m (Text replacement - "גיל פרישה מהעבודה" to "גיל פרישה מעבודה")
אסף מלין (talk | contribs)
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**A hospitalization summary - for one who has been admitted to the hospital within the 3 months before filing the claim.
 
**A hospitalization summary - for one who has been admitted to the hospital within the 3 months before filing the claim.
 
** Proof (as explained on the [https://www.btl.gov.il/%D7%98%D7%A4%D7%A1%D7%99%D7%9D%20%D7%95%D7%90%D7%99%D7%A9%D7%95%D7%A8%D7%99%D7%9D/Documents/T2600.pdf#page=4 claim form]) of income for three of the four months preceding the month in which the claim is submitted must be attached to the claim form, not including pensions paid by the National Insurance Institute or pensions paid for those persecuted by the Nazis.
 
** Proof (as explained on the [https://www.btl.gov.il/%D7%98%D7%A4%D7%A1%D7%99%D7%9D%20%D7%95%D7%90%D7%99%D7%A9%D7%95%D7%A8%D7%99%D7%9D/Documents/T2600.pdf#page=4 claim form]) of income for three of the four months preceding the month in which the claim is submitted must be attached to the claim form, not including pensions paid by the National Insurance Institute or pensions paid for those persecuted by the Nazis.
**Letter waving medical confidentiality - One must print, sgn andd attach to the online form a [https://www.btl.gov.il/%D7%98%D7%A4%D7%A1%D7%99%D7%9D%20%D7%95%D7%90%D7%99%D7%A9%D7%95%D7%A8%D7%99%D7%9D/Documents/T2600-VASAR.pdf form waving medical confidentiality] or sign on the waiver at the end of the printed claim form.  
+
**Letter waving medical confidentiality - One must print, sign and attach to the online form a [https://www.btl.gov.il/%D7%98%D7%A4%D7%A1%D7%99%D7%9D%20%D7%95%D7%90%D7%99%D7%A9%D7%95%D7%A8%D7%99%D7%9D/Documents/T2600-VASAR.pdf form waving medical confidentiality] or sign on the waiver at the end of the printed claim form.  
 
** If the claimant suffers from cognitive decline, it is advisable to attach a diagnosis from a geriatrician or psychogeriatrician.
 
** If the claimant suffers from cognitive decline, it is advisable to attach a diagnosis from a geriatrician or psychogeriatrician.
 
**Those age 90 and up that chose to be [[:he:בדיקת תפקוד על ידי רופא גריאטר לקביעת זכאות לגמלת סיעוד לבני 90 ומעלה|checked by a geriatric doctor]] instead of an assessor should include the signed form from the public doctor who completed the exam; on the [https://www.btl.gov.il/%D7%98%D7%A4%D7%A1%D7%99%D7%9D%20%D7%95%D7%90%D7%99%D7%A9%D7%95%D7%A8%D7%99%D7%9D/Documents/T2600-NISPAH2.pdf functionality assessment form] on the online claim form or on appendix b on the printed claim form.
 
**Those age 90 and up that chose to be [[:he:בדיקת תפקוד על ידי רופא גריאטר לקביעת זכאות לגמלת סיעוד לבני 90 ומעלה|checked by a geriatric doctor]] instead of an assessor should include the signed form from the public doctor who completed the exam; on the [https://www.btl.gov.il/%D7%98%D7%A4%D7%A1%D7%99%D7%9D%20%D7%95%D7%90%D7%99%D7%A9%D7%95%D7%A8%D7%99%D7%9D/Documents/T2600-NISPAH2.pdf functionality assessment form] on the online claim form or on appendix b on the printed claim form.

Latest revision as of 18:37, 9 September 2019

Introduction:

The Long-Term Care Benefit is given to people who have reached retirement age, live at home in the community, and need help with daily activities.
Beginning in May 2017, claims for the Long-Term Cae Benefit can be claimed for people about to undergo surgery or people who are hospitalized - during their period of hospitalization (for more information see below
It is possible to immediately receive advance support services, until the claim has been processed

Forms

The Long-Term Care Benefit may be claimed by people who have reached retirement age, live at home in the community, and need help with daily activities, or by their representatives.

Tip
There are various organizations that offer aid during the various stages of submitting a long term benefit claim (see the aid organizations section below).
  • The process for receiving the benefit is described in the following chart. The stages that follow after submitting the claim are described in the table further below.
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

Stages of the Process

  • A Long-Term Care Benefit Claim Form must be filled out. The Counseling Service for the Elderly at any National Insurance Institute branch may be contacted for help understanding the benefit and filling out relevant forms.
  • A claim form may be submitted in the following ways:
    • Online - By filling out and submitting the online claim form and attaching the necessary documents (listed below) to it (pictures of the documents can be taken on a smartphone or they can be scanned).
    • Printing, manually filling in and submitting the claim - one should print and fill out the Long-Term Care Benefit claim form and should submit it with the accompanying documents to his/her local National Insurance Institute branch. The form and documents may be sent in the mail, by fax or left in the service box of the branch.
  • The following documents must be attached to the form:
    • A medical information printout from the health fund (medical file summary, diagnoses and medications) signed by a physician or nurse, or (according to this directive) a printout from the claimant's personal account on the health fund website.
    • A hospitalization summary - for one who has been admitted to the hospital within the 3 months before filing the claim.
    • Proof (as explained on the claim form) of income for three of the four months preceding the month in which the claim is submitted must be attached to the claim form, not including pensions paid by the National Insurance Institute or pensions paid for those persecuted by the Nazis.
    • Letter waving medical confidentiality - One must print, sign and attach to the online form a form waving medical confidentiality or sign on the waiver at the end of the printed claim form.
    • If the claimant suffers from cognitive decline, it is advisable to attach a diagnosis from a geriatrician or psychogeriatrician.
    • Those age 90 and up that chose to be checked by a geriatric doctor instead of an assessor should include the signed form from the public doctor who completed the exam; on the functionality assessment form on the online claim form or on appendix b on the printed claim form.
    • There is the option (not obligation) to add additional information from the kupat cholim nurse or the social worker that deals with the applicant in the welfare department. This can be done on the long term care eligibility information form for online claims and on appendix a on the printed claim form.
    • If the claimant lives in a nursing home or facility, a form filled out by the nursing home or facility administration must be attached to the claim. This is done on the proof of residence in a nursing home or facility form for online claims or in section 9 of the printed claim form.
  • Assistance in the process of submitting a claim can be received from many different places (see the aid organizations section below).


Submitting a Claim before Surgery or During Hospitalization

  • Beginning from 21.05.2017, a Long-Term Care claim can be submitted by someone who is about to undergo surgery or by someone who is hospitalized - during his/her period of hospitalization.

Submitting a Claim Before Surgery

  • One is going to be hospitalized because of a planned surgery may submit a claim in the month before the surgery date.
  • Eligibility, including the income test will be determined without having to wait until the applicant is discharged.
  • The applicant is asked to send the National Insurance Institute an interim summary or a discharge summary as soon as he/she receives it (in this case there isn't the requirement to present a medical print out like there is in a regular claim).
  • If eligibility for the benefit can be established based on medical documentation alone then eligibility will be established through the fast track without a dependency test.
  • The benefit begins (for those who are eligible):
    • Regular eligibility begins on the 8th day after submitting the claim or on the day of hospitalization; the latter of the two dates.
    • Fast-track eligibility begins on the day of hospitalization.
Example
  • Someone who submits a claim 10 days before being hospitalized; regular eligibility is established from the day of hospitalization.
  • Someone who submits a claim 5 days before being hospitalized; regular eligibility is established on the 8th day after submitting the claim (3 days after hospitalization).
  • In both cases (submitting the claim 10 days or 5 days before being hospitalized), fast track eligibility is established from the day of hospitalization.
  • If eligibility can not be determined through the fast track, a dependency assessor should be sent to the house of the applicant as soon as possible after the applicant is released from the hospital.
  • In event that the claim is submitted more than a month before the surgery:
    • If the applicant is interested, a dependency test can be done before the surgery.
    • If the applicant wants his/her eligibility to be assessed after the surgery, the claim will be handled in the month before the surgery.
  • In a case that 90 days have passed since the beginning of the hospitalization, and the discharge date is still unknown; the claim will be rejected.
  • Submitting a Claim During a Period of Hospitalization

