The Israeli health system works quite differently from the one you are probably used to, and it is perfectly normal to feel lost at first. Here is what you need to know: how you are covered, how contributions work, where to be seen, and what to do in an emergency.

A universal system funded by compulsory contributions

Under the National Health Insurance Law of 1995, everyone resident in Israel is automatically entitled to basic medical cover. The system rests on two quite separate institutions, which are easily confused:

• Bituah Leumi (the National Insurance Institute), which collects social and health contributions and then passes them on to the health funds according to how many members each one has.
• The kupot holim (the health funds), the bodies that actually provide your care: appointments, specialists, pharmacy, hospital treatment, tests and so on.

In other words, you never pay your kupat holim directly for basic care: it is your Bituah Leumi contribution, deducted automatically from your salary, that funds the whole system.

How contributions work

Every resident over 18 owes a monthly contribution to Bituah Leumi, which includes the share destined for your kupat holim — so you do not pay twice. For an employee it is deducted at source by the employer, at a rate that rises with salary.

Someone with no job and no income still owes a small minimum monthly contribution in order to keep their right to care. New olim, for their part, are fully exempt from contributions for the first six months after their aliyah, while still receiving everything covered by the basic health basket.

How the kupot holim work

There are four health funds in Israel: Clalit, Maccabi, Meuhedet and Leumit. They are non-profit bodies, required to provide their members with an identical basic basket of care, defined and imposed by law (the sal briut). That basket covers general practice appointments, specialist appointments, pharmacy, hospital stays, tests and analyses, and certain allied health services.

Every resident freely chooses their kupat holim when registering, and can change later if needed. All four offer the same basic basket, but differ in their clinic network, their geographical coverage, their digital services and their supplementary insurance options. We go through what sets each one apart in our guide to the kupot holim.

Seeing a GP or a specialist

For general practice, you normally book straight into a clinic (clinica) belonging to your kupat holim — online, by telephone or through your fund’s app.

For a specialist, the rules vary by fund and by speciality: some appointments can be booked directly, while others require a referral letter (hafnaya) from your GP. It is worth checking beforehand, on the app or with your fund, whether a referral is needed before you book, so that cover is not refused.

Hospitals: emergency and non-emergency

Hospitals in Israel are reached in two quite different ways depending on the situation:

In a life-threatening emergency (serious accident, chest pain, difficulty breathing, loss of consciousness and so on), go straight to the emergency department (Miyun) of the nearest hospital, or call Magen David Adom on 101 and an ambulance will be sent. No prior authorisation is needed: life-threatening emergencies are treated immediately, whatever your kupat holim.

For a non-urgent hospital stay or hospital appointment (planned surgery, an appointment with a hospital specialist, a particular investigation), prior authorisation from your kupat holim is generally required. That authorisation, known as a hitchayvut, must be obtained before the appointment or admission for the costs to be covered.

Supplementary insurance

The basic basket covers the essentials but leaves some costs out: medicines not included in the sal briut, choosing your own surgeon for an operation, some dental treatment, part of paramedical consultations, and access to a second medical opinion.

To fill those gaps, every kupat holim offers supplementary insurance (bituah mashlim), optional and paid for, with several levels of cover to suit your needs and your budget. You can also take out private health insurance with an Israeli insurer on top, for wider cover still — abroad, for instance, or for easier access to the private sector.

Choosing the right supplementary plan depends a great deal on your own and your family’s situation. We set out what each fund offers in our guide to the kupot holim.

In short

• You contribute automatically through Bituah Leumi, deducted from your salary.
• You belong to one of the four kupot holim, which provides your basic basket of care.
• For a specialist, check whether a referral letter is needed.
• In a life-threatening emergency, head for A&E or call 101 (Magen David Adom) — no prior authorisation.
• For planned hospital treatment, authorisation from your kupat holim is generally required.
• Supplementary insurance covers what the basic basket does not.