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Long Term Care Insurance

What is Long-term Care Insurance?

Long-term care insurance is meant to cover financial support and/or assistance services for a person who cannot carry out Activities of Daily Living (ADL) and needs continual care. ADLs are six basic daily activities: 

  • standing up and lying down
  • dressing and undressing
  • bathing
  • eating and drinking
  • walking
  • continence

The inability to perform several of these activities usually constitutes a long-term care insurance event. 

These policies are most commonly associated with fulfilling the needs of the elderly, but it is important to remember that they can be just as applicable to a younger person that encounters disabling conditions. 

Through the Kupat Cholim

Long-term care insurance offered through the Kupat Cholim is a group insurance plan provided by the health fund in association with a private insurance company.

The policy is not like the other supplemental insurance plans offered by the Kupah in the following ways:

  • There is no obligation to accept every applicant to this plan.
  • The group insurance is for a limited period, and the insurance company is entitled not to renew it at the end of the period.
  • This insurance has no connection to the Health Basket and should be regarded the same as any group health insurance policy.

Comparison

Since Long Term Care Insurance is a private insurance policy, you can compare the terms of the proposed policy from the Kupat Cholim to any other policy offered by a private insurance company. A registered insurance agent can help you determine which policy is suitable and purchase it directly from the insurance company.

One who considers buying long-term care insurance should look into the following details:

Claims and Benefits
  • How is the insurance event defined?
    • How many ADLs does it take to define the insurance event? (In most cases, the qualifying situation is the inability to perform three or four ADLs)
    • Are mental frailty and Alzheimer’s included in the definition of the insurance event?
  • How long can benefits be paid? (Possible periods are three years, five years, and unlimited. The duration has an effect on the level of premium.)
  • What is the level of the monthly benefit? 
    • Can the monthly benefit be enlarged?
    • Does the level of insurance benefits depend on the insured’s age?
  • Are the insurance benefits given in the form of indemnification (against actual expenses) or of compensation?
  • Does the policy cover nursing care in the insured’s home?
    • Are receipts required in the case of at-home care?
  • Does the policy have a nonforfeiture benefit, i.e., an entitlement to partial benefits even if the insurance is terminated? 
Costs
  • Is the insurer allowed to change the premium for insureds at large (in contrast to a declared change in premium that is adjusted to the age of each insured), and under what conditions?
  • Is it possible to buy a policy in which the premium does not change as the insured ages?
  • What rights does the insured have in the event of an increase in premiums? (According to some policies, if the premium scale is raised the insured may pay the old price for reduced benefits and/or become eligible for a nonforfeiture benefit.)
  • Is the insured excused from paying premiums while receiving monthly benefits?
  • Are the premiums for at-home care different from those upon admission to a nursing institution?

 

Related pages:

Private Insurance Consumer Guide

Unlike national health insurance  delivered by the health funds and Misrad Habriut, insurance companies sell policies expanding the basic package of services, offering additional layers, and providing a level of service that the basic package omits, including private health services such as long-term care. These policies can be examined independently via registered insurance agents, as well as compared to the supplemental plans offered by your Kupat Cholim.

The private insurance companies are regulated by the Finance Ministry, and in the year 2000 they released the following aid to the consumer, explaining the types of policies available and offering advice and tools for comparison:

Supplemental Insurance

The Kupat Cholim is permitted to offer supplemental health service plans (“Shaban” – Sherutei Briut Nosafim, which literally means “Additional Health Services”) that offer additional medical services beyond those included in the Health Basket. These plans are optional and require additional payment to the Kupat Cholim beyond the basic health insurance contributions that all residents pay to Bituach Leumi.

A health fund is forbidden to make the provision of services included in the basket of services conditional on enrollment or membership in its supplementary health services plan, and they are not permitted to include components related to those that are in the basic healthcare basket, such as a discount on co-payments for medications included in the healthcare basket, or shortened waiting periods for specific services.

The price for joining an additional health services plan is the same for all policyholders in the same age group in the same plan. 

Differences between Kupot

There are differences in the supplementary plans offered by the different health funds. Each fund is free to choose which services it will offer its members under its supplementary plan, providing that these services are not included in the basic “basket of services.”  All policyholders are entitled to receive a copy of the additional health services plan offered by the health plan to which they belong. For information in English on your specific plan, check out English Websites and Publications for Each Kupat Cholim and Form and Files.

