Long-Term Care

According to the Long term Care Insurance Law, a person who is entitled to long-term care receives services that will help him and his family to perform routine tasks, run the household, and provide him with care and supervision - all as required by the insured and as he chooses with in the framework of his entitlement.

The form Claim for a Long-Term Care Benefit should be submitted to the local National Insurance Institute branch near the place of residence, or sent in by mail. The claim can also be submitted by another person representing the insured (a family member, guardian, social worker or nurse). The opinion of the attending doctor must be written on the claim form, and submitted along with certification of income.

When the National Insurance Institute renders a decision on the claim, the claimant receives notification approving or denying his entitlement. The notification is sent together with information describing the range of services available in the insured’s place of residence, from which he can choose.

Entitlement to a long-term care benefit is not indefinite and, from time to time, the National Insurance Institute examines the condition of the insured, his entitlement to continue receiving the long-term care benefit, and the rate of the benefit that is due to him. If the condition of the insured worsens, he and his family may apply to the NII for a new examination.

The benefit rates are determined by the degree of the insured’s dependency on the help of others or according to the extent of supervision that he requires.

A person who is entitled to the benefit chooses one or more of the services that he wants, from the existing range of services.

The benefit rates in this chapter relate to only 2 types of services out of the entire range of services: weekly home care hours and visiting days in a daycare center. The rates of services that are not listed here will be provided by the social worker who visited your home and advised you on choosing the services that are suitable for you.

Under the law, there are 3 levels of benefit rates:

Anyone who has difficulty filling out the claim form can obtain assistance from the claims officer or from employees of the Counseling Service for the Elderly department at the local branch of the National Insurance Institute. The claim for the long-term care benefit can also be submitted by a person representing the insured (such as a family member, guardian, social worker or nurse).

An appeal from the decision of the NII or the local committee can also be submitted by a family member or guardian of the insured .

Every person who submits a claim for a long-term care benefit has the right to appeal the decision of the claims officer on the degree of dependency that was determined for him with regard to routine activities and the need for supervision.

The appeal may only be submitted on decisions that were made on April 24, 2009 and thereafter.

The appeal, including reasons, should be submitted to the NII branch handling the claim, within 60 days from the date on which the claimant received notification of the claims officer’s decision.

Under an amendment to the National Insurance Law, persons entitled to a long-term care benefit who employ a full-time caregiver may ­­- under certain circumstances – choose to receive their benefit in cash into their bank account, and employ the caregiver exclusively, without the intervention of a manpower company, or may choose to continue the existing arrangement under which both the manpower company and the benefit recipient employ the caregiver.

This possibility is being offered under the law in the framework of a pilot being conducted in 9 local NII branches until December 31, 2012: Ashdod, Ashkelon, Bnei Brak, Holon, Jerusalem, Nahariya, Netanya, Ramat Gan and Tiberias.

Five conditions determine an insured’s entitlement to a long-term care benefit: