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Maccabi Health Services will provide holders of its supplementary health insurance with "all drugs for serious diseases" approved in the US and Europe, it announced Sunday. Maccabi said these and other benefits will begin April 1, without waiting for the Treasury to allocate funds for expanding the basket of health services and a public committee to chose what new medications to add.
Maccabi made a deal with the Phoenix Insurance Company abroad to supply the coverage to its Magen Zahav (Golden Shield) policy holders, who will now pay NIS 3 to NIS 18 more per person each month.
Maccabi, with 1.7 million members, becomes the first health maintenance organization in the world offer the coverage. Some 1.3 million of its members are already part of the Maccabi Zahav plan, while the 100,000 Maccabi members who have the lesser Magen Kesef (Silver Shield) supplementary health insurance policy or none at all will be able to join until April 30 without a waiting period. A member of one of the other four health funds who decides to join Maccabi to enjoy the benefits will have to wait two years for inclusion.
Magen Zahav today costs NIS 9.45 per month up to the age of 17; with the new policy, it will cost NIS 3.55 more. For ages 18 to 24 it will cost approximately NIS 30; 25 to 29 NIS 40; 30 to 45 NIS 56; 46 to 60 NIS 68; 61 to 70 NIS 80; and over 71 NIS 90.
Prof. Mordechai Shani, chairman of the Health Ministry's public committee for expanding the basket, which has not received Treasury approval for any additional funding in 2007, said Maccabi's decision was "a gamble, especially for Phoenix. They probably took into account the expansion of the basket at public expense in 2008, which would reduce the number of the important drugs that the supplementary health insurance policy would have to cover. I am not sure that Phoenix will not get into trouble from what it offers."
Shani, a former director-general of the Health Ministry and of Sheba Medical Center who now heads the Gertner Institute at Sheba, said offering more expensive drugs through supplementary insurance that not everyone can afford is a "slippery slope. I don't like it at all.
"I hope the Treasury doesn't use this as an excuse to refuse to subsidize an expanded basket as it should. The National Health Insurance Law was meant to ensure equity for all with a generous basic basket."
Shani said he had previously suggested to then-finance ministers Ehud Olmert and Binyamin Netanyahu to do as France does - pay for supplementary health insurance for the lowest-decile income group in the population, but they refused to go along.
Shani said he thought it was unlikely that Maccabi would immediately get new members as a result of the expanded coverage because of the two-year wait for eligibility. He said the issue should be discussed by the National Health Council.
The Treasury has not issued any comment on the Maccabi plan, but Finance Ministry officials are reportedly opposed to it because it reduces their power to decide on increased drug coverage.
The Health Ministry, which according to Maccabi approved the plan after initial opposition, said expanding supplementary health insurance plans "is not a replacement for expanding the basic basket for all insured. At the same time, this is a solution for those cases in which drugs are not included in the basket due to budget restrictions and the need for setting priorities for drugs that are candidates for the basket."
Maccabi said Health Minister Ya'acov Ben-Yizri (Gil Pensioners) insisted it inform by letter all its members - especially the elderly - of the option of joining the Magen Zahav policy for expanded drug coverage.
Clalit Health Services, the country's largest insurer, recently expanded its supplementary health insurance plan, which it calls Platinum, to include cancer drugs not included in the basket of health services, but this is much less than what Maccabi offers. Clalit said it was the "pioneer" in expanding supplementary insurance coverage that "shook up" the market. "We welcome any [interested party] that joins us in improving service to its member," the Clalit spokeswoman said.
Maccabi's Magen Zahav also offers more participation in the costs of operations and treatments abroad, dental care, ova donation abroad and ambulance transport to the hospital.