Risk assessment
Definition of risk assessment
Every health insurance company is required by law to accurately calculate the risk it takes on with a new customer. The goal is to keep future costs in check.
Good to know: A risk assessment only applies to supplementary insurance. All applicants have to be accepted into basic insurance unconditionally.
How high are the health insurance reserves?
The Health Insurance Act (KVG/HIA) stipulates that insurance companies have to build up reserves to compensate for risks.
A special solvency test at the beginning of the year checks how great the risks of a health insurance company are and whether it would be able to meet its financial obligations even in the worst case. The health insurance reserves correspond to about two monthly premiums per insured person. If the reserves fall below the minimum required by law, the supervisory authority intervenes.
What is checked with the risk assessment?
The medical risk assessment checks the applicant’s state of health. The health insurer wants to know if high costs can be expected in the years ahead. The applicant has to answer the questions truthfully; this is known as the disclosure obligation.
What does a risk assessment involve?
When you apply for a supplementary insurance plan, you have to complete a questionnaire on your health. The health insurer uses your answers to decide whether to accept your application outright or to apply a restriction . The health insurer may require you to have a medical exam. They can also reject your application. This may be the case if there is reason to believe that high treatment costs are to be expected in the future due to previous illnesses.