Orthopedic Insoles and Reimbursement: What Your HMO and Insurer Really Cover

Orthopedic insoles are one of the items most people assume are covered - and then discover at the shop that they aren't. The reason: most private health policies classify insoles as a personal consumer item, not medical treatment, and explicitly exclude them. That said, there are routes that can provide partial help - especially when it comes to custom-fitted orthopedic shoes, and through the HMO's shaban supplementary plan. This article explains what's usually covered and what usually isn't, and how to check it properly before buying.

Why insoles are usually not covered by private insurance

Most private health policies define an explicit list of exclusions, and orthopedic insoles appear on it frequently. The logic: an insole is treated as a support or comfort accessory, similar to other orthopedic products that aren't classified as "medical treatment" in the narrow sense - even if a doctor recommends it. Insurers distinguish between a condition that requires medical intervention (like surgery or physiotherapy) and a day-to-day assistive accessory, and insoles usually fall into the latter category. The practical implication: before buying insoles on the assumption that "it's probably covered," check the exclusions section of your policy explicitly - not just the coverage section.

Custom-fitted orthopedic shoes - a different story

Unlike insoles, orthopedic shoes manufactured specifically to a patient's foot structure, due to a defined medical condition (for example, a significant foot deformity or a chronic disease affecting gait), are sometimes treated as a medical device rather than a consumer product. In such cases there's a higher chance of partial reimbursement, mainly through shaban and subject to a referral from a specialist physician. It's important to understand: not every shoe labeled "orthopedic" sold in a store meets this definition - the distinction is between a shoe made specifically due to a documented medical condition, and a comfortable shoe marketed as suitable for sensitive feet.

Shaban: partial reimbursement is possible - but not automatic

Some HMO shaban plans include partial participation in the cost of orthopedic insoles, usually up to a defined cap over a certain period (for example, once a year or once every two years), and subject to a referral or prescription from a doctor. The scope of participation, the cap, and the conditions vary a great deal between HMOs and between different plans at the same HMO - some basic plans don't include this clause at all, while expanded plans include it with a higher cap. So even if you've heard that a certain HMO "reimburses for insoles," it's important to check this against your specific plan, and not assume the participation is the same for all members of the same HMO.

A prescription and the podiatrist or orthopedist route

In almost every route where reimbursement exists - whether through shaban or through a private policy that does include such a clause - the basic requirement is a referral or prescription from a doctor, usually an orthopedist or a podiatrist (a specialist in foot care). The prescription usually needs to detail the specific medical condition and the need for insoles or custom-fitted shoes, not just a general recommendation. Buying insoles independently at a store, without a prescription and without a documented diagnosis, almost never qualifies for reimbursement - even if you technically have such a clause in your plan.

What to check in your own private policy

Three main things: whether orthopedic insoles are explicitly mentioned in your policy's exclusions list; whether there's a distinction between insoles and custom-fitted orthopedic shoes, and if so, what the conditions for shoe coverage are; and what's required to file a claim - a referral, prior approval, or both. If you don't have your full policy documents on hand, make sure you're checking the current version rather than a general assumption from memory.

How to actually file a claim

When partial reimbursement exists in principle - through shaban or a policy - the process usually includes getting a referral or prescription from a doctor, sometimes prior approval before the purchase, and then filing an itemized receipt from a recognized store or orthopedic institute through the HMO's or insurer's website or app. It's recommended to check the filing requirements before the purchase, not after, to make sure the store you buy from and the documents you receive meet the requirements - a filing that doesn't meet the procedural conditions can be denied even when coverage exists in principle.

How Ravit can help

Send Ravit your policy or shaban plan documents on WhatsApp, ask whether insoles or orthopedic shoes are included and what's required to file, and get an answer based on your plan 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.

Related articles: Physiotherapy coverage · Medical devices coverage · Prosthetics coverage · Posture and ergonomics · Shaban vs. private insurance