# Israeli Oncology Navigator

> Bureaucracy navigator for cancer patients and caregivers in Israel. Covers Bituach Leumi (disability, full 4-rate שר\"מ table 50/112/188/235% + child-under-3 supplement, pediatric ילד נכה at 235%, Section 9(5) tax exemption, 40% arnona, 60-day appeal); 2026 sal habriut (drugs, exceptions committee, severe-illness co-pay exemption, dental funding, surgery wait-time + Form 17, hereditary-cancer gen…

- **Type:** Skill
- **Install:** `agentstack add skill-skills-il-health-services-israeli-oncology-navigator`
- **Verified:** Yes — security-reviewed for prompt injection and unsafe behavior
- **Seller:** [skills-il](https://agentstack.voostack.com/s/skills-il)
- **Installs:** 0
- **Category:** [Agent Skills](https://agentstack.voostack.com/c/agent-skills)
- **Latest version:** 0.1.0
- **License:** MIT
- **Upstream author:** [skills-il](https://github.com/skills-il)
- **Source:** https://github.com/skills-il/health-services/tree/master/israeli-oncology-navigator

## Install

```sh
agentstack add skill-skills-il-health-services-israeli-oncology-navigator
```

Requires the [AgentStack CLI](https://agentstack.voostack.com/docs/cli). Works with Claude Code, Cursor, and any MCP-compatible agent.

## About

# Israeli Oncology Navigator

## Critical Disclaimer

**Read this before using the skill. Every response based on this skill must repeat the relevant disclaimer.**

This skill is a **bureaucracy navigator** for Israeli cancer patients and their families. It is NOT medical advice, NOT legal advice, and NOT a substitute for professional help. Specifically:

1. **Always route the user to the hospital oncology social worker (עובד סוציאלי אונקולוגי / עו"ס אונקולוגי) as the first step.** Every oncology department in Israel has one. They know the current procedures at that specific hospital and file most of the paperwork on behalf of patients at no cost. Telling a patient to "apply on the Bituach Leumi site" before routing them to the social worker is a failure mode.
2. **Never give medical advice.** Do not recommend treatments, drug dosages, or clinical decisions. Redirect medical questions to the treating oncologist.
3. **Figures in this skill are 2026 values** and change annually. The 2026 health basket list, Bituach Leumi amounts, and HMO supplementary regulations all update every January. Always cite the effective year and point the user at the authoritative source URL.
4. **HMO supplementary caps and exclusions vary by plan tier and renewal date.** This skill gives the shape of coverage; the patient must verify the current regulations PDF for their specific plan before acting on any financial figure.
5. **Do not fabricate legal references.** If you cannot verify a law section, form number, or entitlement amount against the sources listed in the Reference Links section, say so plainly and point the user at the source, do not guess.

## Problem

A cancer diagnosis in Israel triggers weeks of bureaucracy at the worst possible time. Entitlements are split across **four separate systems** that do not talk to each other: Bituach Leumi (nechut, special services, child-nechha, tax exemption, arnona discount), the health basket (drugs, co-pay exemptions, dental, surgery wait-time, home chemo, post-surgical rehab), the HMO supplementary insurance (non-basket drugs, second opinions, transport), and dozens of NGOs with overlapping but different eligibility. Patients and caregivers routinely discover entitlements months after they could have been claimed, or fight a valid claim through an appeal because nobody told them about the 60-day deadline. This skill consolidates the bureaucracy map so the family can act in the first weeks, while routing the hard decisions to the hospital oncology social worker who files the actual paperwork.

## Instructions

### Step 0: Route to the hospital oncology social worker FIRST

Before anything else, tell the user:

> Your first call, before Bituach Leumi and before the NGOs, is the **oncology department social worker (עו"ס אונקולוגי)** at the treating hospital. They know your specific hospital's procedures, they have the current forms, they file most Bituach Leumi claims for you at no cost, and they refer to the right NGO based on your diagnosis and family situation. Ask the oncology ward or the hospital switchboard for "the oncology social worker".

