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Sharap 101

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Note: This post is specifically about Hadassah Hospital’s Sharap service. Other private and non-profit hospitals in Israel offer similar services.

If you are dealing with specialists or procedures in the Jerusalem area, you should know about Sharap.

Sharap is the private health services associated with Hadassah Hospitals that enables patients to select the senior physician who will treat them, both for the outpatient clinics and for surgery and hospitalization at Hadassah. Sharap can also be arranged to obtain more timely clinic appointments or procedure scheduling as well as access to preferred laboratories, imaging equipment, and operating theaters.

According to Hadassah’s website, Sharap services also make accessible medical treatment in all medical fields, “second opinion” consulting, and legal medical opinions for use in court or for the medical committees of the National Insurance Institute, Ministry of Defense, Ministry of Health, etc.

Sharap is a private, paid service, however your Kupat Cholim’s supplemental plan may include reimbursement, sometimes as much as 90%. Speak to your kupah first to find out what the policy is for your plan.

Sharap Hadassah Ein Kerem
Location: Hospital entrance level.
Hours of operation: Sunday – Thursday, 8:00 AM to 7:00 PM
Fridays, 8:00 AM to 12:00 noon.
Telephone: 02-6778899
Fax: 02-6776600

Sharap Hadassah Mt. Scopus
Location: Hospital entrance level.
Hours of operation: Sunday – Thursday, 12:30 PM to 8:00 PM
Telephone: 02-5844044
Fax: 02-5323307

Sharap Tel Aviv – 10 Dubnov St.
Location: 10 Dubnov St., Tel Aviv.
Hours of operation: Sunday – Thursday, 12:00 noon to 8:00 PM
Fridays, 8:00 AM to 12 noon
Telephone: 03-6955333
Fax: 03-6954433

English Websites and Publications for Each Kupat Cholim

It’s important to understand your kupat cholim. Getting familiar with your kupat cholim’s services and how to use them can save you time and money, or possibly make a difference in more important ways. Below are the links to the English sites for each Kupat Cholim, and you can also see our “Forms and Files” page to browse and download the English brochures and regulations that they have produced. Take a few moments to browse, and don’t stop until you’ve found out something you didn’t know:

Meuhedet- lang.meuhedet.co.il

Very simple sidebar navigation for English descriptions of all Meuhedet’s services, including PDF versions of their English pamphlets on supplemental insurance services and regulations.

Maccabi- maccabi4u.co.il/1781-he/Maccabi.aspx

Also simple navigation for good English descriptions, and downloadable PDFs. Plus, a handy summary of major points in the National Health Law.

Clalit- clalit-global.co.il/en/

Top navigation bar with drop down menus so it’s easy to navigate to very specific descriptions of services.

Leumit- leumit.co.il/eng/homepage.asp

Definitely the weakest English portal of the pack. Short lackluster descriptions and summaries of services. Tip- If you don’t see the sidebar navigation, try a different browser.

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Where to Turn: Social Workers

 

When you are struggling to navigate the system, just remember that Israel’s medical social workers serve the number one guidance function in the healthcare system here.


Guidance

Have you ever had a sit-down meeting with your Kupat Cholim social worker? Hospital social worker? Medical social workers are trained assistance professionals there to offer guidance when you need it. What kind of guidance?

  • Information about rights and services that relate specifically to a person’s circumstances, and practical guidance on acquiring them.
  • Practical insight, and some hand holding, on navigating the medical system, whether it be within the Kupat Cholim network,  in the hospital, or where the two overlap.
  • More practical insight and assistance with other bureaucratic institutions, like Bituach Leumi.
  • Help finding and connecting with organizations dedicated to particular conditions, where there may be even more resources of specific interest to you.
  • Help with emotional coping in difficult situations.

 

When to see a social worker

Make an appointment when you …

Feel like you’ve hit a brick wall. You’re trying to get a particular service from the Kupah and it’s not working out well. A decision was made and you need help appealing it.

Have an ongoing medical issue. There may be medical or social services you are unaware of, or specific organizations or government programs specifically dedicated to your circumstances.

