Zhuti Experts Explain: Everything You Need to Know About Long-Term Care Benefit Eligibility Levels
Adi Way Editorial TeamPublished:
Israel's National Insurance Institute recently published figures indicating that more than 300,000 insured people in Israel are entitled to a benefit or long-term care. Many nevertheless feel they receive insufficient state-funded care given their condition. This may stem from unfamiliarity with how National Insurance determines what a person needing care is entitled to. We are here to clarify. With help from Zhuti's experts, we will examine benefit eligibility levels, how each potentially eligible insured person is assigned a level, and what each level provides.
"In determining eligibility for a long-term care benefit, the claimant's ability to function in daily activities is assessed," experts at Zhuti, a company specializing in securing medical entitlements, told us. "In some cases, functional ability can be determined from the documents attached to the application and a telephone interview. When it is difficult to grade eligibility by telephone, a functional assessment is conducted during a home visit." In general, eligibility is determined using a points system for the ability to perform various basic activities. The total determines which benefit level the claimant qualifies for.
The dependency assessment
The dependency assessment, ADL (Activities of Daily Living), is based on an evaluation form containing a list of criteria. It includes 5 everyday activities needed for normal daily functioning: mobility, dressing, bathing, eating, and managing bodily waste. For each category, the assessor gives the claimant a score: full independent performance earns no points, partial performance earns half a point, and inability to perform earns one point.
"Alongside physical ability to perform the five basic activities independently, the dependency assessment examines the claimant's cognitive and emotional ability to manage without another person's supervision," Zhuti's experts added. "This means examining the insured person's ability to understand what is happening around them, orient themselves, recognize people, and so forth." After some time, National Insurance determines whether the person qualifies for a benefit, whether it will be temporary or permanent, and which assistance level applies.
What does each eligibility level provide?
Each point awarded to an insured person who has undergone a dependency assessment is worth a "service unit." Each unit can represent one hour of care per week, a cash payment, or another form of long-term care assistance.
Level 1 long-term care benefit recipients are those who accumulated between 2.5 and 3 points in the dependency assessment. They can choose between 9 service units for various care services, such as absorbent products, day-center visits, an emergency call button, and so on, or 5.5 service units for personal care at home.
Those who accumulated between 3.5 and 4.5 points qualify for a Level 2 benefit. They receive 10 service units, meaning 10 weekly care hours. Level 2 recipients may receive up to 4 service units in cash.
Insured people who accumulated between 5 and 6 points qualify for a Level 3 benefit. This level provides 17 weekly care hours for those employing a foreign worker, or 14 hours for those employing an Israeli caregiver.
Level 4 recipients are those who accumulated between 6.5 and 7.5 points. They may receive 18 weekly care hours if employing a foreign caregiver, or 21 hours if employing an Israeli caregiver. They may receive up to 4 service units in cash, or up to 7 with a social worker's approval.
Those who accumulated between 8 and 9 points qualify for a Level 5 benefit. As with previous levels, insured people employing an Israeli caregiver receive more: 26 weekly care hours, compared with 22 for those employing a foreign worker. Up to 4 care hours may be received in cash, or up to 9 with a social worker's approval.
Insured people awarded at least 6.5 points qualify for Level 6, the highest benefit level. This provides 26 weekly care hours, or 30 if an Israeli caregiver is employed. Here too, up to 4 care hours may be received in cash, or up to 10 with a social worker's approval.
The right to appeal
"It is important to note that an insured person can change their choice between cash benefits and care services at any time, according to their situation," the experts concluded. "Also, if their medical condition unfortunately worsens, they can, and should, request a reassessment of eligibility. Of course, the insured person or their representatives can appeal to National Insurance if dissatisfied with the assigned care level. Winning such an appeal is not simple, but it is possible. 'Zhuti' has 18 years of experience defending Israeli insured people's medical entitlements, with more to come."
This is general news information and is not a substitute for personal advice from a doctor or dietitian.
