Health screening

In traditional private health insurance, the medical underwriting process is a central element of risk assessment: The insurer inquires about pre-existing conditions, treatments, and surgeries from recent years and uses this information to determine whether to accept the applicant, set the premium amount, or impose exclusions. For supplementary health insurance (bKV), almost all modern group plans follow a fundamentally different principle: Medical underwriting is completely eliminated.

Why supplementary health insurance policies work without a medical exam

Under a group policy, the insurer does not calculate the individual risk of each employee, but rather the collective risk of the entire workforce. This collective calculation, combined with the employer’s obligation to insure all employees or a clearly defined group of employees, results in pools that are sufficiently large and diverse. Young, healthy employees and older employees with pre-existing conditions balance each other out statistically. The insurer saves on the time-consuming individual assessment, and the employer avoids dealing with exclusions and rejections.

For employees, this means that no one is required to disclose sensitive health information to their employer or insurer. No one is denied coverage due to chronic conditions, mental health diagnoses, or past treatments. Even employees who would have no chance of being accepted into private health insurance are fully covered under group health insurance.

What requirements employers must meet

In order for an insurer to waive the medical examination, it typically requires a minimum participation rate: either the entire workforce must be insured (mandatory coverage), or a minimum number of participants as specified by the insurer. Depending on the provider, the thresholds range from 3 to 20 employees, and may be even higher for very large companies with differentiated rate groups.

In addition, participation must be employer-funded or at least predominantly covered by the employer. Pure employee-contribution models—that is, plans in which employees pay the premiums themselves and the employer merely acts as an intermediary—often result in the insurer requiring a medical examination again, because the selection risks (only sick employees enroll) become too high.

When a medical examination is required anyway

There are situations in which supplemental health insurance policies also require a medical examination—usually a simplified one:

• For very small groups (some with fewer than 10 employees), some insurers require a simplified health declaration consisting of 2–4 questions
• If family members are to be insured in addition to the employee, some insurers require a medical examination—though usually only outside a specific enrollment window following the start of the policy; within this window (which ranges from 3 to 12 months, depending on the insurer), family members can be enrolled without a medical examination
• For extremely large budgets (2,000 euros or more per year), some providers require an audit
• If employees join the company after the so-called "onboarding window" has closed, a medical examination may be required

What this means in practice

The absence of a medical examination is one of the strongest selling points of supplementary health insurance when communicating with employees. Many employees have already experienced being denied coverage under private supplemental insurance due to asthma, high blood pressure, back problems, or anxiety disorders. For them, supplementary health insurance is often the first realistic option for accessing private healthcare services—an argument that is frequently underestimated in outreach communications.

At the same time, employers should be aware that the absence of a medical examination does not mean that all costs will be covered. Insurers exclude certain categories of benefits under their plans (such as psychotherapy services in some budget plans) or set limits on them (such as caps on dental prosthetics during the first few years of the contract). However, these coverage limits are the same for all employees and are independent of individual diagnoses.

FAKTOR MENSCH : In practice, we find that employees with pre-existing conditions benefit disproportionately from supplemental health insurance and consequently have high utilization rates. It is important for employers to understand that if the utilization rate is 60 percent, this does not necessarily mean that 60 percent of the cases are minor. A significant portion consists of employees who finally have predictable access to treatments that were otherwise denied to them—and who appear noticeably more motivated and healthier in the workplace. These cases are the actual ROI drivers of supplemental health insurance, but they do not appear in any standard statistics.

Privacy: What the Employer Learns

A common misconception: Employees worry that their health data will be shared with their employer through the supplementary health insurance plan. This is not the case. The employer receives no information from the insurer regarding submitted bills, services used, or medical diagnoses. All claims processing takes place directly between the employee and the insurer—usually via an app or a member portal. The employer is only informed whether an employee is enrolled in the insurance plan and receives aggregated usage statistics without any personal details.

Conclusion

The absence of a medical examination is not a side effect, but a structural feature of modern group supplementary health insurance policies and one of the main reasons why supplementary health insurance is so popular in Germany. For employers, it reduces administrative burdens and prevents frustration among employees; for employees, it provides access to benefits that would not be available under individual insurance—regardless of age, pre-existing conditions, or life circumstances.