Question: Can the process of applying for a special services allowance (SSA) negatively impact a general disability pension or an income tax exemption if, during the review for the SSA, it is determined that the patient “has no significant disabilities”? This could lead to reopening the case, similar to when a worsening of condition is reviewed for general disability. What are the criteria for an SSA? Does cognitive disability also count?

Answer: Several questions were asked here, and I will answer them in parts:

1. Generally, the process of assessing eligibility for an SSA does not impact other benefits. However, in theory, there could be a reduction in the percentage of medical disability determined during the SSA assessment, which might also reduce eligibility for a general disability pension. However, in practice, this scenario rarely occurs.
2. The primary criteria for an SSA are a dependency on assistance from others for daily activities. These activities include bathing, dressing, controlling bodily functions, eating, and walking within the home. Once it is established that the applicant depends on assistance for any of these activities, their dependency on help for household management tasks, such as taking medication, meal preparation, or operating devices, is also evaluated. The level of dependency determines the degree of eligibility for the SSA, which has four levels ranging from 1,771 NIS to 8,313 NIS per month.
3. Cognitive disability is indeed considered, especially in cases involving risks where the patient is unaware of dangers and may pose a threat to themselves or others.

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Question: I was diagnosed in 1990 but refrained from sharing the diagnosis with my family and am not recognized by the National Insurance Institute (NII). How can I update the NII now, after so many years, and what are the implications in terms of exposure?

Answer: I completely understand the desire to maintain privacy and not disclose the diagnosis to others. However, it’s essential to consider that such a choice can come at the cost of losing out on benefits and rights. It is not possible to claim retroactive benefits dating back to 1990. Every claim has a maximum retroactive period:

• General Disability Pension: Can be claimed retroactively for up to one year, provided the conditions were met during that time.
• SSA: Can be claimed retroactively for up to six months.

Applications can be submitted until retirement age.

The process and implications depend on how the illness manifests in daily life, its impact on lifestyle, and whether there are difficulties with employment, mobility, or daily tasks.

In Israel, rights are not determined solely based on the diagnosis but on how the medical condition affects various functions. Every functional impairment may grant different entitlements.

For example, a person who struggles to work and earns less than 7,522 NIS per month (as of 2024) due to a medical condition may be eligible for a General Disability Pension of up to 4,291 NIS per month (2024).

The Process Includes Two Steps:

1. Medical Assessment: The applicant’s medical condition is evaluated, and a percentage of medical disability is determined. Eligibility requires:
   • A combined disability percentage of at least 40%, with at least one impairment rated at 25%.
   • Alternatively, a total medical disability percentage of 60% if no single impairment is rated at 25%.
2. Impact on Earning Capacity: The impact of the medical condition on the ability to work is assessed. The applicant must demonstrate a loss of at least 50% of their earning capacity.

The maximum general disability pension in 2024 is 4,291 NIS per month, with additional benefits and intermediate levels of support.

If the illness impacts earning capacity, it is also worth exploring eligibility for a disability pension from a pension fund or loss of work capacity insurance, which may provide up to 75% of the insured salary. These benefits are often higher than people realize.

If the patient struggles with daily activities, refer to the answer about SSA eligibility. Additionally, check for long-term care insurance policies with private insurers.

If mobility is an issue, the patient may consider applying for Mobility Benefits. Under an agreement between the Ministry of Finance and NII, certain patients may be entitled to benefits, including:

• A monthly allowance (up to 2,400 NIS).
• State assistance in purchasing a new vehicle based on the mobility disability percentage and the car size stipulated in the agreement.
• A disabled parking permit and reduced vehicle registration fees (the last two benefits can be obtained independently through the Ministry of Transport).

The mobility assessment is conducted by the Ministry of Health, not the NII. The percentage of mobility limitation is unrelated to the medical disability percentage.

Lastly, it is possible to examine eligibility for an income tax exemption for medical reasons. This exemption is granted to individuals with a combined medical disability of at least 89.2%, where one impairment is rated at 40% or higher, and the disability is determined to last for more than six months.

All these procedures are strictly confidential, and no one in the patient’s life needs to be involved, except in the SSA process, where demonstrating dependency on assistance may require involving others.

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Question: Can I receive accommodations at work? I work as an assistant in kindergarten.

Answer: Unfortunately, this question falls under labor law and should be addressed to an expert in this field.

