Bituach Leumi (ביטוח לאומי, ‘National Insurance’) is a governmental system meant to provide an economic safety net for eligible citizens. The BL recognizes that, while trans identity is not a mental disorder, it might be correlated with significant challenges to function in various aspects of life, and may be expressed through, among other things, gender dysphoria. קבלת הקצבה תלויה בהכרה של נכות על רקע נפשי.
You can receive a disability pension (also known in English as benefits or stipend) from Bituach Leumi for reasons that aren’t related to gender transition, and not just for transition-related reasons; but we won’t be addressing those in this entry. If you have additional justifications for getting the pension, you should consider adding them to your claim too. In this case you should consult with professionals in the relevant field.

Most pensions are approved for a period of two years, but in some circumstances, and depending on the track you filed your claim in, there’s an option to get permanent recognition of disability and a permanent pension.

For people who identify on the trans spectrum, Bituach Leumi offers a disability pension through several tracks:

A disability pension in a shortened track for those who are in their first two years after beginning gender affirming medical procedures (such as hormone therapy or gender affirming surgeries).
A disability pension in a standard track based on psychological distress relating to the trans identity.
A disability pension for the period of recovery from surgery.

Who is eligible for a temporary or permanent pension from Bituach Leumi on the basis of gender affirming care?
You must meet all of the following requirements:

Adults (from age 18, including soldiers and national service members) who are residents of Israel and are younger than retirement age.
People who earn a salary of less than 60% of the national average salary for a period of at least 90 consecutive days. Information about the up-to-date amount can be found here on the Bituach Leumi website.
In 2023 the maximum salary you could earn and still get a pension was 7,122 NIS, and in 2024 it’s 7,522 NIS. More information about the income ceiling can be found in the next section.
One or more of the following:
- People who identify on the trans spectrum and who have gender dysphoria (a feeling of mismatch between their gender identity and sex assigned at birth) and who experience psychological distress and employment difficulties.
- People who have begun gender affirming medical procedures and who haven’t yet gone two years since beginning the first procedure. People in this category will receive a full pension for the two years from the start of the first procedure.

The income ceiling for a disability pension

While processing your claim, Bituach Leumi checks twice that there’s at least 3 months’ income below the income ceiling:

-The first time: when filing your claim for disability, they check that during the last 15 months there are 3 consecutive months when your salary was below the ceiling. Only if they find 3 such months do they continue handling your claim.

-The second time: after determining medical disability of 40% or higher, they check if there are 3 consecutive months from the day that disability was determined to have started when the salary was below the ceiling. In other words, they check if there have been 3 consecutive months when the person is both recognized as disabled, and making less than the income ceiling. Only after there are 3 such months is the pension approved. After this point you can start working and earning above the ceiling, in accordance with the Laron law.¹

Note! The BL might approve a pension, and only then check if the income in the first 3 months of recognized disability is below the income ceiling. If they don’t find that those 3 months’ income are below the ceiling they may demand you return the money.

First example: I filed a claim for disability on Jan. 29th, 2024, on the basis of gender dysphoria, with no medical procedures done, through the standard track for the trans community. As part of my claim I added my last 15 pay slips, which include 3 consecutive months with a salary below the income ceiling. I was approved for disability starting from the month I filed my claim, from Jan. 1st, 2024. In the months January, February and March 2024 I must make less than the ceiling (which is 7,522 NIS in 2024) so that I’ll have 3 months when I’m both recognized as disabled and earning below the ceiling. After these months I’ll be able to earn more than the income ceiling, in accordance with the Laron law.

Second example: I filed a claim for disability through the shortened track for the trans community on March 15th, 2024, on the basis of beginning HRT on Sep. 1st, 2023. As part of my claim I added my last 15 pay slips, which include 3 consecutive months with a salary below the ceiling in the months September, October and November 2023. I was approved for disability starting from the month I began HRT, from Sep. 1st, 2023. Therefore, there are already 3 months for which I am recognized as disabled and when I earned a salary under the income ceiling.. In this case I can immediately begin earning more than the income ceiling, in accordance with the Laron law.