 

Make sure the interaction is productive

A Few Tips:

  • Schedule a sit-down meeting and make sure there is enough time blocked out to discuss what you need.
  • Delegate tasks to accomplish your goals. Note the things you need to do (e.g. call this office, obtain these documents, etc.) and the things the social worker is committing to doing (e.g. calling that office, finding out about that service, getting ahold of those forms, etc.).
  • Schedule the next contact. e.g. The social worker will call you in two days with some more information on something, or you will meet again in a week to fill out forms together, etc.
  • Show your appreciation. Everyone in the healthcare sector chose to go into a profession dedicated to helping others. The social workers especially, did not do it for the glamour.

 

Okay, it’s not always peachy

Plenty of people have met with a social worker without productive results, or perhaps even had an unpleasant experience (I’m treading lightly here), but the thing is, guidance is a necessity in many circumstances. It shouldn’t be an option to resign oneself to fumbling around in the dark because the first match was a little soggy. Just like finding the right doctor, you can’t give up until you’ve found the social worker that you can communicate with and find the guidance you need. So just look for…

 

More Options

The first interaction with the kupah or hospital social worker may not have satisfied,  so try:

  • Another kupah or hospital social worker. Speak to a branch or department secretary and ask how you can arrange a meeting with another social worker, perhaps with better English…
  • Hadassah Kivunim. This is an admirable initiative in Hadassah Hospital, Ein Karem, where anyone, not just Hadassah patients, can access trained personnel for assessment of needs, assistance filling out forms and advice regarding benefits and services. Visit their offices, call 02-6777011 or email kivunim@hadassah.org.il.
  • The Shira Pransky Project has absolutely no pretensions of actually performing the functions of medical social workers, but we will try to help you find one if you’re having some trouble. Send us an email.

 

And remember

There are times when guidance in healthcare is absolutely necessary, and the medical social workers of Israel are at your service.

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5 Things To Know About Your Kupat Cholim

 

Leumit Logo

 

1. Your Branch Secretary is the Center of the Universe

If you need anything the Kupat Cholim offers and you want to know how to get it, ask the branch secretary. In practically every publication from the Kupah you are told to contact your local branch for clarifications about rights, permissions, required documents, payment authorizations, etc.
 
There are surrogates, of course. While away from home you can call the closest branch, and you can always call the Kupah’s 24 hour number. You can even directly access most of the information you need straight from the Directory of Services (Madrich Sherutim) or online. But really, learning the local secretary’s name and establishing some sort of rapport might be the most valuable investment in your wellbeing that you could make.
 
Also, remember you can just call to ask questions, or fax to transfer documents. You may get a small charge if the Kupah has to fax some document to or for you, but the hours saved in making the trip are probably worth it.
 

Finally, it’s usually not worth it to ‘sort of get’ crucial information, so if you need to, speak English. Most professionals know it, or can pass you on to someone who does. Besides, you’re about to learn the most essential vocabulary-

2. Two Words: Hafnaya and Hitchayvut

 

Always ask if you need either or both of these to get the service you need.

A Hafnaya (הפנייה) is a referral to a specialist or other medical  services, sometimes necessary for internal Kupah services, and very often necessary for services from other institutions.

A Hitchayvut (התחייבות) is a payment voucher from the Kupah, usually necessary for services, including tests and hospitalization, from other institutions. This payment voucher is also referred to as Form 17 (“Tofes Shva Esrei”), or a letter of financial obligation (“Tofes Hitchayvut”).  Click here to learn more about this important concept from a page we translated as part of our collaboration with Kol-Zchut.

3. Your Primary Doctor is the Center of your Galaxy

 
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Your primary doctor is the Kupah’s point man for your physical wellbeing. He/she should be the fount from which flows all (or most) referrals, prescriptions, and communiqués.

Got a prescription from a private specialist? Ask your doctor to reissue it as a Kupah prescription. Looking for lab results from blood work? They get sent to your doctor. Need to see a physical therapist? Ask for a referral from your doctor,  etc.