    • One who is hospitalized may submit a claim during his/her period of hospitalization.
    • The applicant is asked to provide the National Insurance Institute with n interim summary or a discharge summary when he/she receives it.
    • If eligibility for the benefit can be established based on medical documentation alone then eligibility will be established through the fast track without a dependency test.
    • The benefit begins (for those who are eligible):
      • Regular eligibility begins on the 8th day after submitting the claim.
      • Fast-track eligibility begins on the day the claim is submitted.
    • One who remains hospitalized for over 30 days, will have his/her claim handled in accordance with the guidelines set forth for a Long-Term Care Benefit During Hospitalization.
    • If eligibility can not be determined through the fast track, a dependency assessor should be sent to the house of the applicant as soon as possible after the applicant is released from the hospital (the home visit can be postponed up to 3 days after discharge).


    Continuing the Process

    What Now? For More Information Notes
    If the applicant meets the basic conditions of eligibility and is eligible for a benefit (full or 50% based on income level), an assessor will come to the applicant's house to perform a dependency test.
    • In certain cases benefit eligibility can be established by a "fast track", through medical documentation only.
    • There is an option to immediately receive "Pre-Care" services until the claim process is completed.
    • If the applicant's functioning is expected to improve he/she will most probably be issued a Temporary Long-Term Care Benefit without requiring a dependency test.
    The claim's clerk will put together a summary of the information and decide whether the applicant is eligible for a long-term care benefit.

    Points Calculation to Determine Eligibility for a Long-Term Care Benefit

    For those entitled to a benefit, it will be determined if the benefit should be temporary or permanent and what the benefit rate should be - Level 1, Level 2, Level 3, Level 4, Level 5, Level 6.

    Receiving the decision and the start of eligibility

    The National Insurance Institute decision will be sent in the mail after the assessor visits the applicant's home.

    Eligibility for the benefit begins 7 days from the day that the benefit claim was submitted.

    If benefit eligibility is approved a social worker or health fund nurse will visit the applicant's house to check what long-term care services are needed by the applicant. A local committee will decide what services will be given based on this assessment.

    Local Professional Committee to Establish the Services Included in the Long-Term Care Benefit

    The decision of the local professional committee may be appealed.
    If you are not satisfied with the decision made as a result of the dependency test (in the case where the claim is rejected or the benefit level is too low), you can appeal to the appeals committee. Appealing a Decision Regarding Level of Dependency for Long-Term Care Benefit Applicants You may appeal the decision of the appeals committee to the district labor courts.
    If you are interested in a appealing a decision given that is not connected to the dependency test (for example the income test), an appeal may be submitted to the district labor court. Appealing a National Insurance Institute Long-Term Care Benefit Decision
    If there is a deterioration in the functioning of a person who is eligible for long-term care benefit lower than Level 6, , he/she may submit a request to increase the level of the benefit. Updating Long-Term Care Benefit Level Due to Worsening Condition Eligibility begins on the 1st of the month after the date that the request to reexamine was submitted (or on the 1st of the month after the date of hospitalization, the latter of the two dates - for those who submitted a claim for a reexamination during, or right before being hospitalized).


    Court Rulings

    Aid Organizations

    Government Agencies

    Government Agency Website Rights and Areas of Responsibility
    *6050 hotlines - The National Insurance Institute Senior Citizens' Rights on the National Insurance Institute's website. Rights to various allowances given based on age and economic situation.
    *9696 hotline - The National Insurance Institute's Call Center for Senior Citizen Counseling Services 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 *8840 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

    Shil - Citizens Advice Service hotline - 118

    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

    *5400 "Kol HaBriut" Ministry of Health Hotline

    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


    Credits