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Financial Services Supervision Law (Insurance), 5741-1981

חוק הפיקוח על שירותים פיננסיים (ביטוח), תשמ"א-1981

Published: 1981-04-23Consolidated Hebrew text as of 2026-07-26 · Last amended 2026-07-22✓ Amendment status checked against the Knesset legislation record on 2026-09-29
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Unofficial English translation — for reference only. It may contain errors or omissions and cannot be relied on as a legal text. Only the Hebrew text published in Reshumot is legally binding.More

This English text was translated from the official Hebrew using a range of translation tools, and it undergoes ongoing checks and updates. It is not a certified translation.

Despite these checks, it may contain errors, omissions, or imprecise renderings of legal terminology and cross-references, and it may not yet reflect the latest amendments. It cannot be relied upon as a legal text.

The Hebrew text as published in Reshumot (ספר החוקים) and on the Knesset website is the sole authoritative and legally binding version. In any discrepancy, the Hebrew text prevails.

This translation is provided for informational purposes only and does not constitute legal advice. For use in legal proceedings, request a certified Expert Legal Opinion.

Chapter VII-C: Similar Insurance Coverage for Private Surgery in Israel

Definitions – Chapter VII-C§

78w.

In this Chapter –

"payment notice" – as defined in section 78aa(c);

"surgery expenses" – all medical expenses required for the performance of the surgery and the hospitalisation attendant thereto, including the fee of an anaesthesiologist, expenses for an operating theatre, consumable equipment, implants, medications administered during the surgery and hospitalisation and tests performed as part of the surgery, as well as expenses for hospitalisation, including pre-operative hospitalisation, up to a ceiling of 30 days of hospitalisation;

"surgery arrangement" – as defined in section 13 of the Economic Programme Law (Legislative Amendments for the Implementation of the Economic Policy for the Budget Years 2015 and 2016), 5776-2015;

"National Health Insurance Law" – National Health Insurance Law, 5754-1994;

"the online interface" – as defined in section 78z(a);

"surgery" – including medical treatment performed by a specialist physician as a substitute for the performance of surgery, and intended to achieve a purpose similar to the purpose of the surgery it replaces;

"private surgery in Israel" – surgery performed in Israel outside the framework of the health services basket as defined in the National Health Insurance Law, including outside the framework of the health fund's services and payments basket as defined in section 8(a4) of that Law;

"first shekel surgery insurance policy" – a policy issued under a surgery insurance plan, which includes indemnification in respect of private surgery in Israel, including coverage of surgery expenses, provided independently of the insured's entitlements under a supplementary health insurance plan, if any;

"health fund" – as defined in the National Health Insurance Law in respect of the provision of additional health services, including a health fund as defined in section 10(a) of that Law;

"surgery insurance plan" – an insurance plan as defined in section 40(i), which includes insurance for private surgeries in Israel, introduced on the 22nd day of Shevat 5776 (1 February 2016) or thereafter;

"supplementary health insurance plan" (Sherut Briut Nosaf – SBN) – a supplementary services plan as defined in section 10(a) of the National Health Insurance Law;

"Ministry of Health fee schedule" – the rates applicable to patients referred by the health funds, according to the list of hospitalisation, ambulatory and differential service rates published by the Ministry of Health on its website, reflecting the rates as updated from time to time pursuant to Orders made under section 12 of the Commodities and Services Price Supervision Law, 5756-1996.

Insurer's obligation to pay a health fund in respect of surgery funded through a supplementary health insurance plan§

78x.
(a)An insurer shall transfer to a health fund a payment in the amount set out in subsection (b), in respect of private surgery in Israel performed on an insured (in this section – the payment), if all of the following conditions are met:
(1)the member of the health fund's supplementary health insurance plan is insured under a first shekel surgery insurance policy;
(2)the policy includes coverage for surgery of the same type, subject to the exclusions and exceptions set out in the insured's policy and to the conditions set out in sections 6 to 8 of the Insurance Contract Law, 5741-1981;
(3)the physician who performed the surgery is party to a surgery arrangement with the insurer or is included in the insurer's list of specialist physicians pursuant to section 17(b) of the Economic Programme Law (Legislative Amendments for the Implementation of the Economic Policy for the Budget Years 2015 and 2016), 5776-2015;
(4)the surgery was funded through the supplementary health insurance plan, except for the co-payment of the member of the supplementary health insurance plan.
(b)The amount of the payment shall be the lower of the following, after deduction of the co-payment of the member of the supplementary health insurance plan:
(1)the price of the surgery according to the Ministry of Health fee schedule;
(2)the price of the surgery determined by Order under section 78y, if determined.

