Israel is a prosperous nation with an excellent standard of healthcare, ranked as one of the best in the world. Under the National Health Insurance Law of 1995, the government extends universal coverage to every Israeli citizen and operates a two-tier health insurance system based on both public and private health insurance. Signing up with a national scheme is compulsory for all Israeli residents but as a foreign worker, you will be entitled to private coverage arranged by your employer. There are also some specific conditions which apply if you have immigrated to the country under the Law of Return.

The Israeli state health insurance system is run on a not-for-profit basis and residents are obliged to sign up to one of four official health insurance organizations, known as Kupat Holim (קופת חולים - "Sick Funds"). You have the right to choose which fund you register with, and can change funds if you wish: there is an opportunity to do this once a year.

The funds are:

• Clalit
• Leumit
• Maccabi
• Meuhedet

Each fund runs its own medical facilities, so it is important to check that your doctor or hospital is registered with the network, although you can choose which medical provider you see (even if they are not with your specific fund).

If you are an expat who is earning an income and paying national insurance contributions, you will be covered by state healthcare automatically, but employers in Israel are legally obliged to register their foreign employees with a health insurance plan – even those who do not yet have a visa – and these will be with private health insurance companies. Check with your employer that this forms part of your employment package.

Your employer is legally obligated to sign you up with a health insurance provider, usually a private one. Check with your employer as to the conditions of your package.

If you are self employed, you will need to approach either one of the public funds or a private provider directly.

The state system is comprehensive and covers:

• primary care
• hospital care
• specialist treatment
• geriatric care
• maternity care
• psychiatric treatment
• medical equipment and appliances
• transport to hospital
• medication for serious illnesses
• IVF and fertility treatment
• abortions
• physiotherapy
• transplants
• preventative medicine

The Israeli public system is legally obliged to accept everyone who applies, so you should be covered as a retiree. The nature of your entitlement will depend somewhat on whether you have come to Israel on an Aliyah program (immigration into Israel under the Law of Return for Jews): if so, you may not be covered between arrival and the approval for your Aliyah. Thus you will need some form of coverage and this may depend on your age and your particular provider; some companies operate an age limit. You can consult the Bituach Leumi (National Insurance Institute) if you have any questions about your retirement entitlement once in Israel.

Some Israeli educational providers require that international students take out private policies with an Israeli provider, for instance Harel-Yedidim, which offers two types of plan to overseas students. Check with your educational institution as to their particular requirements.

Israel has universal coverage so your family will be automatically covered under the national scheme. Since your employer is obligated to sign you up with a private plan, you need to check with them to see whether this also covers your dependents, although the public scheme and private healthcare in Israel are of a comparable standard.

Dental treatment is not covered under the national health insurance, and neither is optical care, so you may choose either to pay out of pocket. If you think that you may require extensive treatment, you may prefer to take out a private policy to cover your dental care.

You can do so either through one of the international providers or with one of the kupat holim, who offer supplementary insurance to cover any additional costs for your medical treatment that are not included in the basic national plans. The four funds run for-profit dentistry practices at a discount for members who have supplementary insurance. You will be assigned a dentist if you attend one of these clinics and may not see the same dentist every time.

You will need to pay 3.1% of your monthly salary up to 5,804 ILS (US$1693) and 5% of anything earned above that. If you are employed, this will be deducted directly from your salary. If you are self employed, you must make your own contributions.

If you are not working but receive an income, you will need to pay 5% of this in contributions. If you are not working and have no income, you will need to pay a monthly contribution of 170 ILS (US$50).

If you have come to Israel under the Law of Return, or you are an Israeli citizen who were born abroad or left as a minor, and who settles in Israel, you will be entitled to one year of free health insurance if you are not working, subject to some exceptions.

You have the option of taking out private insurance, known as sharap, in Israel, for a higher quality of comfort (such as a private room and beds for visitors) and swiftness in accessing health services.

Although the Israeli national system is of a high standard, equal to that of the private sector, there can be lengthy waiting times for routine treatments. The country is facing a shortage of doctors due to retirement, and there is also a chronic shortage of nursing staff. There is a shortage of hospital beds as well.

The Israeli government does not put as much of its GDP into healthcare as some neighbouring nations.

Medical tourism is a growing sector in Israel, with visitors from the US in particular finding that high quality medical treatments, such as dental care, are significantly cheaper in Israel than the States. You may wish to go through a medical tourism broker, who will usually be paid by the hospital with which they are affiliated.

The private sector in Israel will cover all forms of primary and secondary treatment, as well as advanced dental care and cosmetic surgery, and some alternative forms of treatment.

This will depend on factors such as your age and your medical history, but as an example the average cost for an Israeli private health insurance plan for a family is in the region of 10,783 ILS (US$3146) annually. A family with two adults in their thirties can sign up to a policy for under 300 ILS (US$87) a month. You can also purchase a cheap policy for around 50 ILS (US$14) that only covers transplants and medications.

As above, the four funds offer supplementary insurance, with premiums based on your age, gender and medical history. Obviously, the higher your premium, the more extensive your cover: you can, for example, take out a policy that will cover treatment anywhere in the world.

Public funds cannot deny supplementary cover if you have a pre-existing condition, whereas private funds outside the Israeli national health network may well do so. You cannot be denied supplementary insurance, but check your policy carefully as the supplementary insurance run by the four main funds covers some forms of treatment but not others: for instance Darconaim, from the Maccabi Health Fund, covers pregnancy but does not cover hospitalization or childbirth.

Outside the network of the four funds, Israeli insurance providers also offer health cover, for instance:

• Harel Insurance Investments and Finance Services
• Migdal Holdings
• Phoenix
• Menora Mivtachim
• Clal Insurance Enterprises

In addition, some of the main international providers cover Israel, including:

Bituach Leumi - National Insurance Institute

Kupat Holim / קופת חולים - "Sick Funds": the four national insurance funds