Medical questionnaire at signup: what an inaccurate answer can cost

International private health insurance runs on an individually assessed risk basis: the insurer sets its price and coverage terms based on the health status declared by each applicant. The medical questionnaire is the tool that lets it make this assessment before agreeing to provide cover — ongoing treatment, past hospitalisations, chronic conditions are all recorded there.

It is this declaration, and this declaration alone, that later serves as the reference in the event of a claim: the insurer compares what was declared at signup with what is discovered at the time of reimbursement.

Article L113-2 of the French insurance code requires the policyholder to answer accurately to the questions asked by the insurer, notably in the risk questionnaire. This obligation covers the information requested at signup, but also, during the life of the contract, circumstances that increase the risk already accepted.

This obligation only applies to questions actually asked: an insurer cannot fault a policyholder for not spontaneously mentioning information that no specific question invited them to declare.

The insurance code clearly distinguishes two situations, with very different consequences.

• Omission or good-faith error (Article L113-9): if the insurer discovers the inaccuracy after a claim, without the policyholder’s bad faith being established, the contract isn’t cancelled — the payout is reduced in proportion to the gap between the premium paid and the one that should have been paid had the risk been declared accurately.
• Intentional false declaration (Article L113-8): if the intentional nature is established, the contract is void — not just for the item concerned by the omission, but as a whole, even for care unrelated to the undeclared history. Premiums already paid remain the insurer’s.

It is this second case that makes the completeness of the medical questionnaire particularly important: voidance isn’t limited to the omitted history, it deprives the policyholder of all cover, including for a claim discovered later and entirely unrelated to the initial omission.

The consequences of an inaccurate answer (above) shouldn’t be confused with the decision the insurer makes, in full transparency, based on a questionnaire filled in correctly. Once the medical history has been reviewed, the insurer generally has several options:

• accept the application with no particular condition;
• accept the application while excluding from cover the care linked to a specific medical history item — a targeted exclusion, with the rest of the contract fully applicable;
• accept the application in exchange for a loading, with no exclusion;
• outright refuse the application for the profile presented.

The difference is fundamental: a targeted exclusion is a condition of the contract, known and accepted before signing — it only deprives the policyholder of one specific benefit, identified in advance. Full refusal to grant cover, on the other hand, leads to no contract at all: the applicant must look for another cover option, possibly from an insurer with a broader underwriting profile. Neither of these outcomes has anything to do with the voidance for intentional false declaration seen above, which punishes a lie, not a risk declared honestly.

This mechanism is specific to international private insurance. CFE works on an open voluntary affiliation basis, with no medical questionnaire or screening on health status: joining CFE therefore doesn’t expose you to the risk of voidance for false declaration described above, since no health declaration is requested at signup. This is one of the trade-offs to know between the two options — see the guide CFE or private insurance.

• Declare a medical history item even if it seems minor, old or resolved: it is the intentional nature of the omission that exposes you to voidance, not the severity of the condition itself.
• Answer every question asked without interpreting its scope narrowly.
• Keep a copy of the completed questionnaire and any attachments: in the event of a dispute, it is the declaration actually submitted that counts.
• Read the exclusions and loadings shown in the specific terms before signing, rather than discovering them at the time of a claim.