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MEDICAL TREATMENTS ARE ONLY COVERED WITHIN THE STATE OF ISRAEL * With the AIM PREFERRED PLAN, the registrant receives the following:
A. MEDICATIONS: Prescriptions issued by AIM participating physicians, for acute or urgent care, shall be generic and furnished by authorized pharmacies. There will be a $10. or 40 NIS co-payment for all medications. All medications shall have a maximum limit of $500.00 for the school year.) Over the counter medications and medications for non-covered conditions, are excluded.* Does not cover medications taken on a regular basis.* B. EMERGENCY DENTAL care consists of initial evaluation and palliative treatment for immediate relief of pain up to $400 for the year. Registrants on the AIM GOLD PLAN are covered for first aid emergency treatments only; e.g.: replacing lost fillings, draining an acute abscess, stabilizing acute traumatic events, etc. Not included are root canal, fillings, wisdom teeth extraction, TMJ disorders, bondings, orthodontics, and cosmetic dentistry, etc. and as defined by the AIM Medical Director. Dental care other than First Aid and registrants on the AIM BASIC PLAN, have bills sent home for payment.* C. SPECIALISTS: Referrals to specialists, other physicians and/or diagnostic services for acute or urgent care, must be authorized by the Medical Director or the AIM physician on duty. A referral slip will be issued in each case. The member is responsible for payment of non-authorized visits.* In instances where medical care is urgently needed and there is no doctor/hospital/pharmacy in the neighborhood of the registrant – the AIM emergency hotline must be used to receive instructions from the physician on duty. Only when authorized will AIM reimburse the registrant, on the strength of the following documents being displayed: a. Medical documentation. b. A tax invoice (chesbonit) of the provider of the services, stating the amount of the payment. c. The refund level shall be up to a maximum of $100 per illness. In the absence of these documents AIM shall be released from refunding payment. 1. PRE-EXISTING CONDITIONS and/or SYMPTOMS THEREOF: Medical or dental illness or injury and/or symptoms thereof, which occurred outside of Israel and/or originated before the effective Date of Coverage (including any recurrence of a previous condition or complications of a pre-existing condition or symptom) and treatment of pre-existing or chronic conditions of any kind, or conditions that are deemed to have been present prior to arrival in Israel, even though they were not previously diagnosed, are not covered by the AIM GOLD and BASIC Plans. I n these situations, AIM will make all necessary arrangements for care and bill the family for the services. 2. Emergency Room and Hospitalization coverage: AIM reserves the right to review and deny claims for non-covered conditions. In the event of hospitalization AIM is authorized to receive payment for medical services from the patient's primary insurance carrier. 3. Hepatitis, flu and other vaccines are administered without charge, however the costs of the vaccines are not covered. 4. The AIM Plans do not cover medical expenses with respect to hormonal imbalances, menstrual irregularities, pregnancy, prevention of/or pregnancy related problems, preservation of pregnancy, childbirth or miscarriage. 5. Does not include services and expenses with respect to eating disorders, nutritional counseling, weight loss/gain, diet control, dyspepsia, irritable bowelsyndrome, mental illnesses, psychological disturbances, learning disabilities, sleep disorders or migraine headaches. Podiatric treatment is not covered. 6. Does not include expenses due to alcohol intoxication, substance abuse, medical treatment for the purpose of drugs and/or alcohol rehabilitation, or consequences , injuries as a result of brawls, self-inflicted injury, attempt at suicide or consequences related to the influence of any of the above. 7. Does not include coverage for sexual related illnesses, AIDs or malignant conditions. 8. The AIM GOLD PLAN does not cover expenses with respect to optometry, glasses or eye conditions related to contact lenses. 9. Does not include services and expenses with respect to alternative medicine, acupuncture, chiropractic or non-conventional medicine. 10. Does not include coverage for cosmetic or plastic treatments, warts, previous skin lesions, acne, nevi, eczema, asthma and treatment for allergies. 11. AIM does not cover the following orthopedic problems e.g. scoliosis, back pain, flat feet, and problems with arches, whether previously diagnosed or not. AIM will only cover for acute traumatic orthopedic events. Physiotherapy, when prescribed is limited to 4 sessions. 12. AIM does not cover elective surgery, private surgeon's fees or conditions which require elective (not urgent) treatment or evaluations of chronic disorders e.g. polycystic ovary syndrome, hypertension, celiac disease hair loss, hernias, cysts, biopsies, etc. 13. AIM does not cover injuries associated with an event connected with professional and organized competitive sports. Hazardous sporting activities such as bungee jumping, motorcycles, jet skis, and other unnecessary risks deemed by the AIM Medical Director, are not covered. 14. Does not cover CAT scans, Bone scans, MRI, or serological tests eg: EBV, CMV blood test or celiac anti-bodies. 15. Does not include coverage for earthquakes, volcanic explosions, nuclear fission, meltdowns or radioactive contamination. 16. Road accidents are covered by no-fault Israeli insurance. Work accidents are covered by the National Health Insurance. AIM shall not compensate or cover expenses for an event in which a medical body, insurance, government body or other institute in Israel is said to cover such expenses. 17. Does not include coverage for hospitalization with respect to active participation by the registrant in warlike, military, underground activities, revolution, revolt, riots, civil commotion, strikes, illegal activities, reckless behavior, intentional physical injury by the registrants exposing themselves to danger-except for the purpose of saving lives. 18. Shall not compensate or cover expenses in the event of a discovery of a case of fraud, deception or concealment relating to any matter influencing the presentation of a claim. 19. Visits to emergency or urgent care centers after office hours, without referrals from the 24 hr. hotline physician on duty, shall be reviewed and if deemed by the AIM Medical Director not to have been urgent, the family will be responsible for the billing. 20. Acute and urgent care are defined as conditions that require medical attention and intervention within 12-24 hours. 21. American Israel Medi-Plan is not an insurance plan but a group of participating physicians providing comprehensive private medical services in Israel. 22. In events where the family is responsible for payments, when possible, the family will be contacted for consent and to arrange payments, prior to performance of services. In the event of emergencies or at any time after services are rendered, if services are determined to have been a pre-existing condition or excluded from coverage, the family will be responsible for payment without the prior consent and authorization for such service. In the event of any question, the decision of the AIM Medical Director will be final. * MEDICAL COVERAGE IS ONLY FOR ILLNESSES OR INJURIES OCCURING WITHIN THE STATE OF ISRAEL DURING THIS REGISTERED PERIOD OF THE 2010-2011 school year. REMEMBER: You are only covered for services authorized by your primary care physician at the AIM Healthnet Center or the physician on duty. Office hours at the center are Sundays to Thursdays 9:00am to 5:00pm and Fridays 9:00am to 12:00 noon. A physician is on duty for assistance and referrals each day at the 24 hour emergency hot-line: Emergency Hot-line: 057-753-7111 |