Determination of the price of surgery under an insurer's surgery arrangement§

78y.
(a)If the Commissioner is of the opinion, on the basis of data presented to him by one or more insurers, that the price of surgery of a particular type, including surgery expenses, under an insurer's surgery arrangement, is lower than the price of surgery of the same type according to the Ministry of Health fee schedule, the Commissioner may recommend to the Minister of Finance to determine, by Order under subsection (b), that the price of the surgery for the purposes of section 78x shall be the lowest price under the surgery arrangement referred to above for that type of surgery, provided that the Commissioner is satisfied that that price is a reasonable price in the circumstances of the matter; the Commissioner shall attach to his recommendation the data on which it is based.
(b)The Minister of Finance, with the consent of the Minister of Health, may determine, by Order, pursuant to the Commissioner's recommendation referred to in subsection (a), a price for surgery that shall be the price determined under an insurer's surgery arrangement and that shall apply for the purposes of an insurer's payment obligation under section 78x; the Minister of Finance may decline to accept the Commissioner's recommendation, and the Minister of Health may decline to give consent to the Order, for reasons to be recorded.
(c)The Minister of Finance shall transmit to the Minister of Health the Commissioner's recommendation and the data attached thereto, for the purpose of obtaining his consent as referred to in subsection (b).
(d)An insurer's request for the determination of a price for surgery under this section shall be submitted to the Commissioner together with all documents directed by the Commissioner.

The online interface§

78z.
(a)The Authority shall operate and maintain a secure online interface for the purpose of implementing the provisions of this Chapter; the online interface may form part of a technological tool used for the transfer of information otherwise than under this Chapter.
(b)The Commissioner may issue implementation instructions that shall apply to insurers and health funds in respect of the operation of the online interface and the transfer of information referred to in sections 78aa(a) and 78af(c) by means of the online interface.
(c)Health funds and insurers shall transfer between them, by means of the online interface, the information required for the performance of the actions referred to in sections 78aa and 78af, all in accordance with the Commissioner's instructions under subsection (b), provided that no information exceeding that which is required shall be transmitted.
(d)The Authority shall not retain information referred to in subsection (c) beyond the shortest period of time necessary for the proper operation of the online interface, and health funds and insurers shall not retain information referred to in subsection (c) beyond the shortest period of time necessary for the implementation of the provisions of this Chapter.

Verification of particulars through the online interface, payment notice and date of payment§

78aa.
(a)For the purpose of receiving the payment referred to in section 78x, a health fund shall check, by means of the online interface, against the lists of insured persons who have completed the waiting period under a first shekel surgery insurance policy, which the insurers shall transmit to the online interface on the 5th of each month, whether the member of the supplementary health insurance plan is insured under a first shekel surgery insurance policy; if the member of the supplementary health insurance plan is so insured, the health fund shall check the following:
(1)by means of that same interface – the identity of the insurer and the commencement date of the policy and the end of the waiting period;
(2)whether the physician who performed the surgery is a physician as referred to in section 78x(a)(3).
(b)A health fund shall notify a member of the supplementary health insurance plan who approached it for the purpose of undergoing surgery through the supplementary health insurance plan –
(1)that it intends to ascertain the particulars listed in subsection (a) in respect of that member, and that additional information about that member may come to its knowledge in the framework of an appeal under section 78ab;
(2)that if the member is insured under a first shekel surgery insurance policy, it will transmit the information under subsection (c), and that if the member is insured under several such insurance policies, it will transmit to the insurer of the policy to which it refers under this Chapter the identity of the additional insurers;
(3)that the member may have insurance coverage entitling him to a refund of the co-payment in respect of the surgery, and that in order to ascertain his entitlement he must apply to the insurer of a policy issued under a surgery insurance plan under which he is insured, if he is so insured.
(c)If a health fund is of the opinion, on the basis of the information it checked under subsection (a), that the insurer's payment obligation under section 78x(a)(1), (3) and (4) applies, the health fund shall send the insurer a payment notice; the notice shall be sent on the 30th business day following the quarter in which the surgery that is the subject of the notice was performed, and shall include the following particulars in respect of the member of the supplementary health insurance plan, notwithstanding the provisions of any law:
(1)the name of the member of the supplementary health insurance plan and the member's identity number;
(2)the amount payable under section 78x;
(3)the name of the surgery and the surgery code according to the Ministry of Health fee schedule;
(4)the particulars of the operating physician who signed the surgery report;
(5)the date of the surgery.
(d)The insurer shall pay the health fund the amount of the payment required in the payment notice within 90 days of receipt of the notice.
(e)If a health fund is of the opinion, on the basis of the information it checked under subsection (a), that the payment obligation under section 78x(a)(1), (3) and (4) applies to more than one insurer, the health fund shall send the payment notice referred to in subsection (c) to the insurer of the policy with the earliest commencement date, and shall update in its notice the insurer to which it referred as to the identity of the additional insurers under a first shekel surgery insurance policy, if any, according to the information it received from the online interface; the insurers shall bear, among themselves, the payment obligation in equal shares, in the amount required in the payment notice.

