When Switching to Private Health Insurance: The Importance of Accurate Health Data
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When switching to private health insurance, you should pay attention to correct health information, advises expert Bastian Kunkel – and describes the risks of untruths.
Switching to private health insurance (PKV) is a important step for many people – with the aim of securing better services and individual care. But before the contract is signed, applicants must answer comprehensive health questions. these play a central role in risk assessment and determine whether and under what conditions you will be accepted.
Insurance expert Bastian Kunkel from Versicherungen mit Kopf explains why absolute transparency is required when it comes to health issues, how long the look back into your medical history goes back – and what consequences incorrect or incomplete information can have.
[Image of File and stethoscope on the desk: Switching to private health insurance (PKV) is a significant step for many people. (symbolic image) © IMAGO / Westend61]
What insurers check with health questions
In contrast to statutory health insurance, private health insurers are allowed to carry out a risk assessment. This means: You evaluate based on the health information provided by the applicant. This is permitted as PKV is based on the principle of solidarity, but only within a defined risk group. Insurers need to know the existing health status to assess whether an applicant fits into this group.
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The Risks of Incorrect Health Information for Insurance
Providing inaccurate or incomplete information when applying for private health insurance can have far-reaching consequences.
What threatens with false information
If you answer health questions incorrectly or incompletely, you risk losing insurance coverage in the worst-case scenario. Legally, a distinction is made based on the degree of fault:
- Fraudulent deception: If the information is deliberately concealed or lies, the insurer can challenge the contract – even years later. The protection ends retroactively, and benefits paid can be requested back.
- gross negligence: If something is kept secret that should have been known, the insurer can terminate or adjust the contract – such as, thru retroactive premium surcharges.
- Simple negligence: In the case of minor omissions, the insurer is usually only allowed to make adjustments but is not allowed to cancel or dispute the agreement.
In the event of a claim, this can lead to the insurer refusing payments – for example, in the event of an inpatient stay or expensive therapy. Incorrect information can also be an obstacle when changing tariffs later within the private health insurance system.
This way you can prepare yourself optimally for the health questions
To prevent problems from occurring in the first place, it is recommended to proceed systematically and carefully. The following steps will help with planning:
- Request patient file: Get Excerpts of Your Medical Record to have a complete overview of your medical history.
- Collect all relevant documents: Gather all doctor’s reports, hospital discharge summaries, and medication lists.
- Consider consulting a doctor: If you are unsure about certain medical details, ask your doctor for clarification.
- Answer truthfully and fully: Be honest and provide all requested information, even if it seems unfavorable.
- Document everything: Keep copies of all submitted documents and correspondence with the insurer.