It’s true that you can find your own specialists and services in the Directory of Services, and many will not require a referral. Perhaps you don’t need to check with your primary care physician every time you want to see a dermatologist, but it’s important to keep in mind the Kupah’s point-man perspective when deciding a course of action.

You might even want to consider adopting the philosophy yourself. In many health related situations it’s important to have a professional to rely on with an eye on the big picture.

Not sure if the doctor you’ve got actually fits the bill for your ideal point-man? The Kupah won’t fuss if you change doctors after one calendar quarter. If you need a more immediate change, consult the branch secretary for advice.

Finally, keep in mind that if your doctor is not available, or you just want to see someone else for some reason, there are other options-

4. Round the Clock Service

Any time you’re in need when the Kupah is closed, or the timing is simply inconvenient, call the Kupah’s 24 hour number to check if the service can be sent to your door, or  where the closest emergency medical center is that you can walk into any time.

Despite the operating hours of local branches, the Kupot have admirably committed themselves to round the clock basic medical services like diagnosis and prescriptions, and sometimes even lab tests and imaging.
The Kupah has arrangements with emergency medical centers, like Terem, as well as house-call services, though the services offered by these institutions will vary, as well as the expected co-payment.

It’s worthwhile to know the capabilities of the closest emergency medical center for times when your need is not just a matter of convenience. In certain urgent situations you should go straight to the hospital or call an ambulance. Click here for information about coverage of ambulance costs from a page we translated as part of our collaboration with Kol-Zchut.

5. Knowing Your Insurance Plan is Totally Worth it


In the USA  “good health insurance” is so elusive (read: expensive) and coveted it’s almost mythical. Here it’s really quite cheap.

By law, the Kupot cover doctor visits, diagnostic and laboratory services, some paramedical services, medical equipment, rehabilitation, hospitalizations and many prescription medications. Still, what’s left out, and how these services are provided can sometimes feel restrictive.

Supplementary Insurance (Bituach Mashlim) plans cost an extra monthly membership fee but offer a much wider selection of medications, more opportunity for using private doctors and specialists, and more options and benefits in general. If you already have it, review your additional benefits, and remember to check with the Kupah before paying for any medical service out of pocket.

If you don’t already have a supplementary insurance plan but want to join, do it immediately. There may be a waiting period before all the extra benefits kick in, though the Kupah must accept you to their supplementary health insurance plans regardless of age or medical history. Different benefits also may have different waiting (qualification) periods. Click here for more information about supplementary health insurance on a page we translated as part of our collaboration with Kol-Zchut.

Bonus: Long term care insurance may also be worth it, though it’s a different beast all together. Worthy of a separate post found here.

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Bituach Leumi’s General Disability Program

Note:This information is intended to aid interactions with qualified social workers and other assistance professionals.

Disability applies to a person whose earning capacity, or household function as a homemaker, is significantly reduced due to disability. Children and individuals above the retirement age are not eligible for general disability, and should refer to the respective programs for their circumstances (such as Child Disability or Old Age Pension).
 
All of the details of Bituach Leumi’s General Disability program are available in English on the Bituach Leumi website. The following is a summary of the major details:

Establishing Disability Percentages

Pension rates and other benefits are based on two percentages:

Degree of medical disability: The applicant is examined by a medical committee at Bituach Leumi, except in certain cases when submitted documentation is sufficient, or a doctor will come to the patient.
Degree of incapacity to earn or to function in the household: A claims officer then establishes a second percentage to reflect the consequences of the specified conditions on the individual’s capacity to earn or function in the household.

Both the established percentage of medical disability and the degree of incapacity can be appealed.

Pension Rates

Partial Pension: starts at a 60% incapacity
Full Pension: starts at 75% incapacity (NIS 2,210 as of 01.01.2011)
Additional Increments: added for dependents

Working

While the pension may be reduced or replaced with an incentive pension, the total amount that a person will receive from the pension and employment will always be higher than the amount of the pension alone. An individual can also continue to receive fringe benefits such as discounts on municipal taxes, public transportation and rent assistance, in accordance with the rules established by the organizations that provide the benefits.