Appeal against a payment notice§

78ab.
(a)An insurer may appeal before the Commissioner against a payment notice it received, if it is of the opinion that the insured's insurance policy does not include insurance coverage for the surgery that is the subject of the notice; the appeal shall be submitted within 180 days of the date of receipt of the payment notice, together with the particulars referred to in section 78aa(c), and if the insured submitted to the insurer a claim for a refund of the co-payment in respect of the same surgery – within 30 days of the date of the insurer's decision on that claim, whichever is the later.
(b)The submission of an appeal under this section shall not stay the execution of the payment that is the subject of the appeal.
(c)Before making a decision on an appeal, the Commissioner shall send the relevant health fund the appeal, or if he considers that there is an impediment to doing so – a summary of the appeal, and shall give the health fund an opportunity to present its arguments before him, as he shall direct.
(d)The Commissioner shall notify the insurer and the relevant health fund of his decision on the appeal within 60 days of the date of its receipt; the Commissioner shall state in his decision a summary of his findings.
(e)If the Commissioner determines in a decision under subsection (d) that the insurer is not liable to pay the health fund, the health fund shall refund to the insurer the amount it paid, if it paid, within 30 days of the date on which the decision was served on the health fund; however, if the health fund was of the opinion as referred to in section 78aa(e) that the payment obligation applied to more than one insurer, and the Commissioner's decision determined that the insurer to which the health fund referred is not liable for payment, the health fund may refer to another insurer.
(f)An appeal shall be examined in such manner as seems appropriate to the Commissioner, and he shall not be bound by rules of procedure or rules of evidence; the Commissioner may issue instructions in respect of the manner of examination of the appeal by him, including a requirement to receive the surgery report from the health fund.
(g)A determination of an appeal under this section shall serve for the purpose of ascertaining the insurer's liability to pay the health fund under section 78x, and the insurer and the health fund shall not be entitled to use it for any other purpose.

Agreed arrangement for accounting between a health fund and an insurer§

78ac.

Notwithstanding the provisions of sections 78x, 78z, 78aa and 78ab, a health fund and an insurer may determine, in a written agreement between them, an accounting arrangement other than that set out in those sections, provided that the total accounting amount under the agreement shall be dependent on the number of members of that health fund's supplementary health insurance plan who are insured under a first shekel surgery insurance policy with that insurer; an agreement under this section requires the prior approval of the Commissioner and the Director General of the Ministry of Health.

Confidentiality§

78ad.
(a)A person who received information pursuant to the provisions of this Chapter shall keep it confidential and shall not disclose it to another, except pursuant to the provisions of this Chapter.
(b)The transfer of information pursuant to this Chapter shall not be regarded as a breach of the duty of confidentiality under section 50a.

Restriction on use of information§

78ae.
(a)A person who received information pursuant to the provisions of this Chapter shall not make any use of it, unless the use is permitted pursuant to the provisions of this Chapter and in accordance with the conditions under which it was permitted.
(b)Without derogating from the provisions of subsection (a), an insurer –
(1)shall not make use of information received through the online interface except for the purpose of transferring an insured from a first shekel surgery insurance policy to a supplementary SBN surgery insurance policy pursuant to the provisions of section 78af;
(2)shall not make use of information included in a payment notice sent to it by a health fund under section 78aa(c) except for the purpose of effecting payment, for the purpose of submitting an appeal under section 78ab or for the purpose of referring to additional insurers as referred to in section 78aa(e).

Transitional provision in respect of the transfer of an insured from a first shekel surgery insurance policy to a supplementary SBN surgery insurance policy§

78af.
(a)In this section –

"the insured" – a person insured under the original policy;

"the determining date" – the 16th day of Tishrei 5784 (1 October 2023), and if the Minister of Finance made an Order under section 53(a) of the Economic Programme Law (Legislative Amendments for the Implementation of the Economic Policy for the Budget Years 2023 and 2024), 5783-2023 – the date determined in that Order;

"the original policy" – a first shekel surgery insurance policy that does not form part of a group health insurance policy, and that was entered into before the determining date;

"supplementary SBN surgery insurance policy" – a policy issued under a surgery insurance plan, which includes indemnification as detailed below:

