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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:

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.

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!

Patient Privacy

The Law

The Patient’s Rights Law was approved by the Knesset on May 1, 1996. The law has come to define the relationship between people requiring treatment and doctors and other medical professionals. The following statement appears in the first paragraph of the law: “This law’s purpose is to define the rights of a person requesting medical treatment or receiving medical treatment and to protect his dignity and privacy.”

Medical treatment is a partnership between the patient and the medical team. The assumption upon which the Patient’s Rights Law is based is that the patient is an intelligent person generally capable of asserting his/her right to receive proper medical treatment. The following protections are guidelines that emerge from this law and others, and from directives issued by Misrad Habriut (The Ministry of Health) to protect the patient’s dignity and privacy.

During an Examination

Physical examination in private

Anyone who is examined is entitled to have an additional person present, either a person of his/her choice or an employee, while the examination is being performed.

The presence of a student during a medical examination

A patient has the right to refuse the presence of and/or examination by a student while the patient is receiving medical treatment.

Parents’ Rights

Transfer of medical information to both parents regarding their children

In general, both parents have rights to information regarding a child’s treatment, and giving consent, and the parent who is present is usually sufficient to make decisions and/or represent the other parent. However, there may be mitigating legal or other circumstances.  The Ministry of Health has published precise instructions about health service providers making information accessible to both parents, and when the consent of one or the other must be requested.

Medical Confidentiality

The obligation to maintain confidentiality regarding the treatment given to the patient is the foundation upon which the patient’s trust in the doctor is based. Both the Privacy Protection Law and the Patient’s Rights Law require guarding medical information. These laws are applicable for anyone treating a patient and not solely for doctors. The importance for these rules is clear; for example, the damage that might be done to an individual in certain communities if knowledge of her having an abortion was publicly known or if the facts of a businessman’s illness were known to his associates.

Transfer of Information

The Patient’s Rights Law distinctly establishes the obligation for medical confidentiality and only permits transfer of information to a third party in the follow circumstances:

  • The information is given to a different caregiver for continuation of treatment.
  • Research purposes (in accordance with Helsinki regulations).
  • In accordance with different regulatory requirements (i.e. transfer of information to the Ministry of the Interior for purposes of issuing a firearm license; transfer of information to the National Cancer Registry; notification of infectious diseases, etc.).
  • When the patient has agreed to waive the privilege by signing a “Written Medical Confidentiality Waiver (Vasar)”.

More Information

For more information, check out our page on Waiving Medical Confidentiality, as well as some related pages we have translated as part of our collaboration with Kol-Zchut:

Rights of Patients After a Cardiac Event

After a heart attack or surgery, patients feel vulnerable and anxious and are sometimes afraid of losing their ability to function; they do not always know what action is required in their situation. To alleviate these problems, heart rehabilitation programs have been developed, which are designed for those who suffer from one of the following:

  • Patients who have had a heart attack
  • Patients who have undergone coronary artery bypass surgery
  • Patients with Class II-III heart failure and/or LVEF < 35% decrease in left ventricular functionality with intermediate severity and above
  • Patients who have undergone pacemaker/defibrillator implantation

Before Implantation or Open Heart Surgery

The Ministry of Health requires that before a transplant or open heart surgery, the patient must undergo a comprehensive dental examination and treatment of all of the infections found in the patient, as well as preventive action against infections in the patient.

Recovery and Rehabilitation in a Convalescent Home

Included in the health basket is eligibility for five days of recovery in a convalescent home that has an agreement with the kupat cholim, without any co-payment. In order to obtain the service contact a kupat cholim representative in the hospital before being released or in a kupat cholim branch within 24 hours of being released from the hospital and present a medical recommendation from a cardiologist. As part of a stay in the convalescent home, the patient is entitled to medical oversight, instruction and follow-up, nutritional lectures and supervised exercise.

Also note that every kupat cholim offers an extended stay in the convalescent home in their supplemental health services plan (Shaban). Contact a representative for the details of your plan.

Rehabilitative Exercise

Anyone is who is insured is eligible to receive rehabilitative exercise services for a period of 4 months, with a co-payment. The program includes supervised physical activity with monitoring and follow-up by a cardiologist, a Holter stress test, relaxation and anxiety reduction, plus lectures on proper nutrition and risk factors.

Also note that every kupat cholim offers  an extended program for an additional period in their supplemental health services plan (Shaban). Contact a representative for the details of your plan.

Heart Rate Monitoring/Follow-up

Included  in the health basket is eligibility for receiving a personal monitoring device (cardiobeeper)  for 6 weeks, allowing the E.K.G to be broadcast directly to the medical center which is manned at all times.

Also note that every kupat cholim offers an extension of the service for an additional period of approximately one year  in their supplemental health services plan (Shaban). Contact a representative for the details of your plan.

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