On the care benefit? An insurer may owe you too

01The short answer: yes, and they are entirely separate tracks

Receiving the long-term care benefit from the National Insurance Institute does not prevent you from receiving a payout from a long-term care insurance policy, and the reverse is equally true. These are two different tracks, examined by different bodies, under different rules and on separate forms.

The care benefit is granted under the National Insurance Law and assessed against public eligibility rules: age, residency, income and the degree of dependence on another person. Long-term care insurance is a contract — a private policy or group cover through a health fund (kupat holim) — assessed against the definition written into it.

In practice this means a person may qualify under both, under only one, or under neither. The clear recommendation is therefore to check both, and never to infer the outcome of one from the result of the other.

02Does one offset the other?

This is the question that worries families most, and it is a fair one. The general answer is that these are entirely different sources of payment — one statutory, one contractual — so there is no automatic offset of the kind that occurs between two benefits paid by the same body.

There is, however, one point worth watching. Where the policy is an indemnity policy, meaning payment is tied to proven expenditure, the insurer may examine what is already covered from another source. In a fixed-sum policy, which pays a set amount, that question generally does not arise in the same way.

So we return to the same principle: everything depends on the policy wording. This is one of the reasons to read the document before making assumptions — and not to rely on what a neighbour or relative says about their own policy.

03Why National Insurance approval is not enough for the insurer

Many families arrive with an entirely reasonable expectation: National Insurance examined the case, carried out an assessment at home and determined that dependence exists — so why must the insurer examine it again?

The answer lies in the difference between a statute and a contract. National Insurance applies a uniform dependency assessment to every claimant. An insurer is bound by the definition written into the policy, and that definition may differ — for instance in requiring a specific number of activities the person cannot perform, or in how precisely it defines "unable to perform".

It is therefore entirely possible for someone to be recognised at a high level by National Insurance and still not meet the contractual definition — and equally possible for the opposite to occur. These are not contradictions; they are two different tests.

04How to use the National Insurance decision properly

The fact that the decision is not binding does not make it worthless — quite the opposite. It is one of the strongest documents you can attach to a claim, and many people fail to use it well.

The decision records a professional assessment carried out in the insured person's home, on a specific date, by an authorised assessor. It establishes both the condition and the date — and both matter, particularly when you need to show when the care condition began.

Beyond the decision itself, it is worth requesting the detailed dependency assessment report from National Insurance. It contains a breakdown by functional domain — precisely the information relevant to the insurer — rather than only the bottom line.

• Attach the decision letter stating eligibility and the level determined
• Request the detailed dependency assessment report, not only the decision
• Note the date of the assessment — it establishes when the condition existed
• Check that the description in the report matches what was given to the insurer
• Do not rely on the decision alone without medical and functional documents

05The reverse situation: you were refused by National Insurance

Families refused by National Insurance sometimes conclude there is no point approaching an insurer. That conclusion is mistaken, and it can be expensive.

The National Insurance dependency test also includes threshold conditions that are not functional at all — age, income, place of residence. Someone refused on an income test, for example, was not refused for functional reasons, and the policy definition may be satisfied in full.

Even where the refusal was functional, the policy definition is different. The right step after a National Insurance refusal is to read the stated reason, understand precisely what was not met, and only then decide about the insurance track.

06What to do in practice

The great advantage of filing both in parallel is that the material overlaps to a large degree. A functional description, medical documents and evidence of the help provided at home serve both tracks, even though the forms differ.

The sensible approach is therefore to build one well-organised file and adapt it to each body. That saves time and prevents a situation where the two tracks receive different descriptions — a discrepancy that can prove costly if anyone compares them.