Special Services Benefit (Attendance Allowance) (Right)

From All Rights (Kol-Zchut) (www.kolzchut.org.il)

Introduction:

A Special Services Benefit (Attendance Allowance) is paid to adults who require significant assistance from another person in performing daily activities and who are not hospitalized in a facility that provides medical, long-term care or rehabilitation service
The benefit is paid in addition to a General Disability Pension, and is determined according to the level of functioning and the level of dependence on others
As of 2017 the Basic Special Services Benefit rates are: 50% - 1,095 NIS, 112% - 2,452 NIS, or 188% - 4,116 NIS

Special Services Benefits are paid to National Insurance Institute beneficiaries age 18 years, 3 months old, who require significant assistance from another person in performing daily activities (such as dressing, eating, bathing, mobility in the home, and continence), or who need constant supervision to prevent them from posing a risk to their own lives or the lives of others.

Please note: The National Insurance Institute refers to the Special Services Benefit as an "Attendance Allowance". The two terms are used here interchangeably and "Special Services Benefit" is generally used here because it is a more direct translation of the Hebrew (קצבת שירותים מיוחדים).

Who is eligible?

  • Those insured by the National Insurance Institute who meet all of the following conditions:

1. Help or Care - they require assistance of another person in daily activities (dressing, eating, bathing, mobility and control in discharge), or they need constant supervision to prevent a life-threat to themselves or others. Recently added, one can reapply for an evaluation of the need for help of another person in the household-related activities.

2. Age - Eligibility is from age 18 years and three months.

  • Those insured who reach retirement age can file the claim fund no later than 1/2 year after retirement age. They will be eligible for the benefit, if a National Insurance Institute doctor determines that they were eligible for the period prior to their arrival at that age.
  • One whom is eligible for a pension when they reach retirement age will receive that pension after retirement age, as long as they continue to meet the eligibility criteria.

3. They are In the Country - those who submit the claim must be in the country, except in the following cases:

  • Claimants who are abroad will receive the allowance for 3 months after their departure, on the condition that they received the allowance for at least two consecutive months before leaving the country.
  • Claimants who have gone abroad for medical treatment or work (for themselves or for their spouses) on behalf of an Israeli employer, may be eligible for the allowance up to 24 months from leaving the country, at the discretion of the National Insurance Institute.
  • Claimants who are abroad on behalf the State will be entitled to continue to receive the allowance indefinitely provided they continue to qualify for the conditions of eligibility.

4. Applicants must meet one of the following conditions:

1. The applicant receives a General Disability Pension and his/her disability has been established by the National Insurance Institute as at least 60% (relevant to special services).
2. If the applicant does not receive a General Disability Pension, but his/her disability has been established by the National Insurance Institute as at least 75% (relevant to special services), he/she must meet the following two conditions:

5. The applicant is not receiving a Mobility Benefit, unless his/her mobility disability has been defined by a Ministry of Health medical committee as 100%, or he/she requires and uses a wheelchair, or is bedridden. An applicant who owns a car is only eligible to receive a Special Services Benefit if he/she has mobility disability established as at least 100%.

  • In addition, the following situations entitle a person to claim the benefit:
    • Those who receive dialysis at least twice a week.
    • Those who underwent Organ Transplants (kidney, heart, pancreas, lung, liver) - entitlement is for six months from the date of the transplant.
    • Those who underwent a bone marrow transplant from a donor are entitled to the benefit for six months after the transplant. Those who underwent a autologous bone marrow transplant are entitled for 3 months after the transplant.
    • Cancer Patients who receive treatment from a list of treatments appear which appear in the National Insurance Institute's Circular [[1]]
  • Individuals with disabilities who live in an institution that provides medical services, long-term care, or rehabilitative treatment are not eligible to receive a Special Services Benefit.

Immigrants with Severe Disabilities

  • Immigrants with severe disabilities are entitled to a Special Services Benefit composed of two parts:
    1. Special Services for Immigrants: People with severe disabilities from age 18 to retirement age are entitled to a Special Services Benefit from the 91st day of their aliyah until the end of their first year after making aliyah. Eligibility for this benefit is determined by an examination of their dependence on others and not by any other medical test.
    2. General Disability for Immigrants: Those found to be entitled to the special services for immigrants benefit, are also entitled to a General Disability Pension from the 181st day of their aliyah until the end of their first year after making aliyah.
  • After the first year of aliyah, their eligibility will be reviewed according to the regular rules for General Disability Pension and Special Services Benefit.

Benefit Rates as of 2017

  • Those who require significant assistance performing most everyday activities, most hours of the day, or who need constant supervision, are entitled to receive a benefit which is 50% of the full disability pension - 1,095 NIS. Additionally they receive a pension supplement of 306 NIS.
  • Those who require significant assistance performing all everyday activities, most hours of the day, are entitled to benefit at the rate of 112% - 2,452 NIS. Additionally they receive a pension supplement of 624 NIS.
  • Those who are completely dependent on others for performing all activities, throughout all hours of the day, are entitled to 188% of the full disability pension - 4,116 NIS. Additionally they receiive a pension supplement of 930 NIS.
  • One who receives a benefit at the rate of 188% and is in need of a respirator at all times is entitled to an additional allowance.

