This is the strongest and least known rule in dealings with a health fund: it has a hard deadline to decide, and missing it is treated by law as approval. All that is needed from you is a written application and an eye on the calendar.
The fund must decide in time — or the service counts as approved
A health fund has three weeks to decide, or five where a medical opinion is obtained. Miss the deadline without giving sufficient reason, and the law treats the service as approved.
✓ Verified: 01/08/2026
WHAT TO DO
› Details and tips
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Max recommends:
I waited more than two months for a reply assuming that was normal. I learned about the three-week deadline by chance — one letter turned the whole conversation around.
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Lea recommends:
Put the application date in your calendar and set a reminder for the day the deadline expires. That is all it takes for the mechanism to work for you.
FREQUENTLY ASKED QUESTIONS
How long does the fund have? ▾
Three weeks from receipt of the application. Where an expert medical opinion is obtained the period is five weeks — and the fund must inform you that it is obtaining one.
What happens if the deadline passes? ▾
The law states it expressly: if the fund gives no sufficient reason for the delay, the service counts as approved once the period expires. This is one of the rare cases where official silence works in the individual’s favour — and hardly anyone knows it.
So can I just buy the service myself? ▾
Carefully: the law provides for reimbursement of a necessary service obtained after the deadline passed, but the construction is demanding and depends on the circumstances. Before spending money, record the expiry in writing and take advice.
How do I prove the application date? ▾
Apply in writing and provably: by registered post, through the fund’s portal with a screenshot, or with a receipt stamp. A telephone request does not reliably trigger this mechanism and is hard to evidence.