Duty to provide information: rights and limits

In private health insurance, two situations need to be distinguished. Before the contract is concluded, the pre-contractual duty of disclosure applies. The health questions on the application must be answered completely and truthfully, and additional documents may be needed for the risk assessment. After the contract is concluded, information is needed mainly when you make a claim, for example when the insurer has to review submitted bills, diagnoses or treatment records before reimbursement.

A duty to provide information can also exist when bills are reimbursed. The insurer reviews the treatment to determine whether it has to pay and how much. The insured person gets the necessary data from the doctor. This keeps the reimbursement transparent. The insurer does not request information at random, but only to calculate its obligation to pay and the amount correctly.

The duty to provide information is not a blank check for any question the insurer likes. The insurer may only request information that is necessary for the risk assessment or the review of a claim. Sensitive health data is protected by data protection law. You give a medical confidentiality waiver for a specific purpose and can limit it to the case in question.

Submit requested documents completely and promptly. This speeds up the reimbursement and avoids follow-up questions. It keeps your cooperation with the insurer transparent when you make a claim, and your right to the agreed reimbursement can be settled quickly.