetus’ genetic material. The entitlement is for an NIPT test of the mother’s blood. The Fund shall refund 75% of the cost of the test, or if less, NIS 4,225.

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22. Therapeutic riding, hydrotherapy, music therapy, art therapy and therapy using animals

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

22.1. A child under the age of 12, who according to the determination of the Fund’s certifying authority (a developmental pediatrician/neurologist) requires one of the therapies enumerated in the above heading, shall be entitled to receive up to 40 therapy sessions a year, subject to payment of an excess in the sum of NIS 45 per session.

22.2. A child who is over the age of 12 and less than the age of 18, who according to the determination of the Fund’s certifying authority (a developmental pediatrician/neurologist) requires one of the therapies enumerated in the above heading, shall be entitled to receive up to 24 therapy sessions a year, subject to payment of an excess in the sum of NIS 55 per session.

22.3. The therapies specified in the paragraph heading, shall be given by a participating service provider, apart from riding therapy, 75% of the actual cost of which shall be refunded, and up to a maximum of NIS 110 per therapy session.

22.4. The total number of sessions for all types of therapy during the entire insurance period shall not exceed 100.

22.5. The total number of therapy sessions provided pursuant to this paragraph and under paragraph 27 of the Regulations (“child development”), shall not exceed 40 a year.

23. Deleted

24. Food substitutes which are not included in the health basket Waiting period: 12 months from the date of joining the program.Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Additional

An infant until the age of two years, who is insured under the program, shall be entitled to a discount of 25% — 40 % off the retail price of food substitutes purchased at one of the Fund’s pharmacies which according to the Fund’s physician who is treating the infant he requires (the size of the discount being in accordance with the type of food substitute required), provided that the food substitute is included in the Fund’s list of approved substitutes. The foregoing shall be limited to situations in which, in the opinion of the aforementioned physician, the food substitutes provided in the basic health services basket do not meet the infant’s needs. The Fund’s participation under this paragraph shall be limited to an aggregate period of 6 months.

contribution to the cost of each day of his stay at the convalescence institution, beyond the basic basket entitlement, shall be limited to NIS 222.

19.3. The insured’s entitlement as stated in paragraphs 19.1 and 19.2 above, is conditional upon prior recognition of the need for his convalescence by the Fund’s certifying authority and upon the insured commencing the period of convalescence immediately or within 14 days following his discharge from hospital.

19.4. The insured must present to the certifying authority his letter of discharge from the hospital and original receipts, specifying the name of the person who stayed at the institution, the duration of his convalescence and the sum he was charged.

19.5. Upon expiry of the waiting period, the insured’s entitlement under this paragraph shall replace his entitlement to the cost of convalescence following a complex operation under paragraph 8 of the “Meuhedet Adif” Regulations.

Additional services

20. Treatment of hemorrhoids and fissuresWaiting period: 12 months from the date of joining the program.Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Additional

An insured who according to the determination of the Fund’s attending physician requires treatment for hemorrhoids or fissures, shall be entitled to receive that treatment at a private institute which is contractually affiliated with the Fund at a cost of 35% less than that service provider’s standard charge, or to receive a refund of 70% of the cost of the treatment up to a maximum of NIS 3,766, all in accordance with the agreement between the Fund and the and the service provider.

21. Treatment of sexual function disordersWaiting period: 12 months from the date of joining the program.Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Additional

An insured who requires treatment for a sexual function disorder shall be entitled to receive it at a private institute which is contractually affiliated with the Fund. The insured shall be entitled to a discount of 35% off the service provider’s standard charge, or (if lower) 61 NIS, per treatment, for up to 25 treatments throughout the entire insurance period.

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29. Physician home visitsWaiting period: 12 months from the date of joining the program.Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Additional

An insured who requires a physician’s services at night, when the Fund’s clinics are closed and/or on Sabbaths and Jewish holidays, can order a physician’s visit at his home through a service provider which is contractually affiliated with the Fund in this regard. In return for the visit, the insured shall pay an excess of NIS 30.

30. Pregnancy and birth basketWaiting period: 6 months from the date of joining the program.Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Additional

30.1. Qualifying event: An insured who is pregnant or who gave birth within the last 6 months, who is a member of the Meuhedet C program, and who requires a consultation, test and/or medical treatment and/or a medical service in connection with her pregnancy or the expected birth (and up to 6 months after the birth), which are not included in the basic health basket and/or the Meuhedet Adif and/or Meuhedet C programs. Notwithstanding the foregoing, a member shall be entitled to a refund under this chapter for services which she purchased from a nonparticipating service provider and which are covered under the Meuhedet Adif program, in addition to the refund which she is entitled to receive from Meuhedet Adif. The member only shall be entitled to the pregnancy and birth package and it shall not be given to her partner and/or to the newborn.

30.2. An insured who meets the “qualifying event” criteria shall be entitled to the following cover: The maximum sum which the member is entitled to for each of the qualifying events which fall within the definition of a qualifying event, which shall be a sum equivalent to 75% of the total cost which was actually incurred by the member up to an aggregate ceiling of NIS 2,000 per pregnancy and up to 4 pregnancies only for each period of her membership in the same program, even if the period of her membership in the program was not continuous, provided that the refunds given to the member of the program in question , including previous utilization of the program’s pregnancy and birth package, shall not exceed a sum of NIS 8,000 per membership period. In this regard, “actual cost” shall mean an expense which the member paid from her own pocket after deducting every refund/contribution which the member received or was entitled to receive from the Meuhedet Adif program or pursuant to other paragraphs of this program. 30.2.1. The maximum refund for consultation with a specialist shall be NIS 700.

25. Treatment of snoring problems and nasal congestionWaiting period: 12 months from the date of joining the program.Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Additional

An insured who suffers from these problems shall be entitled to receive treatment from a private service provider which is contractually affiliated with the Fund. The insured shall be entitled to a discount of 35% off the service provider’s standard rate or (if less) NIS 349.

26. Rehabilitation from sports injuriesWaiting period: 12 months from the date of joining the program.Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Additional

An Insured shall be entitled to rehabilitation as a result of sports injuries in one of the Fund’s institutes which is licensed to treat such problems. The insured shall be entitled to receive, according to the determination of the Fund’s treating physician, up to 20 sessions per year, subject to payment of an excess of NIS 56 per session.

27. Child developmentWaiting period: 6 months from the date of joining the program.Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Additional

A child aged between 3 and 9, who exhausted the quota of child development treatments which he is entitled under the National Health Insurance Law and under the “Meuhedet Adif” Regulations, shall be entitled to an additional 15 treatments per year (in all areas of the treatment combined), subject to an excess of NIS 32 per treatment.

28. Nuchal TranslucencyWaiting period: No waiting period is required. Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Additional

A “Meuhedet C” insured who is pregnant is entitled between the 11th and 14th week of her pregnancy to undergo a nuchal translucency test at a private institute which is not contractually affiliated with the Fund and to receive a refund of 75% of the cost involved, or if less, NIS 523.

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33. Postnatal convalescenceWaiting period: 6 months from the date of joining the program.Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Improved alternative

33.1. Following the birth of each of her first three children, a mother shall be entitled to recuperate at a postnatal convalescent home provided that she enters the convalescent home within one month from the date on which she (or if later) the newborn, was discharged from the hospital.

33.2. Upon presentation of a discharge certificate from the maternity home and original receipts attesting to the sums which were paid to the convalescent home or postpartum hotel, the mother shall be entitled to a reimbursement of NIS 279, or if less 75%, of the actual cost of each full day of convalescence up to a maximum of three days.

34. Dental care for children, adolescents and adults34.1. Dental care for children and adolescentsWaiting period: Orthodontics (teeth straightening) — 6 months from the date of joining the program.

An insured who is less than 18 years old shall be entitled to orthodontic treatment at a cost of 50% of the member’s price. 34.2. Dental care for adults who are over the age of 18.Waiting period: “Preventative medical treatment” — 3 months from the date of joining the program.Fillings, root canals and extractions — 6 months from the date of joining the program.

Complex treatments, including rehabilitation, surgery, periodontics and orthodontics — 12 months from the date of joining the program. A “Meuhedet C” insured shall be entitled to discounts on the member’s price at the Fund’s dental clinics and at participating clinics (as detailed hereinafter) as it appears in the Fund’s pricelist.