Waiting period

The health fund may set a reasonable “qualification period” (waiting period), i.e. a certain period between the date when the member joined the supplementary plan and the date when he will be entitled to rights under the plan. When switching health plans, the rights provided by an additional health services plan, including waiting period requirements, are retained in the new health plan and at the same level.

Comparison to Private Insurance Policies

The supplemental plans can be compared to private insurance policies that also cover additional medical services beyond those included in the Health Basket, but with some important differences, including:

  • The health fund is obligated to accept any member requesting to join the plan, regardless of his state of health, and the rights of an enrolling member may not be made conditional or restricted in any way.
  • The price of the plan must be uniform for each age group, regardless of the number of years of membership in the plan or the member’s state of health or finances.

 

In addition, a health fund may introduce changes in its supplementary plan (e.g. payments, addition or removal of medical services, etc.) only after it received the approval of the Ministry of Health. Private insurance policies, on the other hand, are regulated by the Finance Ministry. It is important to understand that the only truly private insurance options offered by the kupot (meaning those in which pre-existing conditions and other personal and medical information may impact premiums) are travel insurance and long-term care insurance.

Click here for more information on the “Additional Health Services (Supplementary Insurance)” page we translated as part of our collaboration with Kol-Zchut.

Rights and Treatment of the Mentally Ill

The Law for Treatment of the Mentally Ill

 A mentally ill individual is one who suffers from  impaired judgment and sense of reality. This law defines the rights of the mentally ill, as well as the measures that can be taken for them. For example, an individual who suffers from schizophrenia and believes that he is the Messiah and as such, believes that it is permissible for him to do anything that he happens to think of, is defined as mentally ill. On the other hand, someone who suffers from anxiety and  is not willing to leave his home, is not defined as having an impaired sense of judgment, and therefore, this law does not apply to him.

Commitment to a Psychiatric Hospital

The pre-condition for committing an individual to a psychiatric hospital, except if he/she has been issued an hospitalization order, is that the individual must have undergone a medical examination (mental and physical) in a hospital, and it was determined that he/she must be hospitalized. If the patient is a minor, he/she must be examined by a child/youth psychiatric expert and only then may the question of his/her consent or lack of consent to being hospitalized be examined.

Voluntary Commitment

A patient who requests to be committed to a psychiatric hospital of his/her own free will must sign a consent form for hospitalization and receiving of treatment. Nonetheless, there are special treatments determined according to the statutes of the Law for Treatment of the Mentally Ill, for which the individual will be required to sign a separate consent form in order to receive them (currently, this only refers to one type of treatment – electric shock therapy).

It is important to understand that if an individual agrees to be hospitalized, he/she may not be released immediately; but rather only within 48 hours of his/her request for release. During this period, the hospital may submit a request to the district psychiatrist to issue a compulsory hospitalization order if the psychiatrists treating the patient in the hospital believe that the patient’s situation meets the conditions required for compulsory hospitalization.

Involuntary Commitment by means of a District Psychiatrist

The district psychiatrist is the one appointed to issue orders for compulsory psychiatric testing. In order to issue such an order, the psychiatrist must be convinced that the individual for whom the compulsory testing is being requested is:

  • Ill and as a result of the illness, significantly impaired in terms of judgment capabilities or the ability to ascertain reality.
  • Liable to endanger him/herself or others and poses an immediate physical danger.
  • Has refused to be tested by a psychiatrist.

The courts have repeatedly determined that a compulsory hospitalization order may not be based solely on medical grounds; it must be based on various considerations including the patient’s liberty, treatment of the patient and the public welfare.

A compulsory testing order issued by the district psychiatrist is valid for 10 days from the day it is issued. This type of order is generally carried out by a team of hospitalizing nurses from the hospital with the assistance of police officers. The hospitalizing nurses and the police officers are permitted to use “reasonable force” for purposes of entering the location in which the individual is located and for purposes of performing the testing itself.

After the individual undergoes psychiatric testing (usually in the emergency room of a psychiatric hospital), the hospital is permitted to submit a written rationale to the district psychiatrist, requesting that an urgent hospitalization order be issued. The conditions for issuing an urgent compulsory hospitalization order are identical to the conditions for issuing a compulsory testing order (illness + an immediate physical danger to oneself or to others).

