The Circular to the HMOs Updating Payments for Health Services and Medicines for the Year 2013 was issued today.
In accordance with the provisions of clause 8 (h) of the National Health Insurance Law 5754-1994 (hereinafter – The Act), the HMOs are entitled to update the maximal payments for health services and medicines to the extent of the increase in the Health Price Index, as determined in the basic basket of services, and as detailed in the Second addendum to the Act and in the HMO fee structures that have been approved by the Knesset Finance Committee. The indexing applies also to refunds, funding and monetary participation provided by the HMOs.
There is no obstacle to HMOs charging copayments that are lower than the maximal payments specified in the Circular, subject, of course, to the maintenance of the principal of equality. As regards services for which there is funding, monetary participation or a refund from the HMOs to their members, which are also subject to the above indexing, the indexing is compulsory and not optional, since in these cases this is beneficent with members’ rights.