For rights-portal research the user can do in parallel (while waiting for the social worker appointment), also mention:
- **Kolzchut (כל-זכות)** at https://www.kolzchut.org.il -- free, the most authoritative Israeli rights portal
- **Israeli Cancer Association (ICA / האגודה למלחמה בסרטן) Telemeda hotline** -- free phone information line:
  - Hebrew: 1-800-599-995
  - Arabic: 1-800-36-36-55
  - Russian: 1-800-34-33-44

### Step 1: Assess which track applies

| Situation | Relevant Steps |
|-----------|----------------|
| Just diagnosed, active treatment (chemo / radiation / biological) | Steps 2, 3, 4, 7 |
| Child diagnosed with cancer | Steps 3 (child-nechha), 9 (pediatric NGOs), 7 (fertility) |
| Drug NOT in the 2026 basket | Steps 4a, 5 |
| Co-pay exemption, dental, surgery wait-time, home chemo, cannabis, post-surgical rehab | Step 4b |
| Hereditary cancer (BRCA, Lynch, Li-Fraumeni, FAP) | Steps 4b (genetic testing), 9 (Bracha) |
| Preserve fertility before treatment (any gender, any age) | Step 7 |
| Patient in terminal stage | Step 6 (palliative) + Step 11 (living will) |
| Family caregiver sick days | Step 8b |
| Summoned by NII for a שר"מ review, or self-requesting a higher rate | Step 3b + 3b-ii |
| Threatened at work / accommodations | Step 8a |
| Other NII-linked benefits (arnona, transport) | Step 3g |
| Clinical trial or treatment abroad | Step 10 |
| Emotional / logistical NGO help | Step 9 |

### Step 2: Nechut Refuit (medical disability) -- fast-track for active patients

**Cancer does NOT automatically set a fixed disability percentage.** A medical committee (ועדה רפואית) determines the percentage per cancer type, stage, and treatment. But:

**Paper-only fast-track for active oncology patients:** Patients receiving qualifying drug treatments (chemotherapy, radiation, biological therapy) can have their Bituach Leumi eligibility determined from **submitted medical documents alone**, without attending a committee hearing. This is the most important thing new patients miss. Source: Kolzchut, "Determining Eligibility for Special Services Allowance for Cancer Patients Without Attending a Medical Committee".

**What this unlocks:**
- Automatic eligibility at **50% of the special services allowance** (see Step 3) for the duration of active treatment
- Minimum eligibility period of **6 months** from the day treatment starts
- Continuation **1 month past** the end of treatment at 235% (home hospice) or dropping to the appropriate lower rate

The hospital oncology social worker files this. The patient does not need to visit a Bituach Leumi office in person.

### Step 3: Bituach Leumi core entitlements

#### 3a. General disability pension (קצבת נכות כללית) -- 2026 amounts

Eligible when medical disability is at least 60% AND earning-capacity loss is at least 50% (salaried) or 75% (housewife). Monthly amounts (January 2026):

| Earning-capacity loss | Monthly (individual) | With spouse supplement |
|-----------------------|----------------------|------------------------|
| 100% / 75% (full rate) | ₪4,711 | ₪6,229 |
| 74% | ₪3,211 | ₪4,255 |
| 65% | ₪2,894 | ₪3,840 |
| 60% | ₪2,718 | ₪3,609 |

Source: Bituach Leumi announcement of 2026 updates (see Reference Links). Amounts are indexed annually.

#### 3b. Special services allowance (גמלת שירותים מיוחדים / שר"מ)

Monthly cash benefit for adults who need help with daily activities. **Four rates are currently in effect** (2026 amounts, source: Kolzchut "קצבת שירותים מיוחדים"):

| Situation | Rate | Monthly (2026) | How determined |
|-----------|------|----------------|----------------|
| Active chemo / radiation / listed biological treatments | 50% | ₪1,943 | Paper only, no committee |
| Help with ALL ADLs most hours OR constant supervision | 112% | ₪4,501 | Committee hearing |
| Help with ALL ADLs all hours | 188% | ₪7,181 | Committee hearing |
| Home hospice or inpatient hospice (terminal) | 235% | ₪9,126 | Committee or paper |

**The 50% paper track is the starting point, not the ceiling.** After the minimum 6 months, NII may summon for a committee review OR the patient can self-request a higher rate based on functional decline. Many active-treatment patients with severe side effects (neutropenia, neuropathy, fatigue, incontinence isolation, cognitive fog) qualify for 112% or 188% -- the difference between 50% and 188% is over ₪62,000/year.

**Child-under-3 supplement:** שר"מ recipients with children under 3 get an extra **₪1,215/month per child, max 2 children = ₪2,429/month**.

##### 3b-ii. Preparing for the שר"מ committee (ADL framework)

The committee scores 6 ADL categories (mobility, dressing, bathing, eating, toileting, continence) and a constant-supervision criterion. **Evaluate based on worst-case days, not averages**: for a chemo patient that means cycle days 1-7, not 14-21. Active-treatment side effects (neutropenia isolation, neuropathy, mucositis, post-surgical mobility, cognitive fog, seizure-supervision) count as functional impairments.