Submitting the Claim

Assistance from a medical social worker, or others familiar with the process, can be very useful in preparing the forms and accompanying documents, which include:

  • The claim form available on the Bituach Leumi website, from a medical social worker, or from Bituach Leumi offices
  • Medical documentation from the Kupat Cholim detailing chronic conditions, treatments and medications
  • Diagnostic summaries (and any other medical support for the claim)
  • Certification of employment and salary, if applicable

Start of Entitlement

Entitlement to a pension begins 90 days after the onset of the medical conditions that are responsible for the disability, regardless of when the claim is submitted, but the pension can only be paid retroactively for up to a year.

Additional Benefits

The other Bituach Leumi programs and benefits from other government institutions are discussed separately; however, the following additional benefits are highlighted specifically along with the disability program:

Vocational Rehabilitation

Individuals with a medical disability of at least 20% are also entitled to vocational rehabilitation, which includes reimbursement of tuition fees and other expenses, even if their percentage of incapacity does not qualify them for a pension. Accessibility services for those with severe disabilities that limit access to studies and to work, and job placement services that specialize in placing people with disabilities, are also available.

Disability Certificate

All recipients of a disability pension receive a disability certificate by mail that enables one to receive discounts from various bodies, such as entrance fees to private and public institutions, as determined by the bodies that grant them.

Grant Following Decease

The spouse or child of a deceased recipient of disability pension is entitled to a one-time grant (NIS 8,260 as of 01.01.2011) upon submitting a claim within 12 months. The survivors may also claim up to six months of uncollected pension retroactively.

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Kupat Cholim Second Opinion/Private Consultation Benefit

Further Reference:
Meuhedet
Maccabi
Clalit
Leumit

The supplemental plans of the Kupot Cholim offer second opinion or private consultation benefits that include a refund of a significant percentage of a private doctor’s fees. Details differ between the Kupot Cholim and are available in each one’s guide to supplemental services.

This benefit may also be useful for a member who wishes to visit an in-network specialist with whom it was not possible to arrange consultation via the kupat cholim directly because of limits on seeing different doctors within the same specialty without officially changing doctors, or for other reasons.

Consultation

The benefit is only intended to include consultation, and not treatment. Diagnoses, treatment recommendations, referrals and prescriptions are normal services- though the latter two often must be rewritten by in-network doctors. The supplemental plans have separate regulations for reimbursing some private treatments (especially if the fees are different from a regular consultation/visit). Refer to a branch secretary or phone representative to find out coverage for different treatments via private arrangements. 

The List

The Kupat cholim retains a list of out of network doctors for every medical specialty that are eligible for this benefit. Before making an appointment with a private doctor, ask the branch secretary to check the name against the list.

Payment

The benefit is often fulfilled by providing receipts and documentation of the visit to the branch secretary for reimbursement of the appropriate percentage. In other cases, a Hitchayvut can be provided in advance. Check with the branch secretary, or Kupat Cholim information services in advance of using this benefit for instructions on the best way to implement it.

On the other hand, people who have already paid out of pocket for private doctor visits should check with their Kupat Cholim to see if they can receive a reimbursement from this benefit.

Restrictions

There are certain conditions specified by the Kupat Cholim that are not eligible for consultation under this benefit. These generally correspond to services that the Kupat Cholim does not cover. For example, dental.

Second Opinion Abroad

The additional insurance plans of the Kupat Cholim also include a benefit to consult with senior specialists in contracted medical centers abroad for certain serious conditions. Consultation for these purposes means sending relevant medical material abroad and receiving the specialist’s opinion on treatment, not sending the patient abroad.

 

 

Note: This information is intended to aid interactions with qualified social workers and other assistance professionals.