Compulsory hospitalization according to a district psychiatrist’s order is for an initial period of only 7 days. According to the hospital’s rationale, the psychiatrist is permitted to extend the hospitalization period for an additional 7 days. At the conclusion of the 14 days, authority regarding continuation of the hospitalization is transferred to the district psychiatric board, which is then authorized, according to a hospital rationale, to continue the hospitalization by an additional 3 months. Afterwards, the board is authorized to extend the hospitalization for periods of up to 6 months. In every instance, the conditions for extending compulsory hospitalization are identical to the original conditions for compulsory testing and compulsory hospitalization (meaning illness + an immediate physical danger to oneself or to others).

Hospitals are permitted, according to their own discretion, to release someone who is hospitalized under civil compulsory hospitalization, or may grant the individual leaves. If the patient or his/her immediate family member opposes, approval of the district psychiatrist is required for release. The district psychiatrist’s decision may be appealed before the psychiatric board.

It is important to distinguish between civil compulsory hospitalization and “criminal” compulsory hospitalization, which is performed according to a judge’s order as part of criminal proceedings against an individual.

The law determines different and stricter instructions regarding compulsory hospitalization of minors. Only the Juvenile Court has the authority to compulsorily hospitalize a minor above the age of 15 who opposes his/her hospitalization.

Urgent Involuntary Commitment

According to the Law for Treatment of the Mentally Ill, a psychiatric hospital manager may also make a decision regarding the necessity of an urgent compulsory hospitalization in unique cases and under special circumstances by means of an exception, as detailed in the law, such as: the patient was mentally and physically tested and was found to have met all of the conditions for hospitalization according to Section 9a of the law, which determines that the tested individual is mentally ill and, as a result of the illness, has significantly impaired judgment or sense of reality, and as a result of which and because of which, is liable to endanger him/herself or others and poses an immediate physical danger.

The period of urgent compulsory hospitalization of this type may not be more than 48 hours. At the end of this period, the patient will be released unless a hospitalization order was given during that period or the patient consents to his/her hospitalization.

In a case in which a minor is brought to a psychiatric hospital by a welfare officer, the hospital manager is permitted to receive the minor for hospitalization against his/her will after a mental and physical examination, even if the conditions for hospitalization according to Section 9a have not been met, if testing has found there to be a substantial possibility that the minor is mentally ill or is seriously mentally disturbed, and is thus liable to endanger him/herself or pose an immediate physical danger to others.

The period of urgent hospitalization of this type may not be more than 48 hours; at the end of this period, the minor should be released, unless a hospitalization order has been issued during that period, or the minor’s guardian agrees to the minor’s hospitalization or, if a minor who is at least 15 years old consents to his/her own hospitalization, or if a court orders the minor to be hospitalized according to the juvenile law provisions.

Commitment of a Minor

With parent or legal guardian consent

The person responsible for a minor (parent or legal guardian who has custody of the minor) is permitted to request that the minor be hospitalized and may consent in the minor’s name to his/her hospitalization and treatment.

If the minor is at least 15 years old and does not consent to be hospitalized, he/she may not be hospitalized despite the consent of their parent or legal guardian, except with court approval given according to the juvenile law provisions, and according to the prescribed grounds for compulsory hospitalization, which are:

  • The minor is mentally ill and there are grounds for his/her hospitalization according to the provision in Section 9 of the Law for Treatment of the Mentally Ill.
  • The minor is mentally ill or has been diagnosed as having a severe mental disturbance which is liable to endanger him/herself or pose an immediate physical danger to others or to cause severe developmental mental damage if not treated by means of hospitalization, and provided that the court did not order hospitalization of the minor, unless proven based on the opinion of a district psychiatric board for children and youth that examined the minor and concluded that he/she may only be treated through hospitalization.

If the hospital manager, psychiatrist or any other individual treating the minor in the psychiatric hospital notices that a minor hospitalized with parent or legal guardian consent does not agree to the hospitalization, that individual must report this as soon as possible to a welfare officer. If the minor is at least 15 years old, the welfare officer must bring the issue for a court ruling; if the minor is younger than 15 years old, the issue must be brought before a district psychiatric board for children and youth, which will examine if the minor may only be treated through hospitalization and, based on its findings, will instruct either to continue the minor’s hospitalization or to release him/her.

