Private insurance issue

2POSTS

7 years ago

Hi all,

I was wondering if anyone can help me out with the following: someone I know got a german private health insurance at the beginning of the year. But he neglected to mention one of his pre-existing conditions at registration, and only realized this a few days ago. No he's not sure what his options are and is afraid that the company might end his contract and fine him for the already submitted treatments.
Does anyone know what he can do about this and what the consequences are?

Thanks!

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TominStuttgart Germany Expert

2807POSTS

7 years ago

Complex question. If I were him I would wait and see what happens. An insurance company maybe possible might have grounds for asking for reimbursement of money paid out - but not to fine or punish anyone for something caused by mistake or oversight rather than deliberate fraud. In the end, they would likely have to determine if the condition would have been serious enough to not accept them. If not, then it probably makes little difference. If something in addition needs to be paid, I would think it would mean higher premiums, paid retroactively 鈥� rather than paying back the cost of treatment for the unmentioned condition. In the end, the only one who can give a definite answer will be the insurance company.

Snoogans20 Member

2POSTS

7 years ago

Hi Tom,

Thanks for you answer! I actually gave the insurance company a call in the meanwhile, and they say that there wouldn't be any consequences if he registers this pre-existing condition retrospectively, unless he had treatment related to that condition. In even in that case they might just need to recalculate the risk rate.
So unless they're lying (I do get paranoid at times), it seems that coming forward seems to be the way to go, rather than them finding out a few years down the road and flagging it as fraud.
Does that sound plausible?

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