Health questions in the application: duty of disclosure, reservation, rejection

Health questions only exist in supplementary insurance

Health insurance consists of two worlds with very different rules. In basic health insurance under the Federal Health Insurance Act (KVG), every insurer must accept every person subject to compulsory insurance in its area of activity (Art. 5 let. i of the Health Insurance Supervision Act, KVAG). It may not ask any health questions or add a reservation, even if you are seriously ill. In supplementary insurance under the Insurance Contract Act (ICA), freedom of contract applies: the insurer assesses your risk and decides whether and on what terms it will insure you.

The health questions are in the insurance application. Based on your answers, the insurer decides whether to accept you, whether to add a reservation or whether to reject you. That is why it is worth filling it in carefully and keeping a copy.

Step by step: filling in the application correctly

1. Gather your documents. A list of doctors, therapies, hospital stays and regular medicines during the period asked about. Your insurer’s statements of benefits and your GP help you remember.
2. Read each question carefully. Pay attention to the period (“in the last 5 years”) and to what is being asked: diagnoses, treatments, complaints, medicines, incapacity for work. Answer exactly this question, not a similar one.
3. If in doubt, disclose. Not sure whether a treatment counts? Disclose it and explain briefly what it was about and whether it has been completed. Additional information may lead to a reservation, but missing information may later lead to termination.
4. Do not leave any question blank. Write “no” if nothing applies. A blank line creates uncertainty.
5. Fill in and check the application yourself. If an intermediary or adviser fills in the application with you, read every answer before signing. When you sign, the answers count as yours.
6. Ask for a copy. On request, the insurer must give you a copy of your statements in the application (Art. 11 para. 2 ICA). Keep it with the policy.
7. Know the deadlines. You are bound by the application for 14 days, or 4 weeks if a medical examination is required (Art. 1 para. 1 and 2 ICA). You can withdraw it in writing or by e-mail within 14 days (Art. 2a ICA).

The duty of disclosure: what the law requires

Art. 4 para. 1 ICA obliges you to inform the insurer, on the basis of a questionnaire, of all significant facts for assessing the risk, insofar as you know or ought to know them. Questions and answers must be given in writing or in another form that allows proof by text.

A fact is significant if it can influence the insurer’s decision to conclude the contract at all or on these terms (Art. 4 para. 2 ICA). If the insurer asks about something in a specific and unambiguous way, the fact is deemed significant (Art. 4 para. 3 ICA). This results in two limits to your duty:

• Only what is asked. You must answer the questions asked in writing. You do not have to volunteer anything the insurer does not ask about.
• Only what you know or ought to know. You cannot conceal an illness you did not know about and did not need to know about.

The consequences of incorrect information

If you have given incorrect information about, or concealed, a significant fact you were asked about, this is a breach of the duty of disclosure. Under Art. 6 ICA, the following then applies:

• The insurer may terminate the contract in writing or by e-mail (para. 1).
• The right to terminate expires 4 weeks after the insurer has found out about the breach (para. 2). This may be years after the contract was concluded, for example if an invoice reveals an earlier treatment.
• With the termination, benefits are refused for losses whose occurrence or extent was influenced by the concealed fact. The insurer may reclaim benefits already paid for them (para. 3). For other cases, the benefits remain.
• If the contract insures several people, such as a family, it remains in force for the others if the insurer would have insured them alone on the same terms (Art. 7 ICA).

When the insurer still may not terminate the contract

Art. 8 ICA lists 6 cases in which the insurer may not terminate the contract despite incorrect information:

1. The concealed fact ceased to exist before the insured event occurred.
2. The insurer itself caused the incorrect information.
3. The insurer knew or ought to have known the concealed fact.
4. The insurer knew or ought to have known the correct version of the incorrectly stated fact.
5. The insurer waived its right to terminate.
6. You did not answer a question and the insurer concluded the contract anyway; this does not apply if the question must be considered answered on the basis of your other information.

Point 2 matters if an intermediary filled in the application for you. Whether they caused the error is a question of proof in a dispute. Your own copy of the application helps here.

