Lev HaTorah 10 Month CHAI 'Wellcome' Student Health Policy Sign Up

 

Please check that your passport is valid until at least three months after the end of the school year.

Home Address


Contact Details

Email for receiving messages and information

Program Address- Your Details in Israel




It is the responsibility of the policy holder to inform us if there are any changes to the end date of his/her policy.
For any changes, please contact rochel@egertcohen.co.il

Health Declaration

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Are you suffering or have you suffered from one or more of the following diseases?


















Optional: Personal Effects coverage (clothing, electronics, jewelry, etc.) covered for theft, fire/water damage in the dorm for up to $4500. It also includes All Risks cover outside the dorm, for electronics or jewelry up to $900. There is no coverage for cell phones, glasses, cash or any items left in a car or bus. In the event of a claim there is a deductible of $35.
The cost of a personal effects policy is $50. For questions regarding personal coverage contact: ahuva@egertcohen.co.il


If the student has any of the following medical conditions, pre-existing coverage is REQUIRED:
  • Anxiety/depression
  • ADHD/ADD
  • Allergies-Epipen
  • Mental health conditions
  • Epilepsy
  • Diabetes (without insulin)
  • Thyroid disorders
  • BMI (over 30)
  • High cholesterol/Blood Lipids

There are some other conditions that Maccabi might consider to be pre-existing. In such a case, we will be in touch with you.



Release of Confidentiality
I agree to waive my HIPAA (Health Insurance Portability and Accountability Act of 1996) rights, Israel’s patient privacy laws (Protection of Privacy Act 1981 and the Patient’s Rights Law 1996) and all other applicable privacy provisions under the law, in order to allow the Staff of Chai Travel Assistance Services (CTAS) and/or the staff of my program to communicate with myself, each other, healthcare/therapeutic providers, parents, and school administrators regarding my health condition/s. This communication can be applicable via phone, email, WhatsApp, Skype, internet-based application or other forms of communication.

I hereby declare, consent and agree that:
* All statements are correct, complete, and provided voluntarily.
* I have read the terms and conditions of the plan as displayed on the Maccabi website, and I accept all the terms and conditions stated therein.
* I, the undersigned, confirm that I have read and understood the plan’s terms and conditions and that all the terms above have been explained to me.
* I acknowledge that Maccabi has the authority to either approve or reject my application for membership of the plan, with no obligation to justify its decision.
* I acknowledge that the contract will be in effect only after I have received confirmation from Maccabi of my acceptance to the plan and after the initial membership fees have been paid in full.
* I acknowledge that Maccabi will be exempt from providing care related to a congenital defect/disease, including hereditary diseases and/or my state of health and/or medical event and/or
disease, whether treated or not, and/or their results, directly or indirectly, which were caused and/or exacerbated due to a state of health which existed prior to the start date of the membership.
* I acknowledge that the monthly rate is updated periodically according to the terms and conditions of the plan.
* I acknowledge that Maccabi has the authority to determine a supplementary fee to the fixed rate or exclude a medical condition, pursuant to the medical state determined as a condition of the
membership’s approval.
* I acknowledge that the application and health declaration are valid for a month from the day they are signed.
* The purpose of staying in my country is not to receive medical treatment and I do not know of any medical treatment I need. All the details I gave in my health statement are true and complete.
If the information I provide is incorrect or incomplete, Maccabi may terminate my membership in the program at any time.
Supplementary Insurance
* I acknowledge that the Well-Come plan membership fees do not include payment for supplementary insurance or Nursing Gold or Keren Maccabi, and these will be paid in addition.
* I acknowledge and I agree herein that my membership in Maccabi Zahav and/or Maccabi Sheli is subject to the joining terms that apply to a member of the Well-Come plan.