34.2.1. Tartar removal and oral hygiene instruction once per calendar year (free of charge), as an alternative to the entitlement in paragraph 11.1.3 of the “Meuhedet Adif” Regulations, first treatment, (up to two x-rays during a calendar year free of charge) hereinafter: “preventative medical treatments”). Fluorine treatment within the framework of hygienist treatments shall be provided at 50% of the Meuhedet insured’s listed price (the member’s price). This service shall be provided to insured who have reached the age of 18 but have not reached the age of 75.

34.2.2. Fillings, root canals — This service shall be provided to insured who have reached the age of 18 but have not reached the age of 75, subject to payment of an excess equivalent to 20% of the member’s price.

30.2.2. The cover with regard to the birth and the 6 months thereafter shall only include the following:

1. Refunds for one of the following services purchased by the member:A. Up to NIS 1,500 per pregnancy for a doula/birth assistant.B. Up to NIS 400 for a newborn sleep consultation, a private nurse in the maternity

home or a personal physical exercise and/or correct nutrition consultation in the maternity home.

C. Up to NIS 400 per night for three extra days of postnatal convalescence, in addition to the separate entitlement which exists under the Meuhedet Adif SHS program, within the first two months following a fourth birth and each birth thereafter.

30.3. The pregnancy and birth package shall not include the following subjects:1. Treatment of any kind which is connected to fertility.2. A nonconventional consultation/test/treatment, including homeopathic, alternative

medicine and/or alternative medication treatments.3. A nonmedical consultation, test, treatment or service of any kind, other than as

specified above.4. No refund shall be given for a consultation with a participating specialist, as that

term is defined in paragraph 5 of Chapter 2 in the Meuhedet Adif Regulations and in paragraph 14 of Chapter 2 in the Meuhedet C Regulations.

31. Diagnosis of attention and concentration disordersWaiting period: No waiting period is required. Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Additional

Children between the ages of 5 and 18, who suffer from attention and concentration disorders as diagnosed by a Meuhedet pediatric psychiatrist or neurologist, shall be entitled to take a one-time specific computerized attention and concentration disorder diagnostic test (TOVA, BRC or MOXO) and at the behest of a neurologist, two consecutive tests (BRC followed by TOVA, or TOVA followed by BRC), subject to the insured’s excess of NIS 244 per test.

32. Complementary MedicineWaiting period: 12 months from the date of joining the program.Classification of the service in relation to eligibility under the “Meuhedet Adif” program: Additional

An Insured, who exhausted the annual treatment quota at the complementary medicine clinics as stated in paragraph 12.2 of the “Meuhedet Adif” Regulations, shall be entitled to a series of 18 additional treatments with a discount of 40% off the regular listed price.

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Should the price of the glasses exceed NIS 700, the insured shall pay the cost differential together with an additional NIS 70.

C. The glasses may be purchased from participating suppliers and the price includes an eye test by a licensed optometrist.

37. Didactic and psychodidactic diagnosisWaiting period: 6 months from the date of joining the program

37.1. Qualifying eventAn insured from the age of 6 to 26 years old shall be entitled to a didactic diagnosis or psychodidactic diagnosis of learning disabilities, subject to the following cumulative conditions:1. A referral from a pediatrician, GP, neurologist, developmental pediatrician

or psychiatrist.2. The diagnosis is made by a Meuhedet-affiliated supplier.3. Utilization of one of the said diagnoses throughout the membership period.

37.2. Amount of the cover An insured shall be entitled to cover for a didactic diagnosis or psychodidactic diagnosis subject to payment of the following excess:37.2.1. For a didactic diagnosis, NIS 592.37.2.2. For a psychodidactic diagnosis, NIS 1,022A list of the participating suppliers and excesses shall be available at Meuhedet’s clinics, on its website and at its customer service center.

38. Financing supervision of fertility treatments at participating institutes

Waiting period: 3 months from the date of joining the program

An insured who is in the process of in vitro fertilization shall be entitled to a refund for expenses incurred in financing the cost of the fertility treatment’s supervision. The refund shall be given for up to 3 days of supervision services per fertility treatment, provided through participating institutes. The amount of the refund shall stand at NIS 125 per day. Insured members can check the list of participating service providers on Meuhedet’s website and at the Fund’s branches.

39. Breastfeeding counselingClassification of the service in relation to eligibility under the “Meuhedet Adif” program: Improved alternativeWaiting period: 6 months from the date of joining the program.

34.2.3. Extractions shall be provided to insured who have reached the age of 18 but have not reached the age of 75, subject to payment of an excess equivalent to 50% of the member’s price.

34.2.4. Complex treatments, including rehabilitation, surgery, and periodontics, shall be provided, subject to payment of an excess equivalent to 50% of the member’s price.

34.2.5. For the avoidance of doubt, rehabilitative dental treatments for insured members who have reached the age of 80 and which are included in the national health basket, shall not be provided within the framework of the “Meuhedet C” program.

34.2.6. Orthodontic treatment shall be provided at a cost of 50% of the member’s price.

34.3. The insured’s entitlement is conditional upon the treatments being approved in advance by Meuhedet’s certifying authority. The treatments and tariffs are listed in Appendix G to these Regulations. Those insured under the program can check the list of the Fund’s dental clinics at Meuhedet’s clinics and on its website.

35. Hearing aidsWaiting period: 3 months from the date of joining the program

A “Meuhedet C” insured shall be entitled to purchase hearing aids from a participating supplier, with the prior approval of an otorhinolaryngologist or a speech and language therapist.The entitlement is subject to payment of the excess specified in Appendix F to the Regulations and is limited to the purchase of two accessories (one from Group A and the other from Group B) once every two years of membership in the program.

36. Optics for children, adolescents and adultsWaiting period: 6 months from the date of joining the program

A. Children and adolescents up to the age of 18 shall be entitled to purchase eyeglasses once a year at a cost of up to NIS 700, subject to an excess of 10%. Should the price of the glasses exceed NIS 700, the insured shall pay the cost differential together with an additional NIS 70.

B. Adults who are over the age of 70 shall be entitled to purchase multifocal or bifocal glasses for a price of up to NIS 1,200 once every two years, subject to payment of a 10% excess. Should the price of the glasses exceed NIS 1,200, the insured shall pay the cost differential together with an additional NIS 120, or alternatively he shall be entitled to purchase eyeglasses once every two years at a cost of up to NIS 700, subject to an excess of 10%.

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Appendix A Monthly payments*

Age group Monthly premium in NIS

Age group Monthly premium in NIS

0-17 NIS 15.13 50-59 NIS 80.04

18-24 NIS 16.19 60-69 NIS 97.55

25-29 NIS 40.13 70-79 NIS 116.31

30-39 NIS 50.08 80 and over NIS 116.44

40-49 NIS 65.41

* As of 1.1.2020.

- The monthly payment shall be updated in accordance with increases in the index as stated in paragraph

8.6 in Chapter 1 of the Regulations.

Remarks A. The price specified in the table is for each person insured, according to age. The

charge for children up to the age of 18 in an insured family applies to the first three children only. There is no charge for the fourth child onwards.

B. The monthly payments (the insurance premiums) listed above are after deduction of a 5% discount for those paying by standing order, credit card or concentrated collection.

C. Those paying through payment vouchers may do so at any branch of the Postal Bank throughout the country or at the Fund’s offices.

D. “Meuhedet C” constitutes an additional tier to “Meuhedet Adif”, and hence the rates specified above are in addition to the payments for “Meuhedet Adif”.

E. Regular payment of the insurance premium is a condition for realizing all the rights reserved to those insured under the SHS programs, subject to the provisions of the Regulations.

F. A delay in payment of the insurance premiums as aforesaid, shall detrimentally affect the insured’s rights up to cancellation of their membership in the program, as specified in paragraph 8 of the Regulations.

Updating of insurance premiumsThe “Meuhedet C” insurance premiums are linked to the rate of increase in the Consumer Price Index which is published by the Central Bureau of Statistics, or if higher, the Health Cost Index (the base index being the last index to have been published prior to April 2004). Subject to Ministry of Health approval, the premiums are also updated in accordance with the composition of the services basket and the actual cost of the range of medical

39.1. An insured shall be entitled to a refund for up to 2 such counseling sessions during the entire period of the pregnancy and resultant birth, NIS 150 for a first consultation and NIS 70 for the second consultation. The excess shall be paid directly to the licensed breastfeeding consultant who is contractually affiliated with the Fund.