What are the impacts of recognition by Bituach Leumi?

Receiving a disability percentage and an incapacity percentage

In the process of your claim to the NI, two main parameters are checked: your capacity to work for a living and earn a salary, and the severity of your physical or psychological state.

The disability degree refers to your medical state. The percentage of disability can grant you various rights and privileges. These rights are granted based on various criteria (see later for more details). The disability degree is determined by medical professionals in the course of a medical board – for instance a psychiatrist.
The incapacity degree checks your ability to earn a salary and determines whether you are eligible to get a monthly pension. The size of the pension changes based on the percentage of incapacity. If the professionals are unsure what to recommend regarding the incapacity degree, a recommendation will be given by a Bituach Leumi social worker.

Monthly pension

One of the major services that you can get thanks to recognition by Bituach Leumi is a monthly pension that is deposited directly into your bank account.

Even after being recognized by Bituach Leumi and getting a disability percentage that is high enough for a pension, the size of the pension changes based on your incapacity degree, as stated above. This degree is determined by the BL and describes your ability to provide for yourself. The size of the pension depends on a few other factors as well, including income from work and the number of dependents (usually children).

The pension rates as of 2026:

The pension sum for an incapacity degree between 75%-100% (a full pension) is 4,711 NIS (this includes the additional sum that was once called ‘additional monthly pension’ or קח”ן).
The pension sum for an incapacity degree of 74% (partial pension) is 3,211 NIS.
The pension sum for an incapacity degree of 65% (partial pension) is 2,894 NIS.
The pension sum for an incapacity degree of 60% (partial pension) is 2,718 NIS.

You can calculate the precise sum on the Bituach Leumi website.

Alongside getting your eligibility to a pension for the first time, you might also be eligible to get the pension retroactively too.
If you submit the relevant paperwork, a retroactive pension can be given for up to one year prior to the date you filed your claim, depending on the decision of the medical board. In your first board you’ll usually get a temporary pension, not a permanent one. Note – if you receive a temporary pension, when the time you were given the pension ends you’ll be summoned to another board in order to extend the pension.

Core rights for those recognized by Bituach Leumi

In addition to receiving a pension, as detailed above, recognition by Bituach Leumi also allows you to receive the following rights depending on the disability degree and incapacity degree that were determined for you:

An exemption from paying Bituach Leumi dues (granted automatically).
A discount on public transportation after updating yourself to a disability profile at Rav-Kav offices or on the app.
A discount on your Arnona tax and water bills (dependent on your municipality and water company; this discount should be granted automatically, but it’s best to make sure this was done).
An exemption from fees for certain medical procedures (should be granted automatically by your HMO / Kupat Holim).
An exemption from waiting in line when you present your disability card.
פטור מתשלום עבור מלווה בהצגת תעודת נכה.
Rent assistance.
Rehabilitation basket (Sal Shikum סל שיקום) – you can read more about the basket and how to get it on the Ministry of Health website.
Vocational rehabilitation (Shikum Miktzo’i שיקום מקצועי) – you can get funding of your tuition for academic degree or professional certificate studies that are recognized by the Ministry of Economy; funding for professional equipment you need for your studies or transit to your studies; funding for support and accessibility services during your studies; and, in certain cases, rehabilitation allowance. These payments are given only once and depend on, among other things, the disability percentage that was determined for you. In addition there’s an evaluation process held in external evaluation institutes, which is intended to check and assess each person’s vocational rehabilitation capability. You can apply through the BL website, or get a referral from your rehabilitation basket (Sal Shikum סל שיקום) coordinator at the Ministry of Health. The request is handled by a vocational rehabilitation social worker at the NI, whose job is to direct you through the evaluation process, and to assist you in choosing studies that are found to be fitting and in taking care of their funding. At the same time they may also get you in touch with a local occupational center, if needed.

You can read in more detail on the BL website and on Kol Zchut about rights such as exemption from Bituach Leumi dues, the disability card, and rights in various institutions and organizations.