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Question: At what stage of the disease is it advisable to start the process with the authorities? When and which organizations should I contact? Is there a guide or explanatory videos for navigating claims for loss of work capacity, general disability percentages, or processes with the Ministry of Transport (e.g., obtaining a disabled parking permit)?

Answer: These are very general questions. The appropriate time to start is when the disease begins to impact your quality of life and influences your decisions. For example, someone accustomed to working 10 hours a day but now, due to disease progression, can work only 5 hours may be eligible for a loss of work capacity pension from their pension fund (up to 75% of the reduced salary, assuming the entire salary is insured). Additionally, they might also be eligible for a general disability pension from the National Insurance Institute (NII).

For detailed instructions, please refer to the response to Question 2 in the original text.

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Question: I have MS and receive a full disability pension from the NII. Am I eligible for assistance with house cleaning?

Answer: Assistance with house cleaning, i.e., household management, is part of the evaluation for an SSA (special services allowance). As explained in the response to Question 1, SSA eligibility depends on being reliant on assistance for daily activities (e.g., bathing, dressing, controlling bodily functions, eating, walking within the home). Only then is the dependency on household management, including cleaning, assessed.

It is not advisable to apply for an SSA solely due to the need for house cleaning assistance.

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Question: A person with primary progressive multiple sclerosis (PPMS) receiving 82% disability + 110% SSA recently experienced a significant deterioration and now resides in a private nursing home. Can they apply for a reassessment due to the worsening condition? I was told it’s impossible for those living in a nursing home.

Answer: Patients residing in facilities providing medical, nursing, or rehabilitation services are not eligible for an SSA.

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Question: At what stage should I register with the NII? Is the process automatic?

Answer: None of the benefits are granted automatically. To claim any benefit, you must actively file a claim along with the relevant medical documentation for each specific claim. Refer to Question 2 for possible claim pathways.

In summary:

• If employment is affected, consider applying for a general disability pension or disability pension from your pension fund.
• If mobility is impaired, consider applying for mobility benefits.
• If daily activities are impacted, consider applying for an SSA and review any private long-term care insurance you may have.

The right time is when the disease begins to affect your lifestyle, e.g., avoiding long walks due to physical limitations.

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Question: How are income tax exemptions determined, and when can one receive both mobility benefits and a pension?

Answer: An income tax exemption is granted to individuals with a combined medical disability of 89.2% or more, with at least one impairment rated at 40% or more, and a disability period of at least six months. There is no conflict between mobility benefits and an income tax exemption; both can be received simultaneously.

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Question: I’ve had MS since March 2018. What benefits am I entitled to?

Answer: Refer to Question 2 for detailed pathways.

In summary:

• If employment is affected, consider applying for a general disability pension or disability pension from your pension fund.
• If mobility is impaired, consider applying for mobility benefits.
• If daily activities are impacted, consider applying for an SSA and review any private long-term care insurance you may have.
• If you have taxable income, you may be eligible for a medical tax exemption, granted to individuals with a combined medical disability of 89.2% or more for a period exceeding six months.

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Question: Shortly after my diagnosis, I was granted 100% loss of work capacity and 55% medical disability by the NII, which does not qualify for a disabled parking permit. Recently, I feel my mobility has worsened. Can I reapply for reassessment, and is there a risk of reducing my benefits?

Answer: Given your situation, it is advisable to apply for mobility benefits. Mobility evaluations are conducted by the Ministry of Health, not the NII. Eligibility for mobility benefits depends on how the disease impacts your ability to walk.

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Question: I need walking aids (sticks) and suffer from a herniated cervical disc with myelopathy. What disability percentage can I expect from the NII?

Answer: For reliance on walking aids, you should consider applying for mobility benefits. The evaluation will assess how your medical condition, including MS, affects your walking ability and your reliance on mobility aids. Benefits under the mobility agreement include:

• A monthly allowance (up to 2,400 NIS).
• State assistance in purchasing a new vehicle based on the degree of mobility impairment.
• A disabled parking permit and reduced vehicle registration fees (these last two benefits can be obtained independently through the Ministry of Transport).

Regarding disability percentages, if filing a claim for general disability, you will likely be evaluated by a neurologist (for MS) and an orthopedist (for the herniated disc). The percentages assigned for each condition will be combined into a weighted disability percentage.

For example, if you receive 10% for hypertension and 10% for hearing loss, the combined calculation is:
10 + (10/90) = 19%.