Acceptance of the application: from application to policy document

When you sign an application, you make a request to the insurer to conclude a contract. The acceptance of the application is the formal process in which the insurer checks whether and on what terms it fulfills this request. There is no obligation to accept you in the regular comprehensive health insurance plan. The insurer decides based on the health information you have submitted.

The process begins when the fully completed and signed application reaches the insurer. From this point, the risk assessment runs. We support the preparation so that the application reaches the insurer as complete as possible and without unnecessary follow-up questions.

The typical process has five steps:

1. Submit the application: the application with complete health information reaches the insurer. Completeness here is not a recommendation, but a duty under § 19 VVG.
2. Risk assessment: the underwriters assess the health information against internal risk standards.
3. Follow-up questions and requests: the insurer can request medical reports or ask follow-up questions. The more complete the first application, the less often this step is needed.
4. Declaration of acceptance with conditions: it sets out whether the contract is concluded on standard terms, with a surcharge, with an exclusion or not at all.
5. Policy document and start of cover: finally, the policy document is issued and the start of cover is set.

The declaration of acceptance is the central document of the acceptance process. It contains confirmation of the plan you chose, any modifications such as a risk surcharge or benefit exclusion, the start of the contract and the due date of the first premium. Read the declaration of acceptance carefully: discuss any modifications you did not expect with your insurance broker before the contract takes effect.

We go through the declaration of acceptance together with our clients. In our advice work, we see that unexpected surcharges often go back to health information that was not clarified well enough in advance.

The risk assessment looks at several aspects:

• Completeness of the health information under § 19 VVG
• Risk evaluation based on the reported diagnoses and treatments
• Plausibility between your own statements and the medical reports
• expected follow-up costs over the term of the contract

Insurers have different internal risk standards. The same diagnosis can lead to acceptance with a slight surcharge at one insurer and to rejection at the next. This is a main reason why we recommend going through the health questions anonymously before the formal application.

Three outcomes are possible, and acceptance with a modification comes as a surcharge or as an exclusion:

• Acceptance on standard terms: the full plan is concluded without surcharges.
• Acceptance with a risk surcharge: additional costs of typically 15 to 30% arise.
• Acceptance with a benefit exclusion: a specific diagnosis remains uninsured.
• Rejection: the contract is not concluded.

A risk surcharge of 15 to 30% is the most common adjustment for known pre-existing conditions. A benefit exclusion means that one clearly defined diagnosis is excluded from cover, while all other benefits remain in full.

Two to four weeks is the typical time frame for the acceptance of the application. It goes faster if the first application is complete and all relevant reports are supplied directly. Delays arise from missing documents, follow-up questions to doctors or complex combinations of several pre-existing conditions.

Respond to the insurer's questions promptly and completely. An open follow-up question can lead to the application being formally rejected, even though there would have been a real chance of acceptance.

Under § 152 VVG, you have a 14-day right of withdrawal after you receive the complete contract documents. The condition is that the documents include the notice of your right of withdrawal. If it is missing, the 14-day period does not run.

In our advice work, we often see that the first 14 days after receiving the policy document are not used enough to check the conditions one last time. We recommend a structured check: does the declaration of acceptance match your original expectation? Are surcharges or exclusions plausible? Which alternatives would the next insurer offer?