39.2. In communities in which no service is provided to her within the framework of the agreement, the insured shall be entitled to a refund, for up to 2 counseling sessions per year of membership, of 75% of the cost, and up to a ceiling of NIS 200 for the first session and up to a ceiling of NIS 80 for the second session. The refund shall be paid upon the presentation of a receipt for the service that was provided by a licensed breastfeeding counselor only. The refund shall not be given for breastfeeding instruction services purchased by the insured.

4948

ORTHOPEDICSFIBULA TIBIA RECONST.OSTEOTOMY Osteotomy + FixationFinger joint fusionExcision of bone growths — exostectomy Meniscectomy Radial head excisionAcromioplasty (shoulder) Diagnostic arthroscopyArthroscopic surgeryArthroplasty — shoulderBone biopsyOpen bone biopsyOpen biopsy — femur/soft tissueKnee — arthrotomyKnee — ligament reconstructionJoint debridement + synovectomyFinger dislocation — correctionDiscectomy — disc removal Lumbar discectomy Cervical discectomyTendon extensionScrew WIRE extraction Spinal tumor removalBone fixation removalRemoval of joint platesUnilateral hallux valgusBilateral hallux valgusCementless knee arthroplastyCementless hip arthroplastyCemented knee arthroplasty Cemented hip arthroplastyFinger amputation

Laminectomy Synovectomy — elbow/wrist Drainage of foot or ankle lesionsHand surgery Foot surgeryshall be Pediatric adenoidectomyEars — abscess or hematoma drainage Excision/biopsyAuricle biopsyBronchoscopyNeck dissectionNon-discectomy spinal operationsHAMMER TOE corrective surgerySpinal scoliosis correctionLumbosacral disk fixationAnkle arthrodesisDisc aspirationTendon release -TRIGGER FINGER Lateral epicondyle releaseSpinal stenosis decompression surgeryNerve releaseCarpal tunnel release — CTSGanglion correction — anesthesiaCorrection of arm flexors -TENNIS ELBOW

OPTHAMOLOGYAstigmatism — (RELAXING INCISIONS)Cornea transplant/+ cataract extraction/+ lens laser treatment (YAG.POST CAPSULOTOMY)Laser TrabeculoplastyLaser iridotomyLaser iridotomy (for glaucoma)Enucleation with/without orbital implant

services included in the “Meuhedet C” services basket, and on the basis of an actuarial calculation made once per period.

Appendix B List of medical services provided within the framework of private hospital/PMS for “Meuhedet C” members

Pterygium excisionCorneal transplantationCataract surgery — under local or general anaestheticChalazionRefractive Surgery -LASIK or Excimer refractive laser surgery (only in cases of significant Anisometropia).Ptosis repair eye lid surgeryLesion removal — verruca/papillomaPosterior vitrectomyStrabismus surgery

ENT Sinus drainage- Nasal endoscopy + septum-FESS Endoscopic bilateral sinus drainage- FESSAdenoids + bilateral grommetsAdenoidectomyOropharynx lesion biopsy Turbinectomy + tonsillectomyTurbinectomy + nasal cavity + septumTurbinectomy/conchotomy TympanoplastyGrommetsGrommets + tonsils + adenoidsParotidectomySubmandibular gland removalLaryngoscopyLaryngoscopy — under general anaestheticLaryngoscopy + biopsyMyringotomy — tympanic membrane paracentesisMastoidectomyCaldwell-Luc antrostomy Floor of mouth abscess/cyst drainageTonsillectomy and adenoidectomyStapedotomy, ossiculoplastySubmucous septal resectionNasal/auricle polypetomy

FrenotomyTonsillectomy

SURGERYLarge ExcisionsRectal PolypectomyCutaneous/ subcutaneous lesion excision/ curettageArteriovenous (AV) fistula — dialysisLymph node and lymph vessel biopsyAxillary lymph node dissection LymphadenectomyRemoval of foreign body under general anesthesiaLymphoma/cyst removalOrchiopexyHemicolectomyStomach reduction (according to clinical indications)Abdominal hernia- Incisional — POVHBilateral hernia

BREAST SURGERY Lumpectomy Double mastectomyBilateral breast reconstructionMastectomy and axillary lymph node removalMastectomy + unilateral reconstructionGynecomastia Surgery (Subject to Medical Division approval)Breast reconstruction following mastectomy due to unilateral malignancyDiaphragmatic herniaUmbilical herniaPediatric umbilical hernia Femoral/inguinal herniaOutpatient inguinal hernia repairPediatric inguinal hernia Varicose vein ligation and strippingHemorrhoidectomy under general anaesthetic

5150

Cholecystectomy Laparoscopic cholecystectomyLeft hemicolectomyGastrectomy Appendectomy Total thyroidectomyDiagnostic laparoscopy Bowel resectionUncomplicated gastrointestinal surgeryClosure A-V fistula closure (for dialysis patients)Thyroglossal duct cyst sistrunk SymptectomyPilonidal sinus incisionPilonidal cyst excision Anal fissure Anal fistulotomyPerianal abscess lancingLaparoscopic femoral/inguinal hernia correction Bilateral femoral/inguinal hernia laparoscopic repair

THORACIC SURGERYLung lobectomy/segmental resection PneumonectomyMediastinoscopyThoracotomy

NEUROSURGERYCraniotomyDiadnostic/surgical stereotaxis Ventriculoperitoneal shunt surgery

VASCULAR SURGERYAngioplasty- catheter PTA Endarterectomy — carotid arteryArteriovenous A-V fistulaBypasses (medium and/or major blood vessels)

UROLOGYRepair — Hypospadias + AdvancementVaricocele /Hydrocele/ High ligation Retro/supra pubic prostatectomyUrethrotomyTesticular biopsyUrethra dilation/meatotomyOrchidopexy Chordee repair for newbornRadical prostatectomy Unilateral orchiectomyBilateral orchiectomyNephrectomyTransurethral resection of the prostate — TURPStone removal and fragmentation through ureteroscopyRemoval of urethral tissue/urethral growthCystoscopyVasectomy Fragmentation of kidney stones through shock wave lithotripsyTransurethral resection (TURT) Non-complex hypospadias/epispadias repair.

GYNECOLOGYUrethropexy, retrograde urethrogramDiagnostic hysteroscopy Hysteroscopy Diagnostic Operative hysteroscopyHysteropexy/ Ligament repairVaginal wideningEndometrial ablationVestibulectomyLaser treatment under general anaestheticPartial vaginectomyExcision of external growths/condyloma — nonspecificExcision of external growths/condylomo — localized

Laparoscopic excision surgeryVaginal myomectomyCervical polypectomyVaginal hysterectomyAbdominal hysterectomyHysterectomy + tear repairHysterectomy + oophorectomyHysterecomy + colporrhaphyOophorectomyDiagnostic laparoscopyLaparoscopy and hysteroscopyMyomectomy — lesion removalLaparoscopic surgerySalpingoplasty (fallopian tube correction)Cystocele/Rectocelecolporrhaphy Anterior/posteriorOvarian cyst removalFemale urinary incontinencecorrection (Bladder suspension surgery)

Female urinary incontinence correction through use of TVT (vaginal tape)Cervical stitch (Cerclage)Stitching of cervical tear

SKIN MOHS excision

CARDIOLOGYBypass surgeryValve replacementDiagnostic coronary angiography Cardiac catheterization treatment

NEUROLOGYPeripheral nerve decompression (Neurolysis)

PLASTIC SURGERY Chordee repair

It is the insured’s duty to clarify with the Fund’s Secretariat prior to under-going the operation, which surgeons and private hospitals are contractually affiliated with the Fund for the purpose of performing the required surgery,

and the refund/excess conditions which apply.

