Supplementary Insurance Denied: Reasons and Options

1. Why can the insurer reject my application?

Unlike mandatory basic insurance, supplementary insurance is voluntary and subject to the Insurance Contract Act (VVG). The insurer may accept the application, accept with policy restriction or reject. A reason is not required.

The decision is based on a risk examination. The insurer judges whether elevated costs are to be expected in the future. The more comprehensive the coverage, the stricter the examination. For hospital private, higher requirements apply than for a reduced model.

2. Which reasons frequently lead to rejection?

A public list with fixed criteria does not exist. Every insurer works with its own admission guidelines. In practice, the following factors increase the risk of a rejection or a policy restriction:

• Ongoing or recent treatments: current therapies or larger interventions in the last months.
• Chronic illnesses: diabetes, rheumatism, multiple sclerosis or severe cardiovascular diseases.
• Mental pre-existing conditions: especially with therapies or medications in the last years.
• Planned interventions: operations or treatments already announced in the application.
• BMI outside the normal range: strongly elevated or reduced values often lead to policy restrictions.

3. What is the difference between rejection and policy restriction?

Rejection and policy restriction are different decisions with different consequences:

With a rejection, no contract comes about. With a policy restriction, the applying person is admitted; certain existing complaints are however excluded from insurance protection. The exclusion frequently applies for several years and can be reviewed after expiry.

Example: A 45-year-old person from Basel with high blood pressure applies for a semi-private hospital insurance. Insurer A rejects. Insurer B accepts the application with policy restriction for cardiovascular diseases. The person is thus insured for all other hospital benefits; only the concrete risk remains excluded.

4. What can I do after a rejection?

A rejection is not a definitive end. Every insurer works with its own admission guidelines. What leads to rejection at one provider can be accepted at another.

Option 1: Submit application at another insurer. The risk examination is not uniform. With lighter or healed illnesses, a renewed application pays off. In the new health questionnaire, you declare the earlier rejection truthfully.

Option 2: Check health dossier. Request your patient file and check the entries for correctness. With faulty or outdated diagnoses, you can request a correction.

Option 3: Enclose current medical report. With healed complaints, a current medical report specifies the situation. This noticeably increases the admission chances.

Option 4: Adjust product. Comprehensive models such as hospital private are examined more strictly than hospital Flex or partial models. A reduced scope of benefits can lead to admission.

5. Which mistakes should I avoid after a rejection?

Four classical mistakes lead to additional problems after a rejection.

Mistake 1: Give up immediately. A rejection by one insurer does not automatically apply to other providers. Especially regional insurers partly work with other admission criteria.

Mistake 2: Underestimate disclosure obligation consequences. With subsequent uncovering of a false answer, the insurer can retroactively terminate the contract and reclaim already received benefits. A later admission at another insurer becomes significantly more difficult.

Mistake 3: Terminate existing insurance prematurely. The termination of the existing supplementary insurance takes place only after definitive confirmation of the new policy. Otherwise a coverage gap threatens.

Mistake 4: Conceal earlier rejection. In the application at a new insurer, earlier rejections are frequently asked about. A truthful answer is mandatory, even if it reduces the admission chances.

The admission criteria differ significantly between insurers. Compare several providers in parallel before deciding on a policy. This way you see at a glance where the admission chances for your profile are highest.

This article was first published on 14/02/2026