- Before: approval needed?
- Complete documents
- Answer questions
- Payment and interim payment
Before treatment
What to clarify beforehand
- Planned treatment? Check in your terms whether your insurer requires prior approval for hospital stays, operations or expensive tests. Without approval, benefits may be reduced.
- Direct billing or reimbursement? Ask whether the insurer settles directly with the clinic or whether you pay first and then claim.
- Emergency: Get treated first. Inform your insurer as soon as possible, usually via the emergency number on your insurance card.
Submitting
Which documents the insurer needs
After an insured event, the insurer may ask for the information it needs to establish the event and the scope of its benefit, and for supporting documents as far as you can reasonably obtain them Sources: [2].
- Invoice with date, provider and itemised services
- Diagnosis
- Medical report
- For medicines: prescription and receipt
- If prior approval was given: the approval
Important
What you stated in the application still counts
What the doctor writes in the report is read by the insurer too. If the application asked about a pre-existing condition and you did not state it, the insurer may assert rights for breach of the duty of disclosure Sources: [3]. So answer fully and honestly when you apply.
Payment
When the insurer has to pay
Under German law, the insurer’s payments fall due once it has completed the investigations it needs to establish the insured event and the scope of its benefit. If these investigations are not finished one month after you reported the claim, you can ask for interim payments of the amount it is likely to owe at least. The period does not run while the investigation cannot be completed through your fault Sources: [1]. Policies with insurers outside Germany may follow other rules; check your terms.
Related topics
Frequently asked questions
Which documents do I need for reimbursement?
Invoice, diagnosis and medical report, submitted together; for medicines also the prescription and receipt.
Sources: [2]
How long may the insurer take to pay?
Under German law, payment falls due once it has completed the necessary investigations. After one month without completion you can ask for an interim payment.
Sources: [1]
Sources
- § 14 Insurance Contract Act (VVG) – due date of payment (German) abgerufen 03.11.2026
- § 31 VVG – policyholder’s duty to provide information (German) abgerufen 03.11.2026
- § 19 VVG – duty of disclosure (German) abgerufen 03.11.2026
This page provides orientation and does not replace individual advice. The law, your contract terms and the competent authorities are binding.