5352

Appendix C List of private hospitals which are contractually affiliated with the Fund for the purpose of performing operations through surgeons who have an agreement with the Fund

Hospital Name City Address Telephone Fax

Elisha Haifa 12 Yair Katz St, Har Hacarmel

04-8389121 04-8389121

Assuta Ashdod Ashdod Menachem Begin Blvd (Kalaniot Center)

08-8677200 08-8677122

Assuta Be’er Sheva

Be’er Sheva 91 Herzl Street, Beit Etzion

08-6279911 08-291426

Assuta Haifa Haifa Lev HaMifratz Mall, 3rd Floor

04-8810600 04-8810631

Assuta Rishon Le Zion

Rishon LeZion 13 Mazal Eliezer St, New Industrial Zone

03-9631631 03-9631666

Assuta Tel Aviv Tel Aviv 20 HaBarzel St, Ramat HaHayal

03-764400

Herzliya Medical Center HMC

Herzliya Pituah 7 Ramot Yam 09-9592555 09-9592919

M.R.B Bat Yam 67 HaAtzmaut Blvd

03-5008888 03-5075764

Medili Rehovot 36 Yehuda HaLevy 08-9415268 08-9416891

Medica MedicalCenter Brenner

Be’er Sheva 19 HaShalom 08-6238358 08-6280717

Ramat Aviv Medi-cal Center

Tel Aviv-Yafo 43 Brodetsky St, Ramat Aviv

03-6421511 036401284

N.A.R.A Medical Center

Ramat Gan Beit Noah, 155 Jabotinsky

03-7557111 03-6131760

Ein Tal Tel Aviv-Yafo 17 Brandies Street 03-5443201 03-5441222

Atidim Medical Center

Tel Aviv-Yafo 24 HaBarzel 03-6445666 03-6496449

Seven Eyes Multidisciplinary Medical Center

Be’er Sheva 10 Yitzhak Ben Zvi 08-6267777 08-6267799

Important note: Not all the hospitals are licensed to perform all the operations listed in Appendix B of these Regulations. A situation may arise in which a particular hospital is not authorized to perform all the operations but is limited to certain areas. The Fund reserves to itself the right to update its agreement with the hospitals from time to time, and it is the insured’s duty to clarify with the Fund’s Secretariat prior to undergoing the operation, which private hospitals are contractually affiliated with the Fund for the purpose of performing the required surgery by surgeons pursuant to an agreement with the Fund, and the terms of the Fund’s contribution.

List of foreign medical centersApplication to the medical centers is made through the Fund. Bad Trussel Oncology Center Munchen University — GermanyBaylor University Medical Center Dallas TexasDeutches Hezzentrum — BerlinEssen Duisburg University Klinikum — GermanyHannover University Medical Center — GermanyHeidelberg University Medical Center — GermanyInternational Neuroscience Institute Hannover- GermanyKing’s College Hospital — LondonKlinikum Grosharden Munchen University — GermanyMemorial Sloane Kettering New YorkMontefiore Albert Einstein Medical Center New YorkMount Sinai Hospital New YorkSick Children Hospital Toronto — CanadaTemple University Medical Center PhiladelphiaThe Cleveland Clinic FoundationThe Gamma Knife Center KerfeldThe Mayo Clinic MinnesotaThe North Westfalia Heart CenterUniversity of Palermo Medical Center — ItalyUniversity of Riga Medical Center — Latvia

5554

ACAMOL TSI IQ 30 + 10 40CAFALPI TIPTIPOT 15 MG/MLALDOLOR TIPTIPOT DRO 100 MALRIN KIDS 0.025% SPRALRIN SPRAY 15 CCANTISITIN 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 OZBEN GAY ULTR. STR 4 OZ OINTBEN GAY ULTRASTRENGTH CRMBEPANTHEN LOT 200 MLBEPANTHEN PLUS CRM 30 GRCALAMANERVIN TAB 20CIALIS 10 MG 4 TABCIALIS 20 MG 4 TABCIALIS 20 MG 8 TABDESTIN 2 OZ OINTDESTIN 1.25 OZ OINTEBIXA 10 MG 56 TABMICRODIOL 3 STRIPS X 21 TMICROGYNON 63 TABMINESSE 28 TAB (NEO) 28TAMINESSE 84 TAB (NEO) 84TMINOXI 2.2% SPRMINOXI 2 WOMEN 80MLMINOXI 2 WOMEN X 2 BOXESMINOXI 5.5% SPRMINOXI 2 WOMEN X 2 BOXESMINULET (NEO) 21 TAB 2MINULET 3X21 (NEO) 63 TAB

MUCOLIT TIPTIPOT 75 MG/MLNEOGYNN 21 TABNICORETE 18 10 MG/DOSE 1

NICORETTE MINT 2 MG 30 TANICORETTE MINT 2MG 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 SOL3 MG/ML 5 ML 1

ORTHO-CYCLEN 21 TAB 2ORTHO-CYCLEN 63 TABOXY PADS MAXIMUM 1

OXY PADS SENSITIVE 1

POLYTAR LIQ 150 MLPROTOPIC OIN 0.03% 30 GRPROTOPIC OIN 0.1% 30 GRREDOXON 1 GR 10 TABREFRESH 30X0.4 MLEVISTA 60 MG 28 TABEVRA 1X3 PATEZETROL 10 MG 30 TABFEMULEN 84 TABFUNGIMON POWDER 30 GMGENTEAL EYE DROGYNERA 21 TABGYNERA 3 X 21 TABHARMONET (NEO) 21 TABHARMONET 3X21 (NEO) 3 TABHYPOTEARS E 30X0.4ML SOLIOPIDINE 0.5% SOL 1

KALGARON FRUIT MIX 24 TABKALGARON LEMON 24 TAB

Appendix DMedications basket for “Meuhedet C” members

Medications for which the insured is entitled to an 85% discount off the retail price

KALGARON MINT 24 TABKALGARON ORANGE 24 TABKALGARON STRAWBERRY 24 TABKIDDI SYRLEVITRA 10 MG 4 TABLEVITRA 20 MG 4 TABLEVITRA 5 MG 4 TAB*MEDIJEL GEL 15GRMERCILON 21 TABMERCILON 3X21 TABMICRODIOL 1 STRIP X21 T.2REGAINE FEMALEREGAINE FEMALE X 2REGAINE FORTE SOL 5% 60 MLREGAINE FORTE SOL X 2REGAINE DIGESTIF 48 TABREGAINE DIGESTIF 96 TABRITALIN LA 40 MG TAB 1

RITALIN LA 20 MG TAB 1


SONGHA NIGHT 30 TAB

STREPSILS HONEY LEMON 24TSTREPSILS LEMON&HERB TABSTREPSILS PLUS 24 TAB STREPSILS VIT CSUPRADYN-N10 TABTHYROGEN IJECION 1.1MGTRIDERM CRM 15 GRTRINORDIOL 28 28 TABTRINORDIOL 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

ACAMOL TSIN CLAS.D21+N13C ACAMOL TSINUN 35 DAY+NIG14ACTIVELLE 28 TAB* ACTONEL ONCE 35 MG 4 TAB ADAFERIN GEL 30 GRADVIL 200 MG 20 CAP ADVIL 200 MG 40 CAPADVIL 200 MG 80 CAPADVIL CHIL FRUIT 100 MG/5 ADVIL CHIL GRAPE 100 MG/5 AERIUS 5 MG 15 TAB*AERIUS SYRUP SYR 0.5 MG/ML*AGISPOR 1% 100 MLAGISPOR ONYCHOSET OINALDARA CRM 5% 12 SACHETS 1

AMARYL 1 MG 30 TAB 1 AMARYL 2 MG 30 TAB 1

AMARYL 3 MG 30 TAB 1

ANDROGEL 50 MG SACARTHREASE 10 MG/2 ML 3 PR 1

AURICULARUM PWD 300 MG*AVODART SOFT 0.5 MG 30 CAPBABYZIM DROBATRAFEN NAIL LACQUER 80 BENZAC-AC GEL 2.5% 60 GRBENZAMYCIN GEL 20.3 GR CARBOSYLAN (24+24) 48 CAP*CILOXAN DRO 0.35% 5 ML* 1

CIPRALEX 10 MG 28 TAB CLEAREX 10% COLORLESS 1 CLEAREX 2% LOTION CLEAREX 5% COLORLESS 1

COMAGIS 15 CRM 15 GR*COMAGIS 7 CRM 7 GR*

Medications for which the insured is entitled to an 50% discount off the retail price

5756

Medications for which the insured is entitled to an 25% discount off the retail priceCONCERTA 18 MG 30 TAB 1

