- Request for Reexamination of a Recipient as the Result of Worsening Condition on the National Insurance Institute website
Long-Term Care Benefit recipients that are not the highest benefit level, that have worsened conditions, may submit a request to be reevaluated and receive a benefit increase.
- The process for receiving the benefit is described in the following chart.
by the claim clerk
or a permanent benefit at one of the Long-Term Care Benefit levels
Rejection of the claim
Target Audience and Prerequisites
- Someone suffering from a deteriorating condition after eligibility for a Long-Term Care Benefit of level 1, 2, 3, 4 or 5 was determined for them (or those receiving Level A or Level B before November 2018).
- The request can be submitted by another person representing the insured (Like a family member, legal guardian, social worker or nurse).
- Applicants aged 90 and over who are interested in being reevaluated, can undergo a dependency examination by a geriatric specialist that will come to their home. In order to do this they need to contact the doctor before submitting the reevaluation claim. For additional information click here.
To Whom and How to Apply
- A Request for Reexamination of a Recipient as the Result of Worsening Condition should be submitted.
- The following documents should be attached to the request form:
- A print out of the patient's medical information (summary of the medical file included diagnoses and medications) signed by the treating doctor.
- If the applicant was hospitalized in the three months prior to submitting the request then a hospitalization summary should be included.
- The form can submitted to your local National Insurance Institute branch.
- The form can also be submitted through the mail, fax, or branch box or by using the online form.
- After filing a claim, the National Insurance Institute will coordinate a time to conduct the in-home dependency examination. See ADL Dependence Test
- The National Insurance Institute has a advice service for the elderly to explain and assist in filling out forms. Click here for more information.
- Reevaluation requests submitted from 01.08.2018 and on:
- The scope of the long-term care benefit will not be decreased and eligibility for the benefit will not be denied because of a new test.
- If there is a changed in the scope of the long-term care benefit as a result of the new test, it will come into effect 7 days after the request for reevaluation was submitted.
- The National Insurance Institute may initiate a re-examination of eligible persons provided that six months have passed since the person's level of dependency was previously determined.
- The benefit amount will be increased within 7 days from when the recipient's request for re-examination was submitted or within 7 days from the re-examination if it was initiated by the National Insurance Institute
- In any case the scope of the long-term care benefit will not be decreased and eligibility for the benefit will not be denied because of a new test.
- Appeals committees must be established for denied Long-Term Care Benefit claims
- Living in a nursing home is not grounds for losing Long-Term Care Benefit eligibility
- 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
Laws and Regulations
- The National Insurance Law - Section J (Long-Term Care Insurance).
- National Insurance Regulations (Long-Term Care Insurance) (Reevaluation of Dependency Level of Long-Term Care Benefit Recepients) 1988
- Original information on this page was written as part of the Welfare Division, City of Jerusalem's Senior Citizens' Rights Accessibility Project, funded by The Mashov Organization.
- English translation and maintenance by The Shira Pransky Project.