The claim process

Keep in mind – if you’re in your first two years of medical gender affirming care (hormones / surgeries), there’s a procedure for a shortened track to get recognition of disability and a pension which should be granted automatically. Once two years have passed from the beginning of this medical care, you must pass a board which checks your medical condition personally to decide whether you’ll continue to receive the pension.

Preparing your documents and filing your claim

You can file your claim through the Bituach Leumi website, by mail, or by handing in the forms at the form desk at the relevant BL branch. You should file your claim together with all the relevant documents:

In the first two years of gender affirming medical procedures

You must add documents from a medical professional (doctor, psychiatrist, endocrinologist, etc.) testifying that you started hormone therapy or underwent gender affirming surgery in the last two years. It’s very important that the date the treatment began be written down, such as the beginning of hormone therapy or the date of a surgery, and not the date of a recommendation for treatment. The document must be written in past tense and include a full date: “began hormone replacement therapy on [date]” / “underwent surgery on [date]”.
Adding an expert opinion from a mental health professional is not required at this time; in this track the disability percentage and incapacity percentage are automatically determined based on the documents you submitted.
You’ll be able to get permanent disability only after the period for automatic disability (first two years) is ended, and after meeting the medical board for a renewal of your pension (second board at least).

After the first two years of gender affirming medical procedures, or after getting no medical procedures

Everyone has the option to file a disability claim in the standard track on the basis of gender dysphoria, regardless of any medical gender affirming care.
You can file a claim for a mental health reason, a medical reason, or both. Keep in mind that each cause you file for will have it’s own board with a licensed professional in that field to evaluate it (a psychiatrist for mental health, orthopedist for orthopedics, neurologist for neurology, etc.).

If you wish to file a claim for a mental health reason, you should add documents that testify to gender dysphoria and describe the distress caused by both the dysphoria and your life as a part of society (for example: trouble finding a job, mental health problems, traumatic experiences, etc.).
These documents should be expert opinions given by a licensed mental health professional such as a psychiatrist, social worker or psychologist (an example of the letter). (You should know: a letter from one mental health professional is enough, so if getting the documents demands a lot from you there’s no need for more than one).

Usually a psychiatrist’s opinion will “count more” than that of another professional, but there’s no requirement for a psychiatrist’s opinion or an official diagnosis of gender dysphoria, and sometimes a letter from a professional who knows you better and for longer will be given more weight and include more details. For this reason, it’s important that the letter come from the professional who knows the applicant best, and therefore a letter from a social worker is just as relevant when it comes to trans people.

If you wish to file a claim for a medical reason, we advise that you add the expert opinion of a professional in the field of the problem you’re dealing with (orthopedist, neurologist, etc.). Among other things you should add documents testifying to the medical problem, how it affects your physical functioning, how it affects your capacity to work for a living, and more.

You can add an opinion from the mental health professional accompanying you (such as a social worker or psychologist) addressing the personal and social distress caused to you by your medical condition, for example: trouble finding work, health problems, responses from other people, mobility difficulties, and more.

If you’re filing for both reasons, you can ask the mental health professional to mention both the medical and mental health hardships in the same letter.

You can and should add medical documents on physical and psychological disability to prove both disability and loss of earning capacity.

More details:

If you have an income, you must add proof of your income such as pay slips or an employer’s confirmation of your income for the past 15 months. You can find the employer confirmation form on the Bituach Leumi website.
You must sign and attach a medical waiver of confidentiality. You can download the waiver here (or fill out online here).
You should add a note on the claim form that this is a claim on the basis of gender dysphoria.
We advise you to request that the medical board take place in one of the BL branches that have received special training for working with the trans community (Tel Aviv, Haifa, Jerusalem, Beer Sheva). The BL should schedule your board in one of these branches in accordance with a request on the claim form.

