Services “of no significant value” will be removed from expanded health insurance coverage

The Ministry of Health has published draft amendments to the criteria for the distribution of funds to support health insurance funds for 2026, providing for significant changes in additional health insurance of health insurance funds (SHABAN).

Unlike compulsory basic health insurance, insurance for additional medical services is not compulsory. Nevertheless, about 80% of the population have it.

The Ministry of Health intends to exclude from coverage services that do not have “substantial medical value.”

In particular, in the sphere of services related to pregnancy and childbirth, it is proposed to exclude payment for the services of a doula (accompanying during childbirth), consultations on children’s sleep, a private nurse in the maternity hospital, days of rest for women in labor (except in specialized institutions), individual consultations on physical activity or nutrition in the maternity hospital.

In the field of child development, it is proposed to exclude therapeutic horse riding, therapeutic swimming and therapeutic sports (except in cases with specific medical indications for children).

In the field of aesthetic medicine, it is proposed to exclude cosmetic surgeries and procedures (except for laser vision correction and cosmetic surgeries that complement medical procedures).

It is also proposed to exclude postoperative recovery in institutions that do not specialize in rehabilitation.

Other measures include reducing the list of doctors available for second opinions to a closed list of 50 specialists.

Health insurance funds have been given two weeks to decide how to use the savings from the reduction in coverage – to include additional medical services, reduce insurance premiums or reduce patient out-of-pocket costs, The Marker reports.