Aviva Yoselis
Board Certified Patient Advocate

Does Israel really want you ‘back’ if you’re sick?

In the spirit of our month-long theme of what to do when you hear NO in the healthcare industry, I thought it would be relevant to identify a big problem within the Israeli system, of what to do when you hear NO from Bituach Leumi when you want to return to Israel after being away for several years.

About five years ago I had a client, let’s call her Leah, who had made aliyah in the 90s, and then for financial and family reasons, had moved back to the US.

Fifteen years later, she had a child, a divorce, and a different financial picture in front of her, and wanted to return to live in the holy land, her right as a Jew through the law of return. She wanted, literally, to return.

She was also returning with cancer.

It seemed like a straightforward process. Leah contacted Bituach Leumi (Israel National Insurance) before she returned, as per their suggestion. She completed the returning citizen’s questionnaire. She paid the ~11,000 ILS redemption fee (I call it a fine), and she got on her flight to Israel.

Only to discover, when she went to an initial doctor’s visit, that she did not have Bituach Leumi, and she was not covered via the national health insurance for the first six months of her return.

In 2006, Bituach Leumi modified their returning citizen law to state the following: Anyone who returns to Israel after living abroad for more than 4.5 years (even if they continued to pay the monthly fee), must re-establish their residency in Israel before receiving coverage.

To re-establish residency, you can either claim it retroactively (I have now been living in the country for six months) or pay the ~11,500 ILS redemption fee upon entry to the country.  BUT HERE’s the CAVEAT.  In addition to establishing residency, you must also demonstrate that Israel is, once again, the center of your life. 

How do you do that?  Proving your own property in Israel and/or registering your children in the school system are a few examples of accepted ways.

But here’s the catch. How many returning residents own property in Israel and have school-age kids? Not a lot. And sometimes this is not enough. Leah had a child registered in school and she had a rental contract, but the Bituach Leumi clerk said, “That’s not enough.  Maybe Israel is not the center of your life.”

That’s just it!  The clerk is the one to determine whether or not Israel is the center of your life.

I wish I could tell you that Leah’s case was an anomaly, but in the last 5 years since helping her, I have personally managed at least ten cases when the returnee was denied immediate Bituach Leumi coverage upon arrival.

And they were all ill with something, usually a chronic disease.

I can’t even begin to count the number of local and national clerks, administrators, and managers I have discussed this issue with, and I always hear the same thing.

“We had to limit the number of people coming back to Israel just for medical care and then returning to the home country.  We can’t just support these people’s expensive medical treatments.”  And some of them even referred to a report by the mevaker hamedina, the national ombudsman’s office, that apparently had identified this issue.

They have all drunk the Kool-aid.  There is no report unless it’s in someone’s file cabinet in an unused office, and, funnily enough, every single one of those people I spoke with from the administration, was born in Israel.

Why do I mention that? Because I feel that they really do not have any understanding of the immigrant experience. They do not understand that returning to Israel is an ordeal, a trial, and not easy. That those who return, almost all of them, just want to go back to where they felt like themselves, like they were home. Despite the fact that it is really challenging to live in a country with little support, especially when you are ill.

I am sure there are those who made aliyah, left two years later, and returned because they needed medical treatment.  There must be, but they are certainly not the majority, and after 5 years of searching I have yet to see actual data on that through Bituach Leumi or any other government agency.

Just like so much of Israeli policy, it is anecdotal, a decision made, I feel, on gut feeling and not based on fact.

And it is those returnees, who do not own property in Israel and have hit retirement age and just want to be back where they feel they belong, they are the ones who suffer.

So…  when you hear this NO what do you do?

  1. Go to another clerk.  Because it’s a personal evaluation, sometimes just having a new person hear your story makes all the difference.
  2. Go to a different bituach leumi office. I found that, in the periphery of the country, the clerks were even less familiar with English speakers returning after years in their home country, and did not ‘get’ it. Jerusalem and Tel Aviv area offices are more familiar with this issue.
  3. Keep pushing. This is a grey area and you do not need to accept the decision as is. Ask to speak to the branch manager and keep pursuing it.
  4. Purchase traveler’s insurance, even with their exorbitant rates, if you can, so you do have some health coverage if disaster strikes.
  5. Bring all the documentation they request and more. Receipts of your life thus far in Israel, letters from family and friends.
  6. Israel does need you, even if she acts like she doesn’t.  Don’t be put off.  You can make it happen and it is important not to give up.

Have your own returnee story to share about Bituach Leumi? Please post in the comments.

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About the Author
Aviva Yoselis, MPH, BCPA, founder of and director of Health Advize, a social impact enterprise to improve healthcare access for all. She is an expert in the field of health research, health behavior modification, and shared medical decision making, with over 25 years of experience teaching about public health issues and health systems navigation. She has a broad understanding of the biological sciences, biostatistics, epidemiology, clinical trials, and current issues in healthcare. She holds a Masters Degree in Public Health and was the first person to become a board-certified patient advocate outside of North America. Prior to moving to Israel, Aviva worked in the USA in health education and advocacy for low-income minority communities
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