Gesundheitliche Zusatzerklärungen | PKV Spezialist Dehua Chen

Dehua Chen
Stand: 26.10.2020

Health Declarations

If you have decided on a private health insurance or a disability insurance, the next step is to submit an application to the respective companies. During the application process, there will typically be questions about your medical history. The companies require this information to determine the insurability of the applicant. These checks are usually conducted via questionnaires.

To optimally support our clients in preparing their applications, Chen Coaching has prepared health questionnaires covering the most common pre-existing conditions relevant for insurers. These questionnaires can be universally used for all companies. Download the forms that apply to you or fill them out conveniently directly in the PDF file. Please pay attention to the time periods specified in the questions! Insurers are not interested in your entire health history, only the relevant periods.

Often, in addition to the questionnaires, insurers will ask for medical reports related to a pre-existing condition (examples: medical certificate, doctor’s diagnosis, reports, or test results). Please include these documents directly with your application or request them from your doctor. It is highly recommended to obtain a medical certificate confirming that, according to the doctor’s assessment, the pre-existing condition(s) are not expected to recur or cause complications. In other words, there is no risk of recurrence. For certain pre-existing conditions, this can have a positive impact on the application process.

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What else should you consider?

Every patient has a medical record in which all medical treatments are documented. According to § 630 g BGB, everyone has the right to request access to their medical record. It is recommended to do so. On one hand, this prevents a pre-existing condition from being forgotten if it occurred some time ago. On the other hand, billing or misdiagnoses can be identified early. These are medical treatments that do not correspond to reality and are unfortunately often found in medical records or patient receipts.

What impact does this have for you as a policyholder?

As the applicant, you are obligated under the pre-contractual duty of disclosure § 19 Abs. 1 VVG to report all existing pre-existing conditions and prior treatments truthfully, carefully, and completely to the insurer. This is done via questionnaires or forms. The insurer may limit benefits if the applicant violates the pre-contractual duty of disclosure. It is frustrating if your medical record lists treatments and diagnoses that are not accurate and of which you are unaware. Therefore, it is advisable to request and review your record beforehand. Diagnoses are encoded in the medical record using ICD10 codes. It is therefore useful to familiarize yourself with them beforehand.

Here are some additional indicators for diagnostic certainty to watch for in outpatient care:

V for a suspected diagnosis

G for a confirmed diagnosis

A for an excluded diagnosis

Z for an (asymptomatic) state after the respective diagnosis

If you identify possible misdiagnoses while reviewing your record, note them along with a justification for why you believe they are incorrect. What is the accurate situation from your perspective, and who could confirm this for you?

We support you at every step of your application process. With this information, we can assess in advance how the misdiagnosis may affect your application and possibly future benefit claims.