Introduction:

Long-Term Care benefit recipients of level 1, 2, 3, 4 or 5 benefits (and those receiving Level A or Level B benefits according to the old law), whose condition worsened, may submit a request to be reevaluated and receive a benefit increase.
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, claims submitted for reevaluation can not negatively impact the eligibility or amount of the long-term care benefit

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.
ADL Dependence Test
for the applicability of the
Conditions of Eligibility
Determining Dependence Level
by the claim clerk
Approval of a Temporary Benefit
or permanent benefit at level
A / B / C
or
Rejection of the claim
If the condition has deteriorated of a benefit recipient at level A or B
it is possible to request reassessment

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 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 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.


Please Note

  • 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.

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