CONCERTA 36 MG 30 TAB 1

CRINONE 8% 15 APPLIC 1

CYCLOMED 5% CRMDAIVOBET OIN 30 GRDAIVONEX CRM 50 MCG/GR 30 G*1

DAIVONEX OIN 50 MCG/GR 100*1

DAIVONEX OIN 50 MCG/GR 30 G*1

DETRUSITOL 1 MG 56 TAB 1



EFEXOR XR 150 MG 28 CAP 1

EFEXOR XR 75 MG 28 CAP 1 ELIDEL CRM 1% 15 GR ELIDEL CRM 1% 30 GREVOREL CONTI 8X1 PATCHEVOREL SEQUI 4X2 PATCHEYECON EYE DROPS (20)FEMINET 21T 1,2FEMINET 63 T 1,2 FELDENE GEL 0.5% 50 GR*FEMINET 21 TAB 2 FEMINET 63 TAB FOSALAN ONCE WEEKLY 70 MG GYNO-TERAZOL 0.8% CRM IMITREX NASAL SPR 0.5% 2L 1

IMITREX REFILL PACK 6 MG 1

IMITREX STARTER PACK INJ 1

INSU NOVOMIX 30 INSULIN HUMALOG MX25/75 1 KALGARON CHERRY LEM SPR 6KALGARON FORTE 24 TABKELO-COTE LAMISIL 250 MG 14 TAB 1 LAMISIL CRM 1% 15 GR LANACORT 1% CRM LARIAM 250 MG 8 TAB LIVIAL 2.5 MG 28 TABMENCEVAX ACWY 1DX 1

MERFEN SPRAY NCH MIDRO TEA

NARAMIG 2.5 MG 4 TAB 1 NASCOBAL FOR 2MONTH SPR 2NOVONORM 0.5 MG 90 TAB 1

NOVONORM 1 MG 90 TAB 1 NOVONORM 2 MG 90 TAB 1 OMNIC 0.4 MG 30 CAP 1 ORTHOVISC 30 MG/2 ML PRS 1

OXY 10 LOT 10% 29 MLOXY 5 LOT 5% 29 MLOXY 5 TINTED LOT 5% 20 ML OXY COVER LOT 100Z PERMIXON 160 MG 60 CAP 1

PINK BISMUTH 30 TABPRIODERM 1% 40 GR NCH PROCTO WIPES - DISPENSERNCH PROCTO WIPES - PACKAGEPROCURE 5 MG 28 TAB 1

REDUCTIL 10 MG 28 CAPREDUCTIL 15 MG 28 CAPRELENZA 5 MG 20 DISRUBLEX D SPR 180 ML* RUBLEX MASSAGE CRM 80 GR* SPORANOX 100 MG 14 CAP 1 TAMIFLU 75 MG 10 CAP TERBINAFINE 250 MG 14 CPS 1

TIGER BALM OINT-WHITE 1 TIGER BALM OINT STR – RED 1

TILOPTIC XE 0.25% GEL 1

TILOPTIC XE 0.5% DRO 1 URIKAL. SAC 1*VAGIFEM 0.025 MG 15 VAT VENORUTON 500 MG 30 TABXANAX XR 0.5 MG 30 TAB XANAX XR 1 MG 30 TAB XANAX XR 2 MG 30 TAB ZIDOVAL 0.75 % GEL 1 ZORAC GEL 0.05% 15 GR 1

ZORAC GEL 0.1% 15 GR 1

ZOSTRIX 0.025 % CRMZOSTRIX HP 0.075 % CRM

ACAMOL TSI IQ 30 + 10 40CAFALPI TIPTIPOT 15 MG/MLALDOLOR TIPTIPOT DRO 100 MALRIN KIDS 0.025% SPRALRIN SPRAY 15 CCANTISITIN 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 OZBEN GAY ULTR. STR 4 OZ OINTBEN GAY ULTRASTRENGTH CRMBEPANTHEN LOT 200 MLBEPANTHEN PLUS CRM 30 GRCALAMANERVIN TAB 20CIALIS 10 MG 4 TABCIALIS 20 MG 4 TABCIALIS 20 MG 8 TABDESTIN 2 OZ OINTDESTIN 1.25 OZ OINTDESTIN 4 OZ OINTEBIXA 10 MG 56 TABEVISTA 60 MG 28 TABEVRA 1X3 PATEZETROL 10 MG 30 TABFEMULEN 84 TABFUNGIMON POWDER 30 GMGENTEAL EYE DROGYNERA 21 TABGYNERA 3 X 21 TABHARMONET (NEO) 21 TABHARMONET 3X21 (NEO) 3 TABHYPOTEARS E 30X0.4ML SOLIOPIDINE 0.5% SOL 1

KALGARON FRUIT MIX 24 TAB

KALGARON LEMON 24 TABKALGARON MINT 24 TABKALGARON ORANGE 24 TABKALGARON STRAWBERRY 24 TABKIDDI SYRLEVITRA 10 MG 4 TABLEVITRA 20 MG 4 TABLEVITRA 5 MG 4 TAB*MEDIJEL GEL 15GRMERCILON 21 TABMERCILON 3X21 TABMICRODIOL 1 STRIP X21 T.2MICRODIOL 3 STRIPS X 21 TMICROGYNON 63 TABMINESSE 28 TAB (NEO) 28TAMINESSE 84 TAB (NEO) 84TMINOXI 2.2% SPRMINOXI 2 WOMEN 80MLMINOXI 2 WOMEN X 2 BOXESMINOXI 5.5% SPRMINOXI 2 WOMEN X 2 BOXESMINULET (NEO) 21 TAB 2MINULET 3X21 (NEO) 63 TABMUCOLIT TIPTIPOT 75 MG/MLNEOGYNN 21 TABNICORETE 18 10 MG/DOSE 1

NICORETTE MINT 2 MG 30 TANICORETTE MINT 2MG 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 SOL3 MG/ML 5 ML 1

ORTHO-CYCLEN 21 TAB 2ORTHO-CYCLEN 63 TABOXY PADS MAXIMUM 1

5958

Remarks• The medications listed in this Appendix shall be dispensed at the Fund’s pharmacies. • Those medications marked with an asterisk (*) may be purchased at a discount from

the Fund’s pharmacies or from private pharmacies which are contractually affiliated with the Fund.

• Medications marked by a 1 require a specialist’s approval.• Medications marked by a 2 are only approved for women aged 20 and over.

OXY PADS SENSITIVE 1

POLYTAR LIQ 150 MLPROTOPIC OIN 0.03% 30 GRPROTOPIC OIN 0.1% 30 GRREDOXON 1 GR 10 TABREFRESH 30X0.4 MLREGAINE FEMALEREGAINE FEMALE X 2

REGAINE FORTE SOL 5% 60 MLREGAINE FORTE SOL X 2

REGAINE DIGESTIF 48 TABREGAINE DIGESTIF 96 TABRITALIN LA 40 MG TAB 1



SONGHA NIGHT 30 TABSTREPSILS HONEY LEMON 24TSTREPSILS LEMON&HERB TABSTREPSILS PLUS 24 TAB

STREPSILS VIT CSUPRADYN-N10 TABTHYROGEN IJECION 1.1MGTRIDERM CRM 15 GRTRINORDIOL 28 28 TABTRINORDIOL 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

Appendix EList of medical accessories and medical equipment for “Meuhedet Adif” and “Meuhedet C” members

The accessory The insured’s contribution

External breast prosthesis (where there is no Ministry of Health cover)

50%

Penile prosthesis — In cases of erectile dysfunction (on medical advice and with Medical Division’s approval only). Insured’s contribution limited to $175

50%

Ocular prosthesis (where there is no Min-istry of Health cover)

50%

Scleral contact lens 50%

Essential medical accessories

In-sured’s contri-bution

Supplier Fund’s maximum contribu-tion**

Inguinal hernia belts* (once a year)

50% Internal pharmacy only

Insoles according to size and special order (twice a year)

50% Participating supplier

NIS 568

Elastic socks* for vascular dis-ease patients (by prescription) and for pregnant women


Orthopedic equipment for stabilization of joints/fractures/prevention of treading/partial treading (once a year)


$600

Contact lenses, only in cases of anterior chamber diseases


$600

Inhaler for asthma or CF pa-tients, including a humidifier (upon pulmonologist’s recom-mendation)


6160




Wig (after chemotherapy / oncology treatment)


NIS 1,703

Glucometer or finger pricker* 50% Internal pharmacy only

Sphygmomanometer* 50% Internal phar-macy only

Sunglasses for albinos and read- ing glasses, including the frame,for level 7 or higher astigma-(tism patients (once a year


$500

Orthopedic shoes by special order, which are designed to equalize the height of the low-er limbs or compensate for feet deformity (two pairs a year)


$250

Walking shoes system NIS 1,500 EPOS Once every 3 years

Personal voice amplifier for damaged larynx sufferers


$750

Earplugs after insertion of tym-panostomy tubes


$80

Telescopic glasses for adults (over the age of 18)


$750

Infant feeding tube 50% Participating supplier

$175




Hearing aids — for those aged 18 and older

Those insured with “Meuhedet Adif” shall be entitled to an addi-tional contribution upon purchasing a hearing aid from a participat-ing supplier, of a sum equivalent to 80% of the remaining cost after deducting the health basket contribution, or if less, a sum of NIS 1,800 per ear.

