Health questions

All insurance companies want to know what risk they are taking on when they accept an insurance application: Has the applicant listed many, few or no health problems when answering the health questions? Health insurers use the information provided to decide whether and under what conditions to accept the insurance application.

No, in accordance with the Health Insurance Act (KVG/HIA) health insurers have to admit every customer to basic insurance without restrictions.

The health questions relate to illnesses and treatments you have had in the last five years. You have to answer all the questions. Health insurers are allowed to decide which health questions they ask.

You have to answer the health questions truthfully. Health insurers have the right to exclude benefits from the insurance cover on the basis of existing illnesses or consequences of accidents. This is known as a restriction. They may even reject an insurance application outright. This way, insurance companies reduce the risk of having to bear high costs at a later date that would burden the pool of policyholders.

Health insurers have the right to apply restrictions retroactively or cancel the contract if it is discovered that someone provided untrue or incomplete information when filling out the insurance application.

Anyone who wants to take out supplementary health insurance has to answer questions about their state of health. This is known as the disclosure obligation. The disclosure obligation is a legal obligation under which a person is obliged to truthfully report all data relevant to the health check for supplementary insurance.

A health insurance company can only provide insurance coverage if it knows exactly the cost risk of the person to be insured before the contract is concluded. Health questions are used to check the applicant’s state of health and to determine the cost risk. A health check is required for supplementary insurance plans. The health check varies depending on the supplementary insurance plan.

Good to know: With supplementary dental insurance, the health questions mainly concern the teeth. In contrast, basic insurance can be taken out without a health check.

Based on the health check, the health insurer decides in consultation with the person to be insured whether and under which conditions they can accept the insurance application. Health insurers are allowed to accept, reject or apply restrictions for applications for supplementary insurance plans.

A restriction means that the health insurer excludes certain benefits from the insurance contract. The restriction reduces the risk that the insurance company will incur high costs in the future. The person to be insured is informed of any possible restriction before they conclude the contract. They can decide to accept the insurance with the restriction or withdraw their application.

Good to know: Under basic insurance, health insurers are obliged to admit all applicants unconditionally regardless of their age, sex or state of health. No health questions have to be answered for basic insurance.

In this case, the insurer has the right to refuse to pay benefits or to exclude a specific condition from the contract.

For example: the applicant forgets to list a previous knee complaint. If this existing condition results in medical treatment at a later date, the health insurer may refuse to cover the subsequent costs.

A breach of disclosure obligation is when someone intentionally provides untrue or incomplete information. In this case, the insurer has the right to terminate the contract.