Scope of treatment
Which treatments, providers and medical indications are included.
Private health insurance
Hospital-cost cover
Design special-class hospital, doctor choice and private-clinic cover correctly.
Scope of cover
Understand benefits and limits in detail.
The actual scope follows from the policy schedule, terms, clauses and individual agreements.
Benefit limits
Review annual maximums, reimbursement percentages and sub-limits.
Personal contribution
Understand excesses, co-payments and costs that remain with the insured person.
Evidence
Clarify prescriptions, medical necessity, invoices and approval requirements.
Before conclusion
Four points should be clearly documented.
Scope of treatment
Which treatments, providers and medical indications are included.
Benefit limits
Review annual maximums, reimbursement percentages and sub-limits.
Personal contribution
Understand excesses, co-payments and costs that remain with the insured person.
Evidence
Clarify prescriptions, medical necessity, invoices and approval requirements.
Benefit and claims practice
Review invoice, medical necessity and tariff limits together.
Early notification, complete documents and a clear timeline help avoid preventable problems.
Inform early
Provide the facts, timing and relevant documents completely.
Policy and evidence
Compare terms, invoices, medical records or documents.
Follow open points
Support questions, additional evidence and settlement through to a clear decision.
Our role: We compare terms, excesses, annual limits and acceptance requirements without promoting individual insurers.
Austrian Supreme Court decisions
View all decisionsRelevant Supreme Court decisions on policy interpretation, disclosures and benefit assessment.
These summaries highlight typical disputes and do not replace review of the individual policy.
Medically necessary treatment
In private health insurance, the insured event begins with medically necessary treatment for illness or accident consequences. Medical necessity and treatment purpose are central.
Official RIS decision →Cosmetic treatment and exclusions
The Court reviewed an exclusion for cosmetic treatment, operations and their consequences. Medical indication and contractual exclusion must be distinguished carefully.
Official RIS decision →Answer health questions carefully
Pre-contract health information requires great care. The policyholder generally bears the burden of showing an absence of fault for an incorrect or incomplete answer.
Official RIS decision →Frequency as well as severity may be material
For health-risk assessment, not only the severity of one illness but also the frequency of treatment or recurring complaints may be material.
Official RIS decision →Frequently asked questions
All questionsFrequently asked questions about this area.
Why does the wording matter?
Because triggers, limits and exclusions are defined in the terms.
Which documents should be collected before applying?
Existing policies, relevant evidence and, for health questions, medical records and doctor information.
Can the policy be adjusted later?
That depends on adjustment rights, new risk assessment and the tariff.
Do you assist with claims?
Yes. We support notification, documents, communication and settlement.
Personal advice
Compare personally and independently.
We compare terms, excesses, annual limits and acceptance requirements without promoting individual insurers.