Various orthopedic belts with-out age restriction (once a year)


Pressure bandage 15% Participating supplier/cen-tral depot

$750

* Assistance shall not be given if purchased from a private pharmacy.

** The refunds specified in shekels shall be updated in accordance with increases in the index on the

dates on which the premiums shall be updated.

* Assistance shall not be given if purchased from a private pharmacy.

** The refunds specified in shekels shall be updated in accordance with increases in the index on the

dates on which the premiums shall be updated.

6362

Accessory Insured’s con-tribution

Supplier

*CPAP device (not including cases in which the indication is snoring problems)


An oxygen generating device shall be purchased by the Fund/Reserve (with the approval of the Medical Division) and provided for the patient’s use. The devise shall be returned to the Fund when it is no longer being used.


Bags for Peragon pump and bags for KAN-GURO

15% Internal pharmacy

Phanurose (accessory used to carry urine within a collection device in men)

0% Internal pharmacy

Purchase of catheter tube to empty the bladder — Foley catheter, silicone catheter

0%50%

Internal pharmacy

A device used by tracheotomy patients to ensure normal air flow to lungs.

15% Central depot

Inhaler accessories (once a year) 15% Internal pharmacy

Insulin pump accessories 15% Internal pharmacy or participating supplier

Punctal plugs 50% Participating supplier

* The contribution of the Health Fund beyond the statutory entitlement is limited to the sum of 2,202 NIS.Remark: For the avoidance of doubt, the discount listed in this Appendix is the maximum for the items regarding which the Fund has a statutory obligation to subsidize the price. The insured shall not be entitled to a cumulative discount and the “Meuhetdet Adif” discount also embodies the statutory discount.

Appendix FHearing aids for “Meuhedet C” members

Description of the item Contribution of “Meuhedet C”

GROUP “A”

Television solutions

Wireless headphones for television. The units are also suitable for use in a theatre

NIS 120

Personal amplifiers

Personal amplifier NIS 120

Alarm systems

Alarm system NIS 180

GROUP “B”

Television solutions

Telephone for persons with impaired hearing NIS 60

Cellular solutions

Hands-free cell phone speaker NIS 60

Alarm System, door bells and alarm clocks.

Cordless high decibel door bell NIS 60

Vibrating alarm clock NIS 60

The excess shall be paid by the insured directly to the participating supplier.No refund shall be given for a purchase from a nonparticipating supplier.* The prices are correct as of 1.1.2020.

6564

Appendix G Meuhedet Dental — Treatments, excess, and waiting periods — The C Program SHS

Treatment Description Excess percentage of Meuhedet member’s price

Waiting Period

Treatment classification

Checkup (free once a year)

No excess 3 months Preventative medicine

Checkup and consultation including a written program

50% 3 months Preventative medicine

Periapical x-ray 20% 6 months Root canal

Panoramic x-ray 50% 3 months Preventative medicine

Status 50% 3 months Preventative medicine

Bite x-ray No excess 3 months Preventative medicine

Alignment status x-ray 50% 3 months Preventative medicine

Set of x-rays for orthodontics

50% 6 months un-til the age of 18, 12 months from the age of 18 onwards

Orthodontic (teeth straightening)

TMJ 50% 3 months Preventative medicine

Cephalometric x-ray 50% 3 months Preventative medicine

Maxillofacial x-rays 50% 3 months Preventative medicine

Occlusal x-ray 50% 3 months Preventative medicine

Computerized analysis 50% 3 months Preventative medicine

Simple filling 20% 6 months Fillings

Two or more surface complex filling

20% 6 months Fillings

Two complex fillings in same tooth


Anterior six light-cured resin compound filling



Waiting Period


Two light-cured resin compound fillings in same front six


Light-cured resin compound blade fracture reconstruction


Light-cured resin compound aesthetic coating treatment, for each tooth


Anchor pin filling — up to three prongs per pin


Composite and wire dental splinting — for each tooth

50% 6 months until age of 18, 12 months from age of 18 onwards

Orthodontic

(teeth straitening)

Composite resin filling in a posterior tooth — single surface

20% 6 months Aesthetic treat-ments — Fillings

Composite resin filling in posterior tooth — two or more surfaces

20% 6 months Aesthetic treatments -fillings

Incisor/canine root canal 20% 6 months Root canal

Premolar root canal 20% 6 months Root canal

Molar root canal 20% 6 months Root canal

Quadruple root canal treatment

20% 6 months Root canal

Incisor/canine root canal retreatment


Premolar root canal retreatment


6766


Waiting Period


Molar root canal retreatment


Quadruple root canal retreatment


Exposed or erupted root canal treatment, per appointment, without final treatment


Removal of post or anchor screw


Endodontic exploration -

Attempt to renew root canal treatment.


Use of advanced dental microscope


Additional treatment of anatomical irregularity


MTA treatment 20% 6 months Root canal

Tartar removal and instruction on dental health, per meeting

No excess 3 months Preventative medicine

Instruction on oral health and fluorine treatment


Oral hygiene — combination therapy + cleaning + fluorine treatment + instruction


Treating up to 3 teeth with Duraphat desensitizer



Waiting Period


Single Duraphat treatment to reduce jaw sensitivity


Deep pocket treatment upon physician’s instructions per appointment/quarter mouth

50% 12 months Preventative Medicine

Anesthesia administered by a physician


PerioChip treatment — unit

50% 12 months Oral hygiene

Spoon carrier for fluoride


Glass fiber reinforcement 50% 12 months Dental rehabilitation

Amalgam/composite structure


Cast structure 50% 12 months Dental rehabilitation

Temporary crown at the clinic

50% 12 months Dental rehabilitation

(Laboratory) manufactured temporary crown


Porcelain-fused-to-metal crown


Anterior porcelain laminate

50% 12 months Aesthetic treat-ments — Dental reha-bilitation

Dimensions learning 50% 12 months Dental rehabilitation

Dimensions learning — setting up of articulator


6968


Waiting Period


Aesthetic crown 50% 12 months Aesthetic treat-ments — Dental reha-bilitation

Transfer/metal anchoring cap


Temporary crown laboratory cost only


Baked acrylic crown for an extended period


Etched metal laboratory splint


Porcelain fused to semi-precious metal crown


Porcelain fused to precious metal crown

50% 12 months Aesthetic treat-ments — Dental reha-bilitation

Front teeth wax-up 50% 12 months Dental rehabilitation

Digital scanning porcelain crown


Complete maxillary denture including teeth and spoon


Complete mandibular denture including teeth and spoon


Prepared mesh for complete upper denture


Precision connection 50% 12 months Dental rehabilitation

Cast partial denture 50% 12 months Dental rehabilitation

Acrylic partial denture including teeth and clasps



Waiting Period


Immediate temporary denture excluding surgical treatment


Flipper — up to 2 teeth 50% 12 months Dental rehabilitation

Telescopic crown 50% 12 months Dental rehabilitation

Dolder bar + caps under paragraph 616


Cast mesh 50% 12 months Dental rehabilitation

Individual spoon 50% 12 months Dental rehabilitation

Valplast partial denture 50% 12 months Dental rehabilitation

Aesthetic clasp cast partial denture


Flexible flipper 50% 12 months Dental rehabilitation

Fixed detachable rehabilitation


Crown repair with acryl 50% 12 months Dental rehabilitation

Light-cured resin compound crown — fissure repair


Crown laboratory repair, not including removal of bridge/crown


Removal of one crown 50% 12 months Dental rehabilitation

Bridge removal 50% 12 months Dental rehabilitation

Solder point 50% 12 months Dental rehabilitation

Repair of denture fracture


Repair of denture and addition of tooth or clasp


7170


Waiting Period


Tooth or clasp additional to paragraph 902


Complete lining in laboratory


Cold lining in clinic — first six months free of charge


Soft lining in laboratory 50% 12 months Dental rehabilitation

Soft lining at clinic 50% 12 months Dental rehabilitation

Denture repaired outside of a Meuhedet clinic


Reexamination No excess 3 months Preventative medi-cine — Dental treat-ment for children and adolescents which are not included in the health basket

