Health questionnaire

What is a health questionnaire?

The health questionnaire is the part of the insurance application in which a health insurer asks about your state of health. Typical questions concern ongoing treatment, hospital stays, operations, medicines taken regularly, therapies, planned procedures or incapacity for work. Your answers allow the insurer to assess how high its risk is and decide whether, and on what terms, it will insure you.

Health questions only exist for supplementary insurance, i.e. for contracts under the Insurance Contract Act (ICA). These include supplementary hospital insurance for the semi-private or private ward, supplementary outpatient insurance, dental insurance and often daily allowance insurance. These contracts are governed by private law: the insurer may choose whom it accepts.

Basic health insurance under the Federal Health Insurance Act (KVG) is different. Every insurer must accept every person required to take out insurance in its area of operation, without a health check. The membership form may only contain information that is needed to join and may not create any link to supplementary insurance. So if you switch basic health insurance, you never have to answer health questions. You can compare basic health insurance in the premium calculator.

How it works

The process is similar at all insurers:

1. Fill in the application. You answer the questions in the application form, on paper or online. The questions must be asked in writing or in a form that allows proof by text, and the same applies to your answers.
2. Review by the insurer. The insurer evaluates your answers. If anything is unclear, it asks follow-up questions, requests medical reports or asks you to release doctors from their duty of confidentiality.
3. Decision. The insurer accepts you on normal terms, imposes a reservation (a specific illness is then not insured), offers other terms or rejects the application.
4. Policy. If you are accepted, you receive the insurance policy. Your answers form part of the contract.

The standard that applies is important: you must disclose all facts that are material for assessing the risk and that you know or should know. Something you forgot although you should have known it also counts. Facts that the insurer asks about in a specific, unambiguous way are deemed material. So a minor matter you consider unimportant must be disclosed if the question covers it.

If an intermediary fills in the form with you, you are still responsible for the answers. Read the whole form before you sign and correct any mistakes.

Legal basis

The law calls the duty to answer health questions correctly the duty of disclosure. Art. 4 para. 1 ICA obliges you to tell the insurer, on the basis of a questionnaire or other questions, all material facts relating to the risk, insofar as you know or should know them. Art. 4 para. 2 ICA defines material: these are facts that may influence the insurer’s decision to conclude the contract at all or on these terms. Under Art. 4 para. 3 ICA, facts about which a specific and unambiguous question is asked are deemed material.

The consequences of an incorrect or missing answer are governed by Art. 6 ICA. The insurer may terminate the contract; this right lapses 4 weeks after it found out about the breach. If the contract is terminated, the obligation to pay benefits lapses for claims whose occurrence or extent was influenced by the concealed fact, and the insurer can reclaim benefits already paid. Art. 8 ICA lists cases in which it may nevertheless not terminate, for example if it knew the fact or itself caused the incorrect information. More on this under breach of the duty of disclosure.

Two further articles help you: under Art. 2a ICA, you can withdraw your application within 14 days. Under Art. 11 para. 2 ICA, the insurer must give you a copy of the statements in your application on request.

For basic health insurance, Art. 5 let. i of the Health Insurance Supervision Act (KVAG) applies: insurers must accept every person required to take out insurance in their local area of operation. Art. 6a of the Health Insurance Ordinance (KVV) limits the membership form to the information needed to join.

Example: a forgotten course of physiotherapy

Lea, 41, applies for supplementary outpatient insurance. The application asks: “Have you been under medical or therapeutic treatment in the last five years?” Lea ticks “No”. She has forgotten that she had nine sessions of physiotherapy three years ago.

What this means for you

Take your time with the application. These steps will help:

1. Have your documents ready. Your insurer’s statements of benefits show which doctors, therapies and medicines were billed in recent years. In your account, you can collect invoices and have them to hand for your next application.
2. Read every question word for word. Pay attention to the period and to whether the question asks about treatment, symptoms or diagnoses.
3. If in doubt, disclose. An extra piece of information harms you less than a missing one. The insurer then decides whether it is relevant.
4. Keep a copy. Ask for a copy of your answers if you do not receive one.
5. Do not cancel your old supplementary insurance too early. Only cancel once the new insurer has accepted you in writing. Otherwise, if you are rejected, you are left without cover.

You can see the benefits of the individual insurers’ supplementary insurance in the supplementary insurance comparison. You will find the insurers themselves in the overview of health insurers. With a new contract, also bear in mind a possible waiting period.

Common mistakes

• Rushing through the application. If you tick “No” without thinking, you risk termination later, exactly when you need benefits.
• Leaving out minor matters. Short courses of treatment also fall under the question if its wording covers them.
• Relying on the intermediary. The responsibility for the answers remains with you, even if someone else fills in the form.
• Confusing it with basic health insurance. If you only switch basic health insurance, you do not have to answer any health questions. A form with health questions always concerns supplementary insurance.
• Cancelling your existing supplementary insurance too soon. Without written acceptance by the new insurer, this is a risk you can no longer undo.

We explain how we use data and sources under how we calculate.