Kupat Cholim Services for Diabetes Patients
Diabetics in Israel are considered chronically ill, and therefore eligible for many benefits. Among some of the benefits are an insulin pump that is covered by the Sal Briut (health basket), medication copayment caps, and potential eligibility for Bituach Leumi Disability. Below is some information on eligibility for insulin pumps, and other medical interventions and benefits. For more information on eligibility for benefits check out our Diabetes Portal in our All Rights Index.
Insulin Pumps:
Diabetics are entitled to receive an insulin pump free of charge under the following conditions with a referral from the treating doctor (generally an endocrinologist):
- Children and adults with diabetes who suffer from hypoglycemic attacks marked by spontaneous loss of consciousness, confusion, and change in behavior without prior warning.
- Those who suffer from repeated attacks of ketosis, acidosis, and hypoglycemia requiring hospitalization.
- Diabetes patients whose HgA1c level is 7.5 and more.
- Diabetes patients who received intensive treatment including three or more injections of insulin throughout the day; however, did not achieve the balance goals.
- Women who suffered from diabetes in the period before pregnancy and during pregnancy.
- Type 2 diabetes patients in cases of severe resistance to insulin and those treated with high doses of insulin who do not reach the recommended sugar level balance.
- For those who suffer from pulmonary hypertension, the service is given with a recommendation from a hospital lung disease specialist. In cases of preliminary pulmonary hypertension, please get approval from the district medical administration.
- The Kupot Cholim are responsible to provide the patient with the supplies needed to operate the insulin pump such as syringes, needles, and strips for checking blood sugar.
- Some Diabetes patients may be eligible for reimbursement or partial coverage for a sugar level measuring device purchased in a Kupah Pharmacy. In order to receive the reimbursement, you must have a letter from a diabetes specialist and the invoice from the purchase. The recommendation must then be approved by the Kupah (generally a clinic manager). This reimbursement is available once every 3 years.
- Nocturnal erection testing, such as RigiScan may be provided to the patient in his home using a designated device in the following cases:
- The patient suffers from impotence and is a prosthesis transplant candidate.
- The patient suffers from impotence due to diabetes and/or high blood pressure.
Laparoscopic surgery without a band
Laparoscopic surgery is available for diabetics who have a BMI over 40, or have a BMI over 35 and have unbalanced diabetes while on insulin treatments of more than 100 units a day. (Additional factors for laparoscopic surgery for those with a BMI between 35 and 40 are heart failure, sleep apnea, and more).
General Rights for the Chronically Ill and/or Disabled
Diabetics are considered to have a chronic illness, and therefore are eligible for the following:
Medication Co-Payment Ceiling
The Medication Co-pay Ceiling means the patient's co-pays are capped at approximately 1,000 NIS per quarter (it varies slightly by Kupah). When calculating the cumulative cost of co-payments, purchases of supplies (syringes, bandages, etc.) must also be included, however additional medications that are covered specially but supplemental insurance, do not count towards the ceiling cap calculation.
General Disability
Anyone who is ill and above the age of 18 is entitled to submit a disability claim to the National Insurance Institute. In the case of a diabetic, they can submit to Bituach on the basis that their diabetes (amongst other diagnoses and disabilities) impacts their day-to-day lives, and they are unable to work full time. It is critical that letters from doctors and specialist includes how your diagnosis or diabetes impacts your activities of daily living (ADLs), and not just a diagnosis.
Click here to see more information about general National Insurance and disability rights.
Income Tax
Parents of children with diabetes are entitled to income tax and municipal tax benefits. Diabetes patients do not generally receive income tax benefits. Those whose disability has been defined as above 90% are entitled to an income tax exemption.
Municipal Tax
The discounts depend on the municipal authority and should be checked on a case-by-case basis.
Insurance companies – Additional rights to which diabetes patients are entitled are rooted in claims against insurance companies for those with policies including coverage for loss of work capacity if their earnings were damaged as the result of diabetes or the detection of serious illness.