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Shira Pransky Project in the Press

The Shira Pransky Project has appeared in a number of media outlets, including:

Haaretz (English)

“Turning personal tragedy into a call to action” – Feature article on the project’s founding
“Running for Life” – Report on the project’s 2014 Jerusalem Marathon team

 

Israel National News Radio

“The Aliyah Time Show” – Interview with former project co-director Zack Rothbart

 

The Times of Israel

“Farewell Ronni Gamzu” – Op/ed on the importance of the Ministry of Health
“Near-Suicide in the Golan Heights” – Op/ed on the state of the mental healthcare system in Israel
“Mental Breakdowns and Anglo Olim” – Op/ed on immigrants’ emotional resilience
“German strengthens Israeli healthcare” – Op/ed on new Ministry of Health committee proposals

 

Other

“Know Your Medical Rights: The Shira Pransky Project” – Article in the Rehovot Reporter
“The Shira Pransky Project: Accedsible Health Information for Israel’s English-Speakers” – Article (in Hebrew) on the Leshonot linguistic accessibility website

 

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Changing Flights Due To Medical Circumstances

When changing a flight date for medical reasons, most airlines will still charge a fee since their expectation is that the customer will attempt to receive compensation through insurance.

If however, the customer needs to change his ticket because of an uncertainty, they can ask the airline to freeze their ticket until a new date can be scheduled. They will still be charged a fee, but it may help avoid being charged multiple times.

 

Here is the process:

  • Call EL AL and choose the option to speak to a sales representative
  • Provide the ticket information and an explanation of the medical circumstances
  • The case will be referred to a supervisor who may need you to provide medical documentation
  • They will get back to you with an answer
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Disabled Parking Placard

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All of the information about the Misrad Harishui’s Disabled Parking Placard is available in Hebrew on the Misrad Harishui website. The following is a summary of the major details:

An individual does not need to be part of Bituach Leumi’s general disability program to be eligible for a Disabled Parking Placard.

Entitlement

The following individuals are entitled to a disabled parking placard:

  • A person who, due to disability in his legs, requires a vehicle for transportation.
  • A person with a degree of disability of at least 60%, for whom transportation without a vehicle may cause a deterioration in health.
  • A disabled person requiring a wheelchair for mobility.

Degree of disability and health risk is established based on submitted documentation, including a doctor’s letter explaining mobility limitations or risks.

 

Submitting the Claim

The claim for the Disabled Parking Placard is available on the Misrad Harishui website. It is a very simple single page request, but it must be accompanied by the following documents:

  1. a copy of the car registration
  2. a copy of the applicant’s Teudat Zehut + insert
  3. a doctor’s letter and medical documentation relating specifically to mobility

If the individual requesting the parking tag is not the vehicle owner then more documentation is required, such as copies of the owner’s identification establishing immediate family relation, or an affidavit from a lawyer establishing a non-relative’s relationship to the applicant, or other documents for leased or employer vehicles.

 

Mail Only

Applications should be mailed to:

יחידה לטיפול במוגבלי ניידות

ת.ד. 72 חולון, 58100

It can take up to 90 days to process an application.

 

Multiple Vehicles

With the proper documentation a parking placard may be issued for multiple vehicles. In this case, one placard will be issued with the identification numbers of each vehicle to which it applies. The placard can then be placed in whichever vehicle is being used by the disabled at the time.

 

Registration Fee Discount

Individuals with a Disabled Parking Placard are also entitled to a significant discount on the vehicle’s registration fee. In order to receive a refund on a registration fee that has already been paid, one must submit this request along with a blank (unsigned) check from the bank account in which the refund will be deposited directly by the Misrad Harishui.

 

Additional Details

There are many additional benefits to having a Disabled Parking Placard besides being able to park in designated parking spots. The full regulations are sent with the placard.

It should also be noted that a few years ago the Misrad Harishui redesigned the placard to the size of a credit card, which must be displayed prominently in the front window of the car. Therefore, along with the card, they send a card holder.

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Mobility Benefits

Note: This information is intended to aid interactions with qualified social workers and other assistance professionals.

The mobility benefits program provides various forms of assistance to people with impairments that limit their mobility, with the aim of helping them to integrate into the community and develop an independent life. These benefits include eligibility for a monthly allowance as well as various loans for vehicles and vehicle accessories. Each benefit in this program has its own conditions of entitlement.

All of the details of Bituach Leumi’s Mobility program are available in English on the Bituach Leumi website. The following is a summary of the major details:

Mobility Allowance

A monthly allowance is paid to those with limited mobility to assist with mobility expenses whether or not they are vehicle owners.