Hospitalization of a minor with the consent of his/her parent or legal guardian, except for hospitalization which does not include residing in the hospital, may not be for a period longer than 2 months. In order to extend this period, a motion must be presented before the district psychiatric board for children and youth. The board may, according to a rationale from the manager, extend the period of hospitalization for additional periods of no more than 3 months each, according to the treatment program, if it has been convinced that treatment requiring an extension of the hospitalization period is necessary for the minor.

The minor’s parent or legal guardian, a welfare officer, a minor who is at least 15 years old, as well as the manager, are permitted at all times to request an additional district psychiatric board for children and youth hearing regarding the minor’s hospitalization.

With the minor’s consent only

A minor who is at least 15 years old may request to be hospitalized of his own free will and consent to being hospitalized the same as any patient requesting to be hospitalized. However; if the minor’s parent or legal guardian does not consent to the hospitalization, the minor may only be hospitalized with court approval according to Section 3g of the Juvenile Law.

Rights in The Hospital

Personal Rights

A patient committed in a hospital may:

  • Send and receive closed letters and other mail parcels;
  • Receive guests at times and under conditions determined by the hospital;
  • Have a relationship with people outside the hospital;
  • Keep personal items to a reasonable extent and wear personal clothing according to the conditions determined by the hospital. 

A hospital may limit these patient rights if required for medical reasons. In all cases, the patient’s right to send closed letters or maintain a relationship with his/her lawyer, guardian, the district psychiatrist, and the district psychiatric board may not be limited.

Assets management

The hospitalization of a patient may not harm the patient’s rights to manage his/her assets, unless the hospital is of the opinion that the patient is not capable of handling his/her own affairs; the hospital must explain the decision in writing and the patient may submit an appeal of the decision to the district psychiatric board.

Receiving details of obligations and rights

A patient received for hospitalization must receive a form detailing his/her rights and obligations, as well as an oral explanation of the topic from the receiving doctor. If the medical condition of the patient makes it impossible for him/her to understand the form, the hospital must indicate this in writing in the patient’s medical file and must explain the rights to the patient when his/her medical condition allows. In addition, the hospital must hang a copy of the patient’s rights and obligations form in a prominent location in every psychiatric department.

Receiving medical information

A hospitalized individual is entitled to receive medical information regarding his/her condition. The law dictates that this information must be transferred to him/her according to the doctor’s opinion. In actuality, one of the common patient complaints is that they are prevented from reviewing the medical file. Quite often, only with the intervention of a lawyer or other external body is a patient able to review the medical records. Sometimes, a hospital only allows a lawyer or another doctor acting on the patient’s behalf to review the information, subject to the requirement that the content will not be transmitted to the patient. There is a legal dispute between human rights organizations and the Ministry of Health regarding the conditions for denying or limiting a patient’s right to review his/her own medical information. It must be emphasized that the Patient’s Rights Law and all of the rights and arrangements detailed in it, apply to the mentally ill, as well.

Transfer between hospitals

A patient may not be transferred from one hospital to another except with the consent of both the patient and both hospital managers; in the absence of this consent, the district psychiatrist of the district in which the hospital to which the patient is being requested to move may decide. This decision may be appealed before the district psychiatric board. Nonetheless, under special circumstances and with consideration of the need for hospitalization, the head of mental health services is permitted to order the transfer of a patient from one hospital to another.

Use of forcible measures (isolation or restraint)

Forcible measures may only be performed if required for medical treatment of the patient or in order to prevent danger to him/herself or others.

The order to use forcible measures must be given in writing by a doctor and is limited to a maximum period of 4 hours. In case of emergency and in the absence of a doctor, a nurse may give this order. The supervising nurse must examine the patient at least once every half hour. Based on an examination, a doctor may extend the restraining order for additional periods of no more than 4 hours each time.

Electric shock treatment

Electric shock treatment may only be given with the decision of 3 doctors in the hospital. Electric shock treatment may not be performed on a patient with consent unless he/she consented in advance and in writing.

