תוכן עניינים
Two Types of Long-Term Care Insurance in Israel
In Israel, long-term care coverage comes from two main sources: supplemental insurance through a Health Maintenance Organization (HMO/Kupat Holim), and private long-term care insurance purchased independently from an insurance company. Understanding the differences is essential before filing a claim.
HMO Supplemental Insurance
Most Israeli HMOs offer supplemental insurance packages that include a long-term care component. These plans are typically lower cost but offer more limited benefits — usually in-home caregiving hours rather than a monthly cash payment. The qualifying criteria and ADL assessment process are determined by the HMO, and the coverage period may be capped.
Private Long-Term Care Insurance
Private policies are regulated by the Insurance Contract Law (1981) and the Supervision of Insurance Business Regulations. They typically provide monthly cash benefits triggered by functional impairment — loss of ADL capacity — and the qualification threshold is defined in the policy. Benefits are paid regardless of actual care costs. Private policies often contain higher benefit levels and longer payment periods.
Key Differences That Affect Claims
The definition of a qualifying event differs between HMO and private plans. HMO plans may require a higher degree of functional loss. Private policies may contain pre-existing condition exclusions that insurers sometimes invoke improperly. The statute of limitations and appeals processes also differ significantly.
When You Have Both: Coordination of Benefits
Many Israelis are insured under both an HMO and a private policy. The two plans operate independently — receiving HMO benefits does not reduce your private policy entitlement. Filing claims on both is not only permitted but advisable.
For help navigating HMO and private long-term care insurance claims, contact Lev-Taieb: 072-2428822.