Deadlines and figures at a glance

Reservation, rejection, acceptance: what happens after the application

After checking your answers, the insurer has three options:

• Acceptance without restriction. You are insured on the terms of the general terms and conditions.
• Acceptance with a reservation. A reservation excludes a particular illness or part of the body, for example a knee after an earlier operation. For everything else you are insured normally. Whether the reservation is time-limited is set out in the contract. There is a statutory maximum duration only in daily allowance insurance under the KVG: 5 years, and the reservation must state the illness and its start and end precisely (Art. 69 KVG).
• Rejection. In supplementary insurance, the insurer does not have to accept you. Another insurer may assess the same risk differently.

You do not have to accept a reservation. You can ask whether the insurer will limit it in time or review it after a medical report confirming completed treatment. You are only entitled to this if the contract provides for it. If the insurer’s acceptance does not reach you within the period during which you are bound, you are no longer bound by your application (Art. 1 para. 4 ICA).

Genetic tests: what the insurer may not ask

The Federal Act on Human Genetic Testing (HGTA) sets limits on the health assessment:

• Before concluding the contract, an insurer may not require a genetic test, neither a presymptomatic nor a prenatal one (Art. 42 HGTA).
• It may neither ask about nor use the results of earlier prenatal tests or tests for family planning (Art. 43 para. 3 HGTA).
• It may only ask about earlier presymptomatic tests for supplementary insurance if the test is reliable, its value for the premium is scientifically proven and you know the result. The result then goes to the insurer’s doctor, who only passes on the risk group (Art. 44 HGTA).

For diagnoses you have received because of complaints, on the other hand, the normal duty of disclosure applies.

Example: a forgotten course of physiotherapy

Example with fictitious people. Selin, 34, applies for supplementary outpatient insurance in 2026. The application asks about treatments “in the last 5 years”. Selin discloses a knee operation from 2023 but forgets a course of physiotherapy for back pain in 2022.

Had Selin disclosed the physiotherapy, the insurer might have added a second reservation for the back. That is unpleasant, but predictable. The forgotten information, on the other hand, puts the whole contract at risk.

Special cases

Registering children before birth

Some insurers accept children registered for supplementary insurance before birth without health questions. There is no statutory obligation to do so; the conditions are set out in the insurer’s acceptance conditions. After the birth, the insurer may ask questions. The procedure is described in Insuring your baby.

Earlier therapy or chronic illness

If you have a chronic illness or were in psychotherapy in the past, you are more likely to receive a reservation or a rejection. What you can do then, for example apply for individual components or ask several insurers, is explained in Previously in therapy: can I still get supplementary insurance?.

Switching basic health insurance

When you switch basic health insurance, you do not answer any health questions. You can keep your existing supplementary insurance: your current insurer may not force you to cancel it, nor terminate it for this reason (Art. 7 para. 7 and 8 KVG). If, on the other hand, you also want to move your supplementary insurance to a new insurer, you submit a new application with health questions there. Only cancel the old supplementary insurance once the new insurer has accepted you in writing. How switching works is shown in Switching health insurer, and the deadlines in the deadline calculator.

Applying for a higher level

If you want to move from the general ward to semi-private with your insurer, the insurer may ask health questions for the additional benefits; ask beforehand what it requires. Whether the higher level is worth it is covered in Semi-private or private. You compare basic health insurance independently of this in the premium calculator.

Common mistakes

• Answering a question from memory. Treatments from years ago are easily forgotten. Check your statements of benefits and ask your GP.
• Letting the intermediary fill it in and signing blindly. The answers count as yours. Read every line before signing.
• Leaving out minor details. Whatever the question covers belongs in the answer, even if it seems insignificant to you.
• Cancelling the old supplementary insurance too early. Until the new insurer has accepted you, it can still reject you or add a reservation.
• Not keeping a copy. Without a copy of the application, it is hard to show in a dispute what was asked and what was answered. You are entitled to one (Art. 11 para. 2 ICA).

Help in a dispute

If the insurer terminates the contract because of a breach of the duty of disclosure or refuses benefits, ask for the reasons in writing and check the 4-week deadline. The Office of the health insurance ombudsperson mediates free of charge, including for supplementary insurance. Key figures and contact options for the insurers are in the health insurer profiles. What counts are the general terms and conditions and the information from your insurer. You will find all articles on the topic in the Supplementary insurance section.