**Full prep guide:** `references/sherum-committee-preparation.md` -- ADL-to-side-effect mapping by treatment type, "summoned vs self-requested" framing, document checklist for the committee package.

**Who helps prepare:** the hospital oncology social worker is the first port of call. The **ICA Rights Center** (helpdesk 03-5721678, embedded in 10+ hospitals) and disease-specific NGO attorneys (One in Nine 03-602-1717 ext 2 for breast cancer) help build the evidence package.

#### 3c. Disabled-child allowance for pediatric cancer (גמלת ילד נכה)

A child with a malignancy is eligible from birth to age 18 years and 3 months. Rates (January 2026):

| Situation | Rate | Monthly amount |
|-----------|------|----------------|
| Active chemo or radiation | 235% | ₪9,126 |
| Five months after active treatment ends | 100% | ₪3,820 |
| Biological treatments (separate track) | 100% | ₪3,820 -- minimum 6 months from day treatment starts |

Source: Bituach Leumi "Disabled Child" benefit page and Kolzchut parents' guide.

#### 3d. Income tax exemption -- Section 9(5) of the Income Tax Ordinance

Cancer patients often qualify for a large income-tax exemption. Threshold: the Bituach Leumi or Ministry of Finance medical committee has determined **at least 90% permanent disability, OR at least 90% temporary disability for 185 days or more**. Patients who had tumor-removal surgery followed by chemo or radiation typically qualify.

Filed digitally through the Tax Authority "Green Wave" (גל ירוק) form. Source: Kolzchut, "Cancer Patients".

#### 3e. Sick pay from day 1

Since 1 June 2022, an employee with a chronic illness absent for treatment or tests is entitled to full sick pay **from the first day of absence**, overriding the standard 0% / 50% / 50% / 100% ladder. Source: Kolzchut, "Cancer Patients".

#### 3f. Right to appeal (ערר)

The statutory appeal window is **60 days** from receiving the written decision, for both general disability (נכות כללית) and special services allowance (שר"מ) medical committees. File a written appeal to the Medical Appeals Committee (ועדה רפואית לעררים). Bituach Leumi in practice does not reject filings submitted within **90 days**, but this is informal grace, not law -- file by the 60-day statutory deadline whenever possible. The patient may be represented by a lawyer, social worker, or representative of their choice. A further appeal on legal grounds only lies to the Regional Labor Court. Source: Kolzchut, "ערר על החלטה רפואית בעניין נכות כללית" and "ערר על החלטה בעניין קצבת שירותים מיוחדים".

#### 3g. Other Bituach-Leumi-linked benefits

**Arnona discount:** 40% off municipal property tax for cancer patients with either (a) general disability pension at 75%+ earning-capacity loss, or (b) 90%+ medical disability. Auto-applied via NII lists, but verify with the municipality. Source: Kolzchut "הנחה בארנונה לחולי סרטן".

**Volunteer transport:** ICA runs a national volunteer-driver program for chemo/radiation appointments -- via Telemeda 1-800-599-995 or the oncology social worker. Reimbursement of out-of-pocket travel: ask the hospital social worker or ICA Rights Center.

### Step 4: Health basket coverage (drugs, exemptions, supportive services)

The basket covers far more than cancer drugs alone. **Full per-cancer-type detail** for sections 4b-4h is in `references/cancer-type-equity-rights.md`.

#### 4a. Cancer drugs in the 2026 basket

The **2026 basket** added 107 drugs and technologies at ₪650M total, of which ~₪337M (52%) went to oncology. Notable verified additions (full list in `references/health-basket-and-hmo-coverage.md`):
- **Solid tumors:** Imfinzi (bladder/gastric peri-op), Tagrisso (post-op EGFR NSCLC), Keytruda (head-and-neck; endometrial), Enhertu (HER2-low breast)
- **Hodgkin lymphoma:** Adcetris (first line)

Bispecific-antibody and ADC additions for R/R MM and lymphoma have been reported -- verify against the MOH 2026 PDF before quoting. Drugs in the basket are dispensed by the HMO at standard co-pay; no separate application needed. **For a drug NOT in the basket,** the patient needs either the HMO exceptions committee (Step 5) OR a supplementary-insurance payout (also Step 5).

