Nursing care Insurance (Bituach Siudi)
Things you should know about nursing care insurance
Nursing care insurance provides some degree of financial security in the event that the insured cannot care for his own personal needs due to severely deteriorated health, and requires long-term nursing care. This type of insurance allows the insured to receive financial assistance from the insurance company towards paying the cost of nursing care – which can be very high – 5,000-10,000 NIS per month, or even higher. The insurance company either pays the insured or forwards payment directly to the nursing home).
A Nursing care insurance policy is a contract between the insured and the insurance company, according to which the insured pays a monthly premium, entitling him to financial compensation if he ever requires long-term nursing care. This condition is defined as the inability to independently carry out several basic daily functions:getting up and lying down,dressing and undressing, bathing, eating and drinking, using the toilet and moving about; or otherwise a state of mental incapacity necessitating constant supervision.
A person’s chances of becoming fully dependent on nursing care increase with age; in some cases, however, this happens earlier in life, as a result of an accident or medical complications. When the insured requires long-term nursing care, he is entitled to assistance from the insurance company in one of three forms: direct insurance payments, contribution towards hospitalization in a nursing home, or payment for a foreign live-in caretaker. The insured is entitled to these payments as long as he requires nursing care, but only within the limits of the compensation period defined in the policy.
Sometimes the State will provide assistance to people in need of long-term nursing care, after their eligibility is examined:The National Insurance Institute (Bituach Leumi) offers a long-term care benefit to people who need nursing care while living at home: 5 to 15 hours a week, depending on the person’s condition. The Ministry of Health contributes towards the expense of a nursing home, based on criteria of income and health. The health funds also pay for hospitalization in specific cases: when a person who requires nursing care also suffers from other serious illnesses; when a person is undergoing rehabilitation; or when someone suffers from mental incapacity combined with some functional limitations. The main financial burden, however, still rests on the elderly person or his family, and this is why long-term care insurance has emerged in Israel.
Insurance companies sell both group and private nursing care insurance policies:
Group nursing care insurance: an insurance policy for a group of people interested in joining an insurance program (for example: people insured through their health fund, government employees, retirees who belong to a retirement association, etc.). In such a situation, the group’s representative (the organization or health fund) conducts negotiations with the insurance company, building a nursing care insurance program for the whole group. The organization is then the owner of the policy, subject to approval by the State’s insurance supervisor. The policy’s conditions apply to all those who wish to join it, and premiums are identical across each age group (except for special cases, when persons with existing illnesses are required to pay higher premiums.) Members of the group are obviously not obligated to join the group insurance program.
The compensation period is usually limited in time (3 years or more) and does not continue throughout the insured’s lifetime. Most people insured with group nursing care insurance are members of health funds. It is important to note that the contract is for a limited period of time and must be renewed from time to time by the insurance company. The insurance company may change the policy’s conditions, or even decide not to renew it.
Private nursing care insurance: a private insurance policy is a contract between an individual and an insurance company, signed through an insurance agent. In this case, the insurance company is not allowed to terminate the contract, and only the insured may do so. The conditions of the policy are agreed upon by both parties, and the monthly premium is determined by the age of the insured, his state of health, the amount of compensation he requests and the length of the compensation period.
Please note! According to data from the office of the state’s insurance supervisor approximately half of the members of Israeli health funds are insured through their fund’s group policy. We therefore highly recommend that you check with your health fund to see if you are already insured through the fund.
For additional information, see The Israel Consumer Council – Guide for the Elderly.