Insured event and benefit event: when does the right to reimbursement arise?

In the terminology of some insurers, the benefit event and the insured event are largely synonymous. In other contexts, the insured event is the event that is insured, meaning the onset of illness, while the benefit event means the actual use of a benefit.

In the everyday life of privately insured people, this distinction is rarely relevant, but it can become important in disputes about the period in which a plan applies.

In plans with a no-claims refund, it can pay to cover smaller bills yourself at first. The usual condition is that you claim no benefits that harm the refund in the relevant insurance or calendar year.

Which year a bill is assigned to depends in principle on the date of treatment or purchase and not on when you submit it. Before you submit small bills, you should therefore check whether the possible reimbursement is higher than the no-claims refund you would otherwise lose. The deductible and tax effects also have to be taken into account.

After a benefit event, the policyholder has certain duties towards the insurer. These include:

• The duty to provide information.
• Cooperation in the review of the claim.
• In some plans, also immediate notification.

If you breach these obligations, you risk a reduction of the reimbursement.

In a plan with a no-claims refund, we recommend that you check carefully which bills you submit and which you pay yourself. A deliberate decision for each insurance year can save real money.

As soon as an illness or injury requires medically necessary treatment. From this point on, you have the contractual right to reimbursement, which you assert by submitting a claim.