Eligibility for a Long-Term Care Benefit is established based on the policyholder's ability to perform daily activities or on the degree of his/her need for supervision.
- The general process to claim the benefit is shown in the following diagram:
by the claim clerk
or a permanent benefit at one of the Long-Term Care Benefit levels
Rejection of the claim
- Eligibility for a temporary long-term care benefit (for a period up to 60 days) is given when the person's ability to function is expected to significantly improve.
Who is Eligible?
- A Long-Term Care benefit is paid to those who meet all of the following conditions:
- This is the first time he/she is granted a long-term care benefit.
- He/she does not suffer from mental, intellectual or cognitive disabilities.
- He/she depends significantly on another person to perform most daily functions (i.e. he/she meets the conditions to receive a Level 1 long-term care benefit).
- The patient's doctor signs the appropriate form stating that the patient suffers from a temporary disability that should not continue for over 2 months.
How to Claim It?
- A Long-Term Benefit Claim should be submitted along with a professional medical opinion stating the need for temporary long term care.
- Someone who is hospitalized can submit the claim form through the hospital social worker.
- In accordance with the National Insurance Institute Circular, a claim in which detailed medical documents are provided it is possible to fast-track eligibility for the benefit based on the documents alone without the need for a dependency test in the person's home.
Continuing the Process
Policyholders Age 80 and Above
- Those age 80 and above that were granted a temporary benefit have the right to have their eligibility checked again (through a National Insurance Institute initiative) towards they end of the temporary eligibility period.
Policyholders Under Age 80
- For those who are not yet 80 as of the month that their temporary eligibility for a long-term care benefit begins, the benefit will automatically end when the period of eligibility ends without performance of a dependency test, unless the person asks to be checked.
- The message the policyholder receives granting his/her temporary eligibility (and the reminder sent approximately two months before the period ends) notes that the benefit ends automatically without any further assessment unless the person requests a dependency test.
- The temporary benefit will stop automatically for anyone who does not request to be tested.
- Anyone who wants to have an additional dependency test performed on them may contact their National Insurance Institute branch by:
- Faxing the branch's long-term care department.
- Calling the Senior Citizen Advice Center that will pass the request onto the long-term care branch.
- It is recommended to submit the request approximately a month before the temporary eligibility is scheduled to end.
- One who submits the request up to two weeks after the temporary eligibility ends will have someone sent to his/her house to check him/her. If he/she is eligible, the benefit will continue without a break.
- One who submits the request between two weeks and a month after the temporary edibility ends and the dependency tests determines that he/she is eligible for a long-term care benefit, will begin receiving the benefit from the 1st of the month after submitting the request.
- If more than a month has passed since the period of temporary eligibility ended, a new long-term care benefit claim should be submitted.
- National Insurance Institute's Senior Citizen Guidance Service
- Segula Unit - Center to Help Hospitalized Senior Citizens
- Free Aid by the National Insurance Institute for Hospitalized Patients Filing Disability Claims
- Click here for a comprehensive listing of health-related assistance organizations
- Click here for a comprehensive listing of organizations that help senior citizens and the elderly
- Click here for a comprehensive listing of organizations that help people with disabilities
|Government Agency||Website||Rights and Areas of Responsibility|
|The National Insurance Institutehotlines -||Senior Citizens' Rights on the National Insurance Institute's website.||Rights to various allowances given based on age and economic situation.|
|The National Insurance Institute's Call Center for Senior Citizen Counseling Serviceshotline -||Senior Citizens' Rights on the National Insurance Institute's website.||Free aid provided through counseling services for senior citizens and the call center for senior citizens and their families.|
|*8840 Ministry for Social Equality - Hotline for Public Inquiries||Ministry for Social Equality website||The hotline run by the Ministry for Social Equality gives the elderly a central address to direct all of their questions, provide information regarding rights, services and benefits entitled to the elderly. It also helps them actualize these rights.|
|Segula Unit - Hotline to help senior citizens in the hospital||The Ministry for Social Equality||A health hotline for senior citizens, to assist them and their families know their rights during the period of hospitalization.|
|The Ministry of Labor, Social Affairs and Social Services
||Senior Citizens on the Ministry of Labor, Social Affairs and Social Services website||Funding of Nursing Homes for independent and frail seniors. Various services are also provided within the community.|
|The Ministry of Health||Senior Health on the Ministry of Health website.||Health Insurance and assistance for those suffering from age related health problems.|
|*5442 The Ministry of Housing and Construction Call Center||The Ministry of Construction and Housing website||Housing Assistance and Problem Solving for Senior Citizens|
Laws and Regulations
- The National Insurance Law - Section 230a
- The National Insurance Regulations (Long-Term Care Insurance) (Temporary Disability), 5760 - 2000
- The Long-Term Care Circular no. 1395 - Determining temporary disability based on medical documents (fast-track)
- The Long-Term Care Circular no. 1434 - End of temporary eligibility]
- Establishing Temporary Disability Based on Medical Documents (Fast-Track) - National Insurance Institute guidelines for local committee members
- English translation and maintenance by The Shira Pransky Project.