Claiming the National Insurance long-term care benefit

01In brief: how do you claim the long-term care benefit?

The claim is submitted to the National Insurance Institute — Bituach Leumi — by the person themselves or by someone acting for them. In practice it has three parts: filing the claim form with current medical and functional documents, a dependency assessment carried out at the insured person's home, and a decision setting out whether entitlement was established and at what level.

It is worth understanding from the start that the care benefit is a public route, entirely separate from a long-term care insurance claim against an insurer or a health fund. The two are assessed under different rules, so a family may qualify under one and not the other — and it is often worth checking both in parallel.

Conditions, levels and amounts are updated periodically. Always check the binding figure on the National Insurance site at the time you apply, rather than relying on a table or a sum from an older article.

02The care benefit versus private insurance: a difference worth knowing

One of the most common confusions is assuming these are the same thing. The care benefit is granted under the National Insurance Law and assessed against public eligibility rules, including age, residence, an income test 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, assessed against the definition written into that policy.

The practical consequence is that recognition by National Insurance does not bind an insurer, and a refusal by National Insurance does not close the door on a policy. Each body examines the file under its own rules, and the definitions can differ materially.

There is, however, real overlap: the material gathered for one route — medical records, a functional description, details of the help needed — is usually relevant to the other. So it is worth building one organised file and using it for both, adapting it to each body's forms and requirements.

• Care benefit — National Insurance, under statute and public eligibility rules
• Long-term care insurance — an insurer or health fund, under the policy wording
• Recognition on one route does not guarantee recognition on the other
• Both routes can be pursued in parallel
• The documents and functional description generally serve both

03Who can claim the care benefit?

Eligibility is assessed against several cumulative conditions published on the National Insurance site. Broadly, these cover the applicant's age, Israeli residency, where they actually live, their level of income, and the extent to which they depend on another person to carry out daily activities or need supervision to prevent danger.

The claim may be submitted by the person themselves, by a family member, by a guardian or by an attorney. Where a family member is acting on the insured person's behalf, check in advance which authorisation documents are required, so the claim does not stall on a technicality.

Someone living in a nursing institution, or receiving other forms of assistance, may be subject to special rules. In any borderline case it is better to clarify with National Insurance in advance rather than assume the position is the same as for another family you know.

04Which forms and documents do you prepare?

The official claim form for the care benefit is available on the National Insurance site, and can be submitted online, at a branch, or by the other routes published there. Always download the current form from the official source — old forms saved on a computer or circulating online may no longer be valid.

Alongside the form you attach material explaining the situation. A good medical document for a care claim is not necessarily the longest one: it is the one that describes not only the diagnosis but its functional consequence for daily life.

• The care benefit claim form, completed and signed as instructed
• Current medical records from the treating doctor or clinic
• Hospital or discharge summaries, where relevant admissions occurred
• A factual description of help needed with washing, dressing, mobility, eating and continence
• Documentation of cognitive decline or a need for supervision, where present
• Bank account details for payment, through the official channel only
• Power of attorney or guardianship papers, if someone is acting for the insured person

05The dependency assessment: what happens at the visit

At some point after the claim is filed, a dependency assessment is arranged — an examination usually carried out at the insured person's home by a professional on behalf of National Insurance. Its purpose is to establish how far the person depends on the help of others in daily activities, and to what extent supervision is needed to prevent danger to them or to those around them.

This is usually the stage that most influences the outcome, so it deserves to be taken seriously — and honestly. The assessment is meant to record an ordinary day, not an exceptional moment of effort and not a picture worse than reality. Either distortion damages the accuracy of the file.

A common mistake is that the person being assessed makes an effort to appear independent out of pride or embarrassment, and the picture recorded does not reflect what happens on most days. It is therefore advisable that a family member or carer who knows the routine is present and able to fill in the facts, in line with how the assessment is conducted.

• Think through an ordinary day in advance: who helps, when, and with what
• Be ready to describe frequency — "every day", "a few times a week", not "sometimes"
• Point to what happens without help: falls, skipped showers, medication not taken
• Show the aids in use — walking frame, shower chair, adjustable bed
• Do not hide difficulty out of embarrassment, and do not overstate it

06Benefit levels and what they determine

After the assessment a level of entitlement is set. It reflects the degree of dependence found, and it is what determines the scope of assistance — whether that is hours of personal care at home, incontinence supplies, an emergency alarm, a day centre, or other components set out in the current rules.

Some recipients have the option of choosing between a basket of services and receiving part of the benefit in money, subject to conditions and limits. The options and rates change over the years, which is precisely why you should not rely on older information here.

If the level set is lower than the family feels matches the situation, you can examine the assessment report, see what was recorded in each domain, and consider a reasoned approach or a request for reassessment — particularly if the medical documentation was incomplete at the time of the visit.

07Timelines, the decision, and what to do after a refusal

How long the claim takes varies with how complete the documents are, when the assessment is carried out, and the caseload. Once the decision arrives, read the letter in full: what was determined, from what date, for what period, and on the basis of what information.

If the claim was refused, or the level set does not match the situation, there are routes of appeal and deadlines for lodging an objection. Those deadlines are not flexible, so do not put the letter aside and return to it months later. Even where you decide not to act, it is better that the decision follows from understanding the position rather than from a missed date.

An effective approach focuses on the point in dispute: what was recorded in the assessment, what actually happens at home, and which document supports that. Flooding the file with unrelated material does not improve the prospects and often lengthens the review.

08Deterioration and a repeat claim

A functional condition is not static. Someone who was refused, or given a low level, can apply again for reassessment when a real change occurs. The critical point is that the change must be documented: a new medical record, an admission, a fall, a cognitive assessment, or an increase in the help provided at home.

A repeat claim resting on the same documents submitted last time is likely to produce the same result. So gather up-to-date documentation before making the fresh approach, not alongside it.

09How this connects to a long-term care insurance claim

Many families discover only at a late stage that a long-term care policy also exists — private or through the health fund — which was never examined. Even where National Insurance has already recognised entitlement, that is a separate process requiring its own claim form and assessment against the definition in the policy.

Conversely, a refusal by National Insurance is not a conclusion about the policy. There are cases where the contractual definition differs from the public test, so it is worth reading the policy wording before giving up.

Pele Yoetz guides families through checking the insurance cover, organising the material and presenting daily function factually to the insurer. The service does not guarantee approval, does not determine entitlement and is not legal or medical advice.