Exemption from Payment for an Emergency Room Visit

Full exemption (exemption from both the emergency room fee and the treatment fee)

A full exemption is granted to HMO policyholders in the following cases:

• An insured patient who visits the ER with a medical letter or an HMO guarantee form (Form 17) but is not hospitalized
• An insured patient who was hospitalized even if they did not have a medical letter or Form 17 (a financial obligation form)
• An employee who was injured at work and brings a work-injury payment authorization form from their employer (National Insurance Institute of Israel Form 250 (HE))
• Car accident victims who bring police confirmation of the accident
• A student who was injured at school or during a school trip and has a school approval document
• Domestic violence victims
• Sexual assault victims
• A person who is referred to the ER of a general hospital as ordered by the district psychiatrist or a court in criminal proceedings under the provisions of the Treatment of the Mentally Ill Law (HE)
• A person who is referred or refers to the ER of a psychiatric hospital
• A person who is referred to the ER in the following cases:
  • A new bone fracture
  • Severe dislocation of the shoulder or a joint
  • An injury requiring stitches or other wound closure technique
  • Dislocation of the jaw
  • Inhalation of a foreign body into the respiratory tracts
  • Foreign body in the eye
  • Snake or scorpion bite
  • Life-threatening allergy
  • Head injury, if the patient is under two years old or over 70
  • Third-degree burn
  • Epileptic seizure of an epilepsy patient
  • Women with labor contractions
  • Cancer treatment
  • Hemophilia treatment
  • Cystic fibrosis  (CF) treatment
  • Familial dysautonomia (FD)  treatment
  • Dialysis patients
  • Sudden high temperature (over 38.5 degrees Celsius) in babies up to two months old
•  A sudden medical emergency that requires transportation by an ambulance (of Magen David Adom) to the hospital from the street or a public place.

Exemption from treatment fees (emergency room fee only)

An exemption from treatment fees is granted to insured HMO members in the following circumstances:

• In the event that the member came to the emergency room between 1:00 a.m. and 6:00 a.m.
• Individuals whose visit to the emergency room is later deemed medically justified, even if not explicitly covered under the "Full Exemption" section, regardless of the time of the visit

• An individual who voluntarily visited the ER is required to provide their HMO with a discharge summary and a receipt
• If the visit is determined to be medically justified, the HMO will issue a prior authorization form for the hospital
• If the visit is determined to be medically unjustified, the patient will be required to bear the entire cost of the ER treatment
• The patient is required to promptly obtain a prior authorization form for the ER department

The HMOs are not required to issue a prior authorization form (Form 17) in the following circumstances:

• In the event that an individual visits the ER without a prior authorization form from the HMO
• If you arrived in the ER under the following circumstances:
  • Outside the criteria outlined in the "Full Exemption" section
  • Not in an emergency
  • For initiated and elective therapies

• Payment for a visit between 01:00 am and 06:00 am: 217 NIS (ER fee only)
• Payment for a visit between 06:00 am and 01:00 am: 911 NIS

• For a visit that is exempt from payment, the hospital will charge the HMO directly
• In other cases, refer to the HMO to find out about your eligibility or to obtain a financial obligation form