Compulsory Clinical Treatment as an Alternative to Hospitalization

Compulsory clinical treatment limits the patient’s rights less. Accordingly, in every case in which compulsory psychiatric treatment of an individual is required, even if the required conditions according to the law have been met, all decision makers are obligated to consider compulsory clinical treatment instead of hospitalization. In legal terms, this examination is called the “Less Severe Means Test”. The more severe means may not be chosen if the same goal may be achieved using less severe means: “A mentally ill individual’s liberty may not be harmed more than that which is required to protect him, treat him, or protect the public welfare. A mentally ill individual may not be compulsorily committed to a hospital if it is possible to treat him and protect the public welfare by means of compulsory clinical treatment; and treatment must not be forced if it is possible to perform without force. Steps should always be taken to achieve the desired goal with the least injury to the mentally ill individual” (Vilenchik ruling).

The pre-conditions required to issue a compulsory clinical treatment order are similar to the conditions required to issue a compulsory hospitalization order.

Compulsory Clinical Treatment

The district psychiatrist has the authority to order psychiatric testing of an individual even if he/she refuses, if evidence has been presented which shows that all of the following conditions have been met:

  • The individual is ill and as a result of the illness, significantly impaired in terms of judgment capabilities or the ability to ascertain reality.
  • The individual is liable to endanger him/herself or others and poses an immediate physical danger.
  • The individual refused to be tested by a psychiatrist.
  • According to the request of a welfare officer that a minor be urgently brought for psychiatric testing, if, according to the opinion of the district psychiatrist, there exists sufficient evidence that the minor is mentally ill or mentally disturbed and the illness or disturbance are liable to physically endanger him/herself or others.

Performing testing on a minor

A psychiatric test of a minor according to every one of these instances must be performed by a psychiatrist who specializes in children and youth.

Submission of an appeal

For every decision of compulsory hospitalization or compulsory clinical treatment (including refusal to issue an order), an appeal may be submitted, which will be heard by the district psychiatric board. Any individual may submit such an appeal, not just the patient or his/her family. The board also deliberates regarding extension of compulsory hospitalization for more than the initial 14 day period. This body has a type of judicial authority, as the law provides it with broad authorities to make decisions regarding compulsory hospitalization.

An appeal must be submitted in writing and include detailed rationale. The board must deliberate on the appeal of a hospitalization order within 5 days of its submission. For appeals of compulsory clinical treatment orders, the board must deliberate within 10 days of the submission.

Every psychiatric board is composed of 3 members: a jurist who also serves as the board’s chairman, and two psychiatrists. The discussion with the individual brought before the board includes both a psychiatric test, and the opportunity for the patient to argue factual claims (i.e.: “The claim that I tried to commit suicide or that I injured another person, is not correct”) and legal claims (i.e.: “I can be treated by means of compulsory clinical treatment and not full hospitalization”, “My behavior does not pose an immediate physical danger”).

The board must allow the patient, the patient’s relatives and their lawyers (if they have lawyers) to argue their claims before the board. Additionally, the board has the authority to permit additional people to argue claims, if it deems them relevant. So, for example, the patient may order witnesses to the hearing, including a medical expert on his/her behalf. The board itself sets the order of the hearing, unless for a specific issue, an order has been specifically determined in the bylaws. It must be emphasized that law gives the psychiatric board the authorities of an investigative committee, enabling it to require witnesses to appear and testify.

Regarding the issue of the right to representation before the board: In 1998, regarding this issue, the Supreme Court stated that, “There is nothing like a mentally ill individual requiring proper representation. A mentally ill individual is not capable, in most cases, of pleading on his own behalf. What value does a mentally ill individual’s right to plea have if he is not capable of pleading on his own behalf? A mentally ill individual’s right to plea, therefore, includes the obligation that he be appointed counsel to plead for him.” As a result of this decision, a governmental committee was established to examine the issue and it determined that there is room to establish a right in the law for individuals to be represented before the board. As of when this information was written (September 2001), the public struggle regarding this issue continues, including in the framework of a claim submitted to the Supreme Court by the Association for Civil Rights in Israel and Bizchut – The Israel Human Rights Center for People with Disabilities.

The rule is that the patient has the right to be present during all court proceedings. If the board determines that the presence of the patient during the proceedings, in its entirety or in part, is liable to damage his/her physical or mental welfare, the board may deliberate that portion of the proceedings in the patient’s absence, as long as the rationale for doing so is recorded.

