What is the health check-up in private health insurance about?

Health checks, also known as risk assessments, are used by private health insurance companies to assess the conditions under which they can insure someone based on their state of health. Read this article to find out exactly what questions are asked during a health check and what is meant by the obligation to register.

Medizinisch geprüft - Siegel
Reviewed by our insurance experts

Table of contents:

5 key facts about health check (risk assessment) in private health insurance

1. Purpose: In private health insurance, both age and state of health are considered in order to calculate the insurance risk through a health check.

2. Risk evaluation: Health checks help insurers prevent unexpectedly high claims by accurately assessing individual risks.

3. Benefits: Private health insurance offers comprehensive coverage at fair prices compared to statutory insurance.

4. Process: Applicants answer questions about their health history to determine acceptance, premiums, and coverage. The obligation to notify the insurer after the policy has been issued requires the insurer to be informed of any change in the insured person's state of health before the policy is issued.

What is the health check-up in private health insurance?

The application for private health insurance relates not only to age but also to the state of health. It defines the risk that the private health insurance policyholder covers for the customer.

The result of this examination is a health status quo. This provides information on how likely it is that an insured event will occur.

All the bases for the health check are set out in § 19 Para. 1 of the Insurance Contract Act.

Why is there a health check in private health insurance?

The top priority for private health insurance is to protect the insurance community from unexpectedly high claims by individual policyholders. If risks already exist before the insurance application, they must be reflected in the premium, otherwise the costs for the entire group would get out of hand.

A person's risks are assessed by the private health insurance company. This enables the insurance company to calculate the costs for the individual private health insurance premium even more accurately. The state of health is therefore an important actuarial parameter for private health insurance - and a basis for deciding whether to accept or reject applications or to calculate risk surcharges.

The advantage: in statutory health insurance, the contribution depends on your salary, but the benefits are limited even for high earners. Private health insurance, on the other hand, offers comprehensive benefits at a fair price. All policyholders benefit in particular from the complex calculations used by private health insurance companies to determine the premium: they ensure that the premium does not rise uncontrollably and corresponds to the personal risk.

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What does the health check-up for expats look like?

The health check is part of the private health insurance application. In addition to personal details such as your gender, age, and job, you also have to answer questions about previous illnesses, upcoming treatments and chronic complaints.

The health check is carried out in writing. As an applicant, you must state all known risk circumstances that are asked about. The questions that must be answered and the relevant time periods depend on the insurance company.

For example, some private health insurance companies are interested in what treatments have been carried out in the last three years, while others look even further into the past - ten years is common for psychotherapeutic treatments, for example.

Do I need a physical health check-up to enter private health insurance?

Whether you need a physical health check-up to enter private health insurance depends on the insurance provider and the specific policy you're applying for. Some insurers may require a medical examination as part of the underwriting process, especially for older applicants or those with pre-existing medical conditions.

However, many insurers offer policies without a physical exam requirement, particularly for younger and healthier individuals. It's advisable to check the requirements of different insurance providers before applying.

Why do I need a physical check-up when my friend/colleague/partner didn't?

When applying for private health insurance, the need for a physical check-up can vary depending on factors like age, medical history, and the specific policy being applied for. Insurers may require it to assess health risks and determine coverage. It's not a one-size-fits-all requirement and depends on individual circumstances and the insurance provider's policies.

The health check typically asks about

More benefits of private health insurance!

Which 11 ottonova health questions are asked when applying for private health insurance?

The health information required depends on the private health insurance policy. At ottonova, customers are expected to answer these health questions as part of the sign-up process:

  1. Do you have or have you had an allergy in the last three years?
  2. Have there been any treatments or examinations (including follow-up care) by doctors or therapists within the last three years?
  3. Have you ever been addicted to alcohol, medication or drugs? Have you been treated for any other addiction?
  4. Have you taken medication for at least two weeks at a time within the last three years?
  5. Have you ever been diagnosed with an HIV infection?
  6. Do you have a chronic illness?
  7. Do you have one or more impairments from the following list?
    1. Do you wear a hearing aid?
    2. Do you wear a body implant? (Dental implants do not count)
    3. Do you wear a prosthesis? (Dental prosthesis does not count)
    4. Have you been diagnosed with infertility or limited fertility?
    5. Is there a disability, a malformation of an organ or a physical deformity?
    6. Is there a reduction in earning capacity or occupational disability?
    7. Is there a war or military service injury?
    8. Are there any missing teeth that have not been replaced? (Wisdom teeth do not count)
  8. Have there been any treatments or examinations (including aftercare) for malignant cancer within the last ten years?
  9. Are any treatments, examinations (including aftercare) or operations by doctors or therapists intended, recommended or planned?
  10. Have there been any treatments or examinations (including follow-up care) for mental or psychosomatic illnesses or complaints within the last ten years?
  11. Has there been any treatment with hospitalization or operations without hospitalization within the last five years?

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In Germany, the private health insurance income threshold for employees working in Germany is set by the Federal Ministry of Labour and Social Affairs (BMAS).

Unfortunately, we're not able to offer you private full-comprehensive health insurance, due to the information provided.

If you live in Germany and work remotely for a foreign employer, please contact us.

If you are insured in the public system in Germany, we can offer you our excellent top-up dental insurance - to cover the gaps in your public health insurance.

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Can I join private health insurance without a health check?

No, this does not exist as a rule. The only exception: in individual cases, supplementary insurance, such as supplementary dental insurance, can also be taken out without a health check.

What must be taken into account when answering the health questions?

The health questions must be clearly stated and must generally be answered with YES or NO.

Questions that are answered with yes often require further information. For example, what specific treatments were received, how long they lasted and what the results were.

To make sure you don't forget anything, it's best to speak to your doctor before answering the health questions and ask to see your own patient file. This is because treatments or diagnoses that are a little further in the past tend to be forgotten.

What is the late registration obligation?

The obligation to re-register applies if the health check has been completed and there is a change in your state of health. The health insurance company must be informed of this change. However, only until the policy is taken out. Once the policy has been taken out, no further notification is required.

Espen Markus Mjøs
HIER SCHREIBT Espen Markus Mjøs

Espen Markus - originally from Norway - is sales agent in ottonova's English sales team. He's in contact with potential customers every day and answers Expats' questions about German health insurance.

ottonova sales experts
HIER SCHREIBT ottonova sales experts

Our ottonova team of experts has over 40 years of experience in private health insurance and answers questions about it every day. What are old-age provisions and for whom does private health insurance make sense? What is the actuarial interest rate and which tariff is right for you? They know!

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