Form 17 (Hitchayvut) — Health Fund Commitment Form

Step-by-Step Instructions

1. 1

   In brief

   Form 17 (in Hebrew: התחייבות — hitchayvut, meaning "commitment" or "undertaking") is the official document your kupat cholim (health fund) issues to guarantee that the fund will pay for your treatment at a specialist, hospital, imaging centre, or other medical provider that is not your home clinic.

   Without a Form 17, the provider can refuse to treat you under your health-fund coverage and may bill you privately. Even when a provider would treat you, presenting Form 17 is what unlocks the fund's payment.

   Form 17 is regulated under the National Health Insurance Law and is one of your core rights as an insured member of any health fund.

2. 2

   When you need a Form 17

   You'll typically need a Form 17 for:

   • Specialist consultations (cardiologist, dermatologist, neurologist, etc.) outside your kupah's regular clinic network.
   • Hospital outpatient clinics and pre-scheduled hospital procedures.
   • Imaging tests — MRI, CT, ultrasound at non-kupah imaging centres.
   • Surgery and inpatient hospital admissions (the hospital admits you under the fund's commitment).
   • Certain laboratory tests that go outside the standard panel.
   • Treatments by providers under the kupah's 'selection arrangements' (hesderey b'chira) — the network of contracted private specialists.

   You do NOT need a Form 17 for:

   • Visits to your family doctor (rofeh mishpacha) or paediatrician at your home clinic.
   • Emergency room treatment for genuine emergencies — the hospital handles billing through the kupah after the fact.
   • Most routine blood tests at your kupah's own lab.
3. 3

   How to request a Form 17

   Each kupat cholim has its own request process. Most can be done online through the fund's personal-account portal or mobile app, with the form sent to you by SMS or email within minutes; some still require a phone call or visit.

   You'll need:

   • A referral (hafnaya) from your family doctor or specialist for the specific treatment.
   • The provider's details — name, address, and (for specialists) the appointment date and time.
   • Your kupah membership number (on the back of your Teudat Zehut or your kupah app).

   Tip: request the Form 17 a few days before your appointment, not at the door. Specialists and imaging centres routinely refuse same-day Form 17s for non-urgent cases.

   Online channels per kupah:

   • Clalit: the Clalit app or Klalit Online — "Issue Form 17" (Hanpakat Tofes 17).
   • Maccabi: the Maccabi app or Maccabi Online — Hithayvut Lerofei Yoetz.
   • Meuhedet: the Meuhedet app or Meuhedet Online — Hithayvut.
   • Leumit: the Leumit app or Leumit Online — Hithayvut.
4. 4

   What's covered and validity

   A Form 17 specifies:

   • The patient's identifying details.
   • The specific provider (clinic, hospital, doctor by name) the fund commits to pay.
   • The specific treatment, test, or appointment covered.
   • A validity period (typically 30 days from issue, sometimes longer for ongoing treatments).

   Important details:

   • Form 17 is provider-specific. You can't take a Form 17 issued for Dr A to Dr B.
   • For courses of treatment (e.g. physiotherapy sessions), the form usually authorises a set number of visits. Check the count.
   • If your appointment is delayed beyond the form's validity, request a new Form 17 before the rescheduled date.
   • Keep the form (digital or paper) until your treatment is complete — providers sometimes ask for it again at follow-up visits.
5. 5

   If your kupah refuses to issue a Form 17

   If the fund refuses to issue a Form 17 for a treatment your doctor referred you to:

   1. Ask for the refusal in writing, with the reason. Funds are required to provide this on request.
   2. Apply to your kupah's exceptions committee (va'adat charigim) — every fund has one. The committee reviews unusual cases and can override an initial refusal.
   3. File an internal complaint with the kupah's public-complaints office.
   4. Escalate to the Public Complaints Commissioner under the National Health Insurance Law (Ministry of Health) if the kupah's internal process doesn't resolve it.

   (See the Filing a Complaint Against Your Health Fund guide for the full escalation path.)

6. 6

   Useful resources

   Health-fund personal portals (online Form 17 issuance):

   • Clalit — Klalit Online / Clalit app
   • Maccabi — Maccabi Online / Maccabi app
   • Meuhedet — Meuhedet Online / Meuhedet app
   • Leumit — Leumit Online / Leumit app

   Ministry of Health Kol HaBriut helpline: *5400 — general health-system information and rights guidance.

   Form 17 details and entitlements are governed by the National Health Insurance Law and the regulations on provider selection arrangements (hesderey b'chira). Specific procedures vary slightly between kupot — when in doubt, check your kupah's app or call their member-service line.

   Clalit Health ServicesMaccabi Health ServicesMeuhedet Health ServicesLeumit Health ServicesKol HaBriut — Ministry of Health information line
7. 7

   Related guides

   Other guides in the Kupat Cholim (Health Fund) — member rights series:

   • Registering with a Health Fund (Kupat Cholim)
   • Switching Between Health Funds (Changing Your Kupat Cholim)
   • Filing a Complaint Against Your Health Fund (Kupat Cholim)