According to the Ministry of Health’s procedures, the patient must be given an abstract and rationale of the board decision in writing within 5 days of the proceedings’ conclusion, except for instances where it is impossible to give the patient the decision on professional grounds. In this case, a copy of the decision must be given to the patient’s proxy.

Submission of a Court Appeal

The patient him/herself, a relative or a governmental representative may appeal every psychiatric board decision before the district court. This type of appeal must be submitted within 45 days of the board’s decision and it is argued before an individual district judge.

The court ruling regarding the appeal may approve the board decision, return it to the board or issue an alternative decision.

Related Links

Health Ministry Responsibilities Under the Health Basket

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Personal Preventive Medicine

The basket includes such services as:

  • Checkups and guidance for pregnant women
  • Tests for early detection of congenital diseases and birth defects
  • Immunization and developmental testing for infants and children
  • Health services for schoolchildren

 

These services are usually provided at family health stations (Tipat Chalav) or within the school framework. Some of the services entail a copayment.

Nursing Home Stay

This applies to patients who meet any of the following criteria:

  • health condition and functioning are poor due to a chronic disease or permanent disability
  • require hospitalization in a nursing home for skilled nursing care 24 hours a day
  • bedridden or confined to a wheelchair
  • need full or partial help in activities of daily living and cannot control their bodily functions

 

Patients are entitled to hospitalization in a nursing home with financial assistance from the Ministry of Health.

Eligibility for this service is conditional on the recognition of the person’s condition by the local health office of the Ministry of Health and on the availability of space based on the quota of nursing home beds determined in the Ministry of Health budget for that year. The service entails a co-payment by the hospitalized person and his family, based on income and financial capacity tests. The services are provided through the district/sub-district health office after determining eligibility for the service and according to the waiting list.

A nursing care patient who requires additional medical treatment – such as feeding by nasogastric tube; prolonged intravenous infusions; dialysis; treatment for severe pressure wounds; or chemotherapy for cancer patients – is defined as a “complex nursing patient.” This service is the responsibility of the health funds and entails a co-payment.

Recovery from Drug and Alcohol Addiction

Hospitalization and clinic services for recovery from drug and alcohol addiction.

Rehabilitation, walking and mobility accessories

The Ministry of Health assists with the funding of rehabilitation (e.g. various prostheses as well as vision or hearing accessories), walking and mobility accessories according to the criteria specified in the ministry’s procedures. The service is provided to the public via the district health offices.

Disabled persons who are workplace accident disabled, victims of hostilities, victims of the Nazis and Nazi persecution, or traffic accident disabled (from 1976 on), receive their assistance from other sources, and are therefore not eligible for assistance from the Ministry of Health.

For the list of devices and information on the funding policy, see Rehabilitation, Walking and Mobility Devices.

Mental Health Services

These services include emergency treatment and emergency room treatment, psychiatric hospitalization and outpatient care at general and psychiatric hospitals, ambulatory services at government mental health clinics, services at kindergartens for special needs populations and psychiatric rehabilitation services for patients referred by a regional rehabilitation board. Hospitalization services and clinic services are also provided for drug and alcohol rehabilitation.

For more information on mental health care and the ongoing transition of many responsibilities to the Kupat Cholim, see Mental Health Care Rights.

Kupat Cholim Responsibilities Under the Health Basket

Services Provided by the Kupat Cholim

  • Diagnosis, consultation and medical treatment.
  • Medications according to a list, some of which are provided only for a particular indication.
  • Hospitalization in a general hospital.
  • Rehabilitation, including hospitalization.
  • Accessories and medical supplies.
  • Medical services in the work place. 

Copayments

The health plans (kupot) are permitted to charge Copayments for a portion of the medical services in the healthcare basket, dependent on approval from the Knesset Finance Committee. The following is a partial list of the services for which a Copayment may be charged:

  • medicine included in the basket; doctor visits;
  • visits to an external clinic in the general hospital framework;
  • visits to institutions outside the hospital framework (x-ray, ultrasound, CT, MRI, EEG, EMG, gastroenterology, etc.);
  • emergency room services;
  • transport in an ambulance;
  • emergency services (medical center);
  • comprehensive hospice care;
  • fetal protein tests;
  • child development treatments;
  • dental treatments for oncological patients;
  • use of medical devices,
  • appliances and equipment;
  • doctor home visits;
  • fertility treatments;
  • psychiatric treatments.

