Tofes 17 - Form 17
The Hitchayvut - התחייבות - Health Fund Payment Authorization
Should you need to go to a public hospital, ambulatory or outpatient clinic for any reason, you will be required to present a payment authorization (hit’chay’vut) from your participating health fund. The "Hitchayvut" is also referred to as "Tofes 17" - Form 17. A Hitchayvut can only be issued upon the presentation of a doctor’s referral.
Once you have your doctor's referral in hand you need to apply for the Hitchayvut. Contact your Health Fund by phone, fax, email, via their smartphone app or their website (as per the options they offer) and tell them you need a Hitchayvut. They will ask you to either fax or email the doctor's referral to them. Once approved, they will send the Hitchayvut Payment Authorization to you. If you do not have a fax or email, you can go to your nearest Health Fund branch and they will issue the payment authorization on the spot.
If you have been rushed to the emergency room, and depending on the circumstances, you may have to provide the payment authorization - the Hitchayvut - to the hospital within a certain time after you have been discharged, as specified by them.
The Hitchayvut is a pre-requisite to selected examinations, treatments and care and without it, the clinic will not carry out the required procedure.
Here is a sample of an electronically transmitted Payment Authorization form. Forms may differ slightly from one Kupat Holim to another.
If for some reason, you no longer require the treatment or the Hitchayvut, please contact your Health Fund and advise them of these changes
The Hitchayvut is valid for a limited amount of time. Check the dates. If your Hitchayvut has expired you can ask for a new one or an extension on the old one.
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