Vehicle owners’ allowance rates are established based on multiple factors, including:

  • Personal Variables such as the beneficiary’s percentage of mobility limitation, if the beneficiary is the driver, an earner and/or a long distance (40 km round trip) commuter.
  • Vehicle Variables such as engine size, insurance prices, gasoline prices, maintenance costs, the value and nature of special accessories installed or vehicle design.

A person without a vehicle is entitled to an allowance in an amount equal to that paid to a person with a valid driver’s license, who earns a salary, owns a vehicle with an engine volume of 1,800 cc, and for whom a 100% mobility limitation has been established.

For example: The mobility allowance paid to a person for whom a 100% mobility limitation has been established with a valid driver’s license, earning a salary, owning a vehicle with an engine volume of 1,800 cc was NIS 2,049 in July 2008.

Vehicle Loans

The following loans may be available to beneficiaries:

  • Loan for the taxes due on the purchase of a vehicle
  • Loan for a percentage of the cost of a new vehicle before taxes
  • Loans for vehicle accessories such as wheelchair lifts and other aids

Loan repayment is postponed for as long as the vehicle is in use by the beneficiary under continuing eligibility conditions, the amount due is reduced over this time, and in some cases the loan ultimately becomes a full grant. If a person remains eligible for mobility benefits he may also be able to receive loans multiple times to replace vehicles and/or accessories.

Establishing Entitlement & Submitting the Claim

The process of entitlement to the mobility benefit involves the Misrad Habriut along with Bituach Leumi. A person must first submit the Application for Medical Examination to Establish Mobility Limitations to the district health office (Misrad Habriut) where a medical committee will established the percentage of limited mobility according to a list of defined impairments, usually after a direct examination of the claimant.

After the percentage of mobility limitation is established,  the Claim for Benefits Under the Mobility Agreement must be submitted to Bituach Leumi.

Both of these forms list the necessary accompanying documents, which include medical documentation, driver and vehicle licenses, and other materials depending on each case. Assistance from a kupah or hospital social worker, or others familiar with the process, can be very useful in preparing the forms and accompanying documents.

Start of Entitlement

The beneficiary is eligible for the mobility allowance from the date the percentage of disability is determined by the Misrad Habriut medical committee. If the claim to Bituach Leumi is submitted later, the allowance is only paid for up to two months retroactively.

Limitations

A person after retirement age can not receive a mobility benefit unless they began receiving it beforehand.

Eligibility for multiple special pensions from Bituach Leumi, such as the Attendance Allowance or Child Disability, can sometimes conflict. In other cases double benefits are acceptable, usually when the circumstances are more severe.

Additional Details

Learning to Drive a Vehicle with Special Accessories

A person with limited mobility who must drive a vehicle for special accessories while sitting in a wheelchair, can learn to drive in a Bituach Leumi vehicle equipped with accessories to assist those learning to drive or learning to use the special accessories that will be installed in their vehicles.

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Tackling the Bureaucracy, Part 1: The Power Hour

Here are some tips on facing those times when you have questions to answer, people to reach, appointments to make, etc. and tackling the bureaucracy out there will take a special brand of cold determination. This game plan is geared towards situations when phone calls need to be made, but you can modify the principles to your situation.

The Power Hour

Dedicate a focused session to accomplishing your goal where your state of mind is: I am not going to be distracted until I get ‘er done! It doesn’t really have to be an hour, but it’s a different concept from setting aside a productivity day, or just saying, “I work on it a little every day”.

 

Lists

A power hour deserves its own list of steps to accomplish your goal. Actually, each power hour often deserves three lists, or a list with three columns:

  • Actions (e.g. numbers to call)
  • Results (e.g. answers to questions)
  • Follow-up tasks (e.g. fax documents)

Make sure you have a pen so you can check things off along the way, make notes, and adjust the list. You may call one phone number just to be given three more to call. You’ve dedicated the time, so just go through the steps methodically. Then again, don’t be afraid to…

 

Start Over

 

If you are making your way through your list and you start to get the impression that you’ve made a wrong turn, or you didn’t really understand what you were supposed to do from the beginning, or something you found out along the way modified your goal slightly, go back a few steps, or even to the beginning. Even if you call the same number you called twenty minutes ago and ask the same questions, you are now better equipped to ask more and/or understand the answers better.