After filing the claim

In the first two years of gender affirming medical procedures

Since you’re filing through the shortened track, the process should go through automatically and you shouldn’t receive a summons for a medical board. The board meets without your presence, though you might get a message about the time it will be held. In this case, you should pay attention and see if this is a message about the board or a summons that demands your presence.
If you got a summons to the board, first you should contact your Bituach Leumi branch through the personal area in their website/app and alert them to the fact this is the shortened track and there shouldn’t be a board meeting. In your message you can add a copy of the regulations (there’s a link to it at the bottom of this page, it’s the first document linked in the regulations section).
If you are nonetheless summoned to a board, you can reach out to the Os Trans service for their assistance.

You should know that even though there’s no requirement to have a medical board, the BL is still allowed to summon you to one. In this case, you must attend. Not attending could bring about a fine and a halt in the process. If you can’t make it, to avoid a fine you should let them know through the website/app personal area at least 3 business days ahead of the board meeting.

After getting confirmation of your eligibility for a pension, you will be granted 40% disability and 100% incapacity until two years from the beginning of treatment – the eligibility is to a full pension until two years have passed from the treatment, not two years from filing the claim. In addition, the claim is supposed to get forwarded to a rehabilitation clerk to check your right to vocational rehabilitation (work, school, etc.), but you should ask for it yourself since this usually doesn’t happen automatically.

About two months before the end of your temporary right to disability, you’ll be asked to submit up-to-date documents (medical documents, an opinion from a psychiatrist, social worker or psychologist) to a medical board deciding on renewal of the pension and continued eligibility. Continuation of the pension depends on them checking your disability and incapacity in accordance with the guidelines. It’s possible to have this board take place at one of the BL branches where doctors have received special training (Tel Aviv, Haifa, Jerusalem, Beer Sheva).

After the first two years of gender affirming medical procedures, or after getting no medical procedures

Usually you’ll get summoned to a board where you’ll meet a trained doctor whose job it is to determine the degree of disability.
If you’ve filed a claim for two causes, both medical and psychological, you might be summoned to two boards or even more.

If you can’t make it to the board at the assigned date, you should update them at least 3 business days ahead of time.

After the board, the medical professional will give a recommendation about the percentage of your disability degree and incapacity degree. These percentages will determine the size of your pension and further rights you may be entitled to by law. As mentioned, you should ask that the board be held at one of the Bituach Leumi branches that received special training (Tel Aviv, Haifa, Jerusalem, Beer Sheva).

If the medical professional is unsure what incapacity degree to determine, you will be asked to come to a meeting with a rehabilitation social worker who makes this decision.

The board itself is usually 15-20 minutes long, but the part you’ll be present for is very short (usually 7-10 minutes). Keep in mind that the board meeting, by its nature, may be a difficult experience. You should prepare yourself and think about what you’d want to emphasize to the board about your condition – you can practice at home, write down notes for yourself in advance, and more. You should remember that this is a board that examines your mental health and how it affects your life! It’s your right (and is even beneficial) to record the board meeting, and to bring an escort with you (partner, family member, social worker, friend, etc.). Usually at the end of the meeting you’ll be asked to approve the protocol as it appears on the screen. If the protocol does not match the meeting or if something is unclear to you, you have a right to ask that it be fixed and to not sign until it is. You should also ask for a copy of the protocol at the end of the meeting to make sure that what was written is true and reflects the meeting.

Receiving an answer

The answer from the board usually arrives after about two weeks through your contact information (email, phone, mail, etc.) or in the personal area on the Bituach Leumi website/app. That said, in periods of heavy workload it might even take a month and a half.

In the outcome letter you’ll be able to see the board’s decision, the disability and incapacity percentages, and the eligibility for a temporary or permanent pension, based on the documents and the board’s opinion.

Appealing the board’s decision

In the case of a denial by the board, as with any claim to Bituach Leumi you can submit only one appeal, up to 60 days from receiving the decision (a second appeal is possible only to a labor law court and only on legal questions).

You can submit the appeal at the following link.

In the appeal you need to repeat your account, raise additional points, and add information that could improve your chances for a pension. You should consult with the Os Trans service before filing your appeal to maximize your chances of getting a pension. Also, you can make use of the disability pension video guide.

For those who choose to write their appeal letter on their own, it’s important that the appeal reply to the reasons why the previous board found you ineligible. You can find their explanation in the board protocol.

