Pre-approval request and claim to a private health insurer (Germany)
Published byDocMuse
This document is in German
The PDF you download is in German — that is the language it has to be filed in, so it is not translated. Everything on this page is here to tell you what it says.
The letter to a German private health insurer (PKV) in two situations: before expensive treatment, as a pre-approval request under § 192(8) of the Insurance Contract Act (VVG) — where costs are expected to exceed €2,000 the insurer must answer with reasons within two weeks if the treatment is urgent, otherwise four, or the treatment is presumed necessary — or afterwards, as the covering letter to a claim with the invoices. With policy number, treatment, costs and IBAN; no diagnosis in the letter. In German.
What you fill in
The details the document asks for.
- Insured
- Insured's address
- Insurer
- Private health insurer's postal address
- City
- Date
- Policy number
- What you are asking the private health insurer
- Person the claim concerns, if not the policyholder
- Treatment or service applied for (e.g. medical aid, operation, rehabilitation)
- Healthcare provider (hospital, clinic)
- Period of treatment
- Estimated cost
- IBAN
Preview
This document is produced for you. Your answers are typed into it and the finished PDF is yours to keep.
Common questions
- From what amount must a German private health insurer give advance information?
- If planned treatment is expected to cost more than €2,000, you can ask in text form before it starts whether and how far the insurer will cover it (§ 192(8) VVG). It must answer with reasons and address your cost estimate: without delay and within two weeks at the latest if the treatment is urgent, otherwise within four weeks, counted from receipt of your request. Below €2,000 you may still ask, but the statutory deadline does not apply.
- What applies if the German private insurer lets the deadline pass?
- If the insurer does not answer in time, the planned treatment is presumed medically necessary until the insurer proves otherwise (§ 192(8) VVG). That is not a promise to pay every item — the limits of your tariff still apply — but it shifts the burden of proof in your favour. Keep proof of when your request arrived, such as the insurer's confirmation of receipt or a return receipt.
- May the German pre-approval request be sent by e-mail, without the insurer's form?
- Yes. The pre-approval request needs text form; an e-mail with this letter as a PDF, a fax or a letter will do (§ 192(8) VVG). For the claim after treatment many insurers offer their own form or an app; this letter is then the covering letter to the invoices. The deadline runs from receipt by the insurer, so a confirmation of receipt is worth having.
How you can sign this document
- Print it and sign by hand. The signature lines in the document are left blank on purpose — sign on them in ink.
- Sign it yourself with a qualified electronic signature. If you already hold a QES — Evrotrust, B-Trust, StampIT, ZealiD or any qualified provider on the EU Trusted List, on a card, a USB token, in a mobile app or in the cloud — our signing guide explains step by step how to sign this exact file without invalidating it. Step-by-step help, and a way to check it worked
DocMuse sells documents, not legal advice. Acceptance always depends on the recipient's rules and your local law.
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