#### 4b. Supportive services (apply across all cancer types)

- **Co-pay exemption (severe illness):** free specialist visits, imaging, diagnostics, dietitian. Auto-applied by HMO on diagnosis code; request with specialist letter if missing.
- **Dental treatment:** HMO covers 50% before chemo/radiation, 100% after (24-month window). **Head/neck radiation = no time limit. Jaw resection = full coverage incl. implants.**
- **Surgery wait-time + Form 17:** if HMO can't meet the legally-mandated wait window, contact מוקד הסדרים -- they have 24h to find a date or issue Form 17 (התחייבות) for any authorized facility.
- **Genetic testing (hereditary cancer):** BRCA, Lynch, Li-Fraumeni, FAP, MEN1/2, VHL, PTEN. Free for patients + first-degree relatives. Positive carriers get structured surveillance.
- **Home chemotherapy:** selected regimens delivered at home via HMO nurse or portable infuser pump. Ask the oncologist about regimen eligibility.
- **Medical cannabis (post-April 2024):** cancer patients need only a prescription from a certified physician -- no license process. Fixed annual prescription fee of ₪180/year.
- **Post-surgical rehab and prosthetics:** site-specific (breast reconstruction, stoma supplies, voice/swallowing rehab, prosthetic limbs, continence supplies, cognitive rehab, wigs). Activate via HMO rehabilitation coordinator (רכז שיקום).

Sources for all: Kolzchut + ICA + gov.il -- full URLs in Reference Links.

### Step 5: HMO exceptions committee and supplementary insurance

#### 5a. Exceptions committee (ועדת חריגים)

Each HMO has a committee that reviews one-off requests to fund a drug or treatment outside the basket. Trigger: **formal refusal by the HMO** to fund the treatment.

Application package:
- Committee-review request form (from the HMO)
- Treating physician's detailed recommendation with medical literature and evidence that basket alternatives were exhausted
- All relevant medical records

Committee members: physicians (including oncologists), pharmacologist, legal advisor, economic advisor.

There is NO statutory response time. **Escalation ladder when refused** -- go in this order, NOT straight to court:

1. **Internal HMO appeals committee (ועדת ערר / בירורים)** -- fast, free, no lawyer required. Clalit example: https://www.clalit.co.il/he/info/Pages/berurim.aspx
2. **MOH Public Complaints Commissioner for the National Health Insurance Law** if internal appeal fails (12,809 inquiries handled in 2024)
3. **Regional Labor Court** -- request an interim order (צו ביניים) if life is at stake; these can issue within days

**Landmark precedent** to cite (full discussion: `references/exceptions-committee-precedents-and-appeals.md`): **חב"ר (ת"א) 5942-09-12** (Tel Aviv Regional Labor Court, October 2012, biliary-tract cancer) established that a drug's exclusion from the basket is not by itself grounds for refusal -- the exceptions committee must evaluate clinical efficacy, consider whether basket alternatives exist, and document budget arguments with calculations rather than assertions.

The **Patients' Rights Association** (https://www.patients-rights.org/) and **One in Nine** in-house attorney (03-602-1717 ext 2 for breast cancer) help with the package and representation. The **ICA Rights Center** is embedded in 10+ Israeli hospitals (rights helpdesk **03-5721678**, shikum@cancer.org.il) and specializes in NII rights, basket entitlements, exceptions committees, and Form 17.

#### 5b. Supplementary insurance (ביטוח משלים) -- cancer coverage by HMO

Each HMO sells a basic + top tier. Top tier covers non-basket oncology drugs (full table + 2025 caps in `references/health-basket-and-hmo-coverage.md`). Quic

…

## Source & license

This open-source skill is cataloged on AgentStack and links to its original source — we do not rehost the code.

- **Author:** [skills-il](https://github.com/skills-il)
- **Source:** [skills-il/health-services](https://github.com/skills-il/health-services)
- **License:** MIT

Install and usage instructions live in the source repository linked above.

## Pricing

- **Free** — Free

## Security capabilities

Automated source analysis of v0.1.0 — what this tool can access:

- **Network access:** no
- **Filesystem access:** no
- **Shell / process execution:** no
- **Environment & secrets:** no
- **Dynamic code execution:** no

*"Yes" means the capability is present in the source — more access means more to trust, not that it is unsafe.*


## Versions

- **0.1.0** — security scan: passed — Imported from the upstream source.

## Links

- Listing page: https://agentstack.voostack.com/l/skill-skills-il-health-services-israeli-oncology-navigator
- Seller: https://agentstack.voostack.com/s/skills-il
- Browse the marketplace: https://agentstack.voostack.com/browse

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