Discounts and Exemptions from Payment

According to the law, certain population groups are exempt from payment. The list of those who are entitled to exemptions and discounts based on socio-economic status is sent to the health plan from the National Insurance Institute (Bituach Leumi).

In order to claim exemptions or discounts, inquire at your closest health plan branch.

Distance, Choice and Continuity

Reasonable distance

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.

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.

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.

The Scope of Treatment

Indications for treatments

For some medications, the basket of health services explicitly determines “indications” – that is, provisions that limit the insured’s right to receive the medication or the medical service to specific medical conditions. A health fund is not obligated to fund the cost of a medication for indications other than those included in the basket.

Treatment alternatives

The choice between treatment alternatives which are included in the basket of health services, such as different medications, is subject to the discretion of the health fund, which may determine that an insured individual will receive the cheaper of two medications that have the same medical effect. Nevertheless, when there is an indication that a certain alternative is preferable for treating the insured’s problem, the health fund is obligated to provide the preferred alternative.

Limits on the scope of treatment

The fact that a certain service or medication is included in the basket of health services does not mean that that service or medication will be provided free of charge and without any limit. For example: physiotherapy for chronic patients may be limited to 12 treatments per year, and may require reasonable co-payment.

Receiving Services Not Included in the Basket

The basket of health services describes a minimum, and the health fund is authorized to provide additional medical services or medications determined by a committee that considers exceptional cases. The committee’s approval will apply to all patients who meet the criteria that were set. The committee must conduct an orderly proceeding, including the hearing of arguments, keeping of minutes, etc. and an insured is entitled to receive a copy of the minutes and any information on the hearing in his case.

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

Community Rehabilitation of the Mentally Disabled

Rehabilitation in the Community

The Rehabilitation of the Mentally Disabled in the Community Law refers to the rehabilitation and integration of the mentally ill in the community in order to facilitate the greatest possible level of functional independence and quality of life.

The law defines “rehabilitation” as a process aimed at developing the abilities and skills of the mentally disabled in a community framework accompanied by medical oversight. It includes rights for the mentally disabled in housing, employment, education and professional training, as well as training in the development of social skills and use of leisure time.

The Regional Rehabilitation Board

A mentally disabled individual who is at least 18 years old and suffers from a medical disability as the result of a mental disturbance, may request that the regional rehabilitation board determine his/her eligibility for a rehabilitation program. The request must be accompanied by the professional opinion of a psychiatrist that the individual requires rehabilitative services as a result of this disability.

Every regional rehabilitation board is composed of 3 members. In order to fulfill its duties, and subject to the legal requirements regarding relinquishing medical confidentiality, the board may refer a mentally disabled individual for a psychiatric functionality examination; study the individual’s medical file; hear and receive expert opinions in different fields; listen to the mentally disabled individual, his/her family or other interested parties; as well as demand required information from the mentally disabled individual or his/her representative, as determined. Additionally, subject to the law, the board may at any time demand information from anyone regarding the extent of the disabled individual’s integration in the rehabilitation program.

For those who are eligible, the board determines a detailed rehabilitation program based on the 7 fields of rehabilitation detailed in the law: employment, housing, education completion, society and leisure, family members, dental treatment, coordination of treatment.

An appeal of the regional rehabilitation board decision may be submitted to the district rehabilitation board within 45 days of the decision being declared. The district board must deliberate regarding the appeal within 60 days of the appeal submission, and it has the authority to approve the regional rehabilitation board decision, cancel it or change it.

Related Links

*This article has been translated and adapted from The Society For Patients Rights in Israel.
**This information is intended to promote general awareness. Make sure to consult an assistance professional to confirm details independently.

Waking Up!

I just got back from an amazing/inspiring/motivating yom iyun, focusing on the accessibility of patient rights. There were presentations from doctors, professors, administrators, social workers and government officials, all surrounding this urgent objective. 

A few important points:

Everybody knows the challenge

Only within the past few years the concept of bridging the awareness gap between patients and the help and support that they are entitled to has gained a life of its own. There are now several organizations dedicated to finding and implementing solutions, and many more institutions collaborating on these initiatives.

Personally, I’m amazed at how an idea can suddenly be “in the air”, with so many people recognizing it on their own and tackling it from different directions. At the same time that I was first formulating my concept and approach to English accessibility, the Hadassah social work department was just launching their Kivunim  information center, Amitai Korn was conceiving Kol Zchut, Bituach Leumi was revamping their website, and many more institutions were waking up!

English is a slice of the (humble) pie

Israel has much to be proud of in its institutions of public support and protection. Universal healthcare, the social safety net, and the protection of patient rights are all enshrined in law and continually maintained and improved upon. But (!), Israelis of all stripes are missing out on some or all of these entitlements. The statistics on uptake of the support programs that are in place (from Bituach Leumi and elsewhere) for all of the relevant populations are dismal.

Still, certain populations are particularly weak, foremost- immigrants. Yes, English speakers in Israel are immigrants, sharing all the challenges of integration encountered by the Russians, French, Ethiopians, etc. with a few unique hurdles of our own. Something must be done to bolster the awareness and acquisition of entitlements among immigrant communities and every participant in today’s yom iyun agrees. The Shira Pransky Project is making sure that the English speaking community specifically is recognized and addressed.

So what is being done right now?

The general director of the Misrad Habriut issued a directive to all medical service institutions in February 2011 that they must reach a certain standard of “cultural competence”. The gist- all information and services must be accessible in Hebrew, Russian, Arabic and… English! Many people and organizations, including The Shira Pransky Project, are working hard to push this objective and assist institutions scrambling to fulfill it (more about that in a moment).

Government institutions are upgrading and updating their websites, opening information centers, and even co-opting social media to inform the public, respond to inquiries and give directions. (We have direct assurance from Gov.il that they respond to English questions on facebook and twitter.)

Kol Zchut, Kivunim and other organizations, are all constantly promoting information and awareness via their programs. The Shira Pransky Project is working directly with these organizations and others to assist them in English accessibility with translations, recruiting bi-lingual volunteers, and more.

The Shira Pransky Project is also constantly engaging more organizations to advocate for the assistance non-profits to adopt, and maybe even lead the way, in meeting the Health Ministry’s standards for cultural competence, and  our website is in a constant state of evolution to better simplify and present useful information

So what can you do right now?

  1. Get Familiar

    Get to know your rights, entitlements, and avenues for information and support. You can start with our website, but also visit your Kupat Cholim’s English site, and the various English Government sites. Read your Kupat Cholim’s English brochure(s). Read the other English publications out there. Save yourself the pain and frustration of navigating the system, or worse- missed opportunity, by understanding the system you belong to right now.
  2. Speak Up!

    Your Kupat Cholim has an ombudsman’s office, and the Health ministry has an ombudsman’s office, dedicated to receiving complaints and protecting your rights. These professionals need to hear your issues about compromised service in English (or any other issues) in order to address them, and to emphasize the importance of English accessibility in their institutions. The public ombudsman from the Health Ministry spoke today specifically about how even a single complaint about an issue can help them raise flags and result in huge reforms! 

    Also, the public advocacy organization Emun Hatzibur has specifically called for complaints relating to language barriers in health service institutions. They will fight for you to address any imminent situation, and they will use your issue to bolster the Health Ministry’s directive on cultural competence. They can be contacted directly, or you can email these specific complaints to The Shira Pransky Project to be passed on to them.

  3. Unite!

    I’ve held back considerably from launching into a diatribe on the need for English speakers in Israel to come together as a community, especially over important issues. We want institutions to recognize and address the specific needs of our community, but we must also recognize ourselves as such. Whether you have been here for years or weeks you are walking in the shoes of all those ancestors that passed through Ellis Island, and all those other ports around the world, for generations. Yes, this time at least we are immigrants to our own homeland (ironically enough), but here once again, we need the support of our fellows in order to integrate and make it in our (please God) final destination.
  4. Get Involved!

    The Shira Pransky Project recruits bi-lingual volunteers to directly assist health and support organizations in English accessibility and for specific projects. We could also use some help ourselves. Of course, our efforts require financial support, so please donate to support English accessibility. And spread the word.

Congratulations!

You read the whole thing! I guess you agree that this is important stuff, so please share it with others, and leave a comment!