Reexamination including bite x-rays

No excess 3 months Preventative medi-cine — Dental treat-ment for children and adolescents which are not included in the health basket

One or two surface filling

No excess 6 months Preservative dental treatment for children and adolescents which are not included in the health basket


Waiting Period


Pulpotomy No excess 6 months Preservative dental treatment for children and adolescents which are not included in the health basket

Milk tooth root canal — not including crown treatment


Milk tooth extraction No excess 6 months Preservative dental treatment for children and adolescents which are not included in the health basket

Permanent tooth extraction


Etched crown No excess 6 months Preservative dental treatment for children and adolescents which are not included in the health basket

Sealing cracks of any tooth

20% 6 months Dental treatment for children and adoles-cents which are not included in the health basket

7372


Waiting Period


Three or more surface filling


Pulp capping as an intermediate treatment


First aid without subsequent treatment including an x-ray if necessary


Tartar removal and instruction

No excess 3 months Preventative medi-cine — Dental treat-ment for children and adolescents which are not included in the health basket

Fluoride treatment and dental health instruction

50% 3 months Preventative medi-cine — Dental treat-ment for children and adolescents which are not included in the health basket

Combined treatment — instruction cleaning and fluoride

50% 3 months Preventative medi-cine — Dental treat-ment for children and adolescents which are not included in the health basket


Waiting Period


Light-cured resin compound blade fracture reconstruction


Light-cured resin compound aesthetic treatment


Replantation of tooth extracted in accident — separate payment for fixation


Unilateral space maintainer


Bilateral space maintainer


Mobile space maintainer 50% 6 months Dental treatment for children and adoles-cents which are not included in the health basket

7574


Waiting Period


Addition to aesthetic filling in premolar/molar


Light-cured resin compound filling (anterior 6)


Two fillings as aforesaid in same tooth (anterior six)


Sealing in permanent molars only


Periapical x-ray No excess 6 months Preservative dental treatment for children and adolescents which are not included in the health basket

Incisor/canine root canal retreatment



Waiting Period


Premolar root canal No excess 6 months Preservative dental treatment for children and adolescents which are not included in the health basket

Molar root canal No excess 6 months Preservative dental treatment for children and adolescents which are not included in the health basket

Quadruple root canal retreatment


Use of advanced dental microscope


Exposed or erupted root canal treatment, per appointment, without final treatment


Any laboratory correction

50% 6 months un-til the age of 18| 12 months from the age of 18 onwards


7776


Waiting Period


Correction of bonded fixation after first year



New brace following loss or repeated breakage



Smart aligners 50% 6 months un-til the age of 18| 12 months from the age of 18 onwards


Irregular/aesthetic braces addition (price per brace)



Diagnostic dental model 50% 6 months un-til the age of 18| 12 months from the age of 18 onwards


Orthodontic retainer as treatment in a mobile device




Waiting Period


Orthodontic retainer 50% 6 months un-til the age of 18| 12 months from the age of 18 onwards


Retainer upon completion of bonded fixation treatment — for one jaw



Retainer upon completion of laboratory bonded fixation treatment — for one jaw



Artificial eruption of two impacted teeth not including surgical treatment


Orthodontics (teeth straightening)

Artificial eruption of an impacted tooth not including surgical treatment



Tongue crib 50% 6 months un-til the age of 18| 12 months from the age of 18 onwards


7978


Waiting Period


Lip bumper 50% 6 months un-til the age of 18| 12 months from the age of 18 onwards


Lifting bite through bonded or cemented material



Lifting bite through plate



Rapid palatal expansion 50% 6 months un-til the age of 18| 12 months from the age of 18 onwards


Preparatory treatment with a functional devise



Partial orthodontic treatment without mobile equipment


Orthodontics (teeth straightening)


Waiting Period


Partial orthodontic treatment with mobile equipment



Short treatment through mobile device.



Short treatment through permanent device.



Basic teeth alignment permanent device



Orthodontic treatment in one jaw without mobile equipment



Orthodontic treatment in both jaws without mobile equipment



8180


Waiting Period


Orthodontic treatment for an adult in one jaw without mobile equipment



Orthodontic treatment for an adult in both jaws without mobile equipment



Orthodontic treatment in one jaw including mobile equipment



Orthodontic treatment in both jaws including mobile equipment



Orthodontic treatment in one jaw for an adult including mobile equipment

50% 12 months Orthodontic (teeth straightening)

Orthodontic treatment in both jaws for an adult including mobile equipment

50% 12 months Orthodontic (teeth straightening)

Orthodontic examination one year after completion of treatment




Waiting Period


Examination/reply to referring physician


Orthodontic night splint 50% 6 months un-til the age of 18| 12 months from the age of 18 onwards


Occlusal equilibration — per appointment

50% 12 months Periodontal

Gum tumor removal surgery


Crown lengthening surgery including bone treatment


PerioChip treatment — unit


Checkup/reevaluation (after 6 months)


Sextant SRP 50% 12 months Periodontal

Quadrant SRP 50% 12 months Periodontal

Sextant gum resection 50% 12 months Periodontal

Quadrant gum resection 50% 12 months Periodontal

Periodontal exploration 50% 12 months Periodontal

Sextant gum graft 50% 12 months Periodontal

Examination/treatment program/reply to referring physician


Dental abscess surgery 50% 12 months Surgical

Ordinary extraction 50% 6 months Extractions

Surgical extraction including stitching

50% 6 months Extractions

8382


Waiting Period


Ordinary extraction of wisdom tooth

50% 6 months Extractions

Rootectomy 50% 12 months Surgical

Impacted cuspid tooth surgical extraction including stitch

50% 12 months Surgical

Quadrant alveoloplasty 50% 12 months Surgical

Gum blister or tumor surgery


Frenectomy 50% 12 months Surgical

Exposure of impacted maxillary canine


Crown lengthening surgery including bone treatment


Hemisection 50% 12 months Surgical

Hemisection surgery 50% 12 months Surgical

Apicectomy and retrograde premolar root filling


Apicectomy and retrograde molar root filling


Cyst removal surgery 50% 12 months Surgical

Biopsy — price does not include pathological examination


Extraction of impacted wisdom tooth from soft tissue including stitch

50% 6 months Extraction


Waiting Period


Extraction of impacted tooth from osseous tissue including stitch


Extraction of impacted wisdom tooth from osseous tissue including stitch


Explorative surgery 50% 12 months Surgical

Closure of a maxillary sinus fistula


Osseous tissue blister or tumor surgery


Sextant periodontal regeneration

50% 12 months Regenerative treatment

Palatal connective tissue graft


Regeneration carried out during surgery


Quadrant augmentation including bone harvesting


Post graft/extraction bone reconstruction not including bone augmentation


Closed 2-3 mm sinus lift not including bone augmentation


Closed 3-5 mm sinus lift not including bone augmentation


8584


Waiting Period


Open sinus lift not including bone augmentation


PRF membrane preparation not including bone block membrane and screws


Autogenous bone graft surgery not including membrane and bone


Alizol treatment 50% 12 months Regenerative treatment

Replacement bone addition — cost per 2 grams

50% 12 months Regenerative preparations

Replacement bone addition — cost per 0.5 grams


1 cm3 block bone 50% 12 months Regenerative preparations

2 cm3 or more block bone


Block bone fixation screw — cost


Emdogain cost per 0.3 grams


Emdogain cost per 0.7 grams


Membrane 15X20 50% 12 months Regenerative preparations

Membrane 20X30 50% 12 months Regenerative preparations


Waiting Period


Membrane 30X40 50% 12 months Regenerative prepara-tions

Team counseling for implants in two or more quadrants

50% 12 months Prosthodontics and prosthodontic reha-bilitation

Examination/treatment program


Implant 50% 12 months Prosthodontics and prosthodontic reha-bilitation

Temporary implant 50% 12 months Prosthodontics and prosthodontic reha-bilitation

Foreign-made implant/special characteristics


Removal/rescrewing of broken implant


Surgical status 50% 12 months Prosthodontics and prosthodontic reha-bilitation

Computerized surgical status


Aesthetic structure for implant

50% 12 months Aesthetic treat-ments — Prosthodon-tics and prosthodontic rehabilitation

