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דלג לתפריט תחתון

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Long-Term Care

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Claim for Long-term Care Benefit (2600)
Order Claim for Long-term Care Benefit (2600)Fill in Claim for Long-term Care Benefit (2600) (נפתח בחלון חדש)Download Claim for Long-term Care Benefit (2600)
Claim form for people who have reached retirement age, who are living at home and who need the assistance of others in performing everyday functions.
An instractional video on how to fill out the claim form (in Hebrew)
Request to Re-Examine an Eligible Person Due to the Claim of Deterioration (2620)
Order Request to Re-Examine an Eligible Person Due to the Claim of Deterioration (2620)Fill in Request to Re-Examine an Eligible Person Due to the Claim of Deterioration (2620) (נפתח בחלון חדש)Download Request to Re-Examine an Eligible Person Due to the Claim of Deterioration (2620)
Claim to reexamine an insured person due to medical deterioration.
Long-term care benefit in cash instead of services for persons employing a full-time caregiver (2655)
Order Long-term care benefit in cash instead of services for persons employing a full-time caregiver (2655)Download Long-term care benefit in cash instead of services for persons employing a full-time caregiver (2655)

The form is meant for those who request to receive a cash benefit instead of a service benefit - who employ a full-time caregiver and who live in one of the areas of the experiment (a locality belonging to one of the following local NII branches: Nahariya, Ramat Gan, Bnei Brak, Ashkelon, Ashdod, Jerusalem and Tiberias).
Waiver of confidentiality- Long-Term Care (7109)
Fill in Waiver of confidentiality- Long-Term Care (7109) (נפתח בחלון חדש)Download Waiver of confidentiality- Long-Term Care (7109)
Opening a file for a service-provider (2614)
Download Opening a file for a service-provider (2614)
This form is for new companies which provide services for recipients of the Long-Term Care benefit (after having won a tender).
Declaration of Single Status determination (2670)
Download Declaration of Single Status determination (2670)
Authorization of residence in an institution/retirement home (2604)
Download Authorization of residence in an institution/retirement home (2604)
Selection of long-term care services for those at first level of entitlement - 2.5 to 3 points (2672)
Download Selection of long-term care services for those at first level of entitlement - 2.5 to 3 points (2672)
Selection of long-term care services for those at entitlement levels 2 to 6 (2673)
Download Selection of long-term care services for those at entitlement levels 2 to 6 (2673)
Consent to transfer a claim for long-term care benefit through the hospital (2666)
Download Consent to transfer a claim for long-term care benefit through the hospital (2666)
The claim form is intended for an insured who is hospitalized and who to submit a first claim for long-term care benefits during his hospitalization. The claim will be sent to the National Insurance Institute directly from the hospital.
Consent to transfer a claim for reexamination due to worsening condition (2668)
Download Consent to transfer a claim for reexamination due to worsening condition (2668)

The claim form is intended for the person entitled to a long-term care benefit who is hospitalized and wishes to submit a condition deterioration claim during his hospitalization. The claim will be sent to the National Insurance Institute directly from the hospital.
Claimant’s statement after discharge from a retirement home or nursing institution (2640)
Download Claimant’s statement after discharge from a retirement home or nursing institution (2640)

The form is designed to those who were discharged from a retirement home or a nursing institution after a period of care of over 90 days and wish to renew their eligibility.
Reexamination request by the eligible for long'term care benefit on ground of worsening condition (2620)
Fill in Reexamination request by the eligible for longterm care benefit on ground of worsening condition (2620) (נפתח בחלון חדש)
In case of modification or worsening of your medical situation you have the possibility to send the latest medical documents through the website without being obligated to fill out a worsening condition form.