Vorvertragliche Anzeigepflicht

What the Anzeigepflicht demands

The Vorvertragliche Anzeigepflicht is your legal duty, when applying for a PKV contract, to answer every question on the Gesundheitsfragebogen (health questionnaire) completely and truthfully. Legal basis: § 19 VVG. The duty extends to every question asked in writing, whether or not you think it is relevant.

The principle is simple in theory: the insurer makes its underwriting decision based on your answers, so those answers must give them an accurate picture. The statute sets out, in detail, what happens when they do not.

The four fault levels, and their consequences

§ 19 Abs. 2-4 VVG grades faults into four tiers, each with a different legal consequence:

Simple negligence

• Example: you genuinely forgot a single consultation that happened 6 years ago

• Consequence: the insurer has the right to cancel with one month's notice (§ 19 Abs. 3 VVG)

• Past claims: generally still covered

Gross negligence

• Example: you omitted a chronic condition you clearly knew about

• Consequence: the insurer has the right to withdraw from the contract (Rücktritt)

• Escape hatch: if the insurer would have taken you on different terms (higher premium or benefit exclusion) had they known, the contract is retroactively adjusted instead of withdrawn (§ 19 Abs. 4 VVG)

• If the adjustment raises the premium by more than 10 % or excludes a benefit, you have a 1-month right to cancel (§ 19 Abs. 6 VVG)

Intent (Vorsatz)

• Example: you consciously omitted a diagnosis to get better terms

• Consequence: withdrawal from the contract, no refund of premiums for the period before withdrawal

Fraudulent intent (Arglist)

• Example: you systematically misrepresented your history in coordination with the broker

• Consequence: Anfechtung under § 22 VVG + § 123 BGB. The contract is voided from the start. Any services already paid out by the insurer can be clawed back. § 124 BGB allows this challenge within 1 year of the insurer discovering the fraud, up to 10 years from contract start.

The deadlines: § 21 Abs. 3 VVG

The insurer's rights to invoke § 19 are time-bound:

• 5 years after contract start for ordinary faults (simple and gross negligence, intent)

• 10 years for fraudulent misrepresentation

Within those windows, the insurer must act within 1 month of becoming aware of the fault (§ 21 Abs. 1 VVG).

One important detail: the deadlines do not apply to insured events that occurred before the deadline. If you had a cancer diagnosis in year 3 that was related to a condition you failed to disclose, the insurer can still refuse benefits for that specific event after year 5, because the event itself fell within the relevant window.

The Belehrung requirement

Under § 19 Abs. 5 VVG, the insurer must provide you, in writing and clearly separate from the body of the application, with a warning about the consequences of non-disclosure before you sign.

If this warning (Belehrung) is missing or legally defective:

• Ordinary fault levels: the insurer's rights to cancel or withdraw are blocked

• Arglist: the insurer's right to challenge the contract remains intact regardless (BGH IV ZR 306/13, 12 March 2014)

This is a consumer protection with teeth. A defective Belehrung has defeated insurer cancellations in court repeatedly.

Burden of proof

§ 19 Abs. 3 Satz 1 VVG sets out:

• The insurer must prove that a specific question was put to you in text form, that your answer was objectively false, that you knew the relevant fact, and that the fact was material to the insurance decision (gefahrerheblich)

• Fault is presumed once the objective wrong answer is proven, you must then actively rebut the fault to escape the consequence

In practice: if the insurer pulls your GP records and finds a treatment you failed to mention, the dispute moves very quickly from fact to fault.

What to do in practice

A short checklist that prevents nearly all Anzeigepflicht problems:

• Request your own GP records under § 630g BGB (free) before filling out the questionnaire

• Write it down with dates, "approximate" answers create proof problems for you later

• When in doubt, disclose. Over-disclosure creates no legal risk. Under-disclosure creates enormous risk.

• Use a Risikovoranfrage if you have any meaningful history, this lets multiple insurers respond before you commit, without creating a formal record

The cost of disclosing a surcharge-worthy condition transparently is, at most, a percentage on your premium. The cost of hiding it is potentially the entire contract, years after you depended on it.

The 2025 reform debate

The Anzeigepflicht in its current form has been in place since the 2008 VVG reform. There is periodic industry and regulatory discussion about shortening the lookback, tightening the Belehrung requirements, or simplifying the fault tiers, but as of April 2026, no major reform has been enacted. The rules above apply to current contracts and new applications.