Israeli HMO Navigator
Community60/100The Problem
Israel's healthcare system with four competing HMOs, multi-tier coverage levels, and Hebrew-language processes can be confusing, especially for new immigrants or when comparing supplementary insurance options, understanding referral procedures, or knowing patient rights under the National Health Insurance Law.
Author: @skills-il
Navigate Israel's four HMOs (kupot cholim) and healthcare system for service comparisons, referrals, and coverage decisions. Use when user asks about Clalit, Maccabi, Meuhedet, Leumit, "kupat cholim", health basket (sal briut), specialist referrals (hafnaya), supplementary insurance (biituach mashlim), or switching HMOs.
npx skills-il add skills-il/health-services/israeli-hmo-navigatorWhen to Apply
- When comparing services and coverage across Clalit, Maccabi, Meuhedet, and Leumit
- When a new immigrant needs to choose an HMO (kupat cholim)
- When understanding the specialist referral (hafnaya) process and wait times
- When deciding whether to purchase supplementary insurance (biituach mashlim)
- When switching between HMOs or understanding transfer waiting periods
Israeli HMO Navigator
Israel's Four HMOs
| HMO | Members | Market Share |
|---|---|---|
| Clalit (כללית) | ~4.8M | ~52% |
| Maccabi (מכבי) | ~2.6M | ~27% |
| Meuhedet (מאוחדת) | ~1.3M | ~14% |
| Leumit (לאומית) | ~0.7M | ~7% |
Every resident must belong to one HMO. HMOs cannot refuse membership. Switching: once per year.
Service Tiers
- Basic (Sal Briut): Mandated by law, identical across HMOs. Covered by health tax.
- Supplementary (Mashlim): Extended coverage, 30-80 NIS/person/month.
- Gold/Platinum: Premium tier, 80-200 NIS/person/month.
Basic Basket Includes
Primary care, specialist visits (with hafnaya), hospitalization, prescriptions, maternity, pediatric care, mental health, chronic disease management, preventive screenings.
NOT in Basic Basket
Adult dental, cosmetic procedures, private rooms, surgeon choice, alternative medicine.
Specialist Referrals (Hafnaya)
- See primary care physician
- Get electronic referral
- Schedule via app or call center
- Max wait (MOH guidelines): 14-30 days by specialty
Copayments
- Primary care: 0 NIS
- Specialist: 20-30 NIS
- ER: ~100 NIS (waived if admitted)
- Generic Rx: 10-15 NIS
- Blood tests: 0 NIS
Switching HMOs
Once per year, apply at target HMO. Basic coverage immediate. Supplementary may have waiting periods.
Metadata
GitHub:israeli-hmo-navigator
installs:0
views:28
reviews:0 (0.0)
Created:March 3, 2026
Updated:March 3, 2026
Supported Agents
Claude CodeCursorGitHub CopilotWindsurfOpenCodeCodex
Tags
hmohealthcarehealth-basketsupplementary-insurancereferralisrael
Best Practices
- Remember that basic basket (sal briut) coverage is identical by law across all four HMOs
- Check clinic locations near your home and work before choosing an HMO
- If specialist wait times exceed MOH guidelines, you have the right to file a complaint
- Compare supplementary insurance by age group, as costs increase significantly with age
Avoid
- Do not use for emergency medical advice or diagnosis
- Not a replacement for consulting with your physician about medical decisions
- Pharmaceutical drug information and interactions are outside scope
Try These Prompts
Choose HMO for New Immigrant
I just made aliyah to Tel Aviv. Compare Clalit vs Maccabi for a young couple with no children
Understand Referral Process
My doctor gave me a hafnaya to a dermatologist. What are the steps and how long should I wait?
Compare Supplementary Plans
Compare supplementary insurance (mashlim) plans across all four HMOs for a 35-year-old
Dental Coverage Options
What dental coverage is available through kupat cholim supplementary insurance vs private dental plans?
Security Analysis
60/100
Trust Score
Code Quality62
Permissions85
Data Handling55
Publisher Reputation35
Maintenance55
Documentation75
Pending reviewv13/3/2026
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Quality Score
64Architecture65
Maintainability60
Content80
Spec Compliance85
Community30
Frequently Asked Questions
Are all four HMOs the same?
The basic health basket (sal briut) is identical by law across all four HMOs. Differences appear in supplementary insurance packages, clinic locations, digital services, wait times, and customer service quality. Choose based on proximity, supplementary offerings, and service ratings.
How much does healthcare cost in Israel?
Basic healthcare is funded through the mandatory health tax (3.1%/5% of income). There is no premium for the basic basket. Supplementary insurance costs 30-80 NIS/month per person. Copayments range from 0 NIS (primary care) to ~100 NIS (ER). Most routine care has minimal out-of-pocket costs.
Can I switch my kupat cholim?
Yes, you can switch once per calendar year. Visit the target HMO branch or apply online. Basic basket coverage begins immediately at the new HMO. However, supplementary insurance at the new HMO may have waiting periods of 6-18 months for certain conditions.
What is a hafnaya and do I always need one?
A hafnaya (referral) is required to see most specialists. Your primary care physician issues it electronically. Without a hafnaya, you typically cannot schedule a specialist appointment under the basic basket. Some supplementary plans allow direct specialist access.
Does kupat cholim cover dental?
The basic basket covers dental care for children up to age 18. Adult dental is NOT covered in the basic basket. For adult dental coverage, you need supplementary insurance (mashlim/zahav tier) or a separate private dental insurance plan.
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