 

Keep your Eye on the Prize

 

Ok, the frustration is already starting to creep in. You’ve gone down too many blind alleys and hit too many brick walls, and maybe somebody was even really rude. Keep your game face on. The Power Hour is only for focused determination and nothing else is going to slow you down. Save the frustration for another time. (See Bonus below)

 

Don’t Assume Anything

 

Nothing beats the frustration of, “I was never told…” So head ‘em off at the pass and ask as many questions as possible about your situation.

 

Try to Walk Away with Something Tangible

 

If you made the appointment, great! Got a question answered, awesome! You have a full follow up task list? Do whatever can be done right away (like send off that fax) and then give yourself a treat.

 

Congratulations! You made it through the Power Hour.

 

Bonus: 2 Tips for Sanity!

 

 

Dedicate Frustration Space

 

It’s not going to help you in the midst of a productive session, but you can’t just bottle it up either- that’s not healthy. You can save the groan/yell/diatribe/whatever, for later as long as you know where your outlet is, be it a (willing) friend/spouse/relative’s ear, a journal, a blog or anything else. (Just make sure you’re getting the frustration out so you can move on, and not amplifying it until you won’t be able to face it again.)

 

Have a Spotter

It may not always be possible, but sometimes just sitting next to someone who’s there to give you support in achieving your goal can give you the strength to make it through. Give them a job, like crossing items off the list or writing down numbers.

 

Stay tuned for Part 2: Attitude

 

And don’t forget to leave your own constructive tips on facing bureaucracy and getting things done in the comments!

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Bituach Leumi’s Attendance Allowance

Note: This information is intended to aid interactions with qualified social workers and other assistance professionals.

An attendance allowance is given to those who require a great deal of assistance by another person for routine activities (i.e. dressing, eating, washing, mobility within the home and control of bodily functions), or who require constant supervision to prevent a danger to their lives or to the lives of others.

Individuals above the retirement age are not eligible for this program unless a Bituah Leumi doctor determines that the insured was entitled beforehand, and the claim was submitted within 6 months of reaching retirement age. Children are also not eligible. For each of these groups, refer to the respective programs for relevant circumstances (Child Disability or Old Age Pension).

All of the details of Bituach Leumi’s Attendance Allowance for the disabled are available in English on the Bituach Leumi website. The following is a summary of the major details:

Establishing Entitlement

The claimant is examined by a doctor on behalf of Bituach Leumi and afterwards, in certain circumstances, he is examined in his home by a professional who assesses his dependence. The level of required assistance is assessed to determine the corresponding allowance rate.

Note:  Even those who not receive a disability pension (for example: if their income is higher than the threshold) are eligible for the attendance allowance if their established medical disability is at least 75%.

 

Rates

The attendance allowance is distributed at three different rates that are described as percentages relative to the amount of a full general disability pension, but are not connected to the actual disability pension amount that one already receives. The rates are based on the level of assistance required for some or all of the the essential daily routine activities: dressing, eating, washing, mobility within the home and control of bodily functions.

Low

50% of a full disability pension, plus an additional increment of NIS 289 (as of 01.01.2011), for those requiring assistance in most routine activities, most of the time.

Medium

105% of a full disability pension, plus an additional increment of NIS 589 (as of 01.01.2011), for those requiring assistance in all routine activities, most of the time.

High

175% of a full disability pension, plus an additional increment of NIS 878 (as of 01.01.2011), for those requiring assistance in all routine activities, all of the time.

 

Re-examination

A claimant whose condition has worsened is entitled to a re-examination if 6 months have elapsed since assessment, or earlier, based on submitted medical documentation of the circumstances.

