What is the Kupat Cholim Selling Me?

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):

What_is_the_kupat_cholim_selling_me

Feel free to print it out and pass it along!

 

If this information is helpful to you, please enable us to help others: 

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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.