We’re often asked what are the differences between the various types of insurance offered by the kupot cholim. We decided to put together the following to help make it a bit clearer what your kupat cholim is actually selling (or trying to sell you):
Feel free to print it out and pass it along!
If this information is helpful to you, please enable us to help others:
Information about the Long-Term Care Benefit in English!
A Long-Term Care Benefit is given to people who have reached retirement age, live at home in the community, and need help with daily activities (such as getting dressed, getting bathed, eating, mobility in the home, etc.), as well as elderly people who need supervision in order to prevent them from endangering themselves, or their surroundings (such as people with decreased mental faculties like Alzheimer’s disease patients who are liable to endanger themselves or their surroundings if left home alone).
The benefit is generally provided in the form of services, and is usually not monetary in nature!
As part of our on-going collaboration with Kol-Zchut, we are proud to have translated and published a Rights Guide for the Mentally Ill and Their Families. While a number of the links in the guide still lead to Hebrew content, it is an easy-to-read, critical and unique resource of information that was not previously available in English. You can either view the guide below or click here to follow an external link.
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
eating and drinking
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.
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.
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?
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?
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: