CLAL INSURANCE. for members of Leumit Health Services As from 1 st July Essential information -
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1 CLAL INSURANCE "Leumit LTC" - Group long term care insurance policy for members of Leumit Health Services As from 1 st Essential information - 1. Description of the main elements of the cover: Monthly indemnification with respect to the cost of an insured staying in a long term care institution or monthly compensation for an insured who remains at home. 2. The monthly insurance premium in NIS for each insured shall be as shown in the following table. The amount of the premium shall vary during the insurance period in accordance with the age of the insured when the premium is actually paid on the dates specified in the tables and changes in the consumer price index to which it is linked: Amount of monthly premium in NIS Age of the insured when premium paid to to to * The premium is linked to the May 217 index which was published on * The premium is likely to vary in accordance with paragraphs 1.2 and 14.1 of the policy. * Details of 15 years projected premiums appear at the end of the document.
2 3. The insurance period is from the date on which the insured joined the policy until , subject to the provisions of paragraph 5 of the policy. 4. Coverage The monthly insurance benefit for an insured who stays at home (compensation): Age upon joining for the first time: up to 49 - NIS 5,5. Age upon joining for the first time: 5 to 59 - NIS 4,5. Age upon joining for the first time: 6 and over- NIS 3,5. The monthly insurance benefit for an insured who stays in an institution (indemnification): Age upon joining for the first time: up to 49-8% and not more than NIS 1,. Age upon joining for the first time: 5 to 59-8% and not more than NIS 6,5. Age upon joining for the first time: 6 and over - 8% and not more than NIS 4,5. * The insurance benefits are payable for a maximum period of 6 months. ** The amounts of the insurance benefits are linked to the May 216 index which was published on 15 th June A. The waiting period under the policy - 6 days. B. Exceptions to the insurer's liability - No cover shall be provided under this policy for an insurance event which occurred: 1. As a result of service in a security force or Police unit, or participation in military or Police operations, combat or hostile activities; 2. As a result of nuclear fission, nuclear fusion or radioactive contamination; 3. As a result of using or addiction to drugs, unless the drugs were prescribed by a physician and not for the purpose of rehabilitation from drug addiction; 4. As a result of a preexisting medical condition, subject to the provisions of the Control of Insurance Business Regulations (Conditions in Insurance Contracts)(Provisions regarding a Preexisting Medical Condition), ; with regard to this paragraph an eligible insured shall be regarded as
3 insured under a replacement contract with the same insurer or another insurer as specified in section 6(a)(2) of the aforementioned Regulations; 5. For the first time before the start of the insurance period or after the insurance period ended, subject to the provisions of paragraphs and of the policy; 6. For the first time during the first 36 months of the insured's life; 7. As a result of a road accident, as defined in the Road Accident Victims Compensation Law, or a work accident as defined in the National Insurance Law [Consolidated Version], which was recognized by the National Insurance Institute. Definitions for the purposes of paragraph 5.B.4: "Preexisting medical condition": A set of medical circumstances which were diagnosed in the insured before the date on which the insured joined the policy, including as a result of an illness or accident; in this regard "diagnosed" - by a documented medical diagnosis or a documented medical diagnostic process which was made or took place in the six months which preceded the date on which the insured joined the policy in relation to a preexisting medical condition as defined above. "Preexisting medical condition exclusion" - A general exclusion in an insurance contract which exempts the insurer from liability, or which reduces the insurer's liability or the extent of the coverage, due to an insurance event which occurred to the insured or beneficiary during the ordinary course of an existing medical condition during the period in which the exclusion applied. The preexisting medical condition exclusion shall apply to the insured in the cases and for the periods as follows: - Where the insured was less than 65 years of age on the determining date - for a period of not more than one year from the date on which the insured first joined for existing medical condition purposes. - Where the insured was 65 years of age or older on the determining date - for a period of not more than six months from the date on which the insured first joined for existing medical condition purposes. Notwithstanding the foregoing, the exclusion of the insurer's liability or the coverage restriction, if decided upon, due to a specific medical condition which was recorded in the policy schedule for a particular insured, shall be for the period stipulated in the policy schedule for that specific medical condition.
4 The preexisting medical condition exclusion shall not apply where the insured informed the insurer in his health declaration about his previous medical condition and the insurer did not expressly exclude cover with respect thereto in the schedule. 6. Method of payment Premiums shall be paid by standing order through Leumit Health Services. * The insurance candidate must answer fully and truthfully questions relating to a substantive matter and a failure to do so may affect payment of the insurance benefits. It is clarified that the contents of this document are subject to the full conditions of the policy, which shall be overriding in the event of a discrepancy between them.
5 The following table shows the premiums for the coming years, after the current insurance period has ended Age of Insured at Time of Premium Payment April 219 to June Amount of the monthly premiums in NIS *The premium is linked to the May 217 index which was published on These premiums were formulated by Leumit Health Services and the Supervision. It is clarified that the figures given in the premiums table is correct as at today's date and may be altered.
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