Sources inform ''Globes'' that on May 1, Maccabi Healthcare Services will close its Silver Shield supplementary insurance plan, and not allow new policyholders to join. The Ministry of Health has approved Maccabi's plan as part of the HMO's effort to deal with a deficit of tens of millions of shekels in its supplementary insurance plans, and because Silver Shield has only 43,000 policyholders, compared with 1.7 million policyholders for the more expensive and comprehensive Gold Shield plan.
However, a senior Ministry of Health official says that this is a strategic move by Maccabi, allowing it to issue another supplementary insurance plan that is more expensive than Gold Shield. The assessment is based on the fact that Maccabi is allowed to raise two types of supplementary insurance plans, and by closing Silver Shield, it will be able to boost its revenue by creating a new premium supplementary insurance plan.
Such a plan would be similar to Clalit Health Services' Platinum supplementary insurance and Meuhedet Health Services' See ("Peak") plan, both of which cost tens of shekels per month for a range of benefits for dental, pregnancy, and esthetics care.
"No rush to switch plans"
Maccabi does not only plan to close Silver Shield to new policyholders, but also to raise premiums for current policyholders. A premiums rate hike is unlikely to cause Silver Shield policyholders to switch to Gold Shield, since the latter's rates were raised on April 1.
Maccabi hopes to see policyholders switch from Silver Shield, but a Ministry of Health source says that there is no need to rush. "It isn't always necessary to rush and switch to a different insurance plan, especially since the rates for Gold Shield offer no incentive to do so. It a person is healthy and all is well, he should stay where he is."
Maccabi does not deny that it might launch a premium supplementary insurance plan. It says that it "is reviewing all options for providing extensive services to all our members".
Maccabi: Deficit due to effectiveness
Maccabi was not satisfied by raising premiums for Gold Shield by NIS 3-12 per month, depending on age group. It also raised several self participation rates and reduced the rights of some policyholders. In fact, whereas until now, higher premiums were accompanied by added services, the opposite is now the case: it raised premiums and reduced rights. For example, whereas until the end of March, a Gold Shield policyholder was eligible for reimbursement of up to NIS 643 for an expert consultant, the reimbursement has been cut to NIS 600.
Policyholders' participation for a cycle of fertility treatments rose from NIS 240 to NIS 680. Participation for surgical procedures was raised by 10%, and subsidies for the purchase of medical devices were cut from NIS 3,155 to NIS 2,000. Discounts for esthetic surgical procedures have been eliminated altogether.
Maccabi claims that its deficit on its supplementary insurance plans was due solely to its effectivenss for policyholders. This is seen in a Ministry of Health report, which states that Maccabi's insurance reimburses more per shekel spent by policyholders.
A top Ministry of Health official says, however, that alongside the fact that Maccabi policyholders use more of the services offered them, it cannot be ruled out that Maccabi is sending more policyholders to the Assuta Medical Centers Ltd. private hospital network, which it owns.
Published by Globes [online], Israel business news - www.globes-online.com - on April 16, 2012
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