(1)indemnification in respect of private surgery in Israel, including coverage of surgery expenses, provided only if the supplementary health insurance plan of which the insured is a member does not cover the surgery expenses or if the operating physician is not party to a surgery arrangement with the health fund;
(2)indemnification in respect of the co-payment paid by the insured under a supplementary health insurance plan of which the insured is a member, for surgery funded through the supplementary health insurance plan.
(b)At the first renewal of the original policy after the determining date, an insurer shall transfer the insured, if the insured is a member of a supplementary health insurance plan, and even if the insured's waiting period under the supplementary health insurance plan has not yet elapsed, from the original policy to the supplementary SBN surgery insurance policy, all in accordance with the provisions of this section.
(c)For the purpose of transferring the insured to the supplementary SBN surgery insurance policy as referred to in subsection (b), the insurer shall check, by means of the online interface –
(1)whether the insured is a member of a supplementary health insurance plan;
(2)in respect of an insured who is a member of a supplementary health insurance plan – whether the waiting period set by the health fund in respect of the member's entitlement to funding of private surgeries in Israel under the plan has not yet elapsed, and if the waiting period has not yet elapsed – its end date.
(d)The insurer shall notify the insured, in advance, of the transfer to the supplementary SBN surgery insurance policy and the date of the transfer, and of the insured's right to notify that the insured does not wish to be transferred or that the insured wishes to cancel the transfer, as the case may be.
(e)Notwithstanding the provisions of subsection (b), the insured may notify the insurer, whether before the transfer to the supplementary SBN surgery insurance policy or within one year of the date of the transfer, that the insured does not wish to be transferred; if the insured so notifies, the insurer shall not transfer the insured to the supplementary SBN surgery insurance policy or shall cancel the transfer – if it was effected, as the case may be, in accordance with the provisions of this section.
(f)If the transfer of the insured to the supplementary SBN surgery insurance policy is cancelled under subsection (e), the insured shall be regarded as if not transferred to the supplementary SBN surgery insurance policy and the original policy shall be regarded as if it had not been cancelled and as if it had been renewed by the insured.
(g)If the insured notified that the insured wishes to cancel the transfer, the insured shall pay the difference between the insurance premiums due under the original policy and the insurance premiums paid under the supplementary SBN surgery insurance policy for the entire period from the date of the transfer until the date on which the insured so notified; however, if an insurance event occurred during that period and before the date of the insured's notice, the insured's entitlement during that period shall be governed by the supplementary SBN surgery insurance policy and the insured shall be liable for that period for the insurance premiums under that policy, and from the date of cancellation of the transfer onwards the provisions of subsection (f) shall apply.
(h)The transfer of the insured to the supplementary SBN surgery insurance policy as referred to in subsection (b), or the cancellation of the transfer as referred to in subsection (e) while continuing the insured's coverage under the original policy, shall be effected without a renewed examination of the insured's prior medical condition and without a waiting period; an insured who at the time of the first renewal referred to in subsection (b) has not yet completed the waiting period under the original policy shall have all periods during which the insured was covered calculated continuously, upon the transfer or its cancellation, for the purpose of accumulating the waiting period.
(i)An insured who is insured under a group first shekel surgery insurance policy and is entitled under that policy to transfer to an individual first shekel surgery insurance policy and has chosen to transfer to an individual supplementary SBN surgery insurance policy shall, at the time of the exercise of the right to transfer to an individual policy as aforesaid, be subject to all the provisions of this section as if transferred at the first renewal from an original policy to a supplementary SBN surgery insurance policy, in continuity, without a renewed examination of the insured's prior medical condition and without a waiting period.
(j)The Commissioner may issue instructions on the following matters:
(1)implementation instructions in respect of the transfer of insureds to the supplementary SBN surgery insurance policy, and in respect of the cancellation of a transfer as referred to in this section, including rules that shall apply in respect of the manner of collection of insurance premiums in the event of cancellation of a transfer;
(2)the manner of notifying insureds as referred to in subsection (d), and the timing of notifications of the transfer, before and after the transfer;
(3)the manner of delivery of the insured's notice that the insured does not wish to be transferred as referred to in subsection (e).
(k)Nothing in the provisions of this section shall derogate from the Commissioner's powers under section 40.
(l)Notwithstanding the provisions of this Chapter and of section 50a, if the Commissioner becomes aware, in the course of examining an appeal under section 78ab, that a health fund did not transmit, by means of the online interface, the information required by an insurer under subsection (c), or transmitted incorrect information, the Commissioner shall notify the Director General of the Ministry of Health or a person authorised by the Director General for that purpose (in this subsection – the Director General); without derogating from the Director General's powers under any law, the Director General may direct that such a health fund shall not be entitled to receive payments under section 78x, in whole or in part, or that the health fund shall be required to refund payments to the insurer, if such payments were made to it.

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