Benefit Rates for those who need Supervised Care

  • In accordance with the National Insurance Institute Circular, as of 01.07.2015, the eligibility rate has been raised for those whom a doctor has determined require supervised care to prevent danger, requiring the presence of people in their daily care:
    • One who requires supervision and is eligible for the benefit at a minimum rate (50%), will be eligible for payment provided at the intermediate level (112%).
    • One who requires supervision, and according to tests of ADL and IADL he/she is entitled to a benefit at the intermediate level (112%), will be eligible for payment given at the high level (188%).

Previous Rates

How to claim it?

  • In preparation for submitting a claim, the applicant should prepare medical documents which detail the ailments he/she suffer from, as well as the treatments and medications he/she has had.
  • Yad Mechavenet Centers, working on behalf of the National Insurance Institute, provides free advice before submitting an application or before meetings before the National Insurance Medical Committee.
What's now? For additional information Comments
Submit the benefit claim Submitting a Special Services Benefit (Attendance Allowance) Claim
After submitting the claim the applicant will be invited to a medical committee Special Services Medical Committee
  • It is important to arrive at the scheduled time or to notify ahead of time if you can't be there.
  • In specific cases eligibility may be determined based entirely on the medical documentation without the need for the applicant to appear in from of the medical committee. For example:
Decision of the Medical Committee and Establishment of Eligibility by the Claims Officer
  • After the exam, the doctor will summarize the findings and establish the degree of dependency of the patient.
  • According to the degree of dependency establish, the National Insurance Institute claims officer will establish the special services benefit amount.
In specific cases, the applicant will also be checked at home by a professional to assess the extent of his/her dependence on others.
Receiving the Decision After the all of the exams are completed, the decicion regarding the claim will be mailed to the applicant's house along with the the medical committee report. There is a fast track for people with serious disabilities that allows the claim to be dealt with, within 30 days.
Payment of the Benefit
  • Entitlement to the benefit begins on the 1st of the month in which the special services claim was submitted, but not before 90 days have elapsed from the date the applicant became entitled to a General Disability Pension or from the day it was established that the applicant has a 75% medical disability (for special services), for those that do not qualify for the general disability pension.
  • Individuals who have been found to be dependent on others for 6 consecutive months and for whom 75% medical disability has been established (for special services) will receive the benefit just 30 days after becoming entitled to a General Disability Pension as long as they did not receive a Disabled Child Benefit during this period.
A National Insurance Institute doctor may establish entitlement to a retroactive benefit for a period of up to 6 months prior to the date the claim was submitted, as long as the applicant meets all relevant conditions of entitlement.
If one is not satisfied with the decision of the medical committee, they may, in certain circumstances, submit an appeal within 90 days. Appealing a Special Services Benefit (Attendance Allowance) Decision
If one is not satisfied with the appeals committee decision, they may submit an appeal on legal questions only to the district labor court within 60 days. Appealing the Decision of the National Insurance Institute's Medical Appeals Committee Free legal aid may be requested from the Ministry of Justice's legal aid division.
If one wants to appeal the claims officer's decision on an issue that is not related to the medical committee (issues such as hospitalization, institutionalization, income amounts etc.):
  • One can submit a request for an additional claim hearing with in 6 months from when the initial benefit request was rejected by the claims officer.
  • Alternitavely, if one is not satisfied with the result of the claims committee, one can submit an appeal to the district labor court within 12 months of receiving the decision from the claims officer regarding the benefit.
  • The claims appeal committee only has the authority to recommend to the claims officer to reconsider his decision (in the cases it deems this appropriate).
  • When appealing to the district labor court, free legal aid may be requested from the Ministry of Justice's legal aid division.
If the severity of the medical situation increases, a new claim may be submitted after 6 months have passed. Renewed request for the special services benefit

Special Services Benefit and Long-Term Care Benefit

  • Upon reaching retirement age, people with disabilities who receive a Special Services Benefit may convert the benefit's monetary value to personal care services as part of a Long-Term Care Benefit.
  • It is not possible to receive both a Special Services Benefit and a Long-Term Care Benefit. Those entitled to both must choose between them.
  • For most levels of entitlement, the monetary value of long-term care services may be significantly lower than the Special Services Benefit.

Receiving Benefits Abroad

  • Recipients who are abroad will continue to receive the benefit for 6 additional months if they received the benefit for at least 2 consecutive months prior to their departure.
  • For recipients who go abroad for medical treatment or for their own or their spouse’s work for an Israeli employer, the National Insurance Institute may, at its discretion, continue to pay the benefit for up to 24 months (from the month they went abroad).

Please note

  • Special Services Benefit recipients are also eligible to employ a foreign nursing care worker.
  • Individuals with disabilities who live at a facility providing medical services, long-term care services or rehabilitation services are not eligible for a Special Services Benefit .
  • The National Insurance Institute sends a Certificate of Disability to anyone found to be eligible for a Special Services Benefit.
  • The National Insurance Institute may review a recipient's medical condition and functioning at any time.

Government agencies

Laws & Regulations

Credits

endarticle