Vorerkrankung

What counts as a Vorerkrankung?

A Vorerkrankung is any illness, condition, treatment, or medical event that existed, or was diagnosed, before the start of a PKV contract. There is no universal list. What an insurer treats as a Vorerkrankung is defined by the questions they put on the Gesundheitsfragebogen, the written health questionnaire that accompanies every PKV application.

If the questionnaire asks about it within its lookback period, and it applies to you, it is a Vorerkrankung that must be disclosed. If the questionnaire does not ask, it is not a Vorerkrankung for that insurer's purposes.

The lookback period

Typical lookback periods vary by topic:

• Minor acute issues (colds, flu, routine infections): 3-5 years

• General medical consultations and examinations: 3-5 years

• Hospital stays, surgery, significant outpatient procedures: 5-10 years

• Chronic conditions (diabetes, hypertension, asthma): 10 years, sometimes longer

• Psychotherapy and mental health treatment: typically 5-10 years

• Cancer history: often 10 years or longer, sometimes lifetime

The lookback is measured from the application date backwards. If the question asks about "treatments in the last 5 years", the relevant window is 5 years ending on your application date.

How the insurer uses the information

A disclosed Vorerkrankung goes through the insurer's underwriting review. The review considers:

• The condition itself, severity, chronic vs. resolved, typical claim patterns

• Treatment history, ongoing medication, past surgery, ongoing monitoring

• Time since last event, a condition that last manifested 8 years ago is assessed very differently from one still being treated

• Comorbidities, multiple conditions interact and may compound the assessment

The output is one of four decisions:

• Normal acceptance, no surcharge, no exclusion

• Risikozuschlag, a percentage surcharge on top of the base premium for the whole tariff

• Benefit exclusion (Leistungsausschluss), specific treatment areas removed from cover; premium unchanged

• Rejection, application declined

Which of the four you get depends heavily on the insurer. One insurer's 0 % is another insurer's 20 % or outright exclusion.

The Risikovoranfrage: your key tool

The Risikovoranfrage is an anonymised risk pre-enquiry. A broker sends 3-5 insurers a profile containing your medical history with no identifying information (year of birth only, no name). Each insurer responds with what they would do if the profile applied formally.

Why it matters:

• Different insurers produce different decisions for the same profile

• A formal application that gets rejected can create a record that complicates future applications

• A Risikovoranfrage produces no such record: PKV insurers do not run pre-enquiries through cross-insurer risk databases (HIS is a life/disability concept, not a PKV one)

For anyone with any meaningful medical history, a Risikovoranfrage before a formal application is close to mandatory. The difference between insurers' responses typically adds up to tens of euros per month, which compound to thousands over a lifetime.

Common Vorerkrankungen that matter, and often do not

Conditions that often lead to surcharges or exclusions:

• Ongoing chronic conditions (diabetes, high blood pressure requiring medication, severe asthma)

• Back and joint problems with imaging or recurring treatment

• Mental-health conditions currently in treatment

• Cancer history within the last 5-10 years

• Autoimmune and inflammatory conditions

Conditions that often result in normal acceptance:

• Common childhood illnesses now resolved

• Single sports injuries fully healed

• Historic mild mental-health episodes with no treatment in 5+ years

• Mild allergies without treatment escalation

• Pregnancy history without complications

Every insurer's guidelines differ. Historic experience is not predictive, which is exactly why the Voranfrage matters.

Do not omit: under any circumstance

The single most expensive mistake in PKV applications is omitting a known condition to secure a better offer. The insurer's underwriting review is paper-based at application time, but if a claim is later submitted, they can request your medical records under the consent you gave at signup.

If a condition surfaces that was not disclosed:

• Simple negligence: contract can be cancelled with 1-month notice

• Gross negligence: contract can be retroactively adjusted or withdrawn

• Intentional omission: contract withdrawn, no premium refund, services paid out may be clawed back

• Fraudulent intent: contract voided from the start (§ 22 VVG + § 123 BGB)

The insurer's rights run for 5 years after contract signing for ordinary omissions, 10 years for intentional or fraudulent ones. Events that happened before the time limit but surface later can still be relied on.

See the Vorvertragliche Anzeigepflicht entry for the full legal framework.