The application for private health insurance: what goes in, what stays out

The application is a formal request to the insurer to conclude a contract. Whether the insurer accepts it is at its discretion: there is no obligation to accept you in the regular comprehensive health insurance plan.

The application consists of several parts, each of which feeds into the risk assessment.

The content of an application falls into four areas:

• Personal details: name, date of birth, occupation and income. Your income determines whether you meet the requirements for the switch.
• Health questions: with some insurers more than 20 individual questions on current and past illnesses, diagnoses, medication and operations. This part takes the most time and is the most sensitive legally.
• Choice of plan: the desired plan, from basic through comfort to premium, plus any supplementary plans such as Krankentagegeld (i)KrankentagegeldPrivate sick pay: a daily allowance from private insurance while you are unable to work. It replaces lost income from an agreed day of illness.More about Krankentagegeld →.
• Start of cover: the date from which your cover should apply. It must be coordinated with the end of your previous membership in statutory health insurance, with termination under § 175 SGB V.

If you want to apply, you do not start by filling in the form, but with preparation:

1. Anonymous risk enquiry if you have pre-existing conditions. It gives an assessment of your chances of acceptance before you disclose any identifying data.
2. Make your final choice of plan: clarify the scope of benefits, deductible and supplementary plans before you submit the application.
3. Compile your health information: prepare medical reports and diagnoses, ideally from the last five to ten years.
4. Submit the application: in writing or through an insurance broker to the insurer you have chosen.

The pre-contractual duty of disclosure under § 19 VVG obliges you as the applicant to answer all of the insurer's health questions completely and truthfully. Breaches have three possible consequences:

• rescission of the contract by the insurer within five years after the contract was concluded (§ 21 (3) VVG)
• termination within the same period
• refusal of benefits in a specific claim

In the case of intent or fraud, the period is extended to ten years, and in the case of fraudulent misrepresentation the insurer can also avoid the contract under § 22 VVG. The duty of disclosure applies in full to the formal application, not to an anonymous risk enquiry.

Many insurers ask for medical reports later if you have pre-existing conditions. It makes more sense to include current examination reports, certificates of diagnosis for chronic conditions and surgical reports from the last five to ten years on your own initiative, without waiting for a request. This speeds up processing, because the insurer can decide without follow-up questions.

In practice, these mistakes occur particularly often:

• Incomplete health information is the biggest risk. Incomplete or understated answers can lead to the contract being avoided, even if the gaps arose unintentionally.
• Plan not fully checked: if you still want to change the plan after you have applied, you may have to answer new health questions, with changed conditions.
• Start of cover not coordinated with the end of statutory cover: double insurance or gaps in cover arise if the deadlines are not coordinated.
• Formal application without an anonymous risk enquiry despite pre-existing conditions: the risk of a rejection and its consequences for later enquiries could have been avoided.

If you have pre-existing conditions, the anonymous risk enquiry is not an optional step, but a must.

In our advice work, we often see that hasty applications without preparation lead to worse conditions. We recommend treating the preparation of the application as a separate step and planning at least two to four weeks for it.