 

Start of Entitlement

Entitlement to an allowance can begin 90 days from the commencement of incapacity. If the claim is submitted later, entitlement can begin immediately, or a Bituach Leumi doctor may establish a retroactive benefit for up to 6 months prior.

 

Submitting the Claim

The claim form for the Attendance Allowance is available on the Bituach Leumi website, from a social worker, or from Bituach Leumi offices, and must be submitted to the local branch. Assistance from a kupat cholim or hospital social worker, or others familiar with the process, is very useful in preparing the form.

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Health Services Abroad

In principle, the obligation imposed by the law for the Kupat Cholim to provide health services to Israeli residents is limited exclusively to the territory of Israel. However, there is a defined set of cases where the insured is entitled to participation in the costs of medical treatment abroad, subject to the fulfillment of all the following conditions:

  1. The treatment is in one of the following fields: organ transplants, congenital defects, tumors, cardiovascular diseases and neurocerebral diseases.
  2. The insured is unable to receive the required treatment or an equivalent treatment in Israel (if a little experience does exist in Israel, it is considered as if the insured is able to receive the treatment in Israel).
  3. The insured is in danger of losing his life if he does not receive the specific health service.

In addition, if in the opinion of the health fund a case presents exceptional medical circumstances, it may fund the treatment abroad.
Note: If a health fund rejects the insured’s request to receive health services outside Israel, the decision may be appealed before a special appeals committee in the Ministry of Health.

For more information of Health Services Abroad click here

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Health Services: Distance, Wait, Choice and Continuity

Reasonable distance and wait time

The law requires that basket of health services be provided to the insured at a reasonable distance from his place of residence, but does not define the term “reasonable distance”. There have been conditions for which the Ministry of Health has ruled that the Kupat Cholim must reach an arrangement with an institute near the insured’s place of residence or, alternatively, it must arrange transportation for the insured to and from the institute to which he was referred. Additionally, if there is no nearby medical facility which can provide a required service within a reasonable wait time, the health plan must provide the required service at a different facility, even if it does not have an agreement or arrangements with that facility. Though, again, the law does not define what “reasonable wait time” is, so it is also open to interpretation.

 

Service in small localities

 

In localities with a population of less than 5,000 residents, not more than one health-fund clinic may operate; in localities with a population of less than 10,000 residents, not more than two health-fund clinics may operate. A health fund that operates a clinic in a locality with a population of less than 10,000 people is obligated to provide medical services, within the framework of the clinic, to members of another health fund that does not operate a clinic in the same locality, upon the same conditions at which it provides them to its own members. There is no need to receive the approval of the health fund that does not have a clinic in the locality and a member of that fund may apply directly to the clinic for services.

 

Choice of health service provider

 

A health fund provides health services through its own service providers or by arrangement with other providers. The Kupat Cholim may establish guidelines for members choosing between its service providers, and is obligated to publish its guidelines for selecting service providers and to provide them free of charge at its branches at the request of any insured individual.

However, where there is medical justification for providing the service at a specific location, the health fund must fund the treatment at that location. For example: when a disease or medical condition warrants treatment at a medical institution that possesses a special degree of knowledge and professional experience, the insured will be given the option to receive the medical service he requires in connection with that disease or medical condition at such an institution.

 

Maintaining treatment continuity

Continuity in treatment must be maintained and the insured must be allowed, when possible, to receive the entire treatment for a disease or for a defined medical condition at the same institution where the treatment was begun . Thus, even if a health fund decided to provide a certain treatment that is not included in the mandatory basket of services, once it was begun and as long as it is suitable and medically indicated, the health fund is obligated to continue providing it.

 

Prohibition on discrimination

 

A health fund is forbidden to discriminate between patients suffering from a particular disease. Thus, all members of a health fund who apply for treatment/hospitalization in a certain department/institute and meet the same conditions are entitled to receive the fund’s approval for that service.

 

This information was translated and adapted from content provided by The Society for Patients’ Rights in Israel and Kol-Zchut.

For more information on this and related topics, see Health Plan Choice of Service Provider Arrangements and the Health Plan Portal, both of which we translated as part of our collaboration with Kol-Zchut.

 

To your health ! לבריאות