Straight/angular structure for implant


8786


Waiting Period


Screwed crown structure 50% 12 months Prosthodontics and prosthodontic reha-bilitation

Plastic temporary structure


Implant cast structure 50% 12 months Prosthodontics and prosthodontic reha-bilitation

Porcelain fused to semi-precious metal crown


Porcelain fused to precious metal crown

50% 12 months Aesthetic treat-ments — Prosthodon-tics and prosthodontic rehabilitation

Aesthetic implant crown 50% 12 months Aesthetic treat-ments — Prosthodon-tics and prosthodontic rehabilitation

Porcelain fused to base metal crown


Retentive ball implant anchor attachment, not including denture


LOCATOR implant anchor attachment, not including denture


Dolder bar LOCATOR implant anchor attachment



Waiting Period


Replacement of prosthodontic anchor attachments for rehabilitation carried out in the Fund


Digitally scanned implant crown


Dolder Bar retentive ball implant anchor


Screw-retained porcelain implant crown


Denture implant anchor 50% 12 months Prosthodontics and prosthodontic reha-bilitation

Overdenture plastic anchor


Digital scanning for bar 50% 12 months Prosthodontics and prosthodontic reha-bilitation

Digitally scanned Dolder bar


Examination through payment or payment undertaking (not including x-rays)


Repeat visit to oral medicine clinic

50% 12 months Oral medicine

Saliva secretion rate test 50% 3 months Preventative medicine

8988


Waiting Period


Oral lesion identification test


Surgical consultation 50% 12 months Oral medicine

Performing of surgical operation


Surgical follow-up visit 50% 3 months Preventative medicine

Pathological examination


Fungal, viral, bacterial smears


Oral cavity mucosity pH test


Intralesional steroid injections


First aid by specialist 50% 12 months Oral medicine

Examination and x-ray if necessary


X-ray 50% 3 months Preventative medicine

Temporary filling 50% 3 months Preventative medicine

Diagnosis and medicinal prescription only


Drainage of tooth abscess


Ordinary extraction 50% 3 months Preventative medicine

Surgical extraction 50% 3 months Preventative medicine

Crown cementation and removal


Waiting periods tableWaiting periods* for the various rights granted within the framework of the “Meuhedet C” program

Without waiting periods Medical consultation before choosing a foreign medical center Periodic screening testsLaboratory testing services in the insured’s homeNutritional consultationWorkshops and coursesNuchal translucency testEarly detection of congenital disorders in the fetusDiagnosis of attention and concentration disorders

3 month waiting period Plastic surgery operationsRecovery following complex surgeryMedical accessoriesOncogenetic testsTreatment of nocturnal enuresis in children Financing supervision of fertility treatments at participating institutesDental treatment — Preventative medicine for children, adolescents and adults

6 month waiting period Anti-aging treatmentsChild developmentRehabilitative exercise following myocardial infarctionShock-wave treatmentsSecond opinion in IsraelUmbilical cord bloodFree preservative dental treatments for children aged 15-18Hydrotherapy treatmentsMusic and art therapyOptics for children, adolescents and childrenDidactic and psychodidactic diagnosisPreservative and orthodontic dental treatments for children and adolescentsFillings, root canals and dental extractions for adultsPregnancy and birth basket

9190

12 month waiting period Treatment/operations in private hospitalsTreatment of hemorrhoids and fissuresTreatment of sexual function disordersCaesarian section within the framework of PMS (from the first birth onwards)Contribution to the cost of food substitutes which are not in the health basketTreatment of snoring problems and nasal congestionRehabilitation from sports injuriesPhysician home visitsComplementary medicineComplex treatments including rehabilitation, surgery, periodontics and orthodonticsNIPT genetic tests to detect abnormalities during pregnancy

24 month waiting period Medications which are not included in the national health basketSurgical operations which the insured chooses to have performed abroadDiagnosis and treatment of male and female infertility disorders

* Waiting periods — A continuous period, as specified in the table, from the month of joining “Meuhedet C” until the date on which the insured is eligible to utilize his rights under the “Meuhedet C” Regulations. It should be noted that the rights which a member of “Meuhedet Adif” has accumulated shall not be detrimentally affected if he subsequently joins “Meuhedet C”.

Appendix HForeign travel vaccinations — List of the Fund’s participating clinics and the excess payable by the insured

City Supplier Address Type of service/vaccination

Excess payable

Tiberias TiberiasMor Lemetayel

First Floor, HaYarden Street, corner of Hashiluach Street

Medical advice on vaccinations before travelling abroad

NIS 24

Haifa Haifa — Horev CenterMor Lemetayel

15 Horev Street, Haifa, 7th Floor, Horev Cen-ter, Haifa

Yellow Fever vac-cination

NIS 35

Kiryat Bialik

Karion Kiryat Bialik Mor Lemetayel

9 HameyasdimKiryat Bialik1 Hakirion Towers

Passive rabies im-munization

NIS 30

Afula Afula Mor Lemetayel

5 Sheinboim Street, Afula

Passive Hepatitus B immunization for adults

NIS 13

Netanya NetanyaMor Lemetayel

13 David Remez Street, Netanya

Meningitis vaccina-tion

NIS 35

Herzliya HerzliyaMor Lemetayel

71 Hanadiv Street, 2nd Floor Herzliya

Tetanus + Diphthe-ria immunization

NIS 4

Rishon LeZion

Rishon LeZion Mor Lemetayel

2 Nim Boulevard, Azrieli Rishonim Mall, Business Tower, 4th Floor

Active immuniza-tion — Hepatitus A (HAV) — adult

NIS 25

Reut ReutMor Lemetayel

Omakim Boulevard, Modi’in Maccabim Reut Commercial Cen-ter, Lev Reut

Active immuniza-tion — Hepatitus A (HAV) — child

NIS 25

Ashdod AshdodMor Lemetayel

1 Habanim Street, Ashdod

Active immuniza-tion — Japanese Encephalitis

NIS 59

Be’erSheva

Be’er ShevaMor Lemetayel

25 Itzhak Nafha (ONE Center, 1st Floor, Briuta Medical Center)

Active immuniza-tion — Typhoid

NIS 20

Bnai Brak Bnai BrakMor Lemetayel

7 Jabotinsky Street, Bnai Brak

Active immuniza-tion — Polio

NIS 12

92

City Supplier Address Type of service/vaccination

Excess payable

Jerusalem JerusalemMor Lemetayel

26 Ben Yehuda Street,Jerusalem

MMR immuniza-tion

NIS 14

Jerusalem Hadassah Jeru-salem

Davidson BuildingHadassah Ein Kerem Medical Center

Typhoid + Hepatitis A

NIS 36

Ramat Gan Hadassah Ramat Gan

7 Menachem Begin Street, Stock Exchange Complex Gibor House

Hepatyrix immuni-zation

NIS 36

Ramat Gan Tel Hashomer Bnei Ishpuz, Outpa-tient Clinics, Entrance Floor, Department 3

Immunization Tetanus + Diphthe-ria + Whooping Cough

NIS 21

Netanya Laniado 16 Divrei HaimKiryat SanzNetanya

Gamma globulin Hepatitis A acceler-ated immunizationImmunizationDiphtheria/Teta-nus/Whooping Cough/Polio

NIS 12

NIS 29

Join today

or at Meuhedet’s clinics Meuhedet

משנים את עולם הבריאות בישראל

meuhedet c

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