How to File a Health Insurance Claim: The Steps, Documents, and Deadlines

You paid for a private consultation, test, or treatment, and now you need to submit it to your insurance — but every company points you to different forms, and it's hard to see what the process actually is. The good news: the mechanism is nearly the same across all the companies, and it's regulated by the directives of the Commissioner of the Capital Market (הממונה על שוק ההון). Here's the full route, step by step: what to gather, when you need pre-approval, how to send it, and which deadlines bind the insurance company.

First things first: reimbursement or pre-approval — two different tracks

Most health claims fall into one of two tracks. On the reimbursement track you pay first — for a doctor's consultation, a test, a treatment, or a medication — and then submit receipts and get reimbursed according to your policy terms. On the pre-approval track, which is mainly relevant for surgeries and expensive treatments, you contact the insurance company before the treatment, and it approves the coverage and sometimes pays the provider directly.

This distinction determines everything that follows: which documents you'll need, when to contact the company, and what happens if you skip a step. So the first step is to check your policy to see which track your treatment belongs to. If your policy isn't within reach, here's how to get a full copy of your policy from the insurance company.

Which documents to gather for a reimbursement claim

The exact list varies by claim type, but you'll usually need:

• The insurance company's claim form — each company has its own form, usually available on its website or app.
• Receipts and invoices for the payment. Keep the original or a clear scan, with the patient's name, the date, and the amount.
• Relevant medical documents: a doctor's referral, a diagnosis, a visit summary, or a treatment summary — whatever the policy requires for that type of treatment.
• A medical confidentiality waiver (כתב ויתור על סודיות רפואית) — a document that allows the company to obtain medical information to review the claim. It's usually part of the claim form.
• Bank account details for the reimbursement transfer, and sometimes a copy of your ID card (teudat zehut) or proof of account ownership.

Worth knowing: under the directives of the Commissioner of the Capital Market, when you notify the company of a claim it is required to give you a document detailing the review process and all the information and documents needed. If something isn't clear — you're allowed, and well advised, to demand that breakdown in writing.

When you need pre-approval (a letter of commitment)

For private surgeries and some expensive treatments, you contact the insurance company before the treatment, not after. You notify the company of the need for surgery, attach medical documents such as a doctor's recommendation and a diagnosis, and the company reviews the coverage and approves it in advance.

If you choose a surgeon and hospital that have an arrangement with the company, it usually issues a letter of commitment (כתב התחייבות) — a document in which it commits to pay the surgeon and the hospital directly — and you pay at most a co-payment. If you choose a private doctor outside the network, the reimbursement is usually capped at the ceiling set in the policy.

The critical point: undergoing private surgery without contacting the company in advance can hurt your reimbursement. Many policies state that the insurer may reduce the payment if prior approval wasn't obtained. So the moment surgery is on the table — contact the insurance company first, and only then set a date.

How to actually submit

Most companies offer several parallel channels, and you can pick whichever suits you:

• Website or app — digital filing through the personal area, with photo uploads of your documents. This is usually the fastest channel, and it's also easy to track the claim's status there.
• Email — sending the form and documents to the claims department.
• Your insurance agent — if you have an agent, they can file for you and follow the review.

Whichever channel you choose, keep a copy of everything you sent along with the filing date, and ask for a confirmation of receipt. If the review drags on or more documents are requested, that paper trail will save you a lot of headache.

What happens after you file: the deadlines that bind the insurance company

From the moment you file, the insurance company is bound by deadlines under the directives of the Commissioner of the Capital Market and the Insurance Contract Law (חוק חוזה הביטוח):

• If documents are missing, the company must request them within 14 business days from the date the need became clear to it — it's not supposed to "remember" new requirements bit by bit.
• Within 30 days from the day it received all the required documents, it must announce whether the claim is accepted, denied, partially accepted, or requires further review.
• Approved insurance benefits are paid within 30 days, and an amount not in dispute is paid even while other parts of the claim are still being reviewed.
• Every written inquiry must be answered in writing within a reasonable time and no later than 30 days.

If responses are delayed beyond that, send a written reminder citing the deadlines — and keep a copy of that too.

Claim denied? It's not the end of the road

A denial must arrive in writing, with detailed reasons. Read the denial letter carefully against your policy: sometimes the denial stems from a missing document or a clause that can be explained, not from a real dispute over coverage.

The standard route: first a written appeal to the company's claims department, with the documents or clarifications that were missing. If the appeal is denied, you can file a complaint with the public inquiries unit at the Capital Market, Insurance and Savings Authority — a free process done online — or go to court. Important to remember: the review with the company does not stop the limitation clock, and health claims have a window of three to five years. Here's how the statute of limitations works in health insurance claims and when the clock stops.

And one final, important reminder: everything here describes the standard process, but your policy is what governs — which documents are required, when pre-approval is needed, and how much is reimbursed all vary between companies and between policies. Checking against the policy itself is always the first step.

How Ravit can help

The answers relevant to you are in the policy itself. Send Ravit your policy documents on WhatsApp, ask in plain language, and get an answer based on your policy with a reference to the relevant clause — and when there’s no certainty, Ravit says so honestly instead of guessing.

The information in this article is general only and does not constitute medical, insurance, legal, or pension advice, and is not a substitute for reading your policy terms or consulting a licensed professional. Coverage, amounts, and conditions vary between policies and change over time — always verify against your own specific policy and an authorized professional.