Functioning capacity examination and reexamination in case of worsening condition

Functioning capacity examination (dependency assessment)

In order to determine whether or not you are entitled to a long-term care benefit and the level of eligibility relevant to you, we will conduct an examination in which your functioning will be assessed.

The functioning capacity can be conducted in several fashions:

1. Functioning examination by an evaluator of the National Insurance

In this process, the functioning examination is established based on the documents you have sent us about your medical and functioning condition, it is therefore very important to attach to the claim all documents related to functioning:

• Updated medical summary letter signed by the handling doctor or a specialist physician
• Hospitalization summaries
• Results of medical diagnostic and imaging exams
• Special treatments
• Medication treatment, etc.

Important information!

• When the evaluator lacks details regarding your medical and functioning condition - he will contact you and the contact person (family member), and will convene a date for information complement by telephone or an assessment visit at your home.
  To allow for a fast assistance and examination of your condition as close as possible to the submission of the claim - it is advised to ask the evaluator to complete the information about your condition over a telephone conversation with you and the contact person who knows your medical and functioning condition.
• If you wish from the outset the evaluator to perform the examination at your home - please point it out in your claim. During the examination, it is advisable for an accompanying person to be present, who knows the elderly, his functioning limitations and medical condition. For person suffering from cognitive decline - a family member or guardian must be present at the time of home examination.
• If you prefer the examination to be performed in your mother tongue other than Hebrew - please point it out in your claim.
• If you prefer the examination to be performed by a man or a woman - please point it out in your claim.

• The examination may only be conducted by a geriatrician as part of his or her work in a public hospital or clinic.
• One must ask the doctor to fill out the functioning assessment on the National Insurance (document is fount in Appendix B of the long-term care benefit claim) and to provide an updated medical summary letter. These documents must be attached to the benefit claim.

For your information: The geriatric physician's is not allowed to charge for the examination (the examination shall not be performed as part of the supplementary or private insurance, including private medical service at a hospital).

Reexamination due to worsening of health condition

You are entitled to submit a request to be re-examined either if your health condition has worsened since the previous examination, or if you were granted a temporary long-term care benefit which is about to end.
Please note, if you submit a request for reexamination, your level of entitlement may either increase or remained unchanged, but will not decrease in any event.

In case a higher entitlement level is granted to you, you will start receiving it as of the eighth day following the day of submission of your re-examination request.

How to submit a claim for reexamination?

One can send medical documents showing the worsening situation by means of the document delivery service on the website to the handling branch or reach the branch of National Insurance nearest your place of residence to submit the medical documents.

Please note, if you receive a benefit at the highest level of entitlement (level 6), you are not allowed to submit a reexamination request.

Reexamination for recipients with temporary entitlement?

If you were granted a temporary entitlement to a long-term benefit, you can submit a reexamination request before the end of the period of entitlement.

• If you are aged under 80 - Approximately 2 months before the end of the temporary benefit period, you will receive a notice from the National Insurance. If you feel that there has been no improvement in your functioning, you can contact the National Insurance in writing or by means of the website with a request to extend your eligibility for the benefit. You need to attach to the request a detailed and updated medical document signed by your handling doctor. We will consider your request and send you notification of our decision. It is recommended to send the request letter at least a month before the end of the temporary benefit.
• From age 80 and older - before the end of the temporary period of entitlement, you need to send to the Long-Term Care Department of the handling branch a detailed and updated medical document signed by your handling doctor. This information will be transferred for the functioning examination and the assessment of the continuation of eligibility for the long-term care benefit. The document can be sent by means of the document delivery service on the website.