Note: appealing the board opens up all of the clauses and all of your eligibilities to a new evaluation. Meaning, if you already have some disability percentage you should take into consideration that the appeals board might also reduce that percentage, but if they’re considering this they’re required to stop their deliberations and allow you to cancel your appeal first.

If get a negative answer in your appeal, too, you cannot file a new claim for at least 12 months, or sometimes less. Aside from an appeal, after 6 months have passed from the NI’s decision you can submit a request for a new evaluation. In this case you’re summoned to a standard board, who may also reduce the disability percentage that was determined (without needing to stop their deliberations first), and you can appeal this board’s decision in the normal way.

Filing a claim for disability based on recovering from surgery

Many members of the community go through various surgeries as part of their gender transition. Many times the surgery requires corrective surgery, or has a long recovery period. In the event that your ability to work and get an income is impaired as a result of surgery or recovery, you should consider filing a claim for post-op disability.

The claim process for post-op disability is almost identical to the standard disability claim. The main difference is that you must submit medical documents that testify to the surgery taking place, its results, the required corrections, and the effect on your functioning. You can only get a pension if you are recognized for a period of incapacity that’s longer than 90 days. Eligibility for a pension will start after 90 days from the date when incapacity was determined to have begun, or after 30 days if it was determined that there is 100% incapacity for at least 6 months.

You should know that doctors are legally prevented from granting sick days for more than a month. Therefore, even after getting surgeries through the Gender Reassignment Committee you might have problems with the recovery period. The Committee is currently evaluating options to make it easier to ask for income support and disability pensions due to recovery from surgery.

Keep in mind that the claim process may take time, and that there is no way to file the claim before the surgery takes place. Therefore, if your income will be impaired by your recovery you should consider filing for income support.

Regulations and circulars:

Instruction videos on the Bituach Leumi pension for trans people

Disability pension guide video 1
Disability pension guide video 2 (the automatic two-year pension is missing from the explanation here)
Disability pension guide video 3
Disability pension guide video 4

Disability pension supplementary rights flyer

Bituach Leumi (National Insurance) Pension

The content of the entry

Who is eligible for a temporary or permanent pension from Bituach Leumi on the basis of gender affirming care?
You must meet all of the following requirements:

The income ceiling for a disability pension

What are the impacts of recognition by Bituach Leumi?

Receiving a disability percentage and an incapacity percentage

Monthly pension

Core rights for those recognized by Bituach Leumi

The claim process

Preparing your documents and filing your claim

In the first two years of gender affirming medical procedures

After the first two years of gender affirming medical procedures, or after getting no medical procedures

More details:

After filing the claim

In the first two years of gender affirming medical procedures

After the first two years of gender affirming medical procedures, or after getting no medical procedures

Receiving an answer

Appealing the board’s decision

Filing a claim for disability based on recovering from surgery

Regulations and circulars:

Instruction videos on the Bituach Leumi pension for trans people

Disability pension supplementary rights flyer

Follow us

Contact us

Bituach Leumi (National Insurance) Pension

The content of the entry

Who is eligible for a temporary or permanent pension from Bituach Leumi on the basis of gender affirming care? You must meet all of the following requirements:

The income ceiling for a disability pension

What are the impacts of recognition by Bituach Leumi?

Receiving a disability percentage and an incapacity percentage

Monthly pension

Core rights for those recognized by Bituach Leumi

The claim process

Preparing your documents and filing your claim

In the first two years of gender affirming medical procedures

After the first two years of gender affirming medical procedures, or after getting no medical procedures

More details:

After filing the claim

In the first two years of gender affirming medical procedures

After the first two years of gender affirming medical procedures, or after getting no medical procedures

Receiving an answer

Appealing the board’s decision

Filing a claim for disability based on recovering from surgery

Regulations and circulars:

Instruction videos on the Bituach Leumi pension for trans people

Disability pension supplementary rights flyer

Follow us

Contact us

Who is eligible for a temporary or permanent pension from Bituach Leumi on the basis of gender affirming care?
You must meet all of the following requirements: