Everyone in Israel is entitled to purchase private long-term care insurance in addition to the entitlement to receive a Long-Term Care Benefit established in accordance with the section dealing with long-term care insurance in The National Insurance Law.
- The conditions and entitlements of the various private long-term care insurance policies vary from company to company and are detailed in the policy agreements.
- There are three basic kinds of private long-term care insurance policies:
- Private policies purchased by individuals through their personal insurance agents.
- Collective policies purchased by labor unions or other groups to which individuals who are part of that group join.
- Insurance policies offered as part of health plan insurance services.
Refusal to Pay Insurance Benefits Due to a Pre-Existing Condition
- Insurance companies require that those joining a policy provide a health declaration.
- Companies sometimes do not check a policyholder's health declaration until the insurance benefits are needed, at which point the company may then claim that the policyholder is not entitled to the benefits or is only entitled to reduced benefits due to a pre-existing condition that appears on the health declaration.
- In order to prevent cases such as this from occurring, in March 2004 the Insurance Business Control Regulations (Insurance Contract Conditions) (Provisions Regarding Pre-Existing Conditions) went into effect, according to which insurance companies may only refuse provision of insurance benefits in whole or in part within one year of enrollment in the policy for those under the age of 65, and within six months of enrollment in the policy for those over the age of 65.
- These regulations are valid regarding policies that were signed or renewed beginning in March 2004, and they are aimed at encouraging the insurance companies to clarify policyholders' medical conditions upon enrollment rather than years later when a problem arises.
- The insurance company determines eligibility, so there may be cases in which the insured is recognized as a nursing care patient by another entity (ex National Insurance) but will not be recognized as a nursing care patient by the insurance company.
- The insurance company may periodically check whether the beneficiary is still in compliance with the criteria for the assistance, and if it is found that he no longer meets them, it may stop paying the insurance benefits.
- If an insurance company refuses to fund long-term care, such a decision may be appealed by first contacting the insurance company and then bringing the case before a court of law.
- A person that becomes a nursing care patient may make claims from the insurance company for up to 3 years from becoming a nursing care patient.
- It is recommended to check the option of purchasing a long-term insurance policy through your kupat cholim.
Laws & Regulations
- The Long-Term Care Law
- Insurance Business Control Regulations (Insurance Contract Conditions) (Provisions Regarding Pre-Existing Conditions)
- The Guide to Long Term Care Insurance - from the REUTH Family Care website.
- English translation and maintenance by The Shira Pransky Project.