A guide to claiming long-term care insurance as a Clalit member: locating the policy and the insurer, preparing documents, describing ADL, filing, following up and reading the decision.
In brief: how do you start a Clalit long-term care claim?
Start by identifying the policy and the body administering the cover in the relevant period, download the claim form from the official source, and only then gather medical and functional documents. Terms of cover can differ between periods and arrangements, so do not rely on someone else's policy or on a general figure found online.
Clalit's official page is the entry point for current forms and instructions. Keep a copy of everything and proof of delivery, and check that each document has been recorded against the correct claim.
Identifying the policy and the right insurer
Long-term care cover through a health fund is group cover. The insuring body, the forms and the applicable terms are determined by the arrangement and the period that apply to the insured person.
Locate the insurance certificate, policy number, joining date and the name of the company handling the claim. If the information is unclear, check the personal area, the documents sent to the insured person, or Har HaBituach — and do not send a medical file before you know who it is going to.
- The insured person's name and policy number, if known
- The period during which the cover was in force
- The name of the body handling the claim
- The current form matching that cover
- Contact details for someone who knows the daily routine at home
Which documents do you prepare?
An effective file is not necessarily the longest one. It has to connect the medical background to the help or supervision actually needed day to day.
Read the list of requirements on the official form and attach current, legible, relevant material. Do not send medical documents, an identity number or detailed medical information through the enquiry form on the Pele Yoetz site.
- A claim form completed and signed as instructed
- A current medical summary and records relating to the condition
- A factual description of help with washing, dressing, transfers, mobility, eating or continence
- Documentation of cognitive decline and any need for supervision, where relevant
- Representation or authorisation papers if a family member is acting for the insured person
- A full copy and proof of delivery of everything sent
What matters in describing ADL and cognitive incapacity
A medical diagnosis does not always describe function. State what the person does alone, where help is needed, who provides it, how often, and what the risk is when there is none.
For a cognitive condition, describe examples that recur in ordinary life: difficulty orienting, unsafe use of medicines or appliances, leaving the house without being able to return, and needing someone present to prevent danger. Do not amplify a difficulty that does not exist, and do not play one down out of embarrassment.
How to file and keep proof
Use the filing channel set out in the current instructions from Clalit and the insuring body. Before sending, give each file a clear name, check it is legible, and keep a file identical to the one submitted.
After filing, keep the reference or claim number, the date and the confirmation of receipt. If a request for further documents arrives, compare it against what has already been sent and answer precisely, within the deadline given.
What happens after the claim is filed
Further documents may be requested, or a functional assessment arranged. The purpose of the assessment is to understand ordinary function, so it helps if someone who knows the routine is available, in line with how the examination is conducted.
When a decision arrives, read the whole letter: what was recognised, from what date, under which definition and for how long. A partial approval or a refusal should be checked against the policy, the documents and the assessment before you decide how to respond.
Mistakes that recur in claims by Clalit members
The first is assuming the name "Clalit Mushlam" tells you about the long-term care cover. The fund's supplementary services and long-term care insurance are not the same thing, and they may be administered by different bodies on different forms.
The second is overlooking parallel cover. A Clalit member may also hold a private long-term care policy bought years ago, sometimes on more favourable terms. Checking Har HaBituach before filing saves a late discovery.
The third is filing with a general functional description. A document listing diagnoses does not explain what happens at home — and in long-term care claims that is precisely what is assessed.
- Do not assume the product name tells you what the cover is
- Check whether a parallel private policy also exists
- Make sure the form matches the correct insuring body
- Describe function with examples and frequency, not in general terms
- Keep proof of delivery and a claim number for every approach
Frequently asked questions
Are Clalit Mushlam and long-term care insurance the same thing?
Not necessarily. The fund's supplementary services and long-term care insurance are different arrangements, which may be administered by different bodies on different forms. Check the joining documents and the specific policy.
How do you activate Clalit long-term care cover?
Locate the policy and its number, download the current claim form from the official source, attach medical records and a functional description, and file through the channel set out in the instructions. Keep proof of delivery and a claim number.
Is Clalit's long-term care cover for life?
The duration of cover and of benefit payments is set in the document that applies to the insured person and varies between arrangements and periods. Do not rely on general marketing wording without reading the policy itself.
What does Clalit long-term care cover cost and how much is paid?
The premium and the benefit vary with the arrangement, the age at joining and the policy terms, and they are updated. Check the binding figure in the official documents or with the insuring body.
Which claim form do we need to complete?
The current form of the body that administers long-term care cover for members of the fund, as it appears on the official page. An old form saved on a computer may be out of date and delay handling.
Does recognition by National Insurance guarantee approval by Clalit?
No. These are separate routes. The National Insurance decision is a relevant document that can support the picture, but the insurance claim is assessed against the definition in the policy.
What if we cannot find the long-term care policy details?
Check the fund's personal area, documents sent over the years, and the Har HaBituach registry of the Capital Market, Insurance and Savings Authority. Do not send medical records before it is clear which body is handling the claim.
Can we claim years after the condition began?
It may be possible, but dates matter — both for prescription and for the period a benefit is assessed for. So do not delay the check, and document when the condition began.
Official sources for further checking
This is general information and does not replace personal medical, legal or insurance advice. Eligibility is determined by the documents and rules that apply to each case.
