What is a claim assessment?
A claim assessment is a regulated review of your policy to determine whether a medical condition existed before your insurance coverage began. It’s usually triggered if a bill or cost plan is linked to a condition that may have existed before you signed up.
Most reviews are resolved without any issues. If information was withheld, your policy may be adjusted (e.g., by adding exclusions or surcharges). Only in rare and serious cases can a policy be canceled.
What it means for you and your bills
Payments for medical bills related to the condition under review are paused until the review is complete.
Under German law and your policy terms, you’re responsible for ensuring all required information is provided, including responses from your doctor or other third parties.
But don’t worry: We’ll guide you through the process and let you know if anything is missing. Throughout, you can track the review progress in the claims tab of your account.
Step-by-step overview
Complete and return the form we emailed you.
It includes a confidentiality release (allowing the underwriter to contact your doctor) and a questionnaire about your medical history.
The underwriter contacts your doctor and/or previous insurer by post
This usually happens within 2 weeks after the information above was provided. Let your doctor know in advance — their quick response helps avoid delays.
Additional information may be requested from you by email
This could be another confidentiality release or to update your medical history.
Decision and next steps
Once all information is provided, the underwriter issues a decision, usually within 4 weeks.
If it turns out that no information was missing from the application, pending medical bills will be paid out. If information was missing, we’ll contact you about any necessary policy changes.